Seclusion use with children and adolescents: an Australian experience.
OBJECTIVE
To summarize the current state of knowledge on the use of seclusion and restraint with children and adolescents and to report the findings of an exploratory study to identify factors that place a child or adolescent at increased risk of seclusion during their admission.


METHODS
Literature searches were undertaken on MEDLINE, CINAHL and PsycINFO databases. Articles were identified that focused specifically on seclusion and restraint use with children and adolescents or contained material significant to this population. The study reports findings from a retrospective review of patient charts, seclusion registers and staffing from an Australian acute inpatient facility.


RESULTS
The data available in regard to seclusion use in this population is limited and flawed. Further research is needed on the use and outcomes of seclusion and restraint and on alternative measures in the containment of dangerousness. Both the literature and this study find that patients with certain factors are at increased risk of being secluded during an inpatient stay. These factors include being male, diagnoses of disruptive behaviour disorder and a previous history of physical abuse. Staffing factors did not show a relationship to the use of seclusion.


CONCLUSIONS
There are patient factors that predict increased risk of seclusion; these factors and their interrelationships require further elucidation. Further research is also needed on the outcomes, both positive and negative, of seclusion use and of alternatives to seclusion.
Fryer
Michelle A
MA
Child and Adolescent Psychiatrist, Integrated Mental Health Services, Gold Coast Hospital, Queensland, Australia. michelle_fryer@health.qld.gov.au
Beech
Michael
M
Byrne
Gerard J A
GJ
D000293:Adolescent; D000367:Age Factors; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D010356:Patient Isolation / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital; D011793:Queensland; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors; D014600:Utilization Review / Q000706:statistics & numerical data