Epidemiology

Abstract

Although often assumed that restraint and restrictive behavior management practices are no longer common and are primarily used in institutional settings, data show that they in fact continue to be used commonly at the present time, for example, in American schools, especially in special education. A minority of American schools use restraint and seclusion frequently. There are also similar contemporary data from youth facilities, psychiatric residential settings, residential settings for people with intellectual disabilities, nursing homes for seniors, and residential settings for people with acquired brain injury. Similar restrictive procedures are also used in dentistry and with detained immigrants, but little is known about the prevalence in these settings. Risk factors can be divided into those relating to the individual and the setting. Individual risk factors are often related to externalizing behavior disorders, such as aggression, self-injury and suicidal behavior, and perceived risk of falling in seniors. Services that appear to have very similar clients also differ dramatically in their use of restrictive behavior management practices, although here the reasons for such differences remain obscure.