Rethinking Restraint and Seclusion

Trauma-informed and strength-based care are two promising interventions that have been widely applied throughout treatment settings (Azeem et al., 2017; Perers et al., 2021; Roy et al., 2019). These practices involve utilizing a person-centered approach and an individualized care plan based on individual experience, mental health history, medication management, and other contributing factors. According to Raveesh et al. (2019), interventions that have been effective in medical settings involve a humanistic approach to care (e.g., a higher presence of nursing staff, regular conversation with patients), increased communication regarding patient care, and appropriate use of authority in situations (e.g., having a senior staff member de-escalate a patient). However, there are many different approaches to these care methods, leaving a level of error for those not effectively trained (De Cuyper et al., 2023; Matte-Landry & Collin-Vezina, 2024; Slatto et al., 2021).

Gaps in Research

Despite efforts to improve R&S use, research on how to reduce these practices is still limited. Many studies use small sample sizes, inconsistent methods, or fail to control for important factors, limiting the reliability and generalizability of the findings.

Another major issue is reporting inconsistency. Due to the lack of a uniform definition of what qualifies as an RTC, some facilities may escape licensing requirements of an RTC, and the reporting rules that come with this. This often leads to gaps in oversight and unreliable data on how often R&S is used (Giraldi et al., 2022; Green-Hennessy & Hennessy, 2015).

These gaps make it difficult to compare programs or evaluate preventative efforts. Stronger regulations, clearer definitions of residential care, and more standardized documentation are needed to improve transparency and accountability. Frameworks like the Six Core Strategies framework can help provide a structured approach to address these gaps by emphasizing data-driven decision making to improve reporting and oversight, leadership commitment to ensure policy adherence and change, and workforce development to train and apply evidence-based interventions effectively (Azeem et al., 2017; Bausman et al., 2023; Lee-Aube et al., 2023; SAMSHA, 2010).