Restrictive Practice Reduction Through Reviewing Access to Preferred Items in PBS

Positive Behaviour Support requires providers to review how access to preferred items, comfort objects and sensory resources is managed. The Positive Behaviour Support hub for rights, behaviour and restrictive practice reduction supports services to connect safety with dignity, autonomy and proactive support.

In specialist services, restrictive practice review and reduction should include locked-away possessions, staff-controlled sensory items, limited access to comfort objects, removed technology, restricted hobby materials and rules introduced because items were previously damaged or used during distress.

This reflects PBS principles around choice, dignity and person-led support, because preferred items often support regulation, communication, identity and emotional safety.

Concept Explained Clearly

Access restrictions occur when a person cannot freely use an item that is meaningful, calming or important to them because staff control, remove or limit it. This may include sensory objects, tablets, music devices, clothing, photographs, craft materials, food-related items, personal collections or objects linked to routine and reassurance.

Some restrictions may be necessary where there are current risks linked to self-injury, choking, property damage, safeguarding, fire safety, online harm, conflict with others or unsafe use. PBS does not ignore those risks. It asks whether the restriction is proportionate, current, reviewed and supported by alternatives.

The central question is whether staff are managing risk in the least restrictive way, or whether item access has become controlled because it feels easier for the service.

Why It Matters in Real Services

Preferred items are often more than objects. They may help a person regulate, communicate distress, tolerate waiting, manage sensory input, feel secure or maintain connection with identity and memories.

When access is removed or delayed, distress can increase. A person may repeatedly ask, search, become anxious, challenge staff or lose trust. Commissioners and CQC will expect providers to evidence why item restrictions exist, how risks are managed and how access is restored where safe.

What Good Looks Like

Strong services identify which items matter, what function they serve and what risks are linked to them. Plans explain when access should be open, when support is needed, what early warning signs matter and what alternatives exist if risk increases.

Providers should be able to evidence PBS plans, item access agreements, risk reviews, incident analysis, staff guidance, supervision notes and feedback from the person. This creates a clear line of sight from item restriction to support adjustment and from support adjustment to reduced distress.

Operational Example 1: Restoring Access to a Sensory Blanket

Step 1 – Context: A person’s weighted sensory blanket was kept in the staff office after it was thrown during a period of distress.

Step 2 – Support approach: Review showed the blanket usually helped the person settle before distress increased. The incident happened after delayed access during a noisy evening.

Step 3 – Day-to-day delivery detail: Staff moved the blanket to an agreed accessible space, introduced earlier sensory breaks and recorded when the person used it successfully.

Step 4 – Restriction reduction: Staff-controlled access was replaced with person-led access during settled periods, with clear guidance for temporary support if risk increased.

Step 5 – How effectiveness was evidenced: Evening distress reduced, repeated requests stopped and the blanket was used safely. The provider evidenced that proactive access reduced restriction and supported regulation.

Deepening the Approach

Item access review should examine the function of the item before deciding whether it should be restricted. An object may provide sensory grounding, reassurance, communication, routine structure or a way to manage uncertainty.

Strong teams use evidence rather than assumptions. Using ABC data to understand behaviour within PBS can help identify whether distress follows delayed access, staff refusal, unclear rules, item removal, sensory overload or anxiety about losing control.

Operational Example 2: Reviewing Staff-Controlled Tablet Access

Step 1 – Context: A person’s tablet was held by staff because previous late-night use affected sleep and led to morning fatigue.

Step 2 – Support approach: Review found that the tablet was important for music, communication with family and relaxation, but unrestricted night use disrupted routine.

Step 3 – Day-to-day delivery detail: Staff agreed a visual tablet timetable, supported music use before bedtime, introduced charging outside the bedroom and offered an alternative audio device overnight.

Step 4 – Restriction reduction: Staff stopped controlling tablet access throughout the day and limited support only to the agreed sleep-protection period.

Step 5 – How effectiveness was evidenced: Daytime conflict reduced, sleep improved and the person used the timetable with less prompting. The provider evidenced that targeted boundaries were less restrictive than broad staff control.

Systems, Workforce and Consistency

Access to preferred items must be consistent. If one staff member allows access and another removes the same item without explanation, the person may experience support as unpredictable and unfair.

Supervision should review whether staff understand the item’s function, current risk and reduction plan. Handovers should record successful access, any concerns, what support was used and whether restrictions still remain justified. Strong services demonstrate that item access is part of PBS planning, not an informal staff decision.

Operational Example 3: Supporting Safe Access to Craft Materials

Step 1 – Context: A person’s craft materials were locked away after scissors and glue were used unsafely during a distressed period.

Step 2 – Support approach: Review showed the person valued craft as a calming evening activity. Risk increased only when materials were available during conflict with another person.

Step 3 – Day-to-day delivery detail: Staff created a supervised craft drawer, separated higher-risk materials, offered safer alternatives and planned craft time after quieter routines.

Step 4 – Restriction reduction: Full removal of craft access was replaced with supported access and proportionate storage of specific higher-risk items.

Step 5 – How effectiveness was evidenced: Craft participation resumed, incidents with materials did not recur and evening regulation improved. The provider evidenced that targeted risk management restored meaningful activity.

Governance and Evidence

Governance should show how preferred item restrictions are identified, authorised, reviewed and reduced. Providers should be able to evidence PBS plans, restriction register entries where relevant, risk assessments, item access agreements, incident reviews, supervision records and person feedback.

Strong governance creates a clear line of sight from behaviour or risk to item restriction, from restriction to support adjustment, and from adjustment to outcome. Providers should be able to evidence that meaningful possessions are not restricted more broadly than necessary.

Commissioner and CQC Expectations

Commissioners expect providers to balance safety with dignity, autonomy and quality of life. They need assurance that people are not losing meaningful access because services rely on removal rather than proportionate support.

CQC will expect care to be person-centred, respectful, safe and least restrictive. Inspectors may review whether people can access personal possessions, whether restrictions are justified and whether staff understand the purpose of preferred items. Strong services demonstrate that item access is reviewed through PBS governance and linked to wellbeing outcomes.

Common Pitfalls

• Removing meaningful items after one incident without reviewing context.
• Keeping items in staff offices because it feels easier to manage.
• Failing to understand the sensory or emotional function of an object.
• Applying broad restrictions when only one use or time period is risky.
• Leaving item access rules out of PBS plans and handovers.
• Measuring success by fewer incidents rather than increased safe access and wellbeing.

Conclusion

Restrictive practice reduction through reviewing access to preferred items helps PBS services protect dignity, regulation and meaningful control. Preferred items can be central to emotional safety and should not be restricted without clear current evidence.

Strong providers evidence why any restriction exists, how safer access is supported and how people regain ordinary control over the things that matter to them. This gives commissioners and CQC confidence that PBS is reducing restriction in practical, respectful and person-centred ways.

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