New Considerations in the Prevention of Aversives, Restraint, and Seclusion: Incorporating the Role of Relationships into an Ecological Perspective

Abstract

While many individuals with challenging behaviors now enjoy the benefits of inclusion and self-determination, large numbers of their peers remain in segregated, restrictive settings and continue to be subjected to coercive intervention plans that include aversives, (nonemergency) restraint, and seclusion as “treatment.” A rising tide of knowledge and expectations has not lifted all boats, and the gap between the “haves” and the “have nots” continues to grow. To address this gap, it may prove helpful to revisit the issue of coercive interventions from theoretical perspectives that can offer new insight into their persistence as well as a sobering appraisal of the complex collateral damage that can result from their use. New means to frame and develop such insights are at hand. The applied science of Positive Behavior Support (PBS), on which current advances in inclusion and self-determination depend, has been evolving in the direction of broader ecological perspectives and the incorporation of theoretical perspectives from related fields. A growing body of research from the fields of mental health and child development can now be incorporated into the PBS model to enrich our understanding of the dynamics of the use of these coercive interventions on individuals with disabilities, and of the cumulative and negative effects such interventions have on their larger support systems of school, work, family, friends, and community. With an enhanced understanding of the crucial role of relationships in fostering emotional and cognitive development and mental health, coercive interventions can be viewed from the perspective of a breakdown in relationship. Such a perspective yields a powerful, but frequently overlooked, rationale for avoiding their use, may prove helpful in analyzing and preventing the antecedents of such breakdowns, and may suggest more effective ways of coping with and repairing the debilitating individual and systemic consequences of the use of aversives, restraint, and seclusion.