Date of Award

8-2009

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Social Work

Major Professor

William Nugent

Committee Members

Karen Sowers, John Wodarski, Barbara Thayer-Bacon

Abstract

This simple interrupted time-series quasi-experimental study examined the effectiveness of a restraint reduction policy implemented in order to reduce the use of physical restraint in a residential treatment facility for children in the southeastern United States. Aggregate data on monthly physical restraint episodes from the agency were analyzed over a period of 4 years. A 22-month period was used as the baseline and the succeeding 26 months- when the restraint reduction policy was implemented- was the intervention phase. A regular regression model, estimated using ordinary least squares (OLS), modeled the effect of the policy change, and autoregressive integrated moving average (ARIMA) models were used to represent the autocorrelation structure of the residuals from the regression model, in the data analysis.

Two ARIMA models, an ARIMA (1,0,0) and an ARIMA (0,0,1), were used to model the autocorrelation structure of the residuals from the OLS regression. The convergence of findings from these models suggested that the results of the analysis of the time-series data from this study were robust in a statistical sense because both models led to the same conclusion. There was a statistically significant decrease of about 1 restraint per child each month when the new policy of verbal de-escalation was implemented during the treatment phase. The rate of physical restraint was reduced by 70% with the implementation of the restraint reduction policy in both models. Although a significant reduction in the rate of physical restraints was associated with the implementation of the restraint reduction policy, interrupted time-series designs such as that used in this study are not strong enough for making cause-effect inferences.

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