By Matt Harrington, BCBA · Behaviorist Book Club · April 2026 · 12 min read

Comprehensive Guide to the Judicious Use of Restraint in Behavior Analytic Practice

Overview & Clinical Significance

The use of restraint in the treatment of severe destructive behavior is one of the most ethically weighty decisions a behavior analyst can face. Individuals with autism and related disabilities sometimes display behavior that poses significant risk of harm to themselves, others, or the environment, including head banging near sensitive areas such as the eyes, concussion-inducing aggression toward staff, and property destruction that creates immediate safety hazards. In these situations, restraint may be needed to keep the individual and others safe while effective behavioral treatment is developed and implemented.

The clinical significance of this topic is immense. The decision to use restraint involves balancing competing ethical obligations: the obligation to protect the client from immediate harm, the obligation to use the least restrictive effective intervention, and the obligation to respect the client's autonomy and dignity. These obligations do not always point in the same direction, and navigating their intersection requires sophisticated clinical judgment, thorough knowledge of the research literature, and deep familiarity with the ethical standards of the profession.

As discussed by Wayne Fisher and Henry Roane, both of whom hold doctoral-level credentials and the BCBA-D designation, the complexity of severe destructive behavior demands a nuanced approach to treatment that includes careful functional assessment, individualized intervention design, and ongoing evaluation of treatment effectiveness. Restraint, within this framework, is not a treatment but a protective measure that is used judiciously while more comprehensive behavioral interventions are being developed, implemented, and evaluated.

The consequences of getting this decision wrong are severe in both directions. Using restraint inappropriately, excessively, or without adequate justification can cause physical and psychological harm to the client, violate their rights, and damage the trust that is essential to an effective therapeutic relationship. Failing to use restraint when it is genuinely needed can result in serious injury or death. Both outcomes are unacceptable, which is why the term judicious is so important. It signals that restraint decisions must be made carefully, thoughtfully, and with full consideration of the individual's circumstances.

The clinical community's understanding of when and how restraint should be used has evolved significantly over recent decades. Historical practices that relied heavily on restraint as a primary behavior management strategy have given way to approaches that emphasize functional assessment, skill building, and environmental modification as the primary treatment modalities, with restraint reserved for situations where immediate safety cannot be maintained through other means. This evolution reflects both advances in our understanding of severe behavior and changes in societal values regarding the rights of individuals with disabilities.

Background & Context

The discussion of restraint use in behavior analysis takes place against a backdrop of significant historical complexity. Physical restraint has been used across various service settings, including psychiatric hospitals, residential facilities, schools, and community-based programs, for centuries. The history of restraint use is intertwined with the broader history of how societies have treated individuals with disabilities, mental health conditions, and behavioral challenges, a history that includes both compassionate intent and egregious abuse.

The deinstitutionalization movement of the latter twentieth century brought increased scrutiny to restraint practices. Reports of deaths and injuries during restraint incidents in institutional settings led to legislative and regulatory reforms that restricted the use of restraint and established requirements for documentation, training, and oversight. These reforms were appropriate and necessary responses to documented abuses, but they also created a complex regulatory environment in which practitioners must navigate overlapping and sometimes contradictory requirements from state laws, federal regulations, accreditation bodies, and professional ethical standards.

Within behavior analysis specifically, the discussion of restraint intersects with broader debates about the appropriate use of punishment and restrictive procedures. The field has moved decisively toward a preference for reinforcement-based approaches and against the routine use of aversive or restrictive procedures. This shift is reflected in the Ethics Code for Behavior Analysts (2022), which emphasizes the use of least restrictive effective interventions and requires specific justification for the use of more restrictive approaches.

Wayne Fisher and Henry Roane bring extensive clinical and research expertise to this discussion. Their work with individuals who display severe destructive behavior has been conducted in specialized treatment settings where the most challenging presentations are addressed through intensive, individualized, and highly monitored interventions. Their perspective reflects the reality that some behavioral presentations are sufficiently dangerous that restraint may be the only available means of preventing serious injury in the short term while effective treatment is being developed.

The town hall format of this presentation is itself significant. Rather than presenting a single authoritative position, the town hall format acknowledges that reasonable professionals may hold different views about the appropriate use of restraint and creates space for dialogue, questions, and the exploration of nuanced positions. This reflects the complexity of the topic and the recognition that there is no one-size-fits-all answer to the question of when restraint is justified.

The current context also includes a growing awareness of the potential for restraint to cause harm, not only physical harm from the restraint procedure itself but also psychological harm from the experience of being physically controlled against one's will. This awareness has informed the development of trauma-informed approaches to behavioral intervention that seek to minimize the use of restraint while maintaining safety, and that provide support and processing for individuals who have experienced restraint.

Clinical Implications

The clinical implications of the judicious use of restraint span assessment, treatment planning, staff training, organizational policy, and ongoing monitoring. Each of these areas requires careful attention to ensure that restraint is used only when necessary, in the manner least likely to cause harm, and within a comprehensive treatment framework designed to reduce the need for restraint over time.

Functional assessment of severe destructive behavior is the essential starting point. Before any discussion of restraint, the clinical team should have a thorough understanding of the variables maintaining the dangerous behavior. Functional analysis procedures, adapted as necessary for safety, provide the most rigorous assessment of behavioral function. The results of the functional assessment guide the development of function-based treatment that addresses the underlying reinforcement contingencies maintaining the behavior, with the goal of making restraint unnecessary.

Treatment planning for individuals who may require restraint must be comprehensive and multi-component. The treatment plan should include proactive strategies that reduce the likelihood of dangerous behavior, such as environmental modifications, schedule changes, skill-building programs, and reinforcement-based interventions. It should include reactive strategies that specify how to respond when dangerous behavior occurs, including de-escalation techniques, crisis intervention procedures, and the specific conditions under which restraint may be used. And it should include long-term strategies aimed at systematically reducing the need for restraint over time.

The specific restraint procedures used must be selected based on empirical evidence and individualized risk assessment. Different restraint techniques carry different risk profiles, and the selection of a specific technique should be guided by the individual's physical characteristics, medical status, behavioral presentation, and the specific risk the restraint is designed to address. Techniques that restrict breathing, compress the chest, or place pressure on the neck are associated with elevated risk and should be avoided.

Staff training in restraint procedures must be rigorous, standardized, and regularly updated. Staff who may be called upon to implement restraint should receive initial competency-based training that includes both the technical skills needed to implement the restraint safely and the judgment needed to determine when restraint is and is not appropriate. Regular refresher training should address both skills maintenance and any changes to organizational policies or clinical protocols.

Data collection on restraint use is essential for clinical decision-making and quality assurance. Every instance of restraint should be documented, including the antecedent conditions, the behavior that prompted the restraint, the specific restraint technique used, the duration of the restraint, the individual's response during and after the restraint, and any injuries sustained by the individual or staff. These data should be reviewed regularly by the clinical team to identify patterns, evaluate the effectiveness of the overall treatment plan, and make decisions about modifications.

The psychological impact of restraint on both the individual and the staff who implement it deserves clinical attention. Individuals who have been restrained may experience fear, anxiety, or trauma responses that influence their subsequent behavior and their relationship with service providers. Staff who implement restraint may experience stress, guilt, or secondary traumatic stress, particularly when restraint incidents are frequent or intense. Organizations should provide debriefing and support for both individuals and staff following restraint incidents.

Ethical Considerations

The Ethics Code for Behavior Analysts (2022) addresses several provisions that are directly relevant to the use of restraint. Code 2.15 (Minimizing Risk of Behavior-Change Interventions) establishes the principle that behavior analysts should use the least restrictive intervention that is likely to be effective. Restraint, by definition, is a highly restrictive intervention. Its use can only be justified when less restrictive alternatives have been found insufficient to maintain safety and when the risks of not using restraint exceed the risks associated with its use.

Code 2.01 (Providing Effective Treatment) requires behavior analysts to provide services that are grounded in current best evidence. For severe destructive behavior, this means implementing function-based treatment that addresses the reinforcement contingencies maintaining the behavior. Restraint alone is not treatment. It is a safety measure that should always be accompanied by a comprehensive treatment plan designed to reduce the frequency and severity of dangerous behavior over time.

Code 2.14 (Selecting, Designing, and Implementing Assessments) requires thorough assessment before implementing any intervention. In the context of potential restraint use, this means conducting a comprehensive functional assessment of the dangerous behavior, assessing the individual's medical status to identify any conditions that may increase the risk of restraint, and evaluating the environmental conditions that contribute to dangerous behavior. Restraint should never be implemented without a thorough assessment of the behavior it is designed to address.

Code 2.11 (Obtaining Informed Consent) requires that the individual or their legal representative provide informed consent before services are implemented. For restraint specifically, this means that the caregiver or guardian should be fully informed about the circumstances under which restraint may be used, the specific techniques that may be employed, the potential risks associated with restraint, and the safeguards in place to minimize those risks. Consent for restraint should be documented and reviewed regularly.

Code 4.01 (Compliance with Supervision Requirements) requires that supervision is appropriate for the complexity of the services being provided. The use of restraint represents a high-complexity intervention that requires close supervisory oversight. Supervisors must ensure that staff who implement restraint are adequately trained, that restraint decisions are made in accordance with the treatment plan, and that data on restraint use are reviewed regularly and used to inform treatment modifications.

Code 1.02 (Conforming with Legal and Regulatory Requirements) is particularly relevant because restraint is heavily regulated in most jurisdictions. State laws, facility licensing regulations, and insurance payer requirements may impose specific requirements regarding restraint documentation, reporting, staff training, and oversight. Behavior analysts must be familiar with the applicable regulatory requirements in their jurisdiction and ensure that their restraint practices comply with all applicable laws and regulations.

The ethical principle of proportionality is central to the judicious use of restraint. The restrictiveness of the restraint should be proportional to the severity of the risk it is designed to address. Brief, minimal restraint to prevent a moment of self-injury is qualitatively different from prolonged, full-body restraint as a response to noncompliance. Ethical restraint practices are calibrated to the minimum level of restriction needed to address the immediate safety concern.

Assessment & Decision-Making

The decision-making framework for the judicious use of restraint should be systematic, documented, and subject to ongoing review. No single individual should make restraint decisions in isolation. Instead, these decisions should be made collaboratively by a clinical team that includes individuals with expertise in severe behavior, familiarity with the specific individual, and knowledge of the applicable ethical and regulatory standards.

The initial assessment for restraint eligibility should include a comprehensive functional assessment of the dangerous behavior, a medical evaluation to identify any conditions that may increase restraint risk, a review of the individual's history with restraint including any adverse events, and an evaluation of less restrictive alternatives that have been tried and their outcomes. This assessment establishes the clinical basis for determining whether restraint may be appropriate and, if so, under what specific conditions.

The decision to authorize restraint for a specific individual should be documented in a written restraint protocol that specifies the exact behaviors that may trigger restraint, the specific restraint techniques authorized for use, the maximum duration of any single restraint episode, the monitoring requirements during restraint, the criteria for releasing the restraint, the required documentation following each episode, and the schedule for clinical review of the restraint protocol.

Ongoing data-based decision-making is essential once restraint has been authorized. The clinical team should regularly review data on restraint frequency, duration, and outcomes to evaluate whether the overall treatment plan is reducing the need for restraint over time. An increasing trend in restraint frequency or duration should prompt a re-evaluation of the treatment approach. A decreasing trend confirms that the treatment plan is working as intended and may support the progressive reduction of restraint authorization.

The decision to discontinue restraint authorization should be based on clinical data demonstrating that the dangerous behavior has been reduced to a level where safety can be maintained through less restrictive means. This decision should not be made prematurely, as a premature reduction in safety measures could result in serious injury, but neither should restraint authorization be maintained indefinitely when the clinical data support its discontinuation.

Families should be involved in restraint decisions at every stage. This includes informed consent for the initial authorization, regular updates on restraint data and treatment progress, and involvement in decisions about modifying or discontinuing restraint protocols. Family members may have important information about the individual's history, preferences, and triggers that can inform the clinical team's decision-making.

Organizational leadership should support judicious restraint decision-making by establishing clear policies, providing adequate staffing to implement alternatives to restraint, ensuring access to clinical expertise in severe behavior, and creating a culture that views restraint reduction as a priority rather than viewing restraint use as an unremarkable routine.

What This Means for Your Practice

If your practice involves individuals who display severe destructive behavior, the topic of restraint use demands your serious attention, regardless of whether you currently use restraint or expect to need it in the future. The judicious use of restraint is not a topic where practitioners can afford to rely on intuition or default to organizational tradition. It requires deliberate, informed, and ethical decision-making.

Invest in your competence in functional assessment and function-based treatment for severe behavior. The single most effective strategy for reducing the need for restraint is developing and implementing behavioral treatments that effectively address the variables maintaining dangerous behavior. When treatment is working, restraint becomes unnecessary.

If you work in a setting where restraint is used, familiarize yourself with all applicable regulatory requirements and ensure that your practices are in full compliance. Maintain your training in safe restraint techniques and participate in regular refresher training. Review your restraint data regularly and use it to evaluate whether your treatment plans are achieving the goal of restraint reduction.

Advocate for organizational practices that support judicious restraint use. This includes adequate staffing levels that allow for proactive behavior management, access to clinical expertise in functional assessment and severe behavior treatment, structured debriefing processes following restraint incidents, and a culture that treats every restraint episode as an event to be analyzed and learned from rather than accepted as routine.

If you are in a supervisory role, ensure that the staff under your supervision receive competency-based training in both restraint procedures and the clinical judgment needed to determine when restraint is and is not appropriate. Model the kind of thoughtful, data-driven decision-making that characterizes judicious restraint practice.