Use Of Seclusion Research Articles

Multidisciplinary, simulation-based training to improve review of seclusion

Purpose Seclusion is the supervised containment of a patient, away from others, when immediately necessary to manage safety on a psychiatric inpatient ward. When seclusion is necessary, it should be used for the shortest time possible, with a regular multidisciplinary review of the patient’s mental and physical health, medication and risk guiding decisions around continuation or ending of this restrictive measure. However, many medical and nursing staff can be anxious about taking part in such reviews. Simulation has been used in many areas of medicine to help people to develop competence and confidence, in a safe setting where their own needs can be paramount. This paper aims to describe the use of a blended learning approach, including simulation, to build confidence and competence amongst healthcare professionals in the safe review of seclusion. Design/methodology/approach A multidisciplinary group, including input from individuals with lived experience of use of seclusion, put together a one-day training course, which included group debate exploring the relationship between seclusion and the Human Rights Act, guided discussion of videos exploring some aspects of practice and a half-day of simulation where multidisciplinary teams could act as the team reviewing a patient who had been secluded. Findings This paper found that the course’s blended learning approach helped participants to feel more confident in their understanding of several aspects of seclusion, including what their team discussions should include before and after seeing a patient and in knowing when to end a period of seclusion. Originality/value While simulation is slowly becoming a more familiar component of the undergraduate and postgraduate education offer in psychiatry, the authors are unaware of any evaluation of a dedicated simulation-based training course around reviews of seclusion.

Physical Restraint, Seclusion, and Time-Out Rooms in Canadian Schools: Analysis of a Policy Patchwork

The intended purpose of physical restraint, seclusion, and time-out rooms in schools is to intervene in a crisis when the behaviour of a student poses an immediate or imminent, and significant threat to physical safety. While the use of physical restraint, seclusion, and time-out rooms is intended to provide protection from immediate physical harm, there is increasing concern that these practices are being used more broadly and that individuals with disabilities are disproportionately subjected to their use. In spite of the importance of this issue, there is a dearth of research analyzing the policy landscape of physical restraint, seclusion, and time-out rooms in Canadian schools. In order to explore this issue, a comparative analysis of publicly available provincial and territorial education documents was conducted. The analysis revealed that in many Canadian provinces and territories, policies and accountability structures on the use of physical restraint, seclusion, and time-out rooms in schools are inconsistent or non-existent. Further, the terminology used to describe seclusion is variable and often conflated with time out, and the conditions under which such practices may be used in some instances are subjective, which may contribute to a broad interpretation of what is deemed acceptable practices in schools. This analysis draws attention to the need for the development of clearly articulated provincial and territorial standards for the use of physical restraint, seclusion, and time out, as well as the need for regulatory and enforcement mechanisms at the school, division, and ministry levels in order to ensure the emotional and physical well-being of all.

A Bayesian network model to identify the associations between the use of seclusion in psychiatric care and nursing managers' attitudes towards containment methods.

Seclusion is used frequently in psychiatric care, despite its potential adverse effects. Several programmes aiming to reduce the use of seclusion identify leadership and management as key strategies-however, studies concerning leaders and managers are missing. Nursing managers' negative attitudes towards seclusion are associated with less use of the measure, and nursing managers' higher age is associated with increased use of seclusion. Nursing managers should be encouraged to guide their staff to reduce the use of seclusion. The negative influences of seclusion and the potential of alternative measures should be highlighted in the education and training of psychiatric nursing managers. Introduction The use of seclusion in psychiatric care should be reduced. The relationship between nursing management or nursing managers' attitudes and the use of seclusion has not been investigated. Aim To describe the associations between the use of seclusion and psychiatric nursing managers' attitudes to containment methods. Method Register data concerning the use of seclusion in Finnish psychiatric care in 2017 were collected. The Attitudes to Containment Measures Questionnaire was used to illustrate psychiatric nursing managers' attitudes to containment methods. An Augmented Naive Bayes analysis was used to investigate the relationships of the use of seclusion and attitudes. Results Nursing managers' age and their attitudes towards containment methods were related to the use of seclusion. Especially nursing managers' negative perceptions of seclusion were associated with less use of seclusion, and seclusion was used more often on wards with nursing managers who were older than the average. Conclusion Nursing managers' negative attitudes towards seclusion have a potential impact on the use of seclusion, which might even result in a reduction in its use in psychiatric inpatient setting. Implications for practice The results suggest that nursing managers should be encouraged to guide their staff to decrease the use of seclusion.

Influence of Organizational Climate and Clinician Morale on Seclusion and Physical Restraint Use in Inpatient Psychiatric Units.

Reducing seclusion and restraint use is a prominent focus of efforts to improve patient safety in inpatient psychiatry. This study examined the poorly understood relationship between seclusion and restraint rates and organizational climate and clinician morale in inpatient psychiatric units. Facility-level data on hours of seclusion and physical restraint use in 111 U.S. Department of Veterans Affairs (VA) hospitals in 2014 to 2016 were obtained from the Centers for Medicare & Medicaid Services. Responses to an annual census survey were identified for 6646 VA inpatient psychiatry clinicians for the same period. We examined bivariate correlations and used a Poisson model to regress hours of seclusion and restraint use on morale and climate measures and calculated incident rate ratios (IRRs). The average physical restraint hours per 1000 patient hours was 0.33 (SD, 1.27; median, 0.05). The average seclusion hours was 0.31 (SD, 0.84; median, 0.00). Physical restraint use was positively associated with burnout (IRR, 1.76; P = 0.04) and negatively associated with engagement (IRR, 0.22; P = 0.01), psychological safety (IRR, 0.48; P < 0.01), and relational climate (IRR, 0.69; P = 0.04). Seclusion was positively associated with relational climate (IRR, 1.69; P = 0.03) and psychological safety (IRR, 2.12; P = 0.03). Seclusion use was also nonsignificantly associated with lower burnout and higher engagement. We found significant associations between organizational climate, clinician morale, and use of physical restraints and seclusion in VA inpatient psychiatric units. Health care organization leadership may want to consider implementing a broader range of initiatives that focus on improving organizational climate and clinician morale as one way to improve patient safety.

Defining Seclusion: A Qualitative Multiphase Study Based on the Perspectives of Youth and Professionals in Secure Residential Youth Care in the Netherlands

ABSTRACT Using seclusion in youth mental health care is controversial, as it can have physical and psychological consequences for youth and professionals. Notably, there is a wide disparity in how seclusion is defined in literature and practice. This leads to a diffuse image of what seclusion comprises, complicates measuring its prevalence, and hampers initiatives to reduce its use. Therefore, the objective of this study was to establish an unambiguous and measurable definition of seclusion supported by youth and professionals in secure residential youth care in the Netherlands. A qualitative multiphase approach was used to examine which elements of the definition are essential and receive consensus among youth and professionals. After a brief literature review, a Delphi survey and focus groups were performed. In total, 11 (ex-)clients and 33 professionals with extensive experience in secure residential youth care participated. Youth and professionals arrived at the following definition: “an involuntary placement in a room or area the client is not allowed or able to leave”. During the implementation process, observations showed broad support for the definition by youth and professionals. With this, a foundation has been provided to monitor and reduce the use of seclusion in secure residential youth care in the Netherlands.

Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital.

Objective:Clozapine remains the most effective intervention for treatment resistant schizophrenia; however, its use is prohibited following neutropenias. We review neutrophil biology as applied to clozapine and describe the strategies to initiate clozapine following neutropenia used in a case series of 14 consecutive patients rechallenged in a United Kingdom (UK) high-secure psychiatric hospital. We examine outcomes including the use of seclusion and transfer.Methods:A case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using this routinely collected clinical data, we describe the patient characteristics, causes of neutropenia, the strategies used for rechallenging with clozapine and clinical outcomes.Results:Previous neutropenias were the result of benign ethnic neutropenia, clozapine, other medications and autoimmune-related. Our risk mitigation strategies included: granulocyte-colony stimulating factor (G-CSF), lithium and watch-and-wait. There were no serious adverse events; at follow up half of the patient’s had improved sufficiently to transfer them to conditions of lesser security. There were dramatic reductions in the use of seclusion.Conclusion:Even in this extreme group, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients. This requires careful planning based on an understanding of neutrophil biology and the aetiology of the specific episode of neutropenia.

Reducing seclusion use for tāngata whai i te ora through integration of Māori culture into practice

Reducing seclusion use for tāngata whai i te ora through integration of Māori culture into practice

Patients’ Experiences of Seclusion during Admission in Psychiatric Settings in KwaZulu-Natal: A Qualitative Study

Background&#x0D; In South Africa, seclusion is one of the practices used in the management of disruptive behaviors in psychiatric settings. Despite its continued use, seclusion is always subject to controversial debates, and patients who undergo it express a range of negative experiences.&#x0D; Objective&#x0D; To explore the experiences of patients regarding seclusion during their admission in a psychiatric hospital. Methods&#x0D; A qualitative descriptive design was used. In-depth interviews were conducted with ten patients attending a community psychiatric clinic in KwaZulu-Natal. Interviews were analyzed using content analysis.&#x0D; Results&#x0D; Two themes emerged from the findings: controversial views of seclusion and negative experiences of seclusion. Seclusion was considered more as a punishment measure which was often used abusively, than a therapeutic intervention. Participants expressed loneliness, humiliation, and powerlessness following their seclusion experience. Limited patient-staff interaction and communication worsened patients’ negativity towards seclusion. Conclusion&#x0D; Findings from this study underscore the need to review practices, policies and procedures regarding the use of seclusion. Seclusion should be only used when the need is absolute and as the last treatment option. Open communication between the care providers and the patients should be emphasized during the time of seclusion.&#x0D; Rwanda J Med Health Sci 2020;3(3):342-361

Evidence-Based Practice: Implementing Trauma-Informed Care of Children and Adolescents in the Inpatient Psychiatric Setting.

At our inpatient psychiatric hospital, which cares for children and adolescents, internal data of use of seclusions and holds as crisis interventions for immediate behavioral health issues demonstrated that we were using these too often. Benchmarking indicated that we were at the 75% in use of these measures, and it became an organizational goal to reduce the use of these strategies in order to reduce the risk of retraumatization to an already traumatized child. We used the Iowa Model for Evidence Based Practice-Revised to initiate an evidence-based practice project introducing and hardwiring Trauma Informed Care to the staff and institution. This involved implementing six core strategies specifically designed to reduce the use of crisis interventions. Data obtained at 6 months revealed a 40% reduction in the use of holds and seclusions, and at 12 months, this change was sustained and even improved, reducing the use of these approaches by another 9%. Furthermore, the culture in the institution was changed, and Trauma Informed Care became the norm. Evidence-based practice is a viable approach to change the culture and improve patient outcomes in inpatient psychiatric care of children and adolescents. Further investigation is warranted to determine the specific patient and staff experiences of being cared for, and caring within, the context of trauma-informed care.

Interrogating Sanctioned Violence: A Survey of Parents/Guardians of Children with Disabilities about Restraint and Seclusion in Manitoba’s Schools

&#x0D; &#x0D; &#x0D; There is increasing concern that restraint and seclusion are being misused in schools, most often with students with disabilities. This issue is silent at the provincial level in Manitoba, with no regulation from the Ministry of Education. In order to examine the extent to which restraint and seclusion were being used in schools in Manitoba with children/youth with disabilities, an anonymous online survey involving a convenience sample of parents/guardians of children/ youth with disabilities was conducted. The 48-item questionnaire was disseminated through disability advocacy organizations in this province. Parents/guardians reported a high frequency of the use of restraint and seclusion, limited consent to the use of these practices, and an absence of written notification that they had occurred. Of great concern, some parents reported that their child was subjected to mechanical restraint and practices known to have a higher risk of causing death (e.g. supine and prone holds, being left in rooms that were locked from the outside etc.). A majority of parents reported their child had suffered trauma, and signs of physical injury also were noted. The results of this study indicate that restraint and seclusion are being misused as behaviour management techniques, especially with students with disabilities. These practices contravene Canada’s commitment to international standards regarding the rights of children and youth with disabilities, and change is required. The implementation of regulatory standards, legitimizing the voice of parents of children and youth with disabilities, and training for educators in positive behaviour interventions and supports are proposed.&#x0D; &#x0D; &#x0D;

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

BackgroundRestraint 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. ObjectivesThis 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. MethodsFor 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. ResultsResults 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. ConclusionThis 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.

Elevated Rates of Restraint and Seclusion in Child and Adolescent Psychiatric Inpatients in China and Their Associated Factors.

To investigate the rate of restraint and seclusion (R&S) use in child and adolescent psychiatric inpatients in China and to examine factors associated with use of these interventions. As part of an official national survey, 41 provincial tertiary psychiatric hospitals in China were selected. Data from 196 youth inpatients discharged from these hospitals from March 19 to 31, 2019 were retrieved and analyzed. (1) The overall rate of R&S was 29.1% (N = 57) and the rate of restraint was 28.6% (N = 56), and seclusion was 11.7% (N = 23) respectively. (2) Compared to patients who did not require R&S, those who required R&S were more likely to have been hospitalized on an involuntary basis, more likely to present with either manic symptoms or aggressive behavior as primary reason for admission, had more frequent aggressive behaviors during hospitalization, and had a significantly longer length of stay. (3) A logistic regression showed that aggressive behaviors during hospitalization was significantly associated with the use of R&S (OR = 21.277, p < 0.001), along with three other factors: manic symptoms as a reason for admission, involuntary admission and a lower GAF score at admission (all p < 0.01). The rate of R&S is dramatically higher in child and adolescent psychiatric hospitalizations in China compared to other regions. Targeted training of staff, development of precise operational guidelines for appropriate use of R&S, and strict oversight are urgently needed to minimize the inappropriate use of R&S in child and adolescent patients.

Does high and intensive care reduce coercion? Association of HIC model fidelity to seclusion use in the Netherlands

BackgroundA new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcare and to reduce coercion.MethodsIn 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics.ResultsResults showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207). The HIC model fidelity scores explained 27% of the variance in seclusion rates (p < 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%.ConclusionsThis study showed that higher HIC model fidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.

Implementing trauma-informed care through social innovation in residential care facilities serving elementary school children

Objectives: This article presents the theoretical basis, initial deployment strategies, and resulting preliminary findings of a program implemented in residential treatment centres (RCs) in child welfare. “Program Penguin” aimed to help workers develop trauma-informed attitudes and implement trauma-informed practices, make the workplace more responsive to the well-being of RC workers, and reduce the use of restraints and seclusion among school-aged children in RCs. Methods: Informed by the theories of complex trauma (National Child Traumatic Stress Network Complex Trauma Task Force, 2003), polyvicitimization (Finkelhor et al., 2007), Attachment, Self-Regulation and Competency (ARC; Blaustein &amp; Kinniburgh, 2018) and Positive Behavioural Interventions and Supports (PBIS; Sugai &amp; Horner, 2002), Program Penguin was developed and deployed using the social innovation approach (Fixsen et al. 2005). The key stages of social innovation will here be used to describe the implementation process. Results: Changes in practices were observed, RC worker attitudes towards trauma-informed care were assessed and showed strong effects between multiple covariables. RC worker support needs were identified, and a reduction in the use of restraints and seclusions was shown. Key strategies towards the development and maintenance of buy-in and meaningful change in practices are also described. Implications: Changes observed at all levels of this implementation suggest Programme Penguin is a promising approach, despite local issues that arose and the challenges inherent to program deployment within child protection settings. It appears a trauma-informed program using positive behavioural approaches and leveraging existing organizational strengths may impact intervention strategies, worker attitudes, and the use of restraints and seclusions against children in RCs.

The Effect of Centers for Medicare and Medicaid's Inpatient Psychiatric Facility Quality Reporting Program on the Use of Restraint and Seclusion.

Patients in inpatient psychiatry settings are uniquely vulnerable to harm. As sources of harm, research and policy efforts have specifically focused on minimizing and eliminating restraint and seclusion. The Centers for Medicare and Medicaid's Inpatient Psychiatric Facility Quality Reporting (IPFQR) program attempts to systematically measure and reduce restraint and seclusion. We evaluated facilities' response to the IPFQR program and differences by ownership, hypothesizing that facilities reporting these measures for the first time will show a greater reduction and that ownership will moderate this effect. Using a difference-in-differences design and exploiting variation among facilities that previously reported on these measures to The Joint Commission, we examined the effect of the IPFQR public reporting program on the use and duration of restraint and seclusion from the end of 2012 through 2017. There were a total of 9705 observations of facilities among 1841 unique facilities. Results suggest the IPFQR program reduced duration of restraint by 48.96% [95% confidence interval (95% CI), 16.69%-68.73%] and seclusion by 53.54% (95% CI, 19.71%-73.12%). There was no change in odds of zero restraint and, among for-profits only, a decrease of 36.89% (95% CI, 9.32%-56.07%) in the odds of zero seclusion. This is the first examination of the effect of the IPFQR program on restraint and seclusion, suggesting the program was successful in reducing their use. We did not find support for ownership moderating this effect. Additional research is needed to understand mechanisms of response and the impact of the program on nontargeted aspects of quality.

Prevalence and risk factors for seclusion and restraint at Geneva’s adult psychiatric hospital in 2017

Background and objectivesCoercion is frequent in psychiatry, with an overall downward trend. Knowledge on the application of seclusion and restraint in open wards remains limited. We aimed to describe the prevalence of coercion in an open inpatient setting and identify risk factors for it. MethodsWe conducted a retrospective analysis of the use of seclusion and restraint in 2017 in the adult psychiatry division of Geneva University Hospital. To identify risk factors for coercion, we estimated incidence rate ratios using multivariable Poisson regressions. ResultsOf 865 patients, 142 (16.4%) experienced at least one coercive measure (mostly seclusion). The incidence of coercion was higher in men, single patients, patients with psychotic or bipolar disorders, patients receiving disability benefits, patients with a higher number of previous psychiatric hospitalizations, and patients with higher global scores and higher scores on item 1 (overactive, aggressive or agitated behaviour) on Health of the Nation Outcome Scales (HoNOS) at admission. Age and referrals from the emergency department were not associated with a higher risk of coercion. ConclusionRisk factors for coercion were being male, being single, having psychotic or bipolar disorders, having previous psychiatric hospitalizations, having high HoNOS scores at admission, and being referred from outpatient centres or private physicians. Ratings on the first HoNOS item at admission might be sufficient for a pertinent aggression risk evaluation and thus for the prevention of coercion due to violence. This study is the first to analyse the risks of seclusion in open wards and calls for further research.

A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit

The use of seclusion is controversial and has been deemed an encroachment on human rights and dignity which can cause psychological trauma and physical injury to patients in the psychiatric setting. This quality improvement project used a quasi-experimental design to implement the TeamSTEPPS educational program, an evidenced-based program to inform nurses about verbal de-escalation to reduce patient aggressive behavior that can lead to patient seclusion. The targeted patient population included all patients admitted 2 months prior to initiation of Team STEPPS (n = 388) and 2 months following completion of the education modules (n = 342). After the implementation of the educational program there was a statistically significant difference in the rate of charting aggressive behavior (p = 0.024). The pre rate was 17.3%, and the post rate was 11.4%. While there was not a statistically significant difference in the rate of seclusion events, (p = 0.349) there was a clinically significant reduction. The pre rate was 5.9%, and the post rate was 4.4%. The results of this study support the importance of educating psychiatric nurses on verbal-de-escalation to reduce patients placed in seclusion and decrease patients’ aggressive behavior in the psychiatric settings.

Prevention and management of aggressive behaviour in patients at psychiatric hospitals: a document analysis of clinical practice guidelines in Hong Kong.

Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced-based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub-recommendation with most in line with the NICE guidelines were restrictive interventions, de-escalation, and improving service users' experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster-based documents, and departmental practices.

Exploring the Disproportionate Use of Restraint and Seclusion Among Students with Disabilities, Boys, and Students of Color

To examine disproportionality in the use of restraint and seclusion for students with disabilities compared with their peers, for boys compared with girls, and for students of color, specifically Black and Hispanic students, compared with White students. We used the 2015–2016 Civil Rights Data Collection (CRDC), in which 21% (n = 19,700) of U.S. public schools reported using restraints or seclusions at least once during the 2015–2016 school year and 6% (n = 5485) of schools reported using restraints or seclusions at least 10 times. We used risk ratios (RR) and robust variance estimation (RVE) meta-regression analyses to estimate a covariate-adjusted mean RR to identify disproportionate use of restraints and seclusions. In schools with reported use of restraint or seclusion at least 10 times, students with disabilities were 200% more likely to be subject to restraint or seclusion relative to their peers; students attending elementary schools were more likely to receive restraint or seclusion than students attending secondary schools. Similarly, Black students were almost 200% more likely and Hispanic students were 45% more likely to experience a restraint or seclusion than their White counterparts. Prior research and results from this study indicate that subgroups of students—particularly students with disabilities, Black students, and Hispanic students—are disproportionately subject to the use of restraint and seclusion. Yet, research has found that restraints and seclusions are not effective interventions and should only be used as a last resort.

The influence of residential workers social climate on the use of restraint and seclusion: A longitudinal study in a residential treatment center for youth

Restraint and seclusion (R&S) are two types of interventions residential workers can use to manage aggressive behaviors in youth residential treatment centers (RTC). Factors related to the environment, children, and residential workers have all been associated with their use. Although research in psychiatric settings has shown a relationship between social climate and the use of R&S, no similar studies have been conducted in RTC. The first objective of this paper was to assess the extent to which social climate was associated with the use of R&S in RTC. The second objective was to observe how each dimension of social climate predicted the use of R&S. To accomplish this, a sample of 198 residential workers completed a monthly questionnaire on their unit’s social climate at three different time points. Crossed-lagged analyses were performed to test associations between different dimensions of social climate and the use of R&S over time. Results suggest that good communication and openness among team members are associated with lower rates of R&S use while the focus on common objectives and planning are associated with an increased use of these measures. Perceptions of a negative team climate were not associated with the use of R&S. Results imply that if residential workers had the time and the training needed to meet the needs of individual children they would favor alternative interventions instead of worrying about creating tensions with colleagues.