Rethinking Restraint and Seclusion

In adolescent residential treatment centers (RTCs), restraint and seclusion (R&S) have long been used as a crisis response when youth pose a perceived risk to themselves or others (Belayneh et al., 2024; Braun et al., 2020; Roy et al., 2019). While these practices are intended as last-resort safety measures, the reality is far more complicated.

Research consistently shows that R&S exposed youth to both physical and psychological injury (Nielson et al., 2020; Wilson et al., 2018). Staff involved in these interventions also face increased risk of trauma, injury, and burnout (Douglas et al., 2021; Kodua & Eboh, 2023; Slatto et al., 2021; Smithard & Randhawa, 2022). Despite the intent to use R&S sparingly, adolescents are subjected to these interventions at alarmingly high rights – with one study finding that youth in inpatient psychiatric care experience restrictive interventions at a rate six times higher than adults in comparable settings (Kodua & Eboh, 2023; LeBel et al., 2004). However, while it is clear that adolescents experience a higher rate of R&S, limited data on adolescent populations exist in the current research (Bystrynski et al., 2021; Pogge et al., 2013; Slatto et al., 2021; Spennato et al., 2022). Raising even more concerns are the disparities seen within the practice: young children, boys, and youth of color experience higher rates of restraint, while girls are more frequently subjected to seclusion (Czernin et al., 2024; Roy et al., 2019; Nunno et al., 2021).

To address these gaps, we will be discussing The Six Core Strategies, a conceptual framework aimed at developing solutions and offering support towards organizational change to impact R&S reduction (SAHMSA, 2010).

These strategies emphasize:

• Strong leadership committed to organizational change
• Using real data to guide decisions
• Comprehensive staff training and workforce development
• Tools and practices that actively reduce the needs for R&S
• Inclusion of youth, families, and advocates in treatment planning
• Meaningful debriefing that leaders to learning and trust building

Taken together, these strategies emphasize the need for building increased communication between staff, patients, and key stakeholders, guiding staff on patient interaction and trust building, and highlight the importance of leadership support to reduce R&S (Azeem et al., 2011; Perers et al., 2021). Under the lens of this framework, we will examine the literature for the following question: What interventions in youth residential treatment care will support reducing or preventing the use of restraint and seclusion?

Promising approaches, such as trauma-informed care, positive behavioral support, and person-centered approaches, have shown some promise in reducing the need for R&S in youth settings (Bystrynski et al., 2021; Pogge et al., 2013; Slatto et al., 2021; Spennato et al., 2022). It is essential to examine current practices and policies related to R&S, identify gaps and areas of change, to support safer and more equitable youth mental health interventions utilizing policy change, staff training, and art therapy as supported interventions.

Source: Restraint Reduction Network (2023)