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This simple interrupted time-series quasi-experimental study examined the effectiveness of a restraint reduction policy implemented in order to reduce the use of physical restraint in a residential treatment facility for children in the southeastern United States. Aggregate data on monthly physical restraint episodes from the agency were analyzed over a period of 4 years. A 22-month period was used as the baseline and the succeeding 26 months- when the restraint reduction policy was implemented- was the intervention phase. A regular regression model, estimated using ordinary least squares (OLS), modeled the effect of the policy change, and autoregressive integrated moving average (ARIMA) models were used to represent the autocorrelation structure of the residuals from the regression model, in the data analysis. Two ARIMA models, an ARIMA (1,0,0) and an ARIMA (0,0,1), were used to model the autocorrelation structure of the residuals from the OLS regression. The convergence of findings from these models suggested that the results of the analysis of the time-series data from this study were robust in a statistical sense because both models led to the same conclusion. There was a statistically significant decrease of about 1 restraint per child each month when the new policy of verbal de-escalation was implemented during the treatment phase. The rate of physical restraint was reduced by 70% with the implementation of the restraint reduction policy in both models. Although a significant reduction in the rate of physical restraints was associated with the implementation of the restraint reduction policy, interrupted time-series designs such as that used in this study are not strong enough for making cause-effect inferences.
This book presents an evidence-based framework for replacing harmful, restrictive behavior management practices with safe and effective alternatives. The first half summarizes the concept and history of restraint and seclusion in mental health applications used with impaired elders, children with intellectual disabilities, and psychiatric patients. Subsequent chapters provide robust data and make the case for behavior management interventions that are less restrictive without compromising the safety of the patients, staff, or others. This volume presents the necessary steps toward the gradual elimination of restraint-based strategies and advocates for practices based in client rights and ethical values. Topics featured in this volume include: The epidemiology of restraints in mental health practice. Ethical and legal aspects of restraint and seclusion. Current uses of restraint and seclusion. Applied behavior analysis with general characteristics and interventions. The evidence for organizational interventions. Other approaches to non-restrictive behavior management. Reducing Restraint and Restrictive Behavior Management Practices is a must-have resource for researchers, clinicians and practitioners, and graduate students in the fields of developmental psychology, behavioral therapy, social work, psychiatry, and geriatrics.
This issue of Child and Adolescent Psychiatric Clinics, guest edited by Drs. Gabrielle A. Carlson and Manpreet Kaur Singh, is Part II of a two-part issue covering Emotion Dysregulation in Children. This issue is one of four selected each year by our series Consulting Editor, Dr. Todd Peters. Topics discussed in this issue include but are not limited to: Explosive Outbursts at School; Treatment of Childhood Emotional Dysregulation During Inpatient and Residential Interventions; Psychopharmacology of Treating Explosive Behavior; Treating explosive irritability in pediatric bipolar disorders; Evidence Base for Psychosocial Interventions for the Treatment of Emotion Dysregulation in Children and Adolescents; Preventing Irritability and Temper Outbursts in Youth by Building Resilience; Psychoeducational Treatments for Mood Dysregulation; A Modular, Transdiagnostic Approach to Treating Severe Irritability in Children and Adolescents; Longitudinal Outcome of Chronic Irritability; and the future of irritability in children, among others.
Royal Assent, 1st November 2018. An Act to make provision about the oversight and management of the appropriate use of force in relation to people in mental health units; to make provision about the use of body cameras by police officers in the course of duties in relation to people in mental health units. This Act extends to England and Wales only
This book is the first to systematically describe the key components necessary to ensure successful implementation of Collaborative Problem Solving (CPS) across mental health settings and non-mental health settings that require behavioral management. This resource is designed by the leading experts in CPS and is focused on the clinical and implementation strategies that have proved most successful within various private and institutional agencies. The book begins by defining the approach before delving into the neurobiological components that are key to understanding this concept. Next, the book covers the best practices for implementation and evaluating outcomes, both in the long and short term. The book concludes with a summary of the concept and recommendations for additional resources, making it an excellent concise guide to this cutting edge approach. Collaborative Problem Solving is an excellent resource for psychiatrists, psychologists, social workers, and all medical professionals working to manage troubling behaviors. The text is also valuable for readers interested in public health, education, improved law enforcement strategies, and all stakeholders seeking to implement this approach within their program, organization, and/or system of care.
Many emergency admissions to hospital are avoidable and many patients stay in hospital longer than is necessary. Improving the flow of patients through the system will be critical to the NHS's ability to cope with future winter pressures on urgent and emergency care services. At a time when NHS budgets are under significant pressure, the number of emergency admissions to hospitals is continuing to rise, albeit at a slower rate than in the past. More patients attending major A&E departments are now being admitted to hospital. In 2012-13, over a quarter of all patients attending major A&E departments were admitted, up from 19 per cent in 2003-04. The rise in emergency admissions is dominated by patients who stay less than two days (short-stay) in hospital. The main factors behind the increase in emergency admissions include the slowness with which the NHS has developed effective alternatives to admission to hospital. There are many local initiatives to prevent avoidable emergency admissions but limited evidence on what works. A lack of alignment between hospitals and community and local services in the hours they are open compromises efforts to avoid out-of- hours hospital admissions and prolongs the length of stay of inpatients. Among the NAO's recommendations is the need for both short-and long-term strategies to address staffing shortages in A&E. The Department and NHS England should also address barriers to seven-day working in hospitals, such as the consultants' contract, which gives consultants the right to refuse to work outside 7am to 7pm, Monday to Friday
Healthy mental, emotional, and behavioral (MEB) development is a critical foundation for a productive adulthood. Much is known about strategies to support families and communities in strengthening the MEB development of children and youth, by promoting healthy development and also by preventing and mitigating disorder, so that young people reach adulthood ready to thrive and contribute to society. Over the last decade, a growing body of research has significantly strengthened understanding of healthy MEB development and the factors that influence it, as well as how it can be fostered. Yet, the United States has not taken full advantage of this growing knowledge base. Ten years later, the nation still is not effectively mitigating risks for poor MEB health outcomes; these risks remain prevalent, and available data show no significant reductions in their prevalence. Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda examines the gap between current research and achievable national goals for the next ten years. This report identifies the complexities of childhood influences and highlights the need for a tailored approach when implementing new policies and practices. This report provides a framework for a cohesive, multidisciplinary national approach to improving MEB health.