Commentary on "Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents" by Green-Hennessy and Hennessy.

In their 2015 study, Sharon Green-Hennessy and Kevin D. Hennessy addressed an important gap in the literature on seclusion and restraint use in child and adolescent residential treatment centers (RTCs). Their analysis revealed that several facility-level characteristics-such as facility size and ownership-predicted the use of seclusion/restraint in child/adolescent RTCs. The authors also examined patient demographic variables that were significant predictors of seclusion/restraint in prior research on individual patients within facilities. However, Green-Hennessy and Hennessy did not find any relationship between these demographic variables and seclusion/restraint. In this commentary I argue that the null relationship between patient demographics and seclusion/restraint was a result of an ecological fallacy. Rather than attempting to use aggregate patient data to infer individual-level processes, this patient data should be used to study aggregate effects. I demonstrate that by re-conceptualizing these patient demographics as indicative of facility characteristics, rather than patient characteristics, new information can be gleaned about the types of facilities that use seclusion/restraint. The arguments presented here have broader implications for future research in this field that relies on aggregate patient data.

Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review.

Understanding how child and adolescent health is influenced by fluctuations in socioeconomic status has important public health and policy implications, as children are often subjected to both micro and macro-level socioeconomic events. This study provides the first systematic review to date on the relationship between changes in household or parental socioeconomic status and subsequent child and adolescent health outcomes. Eighty articles were identified for inclusion in this review, examining 85 different socioeconomic exposures in five categories: Income (n = 64), Employment (n = 14), Socioeconomic Mobility (n = 3), Education (n = 2), and Food Insecurity (n = 2). The health outcomes analyzed by these eighty articles were separated into eight discrete categories, with many articles examining outcomes in more than one category: Anthropometric Measurements (n = 21), Cognition and Development (n = 15), Dental Health (n = 3), Health Behaviours (n = 9), Mental Health (n = 12), Overall Parent/Guardian Assessed health (n = 6); Physical Health Outcomes (n = 11), and Socio-Emotional Behaviour (n = 30). Several consistent patterns emerged in the literature, such as a link between increased income and improved, or decreased income and deteriorating, cognition, dental health, and physical health. The results of this review suggest a need to replicate current studies in diverse geographies to expand generalizability and clarify regional patterns. There should also be an effort to go beyond income, and employment, to assess the relationship between less frequently studied socioeconomic exposures and child health outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40894-021-00151-8.