The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.
- Cotton, N. (1989). The development-clinical rationale for the use of seclusion in the psychiatric treatment of children.American Journal of Orthopsychiatry, 59 442–450.
- Erickson, W. & Realmuto, G. (1983). Frequency of seclusion in an adolescent psychiatric unit.Journal of Clinical Psychiatry, 44 238–241.
- Fassler, D. & Cotton, N. (1992). A national survey on the use of seclusion in the psychiatric treatment of children.Hospital and Community Psychiatry, 43 370–374.
- Garrison, W. T. (1984). Predicting violent behavior in psychiatrically hospitalized boys.Journal of Youth and Adolescence, 13 225–238.
- Garrison, W. T., Ecker, B., Friedman, M., Davidoff, M., Halberle, K. & Wagner, M. (1990). Aggression and counter-aggression during child psychiatric hospitalization.Journal of the American Academy of Child and Adolescent Psychiatry, 29 242–250.
- Giroux, H. (1983). Theories of reproduction and resistance in the new sociology of education.Harvard Educational Review, 55 257–293.
- Goren, S. (1992). Practicing in partnership with families in inpatient child psychiatry.Journal of Child and Adolescent Psychiatric and Mental Health Nursing, 5 43–46.
- Gutheil, T. (1978). Observations on the theoretical bases for seclusion of the psychiatric inpatient.American Journal of Psychiatry, 135 325–328.
- Joshi, P., Capozzoli, J. & Coyle, J. (1988). Use of the quiet room on a childrens' inpatient unit.Journal of the American Academy of Child and Adolescent Psychiatry, 27 642–644.
- Masters, K. J. & Devany, J. (1992). Are physical restraints necessary?Journal of the American Academy of Child and Adolescent Psychiatry, 31 372.
- Miller, D., Walker, M. & Friedman, D. (1989). Use of a holding technique to control the violent behavior of seriously disturbed adolescents.Hospital and Community Psychiatry, 40 520–524.
- Millstein, K. H. & Cotton, N. S. (1990). Predictors of the seclusion on an inpatient child psychiatric unit.Journal of the American Academy of Child and Adolescent Psychiatry, 29 256–264.
- Morrison, E. (1990). The tradition of toughness: A study of non-professional nursing care in psychiatric settings.Image: Journal of Nursing Scholarship, 22 32–38.
- Natta, M., Holmbeck, G., Kupst, M., Pines, R. & Schulman, J. (1990). Sequences of staff-child interactions on a psychiatric inpatient unit.Journal of Abnormal Child Psychology, 18 1–14.
- Patterson, G. R. (1976). The aggressive child: Victim and architect of a coercive system. In E. Mash, L. Hamerlynck, & L. Handy (Eds.),Behavior modification and families: Theory and research (pp. 131–158). New York: Brunner/Mazel.
- Patterson, G. R. (1982).A social learning approach to family intervention: Coercive family process. Eugene, Ore: Castalia.
- Patterson, G. R. & Forgatch, M. S. (1985). Therapist behavior as a determinant for client non-compliance: A paradox for the behavior modifier.Journal of Consulting and Clinical Psychology, 53 846–851.
- Repp, A. C. & Singh, N. N. (1990).Perspectives on the use of nonaversive and aversive interventions in persons with developmental disabilities. Sycamore, Ill: Sycamore Publishing Co.
- Rivkin, L. & Wolfe, M. (1985).Institutional settings in children's lives. New York: Wiley.
- Singh, N. N. & Aman M. G. (1990). Ecobehavioral assessment of pharmacotherapy. In S. Schroeder (Ed.),Ecobehavioral analysis in developmental disabilities (pp. 182–200). New York: Springer-Verlag.
- Singh, N. N. & Repp, A. C. (1988). Current trends in the behavioral and psychopharmacological management of problem behaviors of mentally retarded persons.Irish Journal of Psychology, 9 362–384.
- Wahler, R. & Fox, J. (1981). Setting events in applied behavior analysis: Toward a conceptual and methodological expansion.Journal of Applied Behavior Analysis, 14 327–338.
- Wahler, R. & Williams, A. (1990). The compliance and predictability hypotheses: Sequential and correlational analyses of coercive mother-child interactions.Behavioral Assessment, 12 391–407.
- The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital
Journal of Child and Family Studies
Volume 2, Issue 1 , pp 61-73
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Human Sciences Press
- Additional Links
- child psychiatry
- Author Affiliations
- 1. Department of Community and Psychiatric Nursing, Medical College of Virginia, Virginia Commonwealth University, P.O. Box 567, 23298-0567, Richmond, VA
- 2. Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Virginia