Factors associated with the use of intrusive measures at a tertiary care facility for children and youth with mental health and developmental disabilities
ABSTRACT This study seeks to identify some of the explanatory factors associated with the use of intrusive measures among children with mental health and developmental disabilities in psychiatric facilities. Intrusive intervention data were collected using an organizational database that was developed internally at a tertiary care facility. The sample was composed of 338 children/youth aged between 6 and 18 years (mean = 12.33, standard deviation = 2.70) admitted within a 2-year period. Logistic regression was used to examine the relationship between chemical restraint, physical restraint and secure isolation, and programme type after controlling for demographic and other relevant client characteristics. The study found that the number of chemical restraints and secure isolations was higher for clients with developmental disabilities than for clients with mental health, whereas the number of physical restraints was lower for clients with developmental disabilities than clients with mental health issues. Demographic variables also predicted specific types of intrusive measures. The results of this study outline the differential factors associated with specific types of intrusive measures to control aggressive and self-harm behaviours. The paper also outlines cultural change initiatives, organizational interventions, and policy implications for best practice services for children/youth in psychiatric facilities to further reduce intrusive measures.
Residential Treatment for Children & Youth 10/2014; 31(4):284-300. DOI:10.1080/0886571X.2014.958346
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ABSTRACT: This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children's rights and alternatives to holding are not always respected or explored. Children's experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children's rights will continue to be compromised.Nursing Inquiry 07/2014; DOI:10.1111/nin.12074 · 1.05 Impact Factor
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ABSTRACT: Few studies have examined deliberate self-harm (DSH) among children in residential treatment in Canada. Most of the existing studies examined adolescent students or children from pediatric emergency departments.The objectives of this study were to examine the prevalence of DSH among children in tertiary care residential treatment and the factors associated with DSH.Data on 284 children aged 5–17 years (M = 11.54 years, SD = 2.56) with mental health problems in tertiary care residential treatment were analyzed. Binary logistic regression was performed to examine the likelihood of engaging in DSH.About 35 % of children engaged in DSH. Suicidal talk emerged as the strongest factor to be associated with DSH. Children who used alcohol or drugs were also more likely to engage in DSH than those who did not use alcohol or drugs. Furthermore, symptoms of conduct problems were associated with the likelihood of engaging in DSH.Identifying children at risk for engaging in DSH and suicidal behavior is of critical importance to mental health care providers. These factors could assist in identifying children who might require more specialized treatment related to self-harm during their stay in residential treatment.Child and Youth Care Forum 02/2014; 43(1). DOI:10.1007/s10566-013-9225-y · 1.25 Impact Factor