Physical interventions

Challenging behaviour may occur, even when we have tried our best to stop the person becoming distressed. No matter how hard we try it is not always possible to control triggers and support someone to stay happy and calm. In these situations, family carers and paid staff need to respond to challenging behaviour to keep the person and those around them safe.

‘Reactive strategies’ are used once challenging behaviours occur and provide carers with a clear plan for how to respond. The goal is simply to keep everyone safe. Reactive strategies must never be used on their own. A Positive Behaviour Support plan should be in place with a focus on helping the person to have a good life and preventing challenging behaviours happening.

Download the information sheet: Physical interventions

‘Hands-off’ reactive strategies

‘Hands off’ ways of responding to behaviour such as distraction, redirection and giving the person space should be considered before restraint and seclusion as they are a less restrictive way of responding to behaviour.

Restrictive practices

Restrictive practices are reactive (responding to the behaviour) and restrict or limit the person’s movement or freedom. There are four broad categories of restrictive practices:

• Restraint where there is direct physical contact between the carer and person with challenging behaviour (e.g. holding down of arms)
• Seclusion – isolating a person and preventing them from leaving e.g. by locking the door
• The use of objects or equipment to restrict movement (e.g. the use of arm splints)
• Medication used to calm or sedate the person

Reducing the use of restrictive practices

Government guidance for children, young people and adults who have a learning disability focuses on reducing the use of restrictive practices. Guidance says that when restrictive practices are used they should be:

• A last resort
• The least restrictive option
• Proportionate
• Used for the shortest possible time
• Carried out using the minimum force

They should never be used to intentionally cause pain, suffering or humiliation.

People should never be restrained in a way that affects their breathing. This is dangerous.

Key points

• Plan reactive strategies as part of a positive behaviour support plan
• Teach the person new skills and improve their quality of life
• Get appropriate training
• Use the least restrictive option
• Record incidents
• Review the incidents to see what can be learned
• Regularly review the Positive Behaviour Support plan
• Seek help from your local Child & Adolescent Mental Health Services (CAMHS) or Community Learning Disability Team (CLDT) to reduce the use of restraint and seclusion

If you are concerned about the use of restraint or seclusion seek independent advice.

Download the information sheet: Physical interventions