Minimizing the Need for Physical Restraint and Seclusion in Residential Youth Care through Skill-Based Treatment Programming

Recent and widely publicized increases in client injuries and occasional deaths relating to the use of physical restraint in child care settings have administrators and practitioners searching for alternative methods of managing clients who present a danger to themselves, other clients, or staff. Many care facilities have responded to the problem by providing better crisis intervention training to direct care staff, both to help them defuse crisis episodes without the need for potentially dangerous interventions, and to equip them to use restraint tactics safely when those are required. Some have implemented and enforced vigorous and categorical zero restraint policies or have adopted sharply limited restraint practices. Others have combined these measures to comply with the recent federal mandate regulating the use of restraint and seclusion. This study explored an alternative possibility that definable, systematic, and skill-based treatment programming may inherently reduce the need for these interventions. Frequency of restraint, seclusion, and significant incident report data from two child care facilities before and after their transitions to such a program of care and treatment, the Teaching-Family Model, are examined. The data appear to support the potential for this and other skill-focused treatment programs to minimize the necessity of such interventions. Discussion includes implications of these preliminary results for professionalizing youth care policy and practice.