Relationship Between Youth Restraint and Work Environment

Background and purpose:  Although the practice of child restraint use is well-established, restraints may be the most high risk process in the psychiatric care of children and least investigated in relation to work environment. The purpose of this study was to compare the working environments in programs that utilize restraints and those that do not restrain clients. The study’s research question asked does a high number of restraints negatively impact the work environment?

Methods:  The subject population for this study was the 1,552 employees working directly with children and families within one of 55 programs located within a large human service organization located in the northeast. The organization provided a monthly count of the number of restraints applied by program, and a count of the number of unique youth restrained for those programs that reported restraints. A total of 36 months of data, from January 1, 2008 through December 31, 2010, were provided. The restraint data were provided during the same time period in which the programs’ climate and culture were assessed. Three variables were computed from these data: 1) the mean number of restraints per month, 2) the mean number of unique youth restrained per month, and 3) the mean ratio of restraints per unique youth restrained. This last variable was computed by dividing each month’s number of restraints by each month’s number of unique youth restrained. Work environment was assessed by the Organizational Social Context (OSC) Measurement System which consists of 3 culture scales (proficiency, rigidity, resistance) and 3 organizational climate scales (engagement, functionality, stress).

Results:  Of the 55 programs, 26 reported the use of restraints in a 36 month period and 29 reported no restraint use. The work environment within programs that restrained clients were measured as being significantly more rigid and significantly less engaged with their clients compared to programs that did not use restraints. Within the 26 programs that reported restraint use there were no differences in work environment.

Conclusions and implications:  It would seem reasonable that programs using restraints would perceive their work environment as more rigid and less engaged. What seems less logical is that these factors were the only significant differences found as the OSC tool also measured proficiency, resistance, functionality and stress. Furthermore, the directions of the relationships found that higher frequencies of restraints are associated with increased resistance and decreased functionality, but also with increased proficiency. A preliminary explanation would appear that the more a program restrains the more proficient it becomes. This then would suggest the need for either further refinement of the OCS measure or a better understanding of the relationship between restraints and the work environment.