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A restraint on restraints: the need to reconsider the use of restrictive interventions
W K Mohr1, M M Mahon, M J Noone
1University of Pennsylvania School of Nursing, Philadelphia 19104, USA.
Insights
Children in behavioral units may experience trauma due to inadequately prepared staff. This study highlights how milieu therapy can worsen trauma, emphasizing the need for better staff training and interventions for vulnerable children.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Psychology
- Healthcare Management
Background:
- Milieu therapy units aim to support children with behavioral problems using specialized healthcare teams.
- However, staff directly interacting with children often lack adequate preparation in managing disruptive behaviors.
- This can lead to the therapeutic environment inadvertently exacerbating trauma in vulnerable children.
Purpose of the Study:
- To investigate the experiences and memories of formerly hospitalized children regarding their treatment.
- To identify types of traumatic experiences within these specialized units.
- To examine the impact of staff preparedness and intervention strategies on child patients.
Main Methods:
- Presentation of preliminary data from an ongoing study.
- Qualitative investigation of formerly hospitalized children's experiences and memories.
- Categorization of traumatic experiences into vicarious trauma, staff alienation, and direct trauma.
Main Results:
- Children reported traumatic experiences stemming from staff's inadequate preparation and skills.
- Inappropriate use of power and force by staff was a significant factor in traumatic events.
- Patients frequently lacked understanding regarding the rationale behind interventions, including coercive measures.
Conclusions:
- The current milieu therapy approach can be detrimental, potentially increasing trauma for children.
- There is a critical need for research to identify specific knowledge and skill deficits among staff.
- Development of appropriate, trauma-informed interventions and improved staff training is essential for ethical and effective care.
Abstract:
Children with behavior problems are put in units with milieu therapy for the support and guidance of a specialized health care team, supposedly experts in the care of children with these unique and urgent needs. The reality of such units, however, is that those with the most contact with the children are often inadequately prepared, both in terms of knowledge and skills, to manage disruptive behaviors. As a result, the milieu that is supposed to provide support and structure can actually exacerbate the trauma for the vulnerable child. Preliminary data are presented from an ongoing study that is investigating the experiences and memories of formerly hospitalized children. Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force. There was a marked lack of understanding by the children of why given interventions were used. Although coercive interventions are sometimes necessary, ethical, legal, and other professional considerations make it clear that more work is needed. Research to identify the patterns of lack of knowledge and skills, as well as to develop appropriate interventions are recommended.