Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital

J Child Adolesc Psychiatr Nurs. 2011 Feb;24(1):11-5. doi: 10.1111/j.1744-6171.2010.00262.x.


Objective: The purpose of the study was to determine the effectiveness of six core strategies based on trauma informed care in reducing the use of seclusion and restraints with hospitalized youth.

Methods: The hospital staff received training in March 2005 in six core strategies that are based on trauma informed care. Medical records were reviewed for youth admitted between July 2004 and March 2007. Data were collected on demographics, including age, gender, ethnicity, number of admissions, type of admissions, length of stay, psychiatric diagnosis, number of seclusions, and restraints.

Results: Four hundred fifty-eight youth (females 276/males 182) were admitted between July 2004 and March 2007. Seventy-nine patients or 17.2% (females 44/males 35) required 278 seclusions/restraints (159 seclusions/119 restraints), with average number of episodes 3.5/patient (range 1-28). Thirty-seven children and adolescents placed in seclusion and/or restraints had three or more episodes. In the first six months of study, the number of seclusions/restraints episodes were 93 (73 seclusions/20 restraints), involving 22 children and adolescents (females 11/males 11). Comparatively, in final six months of study following the training program, there were 31 episodes (6 seclusions/25 restraints) involving 11 children and adolescents (females 7/males 4). The major diagnoses of the youth placed in seclusion and/or restraints were disruptive behavior disorders (61%) and mood disorders (52%).

Conclusions: This study shows downward trend in seclusions/restraints among hospitalized youth after implementation of National Association of State Mental Health Program Directors six core strategies based on trauma informed care.

MeSH terms

  • Adolescent
  • Adolescent Health Services*
  • Behavior Control / methods*
  • Child
  • Child Health Services
  • Diagnostic and Statistical Manual of Mental Disorders
  • Documentation / standards
  • Documentation / statistics & numerical data
  • Ethnic Groups / statistics & numerical data
  • Female
  • Hospitals, Psychiatric / standards*
  • Humans
  • Knowledge of Results, Psychological
  • Leadership*
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / therapy
  • Mental Health Services / standards
  • Organizational Innovation
  • Restraint, Physical* / statistics & numerical data
  • Retrospective Studies
  • Social Isolation*
  • Staff Development / standards