Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care.
OBJECTIVE
To reduce the use of restraint and seclusion with children and adolescents in psychiatric inpatient units by promoting a preventive, strength-based model of care.


METHODS
The State Mental Health Authority used data analysis, quality improvement strategies, regulatory oversight, and technical assistance to develop and implement system change over a 22-month period. No changes in regulation or policy were undertaken.


RESULTS
Comparative data collected before and after the interventions demonstrated substantial reductions in the use of restraint and seclusion. Child units (age 5-12) decreased from 84.03 to 22.78 episodes per 1,000 patient days (72.9%), adolescent units from 72.22 to 37.99 episodes (47.4%), and mixed child/adolescent units from 73.37 to 30.08 episodes (59%).


CONCLUSIONS
The use of restraint and seclusion in child and adolescent inpatient settings can be reduced through a systems approach, which may have applicability to other settings and systems.
LeBel
Janice
J
Massachusetts Department of Mental Health, Boston, MA 02114, USA. Janice.LeBel@dmh.state.ma.us
Stromberg
Nan
N
Duckworth
Ken
K
Kerzner
Joan
J
Goldstein
Robert
R
Weeks
Michael
M
Harper
Gordon
G
LaFlair
Lareina
L
Sudders
Marylou
M
D000293:Adolescent; D000296:Adolescent Psychiatry / Q000379:methods; D000298:Adolescent, Hospitalized; D001291:Attitude of Health Personnel; D002648:Child; D002665:Child Psychiatry / Q000379:methods; D002673:Child, Hospitalized; D002675:Child, Preschool; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data / Q000639:trends*; D006783:Hospitals, State; D006801:Humans; D007318:Inservice Training; D008404:Massachusetts; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000639:trends*; D010356:Patient Isolation / Q000706:statistics & numerical data*; D012149:Restraint, Physical / Q000706:statistics & numerical data*