The effect of federal regulations on the physical restraint of children and adolescents in residential treatment with an analysis of client, staff, and environmental variables

For more than 35 years, the utilization of physical restraints to manage aggressive, out of control youth in mental health facilities has been widely debated. In July of 2001 the Federal government imposed strict regulations on their use in residential treatment facilities. This came about largely from pressure from the media and advocacy groups following the investigation of several deaths that resulted from physical restraints. When this study was begun, no other known studies had examined what effects the federal changes might have had. This study examined restraint usage at a single residential treatment facility for the year and a half prior to July 2001 with the year and a half that followed. Results showed a dramatic reduction in restraints following the imposition of the federal law, with restraint usage being essentially cut in half. Similarly, the mean number of clients that had multiple restraints each month and the maximum number of restraints per staff was cut in half. Staff present in both study periods decreased their use of restraints by just over one-third. It was asserted that client variables may now be better predictors of restraint usage because the federal rules have essentially removed many confounding cases where staff restrained children for reasons other than the children being a threat to themselves or others.;A significantly greater percentage of subjects restrained after the federal law change were found to have a diagnosed Learning Disability. Client age at admission also significantly increased. Clients restrained with a high frequency were found to have significantly longer stays in treatment than both non-restrained clients and clients restrained with a low frequency.