Predictors of Injury to Youth Associated with Physical Restraint in Residential Mental Health Treatment Centers
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Predictors of Injury to Youth Associated with Physical Restraint in Residential Mental Health Treatment Centers Jonathan Bystrynski1 · Michael T. Braun2 · Catherine Corr1 · Deserai Miller1 · Courtney O’Grady1 Accepted: 14 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The restraining of children is a pervasive but controversial practice that has resulted in the injury and death of children. Despite this threat of harm, little research has explored what factors contribute to the risk of a child becoming injured during a restraint event. Objective This study examined multiple child and restraint factors to better understand what predicts the injury of a child during a restraint event. Methods Longitudinal data (794 youth, 13,339 restraint events) from six residential treatment centers in the Midwest were utilized to predict injury associated with restraint using nested hierarchical logistic regression models. Results Injuries to the child are a frequent outcome following the use of restraints on a child. Findings show that a child being male and older contributed to the likelihood of an injury, but the race of the child did not predict injury. In addition, three physical hold types—prone, supine, and settle—were associated with a greater likelihood of injury. Conclusions Results suggest those who use restraints on children should reevaluate their behavior management plans to reduce their risk of hurting children by restraints. Eliminating or greatly reducing the use of prone, supine, and settle holds will likely lead to a drop in injuries of children. Keywords Restraints · Injuries · Physical holds · Youth · Residential treatment · Mental health
Introduction The use of restraints on children is a common but controversial tool used by staff in hospitals, schools, and therapeutic residential settings. Restraints are used to reduce the immediate risk of self-harm or violence towards others (Chun et al. 2016a). However, restraints can negatively impact a child’s physical and psychological wellbeing and have resulted in * Michael T. Braun [email protected] 1
University of Illinois at Urbana-Champaign, Champaign, IL, USA
2
Medical College of Wisconsin, Milwaukee, WI, USA
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Child & Youth Care Forum
the deaths of hundreds of children (Mohr et al. 2003; Nunno et al. 2006). Researchers, families, and advocacy groups have sought practice reforms through changes in professional standards and training (Murray and Sefchik 1992; Recupero et al. 2011). Despite these attempts to decrease the use of child restraints, child restraint policies are often misunderstood or ignored by facilities. In these instances, the continued use of restraints can result in child injury and, in extreme cases, the death of a child (Chun, Mace, and Katz 2016a; Curie 2005; Mohr and Mohr 2003). Although some is known as to what contributes restraint use on children, less is understood about the factors that are associated with injury as part of a restr
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