As the last resort: reducing the use of restrictive physical interventions using organisational approaches

Abstract

The development of restrictive physical interventions (RPI) to manage challenging behaviours based upon control and restraint during the 1980s and 1990s led to widespread professional disquiet and campaigning to improve the policies, training and application of physical techniques. This included the promotion of a value base within which physical techniques should be used. This value base may be summarised as any use of physical interventions must be in the person's best interests, 'least restrictive' and used as the last resort following preventive strategies. The last resort principle implies that services should be able to demonstrate support plans to prevent or reduce the frequency and/or restrictiveness of PI used in individual cases. This paper proposes that adopting explicit policies and practice to reduce restrictive PI is likely to be more effective in improving quality of support as opposed to solely managing PI use. Discussion of current policy and practice is followed by discussion of organisations' roles in relation to RPI reduction, with international comparisons.

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

“…The array of factors influencing decisions to use restraint as a last resort or otherwise is clearly multifactorial and complex. However, Deveaux & McDonnell () suggest that the ‘reliance upon the “last resort” principle has the major drawback that it is an easily voiced rhetorical device that is very difficult to observe or challenge’ (p.175).…”

Protecting the rights of pupils with autism when meeting the challenge of behaviour

“…; Hayden & Pike ). Moreover, following the introduction of training in positive handling into schools, pupils can experience an increase in unwanted bodily contact and restrictions on their personal freedoms (Baker & Allen ; Deveau & McDonnell ). This paper uses a vignette that depicts practice that I have observed whilst visiting a number of schools: the taking of a child's hand to lead him/her away from where the child wants to be to where the teacher desires the child to be.…”

“…restrictions on their personal freedoms (Baker & Allen 2012;Deveau & McDonnell 2009). This paper uses a vignette that depicts practice that I have observed whilst visiting a number of schools: the taking of a child's hand to lead him/ her away from where the child wants to be to where the teacher desires the child to be.…”

Physical intervention trainers: the case for greater accountability

“…Structured training was first offered to those working within the high secure hospitals, which pioneered the adoption of control and restraint system from the prison service in England (Wright 1999, Winship 2006). There are now an inordinate number of commercial training providers (Deveau & McGill 2007) offering a multitude of different training systems, but most if not all have their genesis in some form of martial arts. While martial arts purists will point out that the study of their art provides a life‐long journey leading self‐discovery and ultimately self‐enlightenment via the so‐called ‘do’ or ‘way’ (Brooks 2007), on a week‐by‐week and year‐by‐year basis, participants learn how to punch, kick, throw, lock and incapacitate in order to triumph over an opponent.…”

“…The parent organization retains ultimate responsibility for managing the risk of violence at organizational, team and individual levels (Leather et al. 1999) by cultivating the appropriate value base, configuring appropriate policy and commissioning training (Deveau & McGill 2007). It is, however, incumbent on the professional physical intervention trainer, spending face‐to‐face time with staff members, to ensure that it is process and not outcome that becomes the focus of staff learning.…”