TTAUSNZ Balancing reducing restrictive practices with keeping everyone safe

5 minute read…

As caring, compassionate professionals, we strive to create positive and supportive environments where everyone always feels safe, secure and valued. This applies as much to our staff as it does to the individuals we support and care for.
However, given the different contexts we work in, and the nature of the children, young people and adults we may support, there can sometimes be a tension between reducing restrictive practices and keeping everyone safe.

Challenges for staff around balancing wellbeing with safety

Across education and health and social care, many of us are working in complex environments, where individuals have an increasingly wide range of diverse needs. Some may struggle with emotional regulation; others may have communication needs that make it tricky to express themselves.

Staff, too, have numerous and multi-faceted needs, and can sometimes find it hard to juggle competing priorities, such as managing heavy workloads and working within rigid time constraints.

Due to a combination of all of these factors, we can sometimes find ourselves supporting escalating behaviour, where tried-and-tested de-escalation strategies are not working. In such instances, despite everyone’s best efforts and good intentions, there may be a need to use restraint or other restrictive practices.

If this situation occurs on a regular basis over an extended period, it can take its toll on both staff and the individuals we support. It can adversely impact our collective physical, emotional and mental wellbeing, and lead to the creation of environments that feel neither positive nor safe for everyone.

In our latest webinar, ‘Getting the Balance Right Between Reducing Restrictive Practices and Keeping Everyone Safe’, we were joined by an expert panel of guests from the education and disability sectors to discuss how we can promote wellbeing and reduce the use of restrictive practices without compromising safety.

Special thanks to our webinar guests, Bridget Scott, Manager at Allied Health and Training Development, Microboards Australia; Tristan Evans, Director at Karma Abilities Respite Enrichment, SE Queensland; Susan Coull, Director at SCoull Education, Melbourne; and Chrizinda Cole, Intermediate Teacher and Team Teach Trainer at Wairau Valley Special School, New Zealand for their valuable contributions and insights during this discussion.

3 ways to promote wellbeing

It’s worth noting that every context is different, and what works well in one may not work in another. The important thing is to build a toolkit of strategies that meet the needs of our organisation.

1. Developing strong relationships
   Strong relationships sit at the heart of everything we do. We can develop robust, positive connections where we foster mutual trust, understanding, respect and compassion. Getting to know the people that we work with and support helps to build a shared understanding and appreciation of each other.
2. Taking a person-centred approach
   We can work to understand individuals’ behaviour as a form of communication, and always keep their best interests front and centre. Taking a person-centred, individualised approach enables us to make appropriate decisions in any situation.
   We can remember that everyone responds differently to stress – including us as staff. This acknowledgement allows us to approach situations with increased compassion and understanding.
3. Considering communication
   Considering our body language, positioning and tone of voice, as well as reflecting on what we are bringing to a situation, can help to promote organisation-wide wellbeing. Sometimes, due to everyday work pressures, we can become overly task-oriented and lose sight of our own needs, and the needs of those in our care. This can quickly lead to miscommunication and misunderstanding.

Meeting our legal and ethical obligations to keep everyone safe

As both employers and employees, we have a shared responsibility to keep ourselves and others as safe as possible. There is no such thing as a risk-free environment, but there are legal and ethical processes and parameters that we need to adhere to, to maximise safety.

1. Prioritising consistency
   Consistency is key to everything that we do: consistent approaches, consistent training and consistent language. This matters because predictability and coherence build confidence across staff, individuals and families, and facilitate robust decision-making.
   We can build consistency by making sure that we have skilled practitioners and specialists within our staffing teams, who can share expertise and model expectations to colleagues.
2. Providing ongoing training
   We can enhance expertise by facilitating ongoing training and professional learning for our staff teams, to ensure that we are all ‘on the same page’. A consistent approach, where everyone knows exactly what to expect in any scenario, helps individuals feel safe and secure, while also positively impacting staff teams’ wellbeing.
   Regular, quality training ensures that we stay abreast of the latest developments around behaviour support, and always operate in line with local guidance and statutory obligations. We can update relevant policy documents in accordance with any changes, making sure that we follow due diligence procedures and protocols.
3. Using individual support plans effectively
   We can meet our ethical and legal obligations by ensuring that individual support plans are realistic, relevant and up to date. They should be reviewed regularly, as situations can change, and be shared with anyone involved in a person’s care and support.

Staying professionally agile by updating plans and risk assessments in line with legal and statutory requirements enables us to make clearly informed decisions about whether the actions we take are reasonable, proportionate and necessary (please refer to your own regional, industry and organisation policy for matters relating to restrictive practice planning, practice and reporting).

Achieving a positive organisational culture

A positive organisational culture is something that we need to nurture with intent and commitment; it does not simply happen. It starts with leadership and filters through every part of our settings, impacting staff, individuals, and members of the wider community, such as therapists and family members.

When we lead by example, and ‘walk the talk’, we foster a sense of shared purpose and demonstrate that we believe in what we are doing and what we value. This increases the likelihood of ‘buy-in’, and invites others to follow in our footsteps, safe in the knowledge that they will be seen, heard and valued for their contributions.

Time is a scarce resource; however, we need to carve out opportunities, systematically and regularly, to build a positive organisational culture. We can think creatively and ‘go the extra mile’ for staff, making sure we listen and respond to their needs where practical and possible. This helps them feel confident and motivated in their roles.

A positive organisational culture also impacts the individuals we support. When we work in a climate that is rooted in collaboration, support, and compassion, we can respond to individual need, rather than adopting a one-size-fits-all approach.
We can adjust our strategies and responses accordingly, taking internal and external factors into account and always offering the best supports to those in our care.

Getting the balance right in training around understanding behaviour, de-escalation and restrictive practices

Physical intervention should only be considered when it is the only available option to keep everyone safe. However, they may not always be aware of alternatives, or know that focusing on a positive, proactive approach to behaviour support is one of the most effective ways to reduce the need for restrictive practices.

Our role, as leaders and practitioners, is to ensure that we direct our time, training and attention towards leveraging strong relationships, and where necessary, using de-escalation strategies to reduce risk and promote a safe environment. We can be vigilant to the early signs of dysregulation and intervene promptly before situations escalate.

Working collaboratively as a team, sharing best practice, and involving individuals in their own care and support where possible, gives us the best chance of creating environments that feel safe and secure. Reaching out and including the wider network, such as parents, guardians, carers and therapists, helps to ensure a joined-up and coherent approach.

Using our professional discretion to find a balance

We cannot always completely eliminate the use of restraint and restrictive practices: there are occasions when reducing risk and keeping people safe calls for a physical intervention.

However, by providing regular, ongoing and tailored training, creating positive environments where seeking help is a sign of professional strength, and collaborating around the best ways to support individuals, we can improve wellbeing, build confidence, and reduce the need for restrictive practices while keeping everyone safe.