Evaluation of seclusion and restraint reduction programs in mental health: A systematic review Marie-Hélène Goulet a, ⁎, Caroline Larue b , Alexandre Dumais c a University of Montreal, Quebec Nursing Intervention Research Network (RRISIQ), Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Canada b University of Montreal, RIISIQ, CRIUSMM, Canada c Institut Philippe-Pinel de Montréal, Department of Psychiatry, University of Montreal, CRIUSMM, Canada abstract article info Article history: Received 26 January 2016 Received in revised form 17 October 2016 Accepted 18 January 2017 Available online xxxx Context: The effectiveness of seclusion and restraint (SR) reduction programs has not been well established. Objective: To examine the effectiveness of SR reduction programs in mental health settings. Data sources: A systematic review of English and French articles, using CINALH, Web of Science, PubMed, Medline, Embase, and the Cochrane Library. Additional studies were added by searching the references of identified papers. Study selection: All evaluative studies on SR reduction programs in mental health were included based on predefined criteria (n = 23 articles). Data extraction: Data extraction of articles was performed using predefined data fields. The three authors conducted quality assessments independently. Data synthesis: In the 23 articles analyzed, six key components were predominant in SR reduction programs: 1) lead- ership, 2) training, 3) post-seclusion and/or restraint review, 4) patient involvement, 5) prevention tools, and 6) the therapeutic environment. Conclusion: Despite wide variability in SR indicators and methodological rigor, it remains that the outcomes argue in favor of SR reduction program implementation. © 2017 Elsevier Ltd. All rights reserved. Keywords: Seclusion Restraint Psychiatry Aggression management Systematic review Contents 1. Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2. Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.1. Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.2. Eligibility criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.3. Information sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.4. Study selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.5. Data collection process and analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.1. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.2. Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.3. Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4.1. Seclusion and restraint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4.2. Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4.3. Key components of the programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4.4. Relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4.5. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Aggression and Violent Behavior xxx (2017) xxx–xxx ⁎ Corresponding author at: 01-514-277-4809, 7401 Hochelaga, Montreal, Quebec H1N 3M5, Canada. E-mail addresses: marie-helene.goulet@umontreal.ca (M.-H. Goulet), caroline.larue@umontreal.ca (C. Larue). AVB-01090; No of Pages 8 http://dx.doi.org/10.1016/j.avb.2017.01.019 1359-1789/© 2017 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Aggression and Violent Behavior Please cite this article as: Goulet, M.-H., et al., Evaluation of seclusion and restraint reduction programs in mental health: A systematic review, Aggression and Violent Behavior (2017), http://dx.doi.org/10.1016/j.avb.2017.01.019