Reducing Restraint: Working with families

I welcome the publication of the Restraint Reduction Network Training Standards. Not only will the Standards provide the support and training needed for people delivering support in services, but they could also have a significant impact for loved ones caring for family members or friends at home. The Training Standards are important because trainers can then train support teams and families in least restrictive interventions that are person-centred and therapeutic. Such training in reducing restrictive practices meant that one young person I worked with was able to stay at home.

Whilst working in a Child and Adolescent Mental Health Service Learning Disability Team, I worked with a young person who has a learning disability and lived with their Mum. Their behaviour was challenging to Mum, family, friends and professionals supporting the family. The young person attended a special school close to where they lived, which was working hard to adapt the environment and curriculum to manage behaviours presented.

Mum had a very hard time. The challenging behaviour often went on into the night and she often relied on members of her church to support her to manage the behaviour in the evening and on weekends. However, they had little to no training. The only training they received was what Mum was able to give them on the job.

We became aware of this support, which included significant amounts of physical interventions, and we were shown a video on Mum’s phone of prone physical interventions on their bed by 4 adults. We advised that holding the young person down like this on the bed or floor needed to stop immediately as it was so risky. We increased our visits and the team’s psychologist became involved. The aim was to talk to the family and support team about alternatives to keep them as safe as possible whilst working with social care. We highlighted to Mum that we needed to raise this incident as a safeguarding issue. Whilst she was upset, she hoped this would lead to the help she needed to manage the family situation and keep her child at home.

After presenting evidence to social care, highlighting the high risks, a plan was eventually made to have a skilled team of trained staff placed in the home to support the young person and family. These staff were trained in Positive Behaviour Support, and a limited number of breakaway and physical interventions not including prone holds. Having this team of staff placed at the home was difficult for Mum and the young person to accept. The introduction of the new staff was not without its difficulties in the early stages but it meant the young person could remain at home whilst the future was planned. 

This is one story highlighting the need for training in alternative strategies to physical restraint. Unless a person is trained, how can we expect them to know how to best manage challenging behaviours in a safe, preventative way? Support workers, carers and families need to work alongside one another to offer person-centred care that helps them safely manage behaviours they find challenging.

Glyn Connolly, BILD

April 2019

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