Article

Restraint Safety: an Analysis of Injuries Related to Restraint of People with Intellectual Disabilities

Authors:
  • Don Williams Behavioral Consulting
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Abstract

Background There is little research on the safety of the various types of restraint commonly used with individuals with intellectual disabilities who exhibit severely aggressive or self-injurious behaviour. Method This study analysed the use of restraint with 209 individuals with intellectual disabilities over a 12-month period. Results Planned restraint, the use of restraint as a component of a behaviour treatment programme (i.e. planned personal or planned mechanical restraint) was safer than crisis-intervention restraint (emergency personal or emergency mechanical). The overall rate of injuries during restraint was 0.46 injuries per hundred restraints. Restraint was applied 99.54% of the time without injury. Conclusion Restraint was relatively safe and safer than reported in one other study. Planned restraint was safer than emergency restraint. The additional training and programme development associated with planned restraint may have contributed to the greater safety of planned restraint. Due to limited empirical data, restraint safety has yet to be established and this study suggests that restraint should be decreased and closely monitored.

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... Pharmacological sedation is considered highly controversial due to high cost and associated health risks, while medical restraint can cause psychological and physical trauma in people with intellectual disabilities (Table I). [12][13][14][15][16][17] There are options for reducing dental anxiety, such as social and communication training, which do not carry the same medical risks as sedation and restraint. Advancements in special education and behavioral guidance have allowed children with ASD to achieve comfort and relaxation, resulting in more cooperative behaviors during situations known to induce anxiety or stress. ...
... Children with ASD may begin speaking much later than their typically-developing peers, may use a vocabulary of fewer or more simple words, or may be completely nonverbal. Not only does PECS allow the child to learn a larger and more complex vocabulary while associating those words with pictures and ideas, it requires the child to physically present the card to others, thereby initiating [13][14][15][16] social interaction between the child and the communicative partner. 19 Studies using picture cards, such as PECS, as the sole intervention demonstrated increases in verbal speech, spontaneous communication and socialcommunicative behaviors, and a decrease in problem behaviors. ...
Article
Purpose: Autism Spectrum Disorder (ASD) can greatly inhibit a child's communication and social interaction skills, impacting their comfort during dental hygiene treatment and services. Children with ASD may exhibit sensory sensitivities, fear of the unfamiliar and lack of socio-cognitive understanding, leading to anxiety and corresponding behavioral deficits. Since the prevalence rates for ASD have risen significantly in the past decade, increased emphasis has been placed on educational and behavior guidance techniques, which can be helpful for children with ASD because of their increased capabilities in visual-processing. The purpose of this literature review is to summarize the interventions available to reduce dental anxiety in children with ASD, and to determine which strategies are best suited for implementation by the dental hygienist. Advancements in technology and socio-behavioral interventions were assessed for appropriate use, efficacy and engagement in the target population. Interventions were categorized into the following groups: picture cards, video technologies and mobile applications.
... minor bruises or lacerations. A study of RPs used on people with intellectual disabilities in a 12-month period in 1992 reported that 0.46% resulted in an injury (Williams, 2009). Injuries were more likely to occur during instances of emergency RPs (5.2%) when compared with planned RPs (0.30%), p < 0.01. ...
Article
Restrictive practices (RPs) are a contentious issue in health and social care services. While use may be warranted in some instances, there are risks and concerns around human rights infringements. There are limited data available on the types and incidences of RPs used in health and social care services internationally. The objective of this study is to describe the type of RPs and incidence of use in disability residential care facilities (RCFs) in Ireland. RP notifications from disability RCFs reported from November 2019 to October 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. National frequency and incidence of use of categories and type of RPs were calculated. The number and percentage of disability RCFs reporting RP use, along with the mean annual incidence of use, were also calculated. A total of 48,877 uses of RPs were notified from 1387 disability RCFs (9487 beds) during the 12-month period. The national incidence of RPs use per 1000 beds was as follows: all categories: 5152.0, environmental: 2988.2, physical: 1403.0, other: 527.0 and chemical: 233.8. The most frequently used RPs for each category was as follows: environmental: door locks, physical: other physical, other: liberty and autonomy and chemical: anxiolytics. Most RCFs (81.7%) reported at least one RPs use. The median incidence of any RPs per 1000 beds in these RCFs was 4.75 (IQR: 2.00 to 51.66). Usage of RPs was generally low, although some RCFs reported relatively high usage. Nationally, on average, five RPs were applied per resident over 12 months; environmental contributing to more than half. These findings can be used to inform policy, measure progress in reducing RPs use and for cross-jurisdiction comparisons.
... Certains auteurs mettent ainsi en avant ses dangers tels que l'abus de contention [3], l'absence de preuves de l'efficacité thérapeutique et l'existence de conséquences néfastes pour la personne [1,3]. Ce questionnement est également international à propos de la régulation des pratiques suite à des décès observés sous contention [4]. La définition de la contention est entourée d'un flou sémantique aussi bien au niveau national qu'international. ...
Article
This study is part of a current context raising questions on restraint practices in healthcare at the national and international level. It examines how social representations of restraint organize and shape the discourse of professionals within the context of healthcare and support for sick and/or disabled children. The main objective was to understand how these social representations were expressed in restraint practices. A qualitative method using semi-structured interviews was chosen to meet the goals set out. The research was conducted with 15 healthcare professionals in pediatrics, infant intensive care, and neurorespiratory rehabilitation at Raymond Poincaré Hospital. The data were processed using a content analysis of the thematic type. The results suggest that social representations particularly affect the experience of these professionals and the representations they may have concerning the experience of children, parents, and the role played by the latter in restraint situations. They also show that restraint is a multidimensional object that is difficult to understand, particularly because of the current context of questioning this practice within pediatric departments. Despite certain methodological limitations, this study has contributed to a reflective process around restraint practices within a psychosocial approach of understanding the subject and its issues. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
... The use of restrictive measures has a significant negative impact on the quality of life of people with ID (Heyvaert, Saenen, Maes, & Onghena, 2015;MacDonald, McGill, & Deveau, 2011;Mérineau-Côté & Morin, 2014) as well as on staff well-being (Mérineau-Côté & Morin, 2014) and can cause injuries (Williams, 2009). People with ID might experience a physical intervention as being punished, although the intentions of staff were to protect the person from harm (Fish & Hatton, 2017). ...
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Article
Background Community services for Swedish people with intellectual disability (ID) are intended to support self-determination and integrity. Legislation does not allow the use of restrictive or coercive measures. Aim The aim of this study is to identify the extent of, rationale for, and strategies staff believe would reduce the use of restrictive measures in group homes and daily activities services for people with ID. Method A survey was sent to all staff in group homes and daily activities in one large Swedish municipality. The survey comprised four Likert style questions and one free text question, addressing the type of and reasons for restrictive measures, and how much staff value their replacement. A total of 250 surveys were completed. Results A third of staff reported that some restrictive measures were used daily or weekly, primarily to protect and support service users. Adequate numbers of staff, better service design, and training were considered necessary for change. Conclusion Staff report structural reasons, such as staffing, resources time, lack of training, and supervision for using restrictive measures. Staff see reducing the use of restrictive measures as requiring structural changes with engagement from the whole organization.
... First, the process of holding a person, especially if there is active resistance, is often strenuous, emotionally arousing, and difficult to maintain. This type of interaction poses a second prominent concern, namely, the potential for injury to the implementers and recipients of PR (Spreat et al. 1986;Tilli and Spreat 2009;Williams 2009). Third, PR may function as positive reinforcement for some people (Favell et al. 1978;Magee and Ellis 1988), thereby maintaining rather than decreasing the behaviors targeted for intervention. ...
... The primary purpose of physical restraint is to prevent people with intellectual disabilities from harming themselves or others (Heyvaert et al 2015). However, physical restraint can be traumatic for all involved (Parish 2014) and, even when used correctly, there is a risk of injury (Williams 2009). ...
Full-text available
Article
This article explores the ethicolegal and political factors associated with physical restraint in intellectual disability practice in Ireland. The primary purpose of physical restraint in intellectual disability care is to prevent injury or harm to the service user or others, yet research evidence shows it can cause trauma and injury. Physical restraint is a controversial topic and it is important for nurses to remain up to date with clinical governance strategies, regulation and policy developments. In recent years, there has been debate regarding the use and misuse of the restrictive practice of physical restraint, particularly in care settings where vulnerable clients reside. In intellectual disability services, nurses face difficult decisions in caring for clients when managing challenging behaviour. The protection and safety of the service user is of utmost importance and includes: legal considerations regarding professional duty of care and consent; political matters of advocacy and power; human rights; and ethical principles. Ethics require a moral approach that ‘first does no harm’, engaging in beneficial practices that serve to uphold the best interests of service users and engender public trust.
... These results are generally consistent with conventional PR policies mandating that PR must be applied as intervention of last resort, only after less restrictive procedures have been ineffective, and guided by the principle of least restrictive treatment (Sheldon and Sheldon-Sherman 2013). Safety concerns also form the basis of most PR training programs (Lennox et al. 2011), including injury prevention (Luiselli 2013;Williams 2009). It is encouraging to find that parents-guardians of individuals with PR endorsed these same guidelines and procedural conventions. ...
Full-text available
Article
Parents-guardians of adults who had intellectual disability completed a social validity assessment that documented their attitudes and opinions about physical restraint. Both parents-guardians of adults that had and had not experienced physical restraint rated most highly that (a) physical restraint should only be used if less intensive procedures have failed and (b) physical restraint can be adapted to ensure safety and reduce risk of harm. They endorsed less favorably that effective use of physical restraint makes it possible for individuals to progress and achieve a better quality of life. The parents-guardians of adults that had not experienced physical restraint differed from the parents-guardians of adults with a physical restraint history in acceptance of physical restraint to ensure safety of their family member. We discuss these findings and implications for habilitation services programs.
... Chemical restraint introduces medications into the body in order to control or address aggressive behavior. Restraint may be planned or used in an emergency or crisis situation; emergency or crisis restraint is less safe than planned restraint (Williams, 2009). ...
Full-text available
Article
The use of restraint, restrictive interventions, and seclusion are hotly contested with inconclusive evidence of their effectiveness. Because the use of restraint and seclusion on people with intellectual and developmental disabilities (IDD) is controversial, and its effectiveness doubtable, the aim of this study was to explore their allocation in Medicaid HCBS 1915(c) waivers, the largest providers of long-term services and supports (LTSS) for people with IDD. To do so, 111 FY 2015 IDD waivers from across the nation were examined to determine if and how states permitted restraint, restrictive interventions, and seclusion. Findings revealed an overwhelming majority of waivers permitted the use of restraint (78.4%) and restrictive interventions (75.7%). A smaller proportion (24.3%) allowed the use of seclusion.
... Certains auteurs mettent ainsi en avant les dangers de cette pratique, tels que les abus de contention [3], l'absence de preuves de l'efficacité thérapeutique et l'existence de conséquences néfastes pour la personne [1,3]. Ce questionnement se retrouve également au niveau international autour de la question de la régulation des pratiques suite à plusieurs décès observés après la mise en place d'une contention [4]. ...
... Similar to FBI, crisis intervention has strengths and limitations when applied to students with disabilities who exhibit severe challenging behavior. One of the strengths is that training in crisis intervention has led to an increase in safety for those involved (Williams, 2009). Additionally, training has also led to increased confidence among caregivers working with these students (Baker & Bissmire, 2000;Dawson, 2003;Soenen, Goethals, Spriet, D'Oosterlinck, & Broekaert, 2009). ...
Article
We evaluated the effects of protective equipment on arm and scalp injuries caused by aggressive behavior in a child with autism. During intervention phases in a multiple baseline design, teachers wore arm guards and baseball caps. Wearing the protective equipment reduced the frequency and intensity of arm and scalp injuries. Overall daily frequency of aggression also decreased across baseline and intervention phases. The clinical implications of wearing protective equipment for injury prevention and reduction are discussed.
Article
This single-case study of a boy with autism and high-frequency aggression concerned the effects of classroom teachers wearing protective equipment (gloves) on injuries produced to their hands as well as injuries sustained to non-protected areas of the body. A reversal-type design was used to evaluate the effects of protective equipment relative to a baseline (no protective equipment) phase, a low-demand activity phase without protective equipment and a low-demand activity phase with protective equipment. The protective equipment intervention eliminated hand injuries, did not result in other types of injuries, was not associated with increased aggression and was rated favourably by the classroom teachers. The findings suggest that staff-worn protective equipment may be a valuable component of comprehensive clinical safety programmes within service settings for children with intellectual and developmental disabilities.
Article
Objective: The present study measured arm and other body injuries to classroom staff that were caused by a student who had developmental disabilities and treatment-resistant aggression. Methods: Following a baseline (no equipment) phase, staff wore protective equipment on their arms but not on other areas of their body. Results: The frequency of self-reported arm injuries increased with protective equipment, but injury severity decreased. Wearing the protective equipment was also associated with more injuries to other areas of the body. Conclusions: Staff-worn protective equipment may reduce the severity but not the frequency of staff injuries from aggression; as well, the presence of protective equipment may set the occasion for increased injuries to non-protected areas of the body.
Article
We used an organizational behavior management (OBM) approach to increase behavior intervention plans and decrease the use of mechanical restraint. First, recipients were tracked as a member of the priority group if they engaged in frequent self-injurious behavior or physical aggression toward others and/or if they had been placed in mechanical restraint as a result of the problem behaviors. Second, a behavior data monitoring and feedback system was put in place. Third, organizational contingencies for the use of mechanical restraint or the occurrence of frequent self-injurious behavior or physical aggression toward others were initiated. Over the course of 17 months, behavior intervention plans were more than doubled to 124 and mechanical restraints decreased by almost 80%. This study represents the first to use an organizational behavior management (OBM) to reduce restraint with people who have intellectual disabilities.
Article
We analyzed incidence and implementation patterns of physical restraint (PR) among 448 adults with intellectual disability within community-based day habilitation programs and group homes. PR was implemented exclusively as a consequence for self-harming, aggressive, and environmentally disruptive behaviors. Less than 10% of adults received PR and more than 90% of documented restraints occurred as a planned intervention procedure. Several adults accounted for the majority of PR. The clinical implications of these findings are discussed.
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Purpose – This review seeks to provide an overview of the current research evidence on the use of restraint as an intervention in managing challenging behaviours in relation to children with intellectual disabilities. It also aims to discuss legal frameworks and ethical considerations that underpin the use of restraint in intellectually disabled children who present with challenging behaviours. Design/methodology/approach – The authors conducted a search of existing literature primarily pertaining to the management of challenging behaviours in intellectual disability on PubMed, PsycInfo and Google Scholar using combinations of the following key words – children, intellectual disabilities, learning disability, mental retardation, challenging behaviour, restraint, seclusion, physical restraint, mechanical restraint, personal restraint, and chemical restraint. Since research on the use of such interventions in children has been hitherto scant, literature relating to their use in intellectually disabled adult populations as well as cognitively able children was also examined to ascertain whether the broad principles informing the use of restraint interventions could be generalised to their use in intellectually disabled children. Findings – The review finds evidence to suggest that restraint interventions in their myriad forms are widely used to manage challenging behaviours in children with intellectual disabilities and outlines the evidence base, clinical scope, and the risks associated with the use of such interventions in children. It also helps highlight the current absence of comprehensive evidence based guidance that incorporates clinical, ethical, and legal aspects of the use of restraint interventions in children with intellectual disabilities and raises relevant questions in relation to their judicious use in this patient group. Originality/value – The authors believe that the review completes the first in depth evaluation of the use of restraint interventions in children with intellectual disabilities and are confident that this would serve as useful guidance for professionals working with this patient group who may be considering using restraint interventions in their everyday clinical practice.
Article
Clinical safety is a dominant concern for human services organizations serving people with intellectual and developmental disabilities (IDD) and high-risk challenging behaviors. This article is a descriptive analysis of components that comprised an injury-reduction intervention among direct-care staff at a specialized school. Using a behavior-based safety approach, intervention was associated with fewer staff injuries and more weeks without injury reports. The article focuses on systems-level strategies and recommendations for future research and practice.
Article
We report the case of an 11-year-old boy with autism who displayed aggressive behavior and required aggression-contingent physical restraint (protective holding) to protect peers and teachers from injury. During a baseline phase, teachers implemented the boy's behavior support plan and applied protective holding according to a behavior-contingent release (BCR) criterion in which they maintained physical contact with him until he was "calm" for a minimum of 30 consecutive seconds. In the intervention phase, baseline procedures remained in effect, but the teachers terminated protective holding with the boy according to a fixed-time release (FTR) criterion that was independent of his behavior during protective holding and faded (decreased) systematically over time. In contrast to BCR, FTR fading was associated with less exposure to and fewer applications of protective holding. Post-intervention and follow-up results revealed that protective holding was no longer required. We discuss the clinical implications of these findings.
Article
Restrictive measures may have important physical and psychological consequences on all persons involved. The current study examined how these are perceived by persons with intellectual disabilities and staff. Interviews were conducted with eight persons with intellectual disabilities who experienced a restrictive measure and their care providers. They were queried on their understanding of the restrictive measure, its impact on the relationship, their emotions and alternative interventions. Restrictive measures were experienced negatively by persons with intellectual disabilities and their care providers. Service users reported feeling sad and angry, whereas staff mentioned feeling anxious. Moreover, persons with intellectual disabilities appeared to understand the goal of restrictive measures (e.g. ensuring their own and others' safety) and identified alternative interventions (e.g. speaking with a staff member or taking a walk). This study sheds further light on how persons with intellectual disabilities and staff experience the application of restrictive measures. Debriefing sessions with service users and staff may help minimize negative consequences.
Chapter
This chapter reviews the role of therapeutic restraint (TR) in clinical service delivery for behavioral crises. Behavioral crises often involve dangerous destructive behaviors that place the individual or others in harm. To protect the safety of the individual, his/her caregivers, and the environment, TR is often used in conjunction with behavioral programming. The use of TR is always a last resort approach when less invasive procedures have been unsuccessful. In this chapter, we will review (a) what constitutes TR, (b) clinical decision-making strategies when considering use of TR, (c) policy statements on TR by relevant professional organization, (d) forms of TR, (e) limitations of TR, and (f) ways to reduce the necessity and need for TR for IDD in crisis.
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Chapter
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Article
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This paper provides a brief overview of the most recent research (1999-2009) on restraint reduction and elimination efforts in the literature and also examines the characteristics of restraint along with the risks and benefits. Some earlier papers were included in this review because of their importance to the topic. The results of this literature review are discussed in terms of implications for practitioners and researchers.
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Article
This study was a retrospective evaluation of in place treatment procedures. Clinical data were reviewed from 45 cases in which contingent restraint was employed in an effort to modify the inappropriate behaviors of institutionalized mentally retarded persons. Statistically significant decrements in the rates of inappropriate behavior were detected over the 18 months of study. Clinically meaningful improvement in the rates of behavior were detected in 53% of the cases in which the target behavior was either aggression, selfinjury, or property destruction. The inclusion of less serious behaviors in the study did not substantially increase this rate. Effectiveness appeared to be more pronounced for males, younger persons, persons with short institutional tenures, and persons who were free from psychotropic medication during the course of treatment.
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The safety of four general classes of contingent restraint was evaluated in a sample of 231 institutionalized mentally retarded persons. The use of mechanical restraints resulted in a significantly lower injury rate than did personal restraint. The use of restraint in emergency situations was found to be more dangerous than the planned use of such procedures.
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Patterns of injury for institutional residents of differing levels of mental retardation were investigated. Moderately and profoundly mentally retarded persons were found to be much more at risk for personal injury than were mildly or severely mentally retarded individuals. Examination of the specific patterns of injury for persons at each level of mental retardation suggested that mildly and moderately mentally retarded persons were injured by restraint procedures that were related to behavior control. Severely mentally retarded persons tended to be injured by other residents, and profoundly mentally retarded persons tended to receive injuries as a result of their limited physical capabilities.
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This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.
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The social consequences delivered for problem behavior during functional analyses are presumed to represent common sources of reinforcement; however, the extent to which these consequences actually follow problem behavior in natural settings remains unclear. The purpose of this study was to determine whether access to attention, escape, or tangible items is frequently observed as a consequence of problem behavior under naturalistic conditions. Twenty-seven adults who lived in a state residential facility and who exhibited self-injurious behavior, aggression, or disruption participated. Observers recorded the occurrence of problem behavior by participants as well as a variety of consequences delivered by caregivers. Results indicated that attention was the most common consequence for problem behavior and that aggression was more likely to produce social consequences than were other forms of problem behavior.
Article
Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint‐reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior‐specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.
Chapter
Protective equipment has been utilized for many decades with developmentally disabled persons displaying self-injurious behavior (SIB). Unfortunately, the application of protective devices in such cases often times has involved continuous mechanical restraint. For many individuals, the image of protective equipment is that of the self-injurer physically immobilized at the arms, wrapped in a bodyjacket, wearing a helmet, and unable to participate in meaningful habilitation activities due to restriction of movement. It is distressing that this impression lingers because it represents a very narrowly defined focus and the least therapeutic utilization of protective equipment. In fact, recent years have witnessed many advances in the multiple uses of protective equipment for the therapeutic management of SIB.
Article
This paper reviews the published research literature on the use of physical restraint with mentally retarded adults and children. Research on three types of restraint is included. One type involves one or more person(s) holding another. A second method is where a mechanical device is fitted to limit movement or reduce injury. The third type is where the person voluntarily applies a personal or mechanical restraint. The following conclusions emerged: (a) there are numerous processes which contribute to the outcomes associated with restraint, and these are poorly understood; (b) different processes mediate the outcomes for contingent and noncontingent restraint; (c) both noncontingent and contingent restraint can result in long-term reductions in target behaviours, especially when fading procedures are employed (noncontingent restraint) and where staff or carers are involved in the treatment plan (contingent restraint); (d) self-restraint seems to be maintained by the reinforcing effects of the restraint procedure or by escape from the aversive consequences of self-injury; (e) there are (negative) reinforcing consequences for staff who use restraint procedures in service settings; (f) and both staff and clients risk injury, especially from emergency or unplanned restraint.
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This volume presents a review of diagnostic, assessment and treatment issues related to self-injurious behaviour. Adopting an interdisciplinary stance, the text features contributions from psychology, medicine, pharmacology and education. The book is intended for advanced students, clinicians, academics and researchers involved in the treatment and study of self-injurious individuals.
Article
Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint-reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior-specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.
Chapter
Several of the treatment approaches employed to treat self-injury involve the use of brief, contingent physical restraint. Some of these procedures have as an integral part the requirement that the person receiving treatment also comply with commands given by the therapist. All of these procedures involve the use of physical intervention because the therapist needs to physically restrain or prompt a behavior contingent upon self-injurious behavior (SIB). Some methods that involve contingent brief restraint alone include physical immobilization, and momentary movement restraint (described in the following section). Methods that involve the use of contingent brief physical restraint plus compliance training include overcorrection, contingent exercise, and movement suppression.
The extent, nature, and treatment of self-injurious behavior was surveyed among 2,663 developmentally disabled children and adolescents in a large metropolitan school district during the 1984-85 school year. Sixty-nine, or 2.6 percent, of the students exhibited at least one type of self-injurious behavior during the preceding 12 months; 59 percent of these students were males and 41 percent were females. Most of the self-injurious students were either severely or profoundly retarded, and their mean age was 10.2 years. Although almost three-quarters of the students exhibited self-injurious behavior at least daily, only a third were engaged in formal treatment programs for the problem. More than half (53.6 percent) had been restrained during the preceding 12 months for such behavior, and 8.7 percent had received psychotropic medications. The authors believe that the development of effective treatment strategies for self-injurious individuals living in the community may help them avoid institutionalization.
Article
A state-wide prevalence survey was conducted to determine the extent and circumstances of self-injurious behavior (SIB) among institutionalized mentally retarded individuals with 13.6% of the population (1,352 individuals) identified as being self-injurious from the approximately 10,000 clients in Texas' 13 residential facilities serving the mentally retarded. It was found that: (a) 89.8% of the clients were severely and profoundly mentally retarded; (b) differential therapeutic treatment modalities may have occurred according to the sex of the client; (c) 58.4% of the clients engaged in more than one SIB response topography; (d) 57% of the clients emitted SIB at least once per day; (e) 55% of all clients were aggressive toward others, with a higher incidence of aggression, property destruction, and sleep disturbances among clients who received psychoactive medication; and (f) 33.1% of the clients were on formalized positive treatment programs and 6.8% of the clients were on formalized aversive programs. Discussion highlights the extent and circumstances to which SIB exists and the need to implement effective and appropriate programming.
Article
A review of current research in the treatment of self-injurious and stereotyped behaviour is made using rule-out criteria for methodologically inadequate studies and meta-analytic procedures. It was found that profoundly mentally retarded persons between 16 years of age and over are the most likely to be effectively treated. Sex of the subject seemed to have no effect, while the level of mental retardation and the degree to which it was a factor in treatment effectiveness was unclear. The behaviour most frequently treated were head hitting and body rocking. It may also be the case that reinforcement is more effective than frequently believed when compared to punishment. The greatest effectiveness was apparent with DRO, lemon juice therapy, time-out, air splints, and DRO plus overcorrection. The implications of these data for clinicians and future research are discussed.
Article
The author reviewed the literature published since 1972 concerning restraint and seclusion. The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.
Article
Demographic and behavioral correlates of the use of restraint were analyzed in an institutional population of 300 persons with developmental disabilities. Examination of the frequency distributions of restraint frequency and duration indicated that there were 33 consumers who experiences relatively few, short-duration restraint and 11 consumers who had daily restraint for many hours. Separate analyses of these two kinds of restraint were performed. Short-duration restraint was predicted by behavioral variables indicating extra-personal maladaptive behaviors. Demographic variables did not predict short-term restraint. Multiple regression analysis indicated that only independent predictor of short-term restraint was the severity rating of Hurts Others. Similar results were found for predictors of the duration of short-term restraint. The only correlates of long-duration restraint was low weight, Hurts Self, and Withdrawn Behavior. Multiple regression analysis indicated that the only variable that independently predicted long-duration restraint was the severity rating of Hurts Self. The implications of these data for the management of restraint are discussed.
Restraint Reduction. In: Ethi-cal Approaches to Physical Intervention: Responding to Challeng-ing Behavior in People with Intellectual Disabilities
  • P Sturmey
  • A Mcglynn
Sturmey P. & McGlynn A. (2003) Restraint Reduction. In: Ethi-cal Approaches to Physical Intervention: Responding to Challeng-ing Behavior in People with Intellectual Disabilities (ed. D. Allen), pp. 203–218.
Deadly restraint: A Hartford courant investiga-tive report
  • E M Springer-Verlag Weiss
Springer-Verlag, New York. Weiss E. M. (1998) Deadly restraint: A Hartford courant investiga-tive report, October 11–15.
  • Rojahn
Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities
  • Luiselli