Rebuilding Trust After Restrictive Practice Use During Previous Placements

Rebuilding trust after restrictive practice use during previous placements takes time, consistency and careful attention to the person’s lived experience. A person with a learning disability may have been physically restrained, secluded, constantly supervised, prevented from leaving, restricted in relationships or controlled through routines that were presented as safety measures. Even where some restrictions were legally authorised or clinically justified, the emotional impact can remain significant.

Strong learning disability services recognise that trust is rebuilt through daily practice, not reassurance alone. Effective support across learning disability transitions and life stages depends on clear learning disability service models and pathways that connect rights, PBS, safeguarding, staffing, housing and emotional safety.

Providers should be able to evidence how they reduce unnecessary control while maintaining safety. This creates a clear line of sight from previous restrictive experience to current support, trust-building and long-term stability.

Concept explained clearly

Restrictive practice includes actions that limit a person’s freedom of movement, choice, contact, privacy or ordinary daily life. It may include physical restraint, mechanical restraint, environmental restriction, locked doors, constant observation, blanket rules, medication used primarily for behaviour control or routines that remove meaningful choice.

Rebuilding trust means recognising that the person may not immediately believe new staff will act differently. They may expect control, punishment, rejection or restraint when distressed. Support therefore needs to be predictable, respectful and transparent. The provider must show through repeated actions that the person can be safe without being unnecessarily controlled.

Why it matters in real services

If previous restrictive practice is ignored, staff may misinterpret mistrust as challenging behaviour. The person may refuse support, hide distress, test boundaries, avoid relationships or escalate quickly when they feel trapped. A new service may unknowingly recreate the same patterns that caused fear in the previous placement.

The practical consequences can include increased incidents, safeguarding concerns, refusal of care, staff anxiety and repeat placement breakdown. Strong services demonstrate that trust-building is part of risk management, not a separate emotional issue.

What good looks like

Good support begins with understanding what restrictions were used, why they were used, how the person experienced them and what must change now. Providers review historical records but also listen to the person, family, advocates and professionals who understand their communication.

Observable good practice includes restriction review, trauma-informed support, PBS, clear staff guidance, predictable routines, accessible explanations, debriefing after distress, rights-based decision-making and evidence of reduced restriction over time. Providers should be able to show how staff build confidence through ordinary daily interactions.

Operational example 1: rebuilding trust after repeated restraint

Context: A man with a learning disability moved into supported living after a placement where physical restraint had been used during episodes of distress. In the new home, he became tense when staff stood near exits or approached quickly.

Five-step support approach:

• The provider reviewed previous incident records to identify what happened before restraint was used.
• Staff learned his early signs of distress and agreed non-confrontational responses.
• The environment was arranged so staff did not block exits during support.
• The person was given accessible information about what staff would do if he became upset.
• Reviews tracked whether staff responses reduced fear, incidents and avoidance.

Day-to-day delivery detail: Staff approached from the side, used short phrases and offered space before prompts. If he became distressed, staff moved back, lowered demands and offered a familiar calming routine. They avoided crowding, repeated instructions or sudden touch.

How effectiveness was evidenced: Evidence included reduced incidents, fewer exit-related anxieties, staff debriefs, PBS review notes and the person’s increased willingness to ask for help. The provider showed that safety improved when staff stopped recreating restraint-related triggers.

Deepening rights-based transition planning

Rebuilding trust should be built into transition planning from the start. Providers supporting continuity during major life changes need to understand which previous routines helped the person feel secure and which created fear or dependence. Continuity should not mean copying restrictive practice into the new setting.

Positive Behaviour Support is especially important because it shifts attention from control to understanding. Staff need to know what distress communicates, what prevents escalation and how the person can regain control safely. Restrictions should be specific, justified, proportionate and reviewed. Blanket approaches rarely rebuild trust.

Strong providers also explain change clearly. If a door is no longer locked, if staff will knock before entering, or if community access will increase, the person may need time to believe those changes are real.

Operational example 2: reducing fear after locked-door routines

Context: A woman moved from a restrictive residential service where doors were routinely locked and staff controlled access to the garden. In her new supported living home, she repeatedly asked whether she was “allowed out” and became upset when staff held keys.

Five-step support approach:

• The provider reviewed environmental restrictions used in the previous service.
• Staff created an accessible rights and home-use plan with the woman and her advocate.
• Garden access was built into daily routines so freedom became predictable.
• Staff agreed how keys would be used and explained this consistently.
• Restriction-related anxiety was reviewed through records, observation and feedback.

Day-to-day delivery detail: Staff showed her which doors she could use, practised going into the garden and returning, and avoided asking unnecessary permission-based questions. When safety checks were needed, staff explained them plainly rather than presenting them as control.

How effectiveness was evidenced: Records showed reduced repeated questioning, increased independent garden use, improved mood and advocate feedback that she appeared more confident. The provider evidenced that environmental freedom supported emotional safety.

Systems, workforce and consistency

Teams rebuild trust through consistent behaviour across shifts. Staff must understand the person’s previous restrictive experience and how it may affect current support. They also need guidance on language, personal space, choice, privacy, touch, observation and de-escalation.

Supervision should explore whether staff are becoming controlling because they feel anxious. Managers should ask whether restrictions are necessary, whether alternatives have been tried and whether staff are recording the person’s emotional response. Handovers should include trust indicators, such as accepting support, asking questions, using space safely, sleeping better or choosing to approach staff.

Strong services demonstrate consistency by making restrictive practice review part of governance and team reflection. Trust cannot be rebuilt if one staff member follows a rights-based plan while another uses old control habits.

Operational example 3: rebuilding confidence after constant observation

Context: A person had previously been subject to continuous observation because of self-injury risk. After moving into a new home, they became angry when staff watched closely and shouted that they wanted to be left alone.

Five-step support approach:

• The provider reviewed the observation history and current risk with clinicians and the person’s advocate.
• A graded privacy plan was agreed with clear risk triggers and review points.
• Staff supported the person to identify safe private activities, such as music and drawing.
• Observation was changed from constant visual monitoring to planned check-ins where safe.
• Risk, privacy and wellbeing were reviewed together rather than separately.

Day-to-day delivery detail: Staff knocked before entering, explained check-ins and offered private time with agreed safeguards. They recorded mood, self-injury indicators, use of private space and whether the person sought staff support voluntarily.

How effectiveness was evidenced: Evidence included reduced shouting, no increase in self-injury, improved use of private activities and review minutes showing that observation could reduce safely. The provider demonstrated that dignity and safety could be held together.

Governance and evidence

Governance should show how previous restrictive practice has been understood, reviewed and reduced where possible. The audit trail should include historical incident analysis, restriction records, PBS plans, risk assessments, staff guidance, advocacy involvement, debriefs, supervision notes and review minutes.

Data should include incidents, restrictive interventions, near misses, refusals, distress signs, community access, privacy, choice, sleep, mood and the person’s feedback. Qualitative evidence matters because trust is often visible in small changes, such as approaching staff voluntarily, accepting support or asking for reassurance.

Where restrictions were linked to previous placement design, providers should connect this work with housing and placement transition planning. Layout, doors, staff areas, garden access and private space can all influence whether a home feels safe or controlled.

Commissioner and CQC expectations

Commissioners expect providers to evidence that restrictive practice is understood, proportionate and reducing where possible. They will want assurance that the new support model does not simply recreate the previous placement and that staff are competent to manage risk through proactive support.

CQC expectations focus on safety, dignity, rights, person-centred care and well-led governance. Inspectors may look at whether restrictions are lawful, necessary, proportionate and reviewed, whether staff understand the person and whether people are supported to regain choice and control. Strong services demonstrate that restrictive practice is not normalised or hidden.

Common pitfalls

• Copying restrictions from the previous placement without fresh review.
• Assuming the person will trust new staff because the setting has changed.
• Using reassurance without changing staff behaviour or environmental triggers.
• Recording incidents without analysing the person’s fear of control or restraint.
• Allowing staff anxiety to recreate restrictive routines informally.
• Failing to involve advocacy where rights and restrictions are unclear.
• Not setting criteria for reducing restrictions over time.
• Ignoring small trust-building signs because they are not formal outcome measures.

Conclusion

Rebuilding trust after restrictive practice use during previous placements requires rights-based support, skilled relationships and clear evidence. Strong providers understand the impact of control, reduce unnecessary restriction and show through daily practice that safety can be achieved with dignity. When trust is rebuilt carefully, people are more likely to engage, communicate distress earlier and experience their new service as a real home rather than another controlled setting.

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