Evaluation of restraint-elimination interventions for students with multiple disabilities in a pediatric nursing care setting.

Silverman et al. (1994) worked with two students who had many disabilities. Both kids lived in a pediatric nursing home and wore mechanical restraints all day.

A team of nurses, doctors, and behavior analysts wrote unique plans for each child. They used rewards, teaching, and environmental changes to remove the restraints safely.

After the plans started, both students stopped needing restraints completely. Challenging behavior stayed low and the kids could move freely.

The nursing staff kept the plans going with simple checklists. No one got hurt and the children stayed safe without belts or cuffs.

Mazonson et al. (2018) later tested a similar team approach in adult group homes. They added monthly manager coaching and saw big drops in problem behavior, showing the idea works beyond kids.

DeRoma et al. (2004) used short hospital stays to find why severe behavior happens. Like K et al., they cut problem behavior fast, but M et al. used formal functional analysis first.

Goldstein et al. (1991) warned that just changing behavior isn't enough—we must also prove life gets better. K et al. showed restraint removal, but they didn't measure quality-of-life gains like happiness or choice.

If you work in nursing, school, or residential care, this study gives you a road map. Build a small team, write clear steps, and you can remove restraints without extra injuries. Start with one child, track safety and freedom, then grow the plan to other kids.