Reducing Restraint in Individuals with Intellectual Disabilities and Autism Spectrum Disorders: a Systematic Review Group Interventions [2018]

Safe restraint reduction is important to remove unnecessary stigmatizing and harmful behavior management practices in individuals with developmental disabilities. Despite calls to reduce such practices, they remain common. The literature was searched to identify empirical papers using interventions of any kind to reduce restraint and related restrictive behavior management practices in group settings, such as institutions, community group homes, and schools. This systematic review identified 21 empirical papers of which 7 were experiments. The three most commonly used interventions were (1) packages of organizational reform, target setting, staff training and feedback in institutional; (2) interventions in community settings; (3) mindfulness sometimes combined with positive behavior support; and (4) interventions in schools including organizational reform, goal setting, and feedback. Almost all studies reported large reductions in use of restraint and other restrictive behavior management practices without substitution of one form of restrictive behavior management practice by another. Papers that reported data on client and staff safety and economic analyses reported positive outcomes. Those studies that reported follow-up data reported positive outcomes with maintenance of up to 13 years. These findings have three main implications, namely, (1) large-scale, safe restraint reduction is possible in a variety of settings using varied methods; (2) large-scale restraint reduction results in improved safety for clients and staff and reduced costs, primarily due to reduced coasts of staff injuries and lost time; and (3) future research should focus on measures of treatment integrity, independent replication of promising interventions, complete reporting of all settings recruited to studies, manualization of all treatment strategies, and comparison of alternate approaches.

Peter Sturmey
Advances in Neurodevelopmental Disorders, December 2018, Volume 2, Issue 4