I will stand by you: A shared journey towards seclusion reduction in secure residential youth care

A small proportion (0,2%) of all children and adolescents receiving youth care in the Netherlands are placed in secure residential youth care. These children and adolescents have often encountered various hardships in life such as (domestic) violence, neglect, abuse and/or divorced parents. Children and adolescents in secure residential youth care show severe externalizing and/or internalizing behavior such as aggression, substance abuse and self-harm. When these children and adolescents are considered to be a danger to themselves or others, and when other types of care have been insufficient or avoided by the child or adolescent, they can be admitted to secure residential youth care with judicial authorization. Secure residential youth care aims to protect these children and adolescents, and prepare them for successful participation in society. Contrary to open residential youth care, secure residential youth care is authorized to use restrictive measures, of which seclusion is perceived as one of the most detrimental measures. In the past years, secure residential youth care has been subject to criticism. Both organizations for secure residential youth care and society (i.e., general public, media, and politicians) pledged for a system change. Organizations for secure residential youth care moved towards a shared ambition to strengthen placement prevention of children and adolescents, and to improve their treatment and care. Meanwhile, the debate in society highlighted and criticized the excessive use of restrictive measures, and especially the use of seclusion. This urged organizations for secure residential youth care to accelerate actions for a system change and the reduction of restrictive measures. Therefore, all parties involved in secure residential youth care published a joint action plan in which they stated two main goals: (1) prevent youth from being placed in secure residential youth care, and (2) improve treatment and care for youth who are placed in secure residential youth care. Reducing the use of seclusion to zero is one of the ambitions in this action plan. Seclusion is known to have various adverse physical and psychological effects on both youths and professionals. The use of seclusion can be (re-)traumatizing and negatively affects the relationship between youths and professionals, thereby threatening positive treatment outcomes. Because of these adverse effects, seclusion is perceived as a last resort strategy in situations where the safety of youth or others is at risk and when other, less restrictive, interventions aimed at de-escalation have failed. Nonetheless, adolescents report that seclusion is also used as punishment or for practical reasons. In 2018, research project “I will stand by you” was initiated to contribute to the reduction of seclusion in secure residential youth care in the Netherlands. This research project was set up as participatory action research: all stakeholders (i.e., youths and professionals from secure residential youth care, experts by experience, researchers) were involved in a continuous and reflective process aimed at seclusion reduction. Coming from a situation without a clear and uniform way of describing and registering seclusion, the expectation was that the iterative process of “I will stand by you” – amongst which were the development of an unambiguous and measurable definition and a uniform registration system – would contribute to seclusion reduction. Scientific research was an integral part of this research project, which resulted in the contents of this thesis. The overall aim was to contribute to knowledge about seclusion reduction in secure residential youth care in the Netherlands through (1) developing a uniform definition of seclusion, (2) studying change over time in seclusion use following the implementation of monitoring and feedback as seclusion reduction strategy, and (3) elucidating strategies and preconditions related to seclusion reduction.