Reducing restraint and seclusion: Evaluation of systems change in Connecticut

In order to evaluate the efforts of CT state hospitals to reduce seclusion and restraint, we implemented a multi-layered, mixed-method evaluation. In addition to data collected for the SAMHSA-required national evaluation including changes in policies and procedures and rates of seclusion and restraint by patient characteristics, we sought to monitor issues that were important to CT stakeholders, as identified by advisory committees at the state and local levels. These include rates of injury of staff and patients, the need for 1:1 observations, and the satisfaction with new procedures and the hospital environment. Evaluation methods included participant observation, semi-structured interviews, focus groups, client and staff surveys, and review of administrative information. Frequent feedback to the project director and advisory groups helped to shape the initiative as it unfolded. We will present data on the changes over the early course of the initiative and describe the ways that data from multiple sources were blended to draw conclusions. We will describe how hospital context facilitated or impeded the ability of the hospital to launch changes, and the correlation between trauma-informed care system changes and reductions in seclusion and restraint.