Measuring Seclusion in Psychiatric Intensive Care: Development and Measurement Properties of the Clinical Seclusion Checklist

Background: Acute psychiatric units in general hospitals must ensure that acutely disturbed patients do not harm themselves or others, and simultaneously provide care and treatment and help patients regain control of their behavior. This led to the development of strategies for the seclusion of a patient in this state within a particular area separated from other patients in the ward. While versions of this practice have been used in different countries and settings, a systematic framework for describing the various parameters and types of seclusion interventions has not been available. The aims of the project were to develop and test a valid and reliable checklist for characterizing seclusion in inpatient psychiatric care.Methods: Development and testing of the checklist were accomplished in five stages. Staff in psychiatric units completed detailed descriptions of seclusion episodes. Elements of seclusion were identified by thematic analysis of this material, and consensus regarding these elements was achieved through a Delphi process comprising two rounds. Good content validity was ensured through the sample of seclusion episodes and the representative participants in the Delphi process. The first draft of the checklist was revised based on testing by clinicians assessing seclusion episodes. The revised checklist with six reasons for and 10 elements of seclusion was tested with different response scales, and acceptable interrater reliability was achieved.Results: The Clinical Seclusion Checklist is a brief and feasible tool measuring six reasons for seclusion, 10 elements of seclusion, and four contextual factors. It was developed through a transparent process and exhibited good content validity and acceptable interrater reliability.Conclusion: The checklist is a step toward achieving valid and clinically relevant measurements of seclusion. Its use in psychiatric units may contribute to quality assurance, more reliable statistics and comparisons across sites and periods, improved research on patients' experiences of seclusion and its effects, reduction of negative consequences of seclusion, and improvement of psychiatric intensive care.

Patterns of Service Use and Behavioral Health Profile of Children Placed in Out-of-Home Care

Aims: This study focused on describing profiles of children placed in out-of-home care. Background: Research has shown that children placed in out-of-home care have numerous problems related to trauma associated with child maltreatment and behavioral health. However, they often do not receive adequate care. Prior research suggested that to improve outcomes for these children it is essential to address co-occurring problems and tailor services to their individual needs. This, however, can be a serious challenge to service providers due to the lack of information about behavioral health profiles and maltreatment histories as well as patterns of service use. Objective: The aim of this study was to identify subgroups of children with similar mental health profiles and examine service use patterns amongst these groups. Methods: Latent class analysis (LCA) was used to describe the profile of children with similar behavioral health characteristics and service patterns. Results: Two distinct groups were identified: Children with Multiple Needs and Children in Families with Complex Needs. Children with Multiple Needs had a much higher rate of mental health diagnoses, caregiver loss, a higher number of emergency room visits for behavioral health reasons, and spending substantially more days in inpatient psychiatric care. Children in Families with Complex Needs had a much higher probability of experiencing neglect, having parents with substance abuse problems, and having a history of domestic violence. Conclusion: These findings suggest that Children with Multiple Needs represent the most vulnerable population and specific strategies should be developed to address co-occurring needs of these children by utilizing community-based services and the least restrictive settings. Implications of the findings are discussed.

Benchmarks for Needed Psychiatric Beds for the United States: A Test of a Predictive Analytics Model

The ideal balanced mental health service system presupposes that planners can determine the need for various required services. The history of deinstitutionalization has shown that one of the most difficult such determinations involves the number of needed psychiatric beds for various localities. Historically, such assessments have been made on the basis of waiting and vacancy lists, expert estimates, or social indicator approaches that do not take into account local conditions. Specifically, this study aims to generate benchmarks or estimated rates of needed psychiatric beds for the 50 U.S. states by employing a predictive analytics methodology that uses nonlinear regression. Data used were secured primarily from the U.S. Census’ American Community Survey and from the Substance Abuse and Mental Health Administration. Key predictors used were indicators of community mental health (CMH) service coverage, mental health disability in the adult population, longevity from birth, and the percentage of the 15+ who were married in 2018. The model was then used to calculate predicted bed rates based on the ‘what-if’ assumption of an optimal level of CMH service availability. The final model revealed an overall rate of needed beds of 34.9 per 100,000 population, or between 28.1 and 41.7. In total, 32% of the states provide inpatient psychiatric care at a level less than the estimated need; 28% at a level in excess of the need; with the remainder at a level within 95% confidence limits of the estimated need. These projections are in the low range of prior estimates, ranging from 33.8 to 64.1 since the 1980s. The study demonstrates the possibility of using predictive analytics to generate individualized estimates for a variety of service modalities for a range of localities.

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Background Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established.

Blended Care in In-Patient Acute Psychiatric Care. The Example of a Group Training for Social Competences in Adults—A Pretest–Posttest Feasibility Study

Introduction: Deficits in social skills can be an important modulating factor in the development and progress of various mental disorders. However, limited resources in inpatient care often impede effective social skills training. This study investigates the feasibility of a blended group training for social skills (SST) in an inpatient psychiatric setting. Methods and Analysis: For this one-group pretest–posttest trial, inpatients with a diagnosed mental disorder were recruited. Participation in the blended SST lasted four weeks and took place within usual inpatient psychiatric care. The blended intervention comprised four face-to-face group sessions and three complementary online modules within four weeks. Assessments took place before (t1) and after (t2) the training. Feasibility outcomes (use, acceptance, satisfaction, implementability into usual psychiatric inpatient care) and effectiveness outcomes regarding social skills were assessed. Results: N = 15 participants were recruited. Most patients completed all questionnaires (93%) and all modules of the blended SST concept (60%). All participants (100%) would recommend the blended intervention to a friend. Regarding social skills, exploratory analyses revealed a non-significant medium-sized effect (Cohen’s d = 0.5 95%CI 0.3 to 1.25, p = 0.08). Discussion: This trial shows that a blended care SST is feasible for the use in acute psychiatric inpatient care setting. Although the wards were acute, with high turnover and change of inpatients, 60% of participants were treated per protocol over four weeks. Overall, the evidence on blended care concepts in psychiatric care settings is extremely poor to date. Hence, this trial should encourage intensified blended inpatient psychiatric care research.

COVID-19 reinfection in a patient with a serious mental illness within a long-term inpatient psychiatric care hospital

There is an increasing number of case reports of COVID-19 reinfection. The mechanism of reinfection is poorly understood and evolving. Prevention of the transmission of severe acute respiratory syndrome coronavirus 2 for those with a serious mental illness (SMI) living in a congregate setting presents unique challenges. In this case report, we describe an individual with an SMI in a long-term inpatient psychiatric care hospital who was initially diagnosed in June 2020 with COVID-19 infection via a polymerase chain reaction test. Approximately 6 months later, the patient presented with a COVID-19 reinfection and more severe COVID-like symptoms.