Restrictive Practices in disablity the reality part two
So I was starting to
talk about restrictive practices but let’s get down to what they are as this is
where people start to get stuck I will add in where to get accurate information
as this is the thing getting accurate information about what they are and how
they need to be used as there it two major categories and they are approved restrictive
practices and then we have unapproved restrictive practices and this is where
it needs to be reported as this is where it can cause trauma as having a disability
or neurodiversity, can be inherently traumatizing as the world is constantly gaslighting
and we are behind everyone else in some areas and ahead in others and this isn’t
normal and we need to be aware of that.
So, the approved restrictive practices are in a couple of categories
and they are
- chemical
restraint, this is the use of
medications to control behaviour and this is where you need to be able to
prove they are needed as the medications that are used have massive side
effects, such as drowsiness, increased appetite, or decreased appetite
as well, So we need to have appropriate use of medication sheet filled out
and have if you’re in supported accommodation checking your medication and
using the same pharmacy as they can educate you on your medications and
side effects as well, and they can pick up if you are being controlled by
chemical restraints and they are a tool to be used.
For most medications that are
used for behavior control, you need to have a specialist generally a Psychiatrists so this
combines medication and other therapies this can be exhausting looking for answers
for your behavior sometimes it’s just you and it’s a maladaptive coping behavior
and as soon as you have resolved the situation and you can have some control
over the situation that you haven’t had control over then if you have stability
you can start to rebuild your life some medications are used for other
conditions so some that effect behavior or keep you attached to reality are
also used for Eleplisy and Nerve pain.
I
- environmental
restraint This is something that we see are to be used with caution and
this is something that can be seen as common sense, so this is preventing
or supervising access to sharp items, having fridges locked as someone
would steal food, from another person, or would be likely to attack a
person with a knife or scissors. It’s also limiting access to areas of a
house or residence as there might be medications or paperwork or other
people but it needs to be a limited time and not all the time as calm down
rooms need to be used for a limited amount of time because people need stimulation
and they are used to have less stimulation for people who are over stimulated
and this is where a support worker needs to understand and not let a
person get over stimulated to the point that that need a calm down room.
It's also not allowing things into
the house that might trigger a person so if they have food allergies then not allowing
things with preservatives or they have a reaction to this takes planning to be
able to feed them and this is where it crosses over into both activities of daily
living and life skills knowing to not live on coffee or to go to decaffeinated
or drinking water and no rule book says you need to drink cold water, if it’s
something that a person won’t drink, hot water or a bubbly one is an option. Or
if they don’t have any allergies or reactions to fruit putting fruit into it to
give it taste.
- mechanical
restraint This is one that I
understand needs to be used with extreme caution as it can cause more trauma
for both the people it is being used on as well as the people using it, so
these are more used in people who have behaviors of concerns that involve self-harm,
so this could be scratching, biting, or pulling out medical equipment such
as feeding pegs or taking off clothing that might be considered indecent
exposure to others and we also see that handcuffs or rope is considered
abuse, and these are generally in the form of handcuffs used in people who
are engaged in the criminal justice system, but this is another complex
issue to be able to understand as sometimes people needs to be educated on
boundaries for people and this is something that supports workers and caregivers
need to be aware of.
- physical
restraint is something that deserves its post because it’s more controversial
as it can cause harm and death, due to the way that it can be used they
are an extreme last resort and can be mistaken for actively using the duty
of care so removing a hand from a hot plate isn’t a positive practice but
using a takedown to be able to subdue a person to force them to take a
medication is a positive practice.
- Seclusion
is also the most controversial as it increases the risk of trauma as it is
something that can be used to cause harm most restrictive practices can cause
trauma and they need to be implemented with trauma-informed practitioners
and additional training from staff to be able to reduce the practices over
time. But seclusion is the disability
version of time out, so practicing someone's access to other people or TV
or raising them to the house, but if they are free to leave by having a
key that is not a positive practice, if they can turn on the TV by asking
for the remote or have an internet connection isn’t seclusion. But we see
that they can be generally used in conjunction with other restrictive practices so this can
be sending someone to their room, and they can’t leave or other people
leaving until the person calms down.
So we need to be aware of where
it’s appropriate for people to use them, and this is where the appropriate mental
health support comes into it, such as a positive behavior practitioner and a physicist
that can prescribe medication for a person in an appropriate manner and can
seek consent from the person or the person guardian as we see that people with
a mental disability or mental health condition are at higher risk of being coerced
into taking the medication and they might not understand why they need it, and
I see that this is where education and training need to happen.
When a practice is used without appropriate
training this is there is a risk of causing harm and trauma to the person with
a disability. Further training needs to be around education, redirection, planned
to ignore, rewards-based systems, and education for the person with a disability
to understand, boundaries, consent, grooming, and appropriate usage of items,
such as scissors for crafting or knives for cutting.
We also need support for the
support workers and appropriate debriefing where they aren’t breaching a person's
privacy in public this is another issue with these practices as it’s not a restrictive practice
to stop someone running into traffic or to stop because they have taken their
seat belt off and are unrestrained in a car.
I know for myself I am looking
into cotton gloves so I don’t scratch until I have open wounds But need to
justify them as I am getting them with the full knowledge that it is something
to help control my behavior but I am willingly getting them, as a tool so this
is where we need to be aware of what is happening and how to not cause trauma or
cause traumatization and to let a person sit with their emotions as we often as
people with disabilities have been told we can’t have the challenging emotions
or to have negative emotions or to be “ uncompliant” we all have difficult
times and have negative emotions and we need redirecting. So it’s level of education
that Support staff, Head offices, Friends and family, as well as disability advocates
and educators, need to have around these practices as they fall into harm minimization
as well as the duty of care at times and they are designed to be reduced over
time and this is where a positive behavior support plan is needed, and these
practices need to be documented every time they are used to provide a pattern
of behaviors so they can be tracked to see if the behavior is reducing, or escalating.
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