Seclusion & restraint. Understanding recent changes

1. Seclusion and restraint must be a last resort, emergency response to a crisis situation that appears to present imminent risk of harm to the patient, staff, or others. 2. JCAHO-accredited hospitals billing for Medicare or Medicaid must meet HCFA requirements to maintain compliance. 3. Policy writers and administrators must carefully scrutinize all applicable regulatory standards to ensure all requirements are met.     

Least to most restrictive interventions. A continuum for mental health care facilities

While this article does not propose to provide answers to the many questions prompted by the new Patient's Rights CoP (1999) or the newly revised JCAHO standards on seclusion and restraint (JCAHO, 2000), a prudent plan of action for any organization serving patients with a behavioral component to their treatment would be to adopt a policy of least restrictive intervention prior to consideration of seclusion and restraint in response to emergency patient care needs. It was the authors' intent to present a representative sample of the available literature and from that to develop a continuum of intervention possibilities ranging from least to most restrictive. In addition, suggestions found in the literature for implementation of least to most restrictive programs have been provided.     

Dealing with power struggles in clinical and educational settings

When power struggles occur, the implications for early intervention are numerous. Trying to intervene with a person who has already reached the anger phase of crisis can often be like trying to stop a train by standing on the railroad tracks and holding up one's hands. As a direct result of early and purposeful intervention using simple and accessible techniques (i.e., self-awareness, awareness of others' messages, prioritization, decisiveness, consistency, communication), professionals can create an environment of safety and trust in which all individuals feel heard. In this manner, all needs can be addressed without allowing potentially negative interactions to escalate to levels at which restraints, ultimatums, and consequences are needed. In addition, the likelihood of success increases with early intervention. By recognizing that, in many cases, winning and losing power struggles is accomplished at the expense of treatment and educational goals, enlightened professionals can not only avoid future confrontations but also effect desired client or student outcomes.