Addressing structural restrictive practices in disability support organizations.

BACKGROUND: The Convention on the Rights of Persons with Disabilities emphasizes individual rights and autonomy. However, certain restrictive practices in support services for people with intellectual and developmental disabilities (IDD) may limit these rights and undermine autonomy. Structural practices are a type of restrictive practice usually defined as blanket rules or prohibitions that affect all users equally. They are considered restrictive because constrain the freedom of individuals with disabilities. Since these practices are so deeply ingrained in the organizational culture, they often become normalized and invisible. Despite the implications of structural practices for the rights of people with IDD, empirical evidence on their prevalence is limited, particularly in Spain. In this context, this article aims to analyze the presence of structural practices in different support services for people with IDD in Spain.

METHODS: A cross-sectional study was conducted with 45 disability support organizations, which participated by assessing the occurrence of restrictive practices, including structural practices, in their daily contexts using the LibRe scale. Among the structural practices, aspects related to the organization of time and activities, information management and decision-making, money management and established organizational norms were evaluated. The organizations conducted the assessments in teams, involving 194 professionals, 6 family members and 25 individuals with disabilities in the process. The assessment was part of an organizational transformation process. Frequency analyses and ANOVA tests were conducted to identify the most common restrictive practices.

RESULTS: Although organizations generally report a low frequency of restrictive practices, structural practices are significantly more common than others, such as physical or mechanical restraints. Within the structural practices, those referring to limitations in the organization of time and activities of daily living of people with disabilities stood out as frequent practices. Among the most frequent practices were limitations on recreational activities and inflexible meal schedules.

DISCUSSION: Implications of the restrictive practices most frequently reported by organizations on users' quality of life are discussed, as well as the need to reduce structural practices through organizational transformation approaches. Future lines of research are also highlighted.