Alternatives to Coercive Techniques

Pennsylvania is joining the nation-wide movement to enhance trauma-informed care and services within residential facilities. Best practices, high quality programming, and well-trained staff are critical in providing care that reduces the need for the use of restraint, while ensuring the safety of all residents and staff. This page is being developed with the goal of providing technical assistance and resources to assist residential facilities in achieving the ultimate goal of eliminating the need for the use of coercive techniques.

Bibliography on Alternatives to Seclusion and Restraint

This annotated bibliography has been grouped according to the six core strategies identified by the National Association of State Mental Health Program Directors (NASMHPD):

  1. Leadership toward organizational change
  2. Use of data
  3. Workforce development
  4. Use of seclusion/restraint reduction tools
  5. Consumer roles/advocacy
  6. Debriefing activities.

This bibliography was prepared by Gordon R. Hodas, M.D., Statewide Child Psychiatric Consultant to the Office of Mental Health and Substance Abuse Services.

Leadership Toward Organizational Change

Gunn, S. (2000). Organizational systems to minimize restraint and maximize dignity, effective treatment and safety. Presentation to Walker Trieschman Conference, May 11, 2000. This paper is applicable to any system serving children and adolescents in care. It offers an overview of 10 organizational systems needed to provide a safe environment that respects the dignity of the individual and minimizes the use of restraint. These systems are: leadership, treatment program, assessment and care planning, Human Resource issues, accountability and client rights, restraint processes, review of selected training programs, sentinel events and root cause analysis, and risk management. Used by permission of Steve Gunn.

Workforce Development

1. Epidemiology of Childhood Trauma and Maltreatment

Hennessey, M., et al (2004). Trauma among girls in the juvenile justice system. Washington, DC: Juvenile Justice Working Group of the National Child Traumatic Stress Network, www.NCTSNET.org. Data from many sources indicate that females in the juvenile justice system are highly likely to have experienced trauma, especially direct victimization. These individuals are at high risk of substance use, involvement in violent activity, further victimization, and development of mental health problems. Ensuring safety in care is essential. In addition, gender-specific programming is needed.

2. Neurobiology and Consequences of Child Trauma and Maltreatment

Perry, B (2000). Traumatized children: How childhood trauma influences brain development. Journal of the California Alliance for the Mentally Ill. 11(1): 48-51. Starting with a clinical vignette, Perry describes changes in brain structure and neurobiology that occur in children subjected to trauma, and how this may influence the child's functioning.

3. Hiring, Orienting, Training, Supervising and Evaluating Direct Care Staff

Hodas, G. (2005). Empowering direct care workers who work with children and youth in institutional care. Harrisburg, PA: Office of Mental Health and Substance Abuse Services. In recognition of the key role of direct care workers in reducing the use of restraint, the paper proposes a systematic approach to the hiring, orientation, training and supervision, performance evaluation, and mentoring of direct care staff, so that they can provide appropriate interventions consistent with trauma informed care.

Trout, B. (2005). The Silver Springs Model of trauma recovery and resilience for children and adolescents: Key elements in our therapeutic-teaching community. Silver-Springs-Martin Luther School. This document, based on concepts of the Sanctuary Model, is used for staff orientation at the above facility. In a straightforward way, the document helps staff understand the core needs of children and youth in care, including how to respond therapeutically.

4. Understanding and Implementing Trauma Informed Care

Mahoney, K., Ford, J., Ko, S., Siegfried, C. (2004). Trauma-focused interventions for youth in the juvenile justice center. Washington, DC : Juvenile Justice Working Group of the National Child Traumatic Stress Network. Many children and youth in juvenile justice facilities have experienced trauma and maltreatment, and it is essential that their trauma-related needs be recognized and addressed. The authors discuss the importance of pretreatment assessment, trauma-focused interventions, treatment of co-occurring disorders, and family based interventions with this population.

Resources for the DHS Alternatives to Coercive Techniques (ACT) Initiative

Living Sanctuary: Creating Trauma-Informed Systems That Promote Recovery, by Sandra Bloom, M.D.; presentation at ACT forums on September 21 and 25, 2006. Used by permission of Sandra Bloom.

Organizational Systems to Minimize Restraint and Maximize Dignity, Effective Treatment and Safety, by Steve Gunn; presentation to Walker Trieschman Conference, May 11, 2000. Used by permission of Steve Gunn. Annotated Bibliography Prepared by Steve Gunn, also used by permission of Steve Gunn.

The Silver Springs Model of Trauma Recovery and Resilience for Children and Adolescents, Used by permission.

Reducing Seclusion and Restraint Use in Child and Youth Settings: Changing Our Cultures of Care, presentation by Kevin Huckshorn, National Association of State Mental Health Program Directors. Used by permission.

Reducing Seclusion and Restraint Use in Child and Youth Mental Health and Related Settings: Changing our Cultures of Care, list of references prepared by Kevin Huckshorn, National Association of State Mental Health Program Directors. Used by permission.

Responding to Childhood Trauma: The Promise and Practice of Trauma Informed Care, by Dr. Gordon R. Hodas.

Six Core Strategies© to Reduce the Use of Seclusion and Restraint: Planning Tool, by Kevin Ann Huckshorn

A Snapshot of Six Core Strategies for the Reduction of Seclusion and Restraint

Strategies and Practices to Reduce Unnecessary Use of Restraint, Special Transmittal from the Department of Human Services, January 30, 2006

Web Resources

Office of Mental Health and Substance Abuse Services
The Department of Human Services's Office of Mental Health and Substance Abuse Services administers behavioral health services for adults, children and adolescents in the public sector.

Rehabilitation & Community Providers Association
The Pennsylvania Community Providers Association promotes a community-based, responsive and viable system of agencies providing quality services for individuals receiving mental health, mental retardation, addictive disease and other related human services. To achieve that purpose, the association serves as a forum for the exchange of information and experience, represents providers on legislative and administrative matters and serves as a point of contact with other related statewide organizations.

Pennsylvania Department of Education
The Department of Education administers public and private education programs in Pennsylvania, including special education services and the 29 intermediate units throughout the commonwealth. Information about the Student Assistance Program, providing referral services for students with drug and alcohol and mental health needs, is available through the Department.

Pennsylvania Psychological Association
The Pennsylvania Psychological Association advances psychology in Pennsylvania as a means of promoting human welfare. It carries out this mission through activities that educate and support the professional development of their members, educate the public through disseminating and applying psychological knowledge, maintain and build organizational strength and advocate vigorously for public access to psychological services.

Pennsylvania Training and Technical Assistance Network (PaTTAN)
PaTTAN supports the efforts of the Bureau of Special Education and its initiatives and to build the capacity of local educational agencies to provide appropriate services to students who receive special education services. PaTTAN offers many free or low-cost training sessions throughout the commonwealth through its regional sites or by downlink to intermediate units.

The Child Advocate
ChildAdvocate.net serves the needs of children, families and professionals while addressing mental health, medical, educational, legal and legislative issues.

Disability Rights Network of Pennsylvania (DRN) is a statewide, non-profit corporation designated as the federally-mandated organization to advance and protect the civil rights of adults and children with disabilities.