"Reduction of Seclusion and Restraint in CT: Empowering Consumers"

In order to reduce seclusion and restraint on a psychiatric unit, we implemented recommendations from the SAMHSA-sponsored Training Curriculum for the Reduction of Seclusion and Restraint (S/R). We chose to place a special emphasis on partnering with consumers, one of the six major components of this initiative, along with organizational change, data utilization, workforce development, prevention tools, and debriefing. To promote organizational change, the hospital leadership reviewed weekly the progress of this initiative and hospital leader had hands-on involvement in it. A steering committee meeting was held weekly with all stakeholders including clinical staff and consumers, with weekly review of S/R data. Clinical staff received extensive training on trauma-informed care, faulty assumptions about S/R, debriefing, social and independent living skills, etc. A number of S/R prevention tools were introduced, including trauma assessment tools, safety plans, positive behavioral support plans and environmental changes such as comfort rooms and offering sensory modulations experiences. We introduced a process of conducting a rigorous analysis of every S/R episode and endeavored to mitigate the adverse effects of S/R. We made extensive use of consumers throughout all phases of the initiative, along with their families and advocates. Their involvement included serving on the steering committee, assisting in debriefings, offering peer support services, training staff about consumer issues. For example, we employ consumers as remunerated faculty in a variety of training forums, such as the orientation of new staff. We will describe the implementation of this inititative using qualitative as well as statistical data.