Dissertation
Six Core Strategies: A Trauma-Informed Approach for Reducing Restrictive Practices in Pediatric Behavioral Health Inpatients
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: The overuse of restraints and seclusion in child and adolescent behavioral health inpatient settings is concerning due to their lack of therapeutic benefit, ethical conflicts, potential for trauma, and longer hospital stays. Despite criticism dating back centuries, restraint episodes remain high, occurring in 27% to 50% of pediatric inpatient cases (P rtega & Holmberg, 2023). Restraints and seclusions involve physical containment when there is imminent danger (Chieze et al., 2019). Purpose: This project aimed to reduce restrictive interventions by implementing the National Association of State Mental Health Program Directors (NASMHPD) Six Core Strategies (6CS) framework on a 14-bed acute child and adolescent behavioral health unit (NASMHPD, 2006). Methods: A multimodal intervention was conducted, incorporating leadership engagement, seclusion and restraint data analysis, and workforce development through trauma-informed care (TIC) and 6CS training. Tools such as a badge buddy for de-escalation and an enhanced debriefing checklist were implemented (Azeem et al., 2017; Boel-Studt, 2017; Brown et al., 2013; Duxbury et al., 2019; Eblin, 2019; Hale & Wendler, 2023). Data were collected through staff surveys, audits, incident reports, and leadership evaluations. Findings: Staff TIC knowledge improved moderately but was not statistically significant. TIC strategy use did not significantly impact restraint outcomes, though qualitative data indicated alignment with TIC behaviors. Notably, restraint episodes increased post-intervention. Leadership scores related to evidence-based practice showed statistically significant improvement. Discussion: While leadership engagement in evidence-based practice improved and staff demonstrated TIC-aligned behaviors, the goal of reducing restraints was not met. Contributing factors may include reduced patient census or challenging patient behaviors (Boulton et al., 2022). Further research is needed to explore the challenges of implementing TIC interventions like 6CS in pediatric behavioral health settings.
Details
- Title: Subtitle
- Six Core Strategies: A Trauma-Informed Approach for Reducing Restrictive Practices in Pediatric Behavioral Health Inpatients
- Creators
- Sierra Jones - University of Iowa
- Contributors
- M Lindell Joseph (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Health Systems/Administration
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Sierra Jones
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841529202771
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