The Reduction of Mechanical Restraints and PRN Medication in 400 Persons with Neurodevelopmental Disorders: an Analysis of 11 Years Process in 23 Italian Residential Settings

Contrary to public policy and research expectations, restrictive behavior practices continue to be used with individuals with intellectual disabilities. This paper reports the effects of a multi-component service package for a residential service for over 400 adults with intellectual disabilities and challenging behavior. Over an 11-year period, there was a large and near elimination of mechanical restraints and pro re nata medications and a decrease in staff working days missed because of resident aggression, despite an increase in the complexity of resident needs. This study demonstrates that large-scale, long-term reduction of restrictive behavior management practices is possible using a multi-component organizational reform package.