Reducing Restrictive Practices in Learning Disability Behavioural Support Services
In learning disability services, restrictive practices are rarely reduced by policy statements alone. Meaningful reduction depends on how behavioural support is designed, delivered and governed day to day. Within complex needs and behavioural support, providers need practical systems that sit clearly within wider learning disability service models and pathways, so that staff responses are consistent, lawful and focused on quality of life.
This article sets out what “restrictive practice reduction” looks like in operational terms, including assessment, staffing, incident learning and board-level oversight.
What counts as restrictive practice in day-to-day delivery
Providers sometimes focus narrowly on physical restraint, but restrictive practice is wider and includes any restriction on a person’s freedom of movement, choice, communication, privacy or access to ordinary life. In practice, restrictions often appear as “workarounds” to manage risk or staff anxiety: locked kitchens, limited community access, blanket device bans, seclusion-like practices, or rules that apply to everyone in a setting regardless of individual need.
Reduction starts with clarity: services need a working definition, a local list of common restrictions seen in the organisation, and a shared understanding of when a restriction becomes routine rather than proportionate.
Start with lawful and evidence-led decision-making
Restriction decisions must be rooted in lawful frameworks and defensible reasoning. This means providers must be able to show:
• What harm is being prevented (and how likely/severe it is)
• What alternatives were tried first
• Why the restriction is proportionate and least restrictive
• How the person is involved (communication and reasonable adjustments)
• How the restriction will be reviewed and reduced over time
Even where legal processes sit elsewhere (e.g., DoLS/authorisations), providers still need day-to-day assurance that staff understand the boundaries of any restriction and implement it as intended.
Operational example 1: replacing a blanket restriction with graded support
Context: A supported living service supported an individual who would leave the property at night and become disoriented, resulting in repeated police involvement. The service introduced a blanket approach: the front door was alarmed and staff routinely blocked exits, escalating distress and increasing restraint use.
Support approach: The provider redesigned support using a graded model. Staff introduced an evening “check-in routine” based on the person’s preferred activity (music and warm drinks), reduced environmental triggers (noise/light), and created an agreed night-time plan that included a calm “walk option” with staff support when the person was restless.
Day-to-day delivery detail: The rota ensured a consistent pairing at peak times (9pm–1am). Staff documented early indicators of distress in daily notes and used a simple traffic-light prompt card in the staff room. The on-call manager reviewed the plan weekly for the first month.
How effectiveness was evidenced: The service tracked (a) episodes of attempted exit, (b) police call-outs, and (c) staff-reported distress intensity. Within six weeks, police involvement reduced to zero and restraint use dropped significantly. The alarm remained in place initially but was deactivated for trial periods as confidence grew, supported by evidence from incident logs.
Link restrictive practice reduction to behaviour support planning
Restrictive practice reduction works best when it is built into behavioural support planning rather than treated as a separate compliance topic. Plans should specify:
• Primary prevention strategies (environment, routine, communication)
• De-escalation approaches (how staff respond to early signs)
• Clear “red line” thresholds for escalation (what triggers immediate management review)
• Any restriction currently used, with review dates and reduction goals
• A record of alternatives tried and why they were or were not effective
Plans must be usable. If staff cannot summarise the plan in plain language, or cannot explain why a restriction exists, the service is exposed.
Operational example 2: reducing PRN reliance through consistent de-escalation
Context: In a residential service, PRN medication was being used frequently during periods of agitation. Staff described it as “the only thing that works,” and incidents often escalated after multiple staff entered the room.
Support approach: The provider introduced a de-escalation standard: one lead staff member, one supporting staff member, minimal verbal prompts, and a structured “space and time” approach with sensory items the person preferred. The clinical lead reviewed the PRN protocol with prescribers and added a requirement for post-PRN reflective review.
Day-to-day delivery detail: Each shift began with a two-minute “plan refresh” using a short checklist. After any PRN use, staff completed a structured reflection (trigger, approach used, what could be tried earlier). Supervision sessions included review of two recent incidents per staff member, focusing on learning rather than blame.
How effectiveness was evidenced: The service monitored PRN frequency, incident escalation (staff injuries and restraint), and the person’s engagement in meaningful activity. Within two months, PRN use reduced substantially and the person’s activity participation increased, reported through weekly engagement measures and qualitative feedback from family/advocate involvement.
Governance: how you prove restrictions are controlled and reducing
Commissioners and regulators expect more than statements about being “least restrictive.” Providers need governance mechanisms that show restrictions are identified, authorised, monitored and reduced. Strong systems include:
• A restrictive practice register (what restrictions exist, where, why, review dates)
• Monthly incident trend analysis (themes, hotspots, staff teams, time patterns)
• Audit of plan quality (are restrictions documented with rationale and review?)
• Spot checks and observations (are staff doing what the plan says?)
• Provider-level learning reviews for significant incidents
Board/leadership oversight matters because restriction risks often increase when services are under pressure (staffing gaps, inconsistent practice, “temporary” restrictions becoming permanent).
Operational example 3: service-wide reduction programme with board oversight
Context: A provider identified that restrictive practices differed widely between services, with some using locked cupboards and blanket community restrictions for convenience. The provider also noted a rise in restraint incidents during staff turnover periods.
Support approach: The provider launched a three-month restrictive practice reduction programme. Each service reviewed restrictions with the person and, where appropriate, family/advocates. The programme included practice coaching, refreshed incident learning, and escalation routes where restrictions lacked clear rationale.
Day-to-day delivery detail: Each service nominated a “restriction reduction lead” to coordinate reviews. Senior managers attended monthly service meetings to remove barriers (e.g., funding for assistive tech, environmental adjustments, additional staffing at peak times). The quality team conducted unannounced observations focused on de-escalation and staff communication.
How effectiveness was evidenced: The provider reported monthly to governance: number of restrictions removed, number amended, number requiring formal authorisation, and incident metrics. Outcomes included fewer blanket restrictions, reduced restraint incidence, and improved staff confidence measured through supervision feedback and competency sign-off.
Commissioner expectation
Commissioners expect providers to demonstrate that restrictive practices are exceptional, time-limited and proportionate, supported by clear records and evidence of reduction. They will look for a defensible approach that reduces placement breakdown risk, minimises crisis responses and demonstrates improved quality of life.
Regulator expectation (CQC)
CQC expects providers to understand, identify and reduce restrictive practices, with evidence that staff apply least restrictive approaches consistently. Inspectors will test whether plans are understood, whether restrictions are recorded and reviewed, and whether learning from incidents drives measurable improvement.
Making reduction real: what changes in the next 30 days
For many services, the most effective “first month” actions are practical:
• Create/refresh the restrictive practice register and review dates
• Ensure every restriction links to a specific plan rationale
• Introduce structured reflective reviews after incidents and PRN use
• Observe practice on shifts (what staff actually do, not what policies say)
• Agree one reduction target per person and evidence progress
Conclusion
Restrictive practice reduction is a delivery discipline, not a policy. When restrictions are clearly identified, reviewed and reduced through structured pathways, providers improve safety, strengthen commissioning confidence and are better placed for CQC scrutiny. Most importantly, people experience more choice, more ordinary life and less distress-driven escalation.