Exorcising restraint: reducing the use of restrictive interventions in a secure learning disability service
| Date | 12 December 2016 |
| Published date | 12 December 2016 |
| Pages | 176-185 |
| DOI | https://doi.org/10.1108/JIDOB-06-2016-0007 |
| Author | Tim Riding |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders |
Exorcising restraint: reducing the use of
restrictive interventions in a secure
learning disability service
Tim Riding
Tim Riding is a Programme
Director at the Centre for
Perfect Care, Mersey Care
NHS Foundation Trust,
Liverpool, UK.
Abstract
Purpose –The purpose of this paper is to describe the nature and impact of a restraint reduction
strategy implemented within a secure learning disability service in response to the national Positive and
Safe programme.
Design/methodology/approach –The strategy was comprised of three primary interventions –Safewards,
positive behavioural support and data-informed practice –and utilised a programme management approach
to ensure effective delivery. Baseline measures were collected from 12 months of data prior to
implementation of the programme and the frequency of each category of restrictive intervention was then
measured prospectively on a monthly basis throughout the duration of the programme.
Findings –Upon completion of the programme the following results were achieved: elimination of prone
restraint –elimination of mechanical restraint –42 per cent reduction in general use of restraint –42 per cent
reduction in use of seclusion –52 per cent reduction in rapid tranquilisation.
Originality/value –The paper adds to the growing body of evidence that carefully designed interventions
can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert
their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the
need for a stable workforce is considered.
Keywords Learning disabilities, Positive behavioural support, Programme management,
Restraint reduction, Restrictive interventions, Safewards
Paper type Research paper
1. Introduction
In April 2014 the Department of Health launched the two year national “Positive and Safe”
programme, aimed at reducing the need for restrictive interventions in health and social care
services. As a key element of the programme, two guidance documents were published
entitled Positive and Proactive Care (Department of Health, 2014) and A Positive and Proactive
Workforce (Depar tment of Health, Skills for Heal th and Skills for Care, 2014). The se documents
together set out a num ber of recommendations and a fr amework of measures to support th eir
delivery. Signif icantly, the CQC we re also assigned a num ber of key responsib ilities, including
scrutiny of positiv e behaviour suppo rt plans, and monito ring organisatio nal compliance wit h
the guidance.
The following paper describes the restrictive intervention reduction programme subsequently
developed at Calderstones Partnership NHS Foundation Trust. An overview of the programme
and its three constituent project groups is presented, and the practical challenges of
implementation are explored. The paper then continues to describe the impact of the
Received 24 June 2016
Revised 29 July 2016
Accepted 30 July 2016
PAGE176
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
VOL. 7 NO. 4 2016, pp.176-185, © Emerald Group Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-06-2016-0007
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