How can the advanced practice nurse provide culturally appropriate care for this disparity? - How does this disparity compare in a rural versus urban area? - Has this disparity improved or worsened? - Can you relate this information to your current or future practice? Discuss whether the findings are usable for you and whether they served a purpose.

Black Americans and restraint utilization in mental health residential treatment centers Children and adolescents are commonly restrained during treatment in residential centers to prevent them from harming themselves and others. Restraint use can result in emotional and physical harm, even death. Therefore, the use of restraints should be limited to when they are absolutely necessary. These effects of being retrained may be more harmful for youth who have suffered traumatic events, and this is a group that is disproportionately represented in the residential treatment center patient population. In, “An exploration of youth physically restrained in mental health residential treatment centers,” Michael T. Braun, Nicole B. Adams, Courtney E. O'Grady, Deserai L. Miller, and Jonathan Bystrynski (2020) explored the pattern of restraint utilization in mental health residential centers for minors relative to age, sex, race, and primary diagnosis. While this article exposed several patterns regarding the utilization of restraints in youth mental health residential centers, there are limitations related to interpreting the data and finding meaningful and useful information that can inform and transform care within these facilities. The first author of this study partnered with a residential treatment provider in the Midwest who had facilities in several states and provided the research team a dataset with information about children and adolescents living in six residential treatment centers along with their correlated restraint incidents during a three-year period. Each child was represented by a number, along with demographic details including their year of birth, sex, race, and primary diagnosis. The dataset utilized in the study contained information about 794 youth involved in 13,339 restraint incidents. This dataset does not include all of the children in the treatment facilities over the three-year period; only those involved in restraint incidents. Furthermore, actual census information indicating the number of youths in the facility at a given time was not included (Braun et al., 2020). The study found that there were no substantial differences between the number of restraints experienced by girls or boys, and no significant differences between children with different primary diagnoses. However, there was a significant difference by race, with White youth experiencing substantially fewer restraints than African American youth. Wong et al (2021) also found that Black Americans were more likely to be restrained than White Americans during emergency room visits. Alternately, Taylor et al (2020) questions the implication of racial bias in restraint and feels a more thorough examination of the multifaceted factors contributing to racial differences in restraint utilization. His view purports that policymakers, researchers, and administrators may mistakenly direct funds toward implicit racial bias training rather than addressing the more central external societal issues, policies, and power structures that methodically lead to the existence of racial inequalities in restraint use (Taylor et al., 2020). Critique The study includes only youth who have had a restraint which may not reflect the larger picture of the entire residential population. The data does not disclose the percentage of residents who have experienced restraints. Furthermore, there is limited treatment information regarding the residents and no way to know why they were restrained (beyond a simple label) or whether the frequency of restraint increased or decreased during residential care. In two of the centers the reasons for restraint were not identified, and one center used “assault” rather than “aggression” as a cause for restraint. Therefore, it is impossible to understand the most common reasons behind restraint use beyond a superficial label. Additionally, restraint utilization policies in place over time are unknown, so there is no way to account for how these may have impacted restraint use (Braun et al., 2020).