Using Staff Training to Decrease the Use of Restrictive Procedures at Two Facilities for Foster Care Children

Abstract

Objective: Use of some restrictive procedures, including physical restraint, has been controversial. For children within the foster care system, who have already suffered various degrees of abuse and neglect, restrictive procedures could add to their emotional and behavioral problems. The current study was conducted to determine whether a behavioral staff training program would help reduce the use of restrictive procedures at two group facilities housing children in the foster care system. Method: Pre- and posttraining measures (incident reports) were obtained within a nonconcurrent multiple-baseline design to document the use of restrictive procedures. Results: The data revealed decreases in reports of several restrictive procedures (e.g., take downs, physical holds, and physical and pharmacological restraints) at both facilities. Conclusions: The results suggest that training direct care staff personnel, including social workers, in positive behavioral strategies might reduce staff use of restrictive procedures and result in fewer injuries to both children and staff.

Factors associated with the use of intrusive measures at a tertiary care facility for children and youth with mental health and developmental disabilities

“…Using data from free‐standing psychiatric hospitals in the USA, Delaney and Fogg (2005) found that children in foster care or in the custody of the Department of Children and Family Services were more likely to be restrained, thereby identifying this sub‐population to be at high risk of experiencing restraints. This corroborates other studies of restraint use among out‐of‐home youth (Crosland et al . 2008; Day 2008; Sourander et al .…”

“…Clients from the CAS were found to be more likely to receive secure isolation. Children/youth who grow up in a violent environment are more likely to demonstrate aggressive behaviour (Crosland et al . 2008; Huckshorn 2006; Smith & Bowman 2009).…”

“…2006). Given that many of these children have experienced abuse and witnessed domestic violence, behavioural self‐control and emotion regulation skills might be compromised (Crosland et al . 2008).…”

Single-Case Evaluation Designs for Practitioners

“…Replication of these positive changes across the nine clients demonstrated the efficacy of the combined therapies. Crosland et al (2008) also used an NCMBD to gauge the effects of staff training in facilities for foster care children. Didactic instruction, modeling, and role plays were used to teach procedures such as: providing attention, praise, desired items, and activities for appropriate behavior; redirecting children from problem behavior to appropriate behavior; and ignoring minor, non-harmful problem behaviors.…”

Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients

“…In recent years there has been an increasing level of concern raised regarding the safety (LeBel et al 2004), effectiveness (Crosland et al 2008), legality (Kennedy and Mohr 2001), and ethicality (Haimowitz and Urff 2006) of using seclusion and restraint as a means of managing the aggressive behavior of child and adolescent psychiatric inpatients. Therefore, there is a pressing need to more accurately identify the clinical characteristics of the youth who undergo physically restrictive treatment, to help facilitate the development of intervention programs that will forestall the need for seclusions and restraints.…”