Use of Modified Positive Behavioral Interventions and Supports in a Psychiatric Inpatient Unit for High-Risk Youths.

OBJECTIVE: Despite a call for the reduction and ultimate elimination of the use of seclusion and restraint, research on reduction of these practices in behavioral programs has been limited. This study sought to examine the effectiveness of a modified version of the Positive Behavioral Interventions and Supports (M-PBIS) implemented in a youth psychiatric inpatient unit to reduce use of seclusion and restraint. METHODS: This naturalistic, prospective study covered a four-year period (1,485 admissions). RESULTS: The number of seclusion and restraint events, mean duration of events, and percentage of patients placed in seclusion or restraint were reduced, as was the overall seclusion rate for the unit. Furthermore, there was a significant reduction in the use of pro re nata (PRN) medications for agitation. CONCLUSIONS: These findings suggest that M-PBIS is a promising intervention to use in youth psychiatric inpatient units to reduce seclusion and restraint and PRNs.

Risk Factors for Seclusion and Restraint in a Pediatric Psychiatry Day Hospital.

The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.

Interparental conflict in context: exploring relations between parenting processes and children's conflict appraisals.

Children's appraisals of conflict are a mechanism by which parental discord can lead to child maladjustment. The cognitive-contextual framework proposes that parent-child relationships may affect how children perceive conflict, but this idea has rarely been examined empirically. This study investigated relations between conflict appraisals, parenting, and child adjustment in a sample of 150 8- to 12-year-old children, using a multi-informant, multimethod design. Mothers' coercive/controlling and emotionally unsupportive parenting magnified the relation between conflict and children's self-blame; emotionally supportive parenting diminished this association. Children's secure attachment with fathers was linked with less threat and self-blame; more security reduced self-blame for conflict. Data suggest that supportive, responsive parenting can buffer the effects of interparental conflict on children by reducing self-blaming attributions for parental discord.