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BackgroundPhysical and mechanical restraints used in treatment, care, education, and corrections programs for children are high-risk interventions primarily due to their adverse physical, emotional, and fatal consequences. ObjectiveThis study explores the conditions and circumstances of restraint-related fatalities in the United States by asking (1) Who are the children that died due to physical restraint? and (2) How did they die?MethodThe study employs internet search systems to discover and compile information about restraint-related fatalities of children and youth up to 18 years of age from reputable journalism sources, advocacy groups, activists, and governmental and non-governmental agencies. The child cohort from a published study of restraint fatalities in the United States from 1993 to 2003 is combined with restraint fatalities from 2004 to 2018. This study’s scope has expanded to include restraint deaths in community schools, as well as undiscovered restraint deaths from 1993 to 2003 not in the 2006 study.ResultsSeventy-nine restraint-related fatalities occurred over the 26-year period from across a spectrum of children’s out-of-home child welfare, corrections, mental health and disability services. The research provides a data snapshot and examples of how fatalities unfold and their consequences for staff and agencies. Practice recommendations are offered to increase safety and transparency.ConclusionsThe study postulates that restraint fatalities result from a confluence of medical, psychological, and organizational causes; such as cultures prioritizing control, ignoring risk, using dangerous techniques, as well as agencies that lack structures, processes, procedures, and resources to promote learning and to ensure physical and psychological safety.

The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening “upstream” at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

This correction is to alert readers of an earlier version of Nunno, M. A., McCabe, L. A., Izzo, C. V., Smith, E. G., Sellers, D. E., & Holden, M. J. (2021). A 26-year study of restraint fatalities among children and adolescents in the United States: A failure of organizational structures and processes.

Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants' attitudes toward genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (𝑛 = 960), Framingham Heart Study (𝑛 = 955), and Framingham Heart Study–Omni Cohort (𝑛 = 160). Based on a three-question attitude scale, most participants had positive attitudes toward genetic testing (median score = 4.3-5/5). Participants were also asked to select words to describe their attitudes toward genetics. More respondents endorsed the positive words \"hopeful\" (60%-70%), \"optimistic\" (44%-64%), \"enthusiastic\" (35%-43%), or \"excited\" (28%-30%) than the negative words \"cautious\" (35%-38%), \"concerned\" (25%-55%), \"worried\" (6%-13%), \"pessimistic\" (2%-5%), or \"horrified\" (1%-5%). Characteristics associated with favorable attitudes were greater genetics knowledge, higher subjective numeracy, experience with genetic testing, less frequent religious attendance, and not being employed. These findings demonstrate variation in attitudes even among participants in long-standing cohort studies, indicating a need for ongoing participant engagement and education.

Health care professionals report a lack of skills in the psychosocial and spiritual aspects of caring for dying people and high levels of moral distress, grief, and burnout. To address these concerns, the \"Being with Dying: Professional Training Program in Contemplative End-of-Life Care\" (BWD) was created. The premise of BWD, which is based on the development of mindfulness and receptive attention through contemplative practice, is that cultivating stability of mind and emotions enables clinicians to respond to others and themselves with compassion. This article describes the impact of BWD on the participants. Ninety-five BWD participants completed an anonymous online survey; 40 completed a confidential open-ended telephone interview. Four main themes-the power of presence, cultivating balanced compassion, recognizing grief, and the importance of self-care-emerged in the interviews and were supported in the survey data. The interviewees considered BWD's contemplative and reflective practices meaningful, useful, and valuable and reported that BWD provided skills, attitudes, behaviors, and tools to change how they worked with the dying and bereaved. The quality of presence has the potential to transform the care of dying people and the caregivers themselves. Cultivating this quality within themselves and others allows clinicians to explore alternatives to exclusively intellectual, procedural, and task-oriented approaches when caring for dying people. BWD provides a rare opportunity to engage in practices and methods that cultivate the stability of mind and emotions that may facilitate compassionate care of dying patients, families, and caregivers.

To understand the role of patients' beliefs in pain management in a cancer population treated in a primary care setting. Secondary analyses of data from the baseline phase of a randomized study. Eight of the largest primary care clinics in a managed care system. 342 patients with cancer who reported pain that would not dissipate on its own or when treated by over-the-counter medication; approximately half had pain that was not cancer related. Telephone interviews. Patients' demographic characteristics, self-reported history and beliefs about pain and pain treatment, willingness to report pain and take pain medication, recent pain intensity, and administrative data on opioid prescriptions. Patients' beliefs were not associated strongly with reporting pain or taking medication. Regression analyses revealed that patients' beliefs played a limited role in predicting recent pain intensity, whereas the providers' pain management practices seemed to have a far greater predictive role. Additionally, among patients with recent moderate to severe pain, the relationship between patients' beliefs and their history of pain and pain treatment further suggests that beliefs are likely to be formed, in part, as a consequence of the care they receive. Results did not depend on whether the cause of pain was related to cancer. Patients' beliefs were important barriers to effective pain management, either as direct or indirect determinants of pain. Providers' pain management practices were more likely to determine the level of pain relief achieved and the beliefs their patients came to hold based on their personal experiences. Nursing interventions should examine the impact of evaluating patients' beliefs in conjunction with pain assessment on pain-related behaviors and pain relief, as well as the ability of patient educational efforts to strengthen accurate beliefs and enable patients to assert themselves when interacting with less knowledgeable providers.

Children and young people in residential care have often lived lives saturated with loss, neglect, rejection, and traumatic experiences. Children express the pain of trauma in various ways, namely pain-based behaviors manifesting in ways that often leave their care givers confused, frustrated, frightened, angry or exhausted. For residential caregivers to respond to children and young people in a consistent and therapeutic manner, residential environments must provide an ethos of respect, caring, and trust, creating a safe place for children and staff to live and learn together. This paper describes the Children and Residential Experiences (CARE) model, its implementation, and evidence for its effectiveness. CARE is a trauma-informed, principle-based, multi-component program designed to enhance the social dynamics in group care settings and help agencies create a living environment that provides developmentally enriching experiences for children in their care. By incorporating the CARE principles throughout all levels of the organization and into daily practice, the CARE program model has been shown to improve the capacity of staff to establish positive developmental relationships with the children in their care, offer developmentally enriching experiences and a “sense of normality”, and create cohesion and congruence throughout the organization. Through consistent and predictable compassionate and responsive interactions with adults, as well as opportunities to overcome challenges and to experience successful learning opportunities, children can grow, develop and thrive.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest school-based field trial ever sponsored by the National Institutes of Health. The trial demonstrated positive changes in the school food service and physical education program, as well as in students' cardiovascular health behaviors. Because the CATCH intervention programs were implemented in 56 schools (in four states) that were typical of schools throughout the United States, their reception by schools and degree of implementation provide evidence about their feasibility for schools nationally. Extensive process evaluation data were collected from students, teachers, school food service personnel, and physical education specialists throughout the three school years of the CATCH intervention. Four of the CATCH programs—school food service, physical education, classroom curricula, and home programs—were assessed over the three school years. The process data provide information on participation, dose, fidelity, and compatibility of the CATCH programs in the intervention schools for these programs. High levels of participation, dose, fidelity, and compatibility were observed for the four programs during the 3 school years. CATCH emerges as a model of a feasible multilevel health promotion program to improve eating and exercise behaviors for elementary schools in the United States.

Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants’ attitudes towards genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (n=960), Framingham Heart Study (n=955), and Framingham Heart Study-Omni Cohort (n=160). Based on a three-question attitude scale, most participants had positive attitudes towards genetic testing (median score 4.3–5/5). Participants were also asked to select words to describe their attitudes towards genetics. More respondents endorsed the positive words “hopeful” (60–70%), “optimistic” (44–64%), “enthusiastic” (35–43%), or “excited” (28–30%) than the negative words “cautious” (35–38%), “concerned” (25–55%), “worried” (6–13%), “pessimistic” (2–5%) or “horrified” (1–5%). Characteristics associated with favorable attitudes were greater genetics knowledge, higher subjective numeracy, experience with genetic testing, less frequent religious attendance, and not being employed. These findings demonstrate variation in attitudes even among participants in long-standing cohort studies, indicating a need for ongoing participant engagement and education.