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Swapping restraint for Positive Behaviour Support

Richard* is a young man who has a learning disability and violent behaviours of distress.

When he joined Dimensions he moved from a secure unit with a 3:1 staffing ratio, costing around £200k per year. He now needs just 1:1 staffing and understands how to stop triggers to behaviours of distress.

When Dimensions took over his support one of Richard’s goals was to become more independent.

The team initially decided to focus on communication, decision making, and getting out and about.

The team felt that making a difference in these areas would have the greatest overall impact on his quality of life.

Making a difference


Because Richard’s physical aggression involved biting and hitting, staff focused on mitigating this risk. Unfortunately, this often led to a defensive team rather than a supportive team. They identified this as a problem and developed strategies to build a meaningful rapport with him.

Decision making

Richard’s team understand that it is important to give him time and space so he can make his own decisions; they don’t place demands on him and don’t rush him. Richard now decides what time he wants to get out of bed, when he wants to eat and what he does.

Out and about

Most triggers for Richard’s behaviours of distress occurred when he was out in the community. They developed a strategy to help him cope by encouraging him to say the word ‘home’ when he felt uncomfortable. Staff would immediately take him home.

This system took several months to establish but, following each incident, his support team would talk about it and suggest using ‘home’ as an avoidance method. Richard eventually tried saying ‘home’ to staff when he was uncomfortable and was clearly pleased when he was immediately taken home.

Richard has now made so much progress he is able to go on holiday. He loves the seaside and has been to Skegness and Scarborough.

*names have been changed to protect privacy.

Richard's achievements

  • Richard’s support has been reduced from 3:1 to 1:1 full-time, leading to major savings for the local authority
  • There is now one incident of behaviours of distress every two months, down from one a week; Control and Restraint were removed from his support programme after a year
  • Richard is more included in his community, happier and with a better quality of life