Decreasing the use of mechanical restraints and locked seclusion

This article describes attempts by an inpatient unit, treating adolescents with developmental delays and with severe psychiatric disturbances, to reduce its use of physical restraints. This restraint reduction process involved two phases: (1) assessment and (2) systems intervention. The assessment phase consisted of extensive observations of staff response to patient crises, staff interviews, patient interviews, and the development of a data-tracking system for restraint and seclusion (R/S) usage. Multiple contributing factors were identified during the assessment phase that increased R/S usage. The second phase, organizational and clinical intervention, included staff education and training, treatment interventions, and system changes aimed at reducing R/S usage. R/S reduction data over the course of the project are presented.