Best Practice and Reducing the Need for Restraint

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In response to the recent publication of the NICE (National Institute for Health and Care Excellence) Guidelines on challenging behaviour and learning disabilities, CPI’s (Crisis Prevention Institute) Executive Director, Chris Stirling, looks at the impact this has on approaches to reducing the need for restraint.

CPI and our MAPA® programmes have always maintained the philosophy of avoiding taking service users to the floor when using physical restraint, and this is reflected in the new guidelines. Our programmes emphasise avoiding floor holding wherever possible and only opt to pursue this course in the event of an emergency. Our Advanced and Emergency training do not teach forced descents and give a ‘let go’ option before considering any floor holding.

Opt-Out Sequence

When looking at holding someone on the floor, we teach supine, then side lying and finally prone, which clearly reflects the spirit and intentions outlined in the new guidelines. Similarly we emphasise the ‘shortest amount of time’ held in position and integrate the Opt-Out Sequence in all situational practice to reinforce this.

Best Practice

The updated guidelines mark a progression in terms of reducing the use of restraint that’s in line with CPI’s own approach. While the ‘prone debate’ and questions around ‘forced floor restraint’ are likely to continue, it’s reassuring to know that these guidelines reinforce the methodology outlined in the previous Positive and Safe (pdf)  guidance published by the Department of Health and reflect a growing commitment to best practice that continues to work towards reducing the need for restrictive interventions.