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Swapping restraint for Positive Behaviour Support

Richard* is a young man who has a learning disability and severe challenging behaviour. Regularly violent, Richard has hospitalised staff members in the past.

When he joined Dimensions he moved from a secure unit with a 3:1 staffing ratio, costing around £200k per year. He now needs just 1:1 staffing and understands how to stop challenging behaviour triggers.

When Dimensions took over his support one of Richard’s goals was to become more independent.

The team initially decided to focus on communication, decision making, and getting out and about.

The team felt that making a difference in these areas would have the greatest overall impact on his quality of life.

Making a difference

Communication

Because Richard’s physical aggression involved biting and hitting, staff focused on mitigating this risk. Unfortunately, this often led to a defensive team rather than a supportive team. They identified this as a problem and developed strategies to build a meaningful rapport with him.

Decision making

Richard’s team understand that it is important to give him time and space so he can make his own decisions; they don’t place demands on him and don’t rush him. Richard now decides what time he wants to get out of bed, when he wants to eat and what he does.

Out and about

Most triggers for Richard’s challenging behaviour occurred when he was out in the community. They developed a strategy to help him cope by encouraging him to say the word ‘home’ when he felt uncomfortable. Staff would immediately take him home.

This system took several months to establish but, following each incident, his support team would talk about it and suggest using ‘home’ as an avoidance method. Richard eventually tried saying ‘home’ to staff when he was uncomfortable and was clearly pleased when he was immediately taken home.

Richard has now made so much progress he is able to go on holiday. He loves the seaside and has been to Skegness and Scarborough.

Our analysis below outlines the approaches and outcomes achieved for Richard and his staff team.

*names have been changed to protect privacy.

Challenging behaviour

  • Biting and hitting
  • Defensive team
  • Being outside is a key trigger

Communication and decision making

  • Allow time for him to make decisions
  • Don’t place demands
  • Personalised communication technique
  • Gradual implementation

Before and after comparison

Before

  • Physical aggression
  • Control and restraint
  • 3:1 staffing ratio
  • One incident of challenging behaviour a week
  • High levels of anxiety
  • Limited opportunities for choice and control

After

  • Control and Restraint removed permanently
  • 1:1 staffing ratio
  • One incident of challenging behaviour every two months
  • More supportive staff team
  • Improved confidence

Key outcomes

  • More included in his community
  • Significant reduction in incidents of challenging behaviour
  • Better quality of life
  • Safe and happy

Key data

  • Support reduced from 3:1 to 1:1 full-time
  • Dramatic savings for the local authority
  • One incident of challenging behaviour every two months, down from one a week
  • Control and Restraint removed from support programme after six months
  • Control and Restraint removed permanently after one year