Organisation-Wide Interventions to Reduce Behaviours of Concern as well as Restrictive Practices with Children or Adults with a Neurodevelopmental Disorder: a Systematic Review

Abstract

Objectives

Reducing and eliminating the use of Restrictive Practices (RPs) is consistent with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). This systematic review examines the effectiveness of organisation-wide interventions in reducing behaviours of concern (BoC) and the use of RPs in people with a neurodevelopmental disorder (NDD).

Methods

19 electronic databases were searched up to February 2021 for literature, with no language restrictions applied. This systematic review of interventions included any publication aimed at reducing the use of RPs and/or BoC in organisations providing services to people with any NDD.

Results

A total of 15 studies were included in the review. Seven were randomised controlled trials (RCTs) and eight non-RCTs. Most studies focussed on workplace education and training. There was evidence that staff training in Positive Behaviour Support (PBS) and mindfulness-based PBS (MBPBS) reduced aggression, the use of chemical and physical restraints, and peer and staff injuries (MBPBS) in the medium term. A multi-component intervention also showed evidence of a reduction in behaviours of concern in the medium and long term.

Conclusions

A number of studies showed that organisation-wide PBS training, particularly MBPBS training, can reduce BoC and the use of RPs. One multi-component study also substantially reduced BoC. Organisational strategies such as these can improve the rights of people with disability by reducing the use of RPs. However, the generalisability of these findings may be limited as all comparisons were single studies which had potential biases. We are also not able to say whether these findings can be generalised to children, and adults with other neurodevelopmental disabilities, as all but one study focused on adults with intellectual disabilities.