Restrictive interventions are frequently utilized in the care of the I/DD population as a reactive strategy to challenging or maladaptive behavior. The evolution of strategies, techniques, and equipment is associated with controlling the person’s behavior or movements. Four typical behavior types can result in medical, mechanical, or physical restraint or enhanced level of supervision implementations, which are verbal, physical, destructive, or disruptive behaviors. Moreover, the healthcare community should also be aware that these approaches are primarily in reaction to challenging behavior. The most commonly used medical intervention is the administration of psychotropic medication consisting of antidepressants, mood stabilizers, antipsychotics, stimulants, and anti-anxiety drugs. Physical intervention involves strategies and restraints for crisis prevention. These least intrusive to the most intrusive techniques attempt to de-escalate the situation if the person presents a danger to themselves or others. The mechanical restraint is applied with a device to limit a person’s mobility if the situation becomes unmanageable. Finally, an enhanced level of supervision restricts a person’s privacy and independence by instructing a staff or prompting a caregiver to provide close monitoring due to medical or conduct issues.
The prevalence of restrictive interventions is debated because their use has been met with mixed reviews. Regarding a child diagnosed with I/DD and conduct disorder, early restrictive intervention may be medication administration, which can have harmful long-term side effects. Physical restraints can result in short- or long-term bodily injury, medical issues, trauma, or death if performed incorrectly by a staff or caregiver. A similar inference can be made about mechanic restraints. Finally, with the enhanced level of supervision, a person’s independence can be hindered for an extended period, causing complacency by staff and regression. Even the involvement of first responders such as police officers, EMTs, and firefighters with the I/DD population during crisis settings can distress a person’s life. Restrictive interventions also include loss of privileges and environmental modifications.
To reduce the application of restrictive interventions, we must tackle the concept of involuntary care. Limiting a person’s freedom, progression, biophysical balance, and growth with different techniques is considered abuse, neglect, or mistreatment. Therefore, developing a plan of care programs, fading protocols, consistent medical follow-ups, and behavior management treatment plans are evidence-based, allowing the support circle to advocate for a person’s human rights. As a society, we are responsible for creating, supporting, and preserving a person’s self-sufficiency by employing safeguards and ensuring that those protective provide the potential for gradual success.
