Josh K. Pritchard, PhD, BCBA-D (Florida Institute of Technology)
Marc D’Antin, M.A., BCBA (Lodestone Academy)
After reading the article “5 Considerations Before Using Restraints and Seclusions” , we sat down to write a response. Our first thought was – where are the data that support these assertions? What about the number of highly trained behavior analysts who have a long history of taking some people with the most severe behavior problems (that others cannot or will not work with) and made massive improvements in their quality of life? This progress was often made possible with the use of programmed restraint and seclusion. These weren’t failures of their treatment plans, these were part of their treatment plans. Our concern arises from the fact that this article has the potential to vilify these behavior analysts that work with a population on whom others have given up. These few behavior analysts are in the trenches with the kinds of consumers who have no one left to advocate for them.
As we began to write our response, and started to collect the necessary data, we realized that someone had already done so. We recommend that all readers become very familiar with the Association for Behavior Analysis International’s policy statement on this subject matter . The experts they brought together for the task force did a much better job than we can in such a short space, and have a long list of references  that support their perspective.
So – based on this policy statement and our personal experience, we would refute the assumptions upon which the 5 considerations are based.
Assertion: Restraints and seclusions are not function-based interventions.
Restraints/seclusion can indeed be a part of a function-based treatment approach. For instance, using seclusion for escape-maintained problem behavior is contra-indicated.
Assertion: Restraints and seclusions break relationships down.
The use of restraints/seclusion does not automatically degrade relationships or reduce rapport. We do agree that we hope behavior analysts do find that restraining another person is aversive.
Assertion: Using restraint and seclusion as problem-solving tools can shape our own behavior in very unhealthy ways.
As behavior analysts we are trained to recognize when our behavior (or that of those we supervise) is being negatively reinforced. If this is occurring, it is our duty to examine the situation and make a change in the environment. This is not a reason to preemptively cast out potentially effective interventions. Our advice – the goal should be a reduction in restrictive interventions. If behavior analysts graph their restraints/seclusion it would provide the occasion to determine whether they are, in fact, being over-used.
Assertion: Restraint and seclusion frequently results in injuries, and restraints can kill.
Restraints/seclusion (done by folks with proper training and clear criteria) can actually be safer than allowing escalations and continuation of dangerous response patterns. Moreover, the injuries and deaths that are paraded in the media tend to be instances of neglect or in cases in which there was no training, no plan, and the caregivers were simply left to their own devices.
Assertion: Every time a restraint or seclusion happens, we lose something.
There is nothing inherently lost (integrity or otherwise) with the use of restraints or seclusion. As indicated in the ABAI policy statement, restraints and seclusions can be an ethical part of behavior change procedures.
In the spirit of list making, we would like to re-iterate the three guiding principles from the ABAI policy statement, as we agree whole-heartedly with these:
“1. The Welfare of the Individual Served is the Highest Priority- Clinical decisions should be made based upon the professional judgment of a duly formed treatment team that demonstrates knowledge of the broad research base and best practice. Included in this process are the individuals being served and their legal guardians. The team should be informed by the research literature, and should determine that any procedure used is in that individual person’s best interests. These interests must take precedence over the broader agendas of institutions or organizations that would prohibit certain procedures regardless of the individual’s needs. A core value of ABAI with regard to behavioral treatment is that welfare of the individual being served is the absolute highest priority.
2. Individuals (and Parents/Guardians) Have a Right to Choose- ABAI supports the U.S. Supreme Court ruling that individuals have a right to treatment in certain contexts, and that many state and federal regulations and laws create such rights. Organizations and institutions should not limit the professional judgment or rights of those legally responsible for an individual to choose interventions that are necessary, safe, and effective. A regulation that prohibits treatment that includes the necessary use of restraint violates individuals’ rights to effective treatment. The irresponsible use of certain procedures by unqualified or incompetent people should not result in policies that limit the rights of those duly qualified and responsible for an individual through the process of making informed choices.
3. The Principle of Least Restrictiveness – ABAI supports the position that treatment selection should be guided by the principle of the least restrictiveness. The least restrictive treatment is defined as that treatment that affords the most favorable risk to benefit ratio, with specific consideration of probability of treatment success, anticipated duration of treatment, distress caused by procedures, and distress caused by the behavior itself. One may conclude from this premise that a non-intrusive intervention that permits dangerous behavior to continue while limiting participation in learning activities and community life, or results in a more restrictive placement, may be considered more restrictive than a more intensive intervention that is effective and enhances quality of life.”
We don’t believe the author had the intention of vilifying the unsung heroes who work with the population of consumers who require these kinds of intensive treatment. We imagine the author has experienced the misapplication of restraints/seclusion, potentially with individuals for whom it was not appropriate, and was frustrated by that. We, too, have witnessed this and believe it is very important that restraints and seclusions are used only after other less restrictive approaches have failed. We do, however, want to make sure that the people willing to serve consumers who have been failed by these less-restrictive procedures are not labeled as un-ethical or unsophisticated practitioners. Without them, this group of consumers might have nowhere else to turn.
 Sigaud, Clelia. (2016, February 14) Five Considerations Before Using Restraints and Seclusions [Web log post]. Retrieved from https://www.bsci21.org/five-considerations-before-using-restraints-and-seclusions/
 Statement on Restraint and Seclusion (2010) Retrieved from https://www.abainternational.org/about-us/policies-and-positions/restraint-and-seclusion,-2010.aspx
 Reference List: Statement on Restraint and Seclusion (2010, June 10) Retrieved from https://www.abainternational.org/media/7794/randsreferences.pdf