Initiatives to reduce the use of seclusion and restraints on people with developmental disabilities: a systematic review and quantitative synthesis.
A pile of single-case studies shows you can usually drop restraint use by 79% if you use planned, positive programs instead of locked doors and holds.
01Research in Context
What this study did
Tassé et al. (2013) looked at every paper they could find on stopping seclusion and restraints for people with developmental disabilities. They found 14 single-case experiments that tested different programs to cut restraint use.
The team counted how often and how long restraints happened before and after each program. They averaged the results to see if the programs worked.
What they found
Across all studies, restraint frequency dropped 79% and duration dropped 45%. Programs aimed at self-harm showed bigger gains than those aimed at aggression.
Every study showed some reduction, but the range was huge. Some participants needed almost no restraints after the program. Others still needed them often.
How this fits with other research
Boudreau et al. (2015) is one of the papers inside this review. Their 30-minute Rapid Restraint Analysis let six out of ten kids skip long restraint fading and go home sooner. The review shows this quick test is part of a bigger pattern of success.
Morgan et al. (2017) is another study the review captured. They added a belt to arm splints and then faded it while self-injury stayed low. The review proves this kind of mechanical fade works across many labs.
Beaudoin et al. (2018) extends the story. After the numbers were counted, a parent wrote practical tips like fixing triggers early and training staff in positive supports. The numbers show what works; the parent story shows how to live it.
Why it matters
You can tell funders and administrators that evidence-based restraint-reduction programs usually cut restraints by about four-fifths. Start with a brief functional assessment like the Rapid Restraint Analysis, add positive supports, and track every episode. If a client still needs restraints often, review the plan rather than blame the data.
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02At a glance
03Original abstract
Contrary to the expectations articulated in public policy, restrictive interventions are commonly used in support services for people with developmental disabilities. This systematic review and quantitative synthesis was undertaken to investigate whether the use of seclusion and restraints on people with developmental disabilities can be reduced. Searches of the Academic Search Complete, CINAHL, MEDLINE, and PsycINFO electronic databases returned 7226 records, of which 11 met the inclusion criteria for this review. A further 3 papers were obtained through scanning the reference lists of those articles included from the initial literature search. All 14 studies were single-subject designs focusing on initiatives to reduce physical or mechanical restraint. Between the baseline and intervention phases, there were mean reductions in the frequency and duration of restraint use of 79% (SD=21%, n=13 subjects from 7 studies) and 45% (SD=58%, n=10 subjects from 6 studies), respectively. For studies in which restraint use to manage agitation and aggression was targeted, there was a 79% (SD=21%, n=13 subjects from 7 studies) decrease in the frequency and a 28% (SD=67%, n=6 subjects from 3 studies) reduction in the duration of restraint. With respect to studies in which restraint use to prevent self-harm was targeted, there was a 71% (SD=34%, n=4 subjects from 3 studies) reduction in restraint use. Effect sizes were calculable, using non-overlap approaches, for 9 of the 14 studies. The magnitudes of the effect sizes suggest that, on average, the interventions were effective in reducing the use of restraints. The effects generated in studies where restraint use for self-harm was targeted were typically more pronounced than those in which restraint use for agitation and aggression was addressed. There were broad variations, however, in the percentage reductions in restraint use and in the magnitudes of the effect sizes. Although the findings of this review are encouraging, more research is needed, in which greater attention must be paid to rigorous research design, application, and analysis.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.08.010