Behavior Intervention -- Seclusion & Restraint
This paper provides an overview of the seclusion and restraint as well as alternative methods of controlling challenging behaviors. Children and adults with disabilities often possess challenging behaviors. Two methods, seclusion and restraint, have consistently been used over the years to control maladaptive behaviors. This paper should not be construed as advocating for any specific method. The methods provided are informational and allows the reader to decide which, if any, methods are appropriate based on individual needs and circumstances.
Keywords Applied Behavior Analysis; Behavior Intervention; Behavior Modification; Behaviorists; Challenging Behavior; Communication; Communication-Based Intervention; Functional Assessment; Punishment; Restraint; Seclusion; Time Out
Children with developmental disorders, cognitive deficits, autism, and mental retardation often demonstrate challenging behaviors in the school and community environment (Grey & McClean, 2007; Magee & Ellis, 2001; Mueller & Nkosi, 2007). The majority of professionals propose that challenging behaviors are the result of an individual's not being able to influence the actions of others (Weiss, 2005). In other words, many professionals propose that challenging behavior is a primitive form of communicating or influencing others. Thus, individuals with limited communication abilities have to be taught that verbal (speech) or nonverbal (signs) communication can influence others much more effectively. Once communication has been established, the challenging behavior can be replaced with a socially acceptable way of gaining attention, escaping or receiving desired items.
Grey & McClean (2007) state that challenging behaviors could be construed as a manifestation of an underlying psychiatric disorder. In these instances, the medical community often uses pharmacological intervention to manage challenging behaviors (Grey & McClean, 2007; Grey & Hastings 2005).
To eliminate or decrease inappropriate behaviors, one must understand why, when and under what circumstances the behavior occurs. Behaviorists report that with careful observation and data collection one can learn the triggers of inappropriate behaviors and seek interventions to assist in replacing inappropriate with appropriate behaviors (Mueller & Nkosi, 2007; Weiss, 2005).
Whatever the cause of a challenging behavior, a great debate surrounds how to deal with the challenging behavior. This paper will discuss current thoughts on the use of the behavior modification strategies known as restraint and seclusion. These two strategies are used in schools and residential facilities to eliminate challenging behaviors in individuals with disabilities. The use of restraints or seclusion may be necessary to keep the individual from harming him or her self or harming another individual.
Behaviorists use the term punishment to describe a method of controlling behavior and promoting learning. Punishment is defined as an aversive consequence immediately following a behavior that leads to a decrease in the behavior (Block, 2000). For example, someone is speeding on the freeway, stopped, and issued a ticket with a large fine; the person is likely to not exceed the speed limit.
If used appropriately, punishment as a form of behavior management can be effective. However, inappropriate use of punishment can lead to abuse and cause additional behavior problems (Block, 2000; Nelson, 1997; Weiss, 2005). When using punishment, one must keep in mind that the focus is not only on the behavior being modified but also on the behavior being learned to replace it. In other words, the individual must learn that actions result in consequences. Carr, et al. (1997) introduces four basic reactions a person can have to a problem behavior:
• Ignore The Problem
• Protect The Individual And Others From Harm
• Restrain The Individual During The Behavior
• Introduce Cues Or Distractions (Carr, Et Al., 1997)
Block (2000) proposed general guidelines to follow if punishment is to be used. The guidelines include:
• Establishing, Posting, And Reviewing Rules And Consequences Prior To Behavior Issues
• Consistently Model And Reinforce Acceptable Behavior
• Remain Calm And In Control Of Emotion
• Be Consistent With Punishment
• When Punishing, Identify The Behavior That Is Being Targeted
Problem behavior can be defined as aggressive acts such as kicking, hitting, or biting; self injurious behavior including hitting or biting oneself; destruction of property and tantrums with yelling, screaming and crying (Carr, et al.,1997; Mueller & Nkosi, 2007; Weiss, 2005). Problem behaviors are thought to be the result of developing adaptive behaviors to gain attention (i.e., banging head). For instance, an individual may learn that communicative attempts do not gain the attention of the caregiver. However, if the individual bangs his or her head against the floor, then the caregiver will immediately provide attention.
Those involved in behavior modification believe that to change the behavior one must identify the purpose of the behavior (Carr, et al., 1997; Mueller & Nkosi, 2007; Weiss, 2005). Once the purpose of the behavior is identified, intervention efforts must include replacing skills that are more appropriate in influencing people. The purpose of the head banging may be to request the presence of the caregiver. Thus, instead of the individual banging his or her head, the individual may be taught to activate a switch that will call the caregiver.
Typically, an adverse behavior does not consist of one inappropriate behavior. Thus, each behavior has to be viewed within the context of the behavior. For instance, controlling the behavior in one environment does not necessarily control it in another. When replacing a behavior, all stakeholders must have an interest and be consistent in altering the behavior. Thus, behavior intervention should change the quality of life for the individual. The goal of behavior modification is to allow the individual to become a part of society versus being secluded or isolated.
Definition of Restraint
A restraint can be self-imposed by the individual (self-restraint), physical, or medical. Restraints are also used for safety purposes in cars or amusement park rides to provide safety for the individual. Self-restraint implies that the individual uses emotional control to manage verbal or physical behavior in emotional situations. Physical restraint is defined as controlling an individual by making them helpless or keeping them captive through the use of equipment or seclusion. Medical restraint, physically or pharmacologically, is used and prescribed by a physician to prevent an individual from harming themselves or others. Physical and medical equipment used as restraints consist of items such as straitjackets, wheel chair belts, and safety vests. Pharmacological restraint includes the use of medications to keep an individual sedated.
Any restraint can be dangerous if used improperly. Deaths and other injuries (i.e., broken bones) have been recorded due to the improper use of restraints in schools, hospitals, nursing homes, and private homes (Grey & Hastings, 2005; Protection & Advocacy, 2007; Weiss, 2005). Thus, due to the potential for abuse, restraints are regulated in many environments. Each state and local agency determines the specifics of restraint use. However, states often dictate that once a physician orders a medical restraint the order is only valid for twenty-four hours.
Seclusion can be defined as placing an individual alone in a room or keeping a person in an area in which they cannot leave (Nelson, 1997; Protection and Advocacy, 2007; TASH). As with restraint, seclusion or time-out can be dangerous or can increase inappropriate behavior of the individual. For instance, an individual who is repeatedly placed in isolation may develop additional psychological problems.
The use of restraint or seclusion should be used only in extreme circumstances, primarily when the individual needs protection from serious harm (Nelson, 1997; Protection & Advocacy, 2007; Weiss, 2005). Weiss (2005) has proposed that seclusion and restraint are considered to be aversive interventions. Weiss's viewpoint is that these types of procedures lead to traumatic injury and even death with no supporting research data on their usefulness. He proposes the use of positive behavior reinforcement as an alternative in controlling behavior.
TASH, an organization for individuals with disabilities, families, and advocates, developed a resolution for the use of aversive and restrictive behaviors (i.e., restraint or seclusion). The premise of the resolution is to advocate against the use of controlling behaviors through the use of restraints or seclusion. TASH does recognize the need for brief physical restraint for the purpose of protecting the individual. However, TASH is clear that restraint or seclusion in these circumstances is a safety measure not an intervention method.
The use of seclusion or...
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