Exploring Reasons Motivating the Use of Restraint and Seclusion by Residential Workers in Residential Treatment Centers: A Qualitative Analysis of Official Reports

ABSTRACT

In situations where the immediate safety of children or others is at risk, residential workers are authorized to use specific measures intended as last resort, namely restraint and seclusion (R&S). This study sought to identify and detail the reasons invoked by residential workers when justifying their decision to restrain or seclude a child. Researchers reviewed and coded 628 anonymized official R&S reports written by residential workers from two different residential treatment centers over the 14 months between September 2015 and May 2017. Researchers used qualitative thematic analysis to analyze official reports. Researchers found nine reasons invoked by residential workers that they regrouped into four themes as follows: workers justified their use of R&S based on their own perceptions of 1) the danger associated with children’s affects and behaviors; 2) their obligation to yield to external constraints; 3) the benefits associated with R&S for children, and 4) the demands imposed by their professional culture. Researchers found that the reasons invoked in official reports by residential workers to justify their decisions are not always consistent with R&S as being methods of last resort. Specifically, residential workers appear to be missing the training and organizational resources needed to use alternative forms of intervention.

KEYWORDS:

• Restraint and seclusion
• reasons for using coercive measures
• decision-making process
• residential care
• official reporting

Disclosure Statement

The authors have no conflict of interest.

Data availability statement:

Data not available due to [ethical/legal/commercial] restrictions

Practice Implications

• Residential workers sometimes restrain and seclude children for various reasons, not just to prevent harm to children or others.

• Organizational dynamics sometimes influence the misuse of R&S through insufficient resources, a lack of supervision and training, and the absence of an accountability structure.

• The standardization and periodic review of official reports could help ensure the proper use of R&S in residential treatment centers.

Additional information

Funding

This work was supported by the Fonds de Recherche du Québec-Société et Culture [2018-NP-205308,268274]; Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail [268274]; Social Sciences and Humanities Research Council of Canada [430-2016-00170].