2.
6 Search Strategy and Literature Identification
2.6.1 Research Questions and Framework
The PICO framework (Moule, Aveyard, and Goodman, 2017) was utilized to guide
this review which shaped the research question and its scope. The population (P)
comprised forensic patients with Autism Spectrum Disorder (ASD) and/or Learning
Disabilities (LD). The intervention (I) under consideration was seclusion. The
comparison (C) examined alternative trauma-informed care and Positive Behavior
Support (PBS). The outcome (O) of interest was recovery in mental health,
specifically pertaining to the psychological and emotional wellbeing of the patients.
This provided a framework scope to be uncovered, some which could assimilate
evidence as and where needed.
2.6.2 Keyword Development and Search Terms
Following the creation of the research question, focus the attention on creating the
search terms systematically. The project worked with a subject librarian to derive
keywords based on the PICO, which incorporated synonyms to broaden coverage.
For example, the population group was captured through Autism Spectrum Disorder,
ASD, autistic, learning disabilities, and intellectual disabilities. The intervention
keywords included seclusion, isolation, and restrictive practices. Mental health
recovery, emotional wellbeing, trauma, and rehabilitation were the outcome related
keywords. Boolean operators (AND, OR) were also used to logically design the
search, coupled with sensitivity maximization techniques such as truncation and
phrase searching.
2.6.3 Databases Searched
To attain a thorough literature review, a number of databases relevant to forensic
mental health, autism, and psychology were included. These databases were
PubMed, PsycINFO, CINAHL, Scopus, as well as Google Scholar. All databases
were searched using the modified Boolean search strings, which were customized
for each database’s indexing protocol. Filters were set to include only articles written
in English and published between the years 2010 to 2025. These benchmarks
ensured that the literature was relevant and applicable to the population of interest.
2.6.4 Screening and Selection Process
The first step of the process was to check the titles and abstracts for relevance. If the
abstracts did not contain sufficient information, the document was obtained and
analyzed in its entirety. Studies were included if they focused on forensic populations
with ASD and/or LD, addressed the use of seclusion or related restrictive practices,
and evaluated outcomes related to mental health recovery. Studies were excluded if
they concentrated solely on non-forensic or paediatric populations, lacked reference
to seclusion, or did not address psychological outcomes. Duplicates across
databases were identified and removed manually to prevent repetition in the final
review.
2.6.5 Documentation and PRISMA Flowchart
The search and selection procedures were documented with the help of a PRISMA
flow diagram, which is displayed in Figure 2.1. This figure illustrates the count of
records that are noted, reviewed, omitted as well as those that are included so as to
maintain transparency on the review process undertaken. The remaining studies
were then analyzed thematically to identify and define emerging themes and findings
pertinent to the study focus.
PICO Framework for This Study
PICO Component Explanation
Element
P – Forensic patients with Autism This group is uniquely vulnerable
Population Spectrum Disorder (ASD) to the effects of restrictive
and/or Learning Disabilities practices such as seclusion.
(LD)
I – Seclusion The intervention or exposure being
Intervention assessed is the use of seclusion
as a behavior management
strategy.
C – Alternative approaches to Although some studies may not
Comparison seclusion (e.g., Positive offer direct comparisons,
Behavior Support, sensory- alternatives to seclusion are
informed care) considered in the review.
O – Mental health recovery Outcomes include psychological
Outcome (emotional well-being, impact, progress in rehabilitation,
reduced trauma, engagement and therapeutic engagement.
in treatment)
PICO Question
In forensic patients with Autism Spectrum Disorder and/or Learning Disabilities (P),
how does the use of seclusion (I), compared to alternative therapeutic interventions
(C), affect mental health recovery (O)?
This structured approach helps guide your systematic literature search and ensures
that the evidence collected is relevant, focused, and directly linked to the research
objectives.