Developing a Restraint Reduction Plan

January 17, 2020
Joy DuxburyRRN Chair
Two pairs of hands clasped together.

The organisational plan for restraint reduction is a vital part of the foundations for achieving staff commitment to reducing restrictive practice. Get it wrong and not only could it be confusing for everyone, it could severely hinder progress. In many cases it could cause issues internally with staff morale, safety and retention.

So, with all that in mind, where to start? Well, perhaps start by looking at the end goal and making sure that everyone is clear on what you’re trying to achieve. Liaise with all members of the organisation in developing your plan including ‘experts by experience’. Communicate the mission plainly and ensure people know what kind of work culture and change they’re aiming for.

Essentially, all staff need to be committed to ensuring that the use of coercive and restrictive practice is minimised, and that the misuse and abuse of restraint is prevented.

Restraint-free services

Staff must be focused on a whole-team approach in creating restraint-free services built on continuous learning and improvement and for them to do that, there are a few key points to consider when developing your plan.

As an overview of what your plan should look like, it should:

  • Have clearly articulated policies and plans
  • Be based on clear principles and practices
  • Be open, transparent and be communicated effectively
  • Be co-developed by and targeted to your organisation and its stakeholders
  • Be easy to follow
  • Be subject to review, evaluation and change

Complementing those points, Huckshorn’s Six Core Strategies (2005) should also be taken into account, which can significantly reduce the use of restraint and other coercive interventions.

Huckshorn's Six Core Strategies:

1) Leadership and Governance

The organisation develops a mission, vision and a set of guiding values which promote non-coercion and the avoidance of restrictive practices.

2) Performance Measurement

The organisation uses a ‘systems’ approach and identifies key performance measures.

3) Learning & Development

The organisation ensures its workforce has the necessary knowledge and skills to improve workplace performance.

4) Personalised Support

The organisation focuses on providing personalised support that ‘works’ for the individuals using the service.

5) Customer Involvement

The organisation fully involves those who use services and establishes a clear understanding of their needs.

6) Continuous Improvement

The organisation adopts a culture of reflection and learning in order to improve how it operates.

Sector research

Something else to consider is terms of reference. Review research for your sector relating to restrictive practices and how might these be reduced. Highlight any key points which can be shared with your team. Make sure that someone in the team is responsible for searching and reviewing the literature in your area on a quarterly basis to ensure that you and your team are up to speed with the latest evidence, approaches and guidelines.

Also, it is crucial that your organisation is signed up to the Restraint Reduction Network (RRN) and that you register your pledge and support. This will mean that you are factored into all the latest knowledge exchange and relevant communities of practice. Attending key conferences to share ideas and research and follow best practice will also help with planning and highlighting any tweaks that may be required to keep your plan on track.

The RRN conference runs every November in the UK and is a vibrant forum for discussion and information. And you may have already attended CPI’s own conference for instructors held biennially, also normally in November.

In the meantime, there are also plenty of relevant social media outlets, websites and publications that will help you to stay up to date with sector news and developments. These will help you when it comes to finding ‘real-life’ topical examples, both positive and negative, that you can refer to or use as examples within your plan.

How can you make it work?

It is important to have a dedicated lead person in the area of minimising restrictive practices. This way you can ensure that there is an agreed and transparent direction for the organisation and that teams are fully briefed and supported on a regular basis.

Weave your restraint reduction messaging into any internal communications where you can, making full use of your intranet and any other comms channels you have so staff can stay updated on achievements and goals.

Work with HR or your communications team / person if you have one to keep reminding staff of what the mission is, how to achieve it and whether or not they are on the right track. 

Data is your friend. Don’t shy away from understanding what is happening  in your organisation but embrace the challenges you are facing, interrogate them, work on key issues presenting with all members of the organisation including ‘experts by experience’ to address areas for advancement and, above all, celebrate and share successes.

Ensure that you have a clear approach and/or forum for engaging with experts by experience.

Critical factors

Developing and introducing an organisational reduction plan cannot be done in isolation. Conflict is a multifactorial issue underpinned by complex factors including the organisation itself and its culture, the individual involved and the approaches adopted. Any method employed needs to address these issues and be underpinned by a prevention oriented human-rights approach.

No organisational plan can be complete without a method in place for assessment and evaluation. Self-assessment is one of a number of ways to enable an organisation to better understand its performance.

The RRN has developed a checklist, available to download from the RRN website, structured around the six core principles. It’s a self-assessment tool which has been tried and tested by five organisations and has been designed to help member organisations identify and think about those aspects of performance that can be celebrated and shared as well as to understand which aspects of performance are weaker or not fully implemented. By undertaking this assessment, the information can be used to inform your organisation’s improvement/development plans.

In addition to informing organisational learning and improvement, the checklist enables organisations to share their performance so that service users and families, frontline staff, commissioners and regulators can easily see what is happening: what is going well and what aspects are being improved.

There isn’t a ‘one size fits all’ solution to creating a plan suitable for all organisations but the key factors are the same for every sector.

Essentially, plans must be well researched and informed and based on real-life situations and statistics. Then for the plan to have the desired outcomes, the whole team must be on board to deliver it, undertake ongoing evaluation and above all, celebrate its successes.

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