“Seclusion and restraint” is using physical force, restricting movement, or involuntarily medicating or isolating people to manage their behavior. These methods often are used to control people at risk of harming themselves or others in settings such as juvenile detention centers, psychiatric hospitals, residential treatment facilities and schools.
The use of seclusion and restraint is a complex, controversial issue that touches many Texas agencies. Use of seclusion and restraint is considered a failure in treatment because it can be traumatic and dangerous to consumers and staff. It can cause severe physical and psychological harm, and even death. It can also lead to mistrust and power struggles that conflict with a positive therapeutic environment and hinder recovery.
Residential Treatment Centers Funding Initiative
The Hogg Foundation awarded a three-year grant in the amount of $589,172 to Texas Network of Youth Services to provide technical assistance to residential treatment centers (RTC) implementing trauma-informed systems of care to reduce their reliance on seclusion and restraint.
As part of this project, the Hogg Foundation hosted two training seminars on trauma-informed systems of care – one in Houston and one in Austin. The seminars were led by national experts on trauma-informed care, Beth Caldwell, MS; Kevin Ann Huckshorn, RN, MSN, CADC, ICRC and Janice Lebel, PhD. These trainings were offered to staff from all residential treatment centers in Texas in January 2012.
Texas Network of Youth Services will provide intensive technical assistance and follow-up support to selected residential treatment centers for up to three years after the training seminar.
Through this initiative, the Hogg Foundation hopes to:
- Raise awareness of the prevalence and influence of trauma in the lives of RTC residents and the ways in which trauma affects behavior.
- Highlight the ways in which the use of seclusion and restraint pose the risk of causing further traumatic experiences and examine the complex relationship between trauma and behavior.
- Demonstrate the significance of and need for cultural change at every level of an organization in order to successfully implement trauma-informed practices that reduce the use of seclusion and restraint.
Reducing Restraint through Trauma-Informed Care for People with Intellectual Disabilities and Behavioral or Mental Health Conditions
Traumatic experiences affect both brain development and behavior. Individuals with intellectual disabilities are at much higher risk than the general population of abuse, neglect and the associated trauma. Behaviors caused by trauma can create challenging and sometimes dangerous situations for the individual and the support staff assisting those with intellectual disabilities. These challenging behaviors are often attributed solely to the disability with minimal attention to the individual’s mental health.
The Hogg Foundation is partnering with the Department of Aging and Disability Services to provide training and technical assistance on trauma informed care to service providers supporting individuals with intellectual disabilities. Understanding the impact of trauma on behavior and using trauma-informed strategies can help reduce the use of restraint on individuals with intellectual disabilities in both facility and community settings.
The foundation coordinated trainings at two state supported living centers in February 2012. Both facility staff and community service providers were invited to participate. As organizations begin to plan and implement new strategies learned at the trainings, the foundation will offer on-going technical assistance to support the restraint reduction efforts.