In psychiatric settings, the use of seclusion and/or restraints can be emotionally and psychologically traumatizing for patients. Patients often experience these interventions as inhumane and humiliating, and such interventions can have physical and mental adverse effects and in some cases can be fatal. This study examined the role of demographic, clinical, and hospital variables in predicting seclusion and/or restraint episodes in adult psychiatric inpatients. A total of 395 patients were included in the study. Adult psychiatric inpatients previously restrained (n = 91) were compared to psychiatric inpatients never restrained (n = 304). A binary logistic regression research design was used to examine the relationship of demographic variables, clinical variables, and hospital variables on the likelihood of being placed in seclusion or restraints. The results yielded age as a significant predictor for patients being restrained. Also, individuals diagnosed with bipolar disorder were less likely to experience a seclusion and/or restraint event than patients diagnosed with depressive disorder or within the schizophrenia spectrum. In addition, findings suggest that adult psychiatric inpatients that experienced restraint episodes were restrained within the 1 st month of admission, during the weekday and during the 1 st shift. In summary, given the findings from this study, knowledge of risk factors that precede patient restraint could enhance education and provide staff with information necessary to meet the clinical needs of the psychiatric inpatient population. Research indicates that the use of seclusion and restraint has decreased followed by implementation of educational programs designed to help staff assess patient clinical care needs and develop more therapeutically appropriate alternatives (Bower et al., 2003). By being aware of possible risk factors associated with seclusion and/or restraint, mental health providers can use early intervention and prevention strategies to reduce the use of seclusion and/or restraint. This would provide safer environments for mental health patients receiving treatment.

Purpose. The purpose of this dissertation is to examine the role of demographic, clinical, hospital, and medication variables in predicting seclusion/restraint episodes in adult and adolescent inpatient psychiatric patients.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

Nonsuicidal self-injury (NSSI) is a baffling, troubling, and hard to treat phenomenon that has increased markedly in recent years. Key issues in diagnosing and treating NSSI adequately include differentiating it from attempted suicide and other mental disorders, as well as understanding the motivations for self-injury and the context in which it occurs. This accessible and practical book provides therapists and students with a clear understanding of these key issues, as well as of suitable assessment techniques. It then goes on to delineate research-informed treatment approaches for NSSI, with an emphasis on functional assessment, emotion regulation, and problem solving, including motivational interviewing, interpersonal skills, CBT, DBT, behavioral management strategies, delay behaviors, exercise, family therapy, risk management, and medication, as well as how to successfully combine methods.