Reducing Restraint and Restrictive Behavior Management Practices

This book examines effective evidence-based interventions for the safe reduction and elimination of restraint use. It addresses the issues surrounding restraints and restrictive behavioral management practices (RBMPs) - including physical and personal restraints, seclusion and timeout rooms, emergency PRN (pro re nata, or "as needed") medication, movement restrictions, and loss of property - within three sections.§§The first section clearly defines what constitutes restraints, surveys the extent of problems associated with such restraints, and describes both historical and contemporary uses of RBMPs. Despite the availability of models from 200 years ago that detail how to eliminate restraints effectively, RBMPs continue to be used commonly in contemporary services (e.g., community services) as well as within families. The second section provides a detailed review of the research literature, including randomized controlled trials that were primarily conducted in nursing home settings for seniors; the use of applied behavior analysis, mostly, but not exclusively, with children with developmental disabilities; and interventions for large-scale organizations (e.g., mental health services). The final section offers examples and case studies of how to analyze and reduce restraint use and provide other interventions for dealing with such common problems as aggression, chronic self-injury, pica, and medical and dental procedures. In addition, it outlines restraint-free methods for use in environments ranging from smaller (e.g., classrooms, group homes) to larger (e.g., schools and adults psychiatric services) and identifies future directions for research and practice. This book is a must-have resource for clinicians, practitioners, and professionals as well as researchers and graduate students in the fields of child and school psychology, behavioral therapy, social work, psychiatry, geriatrics, and adult and youth residential services.§