Reducing seclusion and restraint in a child and adolescent inpatient area: implementation of a collaborative...

Area of Science:

• Child and Adolescent Psychiatry
• Mental Health Services Research
• Clinical Psychology

Background:

• Seclusion and restraint are restrictive interventions used in inpatient psychiatric settings.
• There is a need for evidence-based approaches to reduce the use of restrictive interventions.
• Child and adolescent inpatient units face challenges in managing challenging behaviors.

Purpose of the Study:

• To evaluate the impact of implementing a collaborative problem-solving (CPS) approach on seclusion and restraint rates.
• To assess changes in treatment length, patient/clinician-rated outcomes, and staff perceptions post-CPS implementation.

Main Methods:

• A naturalistic study was conducted in a child and adolescent inpatient unit.
• A collaborative problem-solving (CPS) approach was implemented.
• Data on restrictive events, treatment duration, and patient/clinician-rated outcomes were collected before and after implementation.

Main Results:

• A significant decrease in restrictive events, including seclusion, full restraint, and partial restraint, was observed.
• Patient- and parent-rated outcomes showed significant improvement post-implementation.
• Treatment length and clinician-rated outcomes remained consistent, while staff found the CPS approach useful.

Conclusions:

• The collaborative problem-solving (CPS) approach was successfully implemented in a child and adolescent inpatient unit.
• CPS implementation was associated with a significant reduction in seclusion and restraint events.
• The CPS approach offers a promising alternative for managing challenging behaviors in pediatric psychiatric settings.