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Modifying Physical Environment to Reduce Restrictive Practices

Learn how modifying the physical environment can reduce restrictive practices such as physical intervention, seclusion, medication, and restraints. Real case studies and recommendations provided.

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Modifying Physical Environment to Reduce Restrictive Practices

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  1. Presentation title Reducing Restrictive Practices by modifying the physical environment Samantha-Louise Stallard, MSc, MBPsS, BSc (hons) Behaviour Support Advisor

  2. Introduction and Overview Introduction to: Myself & Dimensions Our mission is to provide high quality personalised support for people with learning disabilities and autism, helping them to be actively engaged with, and contribute to, their communities. Rationale for adapting the environment Case Studies Recommendations Questions

  3. Why adapt the environment? • Allows people to live in the community • Can give people more freedom • Chances to increase independence • Antecedent control • We can be reducing the “triggers” to challenging behaviour Reduces restrictive practices such as; Physical intervention, seclusion, medication and restraints

  4. Case Studies

  5. Carol* • Carols old service; • Physical aggression – resulting in a staff member being knocked unconscious. • Property was dilapidated • Stairs and windows were a high risk area • His provider served noticed • Relationship with the neighbours * Name changed

  6. What Happened when Carol moved? • Wet room • Light Blubs • First floor flat with garden access • Laminated floor • No radiators

  7. How this affected Challenging behaviour • Part of Carols de-escalation was engaging in water activities • When allowed to do this in the wet room the duration of an incident decreased from 4 hours to 20 minutes • No physical interventions were needed when free access to the bath was permitted. Other forms of property destruction reduced

  8. Ivy* • In ATU Full floor restraint was being used • Biting and scratching of staff only occurred during restrictive physical intervention • Sofa – ABC • The high level interventions are not needed in community setting because of other options (e.g. withdrawal and room positioning) * Name changed

  9. Recommendations

  10. Tips to avoid using physical intervention & reducing restrictions • Room and seating arrangements • Consider furniture type • Sensible shoes and clothing • Wear hats / long sleeves / protective clothing • Know where your exits are • Role play crisis situations before you get into them • You can still offer access to a “high risk room” such as the kitchen by: having lockable draws, plastic table ware, utility shut offs, Induction hobs • Have free-access cupboards

  11. Checking specification Sometimes equipment passes standard tests but is not fit for the specific purpose; • Sound proofing • Toughened doors • Wipe-able and waterproof paint • Material of the walls • DVD and projector case • Towel hand rail • Thumb print locks/card swipes Location, Location, Location!

  12. Solutions from outside of the sector When trying to find answers to environmental risk factors other sectors may have the answers e.g. • Marine ply • Anti-vandal toilets • Car manufacturers • Bespoke carpentry

  13. Health Communication/Social Interaction Activities and Skill Development Physical Environment Relationships / Family and Others Service Staff Service Management Wider Organisation

  14. Time for Questions Presenters contact details Samantha-Louise Stallard, MSc, MBPsS, BSc (hons)Behaviour Support Advisor Dimensions Proving life can get better Mobile: 079 402 72480                 Email: Samantha.stallard@dimensions-uk.orgWeb: www.dimensions-uk.org  Twitter: www.twitter.com/dimensionsuk Address: Dimensions, Mill House Centre, Mill Road, Totton, Southampton, SO40 3AE

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