The Ohio Association of Adult Services has been a partner in the review of behavior support practices for many years. In keeping with the Association's mission to provide leadership and promote quality services that are responsive to the needs and choices of individuals served, we have continuously sought to improve upon the methods used to support individuals to manage their own behavior in a safe and growth-enhancing environment. Tremendous progress has been made in the field and particularly, in Ohio. In this evolution, we have realized the true benefit of positive behavior supports and are now prepared to move to the next level. That is, the eventual elimination of certain types of restraints. The following is the Ohio Association of Adult Services Position Statement on Prolonged and Horizontal Behavior Restraints.

The Ohio Association of Adult Services (OAAS) welcomes a comprehensive state policy pertaining to safe and appropriate supports for persons who demonstrate the need for specific behavioral strategies and intervention. It is in this spirit that OAAS advocates for the eventual elimination of aversive behavior supports. OAAS is especially opposed to the use of prolonged restraints of any kind, as well as to manual and mechanical restraints applied to a person who is in a horizontal position for purposes other than medical support. This position statement will summarize the ethical and treatment reservations regarding the use of these types of restraints.

1. The need for restraint should be considered the result of unsuccessful treatments, strategies or interventions rather than the methods themselves are approved treatments, strategies or interventions. As such, it should be the last approach or tactic for protecting individuals from serious risk of harm.
   
   
2. There are no approved or generally accepted methods for safely restraining persons who have developmental disabilities, nor is there a system for direct monitoring and oversight of such restraints.
   
   
3. The prevalence and use of restraints are not monitored in aggregate, nor are the results of such applications analyzed. Without such crucial data, the risks from the use of restraints cannot be evaluated empirically.
   
   
4. There is a significant risk that a person may experience severe emotional, psychological, health and physical problems when restrained. Additionally, the application of restraints may result in increased agitation and restlessness when movement is restricted.
   
   
5. The use of restraints except in life threatening emergencies is prohibited in all systems of community-based care excluding services for persons who have developmental disabilities and the elderly. Moreover, the standards for the use of force and restraint in prison settings are elevated, even for those who have committed the most heinous of crimes, and such applications are vigorously monitored by human rights organizations.
   
   
6. There is no evidence that continuing to “hold” a person beyond the time needed to redirect to an alternative activity promotes the acquisition of greater coping and management skills for persons who have developmental disabilities. On the contrary, persons who are being held may resist for longer periods of time and may become dependent on the external control of their behavior.
   
   
7. The risk of injury to the person and those applying the restraint increases correspondingly to the length of time that the person is being restrained.
   
   
8. Risks of prolonged restraint and restraint in a horizontal position include:

   Elimination Problems – bowel and bladder
   
   Injury – Soft tissue damage and fractures (resistance, falls and misapplication)
   
   Lung Problems – Choking, breathing, pneumonia, infection
   
   Emotional Problems – Depression and anxiety, particular for persons who feel they are being punished or triggering reactions to previous abuse
   
   Nutritional Problems – Hydration, consumption and digestive functioning
   
   Physical – Blood flow and clots, muscle deterioration
   

The OAAS remains committed to its principle objective to provide support to its membership as the profession seeks to improve the quality of services provided to persons who have disabilities. Accordingly, OAAS will continue to solicit and advance best practice resources, particularly including behavioral assessment and positive behavior supports.

The Ohio Association of Adult Services joins the following leaders in advocating for the elimination of aversive behavior supports: The ARC, AAMR, TASH, MANDT System, The American Psychiatric Association, The Autism Society, Advocates for Children in Therapy, and The General Conference of the United Methodist Church.