A 26-Year Study of Restraint Fatalities Among Children and Adolescents in the United States: A Failure of Organizational Structures and Processes

Abstract Background Physical and mechanical restraints used in treatment, care, education, corrections programs for children are high-risk interventions primarily due to their adverse physical, emotional, fatal consequences. Objective This study explores the conditions circumstances of restraint-related fatalities United States by asking (1) Who that died physical restraint? (2) How did they die? Method The employs internet search systems discover compile information about youth up 18 years age from reputable journalism sources, advocacy groups, activists, governmental non-governmental agencies. child cohort a published restraint 1993 2003 is combined with 2004 2018. study’s scope has expanded include deaths community schools, as well undiscovered not 2006 study. Results Seventy-nine occurred over 26-year period across spectrum children’s out-of-home welfare, corrections, mental health disability services. research provides data snapshot examples how unfold consequences staff Practice recommendations offered increase safety transparency. Conclusions postulates result confluence medical, psychological, organizational causes; such cultures prioritizing control, ignoring risk, using dangerous techniques, agencies lack structures, processes, procedures, resources promote learning ensure psychological safety.