8.1 There may be times when behaviours cannot be prevented or de-escalated in any other way, and this may put the person or others at risk of harm.
8.2 Only when other preventions have failed and there is risk of harm to the person or other people (including staff) and there is no other way of keeping people safe, we will use pre-agreed reactive strategies to manage behaviours that challenge.
8.3 Reactive strategies may be:
- non-restrictive i.e., a non-physical intervention that does not involve any physical contact with the person or
- When strict requirements are met: a restrictive physical intervention
8.4 Reactive strategies include:
- Breakaway – a self-defence move to allow staff to move away from the person
- Seclusion – separating the person from others, even if they remain in the same room until they are calm enough to safely rejoin activities
- Restraint / safe hold – holding the person in a safe position until the situation is less unsafe
- Removal – moving the person from the area to a safer place
- Administering a PRN (‘as required’) medication in accordance with the person’s PRN protocol. This is medication specifically prescribed to the person by a medical professional to be used in circumstances when risks to the adult / other people are severe and cannot be managed in any other ways
8.5 Use of reactive strategies must be:
- Part of a package of behavioural support which includes primary and secondary prevention. Reactive strategies must not be used alone
- As specified in the behavioural support plan
- Monitored and audited
Restrictive interventions
8.6 A person may experience reduced quality of life and adverse outcomes because of restrictive responses to behaviours that challenge such as:
- Being excluded from activities, services or community facilities
- Being denied contact with other people or allowed only reduced contact
- Physical injury or increased disability
8.7 Restrictive interventions must be:
- In the person’s Best Interests, necessary in order to prevent them suffering harm or harming others and proportionate to the likelihood of the providing suffering harm, and the seriousness of that harm
- Thoroughly risk assessed before they are agreed and take into consideration all possible contra-indications and / or complications
- Agreed in consultation with specialist services / teams and any relevant professionals. This may include specialist council services (such as the Positive Behavioural Support Service) as well as external providers / professionals such as the person’s GP or medical professional
- Sanctioned for use for the shortest possible period of time and regularly reviewed
- The most ethical and least restrictive measure necessary in the circumstances. When a range of restrictive interventions is agreed, these must be ranked from least to most restrictive. The least restrictive intervention appropriate to the immediate situation must be used as the first option
- Able to be performed by all key carers
- Recorded in the behavioural Support Plan which must be kept up to date
8.8 Restrictive interventions must:
- Be proportionate and appropriate to the immediate situation
- Use the minimal amount of force necessary to contain the situation and make it safe
- Be used for the minimum amount of time necessary to manage the immediate situation
- Return control to the adult as quickly as possible Meet the BILD Association of Certified Training requirements (BILD ACT) and Restraint Reduction Network Training Standards
8.9 Restrictive interventions must not:
- Be used as a punishment
- Inflict pain in order to achieve compliance
- Involve hyper extension and/or hyper flexion of any joint
- Involve potentially dangerous positions that may compromise an person’s health and well-being
- Involve vulnerable parts of the body (neck, chest, and groin)
- Impede breathing
- Be performed without an appropriate medical assessment for individuals with a history of certain medical conditions (for example orthopaedic issues, recent surgery, those prone to skin tears/bruising etc.) or
Where the use of such techniques has previously been unforeseen, this assessment should take place as part of a ‘de-brief’ of the situation where the techniques were applied and before further use is agreed
8.10 Staff are responsible for the safety of the person and other people when using restrictive strategies. Immediately after the use of a restrictive intervention, staff must:
- Assess for any signs of injury or psychological distress to the person
- Calm the person and support them to rejoin activities
- Support and calm any other people distressed by the incident
- Record use of the intervention and any concerns in the person’s case notes
- Report the use of the restrictive intervention as an incident to the SHE unit
All Gloucestershire County Council staff are responsible for providing safe care for the people who use our services – if you see something that doesn’t comply with the above please follow our Whistleblowing | Gloucestershire County Council
