Prevention, Not Intervention
Strategic approaches to creating environments where restrictive practices become unnecessary through culture change, not compliance.
Understanding Restrictive Practices
The Restraint Reduction Network (RRN) defines restrictive practices as any intervention that limits an individual's freedom of movement, liberty, or restricts their rights or choices.
The Critical Principle
The most effective restrictive intervention programme is the one that never needs to be used. Reduction begins with understanding that the behaviour of the organisation matters more than managing the behaviour of the individual.
Physical Restraint
Direct physical contact to restrict movement, including holds, escorts, or the use of force to limit mobility.
Mechanical Restraint
Use of devices or equipment to restrict movement, such as bed rails, straps, or locked doors.
Chemical Restraint
Use of medication primarily to control behaviour rather than treat an underlying condition.
Environmental Restrictions
Limitations placed on access to spaces, activities, or resources including seclusion and isolation.
Psychological Restraint
Use of threats, coercion, or blanket restrictions that limit choices and create fear or compliance.
Our Four-Stage Identification and Audit Process
We work in partnership with your organisation to build a complete picture of current practice, identify hidden risks, and create measurable pathways for reduction.
Baseline Assessment
Comprehensive audit of current restrictive practices across your service, including visible interventions and hidden environmental restrictions. We examine policies, incident data, and staff perceptions.
Culture Diagnostics
Measurement of psychological safety levels across your teams using validated tools. We assess inclusion safety, learner safety, contributor safety, and challenger safety to identify cultural barriers to reduction.
Risk Factor Analysis
Identification of organisational and environmental factors that increase reliance on restrictive practices. This includes quality of life assessments, communication environment reviews, and support structure evaluation.
Strategic Planning
Development of a comprehensive, evidence-based reduction strategy that addresses root causes rather than symptoms. Training becomes one element within a broader cultural transformation programme.
The Three-Tier Strategic Framework
Effective reduction requires intervention at multiple levels simultaneously. We work with you to implement strategies across primary prevention, secondary intervention, and tertiary response.
Addressing the Root Causes
Primary prevention targets the biological and psychosocial factors that increase the risk of distress in the first place. These interventions focus on quality of life improvements, environmental design, and organisational culture.
Strategic Focus: Improving physical environments, increasing meaningful activity, ensuring effective communication, addressing unmet health needs, reducing institutionalised practices, building psychological safety, creating person-centred support structures.
Early Identification and De-escalation
Secondary prevention involves recognising early warning signs and implementing personalised strategies before crisis occurs. This requires staff training in communication, relationship building, and understanding individual triggers.
Strategic Focus: Person-centred planning, identification of setting conditions, development of individual support strategies, staff training in de-escalation, implementation of sensory approaches, trauma-informed practice.
Safe Crisis Management
When prevention fails, tertiary responses ensure safety whilst minimising trauma and maintaining dignity. This is where physical skills training sits—as a last resort within a much broader reduction strategy.
Strategic Focus: RRN-certified training in breakaway techniques and safe holding, post-incident review processes, hot debriefs, learning from incidents, continuous improvement cycles, staff wellbeing support.
Primary Risk Factors for Distress
Based on RRN standards, these cumulative factors significantly increase the likelihood of distress and subsequent use of restrictive practices. Primary prevention addresses these systematically.
Individual & Environmental Factors
- Underlying or undiagnosed physical or mental health issues
- Organic mental health conditions (dementia, head injury, acute confusion)
- Sensory differences and inappropriate sensory environments
- Medication side effects
- Poor communication environment
- Inadequate physical environments
- Lack of meaningful activity
- History of trauma and exposure to trauma triggers
Organisational & Systemic Factors
- Lack of control, choice, and involvement in care planning
- Absence of social networks
- Poor relationships with carers and support staff
- Institutionalised environments with blanket restrictions
- Existing use of restrictive practices
- Poorly organised or under-skilled support teams
- Societal inequalities and socioeconomic disadvantage
- Cultural distress due to dominant norms
Training Within Strategy: The Proper Context
Training is essential—but it is not sufficient. For over three decades, the sector has invested heavily in physical intervention training whilst neglecting the strategic and cultural changes that actually prevent the need for restraint.
RRN standards mandate two full days (12 hours) of preventative training before any physical skills are taught. This reflects the evidence: prevention outperforms intervention.
Our approach ensures:
- Training is delivered only after baseline assessment
- Training content is informed by your specific risk profile
- Physical skills are positioned as last resort, not first response
- Staff understand the "why" behind reduction, not just the "how"
- Training is embedded within ongoing cultural change
- Impact is measured through reduction data, not just attendance
Training sits within strategy, not separate from it.
The Psychological Safety Connection
Restrictive practice reduction cannot occur in psychologically unsafe environments. Staff who fear speaking up about concerns, admitting mistakes, or challenging poor practice cannot drive the cultural change required for prevention.
"A psychologically unsafe staff team cannot provide a physically safe environment for clients."
Our reduction strategies simultaneously build the four stages of psychological safety—inclusion, learner, contributor, and challenger safety—creating environments where staff can identify risks early, learn from incidents, contribute innovative solutions, and challenge established practices that perpetuate reliance on restriction.