Imposing physical restraint on an individual is an extreme tactic.
Although it is sometimes necessary, it should only be used as a last resort. Strategies and practices can be put into place in order to avoid the use of restraint, and, hopefully, at the very least, reduce its implementation.
Below are 16 defined strategies we can apply to the foundation and successful utilization of restraint-reduction philosophy and practice.
Policy, Procedure, and Protocols
A mission statement defines the ultimate goal of each organisation. Within are expressed core values, beliefs, and ethics. Additionally, policies, practices, and procedures exist to assure proper guidance of the mission. It is imperative that restraint reduction, as an initiative, be entered and entirely congruent with the policies and the practices of the organisation.
Organisational Leadership
Executive leadership acts as a guide and a model. If there is to be a successful restraint-reduction initiative, it must be led from the top. A reduction plan must be formulated, communicated, and then implemented. Organisational leadership should ensure guidance, direction, and also participate in the review of the reduction initiative—on a continuous basis.
Data Practice and Quality Assurance
Empirical data must be collected. This would include baseline and intervention phases in order to measure restraint-reduction levels. This will assist in analysing characteristics and practices of individual services as well as the recording of incidences. Service-specific goals and objectives can then be set. Services can then be compared and monitored in all areas; outcome effectiveness can then be reviewed efficiently and accurately.
Person-Centred Environment
Understanding of and practice in the principles of person-centred care is critical and necessary. A person-centred environment allows for mutual respect, joint decision-making, and a non-hierarchical setting. It’s with this type of environment, trust, partnership, and self-actualization can thrive. An atmosphere without coerciveness or conflict can lead to successful self-management and full inclusion. Everyone’s dignity remains intact or, even preferably, self-worth becomes elevated.
Staff and Training
Training may be one of the most vital elements involved in achieving success. Staff’s goal, which should, expectantly, be in sync with the organisation’s goal of restraint-reduction, is to arrive at the practice of non-violent intervention. Being trained in a select, myriad of ways to avoid and preclude severe behaviours, and ultimately, restraint is paramount.
Via staff education, person-centred care can be achieved. Behaviour support training is a must. Emphasis should be placed on preventative methods rather than reactive. Although the goal is to avoid restraint and use it as a last resort, safe “restraint techniques” must be taught, nonetheless.
In regards to job descriptions, it is imperative that staff have the ability to teach life skills as per service requirements. Additionally, attitudinal competencies should be considered. (Both should be weighed in performance evaluations.) However, in order for staff to perform brilliantly at each checkpoint, training is necessary. Training will inform how to: avoid a swift and unsafe reaction, understand challenging behaviour, and intervene before it escalates into a position of necessary restraint.
Functional Analysis
In order to assuage further or frequent escalation, understanding the reasons for the presence of challenging behaviour is key. Staff should attempt to identify the variables that impact the incidence of behaviours. Why today? What changed? Are needs being met? Using functional analysis as a methodology will assist in creating a behavioural assessment.
Clinical Team (Psychological Input)
The role of the clinical team, in relation to behaviour support, is crucial in order to fully and accurately understand functional analysis. Observations, interviews, and data—all need to be compiled, examined, and brainstormed within the team.
Antecedent Assessment and Intervention
The situation, circumstance, or event that immediately precedes the challenging behaviour is known as an antecedent. Solving the problem of antecedents, what triggers the behaviour, is one of the keys to preventing the behaviour from occurring. Removing or avoiding the trigger should prevent non-preferred behaviour; hence, the need for restraint would not be deemed.
Use of Reduction Tools, Individual Support Plans, and Crisis Management
A variety of assessments, tools, and techniques must be integral to each service user’s plan. Individualised antecedent triggers for behaviour, risk factors for aggression, and incident and restraint history are essential and should be carefully detailed in the IBSP. Risk assessments for acceptable restraint-techniques must be obtained from the training provider; they should be carefully examined and understood by all staff. Crisis management strategies should be detailed in clear, safe, and practical plans for responding to known risk behaviours.
The Use of Primary Prevention Strategies
Primary prevention will require a portfolio of tools, which begins with utilizing clear communication. Verbally, staff will want to pay attention to their use of volume and tone of voice. Carefully choosing verbiage and keeping communication succinct, simple, and direct is essential. Listening, being positive, patient, and non-judgmental are worthy proactive tools. In LD and Autism settings, visual aids will help greatly. Awareness of body language and proxemics are also essential.
The Use of Secondary Prevention Strategies
Should primary strategies become unsuccessful, the use of de-escalation tools will become necessary. The ultimate objective is to keep everyone safe. Remove other people, objects, and maintain a safe distance from the person acting-out. Offer options that will assist in calming. Call on others for help to visually supervise and/or intervene. Assemble team members should restraint become necessary. Ideally, the behaviours will decrease and/or diminish before physical intervention is required.
Programmatic Structures
Meaningful routines along with social and physical activities should be integral to each individual person. Skills should be taught on a daily basis and learning objectives achieved through effective planning. Empowering individuals with decision-making is paramount to personal development.
Service User Involvement
The organisation must integrate the service-users’ input, their families’ input, and advocates’ choices wherever possible. They should be represented in committees and action groups and be involved in assessment and intervention procedures.
Effective Recording of Incidents
Calling upon others in the team for support during escalation and/or imminent restraint is important for safety purposes as well as observation and witness for the record. In a heightened state, staff may not be able to recall exact replay of happenings. It’s imperative that recording of incident ensues as soon as possible afterwards. A recollection of antecedent, behaviour, escalation, aggression, staff intervention and tools utilized to avoid restraint should all be required when recording details.
Debriefing and Processing Following an Incident
Incident debriefing should be carried out in two stages. 1) Immediately following the event to ensure everyone’s safety and security, the environment is restored and the service-user involved is monitored. Any emotional aftermath must be effectively managed and supported. Reports must also be written outlining event for later analysis. 2) In the days following, an in-depth debrief will analyse exactly what happened. This debrief will revise and improve the IBSP (Individual Behavior Support Plan).
Staff Inductions
After staff have been hired and trained, they must be properly introduced to the job and their role. Thoroughly understanding duties will facilitate the realisation of the organisation’s goals. Expressing the need for behaviour support, understanding the reasons for behaviour, the role of IBSP’s, and the need for effective recording are critical elements to be delivered during staff induction.
The utilization of physical restraint on an individual can be traumatic for the restrained, the person restraining, as well as for those witnessing the event. It is a radical action that should only be embarked upon when safety is at stake and when all other viable methods of de-escalation have been presented or performed. Optimistically, with the implementation of the above strategies, the use of restraint will be greatly reduced.
