Dealing With Aggressive Young Offenders With Psychiatric Disorders

Main Category: Psychology / Psychiatry
Also Included In: Mental Health;  Pediatrics / Children's Health
Article Date: 05 Nov 2011 - 0:00 PDT

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Seclusion should always be the last resort when it comes to dealing with aggressive episodes involving young offenders with psychiatric disorders, according to staff who took part in a four-country study published in the November issue of the Journal of Psychiatric and Mental Health Nursing.

Researchers led by the Universities of Turku and Tampere, Finland, report that the multi-disciplinary teams they spoke to said that verbal intervention was their first choice. Putting adolescents in a bare, locked room was viewed as the least favoured option in the three countries where seclusion remains legal.

The research team also found that countries with a longer history of treating adolescents in medium to high security units tended to use less physical restraints on fewer occasions.

"Adolescent aggressive behaviour poses a challenge for staff working in forensic units, which cater for 12 to 18 year-olds who have been in trouble with the law, because it occurs so frequently" says lead author Johanna Berg from the Department of Nursing Science at the University of Turku.

"Our study of units in Belgium, Finland, the Netherlands and UK found that while the principles of dealing with aggression were fairly similar, there were some differences in the practical solutions."

The study comprised forensic units ranging from eight to 12 beds, treating young offenders with a range of problems, including: severe mental health disorders, delinquent, violent and non-compliant behaviour and impulse control problems. One unit was established in the 1980s (UK), two in the 1990s (Belgium and the Netherlands) and one in the 2000s (Finland).

The 58 staff, including nurses, doctors, psychologists, social workers, educators, support workers, occupational, art and family therapists and sports instructors, had an average age of 36.

Key findings from the one-to-one interviews included: Verbal intervention was the favoured technique and was most effective when it was clear, structured and used in the early stages of aggression. Talking about the incident afterwards was also very important, so that both the adolescent and staff could reflect on why it happened and how it could be prevented in future. Staff planned daily routines and worked together so that risks were minimised. Being able to respond quickly and call on colleagues for support, including staff from other units, was vital. Isolation techniques ranged from separating the aggressor from other adolescents for five to 15 minutes, to give them a chance to calm down, to seclusion, which was only used when less restrictive interventions had failed. It was not used in Finland, where it is banned by legislation. Duveting, where the adolescent is swathed in blankets to prevent violent acts and enable staff to transfer them to the seclusion room was not used in the UK unit. Restraint beds with straps were only used in Finland, for intensive care and for as short a time as possible. If medication was needed it was jointly decided between the staff and adolescent, if possible. Forced medication was rarely used and only in major incidents where safety was seriously compromised. Key factors that determined the level of response included the level of aggression involved, how well staff knew the individual adolescent's behaviour and what had proved helpful in the past. Teamwork was important and all members of the multi-disciplinary team needed to be committed to therapeutic aggression management. "Staff in all four units displayed high ethical standards when it came to the use of restrictive treatment measures" says Johanna Berg. "They endeavoured to cooperate with the adolescent as long as possible and avoid coercive measures, while still maintaining the safety of others." The research team have come up with a number of key recommendations for clinical practice as a result of their research: Continuous education is necessary to ensure that staff know how to evaluate incidents and implement the safest and most effective practices when intervening in aggressive situations. Sufficient resources should be available so that the needs of adolescents can be met without compromising the occupation safety and well-being of the staff that care for them. This will help to retain qualified staff in this challenging working environment. Further studies are needed to identify current practices, measure how effective they are and suggest how they could be improved. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our psychology / psychiatry section for the latest news on this subject. The full paper includes further details of the different approaches employed by the four units, together with quotes from various participants.
Management of aggressive behaviour among adolescents in forensic units: a four-country perspective. Berg et al. Journal of Psychiatric and Mental Health Nursing. 18, pp776-785. (November 2011). doi: 10.1111/j.1365-2850.2011.01726.x
Wiley-Blackwell Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Wiley-Blackwell. "Dealing With Aggressive Young Offenders With Psychiatric Disorders." Medical News Today. MediLexicon, Intl., 5 Nov. 2011. Web.
9 Dec. 2011. APA

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View the original article here

Dealing With Aggressive Young Offenders With Psychiatric Disorders

Main Category: Psychology / Psychiatry
Also Included In: Mental Health;  Pediatrics / Children's Health
Article Date: 05 Nov 2011 - 0:00 PDT

email to a friend   printer friendly   opinions  

Seclusion should always be the last resort when it comes to dealing with aggressive episodes involving young offenders with psychiatric disorders, according to staff who took part in a four-country study published in the November issue of the Journal of Psychiatric and Mental Health Nursing.

Researchers led by the Universities of Turku and Tampere, Finland, report that the multi-disciplinary teams they spoke to said that verbal intervention was their first choice. Putting adolescents in a bare, locked room was viewed as the least favoured option in the three countries where seclusion remains legal.

The research team also found that countries with a longer history of treating adolescents in medium to high security units tended to use less physical restraints on fewer occasions.

"Adolescent aggressive behaviour poses a challenge for staff working in forensic units, which cater for 12 to 18 year-olds who have been in trouble with the law, because it occurs so frequently" says lead author Johanna Berg from the Department of Nursing Science at the University of Turku.

"Our study of units in Belgium, Finland, the Netherlands and UK found that while the principles of dealing with aggression were fairly similar, there were some differences in the practical solutions."

The study comprised forensic units ranging from eight to 12 beds, treating young offenders with a range of problems, including: severe mental health disorders, delinquent, violent and non-compliant behaviour and impulse control problems. One unit was established in the 1980s (UK), two in the 1990s (Belgium and the Netherlands) and one in the 2000s (Finland).

The 58 staff, including nurses, doctors, psychologists, social workers, educators, support workers, occupational, art and family therapists and sports instructors, had an average age of 36.

Key findings from the one-to-one interviews included: Verbal intervention was the favoured technique and was most effective when it was clear, structured and used in the early stages of aggression. Talking about the incident afterwards was also very important, so that both the adolescent and staff could reflect on why it happened and how it could be prevented in future. Staff planned daily routines and worked together so that risks were minimised. Being able to respond quickly and call on colleagues for support, including staff from other units, was vital. Isolation techniques ranged from separating the aggressor from other adolescents for five to 15 minutes, to give them a chance to calm down, to seclusion, which was only used when less restrictive interventions had failed. It was not used in Finland, where it is banned by legislation. Duveting, where the adolescent is swathed in blankets to prevent violent acts and enable staff to transfer them to the seclusion room was not used in the UK unit. Restraint beds with straps were only used in Finland, for intensive care and for as short a time as possible. If medication was needed it was jointly decided between the staff and adolescent, if possible. Forced medication was rarely used and only in major incidents where safety was seriously compromised. Key factors that determined the level of response included the level of aggression involved, how well staff knew the individual adolescent's behaviour and what had proved helpful in the past. Teamwork was important and all members of the multi-disciplinary team needed to be committed to therapeutic aggression management. "Staff in all four units displayed high ethical standards when it came to the use of restrictive treatment measures" says Johanna Berg. "They endeavoured to cooperate with the adolescent as long as possible and avoid coercive measures, while still maintaining the safety of others." The research team have come up with a number of key recommendations for clinical practice as a result of their research: Continuous education is necessary to ensure that staff know how to evaluate incidents and implement the safest and most effective practices when intervening in aggressive situations. Sufficient resources should be available so that the needs of adolescents can be met without compromising the occupation safety and well-being of the staff that care for them. This will help to retain qualified staff in this challenging working environment. Further studies are needed to identify current practices, measure how effective they are and suggest how they could be improved. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our psychology / psychiatry section for the latest news on this subject. The full paper includes further details of the different approaches employed by the four units, together with quotes from various participants.
Management of aggressive behaviour among adolescents in forensic units: a four-country perspective. Berg et al. Journal of Psychiatric and Mental Health Nursing. 18, pp776-785. (November 2011). doi: 10.1111/j.1365-2850.2011.01726.x
Wiley-Blackwell Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Wiley-Blackwell. "Dealing With Aggressive Young Offenders With Psychiatric Disorders." Medical News Today. MediLexicon, Intl., 5 Nov. 2011. Web.
8 Dec. 2011. APA

Please note: If no author information is provided, the source is cited instead.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Steroids help very young babies survive: study

Babies born as early as 23 weeks showed better survival rates and less brain damage if their mothers were given steroids in the days preceding their birth, a US study said Tuesday.

The research in the December 7 issue of the Journal of the American Medical Association suggests that preterm babies may benefit sooner than thought from the boost in lung power and organ growth they get from exposure to steroids.

Until now, little was known about the efficacy of giving a pregnant woman steroids for a fetus less than 24 weeks old, and some were worried it could raise the risk of infection in the mother.

Current guidelines, published in 1995, recommend a two-shot regimen for mothers who go into preterm labor when the fetus is between 24 and 34 weeks of age. A normal full-term pregnancy is between 37 and 42 weeks.

However, even though premature babies exposed to steroids were twice as likely to survive as those who were not, the researchers cautioned that overall survival still remained relatively low, at 36 percent.

To determine if steroids could help the youngest babies survive after being born on the edge of viability, doctor Waldemar Carlo of the University of Alabama at Birmingham and colleagues looked back at records between 1993 and 2009 at 23 academic perinatal centers in the United States.

Data included babies born between 401 grams (14.1 ounces) and 1,000 grams (35.3 ounces) at 22 to 25 weeks' gestation.

Among babies born at 23 weeks who were exposed to steroids, 83 percent either died or had brain development problems by age 18-22 months. Ninety percent of those who weren't given steroids either died or showed brain damage.

The same advantages were not seen at a statistically significant level in babies aged 22 weeks who were exposed to steroids.

The improvements were more pronounced in babies aged 24 weeks, 68 percent of whom died or had brain damage after getting steroids compared to 80.3 percent who did not.

Concerns about potential infection in pregnant mothers, whose immune systems would dip after being given the steroids, were unfounded, he said.

"The results of the study showed that mortality was decreased by more than 33 percent and neurodevelopmental impairment was decreased by more than 20 percent," Carlo said.

"We also found that using the antenatal corticosteroids did not increase the infection rate for the mothers."

Carlo and colleagues urged further research and said doctors should consider giving preterm mothers steroids starting at "23 weeks' gestation and later if the infant will be given intensive care because this therapy is associated with reduced mortality and morbidity."