Responding to Escalating Behaviors on a Child Inpatient Unit: Five Elements Often Missing in De-escalation Dialogs

Area of Science:

• Child and Adolescent Psychiatry
• Behavioral Health
• Inpatient Psychiatric Care

Background:

• Staff training often covers basic de-escalation techniques.
• Subtle milieu elements critical for de-escalation effectiveness are frequently overlooked in training.

Purpose of the Study:

• To elaborate on patient engagement and teamwork elements supporting de-escalation in tense inpatient child/adolescent settings.
• To identify key practice elements for effective de-escalation.

Main Methods:

• Synthesis of practice experience and relevant literature.
• Focus on milieu leadership, teamwork, and relationship leverage in child inpatient psychiatric units.

Main Results:

• Identified five key elements: teamwork, charge nurse leadership, common understanding of behavior, understanding aggression dynamics, and relationship leverage.
• Discussed how these elements support de-escalation.
• Outlined strategies for unit managers to cultivate these elements.

Conclusions:

• Unit leadership must cultivate knowledge in teamwork, shared behavior understanding, aggression dynamics, and engagement.
• These nuanced aspects of teamwork and unit culture are critical for safety and de-escalation.
• Articulating and cultivating these elements is essential for novice and new staff.