Restraint Reduction Initiatives
Recently there has been an explosion of interest in the use of sensory modalities to help patients calm down and avoid restraints. Evidence is mounting that coping strategies based on the use of sensory modalities are helping patients with emotional regulation resulting in a decrease in the need for physical restraints (Champagne & Stromberg, 2004). Mental health units around the state and the nation are becoming actively involved in seclusion and restraint reduction programs (Childs, 2004). Occupational therapists can be key advocates in these initiatives for incorporating sensory related coping strategies. Occupational Therapists have the educational background in sensory modalities necessary to help train other professionals and staff members to safely utilize sensory activities for treatment. The experience and expertise of occupational therapists in the use of sensory modalities may revitalize their role in mental health settings.
UMASS Memorial Medical Center Restraint Reduction Initiative
The Acute Psychiatric Unit at UMASS Memorial Medical Center is one program that has taken a lead in the restraint reduction initiative and trauma informed care. Staff members and patients on this 28 bed unit where the author worked for more than ten years are already familiar with some of the positive results of sensory-based treatment. A Sense-ability Group is run daily on the unit and skill building groups often focus on coping through the senses strategies.
When a patient arrives on the unit a "Safety Tool" developed by the State of Massachusetts is used to acquire information to understand what strategies might be the most useful for a patient. Information that could help the patient in crisis is kept at the front of the chart. The occupational therapy department also documents any sensory strategies that the patient finds useful along with any sensory problems or sensitivities noted in evaluation or treatment.
The Unit is in the process of developing a Sensory Room where patients can go to calm down, relax, and learn about helpful sensory input. In the meantime sensory supplies have been collected and stored in a suitcase which can be accessed to help patients who are agitated, upset, or on the verge of losing control. Items are chosen according to the clinician's experience with the client and from information in the chart regarding sensory preferences and problems. The unit purchased a weighted blanket which has been very popular with some patients and clearly helped them to reduce episodes of restraints.
All of the staff members on the unit have received training regarding the use of sensory modalities to help patients remain in control and avoid the need for restraints or seclusion. Staff occupational therapists, nurses, psychologists, medical students, mental health workers, and several of the psychiatrists participated in a three hour workshop on sensory related treatment strategies. The workshop was prepared specifically for the unit by the author and consisted of the following objectives:
- The learner will define the differences between excitatory and inhibitory sensory input.
- The learner will identify sensory techniques and potential sensory problems related to specific psychiatric diagnoses.
- The learner will identify strategies for maintaining patient and caregiver safety when treatment an agitated patient.
- The learner will define the use of specific sensory equipment appropriate for clinical examples of crisis situations.
Participants received an informational packet that can be used for future reference. Posters and handouts were provided to the unit on Symptoms of Distress, Safe Sense, and Abdominal Breathing. Staff members were very receptive to the training and very grateful for having new tools and strategies to deal with volatile patients and crisis situations.
The unit plans to continue training with workshops on Trauma Informed Care and other restraint reduction strategies. The occupational therapists provide ongoing support to staff members regarding sensory related strategies.
Quality Improvement Study
Tina Champagne is an occupational therapist working in Western Massachusetts who has spearheaded the development of Sensory Rooms at Cooley-Dickenson Hospital, Northhampton and the Berkshire Medical Center. A quality improvement study was performed at Cooley Dickenson Hospital after the introduction of the Sensory Room. Champagne and Stomberg's study evaluated consumers perception of the sensory-based treatment delivered in the sensory rooms. 89% of the patients reported positive results. There was a reduction in restraint and seclusion episodes by 75% in the two year period that followed (Champagne & Stromberg, 2004).
Tina Champagne offers workshops throughout the year on Nonlinear Dynamics Approach to Sensory Modulation. She has participated in national as well as state initiatives to reduce restraint and helped to educate mental health professionals about the role that sensory approaches can play in helping patients to avoid the re-traumatizing experience of restraint. Information on this program can be found at: www.ot-innovations.com
The Emerging Science of Trauma Informed Care
NASMHPD (National Association of State Mental Health Program Directors) is leading a national initiative to reduce restraints in mental health facilities. Learn more about their program on their website: www.nasmhpd.org
SAMPSHA (Substance Abuse and Mental Health Services Administration) is another national organization committed to the elimination of seclusion and restraint. Follow this link to download an article describing their work.
The State of Oregon has been actively involved in restraint reduction initiatives. Kevin Ann Huckshorn, RN has authored a Powerpoint Presentation entitled Creating Violence Free and Coercion Free Mental Health Treatment Environments for the Reduction of Seclusion and Restraint. You can view the PowerPoint presentation at the Oregon DHS Website www.oregon.gov/DHS/addiction/
Pennsylvania's Restraint and Seclusion Reduction Initiative has resulted in dramatic drops in mechanical restraints from almost 11,000 to slightly more than 90 in the period of February 1993 to February 2003. Several Pennsylvania State hospitals have not used restraints in over two years. Critical factors in their success include adequate prepared staffing, consumer involvement, patient and staff debriefing policies (reviewing details of restraint episode and development of plans for crisis intervention), and a care environment that prioritizes patient dignity. More information can be found by following this link: http://psychservices.psychiatryonline.org/cgi/reprint/56/9/1115.pdf
Consultation and Training Workshops
If you are interested in consultation on developing a Sensory Connection Program, training staff members in the use of sensory modalities, using sensory strategies as part of a restraint reduction initiative, or developing a Sensory Room please contact the author using this contact form.