What Does Person Centred Planning to Reduce Restrictive Practice Look Like?

I have linked below a very informative and clear article about the need for Person-Centred Planning to reduce restrictive practice. I have had the pleasure to work alongside the fabulous Chris Dzikiti in the past in CTRs. A very dedicated and committed professional.

How do leaders in Social Care go about Person-Centred planning to reduce restrictive practices?

* Identification and operationalisation of the challenges

* Co-Production with all relevant stakeholders

* Completion of the Barriers Assessment

* Completion of Skills Assessment

* A Functional Behaviour Assessment (if required)

* Goal Setting for the Person and Support Network

* Skills-Based Teaching

* Data, Monitoring, Evaluation

* Workforce Development, Training, and Coaching

* Supervision and the Systems for Implementation

Essential to all of this is the leadership and the vision to understand the scale of what is required for real and meaningful change, to enable the person to have the best quality of life possible, with the least restrictive approach possible. This includes at a national level to understand what is required for people that have complex care and support needs to live within the community, at the level of commissioning, and at the level of where the support is being provided.

What is possible?

Our team are involved with a person that has been in an inpatient setting for a number of years. Four of these years had been spent in long-term seclusion. A person-centred approach has supported with challenging this approach and helping the person to spend increasingly less time being secluded. There is more work to do here and this continues, alongside supporting the wider network with planning for a successful discharge.

How has this been achieved?

* A number of meetings and interviews to understand the challenges and barriers

* A records review

* Direct observations

* A series of workshops

* The development of systems, training, coaching, and feedback

* Monitoring, evaluation, and systems to ensure a consistent, predictable approach that provided safety, and fidelity to the approach

It was clear that what was required was an understanding of this person's presentation, and the observable behaviours when distressed. PBS uses a RAG rated system, but its importance is not always fully understood. Especially for proactive systems of support when the person is an Amber where the aim is to support with rapid de-escalation and creating safety.

One of the key person-centred approaches used was a workshop with the staff that knew the individual really well. The staff had been directly involved with challenging situations that had led to the person to being secluded, and could participate in an active discussion of the observable behaviours.

By understanding the person's observable presentation, our team were able to plot the person's increasing distress against the Escalation Cycle. By differentiating behaviours in 'Amber' and creating a hierarchy of antecedent behaviours prior to crisis, we were able to:

• Agree and operationalise 5 levels of observable co-occurring Amber behaviours against the Escalation Cycle
• Agree the earliest observed behaviours of distress against the Escalation Cycle
• Agree the last stages of observable behaviours against the Escalation Cycle
• Identify at what point the person moved from Amber to 'Red' - Crisis Management

During the workshop it was identified that the support staff were moving to seclusion at the earliest points on the person's individual cycle of escalation. The team had no other strategies to support with de-escalation and maintaining safety. Theoretically, the earliest stages and observable behaviours on the Escalation Cycle should be those that provide an opportunity for early intervention and rapid de-escalation. The further the person continues through this cycle, the more difficult it is to provide rapid and safe de-escalation without a full crisis.

By understanding the person's individual escalation cycle, changes in support and de-escalation strategies were possible. This required training, coaching, direct observation and feedback, and monitoring to ensure consistency and fidelity.

The result, a significant reduction in the use of restrictive practices, including seclusion, that were measurable.

I will talk more on a further post about Positive Behaviour Support plans, the RAG rating, Amber, and the importance of understanding the observable behaviours at this point in the person's presentation.

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Article by Rebecca Bauers & Chris D.

https://carequalitycomm.medium.com/restrictive-practice-a-failure-of-person-centred-care-planning-b9ab188296cf