E: Group B Practice Experience Discussion – Week 4


E: Group B Practice Experience Discussion – Week 4

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Excessive or Unnecessary Use of Restraints and Seclusion of Mentally Ill Children

In mental health inpatient facilities, mentally ill children die, get injured and psychologically traumatized by unnecessary seclusion and restraint practices (De Hert et al., 2011). In my practice setting, Aida Bugg, a nurse practitioner says that the use of noncoercive de-escalation where the patient is calmed down when agitated helps gain their cooperation and hence makes it easier to evaluate and treat the patient.

Proposed Action Steps

To improve mental health care for children, action steps can be taken to improve mental health care for children through:

Influencing cultural change in mental health issues regarding restraint and seclusion by researching children’s personal experiences of seclusion and restraint, understanding the impact trauma has on children and then sustaining change by involving the patients and the staff (Matte & Collin, 2020). Assessing the risk of violence among secluded children, any medical risk factors and past traumas can be used to develop better safety plans.

Trauma informed care of children with mental health issues shifts tradition from what is wrong with the child to what has happened to the patient. This way, health practitioners can understand that mental health issues are related to traumatic experiences and hence it doesn’t help to inflict more trauma on patients. This action step would be effective with the use of accurate data about how serious the issue is, how effective interventions for the issue will be and alternatives when these interventions don’t work (Raveesh et al., 2019).

Conducting a movement against restraint and seclusion and the effect it has on children who are mentally ill by involving family members and other relevant advocates for inpatient care. This movement can be used to debrief those concerned about policy, procedures and practices that can be used to minimize the future use of restraints and seclusion (Roy et al., 2020). The movement can also be an avenue to address any adverse or traumatic events of restraint and seclusion.

Partnerships and collaborations with both private and public sectors can be used to further influence cultural change, prevent and reduce the use of restraints and seclusion. Partners and stakeholders can be consulted to take an active role in developing new alternatives and taking role in the change process while ensuring accountability.

Potential Challenges

Implementation of the project can be compromised by lack of proper communication among stakeholders involved. Inadequate finances and resources can deter the project from running effectively and efficiently especially when mobilising new partners or conducting movement (Roy et al., 2020). Also lack of proper stakeholder engagement and cooperation when stakeholders are disinterested or do not give open feedback.


The resources that would be needed to implement the project include health care practitioners such as nurses, managers, researchers, material resources and computer software for proper communication with stakeholders and partners (Raveesh et al., 2019). The resources will be cost effective because taking steps to find alternatives or prevent seclusion and restraints will improve the mental health of these children and encourage health seeking behaviour which in turn reduces admissions.


De Hert, M., Dirix, N., Demunter, H., & Correll, C. U. (2011). Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. European child & adolescent psychiatry, 20(5), 221-230.

Matte-Landry, A., & Collin-Vézina, D. (2020). Restraint, seclusion and time-out among children and youth in group homes and residential treatment centers: a latent profile analysis. Child Abuse & Neglect, 109, 104702.

Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693.

Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693.


 Group B Practice Experience Discussion – Week 5


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Practice Experience: Applying Key Interventions to a Practice Problem

Restraint and seclusion are utilized to prevent injury and alleviate agitation, as it is hard to administer a program for mentally challenged individuals without utilizing some restrictive intervention (Nielson et al., 2021). Children are subjected to restraint because they are reported to be excessively violent. Retraining is being conducted to decrease the occurrence of risky behavior such as irritation, threat, and assaulting personnel. However, secluding and retraining mentally disabled children has medical and psychological consequences, including developmental issues, psychotic and externalizing diseases, mood and depression, and anxiety (Nielson et al., 2021). Additionally, S/R is contentious since it impinges on patient autonomy and liberty.

Huckshorn Six Strategies

According to Hammervold et al. (2019), the Huckshorn six strategies is a successful planning tool that leads the creation of seclusion and retraining (S/R) reduction plans by combining a prevention strategy.  Huckshorn six strategies in the care setting include work development, thorough debriefing, leadership in organizational changes, data-driven practice, use of seclusion and restraining techniques, and full engagement of patients and families are among the strategies. According to Hammervold et al. (2019), these measures can significantly reduce isolation and restrain mental healthcare. The first phase is to establish leadership in response to organizational challenges.

Senior leadership is involved in the techniques chosen to reduce seclusion and to restrain (S/R) use. The leadership measures include creating a vision, values, and philosophy for S/R, as well as preparing a performance improvement strategy. The vision is critical because it outlines the desired future state and what is expected to be accomplished in the future. In contrast, the improvement action plan directs employees on accomplishing S/R reduction (Perers et al., 2021). The second step entails data collection to inform practice. The purpose of the data collection is to establish a facility’s S/R baseline and collect data on the usage unit, shift, individual staff members participating, consumer demographics, and injuries linked with S/R.

The third phase is to establish a workforce. Policies, procedures should guide the treatment environment and practices founded on recovery knowledge and principles and the characteristics of trauma-informed care. The initiatives are carried out with the assistance of extensive and continuing staff training and education. The training will emphasize S/R application training and vendor selection, and the provision of sufficient therapy activities that provide patients with options (Perers et al., 2021). Providers will be educated on sickness and emotional self-management of symptoms and personal triggers that contribute to patient loss of control. The training will further emphasize on educating providers on how to construct customized person-centered treatment plans tailored to each individual’s needs.

The team will get instruction on the impact of traumatic experiences on developmental learning, emotional development, recovery, resiliency, and overall health. This will ensure that staff members understand what to do and act professionally to avoid inflicting traumatic experiences on the patient (Perers et al., 2021). Thirdly, isolation and restraining preventative measures are used. The facility’s policies and procedures and each client’s recovery plan incorporate various tools and assessments. The evaluation tools are used to ascertain a child’s risk of violence and his or her history of S/R. Additionally, the universal trauma assessment instruments are used to identify children who are in danger of death or serious harm.

Another intervention that is integrated into the individual consumer recovery plan is a de-escalation survey or assessment tool for safety planning to determine individual triggers. The instruments are effective in determining which interventions are most beneficial for emotional self-management. Environmental modifications such as comfort and sensory rooms, sensory modulation interventions, and other therapeutic activities included to teach children self-management skills (Perers et al., 2021). The aggressiveness control behavior scale supports staff in classifying patients who exhibit agitated, disruptive, dangerous, or fatal conduct, thereby avoiding unnecessary restraining and confinement. The fifth phase comprises of performing consumer tasks in a hospital setting.

This technique is critical in the S/R treatment plans since it entails the consumer, children, relatives, and external advocates all playing roles in assisting with seclusion and restraint reductions. Consumer assistance includes oversight and monitoring to ensure that seclusion and restraining are conducted in accordance with fundamental human rights, that ensures patient integrity and dignity are preserved, and that patients are treated with care and respect (Perers et al., 2021). Providers conduct debriefing sessions to determine what they could have done differently and make short-term goals to avoid repeated restraint use. The debriefing will aid in elucidating both parties’ behavior concerning prior restraining use.

Peer support is also required to guarantee that the patient obtains the critical support necessary for their rehabilitation plan. The final step of seclusion and restraining(S/R) reduction involves employing a debriefing strategy. Debriefing is critical for lowering S/R use since it aids in collecting necessary knowledge that informs policy, procedures, and practice. The treatment team conducts a debriefing in two sections. The first is an immediate post-event acute analysis, and the second is formal problem analysis. Multiple hold debriefings are conducted with children, and staff members involved in treatment events are recognized for instruction on adjusting the treatment plan. Debriefing encompasses all consumer stakeholders, including family, peer support, advocates, and providers.


Hammervold, U. E., Norvoll, R., Aas, R. W., & Sagvaag, H. (2019). Post-incident review after restraint in mental health care-a a potential for knowledge development, recovery promotion, and restraint prevention. A scoping review. BMC health services research19(1), 1-13.

Perers, C., Bäckström, B., Johansson, B. A., & Rask, O. (2021). Methods and strategies for reducing seclusion and restraint in child and adolescent psychiatric inpatient care. Psychiatric quarterly, 1-30.

Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care25(3), 342–367. https://doi.org/10.1177/1367493520937152

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