|Reducing Restraint: Some Practical Strategies for Children With Severe Challenging Behavior
|Monday, May 31, 2010
|9:00 AM–10:20 AM
|Area: DDA/EDC; Domain: Service Delivery
|Chair: Jonathan Seaver (The New England Center for Children)
|CE Instructor: Kathleen McCabe-Odri, Ed.D.
|Abstract: Physical restrain is often used to safely manage dangerous aggressive and self-injurious behavior exhibited by some children with autism spectrum disorders (ASD). Although physical restraints may be effective in many cases, they are not without risk and are subject to abuse. Safely and effectively reducing or eliminating the use of physical restraints, however, can present considerable practical challenges. This symposium contains four papaers. One paper discusses the elimination of physical restrain through the use of an alternative intervention. The second paper discusses the gradual fading and elimination of physical restraints. The third paper discusses the reduction of the use of physical restraints through behavioral programming and medication. The final paper discuses the elimination of restraint through simply not doing it. Each paper discusses the considerations involved in each approach to eliminating or reducing physical restraints, as well as the risks and benefits. Case studies are used to illustrate successful implementation of each approach. Overall, these papers demonstrate that physical restraint can be safely reduced or eliminated even in cases involving difficult to treat dangerous behavior, but not without risks and costs.
|Reducing Physical Restraint Through the Use of Alternative Interventions
|JONATHAN SEAVER (The New England Center for Children)
|Abstract: Physical restraint is often used as an intervention for children who engage in severe self-injury. Fading or eliminating physical restraint may be especially difficult in these cases as (a) physical restraint may function as a reinforcer for some children, (b) physical restraint may be a functional replacement for self-restraint, and (c) alternatives to physical restraint may expose the children to significant risks of injury from their own behavior. The use of equipment may reduce the self-injurious behavior and thereby reduce the frequency of physical restraint. In this paper, data on physical restraint and self-injury are presented from several cases involving the use of arm splints to reduce self-injury. Procedures for using the splints are reviewed and risks and benefits are discussed.
|Reducing Physical Restraint Through Systematic Fading
|KELLY L MCCONNELL (New England Center for Children), Leah L Bean (New England Center for Children), Paula Ribeiro Braga-Kenyon (New England Center for Children)
|Abstract: Although physical restraint is used to safely manage aggressive and self-injurious behavior, even under the best circumstances physical restraint carries the risk of harming those it is used to protect. For this reason as well as others, the reduction or elimination of physical restraint is a common goal for schools and agencies using such measures. One method for reducing and eventually eliminating restraint is to systematically fade dimensions of the restraint. The intrusiveness of a physical restraint may be faded by reducing the form of restraint and/or the number of people implementing the restraint, as well as by reducing the duration of the restraint. In this paper, data from several cases on the systematic fading of restraint is reviewed. Procedures for determining how and when to fade are reviewed, and the risks and benefits of this procedure are discussed.
|Reducing Physical Restraint Through Behavioral Programming and Medication
|MAEVE G. MEANY (The New England Center for Children), Allen J. Karsina (The New England Center for Children)
|Abstract: Severe aggressive and self-injurious behavior can result in life-long injuries, social isolation, reduced opportunities, and lower quality of life for the individuals who exhibit such behavior. When the use of applied behavior analytic techniques alone do not eliminate or significantly reduce dangerous behavior, the use of behavioral medication may be warranted, especially if physical restraints are necessary to protect the individual and/or his or her care-givers. In this paper, several cases in which behavioral programming and medications have been correlated with a significant decrease in dangerous behavior and physical restraint are presented. The risks and benefits of the use of medication are reviewed, and future directions for research are discussed.
|Reducing Physical Restraint Through Simply Not Doing It: Risks and Benefits
|SORREL RYAN (The New England Center for Children), Shawn E. Kenyon (New England Center for Children), Myrna E. Libby (New England Center for Children)
|Abstract: Schools and agencies are faced with increasing pressure to reduce or eliminate the use of physical restraints to manage dangerous aggressive or self-injurious behavior. However, there is very little empirical guidance for how these schools and agencies should best proceed. In some cases, it may be that criteria for restraint is too conservative, resulting in unnecessary restraints. In these cases, the criteria can be adjusted so that implementation of restraint becomes rare or non-existent. In this paper, considerations for determining appropriate criteria for restraint are examined, and several such cases are presented. The risks and benefits of this procedure are discussed.