Rethinking Restraint and Seclusion

Environmental factors are a key influence in shaping and mitigating harmful behaviors among youth in residential treatment settings.

Physical Environment

Recent research has highlighted the positive impact of the physical environment on mental health, with the environmental design potentially playing a role in dysregulated behaviors (Czernin et al., 2023; Oostermeijer et al., 2021; Yan et al., 2024). Oostermeijer et al. (2021) placed a focus on the implementation of sensory or comfort rooms and private or uncrowded spaces for the reduction of R&S.

These environmental enhancements help foster a sense of calm and connection and reduce feelings of loneliness (Oostermeijer et al., 2021). Utilizing the Six Core Strategies framework encourages the adoption of prevention tools, such as environmental aids, as a fundamental approach to foster a therapeutic environment and reduce R&S use (Azeem et al., 2017; Bausman et al., 2023).

Time of Day

In addition to the physical environment, time of day (e.g. morning, mid-afternoon, evening) and day of the week are associated with R&S. Research has shown that restraints are more likely to occur in the evening and on Mondays, suggesting that the timing of care delivery may place a vital role in behavior management (Braun et al., 2020; Leidy et al., 2006). For example, evening hours may often involve fewer structured activities, reduced therapeutic engagement, and lower staffing levels, all of which can contribute to lower emotional regulation (Lustig & Burch, 2023; McKeown et al., 2019). Additionally, both staff and youth may experience greater fatigue later in the day or at the start of the week, which may diminish their ability to manage stress and respond effectively to high-risk behaviors (Geoffrion et al., 2021).