The Use of Physical Interventions

Even when really good support plans are in place, there may be times when challenging behaviours occur. At such times, carers will often need to intervene in order to prevent harm to the person concerned or to themselves. 

‘Reactive strategies’ are used once challenging behaviours occur and provide carers with clear plans for how to respond to them when they do. Their use will not result in any future change in the pattern of a person's behaviour. Their goal is simply to help carers achieve fast, safe, and effective control of challenging behaviours. Reactive strategies must never be used on their own, but should instead be employed within the context of an overall Positive Behaviour Support plan.




Physical interventions

The term 'physical interventions' refers to any method of responding to challenging behaviour which involves some degree of direct physical force to limit movement.                           

There are three broad categories of physical intervention:

  • Direct physical contact between the carer and person with challenging behaviour (e.g. holding down of arms)
  • The use of barriers to limit freedom of movement (e.g. locked doors)
  • The use of materials or equipment to restrict or prevent movement (e.g. the use of arm splints)

Using physical interventions

This is a sensitive topic which creates many ethical and practical concerns. Some guidelines (designed by the British Institute of Learning Disabilities) to help services improve their practice in this area are:

  • Physical interventions should only be used in the best interests of the person with learning disabilities
  • They should only be used alongside other strategies to help people learn to behave in non-challenging ways
  • They should be individualised and reviewed regularly
  • They should use minimal force and not cause pain

Reducing the use of reactive strategies

We know that the use of restrictive practices can be significantly reduced in services that:

  • Have leaders that have reducing the use of restrictive practices as a clear priority
  • Record and closely monitor how often they are used
  • Use procedures such as risk assessments that are known to work
  • Involve service users in planning to reduce restrictive practices
  • Good debriefing procedures so that lessons are learnt when things go wrong/ right.
  • Develop the appropriate skills in staff
  • Use Positive Behaviour Support Plans

To download the full version of the Challenging Behaviour Foundation information sheet ‘Physical Interventions for Challenging Behaviour,’ by Professor David Allen, Abertawe Bro Morgannwg University Health Board & Welsh Centre for Learning Disabilities, Cardiff University click here.

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