The rules apply to in-patient care received in a residential center, which officials say are rapidly replacing hospitals as alternatives for children and teens with psychiatric disorders. Media and government reports of injuries and deaths in recent years have focused attention on how restraints and seclusion have been used in psychiatric hospitals and other facilities such as treatment centers for youths with behavioral or emotional problems. Physical restraints restrict a person's movement, such as by pinning the person to the floor. They may also include the use of straitjackets, leather straps or shackles. Patients may also be given sedatives, or other drug-induced restraints.
Some patients are also secluded to protect themselves or others.
HHS already has rules on how hospitals, nursing homes and other facilities receiving federal funds should use restraints on the mentally ill. Those rules cover adults and some children. Earlier this year, the Health Care Financing Administration, which runs Medicare and Medicaid health programs for the needy, crafted rules to address the treatment of children served in the Medicaid program for special residential centers. The rules were postponed in March, along with several other regulations evaluated by the Bush administration. Slight changes were made, officials said, mainly clarifying which professionals could order and evaluate restraints.