In November 2000, the Massachusetts Department of Mental Health (DMH), through its Licensing and Child/Adolescent Services Divisions, embarked on a mission to reduce and ultimately eliminate the use of restraint and seclusion in all child and adolescent inpatient and intensive residential treatment facilities in the state. Between November 2000 and January 2005, episodes of restraint and seclusion (per 1,000 patient days) decreased 84.4%, 80.4% and 78.7%, respectively, in child (ages 5-12), adolescent and mixed child/adolescent units. This work is ongoing.
In the fall of 2004, Massachusetts DMH was one of eight states selected by SAMHSA to receive a State Infrastructure Grant (SIG) to develop alternatives to restraint and seclusion in DMH-operated and contracted adult inpatient facilities, which also include three adolescent inpatient units. DMH kicked off this new initiative to reduce/eliminate restraint and seclusion in DMH facilities in July 2005.
Included on this web site are some of the tools that have been used to provide technical assistance and consultation to the units/facilities and some other, associated statistics. Other information will be added from time to time.
Sample Safety Tools
- Promoting Alternatives to the Use of Seclusion and Restraint - Issue Brief #4(PDF)
- Family Position Statement on Restraint/Seclusion Prevention
- Youth Position Statement on Restraint/Seclusion Prevention - Designed for Youth (PDF)
- Youth Position Statement on Restraint/Seclusion Prevention - Designed for Adults (PDF)
- Regulatory Change: A Pathway to Eliminating Seclusion and Restraint or
- Child and Adolescent Inpatient Restraint Reduction: A State Initiative to Promote Strength-Based Care (PDF)
- Final Improvement Planning Document (PDF)
- Rate of Injury - Staff and Patients (PDF)
- Massachusetts DMH - Staff and Resident injuries in Continuing Care Units (Chart) (Excel)
- DMH Restraint and Seclusion Philosophy Statement, Sept 2007 (PDF)
- SAMHSA Grant Kick-Off (PDF)
- The Economic Cost of Using Restraint and the Value Added by Restraint Reduction or Elimination (PDF)
- Sensory Approaches in Inpatient Psychiatric Settings (PDF)
- Resource Guide: Creating Positive Cultures of Care (PDF)
Interagency Restraint and Seclusion Prevention Initiative
In response to growing concern about restraint and seclusion use in child-serving settings, the Commonwealth has organized a cross-secretariat effort to reduce and prevent their use. The Initiative brings together leaders from the state Departments of Children and Families (DCF), Mental Health (DMH), Youth Services (DYS), Early Education and Care (EEC), Elementary and Secondary Education (ESE) to work in partnership with the Office of the Child Advocate and parents, youth, providers, schools and community advocates to focus on preventing and reducing the use of behavior restrictions that can be re-traumatizing. The vision for the multi-year effort is that all youth-serving educational and treatment settings will use trauma informed, positive behavior support practices that respectfully engage families and youth.
This initiative capitalizes on the Department of Mental Health's award-winning, nationally recognized, 10-year restraint and seclusion prevention effort that has occurred statewide across all psychiatric facilities and produced significant results, making DMH's work a national model of innovation in reducing and preventing seclusion and restraint.