Commentary: Interventions based on learning principles can supplant seclusion and restraint.

نویسنده

  • Robert Paul Liberman
چکیده

Regulatory and administrative imperatives, when paired with staff training in humanistic, verbally mediated interventions can reduce the frequency of seclusion and restraint but can be associated with increases in the frequency and severity of staff injury, with concomitant tension and apprehension in the treatment setting. Even when educational programs for staff are made available for patient-centered, therapeutic, and persuasion-based modes of de-escalation, aggression, destructiveness and self-injury may continue to occur or even increase. Administrative contingencies can lead to less reporting of such incidents by staff with consequential, adverse effects on their morale and the unit milieu. Given the neurocognitive deficits, learning disabilities and lengthy histories of inadvertent reinforcement of provocative and aggressive behavior among persons with developmental and serious psychiatric disorders, basic principles of learning are needed to teach alternatives for belligerent behavior. Examples of behavior therapies that have been documented as effective in reducing aggression and self-injury include differential reinforcement of other behavior, social skills training, teaching interaction, social learning modalities, and time out from reinforcement. These evidence-based behavioral interventions must be superimposed on optimal, diagnostically driven, and monitored pharmacotherapy. When evidence-based, person-centered, and recovery-oriented biobehavioral interventions are made available to inpatient units, favorable clinical outcomes with reductions in the use of seclusion and restraint are likely.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Commentary: seclusion and restraint in corrections a time for change.

Seclusion and restraint are essential interventions in the acute psychiatric care of patients in correctional environments. When administered and monitored properly, they are safe and effective in reducing the risk of harm. However, correctional systems have not developed uniform practices that are consistent with current community standards. There has been no clear national standard of care fo...

متن کامل

Commentary: seclusion practice in a Canadian forensic hospital.

The article, "Seclusion Practice in a Canadian Foren sic Hospital," by A. G. Ahmed and M. Lepnurm1 evokes further questions about the use of seclusion and restraint in psychiatric hospitals. This subject remains at the heart of intense debatewithin psychi atric and consumergroups, and recently there have been legislative interventions that have intensified the discussion. Although most of the d...

متن کامل

Summary of the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint.

This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressi...

متن کامل

A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients.

This review examines the nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients. Thirty-six post-1960 empirical studies were identified. The interventions were diverse, but commonly included new restraint or seclusion policies, staffing changes, staff training, case review procedures, or crisis management initiatives....

متن کامل

Commentary: On regulation, wishfulness, and denial.

Restraint and seclusion are unsavory topics within a discipline that cherishes verbal interventions. As such, the principles of use are haphazardly taught by in-house clinicians or private agencies. Policy standards were published in the 1980s, but they have not been officially updated, despite the fact that an American Psychiatric Association (APA) committee met in 2003 to overhaul the standar...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • The journal of the American Academy of Psychiatry and the Law

دوره 39 4  شماره 

صفحات  -

تاریخ انتشار 2011