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Article   |    
Impact of Therapeutic Management on Use of Seclusion and Restraint With Disruptive Adolescent Inpatients
Ikar J. Kalogjera; Ashok Bedi; William N. Watson; Anthony D. Meyer
Psychiatric Services 1989; doi:
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The authors thank the division of child and adolescent psychiatry of the Medical College of Wisconsin, H. David Sackin, M.D., Dalma Kalogjera, Ph.D., Marvin Lyttle, Cheryl Kelber, and Dorothy Peshak.

Department of Psychiatry and Mental Health Sciences at the Medical College of Wisconsin in Milwaukee, The Division of Child and Adolescent Psychiatry

Milwaukee Psychiatric Hospital, The Department of Psychiatry and Mental Health Sciences at the Medical College of Wisconsin in Milwaukee, The Division of Child and Adolescent Psychiatry

The Division of Child and Adolescent Psychiatry, The Department of Psychiatry and Mental Health Sciences at the Medical College of Wisconsin in Milwaukee

1989 by the American Psychiatric Association

An erratum to this article has been published | view the erratum
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Abstract

Use of seclusion and restraint on three inpatient adolescent psychiatric units was examined during two five-month periods before and after implementation of a "therapeutic management" protocol. Under the protocol, staff classified disruptive behaviors into four stages and provided verbal and behavioral interventions to control behavior at each stage. Patients who required seclusion and restraint had significant latitude to determine the timing of their release from the interventions and met with staff one hour and 24 hours after their release to explore alternatives to aggression. The number of episodes of sedusion and restraint fell by 64 percent after the protocol was adopted, and the number of patients who required those interventions dropped by 39 percent. The mean duration of episodes of seclusion and restraint was reduced by 59 percent. Therapeutic management provides a corrective experience by addressing the developmental needs, deficient cognitive skills, and poor internalized controls of disruptive adolescents.

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