Prevention and Management of Aggressive Behavior in Psychiatric Institutions with Special Reference to Seclusion and Restraint

Approved by the AACAP Council on October 24, 2000
To be reviewed

Seclusion and restraint are medical interventions, which are utilized during the psychiatric treatment of children and adolescents in hospital-based settings or other specialized clinical treatment programs. Seclusion and restraint are the most restrictive interventions for reconstituting behavioral control and establishing and maintaining safety for the out-of-control patient, for other patients, and for staff. Seclusion and restraint should be employed only when other, less restrictive, interventions have been determined to be ineffective or inappropriate. A major goal of each patient's treatment should be to promote self-control, thereby minimizing and preventing the need for seclusion and restraint.

Every facility or institution must establish policies and procedures governing the use of seclusion and restraint. Such policies should address:

  1. circumstances under which different types and/or degrees of seclusion and restraint will be used, given clinical indications and developmental considerations;
  2. monitoring frequency and duration of seclusion and restraint interventions;
  3. qualifications of clinicians who can authorize, implement, monitor, and terminate seclusion and restraint procedures;
  4. the documentation required, both in patient records and in institutional logs of all episodes of seclusion and restraint;
  5. in-service training requirements for new and existing staff; and
  6. quality review and reporting of seclusion and restraint indicators, with particular attention to safety and staffing levels.
Safety measures must be integrated into the implementation and practice of seclusion and restraint at all times.

Prevention measures and de-escalation strategies are essential parts of minimizing the use of seclusion and restraint. Staff must receive training in such interventions, and patients and his/her family members also should be aware of these strategies. After each episode of seclusion and restraint there should be a review of the patient's treatment plan, as soon as it is practical. Whenever possible, staff should conduct this review in consultation with the child or adolescent and his/her family, including a review of how the incident could have been prevented. Seclusion and restraint policy must be congruent with local and/or federal statutes and licensing requirements, and should be relevant to the needs of the children and adolescents served by the institution.

Seclusion and restraint should only be used as emergency interventions to maintain safety and should be implemented in a manner sensitive to the child's particular developmental level, any specific vulnerabilities, and the overall treatment goals. The prevention of aggressive behavior requires the combined efforts of the patient, his/her family and the staff working together to achieve optimal results. Seclusion and restraint interventions are meant to protect the patient, with the important goals of maintaining safety and helping him or her to establish appropriate behavioral self-control.