The Relationship Between Choice and Injuries of People With Intellectual and Developmental Disabilities.

Carli tracked 251 adults with intellectual or developmental disabilities. The team counted how many everyday choices each person had in their service plan. They then looked at medical records to see who got hurt.

No new treatment was given. The study simply linked existing choice levels to injury reports.

Each extra unit of choice cut injury risk by 35 percent. People with more say over meals, bedtime, or activities were hurt less often.

Matson et al. (2013) already called choice “best practice.” Carli now shows one clear reason: fewer injuries.

Rieth et al. (2022) found the same people who lack choice also get more behavior meds. Carli’s injury data line up—restrictive settings create multiple harms.

Navas et al. (2025) and Armas Junco et al. (2025) show moves to community homes only help if staff keep offering real choices. Carli adds: keep those choices or injuries will rise.

You can write “client will have three daily choices” in a plan and know it is medical risk management, not just nice. Start tomorrow: let the person pick drink, seat, and music on the van ride. One small choice may equal one less trip to urgent care.