School of Nursing
L. Kathleen Sekula
Child abuse, Children, Collaborative problem-solving approach, CPS, Inpatient treatment, Psychiatric nursing
Aggressive or explosive behaviors in children typically occur within the context of a variety of psychiatric diagnoses and pose additional challenges when children present with histories of abuse. These behaviors are often interpreted as deliberate or noncompliant and management of these extreme behaviors often results in locked seclusion in most inpatient psychiatric settings. Locked seclusion remains controversial at best and raises legal and ethical issues regarding its safe and therapeutic use.
This retrospective quantitative study evaluated the effectiveness of the Collaborative Problem-Solving (CPS) approach as a less restrictive behavioral intervention on an inpatient child psychiatric unit with children ages 5-12 years that introduced the CPS approach during a nine month performance improvement project from July 1, 2006 - March 31, 2007. This study sought to determine what variables, if any, impacted the use of locked seclusion before, during, and after CPS implementation and whether children with histories of abuse were placed in locked seclusion at a significantly different rate relative to admissions of children who did not have histories of abuse. Erik Erikson's Theory of Psychosocial Development served as the theoretical framework.
The closed medical record review involved 197 admissions and 167 children. All data were analyzed in two parts: the entire nine month period of 197 admissions and by time period, based on when the CPS intervention was introduced and implemented on the unit.
Length of stay was the only variable statistically significant during the nine month period (n=197) and third time period of January -March 2007 (n=65) when CPS was fully implemented and assessed. This finding suggests that a child's longer length of stay may have had a relationship with being placed in locked seclusion. When length of stay was controlled as an influence with history of abuse, the variable of interest for this study, children with histories of abuse for the nine month period were not significantly more likely of being placed in locked seclusion than children without histories of abuse; for the third time period, they were found to be almost eight times less likely of being placed in locked seclusion with an odds ratio of 7.81.
Although these findings suggest a favorable response to the CPS approach and that behaviors associated with traumatized children were normalized to that of their peer group, the results must be considered with caution. There were many limitations to the initial project and any inferred success with abused children and the CPS approach is based on statistical outcomes only. Other variables not measured or controlled must be considered as potential influences that may have impacted these outcomes. As such, future research evaluating CPS effectiveness with traumatized children is recommended.
Finnie, H. (2013). The Collaborative Problem-Solving Approach with Traumatized Children: Its Effectiveness in the Reduction of Locked Seclusion in an Inpatient Psychiatric Setting (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/540