Time-out, isolation and seclusion are used as a response to challenging behaviour, and children are particularly likely to be subjected to it. However, there is a world of difference between a two minute slow-down in a child’s bedroom and an hour’s detention in a bare room. As more has become known about the detrimental effects of isolating people and depriving them of social contact, the use of seclusion as punishment or control has been discouraged in many institutional settings. However, more can be done to minimise its use.
Seclusion is the involuntary placement of a person in a room, exit from which is not permitted (Ferleger 2008). Physical and mechanical restraint often precedes or accompanies seclusion. Isolation in prisons and other detention facilities ranges from solitary confinement away from any human contact except for staff, to prohibition on joining others in scheduled activities including the sharing of meals.
Regulations for the provision of residential care for children in South Australia include instruction about the use of force and isolation. Detention in a room is prohibited in residential care but not in training centres. Training centre residents aged under 12 must not be detained in a detention room and there are time limits for others.
The Office of the Guardian monitors its use at the sites the advocates visit though there have been difficulties in getting accurate information about the use of seclusion. In the one residential facility where it had been used, the practice was discontinued as a result of the visit. In the training centre, where its use is more common, the Office has agreement with the Department on what is expected and how this will be measured. Most detention periods are now under one hour which is a huge change from when monitoring commenced in 2006 when long periods of detention were common.
There is no evidence to suggest that restraint or seclusion effectively reduces either the frequency or the intensity of challenging behaviours, though restraint may temporarily protect the child or others from immediate and serious harm. Contemporary guidelines and policies on managing behaviour in service settings say that restrictive practices should only be used as part of a treatment plan and that its use must be reduced by positive behaviour supports, appropriate physical environments and individualised planning (Australian Psychological Society 2011; Office of the Public Advocate of SA 2012).
A treatment-based approach recognises that the causes of challenging behaviour have to be addressed and new ways of behaving introduced and learned. It is not simple but it is effective. It requires expertise from those working with the young people and energy and enthusiasm in its application. Those who work with children need support and supervision but most importantly training to give them a range of responses to challenging behaviours, and a common language and understanding with the therapists providing the advice.
Australian Psychological Society 2011 Evidence-based guidelines to reduce the need for restrictive practices in the disability sector. http://www.psychology.org.au/practitioner/resources/restrictive/
Ferleger D 2008 ‘Human Services Restraint: Its Past and Future’ Intellectual and Developmental Disabilities Vol 46 No 2
Office of the Public Advocate of South Australia (2012) Guardian Consent for Restrictive Practices in Disability Settings http://www.opa.sa.gov.au/resources/restrictive_practices
Reducing the use of restraint or seclusion requires:
- Leaders who set an organisational culture change agenda;
- Systematic collection of seclusion and restraint data;
- Use of data to inform staff and evaluate incidents;
- Improvement in environmental conditions;
- Individualised treatment and responsiveness to clients;
- De-escalation tools;
- Debriefing to both analyse seclusion events and to mitigate their adverse effects; and
- Staff training.