Patterns of Change in Restraints, Seclusions and Time-outs over the Implementation of Trauma-informed Staff Training Programs in Residential Care for Children and Youth

ABSTRACT Trauma-informed care (TIC) is receiving growing interest and support as a promising approach to reducing the use of restrictive measures (restraints, seclusions and time-outs) in children and youth living in residential care. In this study, we aimed to compare the use of restrictive measures prior to and following the implementation of a TIC staff training initiative in 44 residential units for children and youth and to explore differences between units and type of measures used. Patterns of change in monthly use of restrictive measures 6 months before and 12 months after the training were compared using growth curve models. Restraints, seclusions and time-outs decreased by 41.82%, 19.91%, and 48.15%, respectively, over a year following the training. Despite these important declines, trajectories of restrictive measures did not change significantly from pre- to post-training when holding the TIC training against stringent criteria. Nonetheless, some units’ characteristics were associated with successful changes. Results are promising, but not conclusive about the ability of this TIC training to produce changes in trajectories of restrictive measures, at least in the first year of implementation. This study highlights the need for rigorous statistical models in further studies to ensure accurate empirical evaluation of TIC staff training programs.