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Cornell University

RCCP Research Reports

Below are published studies conducted by Residential Child Care Project faculty.

Learning From Tragedy: Restraint Fatalities In Child Welfare, Mental Health and Juvenile Corrections Facilities

Evaluating and Monitoring the Impact of a Crisis Intervention System on a Residential Child Care Center

Using a Prone/Supine Perception Survey and Literature Review to Forward the Conversation Regarding All Restraints

2008 Prone/Supine Perception Survey and Literature Review Comparison Study

Learning From Tragedy: Restraint Fatalities In Child Welfare, Mental Health and Juvenile Corrections Facilities

Michael A. Nunno, DSW
Martha J. Holden, MS

Abstract: This descriptive study examines 45 child and adolescent fatalities related to restraint in residential (institutional) placements in the United States from 1993-2003.
Method: The study team used common Internet search engines as a case discovery strategy to determine the frequency and the nature of the fatalities, as well as the characteristics of the children and adolescents involved.
Results: Male children and adolescents were over represented in the study sample. Thirty-eight of the fatalities occurred during or after a physical restraint, and 7 fatalities occurred during the use of mechanical restraints. Twenty-eight of the deaths occurred in a prone restraint. In 25 of the fatalities, asphyxia was the cause of death.
Conclusions: In the 23 cases in this study where information is available, none of the child behaviors or conditions that prompted the restraint would meet the standard of danger to self or others: the commonly accepted criteria for the use of a restraint in any circumstance. The study points to deficiencies in fatality reporting, recommends reporting fatalities to established state child fatality review board, and reinforces that restraints be governed by strict protocol and monitoring. The study also urges caution to policymakers in substituting or changing restraint procedures based on the incomplete data reported in this study.

Click here to download this report as a printable PDF file.

Evaluating and Monitoring the Impact of a Crisis Intervention System on a Residential Child Care Facility

Michael A. Nunno, DSW
Martha J. Holden, MS
Brian Leidy, PHD

Published in: Children and Youth Services Review, Vol. 25, No. 4, pp. 295-315, 2003.

Abstract: Residential child care staff require specialized knowledge and skills to prevent and manage aggressive and acting out behavior on the part of children in their care. Often a child’s aggression is visible through crisis episodes that leave both the child and the care worker in turmoil. Without proper training and supervisory support, staff can react to a child’s aggression with counter-aggression; or worse, staff can respond with abusive behavior toward the child. This article reports the process and impact of implementing a consistent crisis intervention methodology known as Therapeutic Crisis Intervention (TCI) within one medium sized facility in the northeastern United States. Impact was measures by monitoring critical incidents, staff knowledge, confidence and skill levels, and the consistency of staff intervention pre and post implementation. The implementation of TCI was successful in substantially reducing critical incidents, significantly reducing documented physical restraint episodes in one unit, and increasing staff knowledge, confidence and consistency in crisis intervention facility-wide. This article discusses the limitations of this evaluation and monitoring system, and suggests additional evaluation strategies that might overcome these limits.

Click here to download this report as a printable PDF file.

Using a Prone/Supine Perception Survey and Literature Review To Forward the Conversation Regarding All Restraints

Jack C. Holden, PHD
Teisha Johnson, MS
Michael Nunno, DSW

Abstract: The concern for safer physical restraints continues to permeate discussions for child and youth residential care facilities world wide. The most controversial conversation appears to be centered in prone physical restraints versus supine physical restraints. In New York State, the Office of Mental Health (OMH) teaches the use of supine restraints and has banned the use of prone restraints in its licensed youth residential centers. The Office of Child and Family Services (OCFS) allows the use of prone restraints in its licensed youth residential centers. Many youth residential centers are licensed by both agencies, which has resulted in confusion and contradictions in training and program implementation. This quantitative study and literature review is designed to assess basic differences in physical and emotional risk, safety, efficiency, and training associated with using supine, prone, and all physical restraints. The data will be forwarded to the OMH and OCFS for review to determine if a shift in the type of floor restraints is warranted.

Click here to download this report as a printable PDF file.

2008 Prone/Supine Perception Survey & Literature Review Comparison Study

Jack C. Holden, PHD
Michael Nunno, DSW
Brian Leidy, PHD

Abstract: The concern for safer physical restraints continues to permeate discussions for child and youth residential care facilities worldwide. The most controversial conversation appears to be centered in prone physical restraints versus supine physical restraints. In New York State, the Office of Mental Health (OMH) teaches the use of supine restraints and has banned the use of prone physical restraints in its licensed youth residential centers. The Office of Child and Family Services (OCFS) allow use of prone restraints in its licensed youth residential centers. Many youth residential centers are licensed by both agencies that had resulted in confusion and contradictions in training and program implementation. This three (3) year quantitative perceptions study and literature review is designed to assess basic differences in physical and emotional risk, safety, efficiency, and training associated with using supine, prone, and all physical restraints. The data will be forwarded to the OMH and the OCFS for review to determine if a shift in the type of floor restraints is warranted.

Click here to download this report as a printable PDF file.

Click here to download the Table, "2008 Literature Review Prone/Supine Comparison Study of Restraints" from the report.