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Dissertation

An Alternative to Seclusion And Restraint: Collaborative Problem Solving

28 September 2011

Abstract

The use of seclusion and restraint within psychiatric and residential settings is controversial, particularly when used with children. No consensus exists that supports its use despite it being a widely accepted form of intervention throughout the world. Research suggests the use of such interventions can have deleterious effects and national guidelines have been implemented to govern the practice of seclusion and restraint with children. Collaborative Problem Solving (CPS) is a transtheoretical model designed to decrease aggressive and explosive behavior in children and adolescents. Evidence suggests CPS is effective in the reduction of seclusion and restraint in inpatient settings. This study investigates the effectiveness of CPS in reducing the incidents of seclusion and restraint on a child and adolescent inpatient unit. Participants of the study ranged in age from 9 to 18 years of age. Eight years of seclusion and restraint data was analyzed that included four years pre and four years post the implementation of CPS. A time-series segmented regression analysis was used to analyze the data. A significant reduction was found in the incident of restraints immediately following the implementation of CPS; however, the results did not sustain over time. A discussion of the research is provided concluding that CPS was not a highly effective method for reducing seclusion and restraint rate. Limitations of the study and directions for future research are also discussed.


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