Restraint and seclusion use in U.S. school settings: recommendations from allied treatment disciplines

Patterns of change in restrictive measures in residential care: Trauma-informed staff training benefits children and youth who need it the Most

BACKGROUND

Implementation of trauma-informed staff training is promising to reduce restrictive measures (restraints, seclusions, and time-outs) used to address problem behaviors in youth in residential care. Previous mixed results may be explained in part by the heterogeneity in the use of restrictive measures among youth.

OBJECTIVE

The objective was twofold: (1) to examine whether heterogeneity in the initial number of restrictive measures experienced by youth, before implementing trauma-informed staff training, moderates the effect of the training and (2) to explore whether children and youth's characteristics are associated with the number of restrictive measures.

PARTICIPANTS AND SETTING

A trauma-informed staff training was implemented in 44 residential care units in Quebec, Canada.

METHODS

This study used administrative data. The sample (n = 297 youth) was divided into three subgroups based on the number of restrictive measures experienced in the six-month period prior to the training: 1) absence or low (52 % of the sample); 2) moderate (23 %); 3) high (25 %).

RESULTS

The use of restrictive measures was compared between the subgroups. Main and interaction effects were all significant. None of the slopes for groups 1 and 2 were significant. In contrast, significant decreases from T1 were observed at T2 (-0.18 (0.02), p < .000) and T3 (-0.22 (0.02), p < .000) in group 3. Several children and youth's characteristics distinguished groups.

CONCLUSIONS

Implementation was more beneficial to youth who experienced a high number of restrictive measures. Training opportunities can lead to positive changes in measures used to address problem behaviors in youth.

Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses

BACKGROUND

People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety.

METHODS

This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by full text retrieval. Quality of the included studies was assessed using Cochrane Risk of Bias (ROB)-2 for crossover trials and data extracted by two reviewers. The details of the interventions and effectiveness were compared and discussed narratively, and comparable outcomes were included to meta-analyses using R software.

RESULTS

A total of 622 articles were identified and five articles met eligibility for inclusion. Three studies used multi-sensory adaptations and one used single sensory adaptation of music. Narrative synthesis showed some evidence of SADE reducing magnitude and duration, although, questionable for reducing the number of maladaptive behaviours. Two studies demonstrated conflicting evidence of the effect of SADE on cooperation. Three studies demonstrated significant positive impact of SADE on psychophysiological outcomes. Despite an overall tendency to favour SADE, no statistically significant difference of maladaptive behaviours was found between SADE and regular dental environment (RDE) (Standardised mean change (SMC) = 0.51; 95% Confidence Interval (CI) -0.20 to 1.22; p = 0.161). SADE was superior to RDE (SMC -0.66; 95% CI -1.01 to -0.30; p =  < 0.001) in reducing psychophysiological responses of dental anxiety.

CONCLUSION

Current evidence suggests that adapting visual, tactile, and auditory aspects of the dental environment in a single or multi-sensory approach demonstrates small positive effects on psychophysiological responses and maladaptive behaviours of dental anxiety for people with IDD.

TRIAL REGISTRATION

The title of this review was registered with PROSPERO (CRD42022322083).

The Effectiveness of Sensory Adaptive Dental Environments to Reduce Corresponding Negative Behaviours and Psychophysiology Responses in Children and Young People with Intellectual and Developmental Disabilities: A Protocol of a Systematic Review and Meta-Analysis

People with Intellectual and Developmental Disabilities (IDDs) are disproportionately vulnerable to poorer oral health due to their complex needs specifically sensory processing difficulties. This leads to increased maladaptive behaviours and psychophysiology responses of dental anxiety amplified by the overstimulating aspects of the dental environment. Although, there is a growing body of evidence to suggest that sensory adaptions are an effective strategy for individuals with IDDs in a wide range of settings, there is a lack of high-quality evidence detailing the effectiveness in a dental setting. The objective of this review is to assess the effectiveness of sensory adaptive dental environments (SADE) to reduce dental anxiety, corresponding negative behaviours and psychophysiology responses in children and young people with IDDs. The systematic review will include all Randomized Controlled Trials (RCTs) that investigate the effectiveness of SADE compared to control (no intervention), waitlist or usual care (regular dental environment) to reduce dental anxiety and the corresponding negative behaviours and psychophysiology responses in children and young people (upto the ages of 24 years) with IDDs. This review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases including MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker will be searched using appropriate keywords. Additionally, citation searching will be conducted. Screening based on titles and abstracts will be done after de-duplication, followed by full-text reading for selection based on the inclusion criteria. Data extracted from the included studies will be tabulated and assessed for risk of bias. If applicable, a meta-analysis of the pooled data will be conducted. The review is registered with PROSPERO (CRD42022322083).

Restraint, seclusion and time-out among children and youth in group homes and residential treatment centers: a latent profile analysis

BACKGROUND

Many children and youth living in residential units have experienced multiple traumas that may result in challenging behaviors. Among a range of professional responses, staff may use restraint, seclusion and time-out to manage these behaviors.

OBJECTIVE

To enhance our understanding of these restrictive interventions in residential units as a means of improving professional practices involving children and youth in out-of-home care.

PARTICIPANTS AND SETTING

Administrative data were used. Restrictive intervention data for 324 children and youth (29 units) over a 6-month period were extracted.

METHODS

Latent profile analysis was used to identify subgroups of children and youth with distinct restrictive intervention profiles. Children and youth in these profiles were compared on individual (age, sex, ethnic group, length of stay in unit, reasons for services) and environmental characteristics (unit type, type of services, specialized designation).

RESULTS

Restrictive interventions, especially time-outs, were frequent (5136 interventions; 69% time-outs), yet approximately half of the sample did not experience any. Restraints, seclusions and time-outs differed in frequency, duration and reason for use. A two-profile model was favored for children and youth who were subjected to restrictive interventions (classification accuracy = 94%). Children and youth in these two profiles differed from each other, and from those not subjected to restrictive interventions, on numerous individual and environmental characteristics.

CONCLUSION

The use of restrictive interventions is frequent, and attention should be paid to individual and environmental risk factors identified in this study (i.e., being a boy, non-Caucasian, taken into care for neglect, and having a longer stay in unit).

Living Without Restraint: One Parent's Reflections and Recommendations for Supporting At-Risk Individuals With Developmental Disabilities

In the past several years, there has been an important movement to reduce the utilization of restraint for individuals with developmental disabilities. Legislatures, local and national, are taking on the task of shaping the way that our culture supports people who, up until now, have been often treated in a punitive manner rather than truly supportive in a therapeutic way. Schools and systems of care struggle to identify strategies that offer more positive outcomes to all individuals, even those with challenging behaviors. This article represents the thoughts and recommendations of one parent who has lived with the damage done by restraint to his son. The recommendations are intended to speak to administrators, schools, and caregivers. The intent is not to assign blame, but rather to reflect on our experiences and share some strategies that have worked for us. Although much of what is recommended may not be new, the hope is that this article might provide a fresh way to understand some of the factors that contribute to the use of restraint, in addition to providing some suggestions to proactively address those factors.

The Restraint and Seclusion of Students With a Disability: Examining Trends in U.S. School Districts and Their Policy Implications

Restraint and seclusion are possible aversive responses to problematic student behavior used in some public schools, most commonly on students with a disability. Considerable recent attention has been paid to these practices both in the media and in Congress, and subsequently roughly half of U.S. states have made changes to their laws or policy statements around restraint and seclusion since 2009. In this article, we illuminate trends in restraint and seclusion across the United States in recent years to better inform policy discussions on these matters. Specifically, we examined rates of reported restraint and seclusion across U.S. districts in the 2009–2010 and 2011–2012 school years. We found that general trends persist between the data collections: Most districts report no/little use of restraint or seclusion, with a small percentage of districts reporting exceedingly high rates. Furthermore, the vast majority of variation exists within rather than between states, which may suggest the importance of local factors such as district policy, school culture, and practitioner support in determining the frequency of restraint and seclusion in schools.

The use of restraints or seclusion in the school setting

It is the position of National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) is an essential advocate for the health and well-being of all students. Promoting a safe and secure environment is vital to the educational success and emotional development of children. The use of restraints or seclusion can potentially cause injury or death and therefore should be used only as a brief intervention where there is the risk of imminent danger to the child, staff, or classmates (Mohr, LeBel, O’Halloran, & Preustch, 2010; United States Department of Education [USDE], 2012).