1. Mechanical Restraint Project Lynne Webber, Practice Leader, Research and Service Development Office of Professional Practice Katie White, Occupational Therapist, Research Fellow Deakin University

2. In 2012-13 number of people mechanically restrained was increasing

3. So, in 2013-14 began the mechanical restraint project: 3 phases 1.Who was at risk of being mechanically restrained? Everyone mechanically restrained vs. everyone restrained and secluded but not mechanically restrained 2. What was known about people of most concern? File review of 39 people who had been mechanically restrained for several years 3. What were unmet needs that might lead to continued use of mechanical restraint? 10 people followed up with specific assessments to determine unmet needs

4. Phase 1 results: Individual risk factors

5. How is this information useful? Difficulty hearing/seeing what people are asking Assess hearing and vision Sensory impairment Difficulty communicating needs Assess communication to find out best way to communicate Communication impairment Neurological impairment may make it difficult to process information Assess to find out best way person can process information Neurological impairment

6. Does the support team understand why the person shows behaviour of concern? What does the person get by using the behaviour? Get something they want Relationships? Sensory information? Escape from something Noise?

7. They would have difficulty in letting other people know what they needed What we found 94% had moderate-severe communication difficulties Over 30% had a hearing impairment + there was little information about how best to support these people in their behaviour support plans They would have difficulty understanding information provided The majority of the group had moderate- profound intellectual disability The team would not know how best to support the person

8. When the person is well supported mechanical restraint can be reduced and eliminated

9. Results: Mechanical restraint last two years

10. Phase 3: Aims and objectives To investigate the support of a group of identified individuals with disabilities subject to mechanical restraint. To support staff to address the needs of identified individuals subject to mechanical restraint, with the intention of reducing the use of mechanical restraint. To provide recommendations for future directions in reducing mechanical restraint through policy, organisational initiatives, and clinical programmes.

11. Phase 3: What we did -Selection of 10 clients

12. Phase 3: What we did Assessments and Intervention -Initial investigation assessments -Health and medical assessments -Functional Behaviour assessments -Communication assessments -Occupational Therapy assessment and intervention

13. Phase 3: What we found Behaviours of concern TypeBehaviourNo. of Clients Hand to face area Hitting head2 Hand to mouth (gouging)3 Picking at scalp1 Hand to nostril (gouging)1 Biting fingers and wrists1 Access to genitals Injury (anal picking, tearing scrotum)2 Masturbation (in public places)1 Safety in chairs Will throw self out of chair, head and pelvis banging on floor 1

14. Phase 3: What we found -Types of mechanical restraints used -Origin of mechanical restraint use -When mechanical restraint was first used -Adaptive behaviour -Behaviour -Reinforcement inventory

15. Phase 3: What we found Hypothesised functions of behaviour ClientBehaviour Hypothesised Function 1 Hypothesised Function 2 1Head hittingAttentionEscape 3Hand to nostrilAutomatic- Forceful hit to faceAttentionEscape Forceful head bangingAttentionTangible 4 Chewing/sucking on handsAutomatic- 5 Face slapping, body/head hitsEscapeAttention 6MasturbatingAutomatic- 7UndressingAutomaticEscape MasturbatingAutomatic - 8Biting fingers/wristsEscapeTangible 10Nose picking, hand to headAttentionTangible

16. Phase 3: Recommendations Up-to-date comprehensive health assessments Functional behaviour assessments Communication assessments Positive behaviour support strategies Short and long term plans People with disabilities demonstrating self-injurious behaviour and who are subject to mechanical restraint require:

17. Phase 4: -Nine disability clients and there support teams -On-ground investigation of barriers and facilitators to the implementation of an action plan based on the recommendations of phase 3. -Clinician to provide direct support to staff teams to implement the action plan.

18. Questions