Use of Force Act Policy

As a provider of services to individuals who may present behaviours of concern, CareTech’s primary focus will always be to create capable environments that support wellbeing and contribute to an improved quality of life.

Our approach will be value based and holistic, underpinned by coproduction with the individuals themselves and others with lived experience.

Use of restraint can never be seen as a long-term solution or standalone response.

Where agreed necessary, the use of restraint must always sit behind bespoke positive behaviour supports plans. Plans should be clear, comprehensive and centred around approaches that are evidence based, innovative and proactive.

Paramount to this, must be inclusion of methods and timelines to reduce and ultimately remove the need for any use of physical and chemical restraint and other restrictive practices (i.e. blanket restrictions).

The following objectives set out our goals and how we will measure success:

The Reducing Restrictive Practices Strategy

Strategy 1:

LEADERSHIP AND GOVERNANCE > The organisation develops an organisation wide plan designed to increase the quality of life for service recipients as well as reduce and minimise the use of restrictive interventions and restrictive practices. Such a systems approach should have review and planning mechanisms.

What is the main priority in this area:

The organisation has committed to affiliation to and supporting the Restraint Reduction Network (RRN). The organisation’s current restraint reduction strategy outlines a range of approaches to reduce coercive practices and to prevent the misuse and abuse of restraint and improve quality of life using a Human Rights approach.

What we have done so far:

• The organisation’s policy/pledge on the use of restrictive practices provides clear criteria outlining when restrictive practice may be considered an appropriate and reasonable intervention. Whilst the term ‘restrictive practice’ has been widely used to cover physical, chemical, mechanical restraint and seclusion, Positive and Proactive Care refers to these as ‘restrictive interventions’. Restrictive practices may also include the design and use of the environment and ‘deliberate acts on the part of other person(s) that restrict an individual’s movement, liberty and/or freedom to act independently’
• Set up a Positive Behaviour Practitioner group that has met monthly to develop organisational oversight and its terms of reference. Ongoing it will meet four times a year.

What we plan to do next in this area:

• The Board to discuss and adopt the pledge and supporting objectives
• The organisation’s Senior Management Team and Board will receive regular reports on the organisation’s performance in relation to restraint reduction from the Positive Behaviour Practitioner group.
• The Board to complete a self-assessment on compliance with this strategic objective annually using the RRN Reducing Restrictive
• Practices Checklist Strategy 1 and receives the assessment of progress against the other 4 strategies. Add detail of self-assessment

Strategy 2:

USING DATA TO INFORM PRACTICE > The organisation uses data to identify, plan and review the overall organisation wide plan to reduce restrictive practice/interventions, improve service delivery and/or increase quality of life.

What is the main priority in this area:

The organisation will set out clear measures that are used to determine the level of performance in relation to restraint and restraint reduction using data that is closely monitored. Recognising that chemical restraint is as significant a restriction as physical, the routine collection of data on the use of PRN medication to manage behaviours will be implemented.

What we have done so far:

• The data that is collected relating to restrictive practices is used at a local and senior level to inform and plan strategies to help staff understand the needs of the people they support.
• Data on restraints and de-escalation will be collected across the group
• A new Management Information System is being implemented across Caretech schools, which will enhance our ability to capture and analyse data associated with behaviour support and thus better inform our understanding and practice.

What we plan to do next in this area:

• The organisation will set out clear guidance of how data is collected, stored centrally and safely and there will be clear oversight of this information and how it is used to inform performance in line with the requirements set out in the Strategy 2 Reducing Restrictive Practices Checklist
• Develop the quality of data to meet the following requirements:
  • The measures used are valid and the data captured takes account of the varying number of users accessing the service (e.g., incident rates are expressed as a rate per number of those we support with lived experience; rates per number of care hours/days delivered).
  • The measures used capture the use of all restrictive practices to ensure a reduction in one method of restrictive intervention does not lead to an increase in another. (The proposal is to capture use of PRN Medication to manage behaviour)
  • The organisation has an approach to incident reporting and recording which accurately captures measures of performance.
  • Data is captured and used to inform the organisation about performance in relation to the specified measures.
  • Data is shared at all levels within the organisation so that everyone is aware of the organisation’s performance (organisational, department, team and individual level)
• The Positive Behaviour Practitioner group to submit quarterly reports for the clinical governance group and board and updates for service leads on best practice

Strategy 3:

STAFF TRAINING AND DEVELOPMENT > The organisation ensures that all members of its workforce have the knowledge and skills they require to implement improvement measures and prevent and respond sensitively to any behaviours of concern

What is the main priority in this area:

The organisation uses Training Needs Analyses in each of its divisions and at local level which sets out the training required to develop and maintain the knowledge and skills staff need to support those with lived exeprience effectively.

What we have done so far:

• All front-line staff will receive regular annual training in the use of non-restrictive practices, and when it is deemed necessary, they will receive high quality and accredited training in the least restrictive practices necessary.
• We are embarking on a review of induction across the business, which will incorporate positive behaviour support methodology with an emphasis on restraint reduction.

What we plan to do next in this area:

• The training provided on restrictive interventions will be data driven, person centred and bespoke to the needs of the people who are being supported.
• There is a standardised approach to training with a common set of benchmarks and audits that establishes a group wide set of standards of assurance
• Complete the self-assessment against strategy 3 RRN Reducing Restrictive Practices Checklist, identifying any gaps for further action in this area

Strategy 4:

PREVENTATIVE MEASURES AND PERSONALISED SUPPORT > The organisation ensures that staff have access to the tools they require to manage risks, to improve or enhance service delivery as well as personalise the support provided to people using the services.

What is the main priorities in this area:

Individual risk assessments, Positive Behaviour Support Plans and personalised care planning will involve co-production with the individual where practicable and appropriate to promote their dignity and welfare.

The organisation will not use blanket restrictions (rules or policies that restrict a patient’s liberty and other rights, which are routinely applied to all supported individuals in a care setting) without individual risk assessments to justify their application.

What we have done so far:

• Positive Behaviour Support plans are developed for all individuals that are at risk of being restrained and this will inform Personal Safety Plans (or equivalent) which is a bespoke training plan for that individual.

What we plan to do next in this area:

• All incidents of physical interventions will be reviewed by the along with the individuals so that everyone can gain a better understanding of what happened, why it happened and what can be done in the future so that it can be reduced or avoided so future restrictive interventions can be minimised. Where the restraint meets the criteria for the potential of reducing harm it will be reviewed by a positive behaviour practitioner to identify any learning and improvement (red flags identified are any prone or supine restraints, restraints lasting longer than 10 minutes or resulting in injury)
• Use the RRN educational materials to raise awareness of blanket restrictions and conduct a local review of current restrictions. To be delivered as part of the Focused Learning Experience (FLEx) sessions as this is complementary to the work under way around Closed Cultures.
• Provide RRN blanket restriction poster for use in all services
• Complete the self-assessment against strategy 4 RRN Reducing Restrictive Practices Checklist, identifying any gaps for further action in this area

Strategy 5:

INVOLVING THOSE WHO RECEIVE YOUR SERVICES > The organisation fully involves the people who use services in order to establish a clear understanding of their needs and to determine whether or not the service that is delivered meets their needs and expectations

What is the main priority in this area:

The organisation will involve as far as practicable and appropriate supported individuals themselves, their families and or an advocate when developing plans or strategies to ensure they are person centred and specific to their needs.

The organisation will provide information on the for patients/those we support with lived experience about the use of force.

This is to be provided on admission should also be provided to families.

What we have done so far:

• Debriefing is always offered/provided to individuals when any restrictive practice is used and the debrief will be delivered in the persons preferred communication method.
• We have committed to using Mind of My Own (MOMO) across our children’s services which will enable us to better hear the voice of the child and triangulate this with debriefs to improve our understanding of their needs.

What we plan to do next in this area:

• Clear information is given to those we support and families which outlines the circumstances when restrictive practices can be used, have been used and how to complain when those we support with lived experience and families are unhappy about the use of restraint.
• Information leaflets and posters are in development for use in our hospital and adult social care settings that will conform to the MHU use of force Act and RRN guidance
• Explore the development of a service user/carer reference group to review the pledge and strategy set out above.
• Complete the self-assessment against strategy 5 RRN Reducing Restrictive Practices Checklist, identifying any gaps for further action in this area

Strategy 6:

CONTINUOUS IMPROVEMENT > The organisation adopts a culture of reflection and positive learning in order to ensure the necessary change can be embedded and implemented at service level, through the workforce scheme of working as well finding its way into everyday interactions between staff and people using the services

What is the main priority in this area:

The organisation adopts a culture of continuous improvement in relation to restraint reduction at the senior level, local team level and individual with lived experience level.

What we have done so far:

• The organisation has developed a culture of candour that accepts when things go wrong and shows a commitment to improve.

What we plan to do next in this area:

• Behaviour Support committees are established across the group. The goal is to find successful improvement strategies to reduce conflict and the use of restrictive practices.
• Recognising the risks of working with many different systems across our services, sometimes within the same or very similar services, a quality improvement goal would be to identify the strongest and most adaptable through an initial SWOT assessment of the approaches ability to meet our corporate goals. Then through an iterative process (PDSA) to reduce the overall number of systems in place to that justified by their particular strengths and best match to the service’s needs.
• Complete the self-assessment against strategy 6 RRN Reducing Restrictive Practices Checklist, identifying any gaps for further action in this area

Appendix One

Local Reporting Requirements

From Towards Safer Services: Minimum Standards for Organisational Restraint Reduction Plans published by the Restraint Reduction Network 2022 V22

1.6 Incident reporting procedures should address:

I. All incidents where physical interventions, rapid tranquillisation, restriction of liberty or seclusion are used must be formally reported.

II. Procedures should allow the analysis of trends such as the frequency and seriousness of different types of restraint over time and in different areas of the provider services.

III. Procedures should allow for the routine gathering of important demographic information relating to the individual, such as ethnicity, age, and gender, etc.

IV. Procedures allow for the routine gathering of important clinical and other care information, in line with current positive practice and legislative standards. This will mean such detail as anonymised reporting of the people involved, location and time of incident, duration of incident, different phases and postures of the incident, possible causes, and injuries to staff and the children or adults subject to restraint.

To meet this standard the following should be recorded at all services, used in local reviews and be available for review by the Positive Behaviour Practitioner Group on request to aid the review of escalated incidents of physical intervention.

Location (As listed on KPI)

Division Incident date

PI - Physical Intervention Type

PI - Physical Intervention Reason

PI - Start Time of Physical Intervention (hh:mm)

PI - End Time of Physical Intervention (hh:mm)

PI - Intervention(s) Tertiary / Held Position

Name of service user Description- Brief account

PI - Who held what

Summary of Action taken

Management review and actions

PI - Post-incident exam completed

PI - Post-incident exam not completed because: PI - Post-incident exam injuries noted

PI - Intervention(s) Primary

PI - Intervention(s) Secondar

Download a copy of our Use of Force Act Policy here.