Choosing Staff Members Reduces Time in Mechanical Restraint Due to Self‐Injurious Behaviour and Requesting Restraint

Abstract

Using mechanical restraints to protect a person who engaged in dangerous self-injury was decreased by manipulation of an establishing operation involving the client choosing the staff person who would work with her. The client was a 28-year-old woman diagnosed with autism, bipolar disorder, static cerebral encephalopathy, moderate intellectual disabilities, hypotonia and musculoskeletal deformities. She had a history of biting herself and further bites could produce irreversible nerve damage. Mechanical restraints were applied when she bit, tried to bite herself or asked for them. When she was allowed to choose staff members, the use of mechanical restraint decreased. Reducing the time spent in mechanical restraint by giving the client a choice of staff members who would work with her demonstrates that such a choice may be an establishing operation. The usefulness of cumulative records and scatterplots to evaluate changes in the occurrence of self-injurious behaviour (SIB) and associated mechanical restraint is shown as are the advantages of using alternating treatment designs to assess the effectiveness of treatment conditions for someone who exhibits long-term cyclic behaviour.