Changing Patterns of Residential Care

The use of soft-tie restraint, a common means of controlling the assaultive behavior of mentally retarded residents in institutions, was examined with a retrospective design. Naturally occurring changes over a 39-month period were divided into (a) changes in management personnel that were associated with changes in management support of behavioral programming, (b) changes in staff training and feedback, and (c) a change in the physical location of the Program. Use of restraint decreased when the use of behavioral programming was supported by management and increased when it was not. When a four-person Training Team provided staff with training and formal and informal fecdback, restraint was used less than it was when the Training Team was outside the Program and training and feedback were not provided. Changing the physical location of the Program had little effect on the use of restraint. Relative to baseline, use of restraint decreased by 80% when management supported the use of behavioral programming and the Training Team was in the Program providing training and feedback. Reductions in the use of restraint were correlated with a corresponding reduction in Special Incident Reports which were filed when an event such as injury to a resident or staff member occurred.