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Is locked seclusion necessary for children under the age of 14?
T Antoinette1, S Iyengar, J Puig-Antich
1Mayview State Hospital, Bridgeville, Pa.
Insights
Implementing unlocked seclusion in child psychiatric units increased tranquilizer medication use. This suggests locked seclusion may be necessary for severely disturbed children with conduct disorders.
Area of Science:
- Child and Adolescent Psychiatry
- Mental Health Services Research
- Behavioral Health Interventions
Background:
- Child psychiatric inpatient units often utilize seclusion as a behavioral management tool.
- The shift towards less restrictive interventions, such as unlocked seclusion, is a growing trend in mental health care.
- Understanding the impact of policy changes on clinical practice is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the effects of implementing an unlocked seclusion policy on medication use and seclusion frequency in child psychiatric inpatient units.
- To determine the association between unlocked seclusion and the administration of tranquilizing medications.
- To explore the relationship between seclusion practices and behavioral disturbances in severely affected children.
Main Methods:
- A retrospective study design was employed.
- Data were collected from three child psychiatric inpatient units in a Pennsylvania state hospital.
- Analysis focused on medication administration records (administered as needed) and seclusion incident reports.
Main Results:
- Unlocked seclusion was associated with increased use of tranquilizing medications administered as needed across all three units.
- Units with higher seclusion rates showed increased clustering of these medications.
- Diverse changes in seclusion frequency and medication correlations were observed across units, particularly in behaviorally disturbed children.
Conclusions:
- The implementation of unlocked seclusion correlated with increased psychotropic medication use.
- Findings suggest that locked seclusion may remain a necessary therapeutic intervention for severely disturbed children, especially those with conduct and impulsive disorders.
- Further research is needed to balance therapeutic interventions with patient safety and de-escalation strategies.
Abstract:
A retrospective study of the effect of the implementation of an unlocked seclusion policy was conducted on three child psychiatric inpatient units in a state hospital in Pennsylvania. Unlocked seclusion was associated with 1) increased use of tranquilizing medications administered as needed on all three units, 2) increased clustering of medications, administered as needed, in the units that used seclusion most, 3) diverse changes in the three units regarding frequency and clustering of unlocked seclusion, and 4) increased correlations between medications administered as needed and seclusion, particularly in the more behaviorally disturbed children. These findings suggest that locked seclusion may be a necessary therapeutic intervention, particularly with severely disturbed children with serious conduct and impulsive disorders.