Search

Trauma-informed care (TIC) is receiving growing interest and support as a promising approach to reducing the use of restrictive measures (restraints, seclusions and time-outs) in children and youth living in residential care. In this study, we aimed to compare the use of restrictive measures prior to and following the implementation of a TIC staff training initiative in 44 residential units for children and youth and to explore differences between units and type of measures used. Patterns of change in monthly use of restrictive measures 6 months before and 12 months after the training were compared using growth curve models. Restraints, seclusions and time-outs decreased by 41.82%, 19.91%, and 48.15%, respectively, over a year following the training. Despite these important declines, trajectories of restrictive measures did not change significantly from pre- to post-training when holding the TIC training against stringent criteria. Nonetheless, some units' characteristics were associated with successful changes. Results are promising, but not conclusive about the ability of this TIC training to produce changes in trajectories of restrictive measures, at least in the first year of implementation. This study highlights the need for rigorous statistical models in further studies to ensure accurate empirical evaluation of TIC staff training programs. [ABSTRACT FROM AUTHOR]

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. 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. A trauma-informed staff training was implemented in 44 residential care units in Quebec, Canada. 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 %). 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. 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. • Heterogeneity in levels of restrictive measures moderate the effect of staff training. • Future studies need to consider this heterogeneity among youth in residential care. • Trauma-informed training works best among youth with high number of measures. • Youth's characteristics are associated with the use of restrictive measures. [ABSTRACT FROM AUTHOR]

• Approximately half of children do not experience restrictive interventions. • There are two latent profiles of children who experience restrictive interventions. • Children in latent profiles differ on individual and environmental characteristics. 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. 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. Administrative data were used. Restrictive intervention data for 324 children and youth (29 units) over a 6-month period were extracted. : 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). 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. 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). [ABSTRACT FROM AUTHOR]