Practice Parameter for the Prevention and Management of Aggressive Behavior in Child and Adolescent Psychiatric Institutions, With Special Reference to Seclusion and Restraint

• NCJ Number: 193243
• Journal: Supplement to the Journal of the American Academy of Child & Adolescent Psychiatry Volume: 41 Issue: 2 Dated: February 2002 Pages: 4S-25S
• Author(s): Kim J. Masters M.D.; Christopher Bellonci M.D.
• Editor(s): Mina K. Dulcan M.D.
• Date Published: 2002
• Length: 22 pages
• Publication Format: Article
• Publication Type: Literature Review
• Language: English
• Country: United States of America

Annotation

This article examines methods of preventing aggressive behavior in child and adolescent psychiatric institutions before the need for seclusion or restraint is necessary.

Abstract

Collecting the history of aggressive behavior begins with the intake phone call, continues through the admission process, and is part of the psychiatric, nursing, and social work assessments. The management of aggressive behavior begins with diagnosis and treatment of the underlying psychiatric illness. The treatment plan should include strategies to prevent aggressive behavior, de-escalate behavior before it becomes necessary to use restrictive interventions, and initiate psychological and psychopharmacological treatments for treating the underlying psychopathology. Repeated staff training in the management of aggressive behavior is necessary to develop the high degree of competence this work requires. Each unit should have its own de-escalation program that helps patients manage angry outbursts. The only indications for the use of seclusion and restraint are to prevent dangerous behavior to self or others and to prevent disorganization or serious disruption of the treatment program including serious damage to property. Seclusion and restraint should not be used as punishment for patients, for the convenience of the program, where prohibited by State guidelines, or to compensate for inadequate staffing patterns. Untrained staff should not institute seclusion and restraint. The decision to seclude or restrain a patient must be made by the professionally trained staff working with the patient at the time of the aggressive behavior in consultation with a physician. The use of seclusion and/or restraint should be followed by a debriefing discussion that allows the patient to process and understand what has happened. Strong clinical leadership is essential in the management of aggressive behavior in order to minimize the need for seclusion and restraint. This parameter may have applications for children and adolescents in general hospitals, detention centers, and group homes that use aggression management programs. Appendix, 120 references