Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit

Kelsie A Boulton; Veena Raghupathy; Adam J Guastella; Michael R Bowden

doi:10.1016/j.jad.2022.02.066

Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit

J Affect Disord. 2022 May 15:305:1-7. doi: 10.1016/j.jad.2022.02.066. Epub 2022 Feb 25.

Authors

Kelsie A Boulton¹, Veena Raghupathy², Adam J Guastella³, Michael R Bowden⁴

Affiliations

¹ Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
² Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia.
³ Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: adam.guastella@sydney.edu.au.
⁴ Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia; Mental Health - Children and Young People, Mental Health Branch, NSW Health, Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia.

PMID: 35227762
DOI: 10.1016/j.jad.2022.02.066

Abstract

Background: In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions.

Method: Multi-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions.

Results: There was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July-September 2015, to 4.7 episodes in January-March 2016, reaching 0.0 episodes by April-June 2016. This reduction was maintained until April-June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant.

Limitations: Due to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change.

Conclusions: Multidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.

Keywords: Child; Inpatient; Neurodevelopmental disorders; Psychiatric unit; Seclusion.

MeSH terms

Adolescent
Australia
Child
Hospitals, Psychiatric
Humans
Inpatients* / psychology
Mental Disorders* / therapy
Patient Isolation
Restraint, Physical