Methods of intervention used in challenging behaviour - Restraint.

My method of intervention I have chosen for an example is; restraint, a form of physical intervention. It is an assertive approach to intervention.

Dictionary description

The act of restraining or the condition of being restrained.

Loss or abridgment of freedom.

An influence that inhibits or restrains; a limitation.

An instrument or a means of restraining.

Control or repression of feelings; constraint.

Restraint can take many forms. It may be both verbal and physical and may vary in degree from an instruction to seclusion.

The purposes of restraint are:

- To take immediate control of a dangerous situation; and

-To contain or limit the patient's freedom for no longer than is necessary; and

-To end or reduce significantly the danger to the patient or those around.

The most common reasons for restraint are:

- Physical assault;

- Dangerous threatening or destructive behaviour;

-Non-compliance with treatment;

-Self-harm or risk of physical injury by accident

-Extreme and prolonged over-activity likely to lead to physical

exhaustion.

Restrictive physical interventions should always be designed to achieve outcomes that reflect the best interests of the adult whose behaviour is of immediate concern and others affected by the behaviour requiring intervention.

"The Adult Guardianship Act applies to abuse

and neglect in a public place, the adult's

home, a care facility or any other place except

a correctional center.

What are the principles guiding intervention

under the Act?

All adults are entitled to live in the manner

they wish and to accept or refuse

support, assistance or protection as long

as they do not harm others and they are

capable of making decisions about these

matters."

This would suggest incapable adults are entitled to help and support, unless they are harming others.

Wherever possible, restrictive physical interventions should be used in a way that is sensitive to, and respects the cultural expectations of service users and their attitudes towards physical contact.

"This guidance has been prepared in the context of The Human Rights Act (1998)

It is based on the presumption that every adult is entitled to:

. The right to respect for his/her privacy

· The right not to be subjected to inhuman or degrading

treatment

· The right to liberty and security

· The right not to be discriminated against in his/her

enjoyment of those rights"

Any form of restraint, for example leg or wrist restraints, should only be introduced after a multidisciplinary assessment, which includes consultation with service users their families and advocates. If used, they should be selected carefully to impose the least restriction of movement required to prevent harm while attempts should continue to be made to achieve the desired outcomes with less restrictive interventions.

Carers who have received specific training in their usage should only use such devices. The rational for using any devices and the circumstances in which they may be used must be clearly recorded within an individual's care plan/ Positive Handling Plan.

The Scottish Social Services Council have their own codes of practice for social service workers and employees.

A quote from their handbook states;

"Social Service workers must:

Respect the rights of service users, whilst seeking to ensure that their behaviour does not harm themselves or others"

This is following a pattern from the previous values and standards mentioned, which stated clients can only really go so far, before a method of intervention has to be used.

In the mid nineties, a form of intervention was introduced in Scotland, which is now widely practiced in the care industry.

C.A.L.M (Crisis and Aggression Limitation Management)

Various systems use a prone position in which to restrain. This can be face up, or face down. In this country, the face down position is usually used. In the case of CALM the prone restraint is only one of a hierarchy of responses. There has been growing anxiety about the use of prone restraint. It has been associated with deaths due to positional asphyxia, although other positions also have this risk associated with them. In the US, some states have banned face down prone restraint; others have banned face up prone restraint. It is a method, which can compromise the dignity of both young person and staff. However, there is anxiety in some quarters that the removal of prone restraint may make methods

less effective.

CALM Training Services are considering removing the prone restraint from their system.

Certain methods of physical restraint include techniques, which include the deliberate use of pain to ensure compliance - CALM does not.

CALM is a training package which covers the management of difficult behaviour, and which contains, as one of its components, strategies for physical intervention, including physical restraint. In addition, when staff have been trained by CALM Training Services, they are then assessed as to how competently they can carry out the physical elements, and thereafter, if they reach an acceptable standard, they receive accreditation, which has to be updated annually.

CALM is now the method of choice of a significant number of employers in Scotland and beyond, and is used in child care services, learning disability services, and mental health services.

·Physical restraint devices--such as safety vests and jackets, lap and wheelchair belts, and fabric body holders--may be beneficial to patients and their caregivers when used properly in settings ranging from nursing homes and hospitals to private homes.

·Used properly, restraints have many benefits for patients and caregivers in both institutions and homes. Restraints may help protect the elderly from falls, which could result in injury or even death. If absolutely necessary, restraints also can help make medical treatment easier if a patient is temporarily uncooperative or highly agitated. If a patient is dangerous, restraints can protect other patients and staff from possible harm. Some patients feel safer and more secure, and need not worry about falling, if they use physical restraints.

The method of restraining can be beneficial for many clients, depending on state of mind/health and situation at present time.

A warning though; putting a restraint on certain patients may actually worsen their condition. For example, a chronically agitated patient may become more agitated with a restraint.