The overall aim of this review is to gain a deeper understanding of how, why, for whom, and in what circumstances interventions used to prevent and reduce the use of restrictive practices on adults with learning disabilities are most successful.

What is the need?

Despite national and international guidelines and political and public pressure to reduce and prevent the use of restrictive practices on vulnerable populations, these are still common. Restrictive practices can include the use of observation, seclusion, physical restraint, mechanical restraint, rapid tranquilisation and/or other chemical restraint (RRN, 2019). Recent data point to a significant 50% increase in the use of restrictive practices on adults with learning disabilities in English hospitals (NHS Digital, 2018). A number of interventions have been implemented in healthcare services over the last decade to address this issue – Positive Behaviour Support (PBS), Safewards, the Six Core Strategies, REsTRAIN Yourself. Despite their widespread use, there is no unifying theory that explains how or why these methods are supposed to ‘work’ in reducing the use of restrictive practices. This review will fill a gap in the evidence base by developing programme theories of why current interventions work and do not work in preventing and/or reducing restrictive practices with this vulnerable population.

What are we doing?

To address these objectives, a realist review will be conducted according to RAMESES guidelines (Wong et al., 2013). The realist review will focus on ‘how’ interventions work and under what circumstances approaches to prevent and/or reduce restrictive practices work. We will use a realist logic of analysis to align data from 4 project phases with context mechanism outcome configurations (CMOs):

(1)         formulating middle-range CMO configurations;

(2)         conducting a systematic search of literature;

(3)         testing and refining the programme theory; and

(4)         developing recommendations and disseminating findings.

Stakeholder engagement is central this project. Stakeholders include the research team, practitioners, steering group, experts by experience and policy makers and will be involved throughout the project to guide the research. They will also be will be encouraged to disseminate findings through their local and national networks.

What will be the outcomes?

Our aim is to use the results from the review to inform future policy, research and practice in the development and implementation of more effective and appropriate interventions to minimise the use of restrictive practices on people with learning disabilities and autism or mental health comorbidities. The research team, advisory panel and experts by experience groups will share findings through their networks and promote change beyond the end of the project.

Using involvement of stakeholders in the review as outlined will allow for better knowledge transfer throughout. To increase the visibility and impact of the research, we will disseminate findings through knowledge exchange with stakeholders and policy makers using social media (Twitter, Blogs, Podcasts), publications in peer-reviewed journals, conference presentations, and formal and informal reports.

What are the timescales?

The project will run from September 2020 for 22 months.

Project links

https://fundingawards.nihr.ac.uk/award/NIHR129524

Publications

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158432