NCJ Number
196064
Journal
Journal of the American Academy of Child & Adolescent Psychiatry Volume: 41 Issue: 8 Dated: August 2002 Pages: 897-905
Editor(s)
Mina K. Dulcan M.D.
Date Published
2002
Length
9 pages
Annotation
This report describes the development of a guide to improve the management of acute aggression for youths in State inpatient and residential mental health care facilities.
Abstract
The only component of the guide completed so far is Phase 1, Development, which is described in this article. Key stakeholders participating in this project were medical directors from five State youth psychiatric facilities, academicians and researchers from the two major child and adolescent psychiatry teaching institutions in Maryland, nurses, psychologists, and social workers representing the front-line mental health staff, and the mental health authority in Baltimore City where many youths reside. A consumer advocate represented the concerns of patients and their families. Current practices for managing acute aggression were assessed by means of a self-administered survey distributed to the nursing and front-line staff who identified the types of interventions they used for a list of 23 behaviors. Seclusion, restraint, and chemical restraint were selected as the practice parameters. Algorithms were discarded as not accounting for all relevant variables influencing the use of an intervention. The therapeutic process was selected because it could provide a theoretical framework for evaluating multiple aspects of a situation and aid in rational clinical decision-making. The intention of this guide was to reduce the number of acute aggressive episodes requiring restrictive interventions with a combination of careful planning, adequate resources, and sufficient training. Three intervention levels were identified with recommended responses based on the severity of aggression. Possible pharmacological interventions at each level were discussed with the patient's preference for restraint versus medication being incorporated to the greatest possible degree, but the safety of all individuals, again, being the highest concern. Existing documentation procedures are being revised and/or new ones developed. The impact of the Guide upon clinical practice will be studied in mid-2002, and necessary modifications will be recommended. 1 Figure, 2 tables, 20 references