title: Relationship Between Seclusion and Restraint Reduction and Assaults in Pennsylvania's Forensic Services Centers: 2001-2010.
abstract: OBJECTIVE
  This prospective study assessed the use of seclusion and restraint in Pennsylvania forensic centers from 2001 through 2010. It also examined the correlation between declining use of containment procedures and patient-to-patient and patient-to-staff assaults.
  
  
  METHODS
  The 2,741 episodes of restraint or seclusion involving 801 unique individuals served in state forensic centers during the study period were entered into a uniform database. Included in this data set were demographic and diagnostic data as well as the causes and injuries associated with each use of these procedures. These data were correlated with rates of patient-to-patient and patient-to-staff assaults with any injury for each month of this study.
  
  
  RESULTS
  From 2001 to 2010, the rate of use of mechanical restraint significantly declined from 1.63 to .04 episodes per 1,000 days (p<.001), and the rate of use of seclusion significantly declined from .89 to .04 episodes per 1,000 days (p<.001). There was a nonsignificant decline in the use of physical restraint during this span. During this decade, the rate of patient-to-staff assaults declined, and the rate of patient-to-patient assaults was unaffected.
  
  
  CONCLUSIONS
  Decreasing the use of containment procedures had a positive effect on reducing assaults. Leadership, data transparency, use of clinical alerts, workforce development, policy changes, and discontinuation of psychiatric use of PRN orders were all contributing factors. A philosophical change toward a recovery model of psychiatric care and services was the driving force behind this transformation.
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Smith
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Ashbridge
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: Aidan
authors.initials: A
authors.lastname: Altenor
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Steinmetz
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Davis
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: Phil
authors.initials: P
authors.lastname: Mader
authors.affiliation: Mr. Smith and Mr. Steinmetz are with Allentown State Hospital, Allentown, Pennsylvania (e-mail: gregs@ptdprolog.net ). Ms. Ashbridge is with Danville State Hospital, Danville, Pennsylvania. Dr. Altenor is with Wernersville State Hospital, Wernersville, Pennsylvania. Dr. Davis, Mr. Mader, and Dr. Adair are with the Office of Mental Health and Substance Abuse Services, Department of Human Services, Harrisburg, Pennsylvania.
authors.forename: Dale K
authors.initials: DK
authors.lastname: Adair
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006783:Hospitals, State / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010356:Patient Isolation / Q000523:psychology / Q000706:statistics & numerical data*; D010414:Pennsylvania; D011446:Prospective Studies; D012149:Restraint, Physical / Q000523:psychology / Q000706:statistics & numerical data*; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult