SAMHSA Helps Reduce Seclusion and Restraint at Facilities for Youth
By Rebecca A. Clay
At some mental health treatment facilities, children who misbehave
risk being tackled, sat upon, and dragged to "seclusion rooms."
That's not the case at the Lakeside Treatment and Learning Center,
a nonprofit residential treatment facility for emotionally and behaviorally
impaired children and adolescents in Kalamazoo, MI.
About a decade ago, the center's leaders realized that those types
of restraint and seclusion techniques not only put their clients
at risk of injury or even death but also were counterproductive.
To avoid retraumatizing already troubled children, staff faced with
problematic behavior these days first try strategies designed to
calm clients and de-escalate conflicts. They only resort to seclusion
or a restraint technique with great reluctance. Even more important,
staff members work to prevent certain behaviors from occurring in
the first place.
"Our agency is moving away from a culture based on coercive
control of children to one based on committed relationships,"
explained Suzanne Friesner, M.S.W., the center's Assistant
Director. "Although we recognize that sometimes safety concerns
mandate the use of restraint or seclusion, our vision for the future
is to move as much as possible to an environment free of restraint
SAMHSA's Center for Mental Health Services (CMHS) is helping to
make that vision a reality. In 2001, CMHS awarded five 3-year demonstration
grants to support the development of effective best-practice training
models to reduce the inappropriate use of seclusion and restraint
in non-medical, community-based, residential and day treatment facilities
for children and youth. Lakeside and four other grantees across
the country are developing methods to train staff who work with
children and youth in facilities providing mental health services
(see article 1 part 2). The Child Welfare
League of America, in collaboration with the Federation of Families
for Children's Mental Health, serves as the project's coordinating
center. Together, the coordinating center and demonstration sites
are developing best practices in training to reduce the use of restraint
"Restraint and seclusion represent treatment systems'
failures," said CMHS Director A. Kathryn Power, M.Ed. "Through
this initiative and others, consumers of mental health services
will have improved opportunities for recovery."
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Emphasis on Training
Over the last decade, investigations revealed that inappropriate
use of restraint and seclusion can result in psychological trauma,
physical injury, or even death (see "Breaking the Bonds,"
News, Volume XI, Number 2). Children are at especially high
"Restraint and seclusion represent treatment systems' failures."
A. Kathryn Power, M.Ed., CMHS Director
Now, a patchwork of state laws and a series of Federal regulations
and laws have been established to try to prevent such problems.
The Children's Health Act of 2000 requires SAMHSA and the Centers
for Medicare & Medicaid Services (CMS) to develop regulations
governing use of restraint and seclusion in health care facilities
receiving Federal dollars and in non-medical, community-based facilities
As part of its Conditions of Participation, CMS already established
standards that prohibit hospitals and residential psychiatric treatment
facilities for people under age
21 from using restraint and seclusion except to ensure safety during
emergencies. The regulations also require facilities to report deaths,
debrief staff and consumers after incidents, and provide education
and training to staff.
That last requirement is especially important, said Paolo del
Vecchio, M.S.W., Associate Director for Consumer Affairs at CMHS.
Because of the field's high turnover rates, staff may not
receive adequate training. "Staff members need ongoing training
on seclusion and restraint—most importantly,
in how to prevent the use of such techniques in the first place,"
said Mr. del Vecchio. "Focusing on alternatives to the use
of restraint and seclusion is the real key."
And that's just what the CMHS grants do. The program's
goals are to develop a range of effective models for training professional
and support staff in the appropriate use of restraint and seclusion
and to analyze the training's impact on use, safety, and other
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