Time-out placements in residential care: Towards a better understanding of restrictive measures in response to the behavioral manifestations of vulnerable youths

Youth in care are significantly more likely to exhibit intense behavioral manifestations (behavior that puts the youth or those around him at risk, or challenges the therapeutic relationship) than are youth in the general population and the majority have a history of multiple traumas. When youth behavior escalate, efforts are made to mitigate these behaviors. In Quebec (Canada), one such strategy is time-out placement (TOP). TOP is a short-term placement whose main objective is to temporarily separate a youth manifesting severe behaviors from the environment in which these behaviors occur. However, literature on trauma-informed practice suggests that TOP may present an increased risk of placement instability. Our study aims to analyze differences between youth who have experienced this measure and those who have not in their placement trajectory, in the restrictive measures employed and in their behavior. The population (N = 3755) consisted of all youth (12–17 years old) having experienced residential care placement one day or longer, between the years 2014 and 2019, in Montreal. To control the potential effect of trajectory in childhood, a propensity score matching method was used to analyze the data extracted and create two groups based on the presence or absence of TOP in adolescence, then compared using hierarchical logistic regression. The results show that youth who have been subjected to at least one TOP in adolescence are more likely to exhibit behaviors of such intensity as to prompt the use of restrictive measures, and that the use of TOPs in the context of runaways may be commonplace. Indeed, TOPs are also associated with greater placement instability. Our study supports recommendations to reform the intervention paradigm of child welfare services and institutions, rethinking current approaches to meeting the needs of youths in care to ensure that care becomes more trauma-sensitive. • The likelihood of experiencing a Time-out placement increased with time spent in care. • Youths with at least one Time-out placement experience more restrictive measures. • Each running away increases youths' risk of experiencing a Time-out placement. • Placement moves are more likely for youths with at least one Time-out placement.