Children placed in residential treatment centers (RTCs) typically present challenging behavior including aggression. In this context, restraint and seclusion (R&S) are seen as “last resort” strategies for educators to manage youth aggression. The use of R&S is controversial, as they can lead to psychological and physical consequences for both the client and the care provider and have yet to be empirically validated as therapeutic. The objectives of this systematic review are to identify the factors related to R&S use in RTCs for youth and to review the interventions aiming to reduce the use of R&S. The identification of these factors is the first step to gaining a better understanding of the decision-making process leading to the use of R&S and ultimately to reducing the use of these strategies to a minimum. Thus, the present systematic review was conducted by searching PubMed, CINAHL, ERIC, and PsycNET for articles published between 2002 and 2017. Key words used were synonyms of R&S, youth, and RTCs. Thirty-one studies met the inclusion criteria: must report on factors affecting the use of R&S in RTCs, must be conducted in RTCs for youth under the age of 21, and must report on original and empirical data. Factors related to the characteristics of the client, the care provider, and the environment, as well as to the implementation of programs for the reduction of R&S, were found to influence the use of R&S in RTCs. A conceptual model is presented. The implementation of programs to reduce R&S use is discussed.
In situations where the immediate safety of children or others is at risk, residential workers are authorized to use specific measures intended as last resort, namely restraint and seclusion (R&S).This study sought to identify and detail the reasons invoked by residential workers when justifying their decision to restrain or seclude a child. Researchers reviewed and coded 628 anonymized official R&S reports written by residential workers from two different residential treatment centers over the 14 months between September 2015 and May 2017. Researchers used qualitative thematic analysis to analyze official reports. Researchers found nine reasons invoked by residential workers that they regrouped into four themes as follows: workers justified their use of R&S based on their own perceptions of 1) the danger associated with children's affects and behaviors; 2) their obligation to yield to external constraints; 3) the benefits associated with R&S for children, and 4) the demands imposed by their professional culture. Researchers found that the reasons invoked in official reports by residential workers to justify their decisions are not always consistent with R&S as being methods of last resort. Specifically, residential workers appear to be missing the training and organizational resources needed to use alternative forms of intervention.
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