Risk factors for physical restraint use with children and youth in community and inpatient mental health settings in Ontario

INTRODUCTION: The application of physical restraints in child and youth mental health settings remains controversial. Physical restraints are control interventions involving the use of a physical device or manual holding to restrict a young person’s movement. Although their use is permitted to manage risky behaviours, physical restraints can cause severe physical and psychological harm in children and youth. Existing literature on restraint use focuses on children and youth in inpatient settings, while research on its use in community health settings remains limited. METHODS: The current study aims to examine patterns and risk factors associated with the use of physical restraints among children and youth in both inpatient and community health settings. Data for this study were drawn from the interRAI Child and Youth Mental Health (ChYMH) assessment instruments (including those with developmental disabilities; ChYMH-DD), implemented by trained professionals as part of standard clinical practice. The sample comprised of 32,422 children and youth aged 4–18 receiving mental health services in Ontario between 2012 and 2022, across community and inpatient settings. This study employed a retrospective secondary analysis of assessment data. Logistic regression analysis was used to identify factors associated with physical restraint use. RESULTS: In our sample, males and younger children (4–11) experienced the most physical restraint. Results indicated that children with a diagnosis of autism (ASD), reactive attachment disorder, schizophrenia and other psychotic disorders, and substance use disorder experienced higher rates of physical restraint than those without a diagnosis. Furthermore, externalizing symptoms, internalizing symptoms, risk of suicide and self harm, high caregiver distress, dependent cognitive skills, and living with a nonrelative were associated with physical restraint use. CONCLUSIONS: Findings provide researchers and clinicians with important insights into risk factors for physical restraint among vulnerable children and youth, which can be used to inform care planning and the development of targeted prevention and early intervention programs. This research highlights the importance of identifying trauma, providing trauma-informed care, and using a standardized assessment-to-intervention approach across service sectors to reduce the use of physical restraints in child and youth mental health settings.