Reducing Violence in a Child Psychiatric Hospital Through Planned Organizational Change

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Abstract
A successful attempt to reduce aggressive behaviors and counter aggressive staff interventions, including seclusion and restraint, in a child psychiatric hospital. To offer a model for reducing violence within child psychiatric facilities. The agency in which this project was carried out was a 50-place public child psychiatric hospital affiliated with an urban university. Discussion includes the strategies utilized including utilization of practice-based research, assessment of the level of aggression within the agency, change in staff perception about the use of coercive interventions to manage behavior, revision of the behavior management program and of policies relating to crisis events, and increased involvement of families. This experience in reducing aggression within the hospital validates theory that suggests that violence within institutions is context-based, involving patients, staff, and the institutional climate. The authors believe that the outcomes support the proposition that the use of coercion is determined more by traditions of practice and the mindset of the staff than by clinical necessity, and that its use can be significantly reduced by organization interventions.

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