Systems-Level Assessment of Interobserver Agreement (IOA) for Implementation of Protective Holding (Therapeutic Restraint) in a Behavioral Healthcare Setting

Abstract

Increasing demands for accountability in behavioral services have required data-based and reliable clinical decisions. The importance of reliable data is magnified in settings where restrictive procedures (e.g., therapeutic restraints) and challenging antecedent behaviors (e.g., aggression) are part of the typical treatment day. While reliable data contribute to valid decision making, a number of challenges exist to obtaining these data including, but not limited to, program wide logistics and uncertainty about the independence of observers. The present study acquired interobserver agreement (IOA) data for therapeutic restraints across an entire program day. Data revealed that staff compliance with the recording protocol was high and that a large proportion of therapeutic restraints were captured for IOA purposes. High levels of IOA were also recorded for a number of dimensions of therapeutic restraint implementation. Implications for future research as well as clinical applications are discussed.