When considering children, the group most cited as victims of poor restraint practices, we must be very careful to not take leave of the realities of developmental factors. Such children most often need to be held lovingly and talked to soothingly. The problem is that in so many programs for these tragic children staff fail to make such skilled therapeutic interventions. Quiet rooms, time outs, or even holdings, can be very appropriate therapeutic interventions for older children. Many parent advocates would strongly support such programs when performed expertly.
Adolescents represent an even more difficult conundrum regarding restraint and seclusion.
States have radically different laws on the involuntary treatment of adolescents and the means one may properly use to constrain a youth who is out of control. If one is going to follow the practices promoted in the CMHS sponsored system of care reform movement one needs to account for what to do with a dangerously out of control teenager being served as an outpatient in an intensive wraparound program. Clearly changes in policy, both legislatively and in the administration of our community based programs, must reflect the complexity of the issues involved. They must be based on our core values of humane care for those who are suffering. We must also recognize that the focus on policy changes regarding restraints and seclusion may be dodging the real issues.