The impact of a whole-organisation approach to positive behavioural support on the use of physical interventions

Background: Allen (2011) reviewed the key independent variables associated with reducing the use of restrictive practices (such as restraint, seclusion and as required medication) and proposed that the adoption of PBS at an organisational level might be expected to produce similar reductions. The present paper seeks to test this proposition.

Method and materials: A series of initiatives were undertaken to establish PBS as the primary clinical model in a specialist service for adults with intellectual disability. Routine monthly data on physical intervention use were collected across eleven different specialist services settings using PBS as their clinical model over a period of seven years.

Results: Clear reductions in physical intervention use were evident over the study period. Reduction profiles were slightly different in acute and long-stay settings, though clear reductions were evident in both.

Conclusions: Though there are a number of important qualifications to this organisational case study, the systematic adoption of PBS within a service system would appear to be associated with substantial reductions in the use of physical interventions.