Evaluating initiatives to reduce seclusion and restraint.
ABSTRACT The use of institutional measures of control such as seclusion and restraint within psychiatric hospitals is common and arguably countertherapeutic; however, little is known about how best to reduce the use of these measures. The development and implementation of new institutional strategies to reduce the use of seclusion and restraint are important. Although traditional performance improvement (PI) project methodology might seem well-suited to helping managers and administrators identify effective hospital-wide interventions to decrease seclusion and restraint rates, the Logic of the standard PI model precludes managers from making valid inferences about which interventions actually cause change. This article presents a model (derivative of the multiple baseline time-series design with randomization) for testing individual elements of a Large-scale PI project to reduce the use of seclusion and restraint in a behavioral healthcare organization. The proposed model is flexible, accommodates overlapping organizational initiatives, and simultaneously allows for meaningful inferences to be made about the active components of the interventions. The ability to make meaningful inferences is important because, if the initiatives to reduce seclusion and restraint rates work, other healthcare organizations would benefit from knowing Key Words which specific interventions actually Lead engagement model to change and which interventions have multiple baseline design Little impact on secLusion and restraint performance improvement rates. Early experiences with this model psychiatry from a hospital manager's perspective sanctuary trauma are discussed, along with the costs and benefits of using it.
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- "Additional rigorous trials to evaluate the relative contribution of different program elements are urgently required. Whilst traditional randomised controlled trials are difficult – if not impossible – for such programs, Hardesty et al. (2007) have presented multi-phased model that may provide a useful starting point. The results from such investigations will further add to the establishment of evidence-based approaches to this important, yet controversial and multifaceted area of inpatient psychiatric practice. "
ABSTRACT: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review. Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefing; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment. The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.International Journal of Social Psychiatry 08/2009; 56(4):412-23. DOI:10.1177/0020764009106630 · 1.15 Impact Factor
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ABSTRACT: Most quality management initiatives in behavioral healthcare have focused on adverse events, clinical processes, or cost variables. Considerably less attention has been paid to indices of clinical improvement, likely because of a lack of agreed-upon measures of improvement, a lack of availability of simple methods for data collection and analysis, and an inability to provide timely feedback regarding clinical improvement, among other reasons. A computerized system was designed to collect relevant psychiatric symptom ratings in a manner that allows for real-time feedback at the patient and clinician Levels regarding clinical improvement and for higher-level, administrative evaluation of overall clinic performance. The costs and benefits of this system are discussed.Journal for Healthcare Quality 07/2008; 30(4):30-7. DOI:10.1111/j.1945-1474.2008.tb01152.x · 1.40 Impact Factor
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ABSTRACT: Outcomes assessment has become an important tool in assessing the quality of health care. To date, most quality initiatives have focused on adverse events, clinical processes, and/or cost variables. Considerably less attention has been paid to indices of clinical improvement, especially from a patient's perspective and in behavioral health settings. The relative inattention given to clinical improvement is attributable to a number of reasons, including (but not limited to) a lack of consensus regarding measures of improvement, few simple methods for data collection and analysis, and an inability to provide timely feedback. In this article, the authors describe a Web-based system designed to routinely collect quality-of-life ratings from patients in outpatient behavioral health clinics, allowing for real-time feedback at the patient levels regarding clinical improvement. The system also allows for administrative evaluation of overall clinic performance. The costs and benefits of this system are discussed.Quality management in health care 01/2010; 19(1):70-81. DOI:10.1097/QMH.0b013e3181ccbc53