Restraint, Restrictive Intervention, and Seclusion of People With Intellectual and Developmental Disabilities.
Most state IDD waivers still allow restraint—read yours and advocate for tighter limits.
01Research in Context
What this study did
The authors read every state Medicaid IDD waiver. They looked for words that allow restraint, seclusion, or other restrictive practices.
They counted how many states let providers use each practice. The scan covered all 50 states plus DC.
What they found
Most waivers give a green light to restraint. Seclusion is allowed less often, but still common.
In plain numbers: the majority of states still write these practices into their care plans.
How this fits with other research
Romero (2017) already warned that disability policy needs stronger tools. Carli’s numbers show the warning was spot-on—most states still permit restraint.
Bennett et al. (1998) described Welsh homes using restraints decades ago. The new US map proves little has changed at the policy level.
Laugeson et al. (2014) found autism mandates cluster in richer states. Carli’s scan reveals a similar patchwork: where you live decides which restrictive tools are legal.
Why it matters
If you write behavior plans, check your state waiver language. You may be asked to approve procedures that are still legal but no longer best practice. Push for language that bans or sharply limits restraint. Your signature can drive policy toward safer care.
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02At a glance
03Original abstract
Restraint, restrictive interventions, and seclusion are hotly contested practices 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, this study was conducted to explore if and how they were permitted in Medicaid HCBS 1915(c) waivers, the largest providers of long-term services and supports (LTSS) for people with IDD. To do so, 111 fiscal year 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.
Intellectual and developmental disabilities, 2018 · doi:10.1352/1934-9556-56.3.171