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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.
Use of physical restraints with people with intellectual disabilities living in Sweden's group homes
- Authors:
- LUNDSTROM Mats O., et al
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 8(1), March 2011, pp.36-41.
- Publisher:
- Wiley
People with intellectual disabilities often exhibit physical and communicative difficulties as well as challenging behaviours, and physical restraints are one method used to manage challenging behaviours and promote physical safety for them, their fellow residents, and professional carers. In the context of a lack of data about the practice of using physical restraints in Swedish group homes, this research aimed to investigate the prevalence of physical restraint use for people with intellectual disabilities and to identify the characteristics of individuals subjected to these restraints. The study included 556 people with intellectual disabilities, aged 16-90 years, living in 118 group homes, with information gathered through a questionnaire completed by a carer. The article describes the study and its results. 17.8% of the residents studied had been subjected to physical restraint over the previous week, with most of them subjected to more than one type of restraint; the most commonly used type of physical restraint was a belt. The authors conclude that despite the absence of legal authority for physical restraint use in group homes for people with intellectual disabilities, physical restraints are frequently used in Sweden, and that both physical impairments and behavioural symptoms are significantly associated with physical restraint use.
Winterbourne – questions should be asked at the highest level
- Authors:
- CITARELLA Vic, FLYNN Margaret
- Journal article citation:
- Community Living, 26(1), 2013, pp.18-19.
- Publisher:
- Hexagon Publishing
This article summarises the findings from the serious case review related to Winterbourne View Hospital. Castlebeck Ltd, the owner of Winterbourne View Hospital, took the financial rewards without any accountability. It placed adults with learning disabilities and autism under the supervision of poorly paid and untrained staff. It did not challenge the frequency with which physical restraint were deployed. It also failed to act on the complaints and concerns of patients, relatives or of visiting professionals. The article concludes that although the sentencing of staff will bring the criminal justice process to a legal conclusion, this will not address the more urgent issue of corporate responsibility at the highest level.
Client factors as predictors of restraint and seclusion in people with intellectual disability
- Authors:
- SCHEIRS Jan G. M., et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 37(2), June 2012, pp.112-120.
- Publisher:
- Taylor and Francis
In public health care in the Netherlands physical or personal restraint may be applied to reduce the unwanted consequences of a person's actions (such as hurting themselves or others), for example in response to challenging behaviours in residential settings for people with intellectual disability. This study investigated the role played by demographic and psychological variables in predicting the use of restraint. The article reports on the results of analysis of data about 475 adolescent and adult residents of a regional institution for people with intellectual disabilities in the Netherlands, including types and severity of restraint and separation. The study found that 60% of the residents had been treated with physical or mechanical restraint or with seclusion or separation. None of the height, weight, age or length of stay variables were related to the application of restraint. However, several psychological variables were significant predictors: low adaptive functioning, the presence of challenging behaviours (other than actual aggressiveness), and a relatively high intellectual level. Aggressive behaviours played a minor role in predicting restraint.
Descriptive analysis of physical restraint (protective holding) among community living adults with intellectual disability
- Authors:
- LUISELLI James K., SPERRY James M., MAGEE Christine
- Journal article citation:
- Journal of Intellectual Disabilities, 15(2), June 2011, pp.93-99.
- Publisher:
- Sage
- Place of publication:
- London
Physical restraint (PR) is sometimes used as a measure of last resort for adults with intellectual disabilities. This study investigated the incidence and implementation patterns of PR among 448 adults, aged 22 to 65, with intellectual disability within two community-based day habilitation programmes and group homes, located in a north-eastern region of the United States. Findings revealed that PR was used exclusively as a result of self-harming, aggressive, and environmentally disruptive behaviours. Less than 10% of adults received PR and more than 90% of documented restraints occurred as a planned intervention procedure. The majority of PR was used on just a few of the adults. The results showed that PR was not used excessively. The research should encourage human service organisations to design system-level processes for analysing PR incidence and implementation, thereby reducing and potentially eliminating PR among adult populations with intellectual disabilities. The clinical implications of these findings are discussed
Joint investigation into the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust
- Authors:
- HEALTHCARE COMMISSION, COMMISSION FOR SOCIAL CARE INSPECTION
- Publisher:
- Healthcare Commission
- Publication year:
- 2006
- Pagination:
- 76p.
- Place of publication:
- London
The report details the findings of a joint investigation into services for people with learning disabilities at Cornwall Partnership NHS Trust. The services investigated were the Budock Hospital near Falmouth, which is a treatment centre for 18 inpatients. The investigation also looked at two other treatment centres, 4 children’s units and 46 houses occupied by groups of up to four people with learning disabilities. The report describes many years of abusive practices at the trust and the failure of senior trust executives to tackle this. Examples of abuse included physical abuse and misuse of people’s money. Investigators found evidence of institutional abuse including some staff hitting, pushing, and dragging people. Some staff were also reported to have withheld food and given people cold showers. The investigation team also found an over-reliance on medication to control behaviour, as well as illegal and prolonged use of restraint.
Joint investigation into services for people with learning disabilities at Cornwall Partnership NHS Trust: easy read executive summary
- Author:
- HEALTHCARE COMMISSION
- Publisher:
- Healthcare Commission
- Publication year:
- 2006
- Pagination:
- 14p.
- Place of publication:
- London
The report details the findings of a joint investigation into services for people with learning disabilities at Cornwall Partnership NHS Trust. The services investigated were the Budock Hospital near Falmouth, which is a treatment centre for 18 inpatients. The investigation also looked at two other treatment centres, 4 children’s units and 46 houses occupied by groups of up to four people with learning disabilities. The report describes many years of abusive practices at the trust and the failure of senior trust executives to tackle this. Examples of abuse included physical abuse and misuse of people’s money. Investigators found evidence of institutional abuse including some staff hitting, pushing, and dragging people. Some staff were also reported to have withheld food and given people cold showers. The investigation team also found an over-reliance on medication to control behaviour, as well as illegal and prolonged use of restraint.
Time to end 'time out'
- Author:
- SHARP Hannah
- Journal article citation:
- Values into Action, 99, 2000, pp.6-7.
- Publisher:
- Values into Action
Expresses concern that the practice of using 'time out' or seclusion rooms for people with learning difficulties may be widespread in residential settings.
Physical interventions in the management of aggression and violence: legal, professional and ethical considerations
- Author:
- STIRLING Christopher
- Journal article citation:
- Journal of Adult Protection, 3(3), August 2001, pp.30-40.
- Publisher:
- Emerald
The use of physical interventions in the management of aggressive and violent behaviour continues to divide opinion and practice. In learning disability services, it is acknowledged that any physical intervention must be non-aversive and considered as part of an overall programme which emphasises positive alternative behaviours. Considers this understanding in the light of recent research and experience.
Abuse by any other name: a critique of some current approaches to behaviour management
- Authors:
- ALLEN David, HARRIS John
- Journal article citation:
- Mental Health and Learning Disabilities Care, 3(6), February 2000, pp.188-189.
- Publisher:
- Pavilion
This article argues that the routine brutality exposed in the BBC's MacIntyre Under Cover documentary on a residential home for people with learning disabilities demands action to improve restraint and challenging behaviour management techniques throughout learning disabilities services.