Communication and Restrictive Practice: Using Information to Reduce Control and Risk
Restrictive practice is rarely caused by intent; it is more often caused by misunderstanding, fear or loss of control. When people cannot understand what is happening or make themselves understood, behaviour escalates and restrictions follow. This article connects Communication, Accessible Information & Total Communication with the ethical and legal foundations of your Core Principles & Values, showing how strong communication practice actively reduces restrictive interventions.
The link between communication failure and restriction
Across services, patterns repeat:
- Instructions are rushed or unclear
- Choices are presented too late or too broadly
- Changes are imposed without explanation
- Distress is misinterpreted as “non-compliance”
In each case, restriction becomes the response to a communication breakdown rather than a proportionate, last-resort measure.
Communication as a primary prevention tool
When communication is predictable, accessible and respectful, people retain control. This reduces anxiety, defensive behaviour and escalation. Operationally, this means designing communication into risk assessments, behaviour support plans and restrictive practice reviews.
Operational Example 1: Reducing physical intervention through choice architecture
Context: A person with autism experienced frequent physical interventions during personal care.
Support approach: The service redesigned communication to increase choice and predictability.
Day-to-day delivery detail:
- Staff offered two concrete choices at each step using visuals.
- Transitions were announced using a countdown and visual timer.
- Staff paused after each instruction and waited for a response.
How effectiveness/change is evidenced: Physical interventions reduced significantly, with incident reviews identifying communication adjustments as the primary factor.
Operational Example 2: Managing refusals without coercion
Context: A homecare service recorded repeated refusals of care, escalating to threats of service withdrawal.
Support approach: Communication was reframed to focus on understanding and negotiated consent.
Day-to-day delivery detail:
- Staff used accessible explanations of purpose and consequence.
- Refusal responses were standardised and non-punitive.
- Staff documented what communication worked before considering escalation.
How effectiveness/change is evidenced: Refusals decreased, safeguarding concerns reduced, and the service could evidence proportional responses.
Operational Example 3: Reducing environmental restriction through information
Context: Doors were locked to manage anxiety-related wandering.
Support approach: Communication tools were introduced to replace blanket restriction.
Day-to-day delivery detail:
- Visual schedules showed when doors would be open.
- Clear explanations reduced uncertainty.
- Staff checked understanding before movement.
How effectiveness/change is evidenced: Locking reduced, with improved autonomy and no increase in risk.
Commissioner expectation: least restrictive practice evidenced
Commissioner expectation: Commissioners expect providers to evidence how communication is used to avoid restriction. They will look for proactive adjustments, not reactive justification after incidents.
Regulator / Inspector expectation (CQC): lawful, proportionate restriction
Regulator / Inspector expectation (CQC): Inspectors will test whether restriction is proportionate, time-limited and reviewed. Communication failures that lead to restriction are viewed as quality issues.
Governance: embedding communication into restrictive practice oversight
Risk assessments and reviews
Communication must be a standing item in restrictive practice reviews: what was explained, how, and with what response.
Incident analysis
Root cause analysis should explicitly test whether communication contributed to escalation.
Training and supervision
Staff should be supervised on how they communicate under pressure, not just what they do.