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

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]