Physical Interventions: Reducing Restrictive Practices in Schools Using the LASER Approach

This short article describes how the Studio 3 LASER Programme approaches the difficult topic of reducing physical interventions and other restrictive practices within schools and other educational settings.

There has been an increased focus on the reduction of restrictive practices within schools as of late, particularly physical interventions and other restrictive practices such as seclusion or timeout rooms. Even so-called sensory rooms, which have been used in educational establishments to provide ‘safe’ containment of individuals, have recently come under scrutiny from concerned parents and professionals alike. Policies and procedures surrounding restrictive physical interventions are now being modified to reduce the instances of these interventions, not just in the UK and the Republic of Ireland but across the world. Whilst these policies and procedures are an important first step towards the eradication of restrictive practices entirely, it is often hard to provide advice on restraint reduction in our current climate of low staffing levels and insufficient budgets to provide staff with training in alternative methods. However, this does not mean to say that we can do nothing. This short article will describe how the Studio 3 LASER Programme approaches the difficult topic of reducing physical interventions and other restrictive practices within schools and other educational settings.

Physical Interventions

The term ‘physical interventions’ has been increasingly used to describe varying methods of restraint in the UK over the last 20 years. The British Institute of Learning Disabilities (BILD) were asked in the 1990s to produce a set of guidelines and regulations for the training of physical interventions in the UK. Studio 3 Director and Clinical Psychologist Professor Andrew McDonnell was personally involved in the early days of this program, and many training organisations joined BILD with the aim of reducing their use of physical interventions. This is been a very long-term and lengthy process, which has in turn led to the evolution of the Restraint Reduction Network (RRN). In the last 20 years, these organisations have contributed to a great deal of progress in the field of restraint, but it is our opinion here at Studio 3 that we still have a long way to go.

The term ‘physical intervention’ covers a broad range of techniques and methods, from seclusion and restraint, to methods of self-protection. For example, an individual might employ a physical intervention to escape from having their hair pulled. Many training courses try to provide a menu of responses to situations such as these, hypothesising about what one should do if they are grabbed, punched, or otherwise threatened by a distressed individual. One of the fundamental flaws in this approach is the assumption that showing a few physical techniques to an individual in a classroom or training setting will translate into a crisis situation. The reality is that people tend to be more efficient in learning situations, but are less able to think logically and reasonably when they are in a heighted state of arousal. It is in this range of emotions, between fear and stress, that most crisis situations occur. In those situations, it is very difficult to safely employ restraints and other defensive interventions. The second fundamental flaw of such training is the inevitable catastrophising that accompanies such ‘What If?’ scenarios. The simple fact is that we cannot be prepared for what may happen in a crisis. What we do know from decades of working in challenging situations with distressed individuals is that ‘less is more’ when it comes to crisis management, and that this kind of training is slowly dying out amongst professionals who, like our colleagues at Studio 3, are choosing instead to take the path of least resistance.

The reality is that, the more people we teach to restrain and reactively respond to potentially threatening scenarios, the more likely those people are to use these skills in practice. It is our view, as an organisation that delivers training in managing behaviours of concern, that restrictive practices are not only unnecessary in most cases, but also dangerous. Injuries to staff can occur whilst they being taught physical interventions on a training course. Injuries to staff and pupils can occur when physical interventions are used in school or educational settings. It is obvious that one simple reason to avoid teaching physical interventions is to avoid causing injury.

Of course, the arguments for and against restraint are far more complex than this, and it is important to recognise that there are, albeit rarely, occasions in which physical interventions may be necessary to prevent harm to the distressed individual or others. The LASER programme will prescribe physical interventions on a case-by-case basis only, after appropriate risk assessments have been carried out. We at Studio 3 do not subscribe to the idea that everyone should get taught some physical interventions ‘just in case’, and as such these will not be taught as part of the LASER curriculum.

The Studio 3 LASER Programme is predominantly focused on changing school cultures, and the ethos surrounding restraint and restrictive practices is an integral part of this. The programme achieves this by providing a stronger emphasis on stress-based crisis management training, which offers alternatives to physical interventions and restrictive practices. If a school or educational setting believes it is necessary to receive physical interventions training, they must submit to a rigorous risk assessment process. This process includes a focus on detailed incident analysis to determine whether physical interventions should be employed or not.

It is inevitable in our experience that some schools will desire, at first, to be taught a limited number of physical interventions on a case-by-case basis. However, many schools, if they agree to take the plunge, will not require any physical interventions training at all. For schools or educational settings where physical interventions are used quite frequently, our team will work closely with the frontline staff to develop a physical interventions reduction plan, with the aim of systematically reducing physical interventions across the board.

A Case Scenario

B was a person who routinely attended a mainstream school. They were ‘included,’ and received extra classroom supports for many of their lessons. Sometimes, their difficulties in class led to an escalation of their behaviour. This had led to them being held in a classroom ‘to protect other students and staff,’ but this was not a regular occurrence. When ‘meltdowns’ occurred, it was clear that all people were traumatised by the restraint process. The solution to this scenario did not take effect immediately... [Read the full article here]

Download the full article by Gareth D. Morewood and Professor Andrew McDonnell to find out the solution of the case example!