Autism adult services: positive risk-taking within restrictive practice frameworks
Positive risk-taking is often misunderstood as being “less safe” or “less controlled”. In adult autism services, the opposite is usually true. Where risk is actively understood, planned and reviewed, restriction reduces and stability improves. This article explains how providers embed positive risk-taking within restrictive practices, DoLS, LPS and legal safeguards, and how this must align with realistic service models and care pathways to remain safe and defensible.
Why risk aversion drives restriction
Restriction often increases when staff and organisations feel personally or organisationally exposed. Common drivers include:
- Fear of blame following incidents.
- Inconsistent understanding of legal thresholds.
- Lack of confidence in staff skill and supervision.
- Absence of structured risk review processes.
Without a positive risk-taking framework, restriction becomes the default control mechanism.
What positive risk-taking means in practice
Positive risk-taking is not about ignoring risk. It is about:
- Understanding risk in context.
- Identifying what reduces risk as well as what increases it.
- Supporting autonomy incrementally.
- Reviewing outcomes regularly.
For autistic adults, this often means enabling choice, routine and predictability rather than removing control entirely.
Operational example 1: enabling independent travel
Context: An autistic adult is prevented from travelling alone due to past incidents of getting lost.
Support approach: Risk is reframed around skill gaps rather than blanket restriction.
Day-to-day delivery detail: Staff rehearse routes, introduce travel cards with prompts, and agree check-in points. Independent travel is trialled in short stages with clear escalation plans.
How effectiveness is evidenced: Successful journeys increase, staff presence reduces, and confidence improves without increased incidents.
Operational example 2: reducing supervision in supported living
Context: Continuous supervision is in place due to historic incidents.
Support approach: Risk assessments identify periods of low risk where supervision can reduce.
Day-to-day delivery detail: Staff step back during agreed times, while maintaining clear response plans. Reviews are held weekly.
How effectiveness is evidenced: Restriction reduces safely, and the legal basis for deprivation is reassessed.
Operational example 3: choice and financial autonomy
Context: Financial controls limit all spending.
Support approach: Risk is managed through skills and safeguards rather than control.
Day-to-day delivery detail: Spending limits, budgeting support and consent-based safeguards are introduced.
How effectiveness is evidenced: Financial incidents reduce while autonomy increases.
Commissioner expectation
Commissioners expect providers to demonstrate positive risk-taking that reduces restriction. They look for structured risk assessments, review mechanisms and evidence that restriction is not the default response.
Regulator and inspector expectation (CQC)
CQC expects providers to support choice and independence while managing risk. Inspectors look for evidence that risk-taking is planned, reviewed and rights-respecting, not reckless or avoided.
Governance and assurance
- Positive risk-taking frameworks.
- Multi-disciplinary review of restrictions.
- Supervision focused on risk decisions.
- Outcome monitoring linked to restriction reduction.
What good looks like
Good practice shows risk being managed, not feared. Restriction reduces, autonomy increases, and providers can evidence that safety and rights are being balanced lawfully and consistently.