For more information about the Network
call 0121 415 6960 or email RRN@bild.org.uk
Like-minded organisations in pursuit of restraint-free services

Tools and resources

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We are building a bank of resources for practitioners and organisations. If you have anything that you think should be added to this list, please contact communications@bild.org.uk. 

Blanket Restrictions – Much time has been spent reducing the use of the more obvious forms of restrictive practices, such as restraint and seclusion. Rightly so! Meanwhile, the apparently innocuous ‘blanket restrictions’ have flown under the radar and received much less scrutiny.

The Restraint Reduction Network were commissioned by NHS England to carry out a project which explored the effects of Blanket Restrictions, and we have created a toolkit to address the long-term harm they can cause. In this video, Alexis Quinn (RRN manager, Autism campaigner and person with lived experience) speaks meaningfully about Blanket Restrictions and what can be done to address their use in our systems. Watch the video here>

 
Six core strategies and human rights infographic – This infographic shows how human rights and the Six Core Strategies enable the culture change necessary in organisations to reduce the use of restrictive practices.     

The Impact of the Covid-19 Pandemic and Lockdown on Restrictive Practices – This survey sought to gain the views of a range of practitioners who work in different settings within which restrictive practices, like physical restraint and seclusion, are used to manage behaviours that present challenges to those services. The survey wanted to find out if those practitioners thought the pandemic had had an influence on the use of those restrictive practices.

Towards Safer Services: National Minimum Standards Organisational Restraint Reduction Plans  This document outlines the National Minimum Standards for the content of Restrictive Interventions Reduction Plans in Mental Health and Learning Disability Settings and offers a framework to support care providers in the reduction of the use of restrictive practices. We produced a webinar on this topic, which can be viewed here>

This WHO QualityRights Core training for mental health and social services course guide helps participants learn about some of the key strategies and approaches which have been shown to be effective in bringing about an end to abusive practices within services.

POWER principles – Working alongside people with lived experience (experts by experience)

Implement the Restraint Reduction Network Training Standards with this new benchmarking tool

Is your training in line with the new standards? More pointedly how do you find out? In order to make the process of comparing existing provision against the new standard simple, a benchmarking tool has been developed.

The Charlie Waller Memorial Trust envision a world where all people understand and talk openly about depression and mental health, where young people know how to maintain well-being, and where the most appropriate treatment is available to anyone who needs it. They understand that much of the mental health advice and support widely available does not necessarily meet the specific needs of autistic people, so they provide courses to children, young people, families and professionals.
The spaces in which we live, work and rest can have a profound impact on our quality of life. Environments may be modified with the intention to control or restrict what people do. In Victoria (Australia), they have been rolling out a project to reduce environmental restraint. A result of this has been a national measure of environmental restraint. The measure was user-tested in Victoria with services and found to be comprehensive, but also quick and easy to use.
This new resource: School-based violence prevention: a practical handbook, is about schools, education and violence prevention. It provides guidance for school officials and education authorities on how schools can embed violence prevention within their routine activities and across the points of interaction schools provide with children, parents and other community members.
This guidance follows on from the Positive and Proactive guidance published by the Department of Health in 2014. It states: “Restrictive intervention should only be used when absolutely necessary, in accordance with the law and clear ethical values and principles which respect the rights and dignity of children and young people” (p.25). It covers children and young people with learning disabilities, autistic spectrum conditions and mental health difficulties in health and social care services and special education settings.
School should be a safe and healthy environment in which children can learn, develop, and participate in programs that promote high levels of academic achievement. Children have a constitutional right to education that must be protected. This resource document, written for the United States specifically in mind but beneficial to all, presents and describes 15 principles for consideration when developing policies and procedures about restraint and seclusion in the education sector. 
 
This tool defines different types of restrictive practices and takes the user through a process of identifying restrictive practices and assessing their appropriateness. You can download an editable version here.

CQC Interim report: Review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability and or autism This report gives the interim findings from the CQC’s review of the use of restrictive interventions in places that provide care for people with mental health problems, a learning disability and/or autism.

INVOLVE was established in 1996 and is part of, and funded by, the National Institute for Health Research, to support active public involvement in NHS, public health and social care research. There are more researchers and research commissioners working alongside the public for the first time than ever before, and INVOLVE are committed to maximising that participation. Access a range of their resources here.
 
The ‘REsTRAIN Yourself’ toolkit encompasses the Six Core Strategies of restraint reduction developed in the US, and was created to suit the UK context. REsTRAIN Yourself aimed to reduce the use of physical restraint in mental health inpatient ward settings through training and practice development with whole teams, directly in the ward settings where change is to be implemented and barriers to change overcome. This paper presents qualitative findings that report on staff perspectives on the impact and value of Restraint Yourself following its implementation.
 
On 30 March 2018, the Children and Young People’s Commissioner Scotland began a formal investigation into ‘Restraint and Seclusion in Scotland’s Schools’. This issue was identified as a priority for the office’s first investigation based on careful consideration of the rights issues at stake, the implications of those rights being breached, the vulnerability of the children and young people involved, and the extent to which concerns have been raised through the office’s advice function.
 
Beth Morrison (mother of child with lived experience and CEO of Active and Positive Support Scotland) and Vivien Cooper (mother of child with lived experience and CEO of the Challenging Behaviour Foundation) have collated and share family carers’ shocking accounts of their children’s experiences of restrictive intervention. They also provide recommendations to be implemented into policy. 
 
Inclusion Ireland has collected stories from a group of parents on the experience of their children in schools. It concludes that rules are needed to say when restraint and seclusion can be used and to protect the human rights of children. This report includes an easy read summary.

Restraint Reduction Network (RRN) Training Standards 2019
Ethical training standards to protect human rights and minimise restrictive practices
These new standards, developed with Health Education England, have been developed to provide a national and international benchmark for training.

Mental Health Act: A focus on restrictive intervention reduction programmes in inpatient mental health services, 2018
On page 9, you can find out more about the HOPE model, an approach to reducing reliance on long term segregation and seclusion that has been developed by Mersey Care NHS Foundation Trust, and used to reduce reliance on restrictive practices in secure mental health services.

Person centred restraint reduction: planning and action Developing individual restrictive practice reduction plans: a guide for practice leaders
This book is for practice leaders who can support colleagues to develop person centred reduction plans and make changes that have direct impact on people’s lives.

Reducing Restrictive Practices Checklist
A self-assessment tool to help organisations ensure that the use of restrictive practice is minimised and misuse and abuse of restraint is prevented. You can also download an editable version of this tool (see below):

Reducing Restrictive Practices Checklist – Editable

Restrictive Interventions in Inpatient Intellectual Disability Services:
How to Record, Monitor and Regulate
This report is concerned with the standards of recording, monitoring, and regulation of restrictive interventions involving people with intellectual disabilities with mental health and/or behaviour that challenges within inpatient services.

Promoting Less Restrictive Practice 
This tool aims to help practitioners identify restrictions in a person’s care, in order to examine whether the care is the ‘least restrictive’ possible, as required by the Mental Capacity Act. It can also be used as part of care planning to ‘promote liberty and autonomy’ in care plans

Guide to Reducing Restrictive Practice in Mental Health Settings
Mersey Care NHS Foundation Trust has brought together the key elements of its award winning, nationally recognised ‘No Force First’ programme to reduce restrictive practices, in order to formulate a comprehensive guide for its inpatient areas.

Positive Cultures of Care
This free resource guide was produced by the Massachusetts Department of Mental Health and remains a useful publication especially for those working in children’s services.

Six Key Restraint Reduction Strategies
This document from the Restraint Reduction Network offers six steps as a way to assess your organisation’s strengths, and look for ways you can improve practice.

Consolidated Six Core Strategies Document
This is a resource from the National Association of State Mental Health Program Directors (NASMHPD).

Restraint in Mental Health Services
A publication from MIND and NSUN.

A Positive and Proactive Workforce
A guide to workforce development for commissioners and employers seeking to minimise the use of restrictive practices in social care and health.

Let’s talk about restraint
A publication from the Royal College of Nursing

NICE Guideline (Violence and Aggression)
Violence and aggression: short-term management in mental health, health and community setting, published 2015

REsTRAIN Yourself Toolkit
This toolkit encompasses the Six Core Strategies of restraint reduction developing in the US by Kevin Ann Huckshorn PhD, State Director, Delaware. It was adapted for the UK by: Joy Duxbury (University of Central Lancashire), Julie Cullen (AQuA), Paul Greenwood (AQuA), John Baker (University of Leeds), Owen Price (University of Manchester), Julia Woods (AQuA Associate, Julia Wood and Associates Ltd) and Anthony Mather (AQuA).

The BPI-S tool
The BPI-S is a simple, easy to use behaviour rating tool that rates the frequency and severity of problem behaviour and provides a score. In a paper by Dr Darren Bowring and colleagues,  data is provided on what score changes would indicate statistically reliable behaviour change and clinically significant behaviour change if the tool was used in a pre-post manner. As reporting behaviour change outcomes become more important this will allow services to use the BPI-S in demonstrating meaningful behaviour change.

Six Core Strategies for reducing seclusion and restraint checklist
A checklist based on the Six Core Strategies checklist developed in the USA by the National Association of State Mental Health Programme Directors Medical Directors Council. This version has been adapted for use in New Zealand.

This learning resource, developed by Social Care Wales, aims to provide an understanding of how to work using positive and proactive approaches and reduce the use of restrictive practices in social care.

Podcasts
Unrestrained is a podcast produced by CPI in the United States.

unrestrained

The Mental Health Safety Thermometer
Iris Benson is an Expert by Experience at Mersey Care NHS Trust. She volunteers her time to educate staff on how restraint effects patients in Mental Health settings. In this film she shares her experiences of trauma in her youth and how restraint can bring those memories flooding back.

https://vimeo.com/107608482

Minimising the use of restraint in care homes for older people: creative approaches
This video, from the Social Care Institute for Excellence, argues that care homes should re-examine their customs and practices to find new and creative ways to support residents to achieve the lives of their choice and to minimise the use of restraint.

Why do they hurt?
A short film from Beth Morrison, CEO of Positive and Active Behaviour Support Scotland and Calum’s mum. Calum endured restraint at his schools that almost cost him his life, this is his story. 

Click here to watch.

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Restraint Reduction Network Conference 2018

An introduction to the Restraint Reduction Network conference 2018, showing coverage from the day and comments from speakers and attendees

Videos from the 2018 RRN Conference

Ben Higgins, CEO of BILD talks about the differences between adult and children’s services and suggests further reforms are needed to change the culture in schools and how they deal with children’s challenging behaviour.

Principal Richard Chapman and his team from Calthorpe Academy picked up the award to recognise a person or organisation that has reduced reliance on restrictive practice in schools at the 2018 Restraint Reduction Conference. Richard talks about how he tackled the ‘toxic’ atmosphere in the school when he joined as Principal. The school was placed into special measures by Ofsted and Richard and his team worked hard to change the ethos of the school.

Rafik Hamaizia, Expert by Experience Lead for Cygnet Healthcare talks about how much we can learn from each other.

Beth Morrison and Kate Sanger discuss how schools should work with parents to reduce instances of restraint and get the best outcome for children.

Richard Wilkins from the Witherslack Group discusses the impact of a PBS approach at his organisation.

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Stopping the over-medication of people with intellectual disability, autism or both (STOMP) and supporting treatment and appropriate medication in paediatrics (STAMP) – positioning paper

People with a learning disability and autistic people are often over-prescribed psychotropic medication. In recent years this has been highlighted by the Care Quality Commission (CQC) and via a number of Serious Case Reviews and inpatient based scandals. Doctors were prescribing medications without there being clear clinical indications for needing them. For example, to manage distressed behaviour resulting from environmental factors rather than taking a holistic or psychological approach. 

Medication has not always been prescribed judiciously and the STOMP pledge (stopping the over-medication of people with intellectual disability, autism or both) has not always been taken up in many care settings.  

The RRN are pleased that members of the Faculty of Psychiatry of Intellectual Disability have responded to these challenges and are clear that prescribing practices must change. The attached position statement gives some indication of how medications can be used optimally and when doctors may choose alternative methods of support for people in their care.  

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Launch of new animation to support understanding of behaviour in the early years and reduce the use of restrictive practice 

A new co-produced animation has launched from the Institute of Health Visiting (iHV), in collaboration with the Challenging Behaviour Foundation, The Sleep Charity and parents / carers.

This new animation aims to help inform the practice of health, education and social care professionals to raise awareness and understanding of behaviour in the early years and what restrictive practice looks like in the under 5s. In addition, the animation reiterates the importance of respectful, behavioural support strategies that safeguard the rights of young children with disabilities.

This co-produced animation shares the voices of parents/ carers through one family’s journey. The animation is supported by a range of new resources specifically for health visitors that collate information about understanding behaviour and using appropriate interventions, and to offer alternatives to restrictive practices. 

You can view the animation here: https://www.challengingbehaviour.org.uk/news/new-animation-raises-awareness-restrictive-practices/

To find out more about these resources and accompanying training to support practice please contact projects@ihv.org.uk

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Rights based standards for children undergoing clinical procedures