Commentary on “Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents” by Green-Hennessy and Hennessy

In their 2015 study, Sharon Green-Hennessy and Kevin D. Hennessy addressed an important gap in the literature on seclusion and restraint use in child and adolescent residential treatment centers (RTCs). Their analysis revealed that several facility-level characteristics—such as facility size and ownership—predicted the use of seclusion/restraint in child/adolescent RTCs. The authors also examined patient demographic variables that were significant predictors of seclusion/restraint in prior research on individual patients within facilities. However, Green-Hennessy and Hennessy did not find any relationship between these demographic variables and seclusion/restraint. In this commentary I argue that the null relationship between patient demographics and seclusion/restraint was a result of an ecological fallacy. Rather than attempting to use aggregate patient data to infer individual-level processes, this patient data should be used to study aggregate effects. I demonstrate that by re-conceptualizing these patient demographics as indicative of facility characteristics, rather than patient characteristics, new information can be gleaned about the types of facilities that use seclusion/restraint. The arguments presented here have broader implications for future research in this field that relies on aggregate patient data.