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Involving Individuals with Developmental Language Disorder and Their Parents/Carers in Research Priority Setting
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Addressing structural restrictive practices in disability support organizations.

Victoria Sánchez-Gómez1,2, Laura Esteban1,3, Natalia Alvarado1

  • 1Institute for Community Inclusion, University of Salamanca, Salamanca, Spain.

Frontiers in Psychiatry
|June 10, 2026
PubMed
Summary

Structural practices, like rigid schedules, are common in disability support services, limiting autonomy for people with intellectual and developmental disabilities (IDD). Addressing these normalized restrictions is crucial for enhancing rights and quality of life.

Keywords:
blanket rulesorganizational culturequality of liferestraintrestrictive practicesstructural practices

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Area of Science:

  • Disability Studies
  • Social Science Research
  • Healthcare Management

Background:

  • The Convention on the Rights of Persons with Disabilities promotes autonomy, yet restrictive practices in IDD support services can undermine these rights.
  • Structural practices, defined as universal rules, are often normalized and invisible within organizational cultures.
  • Limited empirical data exists on the prevalence of structural practices in Spain's IDD support services.

Purpose of the Study:

  • To analyze the presence and prevalence of structural practices in various support services for individuals with intellectual and developmental disabilities (IDD) in Spain.
  • To identify specific types of structural practices that are most common.
  • To inform organizational transformation strategies aimed at reducing restrictive practices.

Main Methods:

  • A cross-sectional study involving 45 disability support organizations in Spain.
  • Assessment of restrictive practices, including structural ones, using the LibRe scale.
  • Involvement of 194 professionals, 6 family members, and 25 individuals with disabilities in team-based assessments.

Main Results:

  • Structural practices are significantly more prevalent than other restrictive practices like physical or mechanical restraints.
  • Limitations in the organization of time and daily activities for individuals with disabilities were identified as frequent structural practices.
  • Specific frequent practices include restrictions on recreational activities and inflexible meal schedules.

Conclusions:

  • Structural practices, particularly those affecting daily routines and activities, are common in IDD support services in Spain.
  • Reducing these normalized restrictions is essential for improving the quality of life and autonomy of people with IDD.
  • Organizational transformation is a key approach to address and mitigate the impact of structural practices.