Non-aversive Reactive Strategies (NARS) to reduce the episodic severity of aggression and to reduce the need for restrictive practices
Successful support of people experiencing behavioural crisis requires person centred responses that maintain safety.
Crisis response strategies should not contribute to escalation of risk, likelihood of injury or exclusion. The effectiveness of positive behavioural support (PBS) in changing a person's behaviour over time is well documented. However, during a behavioural crisis there is evidence of a continued reliance on strategies of 'last resort' such as restrictive practices and seclusion. While the use of strategies of 'last resort' is regulated by legislation and policy, strategies of 'first choice' are less clearly defined. Evidence for the effectiveness of crisis management strategies that may include aversive and restrictive practices and positive approaches, and their associated situational effects during behavioural crises is unclear. In this study aversive and restrictive methods of management are compared with positive non-aversive reactive strategies (NARS), applied during behavioural crises, to examine the resulting situational effects.
Method: A 10-point scale measuring momentary effect (ME) severity during behavioural crises was developed. Standardised behavioural report forms were reviewed and information collected regarding: function of behaviour, the types of reactive strategies used and their effects. Reactive strategies for crisis management were categorised as non-aversive (functionally based or non-functionally based), aversive or restrictive. The resulting situational effects (resolution, continues, de-escalation or escalation) were determined via scores on the ME Severity scale. The degree of change on this scale and the number of steps required to resolve an incident were also recorded.
Results:In this study functionally based non-aversive reactive strategies (FB-NARS) were most effective in resolving behavioural crises. Non-functionally based non-aversive reactive strategies (NFB-NARS) were also effective in resolving behavioural crises while restrictive and aversive strategies were less effective in resolving behavioural crises and frequently led to escalation.
Conclusions: These results indicate that the most effective approach for resolving behavioural crises was through non-aversive reactive strategies (NARS). The benefits of this approach are that it is both non-aversive and person centred. Further research is needed to assess the effectiveness of NARS as crisis management strategies, including their effectiveness as an alternative to restrictive and aversive strategies.
