I am a child psychiatrist and a researcher of seclusion in Japan.
Duration of seclusion in Japan is significantly longer than in other countries. We are making efforts with using six core strategies, but we can’t reduce using seclusion. There are also many reports on the negative effects of seclusion and I feel that I must manage it as soon as possible.
One of the reasons is that we think that treatment of aggression in seclusion is effective.
Many patients in our unit are ASD who are abused.We conduct aggressive assessment at hospitalization and start various treatments (drug therapy, anger management, trauma therapy etc.), but child's motivation for treatment is poor and treatment is often not successful.
Unfortunately children raise dangerous acts and become isolated, and finally children understand the significance of themselves.Seclusion can reduce interference from other children and focus on treatment.If we stop seclusion in about 15 minutes as well as overseas, children can’t motivate the treatment and it seems to cause problems immediately.
Please tell me how you are successful in treating aggression without using isolation in your country.
As a therapist with interests in Narrative Therapy approaches (White and Epston) I'm drawn to the possibilities of how a young person may experience acts of seclusion and how those experiences may influence a sense of the self (identity). Generally, I'm thinking they would probably lead to a problematic or negative view of self. Continued use of seclusion without experiences of inclusion would possibly only reinforce negative identity conclusions.
Kunishiwa,
I am a teacher with experience in working with students with aggressive and sometimes dangerous behaviors. The ASD diagnosis was limited at the time, but I have since become involved with the Recovery movement, which has a different approach to working with children and adults who may engage in activities that may result in injury to self or others. The Recovery movement listens to the lived experiences of those of us who have been treated positively and negatively by traditional psychiatric methods. I commend your care and research efforts in this ASD area and will suggest some places you may find help. First, realize that you, as talented and caring as you are can not fix the situation alone and persons on the ASD spectrum by definition have a problem expressing themselves in all social situations, especially when being aggressive. Research the ACE studies from USA 1995-97 to see if any articles based on that study address persons with ASD diagnosis. Google iNAPS (international Association of Peer Supporters) and ask if anyone in their organization of professional peers and therapists has any sources which may help you in your work and research. Contact Ayako Aikawa from Japan at [email protected] who is on the board of directors at iNAPS, she may know some help available to you in Japan. We struggle a bit with language, as I only know a little Japanese and her English improves every day. She is a very caring person as you are and will help as much as she can. I wish you good fortune in your work and research. Feel free to contact my Email [email protected]. I may not have the answers to all of your questions about children on ASD spectrum, but I can share Recovery methods that can help you as a caring person seeking help for your clients and children in this difficult field of mental health treatment.
Sincerely,
James P. Gillen M.Ed CPS Recovery Educator and Peer Advocate
Hello, Mr.James Gillen
Thank you for your valuable suggestions on peer support .
Yesterday a teacher told me that a class of peer support was held at school. It seems to be adopting even in schools in Japan.
I found the following article.
Peer Training Manual: How to Avoid Seclusion and Restraint
https://www.disabilityrightsca.org/system/files/file-attachments/551901.pdf
I will read it.
Ms. Aikawa holds lectures and seminars about peer training in Japan.I think I will study and participate.
Thank you very much.
Dear Ms. Asuza Zu,
Thank you for following up on peer support and sending me the link to the PDF from California, USA. I read it and although it addresses adults in similar restraint situations, it is an excellent example of teams working on restraint methods with peers before a restraint situation occurs. I don't know where you are located in reference to where Ayako works, but I am glad that you are thinking about attending her lectures and seminars. She is very skilled and intelligent as well as dedicated to peer support to improve mental health treatment. The PDF shows several ways to address your concerns about restraint based on the laws in California. I don't know what the laws are in Japan, but the fact that your colleague knows of her work on peer support brings joy to my heart. Feel free to mention my name to her. We met at an iNAPS convention Philadelphia, PA which is not far from where I live and she was quiet most of the time learning as much as she could about peer support. She smiled happily when I said "kunishiwa" and we kept in touch via email for a while. She is a Christian so we exchanged Christmas cards and now I am working on an article which will access the iNAPS
members to participate in our survey project of peer support workers. It will be the 4th research article examining the effectiveness and experiences of peer workers
we will do and I hope to contact Ayako again during that process. Some of the suggestions noted in the PDF rely on adults with speaking skills that may not be the case with children and adolescents on ADS, but parents or agency persons who know the children may be helpful in developing effective methods to soothe children when placement in locked rooms or restraints is necessary to prevent harm to the child or other children and staff. As a survivor of traumatic abuse I have used a small comforting soft cloth heart to help me when triggered to remember my pain and so have others, some young women find comfort in cuddly stuffed dogs, bears and other toys to take with them if it becomes necessary to restrain and separate from others for all to remain safe and allow time for deescalation. Some studies suggest that the less dangerous than neuroleptics use of lorazapam is just as effective as anti-psychotics in these cases, but you will have to talk with the psychiatrists or whoever orders the use of medications in Japan. Good luck in your research and thank you for your caring for those of us who have suffered from over medication and forced treatment against our will by Psychiatrists who only know the medical model and not the Recovery model. You will become a better therapist and researcher after hearing a lecture or presentation on peer support from Ayako. Remember there is always hope.
James P. Gillen M.Ed CPS Recovery Educator and Peer Advocate
Dear Ms. Azusa Fu,
I am sorry that I misspelled your name in my first response to you. Recovery teaches us to learn from our mistakes. I will keep trying to do better.
JAMES GILLEN
Dear James Gilen
Thank you for your advice on peer support and encouragement . I feel frustrated that my English is not good and I can not convey my thoughts well.
I quickly read the manual. We have already carried out the crisis intervention procedure for clients. Even if we do seclusion, as long as the relationship with the client has been established, the treatment will proceed smoothly, and seclusion can be released as soon as possible.
Rather than whether or not to do seclusion, it may be necessary to construct a treatment relationship.
I am grateful for your advice. I would like to study and use in research and clinical practice.
I feel the same way about Japanese, but I see where your research is going based on the California peer information. A treatment relationship done with input from the person with ASD if possible will allow the person to feel he is part of his own treatment rather than always having to do something others want and may help improve clinical success. This is recovery oriented approach that is what peer supporter would do with a person in treatment. Try to construct plan with person or child and remind them that this
is what they thought was best for them when all worked on plan together.
Hello, no CBT or another processing intervention would get through a brain that is operating from the limbic system or the brain stem (fight, flight or freeze). Isolation may only exacerbate aggression and feelings of inadequacy. You may want to explore research and interventions by Van der Kolb, Bruce Perry, Peter Levinne and others that have done brain research and trauma. More often than not, anger and aggression are the result of deeper issues. You may also want to read research from the Center for the Developing Child from Harvard University: https://developingchild.harvard.edu/science/key-concepts
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