The Use of Seclusions and Physical Restraints: Just How Consistent Are We?

Abstract

Research has yet to verify whether children with greater problems, in more restrictive settings such as inpatient units actually receive more protective interventions such as seclusions/restraints than children in less intrusive settings who should have less need. Despite many strong and conflicting opinions about how these interventions should be used, very little is actually known about when and how seclusions/restraints are in fact used. It is unclear what professions use seclusions/restraints most, in what settings, for which children, how consistently, and with what outcomes. The present research found significant variability in use across the continuum of care which could not be attributed to the severity of children's problems or to the restrictiveness of the setting. The two most similar settings differed the most in their use of these procedures. Patterns of utilization are difficult to explain and are a cause for concern because they suggest possible inconsistencies and use which does not depend upon client needs. Use was significantly but only weakly predicted by age and gender of children with younger males being more likely to receive these interventions. The finding that child and youth care workers in the settings studied were the professionals most likely by far to use these procedures, indicates needs for increased worker involvement in both quality assurance and supportive activities that explore potential for “burnout” and injury associated with high use.