Autism adult services: building a restrictive practice register and governance cycle
Restrictive practices tend to proliferate when they are invisible. Providers often have “lots of small controls” across a service that no one can see in one place: locked doors here, constant supervision there, limits on community access somewhere else. A restrictive practice register is the practical tool that turns restriction into something that can be governed, reviewed and reduced. This article sets out how to build and run a register within restrictive practices, DoLS, LPS and legal safeguards, and how it must align with real service models and care pathways so that reduction is operationally deliverable rather than just a policy aim.
Why restrictive practice registers matter
In adult autism services, restriction is rarely introduced as a single event. It is typically a series of responses to distress, risk or system pressure. Without a register, three predictable failures occur:
- Restriction drift: controls continue long after the original risk has changed.
- Inconsistent review: some restrictions are reviewed in detail; others are never revisited.
- Legal misalignment: DoLS/LPS status and authorisation conditions fall behind real practice.
A register creates visibility. Visibility enables governance. Governance enables reduction.
What a restrictive practice register should contain
A restrictive practice register is not a list of incidents. It is a living record of restrictions in place, why they exist, and how they will be reduced. At minimum, each entry should include:
- Restriction description: what exactly is restricted (e.g., locked front door after 8pm; 2:1 supervision in community; phone access limited at night).
- Purpose and risk rationale: the specific risk the restriction is intended to mitigate, linked to evidence.
- Legal basis: whether this forms part of a deprivation of liberty and the current DoLS/LPS status where applicable.
- Least restrictive options considered: what was tried or considered and why it was insufficient.
- Review date and reviewer: who reviews it, when, and what triggers earlier review.
- Reduction plan: the practical steps to reduce or remove the restriction over time.
- Evidence of effectiveness: what data is tracked (incidents, distress indicators, engagement, safeguarding alerts).
If these fields cannot be completed, the restriction is likely not well-justified.
Linking the register to DoLS and LPS in practice
The register should make deprivation visible. Providers commonly fail to see deprivation because they list restrictions separately rather than assessing their combined effect. A good register supports a “deprivation check” by showing:
- Whether the person is under continuous supervision and control.
- Whether they are free to leave (in practice, not theory).
- Whether restrictions are imposed as part of state-arranged care.
Where deprivation exists, the register should clearly show that safeguards are in place, conditions are being met, and reduction is actively pursued.
Operational example 1: identifying hidden restriction drift across a service
Context: A supported living service supports four autistic adults. The manager believes the service uses “minimal restriction”. A new quality lead begins a register exercise and identifies 14 distinct restrictions across the service, including locked kitchen access, staff holding keys, limits on community access, and informal “rules” about phone use.
Support approach: The provider completes a register entry for each restriction and asks three questions: what risk is it managing, is it proportionate, and what is the reduction plan? A deprivation screening is completed for each person using the register to view restrictions in combination.
Day-to-day delivery detail: Staff are supported to rewrite restrictions into clear, observable descriptions. For each restriction, a reduction action is agreed and assigned: for example, unlocking the kitchen for defined periods with staff coaching rather than locking; replacing “no phone at night” with a sleep routine plan and sensory adjustments; changing “staff must accompany all outings” into a staged community access plan with travel rehearsal and check-in points.
How effectiveness is evidenced: The provider tracks incidents, distress indicators, and use of restrictive measures week-by-week. The register shows restrictions reducing over three months, with evidence that stability improved rather than deteriorated.
Operational example 2: register used to align restrictions with DoLS/LPS conditions
Context: An autistic adult has a deprivation authorisation with conditions requiring increased choice and community access. In practice, staff restrict outings due to anxiety about “absconding” and incidents. The restriction is not clearly documented, and the authorisation conditions are being breached.
Support approach: The restriction is entered into the register and mapped directly to the authorisation conditions. The provider treats the issue as a governance and compliance risk, not a frontline preference.
Day-to-day delivery detail: A revised risk enablement plan is produced with staged outings, predictable routes, and de-escalation strategies. Staff guidance is rewritten to clarify what intervention is permitted and what is not. The provider schedules weekly reviews for six weeks to ensure the restriction reduces and conditions are met.
How effectiveness is evidenced: The register evidences that community access increased, incidents reduced, and authorisation conditions were complied with. Audit records show the provider identified a breach and corrected it proactively.
Operational example 3: managing emergency restrictions without normalising them
Context: Following a safeguarding incident, a provider introduces rapid restrictions: increased observation and limits on visitor access. Staff become accustomed to the controls, and they persist long after the initial risk reduces.
Support approach: The restrictions are placed on the register with clear time limits, review triggers and escalation routes. The provider distinguishes “temporary emergency measures” from long-term support planning.
Day-to-day delivery detail: A 72-hour review is scheduled, then weekly. At each review, staff must evidence what has changed: risk indicators, safeguarding outcomes, and what alternative supports have been implemented. The reduction plan includes environmental changes, routine stabilisation and communication adjustments, aiming to step down observation safely.
How effectiveness is evidenced: The register shows restrictions stepping down according to plan, with incident data and safeguarding updates supporting each change. The provider can demonstrate that emergency restrictions were controlled, reviewed and removed, not allowed to drift.
Commissioner expectation
Commissioners will expect providers to be able to evidence restrictive practice governance and reduction. A register is a practical assurance tool: it enables commissioners to see what restrictions exist, why, whether safeguards are in place, and whether restrictions are actively reducing rather than becoming embedded.
Regulator and inspector expectation (CQC)
CQC will expect restrictive practices to be minimised, time-limited and reviewed, with strong rights-based governance. Inspectors will look for evidence of oversight, lawful safeguards where deprivation exists, staff understanding, and learning from incidents. A well-run register demonstrates that restriction is visible, governed and reducing.
Governance and assurance cycle: making the register work
- Monthly review meeting chaired by a senior lead, reviewing all new and ongoing restrictions.
- Quality sampling of restriction rationales to check evidence and proportionality.
- Supervision prompts requiring staff to justify restrictions and describe reduction actions.
- Dashboard indicators (number of restrictions per person, average duration, reductions achieved).
- Escalation triggers for long-running restrictions or breaches of authorisation conditions.
What good looks like
Good restrictive practice governance is visible in trend. Restrictions reduce over time, deprivation is authorised where required, and staff can explain not only what restrictions exist but why they exist and how they are being removed safely.