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Restraint and seclusion as therapeutic interventions: changes across consecutive admissions

Published online by Cambridge University Press:  18 September 2013

David L. Pogge ,
Stephen Pappalardo ,
Martin Buccolo  and
Philip D. Harvey
David L. Pogge
Affiliation:
Four Winds Hospital, Katonah, New York, USA
Stephen Pappalardo
Affiliation:
Four Winds Hospital, Katonah, New York, USA
Martin Buccolo
Affiliation:
Four Winds Hospital, Katonah, New York, USA
Philip D. Harvey*
Affiliation:
University of Miami Miller School of Medicine, Miami, Florida, USA
*
Correspondence to: Dr Philip D. Harvey, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, USA. E-mail: philipdharvey1@cs.com
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Abstract

Background

We recently showed that restraint and seclusion differed in children and adolescents (n = 2411) who were receiving treatment as psychiatric inpatients, with children experiencing more episodes of both of these interventions of shorter duration. In this report, we examine restraint and seclusion in members of that sample (n = 471) who experienced a readmission within two years.

Methods

The initial database included two years of data on a total of 2411 child and adolescent inpatients, with 20% being readmitted within that period. Statistical analyses examine the characteristics of the sample at the readmission, including correlations between satisfaction with treatment at discharge from the readmission and the comparisons of the frequency of restraint and seclusion at both admissions. These analyses were performed separately for the samples of children and adolescents.

Results

In the cases who experienced restraint or seclusion at their first admission there was a 22% reduction in occurrence of restraint at the second admission for children and 44% for adolescents. Comparisons of the patients who did and did not experience restraint and seclusion across admissions suggested that these are different populations with different overall risk for restraint seclusions. Risk for seclusion and the number of seclusions was correlated across admissions. Length of stay was shorter at readmission for patients who experienced seclusion or restraint during their first admission. Patients who experienced restraint or seclusion at their readmission did not differ in their satisfaction with treatment at discharge from their readmission from those who did not.

Implications

Children and adolescents who experienced restraint and seclusion during a psychiatric admission had a reduced risk of seclusion at a readmission, but were still at higher risk than cases without restraint and seclusion at the first admission. These reductions in risk, as well as a shorter length of stay at readmission, suggest potentially beneficial effects. The lack of increased dissatisfaction with treatment also indicates that these cases did not see themselves as excessively coerced or victimised by the experience. Nonetheless, the high rate of occurrence of restraint and seclusion suggests that alternative treatment interventions are clearly important.

Keywords

Seclusionrestraintchildadolescentinpatient
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 10 , Issue 2 , August 2014 , pp. 84 - 92
Copyright
Copyright © NAPICU 2013 

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