Restraint, seclusion and time-out among children and youth in group homes and residential treatment centers: a latent profile analysis

Abstract Background 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. Objective 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. Participants and setting Administrative data were used. Restrictive intervention data for 324 children and youth (29 units) over a 6-month period were extracted. Methods : 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). Results 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. Conclusion 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).