New York State Project Shows Progress in Reducing Use of Seclusion, Restraint for Children With Mental Illness

Three New York State mental health treatment facilities participating in a project to decrease the use of seclusion and restraint for children with severe emotional disorders demonstrated significant decreases in restraint and seclusion episodes per 1,000 client-days, according to a report published online Friday in Psychiatric Services in Advance titled "The New York State Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project." Moreover, each facility identified specific activities that contributed to success, including ways to facilitate open, respectful two-way communication between management and staff and between staff and youth, and greater involvement of youth in program decision making.

The intervention used by the three facilities included training, on-site mentors and peer specialists, and on-site consultation from the Office of Technical Assistance of the National Association of State Mental Health Program Directors (NASMHPD). The intervention’s primary methodology was implementation of NASMHPD’s “Six Core Strategies to Reduce the Use of Seclusion and Restraint.”

The study authors examined data from the New York State Incident Management and Reporting System on restraint and seclusion episodes per 1,000 client days over a four-year period (2007–2011). Qualitative data were collected via notes from facility consultations, site visits, steering committee reviews, site conference calls with the New York State Office of Mental Health (OMH), and site reports.

At facility one, the number of incidents per 1,000 client-days decreased from 67 to 25; at facility two, the decrease was from 63 to 7; and at facility three, the decrease was from 99 to 13.

“The primary finding of this project was that the creation of coercion- and violence-free environments where use of restraint and seclusion is markedly decreased requires a major commitment by all staff over an extended period to fully understand and internalize the strategies involved and embrace the changes in facility culture,” Lloyd Sederer, M.D., medical director of the New York State Office of Mental Health and a coauthor of the report, told Psychiatric News. “In New York, OMH is promoting facilities’ engagement in learning collaboratives so that facilities can reduce use of restraint and seclusion and realize significant positive outcomes."

For related information, see the Psychiatric News article, "Psychiatric Hospital Aesthetics Affect Seclusion, Restraint Use."

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