There is a high prevalence of individuals with intellectual disabilities experiencing restrictive practices in the community. A quality improvement initiative instructed clinicians in community intellectual disability services to routinely ask about restrictive practices that were in place for service users in the community. This paper aims to summarise an audit, re-audit and service evaluation of this initiative.
An initial audit and re-audit measured the extent to which clinicians routinely asked about restrictive practices. A focus group then explored clinicians’ perceptions and barriers to having these conversations.
Clinicians routinely asked about the presence of restrictive practices in 51% of cases at the time of the first audit, and in 12% of cases at re-audit, although this was from a much larger sample size. Following this finding, a focus group with clinicians identified key barriers: fear of initiating difficult conversations, ambiguity in discerning the least restrictive option, difficulties navigating legal frameworks during transition to adult services and existing workload pressures.
Findings highlighted how early discussions and planning around restrictive practices are imperative for smoother transitions into adulthood. To address barriers in recording such information, the community learning disability service in question has established an area to record restrictive practices on the electronic patient record.
To the best of the authors’ knowledge, this is the first study addressing routine enquiries around restrictive practices for individuals with intellectual disabilities in community settings.
