{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:06:08Z","timestamp":1784696768246,"version":"3.55.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>Physical restraint persists at high rates in human services settings supporting individuals with intellectual and developmental disabilities (IDD), even within organizations that have formally adopted positive behavior support (PBS) frameworks and invested substantially in staff training. This perspective article introduces the Staff Decision Ecology Model, a decision ecology account of physical restraint, which conceptualizes restraint as a context-dependent, staff-mediated decision shaped by nested individual, environmental, and organizational variables, and argues that leadership functions as decision architecture: the organizational force that structures upstream conditions before any crisis arrives. Three empirically grounded mechanisms are examined: psychological safety, implementation climate, and team communication structures. A conceptual model is proposed, and a solutions-oriented agenda is advanced specifying leadership development targets, organizational assessment strategies, and a testable multilevel research program. The central argument is that restraint elimination requires organizational conditions that leaders build or fail to build, and that continued reliance on training-centered approaches, absent that organizational investment, will produce the same unsatisfying results.<\/jats:p>","DOI":"10.3389\/fpsyg.2026.1889369","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:50:23Z","timestamp":1784695823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Leadership as decision architecture: an organizational framework for understanding and eliminating physical restraint in human services"],"prefix":"10.3389","volume":"17","author":[{"given":"Nicole","family":"Sorensen","sequence":"first","affiliation":[{"name":"MyPath","place":["Oconomowoc, WI, United States"]},{"name":"College of Health, Education & Social Welfare, University of Wisconsin-Green Bay","place":["Green Bay, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1111\/jar.13112","article-title":"Organisational impact on the use of restrictive measures: the perspective of Swedish front-line managers","volume":"36","author":"Bj\u00f6rne","year":"2023","journal-title":"J. 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Behav."},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1177\/17446295241280697","article-title":"Staff burnout in intellectual disability services and resistance to change: implications for leadership support","author":"Ntinas","year":"2024","journal-title":"J. Intellect. Disabil."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s10566-021-09646-w","article-title":"A 26-year study of restraint fatalities among children and adolescents in the United States: a failure of organizational structures and processes","volume":"51","author":"Nunno","year":"2022","journal-title":"Child Youth Care Forum"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","article-title":"A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project","volume":"10","author":"Powell","year":"2015","journal-title":"Implement. 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