The use of restrictive physical interventions has been, and still is, common practice in many special schools. It is used with pupils who have social, emotional and mental health needs (SEMH), those who display extreme behaviour in association with learning disability and/or autistic spectrum disorders or for pupils with severe behavioural difficulties in some mainstream settings.
Following the Winterborne View Enquiry and the Department for Health’s publications of guidance such as Positive and Proactive Care: reducing the need for physical interventions and Positive and Proactive Workforce: skills for care, the guidance with regards to the use of restrictive physical interventions significantly changed for adults (18 and over) in health and social care settings.
As senior leaders in a residential special school for pupils with SEMH, we welcomed the new guidance – albeit for adults as we had never been comfortable with the use of restrictive practices. We recognized that sometimes, physical restrictive interventions may be required to keep both staff and pupils safe. However, we felt on occasions the use of physical intervention was used as a first as opposed to a last resort in order to gain compliance and deal with an incident quickly, rather than taking time to use de-escalation strategies.
As a leadership team we agreed that if the guidance issued by the Department of Health was good enough for adults, then it should be good enough for the pupils in our care, hence a restraint reduction programme was implemented.
Restraint Reduction Programme
I enrolled on the BSc in Restraint Reduction programme at Wolverhampton University in October 2014. It quickly became apparent that if we were to be successful in reducing the use of restrictive physical interventions, we needed to support the mental health needs of our pupils rather than concentrating on their behavior, which was a result of not having their mental health needs met.
As part of the programme I researched models of restraint reduction and decided to use Huckshorn’s Six Core Strategies as a model that could be adapted for use within the academy. This was a three-year research project across eight States in the USA in 18 hospital sites. The programme was deemed very successful in reducing the use of seclusion and restraint within these organisations and is now recognized as evidence-based practice.
Huckshorn identified six key areas that need to be in place:
- Leadership towards organisational change
- Use of data to inform practice
- Workforce Development
- Consumer Involvement
- Use of prevention tools
- Use of debriefing techniques
Using the above headings, the model below was adapted for use in a SEMH setting:
As a result of implementing this model, the number of restrictive physical interventions as a percentage of the number of pupils on roll has decreased from 16% in 2013/14 to 1.8% in 2015/16.
In addition to achieving our goal of reducing the use of restrictive physical intervention, the implementation of the programme has also resulted in unexpected but significant improvements in other key performance indicators.
The number of days lost to fixed term exclusion has been reduced by 66% and the amount spent on vandalism/damage has been reduced by 22%. Staff and pupils have also told us that such changes have resulted in a much safer and calmer environment, something Ofsted picked up on in their latest inspection:
“A senior manager has undertaken academic, research-based study, on the emotional impact of physical restraint. This has resulted in a restraint reduction programme being introduced across the school, and there has been a dramatic decrease in the number of incidents resulting in restraints. No young people have been restrained within the residential houses since the last inspection.” (Ofsted 2016)
In the next academic year (2016/17), the Academy aims to become a restraint-free organisation.
We recognise that for some of our pupils, who have been used to having their behaviour managed with restrictive physical interventions in other settings that this transition will need to be managed. Despite this we are confident that we can reduce our current 1.8% intervention statistic to nothing.
We are also going to share our expertise and experiences by delivering training in mental health to staff in 140 schools across four London Boroughs over the next academic year, allowing hundreds of staff in mainstream settings to have a greater understanding of how mental health needs and trauma impacts on the development, learning and ultimately the behaviour of the pupils in their care.