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CHW66-Positive Behaviour Support, Reducing Restrictive Practices and Safe Management of Behaviours of Distress Policy

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Positive Behaviour Support, Reducing Restrictive Practices and Safe Management of Behaviours of Distress Policy

1. Purpose

The purpose of this policy is to set out how {{org_field_name}} supports individuals who may present with behaviours of distress, behaviours of concern, aggression or other forms of communication that may indicate unmet need, pain, fear, anxiety, trauma, cognitive impairment, sensory distress or environmental stress.

{{org_field_name}} is committed to using Positive Behaviour Support and positive, proactive approaches to improve each individual’s quality of life, protect their rights, promote their well-being and reduce the likelihood that restrictive practices will be required.

This policy explains how the service will prevent, understand and respond to behaviours of concern in a person-centred, rights-based, trauma-informed and least restrictive way. It also sets out the circumstances in which control, restraint or any restrictive practice may be used, the safeguards that must be followed, the recording and reporting requirements, and how learning will be used to improve practice.

This policy is written to support compliance with:

The policy must be read and applied alongside each individual’s personal plan, risk assessments, behaviour support plan, communication plan, mental capacity assessments, best-interest decisions and any DoLS authorisation or application where relevant.

2. Scope

This policy applies to all staff, including care workers, nurses, senior care staff, managers, agency workers, bank workers, volunteers, students, contractors and any external professionals working with or on behalf of {{org_field_name}}.

This policy applies whenever staff are supporting an individual who may display behaviours of distress or behaviours of concern, including but not limited to:

The policy covers:

3. Definitions

For the purpose of this policy, the following definitions apply.

Positive Behaviour Support means a person-centred framework for understanding the reasons behind behaviours of concern and improving the person’s quality of life by meeting needs, improving communication, changing environments, teaching skills and reducing the need for restrictive responses.

Behaviours of distress or concern means behaviour that may indicate unmet need, pain, fear, frustration, anxiety, trauma, sensory distress, communication difficulty, cognitive impairment or emotional distress. The service will avoid labelling individuals as “challenging” and will instead seek to understand what the behaviour communicates.

Restrictive practice means any action, intervention, rule, practice or arrangement that restricts a person’s rights, freedom of movement, choice, liberty or ability to do something they want to do, or encourages them to do something they do not want to do. Restrictive practice may be obvious or subtle and may include physical, mechanical, chemical, environmental, psychological or social restrictions.

Control or restraint means any act that uses or threatens to use force to secure an action that the individual resists, or restricts the individual’s liberty of movement, whether or not the individual resists. This includes physical, mechanical or chemical means.

Physical restraint means direct physical contact used to prevent, restrict or subdue movement.

Chemical restraint means the use of medication primarily to control behaviour rather than to treat a diagnosed medical or psychiatric condition.

Mechanical restraint means the use of equipment or devices to restrict movement, where this is not solely for therapeutic, postural, mobility or safety purposes agreed in the individual’s plan.

Environmental restraint means using the physical environment to restrict movement or choice, including locked doors, restricted access to areas, removal of mobility aids, or preventing access to personal possessions.

Blanket restriction means a rule or practice applied to everyone, or to a group of people, without individual assessment, justification and review.

De-escalation means skilled actions taken to reduce distress, prevent harm and avoid the need for restrictive practice.

Last resort means that all reasonably practicable preventative and less restrictive options have been considered or attempted, unless immediate action is required to prevent harm.

4. Principles of Positive Behaviour Support and Reducing Restrictive Practice

{{org_field_name}} will apply the following principles:

4.1 Person-centred and outcome-focused care

Support will be based on the individual’s personal outcomes, wishes, feelings, strengths, needs, history, culture, language, communication style, relationships, routines and preferences. Behaviour support must be linked to the individual’s personal plan and must aim to improve quality of life.

4.2 Rights-based and least restrictive practice

The service will uphold the individual’s human rights, dignity, privacy, autonomy, family life and freedom from degrading treatment. Any restriction must be lawful, necessary, proportionate, time-limited, recorded and reviewed.

4.3 Prevention first

Staff must focus on preventing distress wherever possible by understanding triggers, meeting needs early, adapting communication, reducing environmental stressors and supporting meaningful occupation, relationships and routines.

4.4 Understanding behaviour as communication

Staff must consider what the individual may be communicating through their behaviour. This may include pain, illness, hunger, thirst, tiredness, fear, boredom, loneliness, sensory overload, trauma response, unmet emotional need, misunderstanding or loss of control.

4.5 Co-production and involvement

The individual must be involved in assessments, behaviour support planning, reviews and post-incident learning as far as practicable. Representatives, family members, advocates, commissioners and relevant professionals must be involved where appropriate and lawful.

4.6 Positive risk-taking

The service will support individuals to make choices, take appropriate risks and maintain independence. Risks must be assessed and managed in a way that does not unnecessarily restrict the individual’s life.

4.7 Trauma-informed support

Staff will recognise that restrictive practices, aggression, restraint, isolation or coercion can cause trauma or re-traumatisation. Staff must use calm, respectful, non-punitive approaches and must consider the emotional impact on the individual, other residents and staff.

4.8 Safeguarding and accountability

Any use of control, restraint or restrictive practice must be open to scrutiny. The service will record, review and learn from incidents and will make safeguarding referrals, CIW notifications and DoLS applications where required.

5. Assessment, Risk Assessment and Behaviour Support Planning

5.1 Assessment before and during service provision

Before agreeing to provide care and support, and during ongoing reviews, {{org_field_name}} will consider whether it can safely meet the individual’s care and support needs, including any behaviours of concern, mental health needs, cognitive impairment, communication needs, sensory needs or risks to the individual or others.

Where behaviours of concern are identified, the assessment must consider:

5.2 Behaviour Support Plan

Where a resident has behaviours of concern, a Behaviour Support Plan must be developed and included within, or clearly linked to, the individual’s personal plan.

The Behaviour Support Plan must include:

5.3 Involvement

The Behaviour Support Plan must be developed with the individual wherever practicable. With the individual’s consent, or where legally appropriate, the service will involve representatives, family members, advocates, commissioners, GPs, community mental health teams, dementia specialists, learning disability teams, psychologists, occupational therapists, speech and language therapists or other relevant professionals.

5.4 Review frequency

Behaviour Support Plans must be reviewed:

The current policy says Behaviour Support Plans are reviewed “at least every six months”. This should be changed to align with personal plan review expectations and the need for prompt review following incidents or changes in need. The statutory guidance says personal plans must be reviewed at least every three months and revised as necessary.

6. Preventative and Proactive Strategies

Staff must use preventative and proactive strategies before considering any restrictive response. These strategies must be individualised and recorded in the resident’s personal plan and Behaviour Support Plan.

6.1 Positive environment

Staff will support a calm, safe and enabling environment by:

6.2 Communication

Staff must communicate in a way the individual can understand. This may include:

6.3 Reasonable adjustments

Where an individual has a disability, cognitive impairment, autism, sensory need, mental health need or communication difficulty, staff must make reasonable adjustments to reduce distress and support equal access to care and support.

6.4 Health and clinical factors

Staff must consider whether behaviour may be caused or worsened by pain, infection, constipation, dehydration, hunger, medication side effects, delirium, poor sleep, sensory impairment, mental ill-health or another health need. Where needed, staff must seek advice from the nurse in charge, GP, community nurse, mental health team, emergency services or other relevant professional.

6.5 Active support and meaningful activity

Staff must support individuals to remain involved in ordinary daily life, relationships, preferred activities and choices. Boredom, loneliness and lack of control can increase distress and must be considered in care planning.

7. De-escalation and Early Intervention

When an individual shows signs of distress, staff must act early and use the least restrictive approach.

Staff must:

Staff must not:

Where there is immediate risk of serious harm, staff must call for urgent assistance and follow emergency procedures.

8. Use of Control, Restraint and Restrictive Practice

8.1 General rule

Care and support must not include control, restraint or restrictive practice unless it is necessary to prevent a risk of harm to the individual or another person and is a proportionate response to that risk.

Control, restraint or restrictive practice must only be used:

Control, restraint or restrictive practice must never be used:

8.2 Types of restrictive practice covered by this policy

This policy applies to all forms of restrictive practice, including:

8.3 Planned restrictive practice

Any planned restrictive practice must be:

8.4 Emergency restrictive practice

Where restrictive practice is used in an emergency and was not included in the individual’s plan, staff must:

8.5 Physical intervention

Physical intervention may only be used where there is an immediate risk of harm and no less restrictive option is sufficient. Staff must use only approved techniques in which they have been trained and assessed as competent. Staff must monitor the individual’s breathing, colour, level of distress and physical presentation throughout and must stop immediately if the person appears unwell or the risk reduces.

8.6 Chemical restraint and medication

Medication must not be used primarily to control behaviour unless it is clinically justified, prescribed, recorded, reviewed and used in accordance with the individual’s assessed needs and legal framework.

Where PRN medication is prescribed for anxiety, distress or behaviour, the individual must have a clear PRN protocol stating:

Use of PRN medication must be monitored to identify patterns, side effects, overuse or the need for medical review.

8.7 Environmental restrictions and locked doors

Any environmental restriction, including locked doors, keypad access, restricted access to kitchens, gardens, stairs, bedrooms, personal items or community access, must be individually assessed and justified. The service must not rely on blanket restrictions unless there is a clear, lawful, proportionate and regularly reviewed reason.

8.8 DoLS and deprivation of liberty

An individual must not be deprived of their liberty for the purpose of receiving care and support without lawful authority.

Where restrictions may amount to deprivation of liberty, the manager must ensure that:

9. Incident Recording, Reporting and Notifications

9.1 Recording within 24 hours

A record of any incident involving control, restraint or restrictive practice must be completed within 24 hours.

The record must include:

9.2 CIW notifications

The manager or delegated authorised person must notify CIW through CIW Online where required by the Regulations and CIW guidance. Notifications relevant to this policy may include, but are not limited to:

9.3 Safeguarding referrals

A safeguarding referral must be made in line with Wales Safeguarding Procedures where there is concern that an individual has experienced, or is at risk of, abuse, neglect or improper treatment. This includes unlawful restraint, inappropriate deprivation of liberty, excessive or unexplained use of restriction, injury during restraint, institutional practice, staff misconduct or failure to protect an individual from harm.

9.4 Internal escalation

All incidents involving restraint, significant aggression, injury, safeguarding concern, police involvement, repeated distress or possible deprivation of liberty must be escalated to the manager or senior person on duty as soon as possible. The responsible individual must be informed in line with the seriousness of the incident and the service’s governance arrangements.

10. Post-Incident Support, Review and Learning

10.1 Support for the individual

Following an incident, staff must check the individual’s physical and emotional well-being and provide reassurance, privacy and support. Staff must consider whether the individual requires:

The individual must be supported, where possible, to express what happened from their perspective, what they were feeling, what helped, what made things worse and what they would like staff to do differently in future.

10.2 Support for other residents

Where other residents witnessed or were affected by the incident, staff must provide reassurance, explanation and support appropriate to their needs and level of understanding.

10.3 Support for staff

Staff involved in or affected by an incident must be offered debriefing, supervision and emotional support. Where staff practice concerns are identified, these must be addressed through supervision, training, competency assessment, disciplinary procedures or safeguarding processes as appropriate.

10.4 Management review

The manager, or delegated senior person, must review incidents to identify:

10.5 Learning and improvement

Learning from incidents must be shared through handovers, team meetings, supervision, training, audits and quality assurance processes. Actions must be recorded, allocated to named persons and followed up until completed.

11. Staff Training, Supervision and Competency

11.1 Induction

All staff, including agency and bank staff, must receive an induction appropriate to their role before working unsupervised. Induction must include:

11.2 Restrictive practice training

Staff must not use any control, restraint or restrictive practice method unless they have received appropriate training and have been assessed as competent in that method.

Training in restrictive practice must:

Staff must not receive blanket physical intervention training unless this is justified by the assessed needs of individuals using the service.

11.3 Supervision and team meetings

Restrictive practice, behaviour support and incident learning must be discussed in supervision and team meetings. Staff must be supported to reflect on incidents, identify learning and improve practice.

11.4 Competency and practice concerns

The manager must take action where staff do not follow this policy or where practice falls below expected standards. This may include additional supervision, retraining, competency assessment, suspension from using specific techniques, disciplinary action, safeguarding referral, referral to Social Care Wales, DBS referral or police referral where required.

11.5 Agency and temporary staff

Agency and temporary staff must be given information about residents’ personal plans, Behaviour Support Plans, communication needs, risks and emergency procedures before providing care. They must not use restrictive interventions unless the provider has evidence that they are trained and competent in the relevant method.

12. Governance, Monitoring and Quality Assurance

{{org_field_name}} will monitor the use of behaviours support strategies, control, restraint and restrictive practices to ensure that the service remains safe, lawful, person-centred and focused on reducing restriction.

12.1 Audits

The manager will audit the following at least quarterly, or more frequently where risks are identified:

12.2 Trend analysis

The service will analyse incidents to identify patterns, including:

12.3 Responsible individual oversight

The responsible individual must have oversight of the use of restrictive practice, safeguarding concerns, serious incidents, CIW notifications and quality improvement actions. This oversight must inform the service’s quality-of-care review.

12.4 Quality-of-care review

Records of control, restraint and restrictive practice must be reviewed and reported through the service’s quality-of-care review process. Findings must be used to improve care, reduce restrictive practice and update policies, training and individual plans.

13. Mental Capacity, Consent and Best Interests

Staff must assume that an individual has capacity to make a decision unless it is established that they lack capacity for that specific decision at the relevant time.

Where an individual appears unable to make a specific decision about care, support, risk or restrictions, the service must follow the Mental Capacity Act 2005. This includes:

Where restrictions amount to, or may amount to, deprivation of liberty, the manager must ensure there is lawful authority through DoLS or other relevant legal framework. Restrictions must not be used simply because they appear convenient, traditional or easier for the service.

14. Duty of Candour and Communication

{{org_field_name}} will act in an open and transparent way with individuals, representatives and relevant placing authorities when incidents occur.

Where an incident involving behaviour support, restraint, restriction, injury, safeguarding concern or error occurs, the service will:

Staff must not conceal incidents, falsify records, discourage concerns or prevent another person from raising a concern.

15. Welsh Language and Accessible Communication

{{org_field_name}} will take reasonable steps to meet the language and communication needs of individuals.

Where Welsh is the individual’s language of need or choice, the service will make reasonable efforts to provide support, reassurance, de-escalation and key information in Welsh.

Behaviour Support Plans must record the individual’s communication needs, including:

Staff must ensure communication aids, glasses, hearing aids and other equipment are available and working where these are needed to reduce distress and support understanding.

16. Related Policies and Documents

This policy must be read alongside:

17. Policy Review

This policy will be reviewed at least annually or sooner if:

Any changes to this policy will be communicated to staff through supervision, team meetings, training, policy briefings and updated competency checks where required.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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