Children's moral experiences of crisis management in a child mental health setting

Area of Science:

• Child and Adolescent Psychiatry
• Mental Health Services Research
• Qualitative Research Methods

Background:

• Limited research exists on children's (aged 12 and below) experiences with conflict and crisis management in child mental health settings.
• Understanding children's perspectives on restraint and seclusion is crucial for improving care.

Purpose of the Study:

• To examine the moral experiences of children regarding conflict and crisis management.
• To investigate children's views on the use of restraint and seclusion in a child mental health setting.

Main Methods:

• A 5-month focused ethnography was employed.
• A participatory hermeneutic framework guided the study.
• Research was conducted in a day hospital program for children with severe disruptive disorders.

Main Results:

• Children perceived restraint and seclusion as potentially safety-enhancing in specific situations (e.g., aggression, self-injury prevention).
• Experiences of restraint were predominantly negative, particularly when reasons were unknown or perceived as unfair/punitive.
• Children favored staff discussions and relationship-building over de-escalation or coercive strategies for crisis management.

Conclusions:

• The use of restraint and seclusion as punishment is disagreed with by children.
• Children's perspectives highlight the limitations of uniform de-escalation approaches.
• Building therapeutic relationships and open communication are vital for effective crisis management in child mental health.