Minimizing Seclusion and Restraint on Adolescent Units

Minimizing Seclusion and Restraint on Adolescent Units

Staff from the Adolescent Inpatient Unit sat down to share their experiences about making the transition to minimize seclusion and restraint.

This video was used at the 2011 Thought Leadership Forum

Text Transcript

Staff from the adolescent inpatient unit sat down to share their experiences about making the transition to minimize seclusion and restraint.

Bob Heeney – Child and Youth Worker:
Kid’s come into the hospital and they hear that door lock behind them, I think it sets them apart from the rest of the world, apart from their friends. Things are a lot different. And I think that a lot of these kids carry with them, a certain amount of stigma that happens to them and to their families by them being admitted to a psychiatric facility. That’s something we need to address with these kids and let them understand that we hear them, we’re listening to them, and we’re there for them 24 hours a day, seven days a week.

Rob Pepler – Social Worker:
We’re recovery oriented, and part of that is really a collaborative process. So when a patient comes in, they almost always come in with at least their family and sometimes service providers as well. We’re trying to collaborate with the patient, with their family and with other service providers to understand where they’re coming from. How to be helpful for them, some of the triggers they have and that that’s an ongoing working relationship.

Dr. Diane Warling – Psychologist:
We come together as a team in an interprofessional team of many different professionals and disciplines to understand what’s driving kids' behaviour with the knowledge that behaviour is the language of children and youth. And so, when kids start to escalate, which is often times, we can sort of predict when a situation will get out of control, when in the past might have led to a restraint or seclusion, our key role is to really help support the youth and deescalate.

Sandra Chen – Clinical Practice Leader:
The behavioural profile tool is actually a really helpful way for staff to simply engage and ask patients about what it is that makes them upset and what are some things staff might notice about their behaviours about what they might be saying to give staff the signal that you know what, I’m getting triggered right now. So, it’s a really helpful tool and a part of those questions that are incorporated in the tool are: what might be helpful for us to know about that would help you to feel more relaxed when you’re upset, what are some things that staff might be able to say and offer you, what are some options, soothing techniques, and it’s used both with direct questioning of the person we are talking to and also getting information from family members.

Dr. Mark Fadel – Medical Director:
And also thinking about the treatment plan for the patient in general and maximizing that. So, you know, maximizing the psychological interventions, maximizing the social interventions, maximizing the medical interventions; making sure that all of those treatments are optimized. I think those are sort of good general principles to potentially avoid restraint use and  I think including all of the different members of the team in that planning process is something that in my experience is key.

Carelene McCrae – Registered Practical Nurse:
Our unit has been very, very good at recognizing those early signs and taking interventions to prevent them from escalating to the restraint use.  When we have had to use restraints we try to minimize the length of time that that person is going to be in restraint. And again, we do this by having a constant dialogue with our patients, explaining why they’re in the restraint and what you need to do in order to get out of the restraint. So it’s open communication and full team work that has done this for us.

Dr. Diane Warling – Psychologist:
I did have a very interesting conversation with one patient who had been in multiple residential treatment facilities and hospital units and had a number of restraints throughout her life. She was almost at an adult age and she talked about how she had an incredible level of anxiety and trauma history and so she would react very quickly to any sort of unsafe trigger, any kind of trigger that there was a threat against her. She would either respond with a fight or flight response. So she would either fight staff,  and end up in a restraint in the past or she would AWOL (Away Without Leave).  I was just amazed, first of all at her level of insight and that be able to articulate her experiences and how she did on our unit. I’m not even sure if she had any physical restraints here, she may have had one seclusion but she was here for several months and she did really well and I think the relationships she developed on the unit were significant and meaningful, although short term and the staff really appreciated where she was coming from, understanding her triggers, working with her, coaching her through moments where she was triggered and she knew the skills, she just had a really hard time putting them into practice when triggered. So it was really just staff acting as her coach, her feelings coach, her behaviours coach, to get her to actually implement what she already knew and then giving her a greater sense of confidence which she’s done actually remarkably well in the community since being discharged.