Worker and perceived team climate factors influence the use of restraint and seclusion in youth residential treatment centers: Results from a mixed-method longitudinal study.

BACKGROUND: Restraint and seclusion (R&S) are controversial methods of intervention aimed at protecting children from immediate harm in residential treatment centers (RTC). Previous studies have mainly focused on situational factors and youth characteristics to predict its use. OBJECTIVES: This study sought to evaluate the role other potential predictors could play in the decision to use R&S, namely characteristics of residential workers and their perceived team climate. METHODS: For two months, a total of 132 residential workers from different RTC in the greater Montreal area completed weekly diaries of standardized questionnaires. Using an explanatory sequential design (i.e., mixed methods), this study aimed at exploring the role of residential workers' characteristics (e.g., exposure to client aggression, stress and fatigue) and aspects of their perceived team climate (e.g., order and organization, communication and openness) as predictors of R&S use. Survey results were later also presented to four focus groups for discussion. RESULTS: Results indicated that exposure to verbal violence from youths was associated with the increased use of R&S. Meanwhile, perceived communication and openness were associated with lower rates of R&S use. Participants shared that repeated exposure to verbal violence diminished their level of tolerance while teamwork provided them with the emotional space needed to focus on the needs of youths and find alternatives to R&S. CONCLUSION: This study sheds light on the complex role of human emotions in the decision to use of R&S. Specifically, intense momentary emotions during crisis interventions had a greater influence on the use R&S than chronic states, such as fatigue.

Commentary on "Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents" by Green-Hennessy and Hennessy.

In their 2015 study, Sharon Green-Hennessy and Kevin D. Hennessy addressed an important gap in the literature on seclusion and restraint use in child and adolescent residential treatment centers (RTCs). Their analysis revealed that several facility-level characteristics-such as facility size and ownership-predicted the use of seclusion/restraint in child/adolescent RTCs. The authors also examined patient demographic variables that were significant predictors of seclusion/restraint in prior research on individual patients within facilities. However, Green-Hennessy and Hennessy did not find any relationship between these demographic variables and seclusion/restraint. In this commentary I argue that the null relationship between patient demographics and seclusion/restraint was a result of an ecological fallacy. Rather than attempting to use aggregate patient data to infer individual-level processes, this patient data should be used to study aggregate effects. I demonstrate that by re-conceptualizing these patient demographics as indicative of facility characteristics, rather than patient characteristics, new information can be gleaned about the types of facilities that use seclusion/restraint. The arguments presented here have broader implications for future research in this field that relies on aggregate patient data.

Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents.

This study identified predictors of seclusion or restraint use among licensed and/or accredited residential treatment centers (RTCs) for children and youth in the United States responding to a federally-sponsored survey of mental health services. 693 licensed and/or accredited child and adolescent RTCs responded to questions about the demographic and admission status of clients served on an identified date, services offered, size, ownership, funding, and their use of seclusion or restraint practices within the preceding 12 months. Logistic regression was used to determine factors predicting facility use of seclusion or restraint. A large majority of licensed and/or accredited child and adolescent RTCs (82 %) reported using seclusion or restraint in the prior year. Contrary to prior research, individual patient characteristics (percent of males, minorities, and involuntary admissions) did not predict the use of coercive techniques. Instead facility and funding variables accounted for approximately 27 % of the variance in the use of seclusion or restraint. Larger, privately-owned RTC's funded primarily through public monies and which offered medication and programming for SED youth were more likely to endorse having used seclusion or restraint in the previous year. Despite visible policy and advocacy efforts to reduce seclusion and restraint use over the past decade, a majority of licensed and/or accredited RTCs for children and adolescents report using such practices. Findings emphasize the importance of examining facility-level variables in predicting their use, and highlight the disconnect between nationally espoused goals and current practices regarding coercive techniques in child and adolescent RTCs.