Creating a Culture of Care

Web Photo_Culture of Care

TNOYS is coordinating a pilot initiative to reduce the use of seclusion and restraint at residential treatment centers by implementing trauma-informed practices.

Research suggests that traumatic histories, both physical and emotional, are common among youth in residential treatment centers (RTCs), and systems of care that include seclusion and restraint are likely to re-traumatize residents already having trouble coping with their past experiences.

For the past decade, the Hogg Foundation for Mental Health at the University of Texas at Austin has participated in initiatives to instate systems of care that offer alternatives to seclusion and restraint.  Hogg is collaborating with TNOYS in a three-year grant to provide training and technical assistance to RTCs in Texas s seeking to implement the Six Core Strategies to Reduce the Use of Seclusion & Restraint.  These strategies are an evidence-based curriculum that focuses on “prevention of conflict and violence, the reduction in use of seclusion and restraint, the implementation of informed care principles, and the fullest possible inclusion of the client in his or her care.”[1]

In this program, TNOYS coordinates regional trainings featuring experts in the field of Trauma-Informed Care, open to all RTCs, as well as individualized technical assistance to a selected group of RTCs.

We are excited to share what we saw and learned! We now have available on our website important resources and tools: two videos (see below) featuring TNOYS staff expert Jack Nowicki as well as staff from a participating RTC, Helping Hand Home for Children; and our full, in-depth evaluation report explaining everything from background on the initiative to results to lessons learned for other youth residential programs.


RESOURCES for RTCs (click to download article):

Collaborative Problem Solving

Critical Incident Review

Critical Incident Review Interview Questions

Integrating Sensory and Trauma-Informed Interventions

Post-Restraint Debriefing Form

Promoting Youth Engagement- What Providers Should Know

Promoting Youth Engagement in Residential Settings- Suggestions from Youth with Experience

Staff Debriefing Tool

Debriefing Comment Form

Tied Up Isolated Schoolhouse

Restraint Use In Residential Programs 2010

Recent training topics include:

  • Adolescent Brain Development
  • Neurobiological and Psychological Effects of Trauma
  • Resiliency and Compassion Fatigue in the Helping Profession
  • The Six Core Strategies to Reduce the Use of Seclusion & Restraint

Highlights of early outcomes after Year 1:

~As reported by RTC staff:

  • Less restraints and more communication
  • Increased use of preventative measures
  • Staff morale and attitudes are very much improved
  • Elimination of “points” or “levels” systems

~As reported by youth:

  • Feel more normal, more motivated
  • Now it is just more relaxed and your body is not tense
  • We care about each other more
  • We can focus on our treatment


*For more information on this initiative, including free regional training dates for RTCs, intensive support site applications, and Trauma-Informed Care reference material, please contact


[1] National Technical Assistance Center for State Mental Health Planning & Human Services Research Institute. (2009). SAMHSA initiative to reduce and eliminate the use of restraint and seclusion. Coordinating Center: Alternatives to Restraint and Seclusion (ARS) State Infrastructure Grant (SIG) Program. First round of ARS SIG grantees. Evaluation report. Cambridge, MA: Author.