How we developed the Framework for the use of Non-Pharmaceutical Approaches to Reducing Restrictive Practices in Wales
David O’Brien, Senior Improvement Manager:
In April 2025, we launched the Framework for the use of Non-Pharmaceutical Approaches to Reducing Restrictive Practices in Wales. This was an important milestone in improving the quality of life for people with a learning disability who experience behaviours of concern and their families.
We marked the occasion with a webinar with over 60 stakeholders from across Wales. We were thrilled to have a real conversation about how the framework will benefit our population going forwards, helping care services to meet their needs.
For those who weren’t able to make the launch event, Sarah Leitch, Director of Development at BILD, has explained how the framework was developed and the way our organisations worked together to create this helpful resource…
Sarah Leitch, Director of Development at BILD:
BILD worked with Improvement Cymru to develop a framework to support the use of non-pharmaceutical approaches in reducing restrictive practices in Wales. BILD works in partnership with others to identify and share best practice to help build a more inclusive society. We seek to empower and enable people to thrive, supporting and protecting the rights of people with learning disabilities.
Developing the framework
The start point for developing the framework was a process of engagement and consultation to understand what alternatives to medication people were using or finding helpful in supporting people with a learning disability who may demonstrate behaviours of concern. BILD surveyed family members and professionals from education, health, and social care on current practice:
- 86% of respondents supported someone who was prescribed medication to manage behaviours of concern.
- A majority felt other approaches, rather than medication, could be used some of the time to support behaviours of concern.
- A range of approaches were considered helpful including: providing capable environments (those which enable people to thrive and live a good life), Positive Behaviour Support, psychotherapies, and multidisciplinary team interventions as well as taking a trauma informed approach.
- A key message from this consultation was that no one single approach or intervention was needed, and often it was a range of things in combination that prove most helpful.
Through individual interviews with people with a learning disability and family members, we were able to put these views into context and understand what people wanted to have a good life. People told us a good life involved having choice and control, a circle of support, and access to advocacy services. Families wanted signposting to information to help guide them to care and support options and services. In finding solutions and considering alternatives to medication, one person with a learning disability said:
‘Ask people what is wrong, what they need.’
A literature review of the approaches that people found to be effective was undertaken by Manchester Metropolitan University to help understand what current research says about the approaches being used, and to help identify gaps in evidence.
BILD was grateful for the oversight and contributions provided by a national Task and Finish Group, who guided the development of the framework, supported a tiered approach to identifying alternative supports, and commented on drafts of the framework document.
A tiered approach to prevention
The culmination of the engagement and consultation work is the Framework for the Use of Non-Pharmaceutical Approaches to Reducing Restrictive Practices in Wales. The framework avoids taking a prescriptive approach and shares information, resources, and evidence for a range of approaches and interventions. Most people will thrive with the types of approaches outlined under ‘good support’ in tier one, but if more specific or intensive supports are needed, there should be a seamless journey to providing these through tier two ‘additional support’ and tier three ‘multidisciplinary supports.’ The framework aims to be accessible to a range of audiences, including family members.
Join the action and support implementation efforts
This is where we need you…
The framework will develop over time. We will be looking to hear how you are using it, valuing your feedback and suggestions and will revisit and revise it as appropriate (contact David O’Brien at the email below).
Putting into practice the approaches and interventions will also require ongoing co-production with people with lived experience both in their own person centred planning as well as when engaging people in the design and co-delivery of services in Wales.
Finally, you can join the action and be part of change efforts through our Community of Practice for Behaviours of Concern. We are discussing and implementing learning to ensure alternative supports for people with learning disabilities and behaviours of concern are available across Wales. We welcome new members to the community who share a common interest in improving the quality of life for people with learning disabilities at risk of using behaviours of concern. You can find out more in our Terms of Reference.
Don’t be shy! If would like to join the community and support implementation of the framework, please get in touch with: david.o’brien2@wales.nhs.uk.