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Breaking a cycle of physical intervention in handling violent incidents and adopting positive behavioural approaches brought about a radical turnaround in the behaviour of a young man with autism. As Mark Brend and Dave Jackson explain, the change also had the added benefit of drastically reducing the cost of providing care, and, most importantly, improving the client's quality of life
Keywords
* autism
* challenging behaviour
* empowerment
These keywords are based on the subject headings from the British Nursing Index. This article has been subject to a double-blind review.
Last February The Howard League for Penal Reform stated that unacceptable levels of pain was routinely being used to restrain children in custody. The report was the result of an independent investigation, led by Lord Carlile (2006), which was set in motion after the death of a 15-year old boy in a privately-managed secure unit. The youth died while being restrained by three adults. Among its 45 recommendations, the report said that:
* the use of physical interventions must be severely restricted
* physical force must never be used to secure compliance or as a punishment.
Speaking about the report, Lord Carlile said that some of the treatment of children in custody would, in another setting, be considered abusive, and in some cases may be illegal.
Many people working in learning disability services recognised uncomfortable parallels in the Carlile report with the situation in some services supporting people whose behaviour was deemed 'challenging'. For although most would say that any form of physical restraint should be a last resort management tool, the fact remains that sometimes people with learning disabilities - disempowered, frustrated, their attempts to communicate ignored or misunderstood - will act violently. And when they do, what is the proper response? It is a situation that provokes a number of searching questions for learning disability practitioners. For example:
* How, when managing violent behaviour, can services balance the obligation to avoid physically injuring or emotionally and mentally traumatising service users, with the need to ensure the safety of staff?
* How can we be sure that our management techniques do not provoke the very behaviour they are designed to manage?
* How can services learn to support people in such a way...