Pathways from Traumatic Stress Symptoms to Physical Restraint Incidence Among Youth Enrolled in Psychiatric Residential Treatment

To improve outcomes for youth receiving psychiatric residential inpatient treatment, it is necessary to identify factors that affect the likelihood of direct-care workers’ implementation of physical restraint in these settings. Prior research indicates that youth who report the highest levels of traumatic stress symptoms at intake are the most likely to experience more frequent physical restraint during their residential stay. Moreover, there appears to be significant variability in the relationship between trauma symptoms and restraint experiences. The current study sought to investigate potential mediators of this relationship. Participants included 150 youths aged 6–17 (M = 11.8 years) admitted to a Psychiatric Residential Treatment Facility (PRTF) in the northeastern United States. Data collected as part of routine clinical practice was analyzed to identify variables associated with both traumatic stress symptoms at intake and incidence of restraint across youths’ residential stay period. Results indicated neglect and psychotic symptom severity mediate the relationship between trauma symptoms and restraint frequency in parallel. As such, these factors may represent critical indicators of risk for physical restraint among trauma-exposed youth in PRTFs. Comprehensive trauma-focused assessment of psychotic symptoms and neglect history at intake, accompanied with targeted professional development and training efforts for direct care workers on alternative ways to increase youth safety may enhance restraint prevention and quality of care in PRTFs.