Comments Needed On Seclusion And Restraint Rules To Protect Children

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March 2, 2001—The comment period for the interim final regulations governing the use of restraint and seclusion in psychiatric residential treatment facilities for children and youth will end on March 23, 2001. It's crucial to keep the safeguards in these rules from being weakened. Mental health advocates are urged to review the regulations (you can download them from the Federal Register at http://www.access.gpo.gov/su_docs/aces/aces140.html or you can review the Bazelon Center summary at http://www.bazelon.org/282001alert.html) and write to the Department of Health and Human Services.

Childrens' Rights Must be Protected

Both the October 1998 Hartford Courant articles and the September 1999 General Accounting Office (GAO) report on restraint and seclusion highlight the enormous need to protect the well- being of children and youth in residential facilities. According to the GAO, children and youth are subjected to higher rates of restraint and seclusion use than adults. Furthermore, the prospects for serious injury is far greater for these vulnerable children.

Further Protections Sought

Although, HCFA has promulgated rules that provide higher standards than those in the Children's Health Act (Public Law No. 106-310, see the Bazelon Center's October 4, 2000 Legislative Update for more information) the regulations could be more protective of children's rights in several areas:

Mechanical restraints and young children

• The use of mechanical restraints on children under the age of 13 should be prohibited in psychiatric residential treatment facilities. Children and youth of that age who are in crisis and are acting out should be secluded, held (personal restraint) or subject to continuous, in-the-room monitoring. Banning mechanical restraints entirely in residential placements is not unheard of. In fact the Wright School in Durham, North Carolina, and the Witackar School in Butner, North Carolina operate as two best-practice mechanical restraint-free facilities.

Time-limited orders for restraint and seclusion

• Time limits placed on children in hospitals should be different than the time limits placed on children in residential treatment facilities, where children and youth are not at the same level of crisis. Unfortunately, this is not the case in these regulations. The time-limited orders required (four hours for ages 18-21, two hours for 9-17 year-olds and one hour for children under 9) are entirely too long. Accordingly, we recommend reducing these times to two hours for ages 18-21, one hour for 9-17 year-olds and 30 minutes for children under 9. Similarly, the face to face assessment by a physician or registered nurse should be required within 30 minutes of the initiation of the intervention rather than within one hour.