Restraint, Restrictive Intervention, and Seclusion of People With Intellectual and Developmental Disabilities

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.

Physician Perspectives on Severe Behavior and Restraint Use in a Hospital Setting for Patients with Autism Spectrum Disorder

“…Whereas others have reported using chemical restraint to reactively manage severe behavior in adults (Friedman & Crabb, 2018 ), participants in this study indicated that chemical restraint was most often applied to proactively manage characteristics of ASD or to facilitate completion of medical procedures. This finding is consistent with proactive use of chemical restraint to facilitate safe medical procedures in pediatric patients (Kirwan & Coyne, 2017 ).…”

“…Existing restraint research has largely focused on general patient populations (e.g., Grimes, 2012 ; Larue et al, 2009 ) or examined restraint use within a single department (e.g., psychiatry or emergency; Delaney & Fogg, 2005 ; Wong et al, 2019 , 2020 ). A few studies have considered neurodiverse populations or specifically individuals with ASD, but those investigations were limited to pediatric populations (Friedman & Crabb, 2018 ; Johnson & Rodriquez, 2013 ; O’Donoghue et al, 2020 ). The current study focused on hospital treatment of patients with ASD and severe behavior across the lifespan, including input from medical trainees and physicians in multiple hospital departments.…”

“…Applying restraint is a common strategy for managing severe behavior, despite associated increases in an individual’s risk of depression, anxiety, and post-traumatic stress disorder following restraint implementation (Evans & Cotter, 2008 ; Friedman & Crabb, 2018 ). Mechanical restraint, which entails using equipment such as arm splints or waist straps to restrict movement, may result in skin breakdown and difficulties with balance, strength, and gait, loss of muscle mass, and infection (Evans & Cotter, 2008 ).…”

“…Use of physical restraint, in which at least one person uses their body to restrict an individual’s ability to move their torso, arms, legs or head, is associated with distrust of medical professionals (Wong et al, 2020 ). Both physical restraint and chemical restraint, which entails using medication (e.g., Benzodiazepines) to inhibit patient movement and manage emergent behaviors, can cause serious injury, functional decline, and even death (Friedman & Crabb, 2018 ). Restraint can be implemented both reactively to manage emergent behaviors and proactively to facilitate medical compliance and access to medical care (Allen et al, 2009 ; Kupzyk & Allen, 2019 ).…”

Sexual Assistance for People with Intellectual Disabilities: Proposal for a Service Delivery Model

“…The training must include areas such as those found in the Protection and Advocacy section, which are consistent with rights, such as non-violence (WR 5) and privacy (WR 6) (See Table 1). On the other hand, supports for advocacy is key, as several studies [13,[50][51][52] reveal that context may place barriers to the rights recognized and embodied in Table 1, such as freedom (WR 2), autonomy (WR 3), the right to have a partner (WR 11), to parenthood (WR 12) and to express the sexuality (WR 13).…”