title: Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care.
abstract: 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.
authors.affiliation: Massachusetts Department of Mental Health, Boston, MA 02114, USA. Janice.LeBel@dmh.state.ma.us
authors.forename: Janice
authors.initials: J
authors.lastname: LeBel
authors.forename: Nan
authors.initials: N
authors.lastname: Stromberg
authors.forename: Ken
authors.initials: K
authors.lastname: Duckworth
authors.forename: Joan
authors.initials: J
authors.lastname: Kerzner
authors.forename: Robert
authors.initials: R
authors.lastname: Goldstein
authors.forename: Michael
authors.initials: M
authors.lastname: Weeks
authors.forename: Gordon
authors.initials: G
authors.lastname: Harper
authors.forename: Lareina
authors.initials: L
authors.lastname: LaFlair
authors.forename: Marylou
authors.initials: M
authors.lastname: Sudders
mesh_terms: 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*