Redcue seclusion and restraint through Trauma-Informed Care De-escalation techniques
Faculty Advisor Name
Dr. Sawin
Department
School of Nursing
Description
Abstract
Title: Reduction of Seclusion and Restraint among Children and Adolescents in Inpatient Psychiatric: A Health Policy Analysis
Background: Seclusion and restraint or restrictive intervention in inpatient/ acute hospitals, emergency departments, crisis stabilization units, residentials, or group homes is a pressing and an immediate concern in mental health settings. The federal government, The Joint Commission, and the other National organizations have made significant strides in prioritizing the reduction and elimination of seclusion and restraint among children and adolescents due to its negative physical and psychological consequences. Trauma-Informed care De-escalation techniques are evidence-based first-line management to reduce and eliminate restrictive interventions for children and adolescents.
Local Problem: Research suggest the use of seclusion and restraint among child and adolescents in inpatient psychiatric hospitals is higher compared to adult population. The national statistics shows that the seclusion and restraint rate is six times higher than that of adults. The Commonwealth Center for Children and Adolescents stands out with its reported patient restraint rate, which is 40 times higher than the overall national average. The use of restrictive interventions is negatively associated with trauma, re-traumatization, physical injuries to patient and staff, shame, psychological distress, and even death, ultimately impacting healthcare costs and quality of life.
Methods: This project will aim to provide a re-envisioned policy analysis to present the evidence-based Trauma-Informed care De-scalation techniques to decrease seclusion and restraint among children and adolescents. Retrospective data will be collected and analyzed on seclusion and restraint per 1000 patient days and patient information will remain de-identified. Bardach’s Eightfold Path to Policy Analysis approach utilized to analyze the policy.
Interventions: This policy analysis project involves a review of existing policies, guidelines, and best practices, as well as consultation with experts in the field and stakeholders, and therefore does not involve an intervention. The project will include a review of guidelines and policies from child/ adolescent psychiatric facilities in other states that have incorporated Trauma-Informed care De-escalation techniques to reduce seclusion and restraint. This data gathering process will allow the researcher to compare current policies and practices to address the issue of seclusion and restraint among children and adolescents.
Results: This policy analysis project is still in process. In accordance with Bardach/ Collins Eightfold Path to Policy Analysis, three policy options will be highlighted. These will include 1) continue with the current policy or "status quo". 2) Adjust and improve the policy's current language and introducing the concepts of Trauma-Informed care-based De-escalation techniques. 3) Create a new policy that completely incorporates Trauma-Informed care De-escalation techniques.
Implications: Given the ethical and legal liability to humanely treat patients, especially highly vulnerable children and adolescents, with dignity, the need for a thorough, systematic policy analysis is critical. Recommending a second alternative policy option to adjust the existing policy based on evidence-based practice, such as Trauma-Informed care De-escalation techniques will aid in reducing seclusion and restraint rates. This approach will ensure in achieving an overarching goal of patient and staff safety, reduce health care costs, and improve quality of life.
Redcue seclusion and restraint through Trauma-Informed Care De-escalation techniques
Abstract
Title: Reduction of Seclusion and Restraint among Children and Adolescents in Inpatient Psychiatric: A Health Policy Analysis
Background: Seclusion and restraint or restrictive intervention in inpatient/ acute hospitals, emergency departments, crisis stabilization units, residentials, or group homes is a pressing and an immediate concern in mental health settings. The federal government, The Joint Commission, and the other National organizations have made significant strides in prioritizing the reduction and elimination of seclusion and restraint among children and adolescents due to its negative physical and psychological consequences. Trauma-Informed care De-escalation techniques are evidence-based first-line management to reduce and eliminate restrictive interventions for children and adolescents.
Local Problem: Research suggest the use of seclusion and restraint among child and adolescents in inpatient psychiatric hospitals is higher compared to adult population. The national statistics shows that the seclusion and restraint rate is six times higher than that of adults. The Commonwealth Center for Children and Adolescents stands out with its reported patient restraint rate, which is 40 times higher than the overall national average. The use of restrictive interventions is negatively associated with trauma, re-traumatization, physical injuries to patient and staff, shame, psychological distress, and even death, ultimately impacting healthcare costs and quality of life.
Methods: This project will aim to provide a re-envisioned policy analysis to present the evidence-based Trauma-Informed care De-scalation techniques to decrease seclusion and restraint among children and adolescents. Retrospective data will be collected and analyzed on seclusion and restraint per 1000 patient days and patient information will remain de-identified. Bardach’s Eightfold Path to Policy Analysis approach utilized to analyze the policy.
Interventions: This policy analysis project involves a review of existing policies, guidelines, and best practices, as well as consultation with experts in the field and stakeholders, and therefore does not involve an intervention. The project will include a review of guidelines and policies from child/ adolescent psychiatric facilities in other states that have incorporated Trauma-Informed care De-escalation techniques to reduce seclusion and restraint. This data gathering process will allow the researcher to compare current policies and practices to address the issue of seclusion and restraint among children and adolescents.
Results: This policy analysis project is still in process. In accordance with Bardach/ Collins Eightfold Path to Policy Analysis, three policy options will be highlighted. These will include 1) continue with the current policy or "status quo". 2) Adjust and improve the policy's current language and introducing the concepts of Trauma-Informed care-based De-escalation techniques. 3) Create a new policy that completely incorporates Trauma-Informed care De-escalation techniques.
Implications: Given the ethical and legal liability to humanely treat patients, especially highly vulnerable children and adolescents, with dignity, the need for a thorough, systematic policy analysis is critical. Recommending a second alternative policy option to adjust the existing policy based on evidence-based practice, such as Trauma-Informed care De-escalation techniques will aid in reducing seclusion and restraint rates. This approach will ensure in achieving an overarching goal of patient and staff safety, reduce health care costs, and improve quality of life.
