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Clinical psychopathology, untoward incidents and the use of restrictive procedures in adults with intellectual disability
- Author:
- CHAPLIN Eddie
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.169-178.
- Publisher:
- Wiley
The authors examined all untoward incidents (n = 397) that were recorded for a group of service users (n = 65) referred to a specialist unit for adults with intellectual disability over a 6-year period. Associations between different restrictive procedures and clinical psychopathology were investigated. Physical assault was the most common incident associated with physical restraint, male gender and presence of autism. De-escalation was the most frequently employed intervention associated with less serious incidents such as verbal abuse and theft. Specific interventions seem to be associated with different types of incidents and presence of autism. The results are discussed in terms of clinical practice and possible future directions.
Lived experience of restraint, seclusion and segregation (RSS): stories and recommendations for safer care
- Authors:
- ADVONET, CHANGE
- Publishers:
- Advonet, Change
- Publication year:
- 2020
- Pagination:
- 23
- Place of publication:
- Leeds
This report aims to put the authentic voices of people with lived experience of restraint, seclusion and segregation (RSS) in care settings at the heart of the conversation about safe and effective care. Participant spoke of being afraid, scared, angry, upset when experiencing RSS; they felt that staff in healthcare settings lacked empathy and were not person-centred; and that there was a lack of adequate staffing in care settings. They saw the impact that poor resourcing, lack of training, and unsupportive cultures had on the staff who were at the frontline of their care. Some participants had positive experiences of RSS. They were clear that this was when it was used as part of a person-centred de-escalation strategy, with compassion, and as a last resort where safety was a concern. However, participants also provided very many examples of bad practice in implementing restraint, seclusion and segregation. People spoke of many experiences where they were physically, psychologically and emotionally harmed. People with lived experience expect: robust, personalised and appropriate training for care staff; accountability and action, at all levels, including funding commitments from the government for better, community-led care models; a stronger role for advocacy, including peer and family advocacy, and a more co-operative and involving culture within care providers. Most of our participants voiced the view that restraint, seclusion and segregation should be stopped, and people should be cared for in their own communities with appropriate support. (Edited publisher abstract)
Out of sight: who cares? Restraint, segregation and seclusion review: progress report
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2022
- Pagination:
- 63
- Place of publication:
- Newcastle upon Tyne
This report describes the progress made on the recommendations made in ‘Out of sight – who cares?’ report, published in October 2020, which looked at the use of restraint, seclusion and segregation in care services. The recommendations were made for people with mental ill health, people with a learning disability and autistic people. However, there is more of a focus on people with a learning disability and autistic people, as we visited more services where they lived. This is reflected in the balance of evidence in this report. This report updates on key themes, which means some recommendations are grouped together, rather than being in numerical order. The report finds that no recommendations have been fully achieved. Seventeen recommendations have not been achieved, including: people have a home and the right support in place; people have the right community services commissioned; people have the right support to avoid crisis; people have their rights understood; people receive the right support in hospital; people have skilled staff to support them; people have bespoke services; people who experience restrictive interventions have these reported to CQC; people who are segregated in hospital experience good quality regular independent reviews; people have meaningful Care (Education) and Treatment Reviews because providers and commissioners are accountable; all people in segregation in hospital are recognised through updating the definition of long-term segregation; people see a reduction in the use of restrictive interventions; people in children’s and adult social care services experiencing restrictive interventions would have these reported to regulators. The report also finds that four recommendations have been partly achieved: improving how CQC regulates services for people with a learning disability and autistic people; recording data to improve local services; people’s experience of person-centred care; people who experience restrictive interventions have regular oversight by commissioners. (Edited publisher abstract)
Restraint, segregation and seclusion review: progress report (December 2021)
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2021
- Place of publication:
- Newcastle upon Tyne
This short report comments on the progress following publication of ‘Out of sight – who cares?’ report and highlights the main areas where further work is still needed. ‘Out of sight – who cares?’, published in October 2020, looked at the use of restraint, seclusion and segregation in care services for people with a mental health condition, a learning disability or autistic people. The health and care system has taken action to understand the needs of people with a learning disability and autistic people in inpatient units. However, there is still much to be done. Too many people have still not seen their care improved. While the health and care system has made a commitment to increase the range of community support available to help prevent hospital admissions, this commitment now needs to be converted into real change. The findings of this report show that too many people are still in inpatient wards and they are spending too long in hospital. Getting the right care provision, support services and early intervention in the community will prevent hospital admissions, reduce the time it takes to discharge people into the right support and enable people to live their best lives. (Edited publisher abstract)
Out of sight: who cares? A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2020
- Pagination:
- 74
- Place of publication:
- Newcastle upon Tyne
This report describes the current state of the care system for children, young people and adults who are subject to restrictive interventions, and who are cared for in a range of settings. While the focus of this report is learning disabilities and autism, the findings have also implications and learning for settings that support people who have a mental health condition and/or who are living with dementia. The review found that often people were not getting the care they need, when they need it. There were many examples of care that was undignified, inhumane and that potentially breached people’s basic human rights. While it is possible to support people well in the community, care packages are often not available; and people are frequently not receiving the hospital care that they are entitled to. While the use of restrictive practice is not inevitable, nearly all of the services (hospitals and adult social care services) visited as part of this review used some form of restrictive practice. Where there was evidence of people being restrained, secluded or segregated, it was claimed that this was for their own safety or the safety of others. The report makes four key recommendations: people with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities; people who are being cared for in hospital must receive high-quality, person-centred, specialised care in small units; there must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others; there must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. (Edited publisher abstract)
A human rights perspective on reducing restrictive practices in intellectual disability and autism
- Editor:
- KARIM Sam
- Publisher:
- BILD
- Publication year:
- 2014
- Place of publication:
- Birmingham
This book explores the importance of human rights legislation and ethical decision making on reducing the use of restrictive practices when supporting people with an intellectual disability and people with autism. It provides examples of how legislation, case law and guidance have been used in the countries of England, Wales, Australia and North America to uphold people’s rights and challenge abusive practices. Chapters include: legal reflections on the human rights of restraint reduction; the importance of safeguarding rights and the role of legislation: the Australian perspective; ethical principles and good practice in reducing restrictive practices; replacing restraint: good practices in North American human service programmes for persons with intellectual disabilities and autism; and good practices in Australia in the use of restraint reduction practices for people with intellectual disabilities and autism. (Edited publisher abstract)
Choosing staff members reduces time in mechanical restraint due to self-injurious behaviour and requesting restraint
- Authors:
- JENSEN Craig C., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 25(3), May 2012, pp.282-287.
- Publisher:
- Wiley
This brief report describes an attempt to reduce self-injurious behaviour and associated mechanical restraint of a women who had a history of biting herself to the point of causing nerve damage. The use mechanical restraints to protect her from dangerous self-injury was decreased by the client choosing the staff person who would work with her. The client was a 28-year-old woman diagnosed with autism, bipolar disorder, static cerebral encephalopathy, moderate intellectual disabilities, hypotonia and musculoskeletal deformities. Mechanical restraints were applied when she bit, tried to bite herself or asked for them. When she was allowed to choose staff members, the use of mechanical restraint decreased. The authors conclude that reducing the time spent in mechanical restraint by giving the client a choice of staff members who would work with her demonstrates that such a choice may be an establishing operation. The value of cumulative records and scatterplots to evaluate changes in the occurrence of self-injurious behaviour and associated mechanical restraint is demonstrated as are the advantages of using alternating treatment designs to assess the effectiveness of treatment conditions for someone who exhibits long-term cyclic behaviour.
Physical interventions: from policy to practice
- Author:
- HARRIS John
- Journal article citation:
- Journal of Adult Protection, 3(2), May 2001, pp.18-22.
- Publisher:
- Emerald
This article considers good practice in the use of physical interventions. It describes work undertaken to establish a consensus around policy principles in relation to the use of personal restraints in response to violent behaviour by adults and children with a learning disability or autism. It highlights the benefits of clear local and national policies and identifies work required to promote good practice.
Guidance for restrictive physical interventions: how to provide safe services for people with learning disabilities and autistic spectrum disorder
- Authors:
- GREAT BRITAIN. Department of Health, GREAT BRITAIN. Department for Education and Skills
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2002
- Pagination:
- 32p.,bibliog.
- Place of publication:
- London
This guidance focuses on the need for provider agencies to have effective policies, procedures and training for staff who work with people who may have behavioural episodes where restrictive physical intervention is necessary for their safety and the safety of others. It promotes the concept of including potential strategies and actions in care plans, to help staff and people who use services deal effectively with such episodes. It emphasises training and in using training organisations who have the expertise and experience to provide for this sector. The guidance has now been superceeded by 'Positive and proactive care: reducing the need for restrictive interventions' (2014).