Rethinking Restraint and Seclusion

The demographics of youth in RTCs are diverse; however, significant disparities exist in youth treatment and R&S frequency across race, gender, age, and diagnoses.

Race

Research has consistently shown that African American youth are more likely to be restrained than other adolescents (Daniels et al., 2023; Javandi et al., 2024; Leidy et al., 2006), highlighting potential biases in residential care. These disparities likely reflect larger systemic issues within mental health systems, which often view individuals of color as more aggressive or non-compliant, which may lead to a higher frequency of restrictive interventions being used (Agboola et al., 2024; Roy et al., 2021; Vidal et al., 2020).

Age and Gender

Age and gender have been seen to be significant risk factors. According to Leidy et al. (2006), younger children (11-13 years old) have been found to experience more R&S incidents than older children (14-17 years old), potentially due to a higher frequency of aggressive behaviors. This disparity between ages may be attributed to lower levels of impulse control, a lack of coping skills, and low emotional intelligence. When assessing for gender, Roy et al. (2019) found that female youth are more likely to be secluded, while male youth are more likely to be restrained. This may be attributed to societal perceptions of gender, which often expect males to respond to crisis with aggression.

Mental Health Diagnoses and Medication Management

Youth diagnoses and medication management also play a role when assessing risk factors for restraint and seclusion. In one study, effective management and stabilization of psychotropic medications during a youth’s stay was associated with a 72% reduction in restraint incidents (Roy et al., 2019). In contrast to this, youth who experience R&S often have higher dosages of antipsychotics than youth with fewer R&S events. This may be attributed to several factors, including higher levels of risk behaviors among these youth or the over-reliance on medication management as an intervention (Chung et al., 2023; Council for Children with Behavioral Disorders, 2020; Roy et al., 2019).

What is the importance of these findings? These disparities underscore the urgent need for evidence-based interventions in youth residential treatment care that are specifically designed to reduce or prevent the use of R&S, while integrating an equity and trauma-informed approach to address demographic inequalities in medication use and dosage practices (Katsiyannis et al., 2020). Ongoing workforce development, one of the six core strategies, is critical to reduce biases and equip staff with culturally responsive skills that can address the diverse needs of youth and minimize the reliance on restrictive practices (Azeem et al., 2017; Finch, 2025; Lee-Aube et al., 2023; Slatto et al., 2022).