ABSTRACT
The use of restrictive practices, particularly seclusion and mechanical restraint (S&MR), in psychiatric hospitals and residential treatment centers for children and adolescents has generated considerable controversy and consternation for policymakers, providers, consumers, and other interested parties. Health and mental health professionals have argued for employment of these restrictive interventions as therapeutically necessary. Advocacy and consumer groups have lobbied strenuously for their attenuation (American Psychiatric Association, 2001). The Joint Commission on the Accreditation of Hospital Organizations (JCAHO) has been urging reductions of restrictive practices in hospitals and residential treatment centers for many years through their standards. The Health Care Financing Administration (HCFA), in a sudden and surprising move, changed the entire landscape with regulations promulgated in August 1999. These regulations have had a major impact on S&MR utilization policies and practices. Confusion and widespread changes in procedures resulted from these changes in hospital and residential treatment of adolescents with severe psychiatric disorders.
