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Physical interventions for adults with intellectual disabilities: survey of use, policy, training and monitoring
- Authors:
- DEVAU Roy, McGILL Peter
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.145-151.
- Publisher:
- Wiley
Perceived problems around the use of physical intervention (PI) to manage challenging behaviour have led to UK initiatives to encourage policy development and accredited training. However, information on PI use and the impact of these initiatives remains limited. Adult residential services within an English region were sent a questionnaire regarding PI use, policy, staff training and monitoring/management. Physical intervention use was reported by 47% of the services. Of services using PI, 65% reported having a policy governing its use and 79% reported providing staff training. Where restrictive PI was used, comparable figures were 82% for policy and 84% for training. PI use was reported to be monitored in some way by 94% of services. Opinions offered supported the reduction of PI use. Physical intervention use is widespread. National guidance on policy and training is widely followed though unimplemented by a minority. The time may be right to more explicitly aim for a reduction in PI use within services.
Physical restraint of people with intellectual disability: a review of implementation reduction and elimination procedures
- Author:
- LUISELLI James K.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.126-134.
- Publisher:
- Wiley
This review describes procedures to reduce and eliminate physical restraint of people with intellectual disability. One approach is to assess antecedent conditions associated with restraint and change them so that they no longer produce restraint-provoking behaviour. A second approach is to decrease the duration of restraint by establishing a fixed-time release (FTR) criterion. Research supporting these approaches within community-based service settings are presented. Results found physical restraint can be effectively reduced and eliminated using antecedent intervention procedures and FTR contingencies.
Restrictive behaviour management procedures with people with intellectual disabilities who require dental treatment
- Author:
- NEWTON J.T.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.118-125.
- Publisher:
- Wiley
Dental disease is more common among people with intellectual disabilities than in the general population. Improvements in oral health require individuals to engage in daily oral hygiene and regular visits to a dental practitioner; both may be challenging for the individual with intellectual impairment. A review of policies relating to behaviour management and physical restraint for individuals with intellectual disabilities and challenging behaviours was undertaken. Published studies of behaviour management in individuals with intellectual disabilities attending for dental treatment were reviewed. Reference to studies of children with average IQ and other populations were made where appropriate. There is little published evidence regarding behaviour management for people with intellectual disabilities who require dental treatment. Current policies place great emphasis on pharmacological management and restrictive behaviour management techniques. There is a paucity of studies which have employed a functional analysis framework. There are few incentives for dentists to implement positive approaches to behaviour management as current systems of payment reward the completion of numbers of treatments and thus there is an incentive to complete treatments quickly rather than to spend time with patients.
Restraint safety: an analysis of injuries related to restraint of people with intellectual disabilities
- Author:
- WILLIAMS Don
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.135-139.
- Publisher:
- Wiley
This American study analysed the use of restraint with 209 individuals with intellectual disabilities exhibiting severely aggressive or self-injurious behaviour over a 12-month period. Planned restraint, the use of restraint as a component of a behaviour treatment programme (i.e. planned personal or planned mechanical restraint) was safer than crisis-intervention restraint (emergency personal or emergency mechanical). The overall rate of injuries during restraint was 0.46 injuries per hundred restraints. Restraint was applied 99.54% of the time without injury. Restraint was relatively safe and safer than reported in one other study. Planned restraint was safer than emergency restraint. The additional training and programme development associated with planned restraint may have contributed to the greater safety of planned restraint. Due to limited empirical data, restraint safety has yet to be established and this study suggests that restraint should be decreased and closely monitored.
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.
Restraint procedures and challenging behaviours in intellectual disability: an analysis of causative factors
- Authors:
- MATSON Johnny L., BOISJOLI Jessica A.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.111-117.
- Publisher:
- Wiley
Persons with intellectual disability often evidence challenging behaviours. Physical/mechanical and chemical restraint and the factors that may result in the use and maintenance of restraint are reviewed. The type, rate and intensity of challenging behaviours, and the age of the affected individual and residential placement appear to be among the major factors that put these persons at risk for restraint. Restraint is still a commonly used intervention employed with people with challenging behaviours. Physical and chemical restraint should be used as a last resort, part of a planned programme, and implemented by trained people.
Frequency of use and characteristics of people with intellectual disabilities subject to physical interventions
- Authors:
- McGILL Peter, MURPHY Glynis, KELLY-PIKE Amanda
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.152-158.
- Publisher:
- Wiley
This study sought to clarify the frequency and circumstances of physical intervention (PI) use and gather data on the characteristics of individuals subject to PI. Data on individuals subject to PI were gathered by postal questionnaire completed by service providers from three samples: people who (i) had attended a PI conference and/or purchased a PI policy document; (ii) operated in a specific geographical area of England and (iii) operated specialist assessment and treatment settings for children/adults with intellectual disabilities throughout the UK. Frequent PI use was reported. Restraint was most commonly reported – monthly or more frequently with most individuals. Overall, those receiving PI were more likely to be young, male, not legally restricted and identified as having an autistic spectrum disorder than those who did not receive PI. The relatively frequent use of PI is consistent with routine rather than last resort use. Such use carries risk of physical and psychological damage. Service providers should systematically reduce the frequency of use of PI.
Ethical approaches to physical interventions: volume II: changing the agenda
- Editors:
- ALLEN David, (ed.)
- Publisher:
- British Institute of Learning Disabilities
- Publication year:
- 2009
- Pagination:
- 224p., bibliog.
- Place of publication:
- Kidderminster
The editor brings together a collection of papers from leading academics and practitioners which together provide an overview of key developments and best practice with regard physical interventions. They analyse current policies and practices, examine physical intervention and abusive practices and discuss future needs. The material is divided into three overarching themes. The first looks at training in physical intervention, including a review of the current evidence, the British Institute of Learning Disabilities (BILD) physical intervention training accreditation scheme, the need for an effective assessment tool for intervention and the provision of training to parents. The second theme considers some of the current controversies including, the use of mechanical restraint in relation to self-injury, emergency medication for the management of challenging behaviour, the use of seclusion and time out and a discussion of fatalities that have occurred in restraint within UK adult care services. The final theme considers the paradigm shift required to move from a focus on physical intervention, that reflects a reactive approach to challenging behaviour, towards a more proactive, preventative approach. It considers how teaching new skills to service users can be critical in preventative intervention and looks at the issues and practices around restraint reduction.
As the last resort: reducing the use of restrictive physical interventions using organisational approaches
- Authors:
- DEVEAU Roy, McDONNELL Andrew
- Journal article citation:
- British Journal of Learning Disabilities, 37(3), September 2009, pp.173-177.
- Publisher:
- Wiley
The development of restrictive physical interventions 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 physical intervention used in individual cases. This paper proposes that adopting explicit policies and practice to reduce restrictive physical interventions is likely to be more effective in improving quality of support as opposed to solely managing physical intervention use. Discussion of current policy and practice is followed by discussion of organisations' roles in relation to restrictive physical intervention reduction, with international comparisons.
Predictors of restrictive research strategy use in people with challenging behaviour
- Authors:
- ALLEN David, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.159-168.
- Publisher:
- Wiley
Intrusive reactive strategies (physical restraint, emergency medication and seclusion) are frequently used procedures in the management of challenging behaviour. The present study identifies predictors for reactive strategy use in an attempt to more clearly delineate at risk service users. Eight hundred and thirty-nine agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Full data were available for 901 participants. Univariate and multivariate statistics were employed to identify predictors for reactive strategy use. The individuals most at risk of the use of reactive strategies were those who were subject to formal detention under the Mental Health Act (restraint and sedation), had more severe challenging behaviour (seclusion), showed destructive behaviour (restraint and seclusion) were placed out of area (seclusion) and had behavioural plans in place for specific topographies (restraint and sedation).