By Matt Harrington, BCBA · Behaviorist Book Club · Clinical decision guide
One of the most consequential decisions a behavior analyst makes is not just what intervention to use, but how to approach the clinical question in the first place. For ethical and legal considerations on the use of seclusion and restraint, the difference between an evidence-based, individualized approach and a traditional, protocol-driven one can significantly impact outcomes.
This guide lays out the key factors side by side to support your clinical decision-making.
| Factor | Evidence-Based Approach | Traditional Approach |
|---|---|---|
| Primary investment | Functional behavior assessment, environmental design, antecedent strategies, and replacement behavior instruction for all students with behavioral challenges | Crisis response training, restraint certification, seclusion room maintenance, and post-incident documentation systems |
| Staff skill development | Staff trained to recognize early warning signs, implement de-escalation strategies, and use proactive behavioral support techniques throughout the day | Staff trained primarily in physical restraint techniques and crisis response procedures, with less emphasis on prevention |
| Frequency of restraint and seclusion | Decreasing over time as prevention systems address the conditions that give rise to crisis behavior | Stable or increasing over time because the underlying conditions driving crisis behavior are not being modified |
| Student outcomes | Students develop replacement skills and experience environments designed to support their behavioral needs, reducing both crisis behavior and restrictive procedures | Students may be repeatedly restrained or secluded without learning alternative behaviors, creating a cycle of crisis and response |
| Legal and ethical risk | Lower risk because restraint is rare and well-documented when it occurs, with clear evidence that less restrictive alternatives were pursued | Higher risk because frequent restraint raises questions about whether less restrictive alternatives were adequately explored |
| Staff well-being | Staff feel equipped to prevent crises and experience less occupational stress and physical risk | Staff regularly involved in physically demanding and emotionally draining crisis responses, contributing to burnout and injury |
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Use this framework when approaching ethical and legal considerations on the use of seclusion and restraint in your practice:
Does the data support a need for intervention? Is there a meaningful impact on the individual's quality of life, safety, or access to reinforcement?
YES → Proceed to assessment NO → Document reasoning, monitor
A functional assessment should guide intervention selection. Avoid defaulting to standard protocols without individual analysis. Consider environmental variables, setting events, and private events.
YES → Select evidence-based approach matched to function NO → Complete assessment first
Goals should be co-developed. Assent and informed consent are ethical requirements. The individual's preferences and values matter in selecting both goals and methods.
YES → Proceed with collaborative plan NO → Engage in shared decision-making
This course covers the clinical and ethical dimensions in detail with structured learning objectives and CEU credit.
Ethical and Legal Considerations on the use of Seclusion and Restraint — John Molteni · 1.5 BACB Ethics CEUs · $25
Take This Course →1.5 BACB Ethics CEUs · $25 · BehaviorLive
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.