Changing the Culture of Care: From Restraints to Relationships

Over the past six years, Holston United Methodist Home for Children in Greeneville, TN, has made a concerted effort to change its culture of care and philosophy of treatment. A restraint reduction effort began in 1998, and a Treatment Model Task Force was created in 1999 in order to move the agency from a strict behavior modification treatment modality to one that focused upon establishing healthy relationships between staff and youth. The results of these combined changes have been a 92% reduction in physical restraints, an 85% reduction in the use of seclusion, and a 93% reduction in client grievances between 1998 and 2003. Overall, the culture and philosophy of care is one that has moved from an orientation of “control” to one of “connecting.”