Exorcising restraint: reducing the use of restrictive interventions in a secure learning disability service

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.

Effect of Safewards on reducing conflict and containment and the experiences of staff and consumers: A mixed‐methods systematic review

“…2017), and ‘most of the interventions’ were reported in one study (Cabral & Carthy 2017, p. 168). One study did not report how many interventions were implemented (Riding 2016), and in one study, implementation of interventions had commenced across included adult wards (Stensgaard et al . 2018).…”

“…Other treatments utilized was reported in two studies (Davies et al . 2020; Riding 2016). One study provided limited information regarding methodology, participants and data analysis (Riding 2016).…”

An evaluation of the implementation of Safewards on an assessment and treatment unit for people with an intellectual disability

“…Within any clinical environment there are multiple clinical models and approaches which act as confounding variables, it is therefore unclear to what degree the effect is related to Safewards specifically. Within this service PBS is the primary model of intervention, and as Riding (2016) agreed, the models are complimentary, PBS here is seen as a more individualised approach whereas Safewards if more service led. The only way this could have been addressed is by implementing a double baseline approach which future research could consider.…”

“…Whilest there is research that has focused on the impact of implementing the Safewards model in forensic and acute in-patient's settings (Bowers et al, 2015;Cabral and Carthy, 2017), there is a dearth of research in this area that involves intellectual disability services. Riding (2016), however, aimed to reduce the use of restrictive interventions across low and medium secure services for people with an intellectual disability. A mixed approach consisting of Safewards interventions, positive behaviour support (PBS) and data-informed practice led to a significant decrease in the use of restraint, seclusion and rapid tranquilisation.…”

Minimizing the Use of Restraint in Patients with Mental Disorders at a Mental Hospital: A Systematic Review

“…The second, positive behavioral support, focuses on workforce development, shifting the emphasis to more preventive techniques through increasing the staff competencies supported by relevant training. Third, Monitoring, Reporting and Review, is focused on the use of high-quality data (Riding, 2016). One of the ways to reduce the use of seclusion and restraint is through sensory modulation.…”