Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Could the cost of additional staffing and techniques utilizing lesser restrictive interventions with pyschiatric patients provide an overall reduction of spending for institutions versus total spending with current use of seclusion and restraints and current staffing levels?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Compare current staffing levels and use of seclusion and restraints with increased staffing levels and staff trained in the use of lesser restrictive interventions (including techniques to de-escalate aggressive behavior).

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Psychiatric patients, male and female, between the ages of 16-70, identified after exhibiting aggressive behavior or documented history of aggressive behavior.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Any person receiving medication for depression, bipolar, schizophrenia, anxiety, or other psychiatric need.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Lesser restrictive interventions that de-escalate situations where staff or patient injury might ensue.

Describe any health-related risks, side effects, or harms that you are concerned about.

Injured staff, injured patient, not addressing the real needs behind aggressive behavior.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders
• Developmental delays, attention-deficit hyperactivity disorder, and autism

AHRQ Priority Populations

None

Federal Health Care Program

None

Importance

Describe why this topic is important.

There needs to be a significant re-training of pyschiatric staff in the use of lesser restrictive interventions and skills/techniques taught on a large-scale basis to de-escalate aggressive patients.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I'm a student nurse, and was profoundly impacted by Goetz and Taylor-Trujillo's article entitled "A change in culture: Violence Prevention in an acute behavioral health setting" Journal of the American Psychiatric Nurses Association 2012 18:96.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

This would require increased staffing levels, and significant costly training for staff in de-escalation techniques.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It may contribute to overall change in providing further evidence-based research that would indicate the overall cost effectiveness of using lesser restrictive interventions with pyschiatric patients.

Describe the timeframe in which an answer to your question is needed.

None.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Psychiatric community

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It may contribute to overall change in providing further evidence-based research that would indicate the overall cost effectiveness of using lesser restrictive interventions with pyschiatric patients.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Referred by journal article by Michael J. Rice (2008) Journal of APNA (14:107)