Multinational experiences in reducing and preventing the use of restraint and seclusion.

Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use.

An organizational approach to reducing and preventing restraint and seclusion use with people with acquired brain injury.

Introduction: Seclusion, restraint (S/R) and coercive practices are used across human service populations, settings, with people of all ages. Their use has been increasingly scrutinized by the public, federal government and the media. Alternatives, interventions, and organizational approaches to these forms of containment are now emerging and advancing practice.

The dollars and sense of restraints and seclusion.

Restraints and seclusion are a common practice in many human service settings despite the increasing evidence questioning their efficacy and appropriateness. There are many detrimental effects on people subject to these practices, such as falls, injury, psychological trauma and even death. In addition to the impact on people being served, there is also a range of negative effects on organisations and the workforce.

Restraint and seclusion use in U.S. school settings: recommendations from allied treatment disciplines.

Restraint and seclusion (R&S) are high risk, emergency procedures that are used in response to perceived violent, dangerous situations. They have been employed for years in a variety of settings that serve children, such as psychiatric hospitals and residential treatment facilities, but are now being recognized as used in the public schools. The field of education has begun to examine these practices in response to national scrutiny and a Congressional investigation.

Restraint use in residential programs: why are best practices ignored?

Several states and providers have embarked on initiatives to reduce using restraint and seclusion in residential programs. Restraint and seclusion are associated with harm to youth and staff, significant costs, reduced quality of care, and less engagement of youth and families. Successful reduction/prevention strategies have been identified, implemented, and reported.

Tied up and isolated in the schoolhouse.

In 1999, the United States General Accountability Office (USGAO) investigated restraints and seclusion use in mental health settings and found patterns of misuse and abuse. A decade later, it found the same misuse and abuse in schools. Restraints and seclusion are traumatizing and dangerous procedures that have caused injury and death.

Regulatory change: a pathway to eliminating seclusion and restraint or "regulatory scotoma"?

Historical and current experience indicates that regulatory changes in seclusion and restraint practice are often spurred by patient abuse but can ultimately enhance protection for consumers, prevent use of seclusion and restraint, and help transform care so it becomes recovery oriented. Reports of deaths related to restraint and seclusion fueled recent national regulatory changes and a federal agenda to eliminate their use. Some states, many facilities, and the federal initiative have focused on seclusion and restraint prevention and alternatives and have made important strides in reducing and eliminating these practices.

The economic cost of using restraint and the value added by restraint reduction or elimination.

Objective: The purpose of this study was to calculate the economic cost of using restraint on one adolescent inpatient service and to examine the effect of an initiative to reduce or eliminate the use of restraint after it was implemented.

Methods: A detailed process-task analysis of mechanical, physical, and medication-based restraint was conducted in accordance with state and federal restraint requirements. Facility restraint data were collected, verified, and analyzed.

Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care.

Objective: To reduce the use of restraint and seclusion with children and adolescents in psychiatric inpatient units by promoting a preventive, strength-based model of care.

Method: The State Mental Health Authority used data analysis, quality improvement strategies, regulatory oversight, and technical assistance to develop and implement system change over a 22-month period. No changes in regulation or policy were undertaken.