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

J Am Acad Child Adolesc Psychiatry. 2004 Jan;43(1):37-45. doi: 10.1097/00004583-200401000-00013.


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.

Results: Comparative data collected before and after the interventions demonstrated substantial reductions in the use of restraint and seclusion. Child units (age 5-12) decreased from 84.03 to 22.78 episodes per 1,000 patient days (72.9%), adolescent units from 72.22 to 37.99 episodes (47.4%), and mixed child/adolescent units from 73.37 to 30.08 episodes (59%).

Conclusions: The use of restraint and seclusion in child and adolescent inpatient settings can be reduced through a systems approach, which may have applicability to other settings and systems.

MeSH terms

  • Adolescent
  • Adolescent Psychiatry / methods
  • Adolescent, Hospitalized*
  • Attitude of Health Personnel
  • Child
  • Child Psychiatry / methods
  • Child, Hospitalized*
  • Child, Preschool
  • Hospitals, Psychiatric / statistics & numerical data
  • Hospitals, Psychiatric / trends*
  • Hospitals, State*
  • Humans
  • Inservice Training
  • Massachusetts
  • Mental Disorders / therapy
  • Mental Health Services / trends*
  • Patient Isolation / statistics & numerical data*
  • Restraint, Physical / statistics & numerical data*