Academic journal article Mental Health Aspects of Developmental Disabilities

Effects of Fixed-Time Release (FTR) Fading on Implementation of Physical Restraint

Academic journal article Mental Health Aspects of Developmental Disabilities

Effects of Fixed-Time Release (FTR) Fading on Implementation of Physical Restraint

Article excerpt

The present clinical case report describes an intervention procedure to reduce the duration of time spent in physical restraint with a 13-year-old boy who had intellectual disability and serious aggressive behavior. Starting with a 60-seconds fixed-time release (FTR) criterion from physical restraint, the criterion was gradually decreased to 30-seconds, 15-seconds, and 7-seconds. In a final phase, physical restraint was terminated. Duration of physical restraint decreased as the FTR criterion was lowered. Restraint frequency also decreased during the study. After achieving a 7-seconds FTR criterion, physical restraint was eliminated successfully. FTR fading appears to be an effective strategy for reducing the amount of time physical restraint has to be applied. By establishing a low FTR criterion, it may be possible to avoid using physical restraint in favor of alternative intervention procedures.

Keywords: challenging behavior, applied behavior analysis, intellectual disability, aggression, autism, physical restraint

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Physical restraint is the behavior contingent restriction of voluntary movement by immobilizing one or more extremities with a person in a sitting, standing, or supine position. For many people who have intellectual disability, physical restraint is used to manage emergency situations. (7) However, physical restraint can also be implemented as a planned intervention within a comprehensive behavior support protocol. (6) The therapeutic objective of planned physical restraint is to reduce and ultimately eliminate serious problem behavior such as aggression, self-injury, and property destruction. (2,14,16,17) Though physical restraint can be effective, there are concerns because it can also cause injury, (8) be misapplied, and possibly 8 function as positive reinforcement. (5,13) Furthermore, many people responsible for implementing physical restraint do not approve of the procedure. (3,15) Unfortunately, the outcome of unfavorable social acceptance by service providers could be poor intervention integrity.

Despite the concerns about physical restraint, few studies have evaluated reduction and elimination strategies. (9,18) One macro-level approach adopted by some service organizations has been to establish strict regulatory guidelines for applying, documenting, and reporting physical restraint. (4) This methodology notwithstanding, practitioners have few empirically documented procedures for minimizing and possibly eliminating physical restraint on a clinical level. One example is a study by Luiselli et al. (11) that targeted aggressive behavior by two adolescent boys who had intellectual disability. During a baseline phase, staff at a residential school applied restraint when they judged that aggression had become "unmanageable." An initial intervention phase required that staff continue to implement physical restraint but according to a behavior-specific criterion. Frequency of aggression and corresponding physical restraint were high during these conditions but were essentially eliminated during a subsequent antecedent intervention phase. Intervention consisted of eliminating and altering several situations that seemed to provoke aggression and the requirement of physical restraint. For one boy the procedures were giving him novel instead of previously mastered tasks, providing him access to more active and less sedentary activities, and having him sit with preferred peers. With the second boy, staff interrupted possible aggression by directing him to sit away from his group when he appeared mildly agitated and allowing him to request a break from scheduled activities.

The procedures evaluated by Luiselli et al. (11) focused on the frequency of problem behavior that resulted in planned implementation of physical restraint. Another strategy examines the duration of physical restraint. Typically, practitioners are advised to maintain physical restraint until the person being restrained demonstrates specific behavior indicating he/she is calm and in control. …

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