A RESTRAINT ON RESTRAINTS - THE NEED TO RECONSIDER THE USE OF RESTRICTIVE INTERVENTIONS

Children with behavior problems are put in units with milieu therapy f or the support and guidance of a specialized health care team, suppose dly experts in the care of children with these unique and urgent needs , The reality of such units, however, is that those with the most cont act with the children are often inadequately prepared, both in terms o f knowledge and skills, to manage disruptive behaviors. As a result, t he milieu that is supposed to provide support and structure can actual ly exacerbate the trauma for the vulnerable child. Preliminary data ar e presented from an ongoing study that is investigating the experience s and memories of formerly hospitalized children. Three types of traum atic experiences are described: vicarious trauma, alienation from staf f, and direct trauma. Many of the traumatic events endured by child pa tients are the result of an inappropriate use by staff of power and fo rce. There was a marked lack of understanding by the children of why g iven interventions were used, Although coercive interventions are some times necessary, ethical, legal, and other professional considerations make it clear that more work is needed. Research to identify the patt erns of lack of knowledge and skills, as well as to develop appropriat e interventions are recommended. Copyright (C) 1998 by W.B. Saunders C ompany.