Interventions to prevent and reduce coercive measures in psychiatric and residential care for youth: a mixed-methods systematic review

Coercive measures (eg, restraint and seclusion) remain common in child and adolescent psychiatric and residential care despite efforts to reduce their use. We conducted a mixed-methods systematic review of interventions to reduce coercive measure use. Eligible studies were published between Jan 1, 2005, and Feb 19, 2025; examined interventions in psychiatric, residential, or juvenile justice settings for people younger than 25 years; and reported quantitative outcomes, qualitative experiences, or both. 26 studies (13 quantitative and 13 qualitative) with low-to-moderate risk of bias were included. Quantitative synthesis associated interventions targeting organisational culture and staff practice with moderate-to-large reductions in coercive measures, whereas child-focused behavioural interventions showed smaller or more uncertain effects. Qualitative thematic synthesis generated four analytical themes emphasising relational care, collaboration, staff reflexivity, and organisational support. Integration indicated organisational and staff-focused interventions aligned most closely with qualitative themes and were associated with the largest effect sizes. Limitations include heterogeneity in interventions, settings, and outcome measures, precluding meta-analysis. Interventions most effective in reducing coercive practices in youth care settings are those that simultaneously address relational dynamics, staff reflexivity, and organisational culture. By aligning with both children's rights and staff perspectives, such multifaceted approaches appear promising, but their success is contingent on sustained structural and institutional support.