Advancements in Restraint Elimination and Culture Change: A Comprehensive Review of Therapeutic Approaches and Progressi

Abstract: Physical restraint has long been used in residential and clinical settings to manage high-risk behavior, despite decades of evidence indicating its association with physical injury, psychological trauma, and poor treatment outcomes (LeBel & Goldstein, 2005; Nunno et al., 2006). Implementation barriers remain at the forefront, especially in systems serving individuals with complex profiles such as Prader-Willi Syndrome (PWS). Few studies address how large-scale organizational change can be achieved to reduce reliance on restrictive practices. This presentation explores a multi-year initiative led by the Behavior Services Department at MyPath’s Prader-Willi Homes, which focused on the systematic reduction of restraint through trauma-informed, data-driven behavior analytic practices. Key interventions included the replacement of coercive contingencies (e.g., token economies), the development of individualized Behavior Support Plans informed by FAST and risk matrices, and the integration of blocking strategies and debriefing procedures post-incident. Findings revealed a 79% reduction in restraint use and an 80% reduction in restrictive measure applications within 12 months. Staff reported improved self-efficacy, and residents demonstrated increased trust and emotional regulation.

Learning Objectives:

1. Describe core features of Prader-Willi Syndrome relevant to ABA intervention.

2. Identify ethical implications of restraint use under the BACB Ethics Code and Apply trauma-informed ABA strategies to promote assent-based practices.

3. Analyze real-world case outcomes demonstrating ethical and ABA-based interventions.