Abstract
BackgroundPhysical and mechanical restraints used in treatment, care, education, and corrections programs for children are high-risk interventions primarily due to their adverse physical, emotional, and fatal consequences.ObjectiveThis study explores the conditions and circumstances of restraint-related fatalities in the United States by asking (1) Who are the children that died due to physical restraint? and (2) How did they die?MethodThe study employs internet search systems to discover and compile information about restraint-related fatalities of children and youth up to 18 years of age from reputable journalism sources, advocacy groups, activists, and governmental and non-governmental agencies. The child cohort from a published study of restraint fatalities in the United States from 1993 to 2003 is combined with restraint fatalities from 2004 to 2018. This study’s scope has expanded to include restraint deaths in community schools, as well as undiscovered restraint deaths from 1993 to 2003 not in the 2006 study.ResultsSeventy-nine restraint-related fatalities occurred over the 26-year period from across a spectrum of children’s out-of-home child welfare, corrections, mental health and disability services. The research provides a data snapshot and examples of how fatalities unfold and their consequences for staff and agencies. Practice recommendations are offered to increase safety and transparency.ConclusionsThe study postulates that restraint fatalities result from a confluence of medical, psychological, and organizational causes; such as cultures prioritizing control, ignoring risk, using dangerous techniques, as well as agencies that lack structures, processes, procedures, and resources to promote learning and to ensure physical and psychological safety.
Highlights
Restraints are “any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a person to move his or her arms, legs, body, or head freely” (Substance Abuse and Mental Health Services Administration (SAMHSA), 2010, p. 10)
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
Staff members who employ restraints have limited or no medical training or access to on-site emergency medical resources or even knowledge about the child’s medical profile and risk. This is especially relevant within child welfare and juvenile justice agencies, medical resources and information can be scarce, unreliable, or unavailable even in organizations serving young people with mental health disorders or developmental delays. These dynamics concur with the findings examining restraint deaths in the United Kingdom (Aiken et al, 2011)
Summary
Restraints are “any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a person to move his or her arms, legs, body, or head freely” (Substance Abuse and Mental Health Services Administration (SAMHSA), 2010, p. 10). Restraint incidents may be traumatizing for staff and children who witness the events (Bonner et al, 2002) Acknowledging these iatrogenic conditions, together with the documentation of fatalities (Weiss et al, 1998) and other severe and debilitating injuries (United States Government Accountability Office, 2008), some states have outlawed certain restraints such as the basket hold, single person, supine and prone restraints, and have limited restraint use as a protection against immediate danger to self or others (Butler, 2017; Masters, 2017). Objective This study explores the conditions and circumstances of restraint-related fatalities in the United States by asking (1) Who are the children that died due to physical restraint? Conclusions The study postulates that restraint fatalities result from a confluence of medical, psychological, and organizational causes; such as cultures prioritizing control, ignoring risk, using dangerous techniques, as well as agencies that lack structures, processes, procedures, and resources to promote learning and to ensure physical and psychological safety
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