Background: Aggression is common in children and adolescents admitted to psychiatric inpatient units. Few interventions for reducing aggressive behaviors have been identified.
Aims: This study aimed to evaluate the impact of a milieu-based behavioural management programme on frequency of aggressive behaviors in a child and adolescent mental health inpatient unit.
Method: The behavioural management programme incorporated individualised patient management plans, early detection and prevention, staff training, reinforcement of appropriate behaviors, and intervention using the least restrictive option. Outcomes were assessed for 6 months before and after programme introduction, and included: episodes of aggressive behavior, injuries, use of physical restraint, seclusion, prn sedation, use of security services and staffing factors.
Results: Implementation of behavioural management led to a significant reduction in the episodes of aggressive behavior (p < 0.05) and other unwanted outcomes including injuries (p <0.05), use of physical restraint (p <0.001), and duration of seclusion (p < 0.001). These outcomes were achieved without reducing the number of admissions, changing the types of patients admitted, increasing staff costs, or increasing use of prn medication.
Conclusions: Aggressive behaviors in child and adolescent psychiatric inpatient units can be reduced by implementing a broad-based behavioural management programme. These findings highlight the importance of organisational approaches to behavior and risk management.
