Exorcising restraint: reducing the use of restrictive interventions in a secure learning disability service

2016 ◽  
Vol 7 (4) ◽  
pp. 176-185 ◽  
Author(s):  
Tim Riding

Purpose The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the national Positive and Safe programme. Design/methodology/approach The strategy was comprised of three primary interventions – Safewards, positive behavioural support and data-informed practice – and utilised a programme management approach to ensure effective delivery. Baseline measures were collected from 12 months of data prior to implementation of the programme and the frequency of each category of restrictive intervention was then measured prospectively on a monthly basis throughout the duration of the programme. Findings Upon completion of the programme the following results were achieved: elimination of prone restraint – elimination of mechanical restraint – 42 per cent reduction in general use of restraint – 42 per cent reduction in use of seclusion – 52 per cent reduction in rapid tranquilisation. Originality/value The paper adds to the growing body of evidence that carefully designed interventions can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the need for a stable workforce is considered.

2015 ◽  
Vol 9 (3) ◽  
pp. 116-123 ◽  
Author(s):  
Catrin Morrissey ◽  
Ben Hobson ◽  
Emma Faulkner ◽  
Tamsin James

Purpose – The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service. Design/methodology/approach – Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013. Findings – The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment. Research limitations/implications – There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies. Originality/value – There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures.


2017 ◽  
Vol 22 (4) ◽  
pp. 198-205 ◽  
Author(s):  
Sarah Broadhurst ◽  
Keri Landau

Purpose The purpose of this paper is to review whether current learning disability market position statements (MPS) are actually helping to shape the market and explore their implications for people with learning disabilities and their families. Design/methodology/approach Published learning disability MPS were identified via the Institute of Public Care’s MPS database. The quality of the MPS was analysed using a good practice checklist developed by a range of stakeholders. Findings Learning disability MPS are not currently fit for purpose. They demonstrate that local authorities are not fully engaging in their market-shaping duties, as required under The Care Act 2014. It is suggested that this is in part due to the lack of recognition that market shaping is a council-wide responsibility and can only be successful if senior officers across the council (and their partners) acknowledge this and are held accountable. Unless this happens, people with learning disabilities will continue to lack the enablers that support them to lead the lives they choose in their communities. Originality/value This is the first review of the quality and potential impact of learning disability MPS.


2014 ◽  
Vol 5 (4) ◽  
pp. 167-177
Author(s):  
Mark F Dalgarno ◽  
Sharon A Riordan

Purpose – The purpose of this paper is to explore the lived experiences of learning disability nurses working within forensic services, and their views on their practice as a speciality. Design/methodology/approach – A qualitative, semi-structured interview-based design was used and participant's voices were examined through interpretive phenomenological analysis. Findings – Nurses explored a range of topics related to their practice and overall, five superordinate themes were developed. Forensic nursing as being both the same and different to generic nursing, the journey, and the emotional challenge of forensic nursing, the balancing act of everyday practice and the role of language within forensic nursing practice. Originality/value – Very little research has examined the views of learning disability nurses within the forensic field. This study gives both a voice to these nurses and suggests areas of interest both for research and for clinicians to consider in their practice.


2017 ◽  
Vol 11 (2) ◽  
pp. 74-82
Author(s):  
Heather Welsh ◽  
Gary Morrison

Purpose The purpose of this paper is to investigate the use of the Mental Health (Care and Treatment) (Scotland) Act 2003 for people with learning disabilities in Scotland, in the context of the recent commitment by the Scottish Government to review the place of learning disability (LD) within the Act. Design/methodology/approach All current compulsory treatment orders (CTO) including LD as a type of mental disorder were identified and reviewed. Data was collected on duration and type of detention (hospital or community based) for all orders. For those with additional mental illness and/or personality disorder, diagnoses were recorded. For those with LD only, symptoms, severity of LD and treatment were recorded. Findings In total, 11 per cent of CTOs included LD as a type of mental disorder. The majority of these also included mental illness. The duration of detention for people with LD only was almost double that for those without LD. A variety of mental illness diagnoses were represented, psychotic disorders being the most common (54 per cent). Treatment was broad and multidisciplinary. In all, 87 per cent of people with LD only were prescribed psychotropic medication authorised by CTO. Originality/value There has been limited research on the use of mental health legislation for people with learning disabilities. This project aids understanding of current practice and will be of interest to readers both in Scotland and further afield. It will inform the review of LD as a type of mental disorder under Scottish mental health law, including consideration of the need for specific legislation.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hasan Tutar ◽  
Ahmet Tuncay Erdem ◽  
Ömer Karademir

Purpose There has been a rapid generational change in the business world in Turkey recently, and X generation managers are rapidly leaving their place to Y generation managers. In countries with relatively young populations such as Turkey, management in family businesses passes into the hands of Generation Y. This study aims to examine the moderator role of the difference between old and new generation Y in the effect of self-efficacy perceptions on decision-making strategies. Design/methodology/approach This research, which was designed according to the quantitative research method, was designed according to the cross-sectional survey model, one of the general survey models. The research data were collected from a sample of 441 family business managers determined according to the simple random sampling technique. The data were analyzed and interpreted with various statistical techniques. Data analysis was done with AMOS. 20 and International Business Machines statistical package for the social sciences 22 data analysis programs. Findings According to the analysis findings, there is a significant relationship between the participants’ self-efficacy perceptions and decision-making strategies. Research findings old and new generation Y managers have different decision strategies. The research results showed that the dominant self-efficacy perceptions of the Y generation affect their decision-making strategies. Research limitations/implications This research only examines whether the old and new generation Y perceptions have a moderator function in the relationship between the participants’ self-efficacy perceptions and decision-making strategies. The research is quantitative research limited to family businesses. The results can be compared by repeating the research with other variables and in different samples, for example, by researching in public institutions. In addition, the way of reflecting the differences in perception to the management can be subjected to deeper analysis with mixed studies. Practical implications One of the important reasons for the difference in people’s approaches to events is their personality structure. Generational differences, which have been discussed primarily in recent years, make themselves felt in working life. The new working models arising from the different perspectives of the Y generation differ from the traditional business models. Today, in traditional business models, the manager profile is usually the X generation. However, the process is moving toward gaining essential positions in the management levels of the new Y generation. They put traditional managers in a difficult situation with their impatient behavior and desire to climb the career ladder quickly. Social implications In the studies conducted on the Y generation, it is understood that they do not favor the classical management approach based on the command-command relationship. The sense of loyalty of the Y generation is low compared to other generations and their organizational commitment levels are weak. There are determinations that they attach importance to flexible working style and want to do business using digital technologies. They are highly motivated in setting vision and participating in strategic decisions in organizations. These features differ significantly from the X-generation managers who adopt the traditional management approach. Originality/value Both emotional and cognitive characteristics influence decision-making behavior. The generation gap which shows common personality structures in a certain period is an important predictor of decision-making strategy. Research results and related studies significantly affect the decision strategies of the generation gap. No research has been found comparing the old and new Y generations. In this respect, it is thought that the research will contribute to theory, practice and method.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Andrea Appolloni ◽  
Idiano D'Adamo ◽  
Massimo Gastaldi ◽  
Morteza Yazdani ◽  
Davide Settembre-Blundo

PurposeThe best strategy to apply for the future cannot disregard a careful analysis of the past and is the one capable of seizing opportunities from outside. Manufacturing sectors are characterized by sudden changes, and in this work, we analyze the ceramic tiles sector characterized by a mature technology in which innovation has played a key role.Design/methodology/approachThis study aims to provide a sectorial analysis based on a historical data set (2004–2019) to highlight how an industry is performing both operationally and in terms of eco-efficiency. For this purpose, from a methodological point of view, the data envelopment analysis (DEA) was used.FindingsThe results of the analysis show that the Spanish ceramics industry shows a growing economic trend by taking advantage of lower industrial costs, while the Italian industry is characterized by a modest decline partially mitigated by exports. The industrial districts are an aggregation of companies that in the ceramic sector has allowed to combine innovation, sustainability and digitalization and is a model toward the maximization of sustainable efficiency because it is a place of aggregation of resources and ideas.Originality/valueThis study experiments with an innovative way of addressing traditional industry analysis, namely, integrating the reflective management approach with DEA-based backward analysis. This provides decision makers with the basis for new interpretations of variable trends.


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