Journal of the American Academy of Child & Adolescent Psychiatry
Volume 46, Issue 6 , Pages 711-720 , June 2007

Behavioral Management Leads to Reduction in Aggression in a Child and Adolescent Psychiatric Inpatient Unit

,Accepted 22 December 2006.

REFERENCES 

  1. Angold A. Seclusion. Br J Psychiatry. 1989;154:437–444
  2. Antoinette T, Iyengar S, Puig-Antich J. Is locked seclusion necessary for children under the age of 14?. Am J Psychiatry. 1990;147:1283–1289
  3. Ball GG. Modifying the behavior of the violent patient. Psychiatry Q. 1993;64:359–369
  4. Barnett SR, dosReis S, Riddle MA. Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youths. J Am Acad Child Adolesc Psychiatry. 2002;41:897–905
  5. Barton G, Rey JM, Simpson P, Denshire E. Patterns of critical incidents and their effect on outcome in an adolescent inpatient service. Aust N Z J Psychiatry. 2001;35:155–159
  6. Berrios CD, Jacobowitz WH. Therapeutic holding: outcomes of a pilot study. J Psychosoc Nurs Ment Health Serv. 1998;36:14–18
  7. Brann P, Coleman G, Luk E. Routine outcome measurement in a child and adolescent mental health service: an evaluation of HoNOSCA. The Health of the Nation Outcome Scales for Children and Adolescents. Aust N Z J Psychiatry. 2001;35:370–376
  8. Brantner JP, Doherty MA. A review of timeout: a conceptual and methodological analysis. In:  Axelrod S,  Apsche J editor. The Effects of Punishment on Human Behavior. New York: Academic; 1983;p. 87–132
  9. Connor DF, RH Melloni, Harrison RJ. Overt categorical aggression in referred children and adolescents. J Am Acad Child Adolesc Psychiatry. 1998;37:66–73
  10. Cotton NS. The developmental-clinical rationale for the use of seclusion in the psychiatric treatment of children. Am J Orthopsychiatry. 1989;59:442–450
  11. Dean AJ, McDermott BM, Marshall RT. PRN sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service. Eur Child Adolesc Psychiatry. 2006;15:277–281
  12. Dean AJ, McDermott BM, Marshall RT. Psychotropic medication utilization in a child and adolescent mental health service. J Child Adolesc Psychopharmacol. 2006;16:273–285
  13. Delaney KR. Developing a restraint-reduction program for child/adolescent inpatient treatment. J Child Adolesc Psychiatr Nurs. 2001;14:128–140
  14. Donovan A, Plant R, Peller A, Siegel L, Martin A. Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatr Serv. 2003;54:987–993
  15. Donovan A, Siegel L, Zera G, Plant R, Martin A. Child & adolescent psychiatry: seclusion and restraint reform: an initiative by a child and adolescent psychiatric hospital. Psychiatr Serv. 2003;54:958–959
  16. dosReis S, Barnett S, Love RC, Riddle MA. A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities. Psychiatr Serv. 2003;54:1357–1363
  17. Forster PL, Cavness C, Phelps MA. Staff training decreases use of seclusion and restraint in an acute psychiatric hospital. Arch Psychiatr Nurs. 1999;13:269–271
  18. Garrison WT, Ecker B, Friedman M, Davidoff R, Haeberle K, Wagner M. Aggression and counteraggression during child psychiatric hospitalization. J Am Acad Child Adolesc Psychiatry. 1990;29:242–250
  19. Goren S, Abraham I, Doyle N. Reducing violence in a child psychiatric hospital through planned organizational change. J Child Adolesc Psychiatr Nurs. 1996;9:27–28quiz 37–8
  20. Gowers SG, Harrington RC, Whitton A, et al. Brief scale for measuring the outcomes of emotional and behavioral disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA). Br J Psychiatry. 1999;174:413–416
  21. Greene RW, Ablon JS, Martin A. Innovations: child & adolescent psychiatry: use of collaborative problem solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatr Serv. 2006;57:610–612
  22. Jonikas JA, Cook JA, Rosen C, Laris A, Kim JB. A program to reduce use of physical restraint in psychiatric inpatient facilities. Psychiatr Serv. 2004;55:818–820
  23. Joshi PT, Capozzoli JA, Coyle JT. Use of a quiet room on an inpatient unit. J Am Acad Child Adolesc Psychiatry. 1988;27:642–644
  24. Kalogjera IJ, Bedi A, Watson WN, Meyer AD. Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients. Hosp Community Psychiatry. 1989;40:280–285
  25. Khadivi AN, Patel RC, Atkinson AR, Levine JM. Association between seclusion and restraint and patient-related violence. Psychiatr Serv. 2004;55:1311–1312
  26. Kuster T, Rowland G, Schaffner T, Kupfersmid J. Strategies for the prevention of physical assault among emotionally disturbed youths (PAARR). Child Youth Serv. 1988;10:85–101
  27. LeBel J, Stromberg N, Duckworth K, et al. Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care. J Am Acad Child Adolesc Psychiatry. 2004;43:37–45
  28. Lochman JE, Powell NR, Whidby JM, Fitzgerald DP. Aggressive children: cognitive-behavioral assessment and treatment. In:  Kendall PC editors. Child and Adolescent Therapy: Cognitive-Behavioral Procedures. New York: Guilford; 2006;
  29. Malone RP, Luebbert JF, Delaney MA, et al. Nonpharmacological response in hospitalized children with conduct disorder. J Am Acad Child Adolesc Psychiatry. 1997;36:242–247
  30. Masters KJ, Bellonci C, Bernet W, et al. Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint. J Am Acad Child Adolesc Psychiatry. 2002;41:4S–25S
  31. Mental Health Act 2000 Queensland: Reprint No. 2F, August 2006. Available at: http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/M/MentalHealA00.pdf. Accessed February 1, 2007
  32. Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraint. Can J Psychiatry. 2003;48:330–387
  33. Natta MB, Holmbeck GN, Kupst MJ, Pines RJ, Schulman JL. Sequences of staff-child interactions on a psychiatric inpatient unit. J Abnorm Child Psychol. 1990;18:1–14
  34. Nelson WM, Finch AJ, Ghee AC. Anger management with children and adolescents. In:  Kendall PC editors. Child and Adolescent Therapy: Cognitive-Behavioral Procedures. New York: Guilford; 2006;
  35. Paterson B, Bradley P, Stark C, Saddler D, Leadbetter D, Allen D. Deaths associated with restraint use in health and social care in the UK. The results of a preliminary survey. J Psychiatr Ment Health Nurs. 2003;10:3–15
  36. Petti TA, Mohr WK, Somers JW, Sims L. Perceptions of seclusion and restraint by patients and staff in an intermediate-term care facility. J Child Adolesc Psychiatr Nurs. 2001;14:115–127
  37. Petti TA, Stigler KA, Gardner-Haycox J, Dumlao S. Perceptions of P.R.N. psychotropic medications by hospitalized child and adolescent recipients. J Am Acad Child Adolesc Psychiatry. 2003;42:434–441
  38. Ryan EP, Hart VS, Messick DL, Aaron J, Burnette M. A prospective study of assault against staff by youths in a state psychiatric hospital. Psychiatr Serv. 2004;55:665–670
  39. Sanders MR. Triple P-Positive Parenting Program: towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. Clin Child Fam Psychol Rev. 1999;2:71–90
  40. Sanders MR, Markie-Dadds C, Tully LA, Bor W. The triple P-positive parenting program: a comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. J Consult Clin Psychol. 2000;68:624–640
  41. Sukhodolsky DG, Cardona L, Martin A. Characterizing aggressive and noncompliant behaviors in a children's psychiatric inpatient setting. Child Psychiatry Hum Dev. 2005;36:177–193
  42. Troutman B, Myers K, Borchardt C, Kowalski R, Bubrick J. Case study: when restraints are the least restrictive alternative for managing aggression. J Am Acad Child Adolesc Psychiatry. 1998;37:554–558
  43. Vitiello B, Hill JL, Elia J, Cunningham E, McLeer SV, Behar D. p.r.n. medications in child psychiatric patients: a pilot placebo-controlled study. J Clin Psychiatry. 1991;52:499–501
  44. Vivona JM, Ecker B, Halgin RP, Cates D, Garrison WT, Friedman M. Self- and other-directed aggression in child and adolescent psychiatric inpatients. J Am Acad Child Adolesc Psychiatry. 1995;34:434–444

 Dr. Dean is supported by a National Health and Medical Research Council Research Fellowship. The authors thank the staff and patients of Mater Children's Hospital CYMHS Inpatient Unit. They thank Dr. William Bor for his useful comments on the manuscript.Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.Disclosure: The authors have no financial relationships to disclose.

PII: S0890-8567(09)62150-X

doi: 10.1097/chi.0b013e3180465a1a

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 46, Issue 6 , Pages 711-720 , June 2007