and reach thousands of daily visitors
5 JULY 2010
NO 1598
The use of restraint
This study provides some answers in one locale about the frequency of restraint and perceptions of stakeholders in select residential facilities. Substantial variation was found on every dimension of restraint use. From frequency of physical restraints, to type of technique used, to the use of psychotropic medications with restraint, programs differed. Even through rather limited data collection efforts, it was possible to identify outlier programs whose restraint use differed significantly from peer organizations. These findings have implications for state·level quality assurance initiatives.
With comparative information, facilities can assess whether they are using restraints more frequently than others. For example, in this study, the one outlier facility that was restraining youths the most frequently served youths similar to several other programs in the study. To promote continuous quality improvement, facilities could gather and share information across programs through cooperative agreements. Further, licensing authorities could require reporting of these data. The licensing authority would then need to manage and analyze the data and report it back to agencies in a timely way and in a usable format. Licensing authorities should guge whether they have the capacity to accomplish these tasks.
Despite concerns about the potential dangers of restraint, youths, staff and administrators in this study viewed restraints as an important tool for maintaining safety in the living environment. Youths stated a preference for programs where restraint was allowed and expressed concerns about how chaotic the treatment environment would become without this intervention.
Similar to recommendations made by best practice papers for restraint reduction, the programs in this study were able to identify several strategies for reducing the use of restrictive behavior management practices. However, it was also clear that each program had developed a unique constellation of initiatives that they believed were effective in restraint reduction. These included rewarding non-restraint, charting time since last restraint in view of youth, using line staff to run restraint review meetings, the use of crisis staff, and focusing on organizational culture. Facilities should consider using these strategies in addition to those advocated by national groups.
This study provided only a first look at a complex issue. Because of the limited sample size and possible bias in selection for participation, findings may not be generalizable to other programs. Key informants who provided input about each program may not be representative of all stakeholders. Hence, the findings presented here should be interpreted with caution. From looking through restraint training packages and agency policies, it is easy to imagine that issues related to restrictive behavior management are fairly straightforward. However, in this study, it became clear that restraint practice is a multifaceted issue. These findings suggest that maintaining appropriate restraint use requires consistent vigilance within programs. The tendency for programs to drift towards becoming increasingly punitive and controlling may be linked to the frequency and use of restraint.
LEE, B.R., MCMILLEN, J.C. AND FEDORAVICIUS, N.
Lee, B.R.; McMillen, J.C. and Fedoravicius, N. (2007).
Use and views of physical restraint in select residential treatment
programs. International Journal of Child and Family Welfare, 10,
3-4. pp. 147-148.
