Reducing Restrictive Practices in Supported Living: A Positive Behaviour Support Approach to Rights, Choice and Independence

Reducing restrictive practices is one of the most important responsibilities within Supported Living services. Across adult social care, providers are expected to demonstrate that restrictions are only used when absolutely necessary, are proportionate to risk and are reviewed regularly with the aim of reducing or removing them wherever possible.

This expectation is firmly rooted in Positive Behaviour Support (PBS), human rights legislation and modern social care practice. Providers seeking wider context should explore Restrictive Practices & Human Rights alongside PBS in Tenders. For broader guidance on behaviour understanding, proactive support and restrictive practice reduction, organisations can also access the Positive Behaviour Support Knowledge Hub.

The goal is not simply to remove restrictions. The goal is to understand why restrictions exist, address the underlying causes and create safer, more empowering alternatives that improve quality of life. Restrictive practice reduction is therefore both a safeguarding issue and a quality-of-life issue.

Understanding Restrictive Practices

A restrictive practice is any intervention that limits a person's movement, freedom, choice, privacy or rights. Some restrictions are obvious, while others become normalised within services over time.

Examples may include:

• Locked doors or restricted access to areas
• Physical interventions
• Excessive supervision
• Restrictions on community access
• Restrictions on personal possessions
• Restrictions on relationships or communication
• PRN medication used primarily for behavioural management
• Environmental controls that limit freedom unnecessarily

Not all restrictions are inappropriate. Some may be required to prevent serious harm. However, PBS requires services to continually ask whether a restriction remains necessary, proportionate and in the person's best interests.

Why Restrictive Practice Reduction Matters

Restrictive practices can affect every aspect of a person's life. While introduced to manage risk, they can also reduce opportunities for independence, choice and personal growth.

Long-term reliance on restrictions may:

• Reduce confidence and self-determination
• Increase frustration and distress
• Create dependency on support systems
• Limit social inclusion
• Damage trust between staff and the person
• Increase the likelihood of future restrictions

Positive Behaviour Support promotes the principle that people should experience the least restrictive support possible while remaining safe. This means services must actively seek alternatives rather than accepting restrictions as permanent solutions.

Start With Data and Behaviour Function

Reducing restrictions begins with understanding why they are being used. Many restrictions exist because teams are responding to behaviours of concern without fully understanding the factors driving those behaviours.

Good PBS assessment explores:

• When restrictions are used
• What happens before the restriction becomes necessary
• What risks staff are attempting to manage
• Whether the restriction actually achieves its intended purpose
• Whether alternative strategies have been attempted
• Whether behaviour function has been assessed

Behaviour may serve functions related to communication, sensory regulation, escape from demands, emotional regulation or access to preferred activities. Understanding these factors often reveals opportunities for less restrictive support.

Operational Example 1: Replacing Environmental Restrictions

Context: A Supported Living service kept a communal kitchen locked because one person regularly entered and removed food items outside planned meal times.

PBS assessment: Staff initially viewed the issue as non-compliance. Assessment identified anxiety around food availability and previous experiences of food insecurity.

Support approach: The team introduced personalised food storage, visual meal planning and agreed access arrangements.

Outcome: The kitchen remained accessible, anxiety reduced and the restriction was removed entirely.

Replacing Restrictions With Proactive Support

The most successful restrictive practice reduction programmes focus on building alternatives rather than simply removing restrictions.

Examples include:

• Visual prompts instead of repeated verbal instruction
• Choice-making tools instead of directive approaches
• Sensory regulation strategies instead of reactive intervention
• Structured routines instead of constant supervision
• Environmental adaptation instead of behavioural control
• Communication support instead of behavioural sanctions

These approaches reduce distress while increasing autonomy and dignity.

Building Staff Confidence and Competence

Staff confidence plays a critical role in restrictive practice reduction. Restrictions are sometimes maintained because staff fear increased risk or feel uncertain about alternative approaches.

Services should therefore invest in:

• PBS training
• Low-arousal approaches
• Communication support strategies
• Sensory awareness
• Reflective practice
• Coaching and mentoring
• Scenario-based learning

When staff understand behaviour, they are more likely to use proactive support and less likely to rely on restrictive responses.

Operational Example 2: Reducing PRN Medication Reliance

Context: A person regularly received PRN medication during periods of distress.

PBS assessment: Review identified that distress was frequently triggered by unexpected routine changes and sensory overload.

Support approach: Staff introduced visual schedules, advance warnings, sensory regulation opportunities and quieter transition periods.

Outcome: Distress episodes reduced significantly and PRN use declined over several months.

Involving the Person and Their Family

Restrictive practice reduction should never happen without involving the person wherever possible. Families, advocates and representatives can also provide valuable insight into risks, preferences and potential alternatives.

Good practice includes:

• Co-producing support plans
• Discussing restrictions openly
• Explaining rights and choices clearly
• Seeking feedback regularly
• Reviewing restrictions collaboratively
• Recording wishes and preferences

This ensures reduction plans are both safe and meaningful.

Working Transparently With Commissioners

Commissioners increasingly expect providers to demonstrate active restrictive practice reduction. They want evidence that services are moving towards greater independence rather than maintaining unnecessary controls.

Useful evidence includes:

• Restrictive practice reduction plans
• Trend data
• PBS assessments
• Incident reduction outcomes
• Quality-of-life improvements
• Co-production records
• Family feedback

Commissioners often view successful restriction reduction as evidence of service quality and maturity.

Operational Example 3: Increasing Community Independence

Context: A person was always accompanied by two staff when accessing the community due to historical risk concerns.

PBS assessment: Current evidence suggested the risks had significantly reduced and the arrangement was limiting independence.

Support approach: A graduated reduction plan was developed involving travel training, confidence-building and step-down support.

Outcome: The person progressed to accessing some activities independently and reported feeling more confident and in control.

Governance and Assurance

Restrictive practice reduction requires strong governance. Without oversight, restrictions can become embedded and remain unchallenged for years.

Governance systems should include:

• Restrictive practice registers
• Regular reviews
• Audit activity
• Board reporting
• PBS oversight meetings
• Human rights assessments
• Learning reviews

Leaders should be able to explain why restrictions exist, what alternatives have been considered and how reduction is being progressed.

Commissioner Expectations

Commissioners expect providers to demonstrate that restrictive practices are proportionate, evidence-based and subject to regular review. They increasingly look for measurable evidence that restrictions are reducing over time while outcomes improve.

Strong providers can clearly evidence how PBS is being used to replace restrictions with proactive support.

CQC Expectations

CQC expects providers to uphold human rights, promote least restrictive practice and demonstrate person-centred care. Inspectors may explore whether restrictions are genuinely necessary, whether alternatives have been considered and whether people remain involved in decisions affecting their lives.

Services that actively reduce restrictive practices often demonstrate stronger outcomes under Safe, Effective, Caring, Responsive and Well-Led assessments.

Common Barriers to Restrictive Practice Reduction

• Risk-averse organisational cultures
• Limited PBS knowledge
• Inconsistent staff confidence
• Poor data collection
• Lack of review mechanisms
• Insufficient family involvement
• Over-reliance on historical risk assessments

Addressing these barriers requires leadership commitment, staff development and ongoing governance oversight.

What Good Looks Like

High-quality Supported Living services continually challenge restrictions and seek opportunities to increase freedom, choice and independence. They understand that restrictive practice reduction is not simply a regulatory requirement but a reflection of person-centred values and human rights.

When PBS is embedded effectively, services become more proactive, people experience greater control over their lives and restrictive interventions become less necessary. The result is not only safer support but also better quality of life, stronger relationships and more meaningful independence.

---