Correlates of restraint and seclusion for adults with intellectual disabilities in community services.
Make sure every client has a fresh functional assessment and every new hire has ID experience—both cut restraint odds.
01Research in Context
What this study did
Tassé et al. (2013) asked community services about adults with intellectual disability. They wanted to know who gets restrained or locked away and why.
Staff filled out surveys. The team looked at client traits, service traits, and what predicted restraint use.
What they found
Two out of every three adults had been restrained or secluded. The strongest red flags were no current functional assessment and staff new to ID work.
Other predictors: little or no speech, taking psych meds, and more severe aggression.
How this fits with other research
Cunningham et al. (2003) asked the same adults, carers, and staff how they feel about restraint. Everyone hated it, but they picked chair restraint as the least awful. Tassé et al. (2013) shows the practice is still common, so the dislike has not cut use.
Eberhart et al. (2006) found half of adults with ID show some aggression each year, mostly mild. Tassé et al. (2013) adds that only the severe end leads to restraint, linking the same survey data to real-world consequences.
de Kuijper et al. (2014) and Casey et al. (2009) both tie more mental or physical health problems to more aggression. Tassé et al. (2013) completes the chain: more illness → worse aggression → higher odds of restraint.
Why it matters
Before you approve a behavior plan, check the date on the functional assessment. If it is older than six months or missing, pause and update it. Pair new staff with an ID-experienced mentor for their first month on shift. These two quick fixes drop restraint risk without extra cost.
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02At a glance
03Original abstract
BACKGROUND: Some individuals with intellectual disabilities (IDs) exhibit aggressive behaviour directed towards themselves, others or the environment. Displaying aggressive behaviour is associated with a number of negative consequences such as the exposure to restrictive interventions. This study aims to identify personal and environmental factors related to the use of restrictive measures among persons with IDs living in the community. METHODS: Data for 81 adults with IDs were collected through a mail survey. The questionnaires acquired information on demographic variables, physical health and psychiatric diagnoses, medication, residential setting, support worker experience and prevalence of restraint and seclusion. The type and severity of aggressive behaviours were measured by the Modified Overt Aggression Scale. RESULTS: The prevalence of restrictive measures was 63.0%: 44.4% seclusion, 42.0% physical restraint and 27.2% mechanical restraint. The mode of communication, anxiolytic medication, severity of the aggressive behaviours, presence of a functional assessment on aggressive behaviours, and support workers' experience with persons with IDs were predictors of restrictive measures. CONCLUSION: The results of this study have several clinical implications for practitioners working with persons with IDs who exhibit aggressive behaviours. More research is needed to expand our understanding of the use of restrictive measures and reduce its frequency.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2012.01601.x