We live in an age of high quality care and support, where the safety of vulnerable adults and children is rightly paramount. This means that we have become increasingly averse to using ‘physical intervention’ techniques in response to challenging behaviour. But does this drive for a restraint free environment have unintended, and even undesirable consequences?

In the wake of Winterbourne View, the competencies of support workers were critically reviewed by Camilla Cavendish, following which the Dept. of Health published ‘Positive and Proactive Care: reducing the need for restrictive interventions’. The net result of this has been that we now heading towards an increasingly professionalised workforce, who are rightly reluctant to resort to physical intervention.

Such an initiative is to be welcomed and should be seen as the final stage of the paradigm shift away from large “warehousing” services, and the coercive regimes that prevailed within them. However, human beings are not machines and, as ever, various complex psychological and emotional processes can compromise what is at face value a laudable imperative.

There now seems to be a reluctance to admit to using physical restraint. This can manifest itself by seeing physical interventions being re-classified or re-defined. On a recent course that I attended, one delegate proudly proclaimed that physical interventions were not used within their service setting. When it came time to explore the PI techniques the delegate demonstrated something which was patently a restrictive technique, and said “Oh that’s not PI, that’s guiding and supporting”. It seems that if you don’t call a technique a ‘physical intervention’ then it isn’t.

This reluctance to speak of physical interventions extends to the recording of this phenomenon. “If it wasn’t physical intervention then we don’t have to report its use” seems to be the mind-set. But this is surely the thin end of the wedge. Once such an intervention becomes ‘invisible,’ the danger is it becomes a ‘secret,’ and secrets are rarely, if ever, a good thing in a care setting.

In 2000 the Government stated categorically that there should be ‘No Secrets’ when it published its guidance on developing procedures to protect vulnerable adults from abuse. However in Winterbourne View the power of secrecy ensured that an abusive regime could flourish unseen. Visitors were not allowed access to the wards or individual service-users’ bedrooms. This meant a closed and punitive culture was allowed to develop in secret on the top floor of the hospital, where physical interventions were flagrantly used as tools of bullying and coercion.

This what you might call “corporate cognitive dissonance” seems to take hold across services where there is a misinterpretation of the DoH’s guidelines, and an unjust fear that the CQC will somehow sanction the organisation if physical interventions are used. What ‘Positive & Proactive Care’ actually called for was the avoidance of dangerous techniques, and transparency in relation to the use of approved techniques. The transparency, involving the recording of the use of techniques, in part was designed to make organisations more aware, at a higher organisational level, as to how often physical interventions are being used, but it was also part of the drive to professionalise the sector and transform service providers into evidence-based practitioners.

If you capture data around what physical interventions are being used, and how they are being applied, you can also capture data that relates to the behaviour that was presented. This includes details about the context, including the setting and prevailing conditions, in which it occurred. For behaviour analysts who are keen to apply PBS (Positive Behaviour Support) principles such data is gold dust. It allows them to fine-tune care plans and formulate more nuanced and person centred behaviour support plans.

Physical interventions are likely to still have a role in some of these behaviour support plans, and the thing to grasp is that their use will be quite legitimate. Indeed, services would undoubtedly be failing to meet their Duty of Care if they did not intervene in cases where vulnerable people are behaving in ways which can harm themselves or their peers.

The DoH define ‘Physical Restraint’ (or Physical Intervention) as ‘any direct physical contact where the intervener’s intention is to prevent, restrict, or subdue movement of the body, or part of the body of another person’. It goes on to say that as a form of restrictive intervention it can be used quite ethically to take immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is undertaken (provided of course that it is used for no longer than is necessary).

So, Physical Interventions are not inherently “bad.” They can, in the right circumstances, actually be a force for good. If an organisation is to provide the highest quality care physical intervention is a topic they need to speak about. Their use is too important to be allowed to slip in the shadows.

SecuriCare offer a range of courses designed to enable support workers, carers and foster families to best respond to any ‘Challenging Behaviour’ that may occur. All programmes are finalised after full training needs analysis and delivered by experienced frontline practitioners. Click to see our ‘Preventing & Managing Challenging Behaviour’ Course which includes ‘Positive Behaviour Management’ techniques designed to minimise the need for any kind of restrictive intervention. You can also take a look at our person centred Behaviour Planning Service.

Securicare also offer a ‘Restraint Reduction’ support service and training in support of improving safety. Check out our ‘Physical Intervention’ courses and our online ‘Restraint Risks’ course, or ask for details about our newest course 'Physical Interventions: Removing Risk & Reducing Use' a course that provides practical guidance on how to manage risks within the context of an incident as well as prevent future restraint use. 

Contact us for more information and to discuss your needs: E: trainers@securicare.com or T: 01904 492442