Mini Quiz: Trauma-Informed Care to Reduce Psychiatric Restraint

Thanks to better oversight, guidelines, and regulations, restraint and seclusion tactics for aggressive behavior are on the decline in pediatric psychiatric treatment settings. Unfortunately, serious harm still can result from restraint or seclusion. Consider the following case recently reported in the news:

A teenage patient allegedly restrained by a technician at a mental health facility in Virginia dies of positional asphyxiation according to the medical examiner.

Trauma-informed and strength-based programs are directed to reduce these restrictive interventions and improve care. Six Core Strategies have been found to reduce and prevent restraints and seclusions among children and adolescents in psychiatric settings.

For the answer, see the next page >

Answer E. All of the above

Discussion

The Six Core Strategies have been shown to reduce restraint and seclusion in inpatient settings.¹ These strategies include a focus on the following:

1. leadership

2. use of data to inform practice

3. involvement of youths and families

4. workforce development

5. use of prevention tools

6. debriefing

Primary prevention principles based on trauma-informed care and strength-based approaches are key elements of treatment. Trauma-informed care is conceptualized as mental health treatment grounded in a thorough understanding of biological, psychological, and social effects of trauma on children and adolescents and recognition that coercive interventions cause traumatization and re-traumatization and are to be avoided. Trauma-informed care is effective in reducing restraints and seclusions in residential settings.

At a teaching psychiatric hospital in Connecticut, implementation of the Six Core Strategies reduced restraints and seclusions significantly. This hospital eliminated the use of mechanical restraints and reduced physical restraints by 88% over 10 years.²

For more on this topic, see Strategies to Reduce and Prevent Restraint and Seclusion in Pediatric Populations, on which this quiz is based.

References

1. National Association of State Mental Health Program Directors. Six Core Strategies to reduce seclusion and restraint use. 2008. https://www.nasmhpd.org/content/six-core-strategies-reduce-seclusion-and-restraint-use.

2. Azeem MW, Reddy B, Wudarsky M, et al. Restraint reduction at a pediatric psychiatric hospital: a ten-year journey. J Child Adol Psychiatr Nurs. 2015; 28:180-184.