Restraint Reduction

Over the last few years there has been an ever increasing call for the reduction of restraint used in education, health and social care. This has lead to the development of the Restraint Reduction Network and the subsequent certified training scheme managed by Bild ACT (of which Timian is certified). Unfortunately, it also seems to have had some unintended consequences.

Unintended Consequences

In some of our recent experiences, we found some staff and organisations have started to use alternative terminology to describe restraint. We believe this is partly due to the negative connotations of the word. We’ve been hearing more restraint “euphemisms” as a way of demonstrating less interventions are being used.

Euphemistically Held

Some of the euphemisms we’ve recently encountered are

• “I encouraged him to a safe space”
• “We removed him from the classroom”
• “They used therapeutic holding”
• “We guided him to his room” or
• “We helped him to sit down”.

Clearly, a major concern of staff and organisations is that because “restraint” is seen as something negative, they don’t want to be associated with using it on vulnerable children or adults. This can lead them into a game of verbal gymnastics to try to avoid saying they restrained someone. The reality is, all they’ve done is change the language, not the behaviour.

Minimise Impact of Trauma

One would suggest a major goal of restraint reduction is to minimise the trauma experienced while being restrained. A change in language but not behaviour, does not minimise this trauma.

Far from reducing the trauma, it can belittle the impact restraint has on the person. If, we make it sound like the experience of the person was positive, when in fact it was negative, then we’ve belittled their experience. If we carry on with our restraint behaviours, but dress it up in language to make it sound better, then those people with lived experience have their experiences of restraint downplayed. So, what can we do to minimise the actual trauma rather than downplay it?

Six Core Competencies

In Timian we’d start with the Six Core Competencies(c) These competencies form the backbone of the Restraint Reduction Network approach to reducing restraint and seclusion in health and social care. These include

• Leadership in organisational culture change.
• Using data to inform practice.
• Workforce development.
• Inclusion of families and peers.
• Specific reduction interventions (using risk assessment, trauma assessment, crisis planning, sensory modulation and customer services).
• Rigorous debriefing.

Core Values and Trust

Although the 6 Core Strategies model is a very good place to start. In a Timian training course, we also spend the first chapter discussing Core Values. In this chapter we help staff examine.

• Healthy Relationships
• Empowerment
• Trust, dignity, respect and honesty
• Clarify of descriptive language
• Invitational Theory
• The importance of mistakes
• Communication

Discussing and training in core values enables empathy and a foundation for understanding trauma informed care. We examine whether we could implement strategies to avoid restraint, understand why that person is in crisis and ensure we record everything clearly, concisely and honestly.

Open and Honest

If we truly want to reduce restraint in education, health and social care we need an open and honest dialogue. We need to be clear why restraint is taking place. Restraint can increase trauma and just changing the name of the technique won’t reduce the person experiencing trauma. We need to create a sense of trust between those delivering care services and people with lived experience. Only then can we all say:

In this place and with these people I feel safe

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