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Effectiveness of Six Core Strategies Based on Trauma Informed Care in Reducing Seclusions and Restraints at a Child and Adolescent Psychiatric Hospital

Authors

  • Muhammad Waqar Azeem MD, FAACAP,

    1. Muhammad Waqar Azeem, MD, FAACAP, is Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine, as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine. At the time of the study, Dr. Azeem was with Minnesota State Operated Child and Adolescent Behavioral Health Services; Akash Aujla, MD, is Associate Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine; Michelle Rammerth, RN, BSN, MAN, is with Veterans Administration, Brainerd, Minnesota. At the time of the study, she was Director of Nursing for Minnesota State Operated Child and Adolescent Behavioral Health Services, Brainerd, Minnesota; Gary Binsfeld, MA, is with Minnesota State Operated Child and Adolescent Behavioral Health Services; Robert B. Jones, MD, is Medical Director for Minnesota State Operated Services for Mental Health, Brainerd, Minnesota, USA.
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  • Akashdeep Aujla MD,

    1. Muhammad Waqar Azeem, MD, FAACAP, is Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine, as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine. At the time of the study, Dr. Azeem was with Minnesota State Operated Child and Adolescent Behavioral Health Services; Akash Aujla, MD, is Associate Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine; Michelle Rammerth, RN, BSN, MAN, is with Veterans Administration, Brainerd, Minnesota. At the time of the study, she was Director of Nursing for Minnesota State Operated Child and Adolescent Behavioral Health Services, Brainerd, Minnesota; Gary Binsfeld, MA, is with Minnesota State Operated Child and Adolescent Behavioral Health Services; Robert B. Jones, MD, is Medical Director for Minnesota State Operated Services for Mental Health, Brainerd, Minnesota, USA.
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  • Michelle Rammerth RN, BSN, MAN,

    1. Muhammad Waqar Azeem, MD, FAACAP, is Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine, as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine. At the time of the study, Dr. Azeem was with Minnesota State Operated Child and Adolescent Behavioral Health Services; Akash Aujla, MD, is Associate Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine; Michelle Rammerth, RN, BSN, MAN, is with Veterans Administration, Brainerd, Minnesota. At the time of the study, she was Director of Nursing for Minnesota State Operated Child and Adolescent Behavioral Health Services, Brainerd, Minnesota; Gary Binsfeld, MA, is with Minnesota State Operated Child and Adolescent Behavioral Health Services; Robert B. Jones, MD, is Medical Director for Minnesota State Operated Services for Mental Health, Brainerd, Minnesota, USA.
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  • Gary Binsfeld MA,

    1. Muhammad Waqar Azeem, MD, FAACAP, is Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine, as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine. At the time of the study, Dr. Azeem was with Minnesota State Operated Child and Adolescent Behavioral Health Services; Akash Aujla, MD, is Associate Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine; Michelle Rammerth, RN, BSN, MAN, is with Veterans Administration, Brainerd, Minnesota. At the time of the study, she was Director of Nursing for Minnesota State Operated Child and Adolescent Behavioral Health Services, Brainerd, Minnesota; Gary Binsfeld, MA, is with Minnesota State Operated Child and Adolescent Behavioral Health Services; Robert B. Jones, MD, is Medical Director for Minnesota State Operated Services for Mental Health, Brainerd, Minnesota, USA.
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  • Robert B. Jones MD

    1. Muhammad Waqar Azeem, MD, FAACAP, is Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine, as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine. At the time of the study, Dr. Azeem was with Minnesota State Operated Child and Adolescent Behavioral Health Services; Akash Aujla, MD, is Associate Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, and Assistant Clinical Professor Yale Child Study Center, Yale University School of Medicine as well as Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine; Michelle Rammerth, RN, BSN, MAN, is with Veterans Administration, Brainerd, Minnesota. At the time of the study, she was Director of Nursing for Minnesota State Operated Child and Adolescent Behavioral Health Services, Brainerd, Minnesota; Gary Binsfeld, MA, is with Minnesota State Operated Child and Adolescent Behavioral Health Services; Robert B. Jones, MD, is Medical Director for Minnesota State Operated Services for Mental Health, Brainerd, Minnesota, USA.
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Muhammad.Azeem@ct.gov, with a copy to the Editor: poster@uta.edu

Abstract

OBJECTIVE:  The purpose of the study was to determine the effectiveness of six core strategies based on trauma informed care in reducing the use of seclusion and restraints with hospitalized youth.

METHODS:  The hospital staff received training in March 2005 in six core strategies that are based on trauma informed care. Medical records were reviewed for youth admitted between July 2004 and March 2007. Data were collected on demographics, including age, gender, ethnicity, number of admissions, type of admissions, length of stay, psychiatric diagnosis, number of seclusions, and restraints.

RESULTS:  Four hundred fifty-eight youth (females 276/males 182) were admitted between July 2004 and March 2007. Seventy-nine patients or 17.2% (females 44/males 35) required 278 seclusions/restraints (159 seclusions/119 restraints), with average number of episodes 3.5/patient (range 1–28). Thirty-seven children and adolescents placed in seclusion and/or restraints had three or more episodes. In the first six months of study, the number of seclusions/restraints episodes were 93 (73 seclusions/20 restraints), involving 22 children and adolescents (females 11/males 11). Comparatively, in final six months of study following the training program, there were 31 episodes (6 seclusions/25 restraints) involving 11 children and adolescents (females 7/males 4). The major diagnoses of the youth placed in seclusion and/or restraints were disruptive behavior disorders (61%) and mood disorders (52%).

CONCLUSIONS:  This study shows downward trend in seclusions/restraints among hospitalized youth after implementation of National Association of State Mental Health Program Directors six core strategies based on trauma informed care.

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