Predictors of Injury to Youth Associated with Physical Restraint in Residential Mental Health Treatment Centers

A 26-Year Study of Restraint Fatalities Among Children and Adolescents in the United States: A Failure of Organizational Structures and Processes

“…Analyzing fatal events with multiple and complex causes would ideally include direct access to participants, autopsies, the location of the fatality, the events that triggered the restraint, and the culture and climate of the organization, including the levels of physical and verbal aggression (see Bystrynski et al, 2021;Geoffrion et al, 2021;Smith et al, 2017). In addition, variation and shifts in state-level regulations and oversight policies would also help explain fatality rates over time.…”

“…Physical or mechanical restraints (hereafter referred to as restraints) within children's out-of-home care settings are used to contain a child's acute physical behavior that is likely to cause injury to themselves or those around them. As safety interventions, restraints are never to be used as coercion, discipline, convenience, or retaliation (American Academy of Child & Adolescent Psychiatry, 2002;Centers for Medicare & Medicaid Services, 2008); but when restraints are employed, agency personnel, either alone or in a team, are asked to make a rapid series of consequential choices, under pressure, and within situations that are charged with anger, panic, aggression, counter-aggression, and violence (see Bystrynski et al, 2021;Geoffrion et al, 2021;Smith et al, 2017). Depending on the conditions that surround these events, the outcomes could range from a constructive engagement with learning and growth (Steckley & Kendrick, 2008) to emotional harm and resentment (Mohr et al, 2003), including the potential for serious injury or death (Aiken et al, 2011;Nunno et al, 2006Nunno et al, , 2008Weiss et al, 1998).…”