Other Approaches

Abstract

This chapter reviews the use and effectiveness of non-applied behavior analytic approaches to reduction of restraint. The first is staff training in nursing homes, which has mixed outcomes including highly effective, ineffective, and harmful effects. These studies have significant problems with treatment integrity which may account for the varied outcomes. A note of caution is expressed regarding commercial staff training products and the lack of outcome data for such commercial products. A second approach is mindfulness training for both clients and staff and family members. Such an approach is promising. Limited evidence exists for advanced psychiatric directives. Although legislation is widely advocated and assumed to be effective, there is little evidence that legislation is effective in reducing restraints, due primarily to the lack of implementation of well-designed laws. Aversive stimuli may sometimes reduce the need for restraint, but such approaches raise significant ethical questions. Studies that have attempted to reduce seclusion, time-out, and as needed (PRN) and routine psychotropic medication are also reviewed.