Restraint, seclusion and time-out among children and youth in group homes and residential treatment centers: a latent profile analysis

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

“…These youth comprised approximately 33% of the sample, yet they were more likely to be restrained in comparison to their White counterparts. Althoguh this finding converges with that of the extant literature (Braun et al., 2020; dosReis et al., 2010; Leidy et al., 2006; Matte‐Landry et al., 2020), this continued observation warrants further investigation to identify the source of this racial disparity. Most staff at the PRTF site in the current study identify as White, so this discrepancy may represent a manifestation of the unconscious racial biases of staff members who initiate a restraint.…”

“…These children are also more likely to experience longer stays in treatment. Similarly, the findings from a recent study confirmed that children who experience restrictive interventions in residential treatment, including restraint, are more likely to have a history of neglect (Matte-Landry et al, 2020). Traumatic stress symptoms and PTSD are among the most common outcomes of neglect and childhood physical and sexual abuse (see Leeb et al, 2010, for a review), and participants in the current sample reported high rates of each (i.e., 60.4% and 66.4%, respectively).…”

“…These findings generally converge with those reported in the extant literature. Younger age is a consistent predictor of restraint across studies (Braun et al, 2020;dosReis et al, 2010;Matte-Landry et al, 2020); male gender is a significant predictor of restraint in some studies (Matte-Landry et al, 2020;Stewart et al, 2010) but not others (Braun et al, 2020;dosReis et al, 2010); and the racial disparity in restraint incidence observed in the current study is consistent with earlier investigations (Braun et al, 2020;dosReis et al, 2010;Leidy et al, 2006;Matte-Landry et al, 2020). Additionally, children diagnosed with neurodevelopmental disorders, many with attention-deficit/hyperactivity disorder, were more likely to experience at least one restraint relative to their nondiagnosed peers, whereas children diagnosed with anxiety disorders were less likely.…”

“…Collectively, idiographic predictors associated with increased frequency of restraint identified in initial studies include younger age, male gender identification, the presence of specific psychiatric diagnoses (e.g., developmental, psychotic, externalizing, or internalizing disorders), multiple comorbidities, multiple previous inpatient admissions, a history of self‐harm, and aggressive behavior (see Nielson et al., 2020, for a current review). Racial and ethnic minority youth, particularly African American children, are also at increased risk for restraint (Braun et al., 2020; dosReis et al., 2010; Leidy et al., 2006; Matte‐Landry & Collin‐Vézina, 2020). Other idiographic predictors commonly accounted for within these studies include body mass index (BMI), length of stay, and history of placement in residential care (dosReis et al., 2010; Tompsett et al., 2011).…”

Exploring Reasons Motivating the Use of Restraint and Seclusion by Residential Workers in Residential Treatment Centers: A Qualitative Analysis of Official Reports

“…After a thorough evaluation, this clinical expert could then consult with residential workers regarding an adjustment of work routines to foster improved emotional regulation (e.g., giving this child more one-on-one time, practicing stress management techniques with the child). On a broader scale, it may be that the current structure of RTCs does not meet the specific needs of these vulnerable children and could therefore be reformed (Matte-Landry & Collin-Vézina, 2020 ;Mohr et al, 2009). Specifically, it appears that several instances of R&S were motivated by the residential worker's desire to set some limit (ex., ensuring compliance, compensating for lack of resources, managing the fallout from a recent high-stake event, etc.).…”