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Published Online: 1 October 2014

Efforts to Reduce Seclusion and Restraint Use in a State Psychiatric Hospital: A Ten-Year Perspective

Alok Madan, Ph.D., M.P.H., Jeffrey J. Borckardt, Ph.D., Anouk L. Grubaugh, Ph.D., Carla Kmett Danielson, Ph.D., Stephen McLeod-Bryant, M.D., Harriet Cooney, M.S.N., Joan Herbert, M.S., Susan J. Hardesty, M.D., and B. Christopher Frueh, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 65, Number 10
https://doi.org/10.1176/appi.ps.201300383
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Abstract

Objective

The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time.

Methods

This follow-up study examined archival data by using a longer preintervention baseline phase and examined the sustainability of intervention gains in the absence of a research agenda. Over ten years, 3,040 seclusion and restraint incidents were analyzed across 254,491 patient-days.

Results

The extended baseline phase (N=38 months) exhibited a linear trend upward in seclusion and restraint use, and the formal intervention period and subsequent follow-up periods (N=82 months) showed a stabilization effect (p<.001).

Conclusions

The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice—even in the face of potentially disruptive administrative and environmental changes.

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Information & Authors

Information

Published In

Go to Psychiatric Services
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Cover: Shamrock Ranch, by Peter Hurd, 1962. Watercolor, 12 × 16 inches. New Mexico Museum of Art, Santa Fe. Gift of the family of Edythe C. Mattone, 2005.

Psychiatric Services
Volume 65 • Number 10 • October 2014
Pages: 1273 - 1276
PubMed: 25022602

History

Published online: 1 October 2014
Published in print: October 2014

Authors

Details

Alok Madan, Ph.D., M.P.H.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
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Jeffrey J. Borckardt, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
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Anouk L. Grubaugh, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author
Carla Kmett Danielson, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author
Stephen McLeod-Bryant, M.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author
Harriet Cooney, M.S.N.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author
Joan Herbert, M.S.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author
Susan J. Hardesty, M.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author
B. Christopher Frueh, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.
View all articles by this author

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