Summary of the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint

This parameter reviews the current state of the Prevention and management o f child and adolescent aggressive behavior in psychiatric institutions, wit h particular reference to the indications and use of seclusion and restrain t. It also presents guidelines that have been developed in response to prof essional, regulatory, and public concern about the use of restrictive inter ventions with aggressive patients with regard to personal safety and patien t rights. The literature on the use of seclusion, physical restraint, mecha nical restraint, and chemical restraint is reviewed, and procedures for car rying out each of these interventions are described. Clinical and regulator y agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclu sion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfactio n with treatment while diminishing the necessity of using restrictive proce dures.