National Coordinating Center to Reduce and Eliminate the Use of Seclusion and Restraint

The Alternatives to Restraint and Seclusion State Infrastructure Grant Project (S/R-SIG) is an initiative of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Mental Health Services (CMHS), designed to promote the implementation and evaluation of best practice approaches to preventing and reducing the use of seclusion and restraint (S/R) in mental health settings.

The Technical Assistance Coordinating Center contract was awarded to NASMHPD’s National Technical Assistance. CMHS has also contracted with CSR to conduct the evaluation of state activities under this initiative. The Coordinating Center works in collaboration with a number of stakeholders including a fourteen-member Steering Committee; the state grantees; NTAC; and CMHS.

The current eight state grantees, announced in the fall of 2007, include: Connecticut; Indiana; New Jersey; New York; Oklahoma; Texas; Vermont; and Virginia. Most of the states are implementing best practice alternatives in multiple settings and with a variety of service users. These include facilities serving adults and those serving children and/or adolescents, in community and institutional settings that include forensic and sexual offender populations. The S/R-SIG Initiative is designed to run for three years and end in 2010.

This is the second round of grants. The first round of grantees, announced in the fall of 2004, include: Hawaii; Illinois; Kentucky; Louisiana; Maryland; Massachusetts; Missouri; and Washington. A final report regarding these grants, being compiled by HSRI, should be available in the near future.

The overall purpose of the Coordinating Center is to promote the implementation and evaluation of best practice alternatives to the use of S/R. Project outcomes include:

• to enhance state efforts to develop, implement, and adopt best practices that reduce S/R use in a variety of settings and with a diverse group of service users
• to improve safe outcomes for persons served and staff by reducing S/R use
• to provide recommendations to SAMHSA designed to inform national policy and develop evidenced based practice, including a successful application to SAMHSA’s National Registry of Effective Programs and Practices (NREPP).

The Coordinating Center assesses the impact of the effect of the SIG grants to implement best practice alternatives; serves as a resource center for the SIG sites and other interested states/stakeholders; disseminates best and promising practices and lessons learned to a national audience, and provides onsite and offsite technical assistance to S/R-SIG grantees and others.

CSR is responsible to assess the performance of the sites (process evaluation); to measure the relative impact of various components of diverse best practices for reducing S/R (outcomes evaluation); to develop and test fidelity measures for the interventions; and to support the application for (NREPP).

The Steering Committee’s primary purpose is to serve in an inclusive advisory capacity to the project. The Committee includes nationally recognized experts and stakeholders with specific interest and expertise in S/R use. These members include:

2008 Steering Committee members:

In addition to the S/R-SIG Coordinating Center, NTAC continues its role as a SAMHSA funded technical assistance center to provide training and technical assistance to state mental health agencies on reducing and eliminating the use of seclusion and restraint, using a prevention-based training curricula called The Six Core Strategies© to Create Violence-Free and Coercion-Free Mental Health Treatment Environments. NTAC staff and faculty have to date trained over 46 state delegations, comprised of senior state provider leadership staff, using this framework. NTAC also has technical assistance materials in the public domain that are available to any interested party.

NTAC has also established a bulletin board to facilitate discussion regarding seclusion and restraint SIG grants. NASMHPD, and the current seclusion and restraint grantee sites, have made available various summary site experiences detailing activities by these grantees. These reports can be viewed here. If you would like to post a summary of your experiences, please click here to access our online Invitation to Showcase Successful Seclusion and Restraint Reduction Activities. If you have any questions please contact NASMHPD.