By Larke Huang and Paolo del Vecchio

Too often, children and youth with mental, emotional and behavioral disorders are subject to seclusion and restraint (SR) in settings that are intended to help children and promote their healthy development. 

Once thought to be “therapeutic” techniques, we now recognize these as non-therapeutic, often re-traumatizing for the youth, and disruptive of a therapeutic relationship.  Use of restraints can often result in injuries to both the child and the staff and even deaths. 

A front page article in today’s Washington Post reported on allegations of the repeated use of seclusion and restraints for students who attend a school for those with disabilities.  The family of one of the students has filed a complaint with the U.S. Dept of Education Office of Civil Rights. 

At SAMHSA, we have supported initiatives to reduce and prevent the use of SR in behavioral health facilities and have been successful in reducing, and in some instances, eliminating these practices. 

This year, we worked with the U.S. Dept of Education to develop guidelines to help schools prevent SR in schools, reiterating that SR should only be used in situations where the child’s behavior poses imminent danger of physical harm to self or others. 

Successful efforts to prevent the use of SR have occurred in both behavioral health facilities and in schools where the following strategies have been implemented: 

1)  a demonstrated leadership commitment to reducing  these practices

2) the systematic use of data to track and monitor these practices

3) regular staff training on alternatives to SR, recognizing triggers and using de-escalation and other prevention techniques 

4) full inclusion of families in student plans and programs

5) systematic debriefing when an SR event occurs

For more information, see the SAMHSA webpage on Seclusion and Restraint  and SAMHSA’s National Registry of Evidence-based Program and Practices for the “Six Core Strategies to Prevent Conflict and Violence:  Reducing the Use of Seclusion and Restraint.”

Larke Huang is the Senior Advisor on Children Youth and Families, Office of Policy Planning and Innovation and Paolo del Vecchio is the Director for the Center for Mental Health Services