Issues Emanating From the Implementation of Policies on Restraint Use With People With Intellectual Disabilities

Abstract

Some service providers use restraints and seclusion with people with an intellectual disability, and policies that permit such practices usually state that their use is primarily to prevent the risk of self-injury or risk to others. However, the use and effectiveness of restrictive practices have been questioned due to the negative impact on the service user and staff and may also be considered a contravention of the human rights of the service user. Consequently, policies are now trending toward limiting restraint use or on the prevention of or safe elimination of the use of restraint. In Ireland, new legislation has attempted to formalize the definitions of restraint and seclusion, as well as place restrictions on such practices. However, issues have been raised with respect to the implementation of the new policies, particularly in operationalizing a definition of restraint and applying it to widely heterogeneous clinical groups considering the autonomy that service providers have in devising their own service-level policies. The authors use legislation from Ireland and Victoria, Australia, to illustrate restraint practices and the issues emanating from its use. The authors argue that a gap remains between our understanding of the place of implementing restrictive practices with respect to service provision and their actual applications by providers. They conclude that such discordance between policy and practice needs to be addressed by stronger regulation.

Can sensory integration have a role in multi‐element behavioural intervention? An evaluation of factors associated with the management of challenging behaviour in community adult learning disability services

“…Lundstrom et al () assert the use of restraint is still an issue in practice. This would indicate there is a disparity between policy and practice in the management of CB (Deveau & Mc Gill, ; Feldman, Atkinson, Foti‐Gervais, & Condillac, ; Rickard, Chan, & Merriman, ). As discussed by Webber, Richardson, Lambrick, and Fester (), restrictive intervention ought to be a least restrictive approach and should only be used as a last resort following preventative proactive strategies (Deveau & Mc Donnell, ).…”

Parent-Guardian Evaluation of Physical Restraint Among Adults with Intellectual Disability: a Social Validity Assessment

“…Implementation of PR should only be considered if (a) less restrictive procedures have been ineffective, (b) there is clinical justification for its use, (c) the emphasis of intervention is on positive behavior support, (d) careproviders receive comprehensive training, (e) treatment effects are continuously evaluated, and (f) PR reduction and elimination are therapeutic objectives (Lennox et al 2011;Reed et al 2013;Sturmey 2009) Notably, PR is not easy to implement, can cause injury, and even death (Chan et al 2012;Spreat et al 1986;Tilli and Spreat 2009), and may function as positive reinforcement (Favell et al 1978;Magee and Ellis 1988). However, as articulated by Chan and colleagues (Chan et al 2012(Chan et al , 2014Rickard et al 2013), perhaps the most critical concerns about PR are the vulnerability of people with ID to restrictive procedures, their freedom from potentially abusive treatment, and the protection of fundamental human rights as declared in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (United Nations 2006). Within organizations serving people with ID, Bchanging the practice culture remains a critical step toward the prevention, reduction, and safe elimination of restrictive procedures^ (Rickard et al 2013, p. 253), including PR.…”

“…The information obtained from social validity assessment of PR can direct service organizations in creating implementation policies that are informed by consumers, evidence-supported, value-based, and aligned with the principles of human rights and dignity in the lives of people with ID (French et al 2010;Rickard et al 2013). In the present research, we extended the assessment methodology used by Luiselli et al (2015) to a parent-guardian population of adults with ID receiving community-based habilitation services.…”

“…Rather, our findings contribute to the current discourse about the clinical justification of PR, its therapeutic value, and how utilization policies should be based, in part, on the judgments of consumers. Safeguarding people with ID from restrictive procedures, preserving their human rights, protecting them from harm, and instituting evidence-based practices are the overriding tenets that should always govern implementation of PR (Rickard et al 2013;Vause et al 2009;United Nations 2006). …”

Gendered experiences of physical restraint on locked wards for women

“…National policies typically have the aim of reducing restraint but not eliminating it, to reach a point 'where physical interventions are only used as a last resort' (Department of Health 2014, 9). Components of national policies may include legislation, government endorsement of policy aims, programmes to encourage better leadership within service provider organisations, various forms of staff training, improved regulation and some form of monitoring (Rickard, Chan, and Merriman 2013;Romijn and Frederiks 2012). Despite this array of policies and action plans, it is clear that restraint practices are somewhat resistant to policy direction, with some countries even reporting steadily increasing rates of reported statutory restraint after the introduction of such policies (Søndenaa, Dragsten, and Whittington 2015) and specialist inpatient services reporting little change in commonly used restraint practices after the introduction of restraint reduction policies (Hatton 2016;NHS Digital 2015).…”