Description 

Seclusion or restraint (S/R) is used as an intervention of last resort in the management of severe agitation in patients. These interventions carry considerable risks including, but not limited to, psychological distress, physical injury to the patient or staff, and/or death. Legally, S/R can only be used in emergency safety situations and only when all lesser restrictive interventions have been attempted, in order to prevent immediate harm to a patient or others. An extensive literature exists regarding the fundamental goal of providing psychiatric care that helps to avoid the use of S/R. Clinicians often have a limited understanding of the potential risks of each intervention. A framework for determining when to use either modality is a critical clinical concern. The Patient Safety Work Group (PSWG), a component of the American Psychiatric Association's (APA) Council on Quality Care, was charged by the APA Joint Reference Committee with the task of developing a new resource document to help guide the use of S/R. In this resource document, the PSWG outlines a set of 7 practical considerations for using S/R: 1. Decision-support algorithms help guide the use of seclusion or restraint. 2. Understanding the clinician’s role in seclusion or restraint can lead to more appropriate use of these interventions. 3. Understanding the risks can reduce harm when using seclusion or restraint. 4. Advocating for availability of environmental interventions including seclusion rooms can minimize the need for restraint. 5. The patient experience of seclusion or restraint is important when considering use of these interventions. 6. A culturally competent, trauma-informed, and patient-centered approach is necessary when making decisions about whether to use seclusion or restraint. 7. Patient preferences and psychiatric advance directives are critical when considering the use of seclusion or restraint. This session will be provided by members of the APA PSWG who are psychiatrists working in a variety of mental health care settings around the country. The new resource document will be outlined, and there will be an expert panel discussion. Participants will have the opportunity to consider their clinical cases and challenge their own thinking about the use of seclusion or restraint, update their knowledge of available decision-support resources, and engage in discourse and learn from colleagues on best practices that will not only improve their clinical care safety and quality, but allow for enhanced advocacy regarding seclusion or restraint in their workplace and with local health care organizations.

Format 

Recorded webinar.

This content was recorded during the APA 2023 Annual Meeting.

Learning Objectives 

1. Distinguish use of seclusion or restraint and analyze their risks.
2. Review and employ 7 practical considerations in the use of seclusion or restraint in the management of patients with a behavioral crisis.
3. Utilize helpful resources to support medical decision-making regarding seclusion or restraint.
4. Evaluate APA’s new resource document.

Target Audience 

Residents/Fellows, Psychiatrists, Psychologists

Estimate Time to Complete 

Estimated Duration: 1.5 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit  

In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

The APA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. 

Instructors 

• Jacqueline Hobbs, MD, PhD
• Jose Arriola Vigo, MD, MPH
• Erick Cheung, MD
• Molly Finnerty, MD

Planners  

• Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance