In Part 1, it was discussed that this law sought to address safety concerns regarding restraints and deaths resulting from improper use or force in community treatment facilities (CTF). The population of most CTFs are diagnosed with serious emotional disturbance or SED. An overt objective established from the Children’s Health Act of 2000, was that any death or injury that results from a restraint, must be reported to the licensing body, which is usually the state’s Department of Social Services, within 24 hours of the death or injury.

It is plausible to believe that the reporting requirement, was added in response to the fact that there was limited data acquired in the 1990’s. Remember, some researchers believe that there were more than 142 child restraint deaths between 1988 and 1998. The value of fairness can be applied. One can argue that the lives of SED children are just as valuable as other children. Too many times, society’s most vulnerable and forgotten citizens are disenfranchised, and no attention is given to them. It is not fair that for an entire decade, no attention or value was given to the lives of the children in residential settings. This law attempts to address and rectify that.

Policy objectives are not always blatant or overt. The Children’s Health Act of 2000 says that any facility that does not comply with these regulations, places that individual state in jeopardy of ineligibility of federal funds for other programs. It would be possible to argue that a covert objective was to save money on a federal scale. There is no evidence, however, that any state lost federal dollars as a result of noncompliance.

The policymakers expected The Children’s Health Act of 2000 to make the residents feel safer. They also expected the number of deaths and injuries to fall as a result. Additionally, the policy was expected to bring the conditions in CTFs and group homes to the national consciousness. Two U.S. Senate committees held public hearings on the use of restraints, and this galvanized support, as the Office of the Inspector General issued public reports documenting the grave crisis nature of death and injury resulting from S/R. Here, S/R means seclusion and restraint.

The direct targets of the policy are the SED children residing in community treatment facilities. When CTFs were established in California, it only provided for 5 in all of the state. Michael Nakaji is a supervisor at one of the 5 CTFs in California. The facility, at which he supervises, is the Special Care Facility, located on the campus of Vista Del Mar Child and Family Services in West Los Angeles. He reports that out of the “thousands” of children in the foster care system, California only has 400 community treatment facility beds statewide. This means that SED children who reside in CTFs, are a very small demographic of the population of system youth. This could be why it took 10 years to hear their stories and finally pay attention to the deaths of these children.

The direct targets also include the staff members who are employed at the community treatment facilities. The Children’s Health Act clearly defines guidelines for the training and yearly re-certification of staff members in proper prevention and execution of restraint techniques.

I believe the indirect targets of The Children’s Health Act are the states in which the CTFs are located in. As stated earlier, the law threatens to make states ineligible for other federal funding, if CTFs within their states do not comply with the guidelines set up by The Children’s Health Act. Each state with a CTF will have to hold strict guidelines for their licensing of CTFs, which costs more money due to additional, extensive training and yearly re-certification.

There are intentional effects/outcomes that policymakers expected. Long term, the intentional outcome of the law outlined stricter guidelines regarding the implementation of restraint of children, reducing death and injury. This protects the rights of CTF residents while keeping everyone safe. Another intended result is that staff will have to be trained and re-certified each year for the duration of employment. This is an additional long-term outcome. Another long-term intended outcome was that agencies will start reporting injuries and deaths. These incidents will no longer be ignored and accurate data can be gathered. Short-term, it can be argued that developing this policy slowed the media coverage and backlash that was building, nationwide, against CTFs in the 1990’s.

There are also unintentional outcomes that resulted from this policy. Because the staff is trained in proper restraint techniques now, it has lead to higher usage of restraint. Magnuson explained that youth workers are trained in restraint techniques with the expectation that these procedures are necessary when other less intrusive strategies could be utilized.

Another unintentional outcome of this policy is that a staff can be trained in appropriate restraint techniques, but it does not account for the emotional, mental, and physical effect on the staff member who is involved in a restraint. This is never addressed in the policy, and Nakaji states that in his 15-year experience, staff can experience “burn-out”. This leads to poor staff retention at CTFs.

When examining whether there are any changes in the distribution of materials, wealth, or other benefits as a result of this policy, there are none to speak of on the federal level. As long as CTF programs adhere to the policy, they will not lose federal funding. However, Michael Nakaji explained that his program has had to re-allocate money from other program budgets to pay for training and yearly re-certification of staff (i.e. paying stipends for trainers). Thus, it becomes an internal change in the distribution of resources and money. Special Care conducts a training every 3 months, and each employee must attend their assigned month each year, in order to stay in compliance before their anniversary date of training expires.

As the law states, it establishes a requirement to protect the rights of the residents in CTF placement. So, therefore, the procedure of restraining children had to change. There is finally a law that is written that protects them. I believe that the law, as it is written, is a good policy. It would be difficult to suggest an alternative policy when the current policy does a great job of addressing the social problem of children dying by restraint. However, it would be a good idea to add to the policy. I believe that both the staff and child who are involved in a restraint should do a debriefing and post-restraint counseling. I can imagine that it would not always be beneficial to have them debrief together, but it would be a great idea to have them process what happened, and how they feel about the incident.

In conclusion, California has come a long way in its treatment and neglect of seriously emotionally disturbed youth in community treatment facilities. It was only 30 years ago, in 1985, when the idea of a CTF was presented to prevent California’s children from going across state lines to receive higher levels of care for their SED symptoms. Throughout a turbulent decade of the 1990’s, far too many children died a preventable death, as a result of being restrained. The Children’s Health Act of 2000 sought to fix that problem. Here in this country, we believe in protecting our children and keeping them safe. It is no wonder that this law passed and remains a national standard by which agencies across the country adhere to, and base their own restraint policies. No law is perfect, but it is understood and widely agreed that any law that protects society’s elderly and children, is a good thing.

Delmar Devers is an MSW intern at Cal State Long Beach. You can more of his work on his blog at