New and revised requirements for BHC organizations that use restraint and/or seclusion

Effective Jan. 1, 2025, new and revised requirements will apply to behavioral health care and human services (BHC) organizations that use restraint and/or seclusion. The changes include revising the definition of restraint; reducing redundancies; streamlining processes; and removing requirements for physical holding of a child or youth and incorporating this concept into the requirements for restraint and seclusion because physical holding that restricts freedom of movement is a type of restraint.

Physical holding restraints can be as dangerous as other types of restraint and should be held to the same requirements, as evidenced by a study that examined data collected over 26 years regarding restraint fatalities among children and adolescents in the United States. The study confirms deaths from physical holding restraints (that is, without any devices). In this study, 63 of 79 reported deaths were from physical holding without mechanical devices.

Recommendations to improve safety when using any restraints include implementing and following robust organizational processes (Nunno MA, et al. A 26-year study of restraint fatalities among children and adolescents in the United States: A failure of organization structures and processes. Child Youth Care Forum. 2022;51(3):661–680. Accessed Jun 5, 2024). As part of these processes, well-established clinical practice and many federal and state regulations require the oversight of licensed practitioners who order restraints and evaluate individuals who are in restraint and seclusion.

The revised definition of restraint in the Glossary (GL) of the Comprehensive Accreditation Manual for Behavioral Health Care and Human Services (CAMBHC) clarifies what is and is not a restraint as follows:

• restraint Restraint is any method (chemical or physical) of restricting the freedom of movement of an individual served to manage their behavior. This includes any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of an individual to move their arms, legs, body, or head freely. It also includes any drug or medication when it is used as a restriction to manage the individual’s behavior or to restrict their freedom of movement and is not a standard treatment or dosage for their condition.

Interventions that do not restrict movement (such as a light grasp that the individual could easily remove or escape from) do not meet the definition of restraint. Examples of this include the following:

• Briefly holding an individual to calm or comfort them
• Physically assisting someone to complete a task
• Escorting or guiding someone away from an area or situation
• Separating individuals to break up a fight
• Physical interventions to prevent imminent danger (stopping an individual from running into traffic, tripping, or falling)

The new and revised requirements will be posted on the Prepublication Standards page of The Joint Commission’s website and will publish online in the fall 2024 E-dition® update to CAMBHC. For those who purchase them, the fall 2024 update service and the 2025 hard-copy and PDF versions of CAMBHC will include these requirements.

For more information, please contact The Joint Commission’s Standards and Survey Methods.

See the prepublication standards Learn more about the prepublication standards