In 2002, ministerial guidance was issued on the exceptional use of installation control measures. As for home support, no ministerial guidelines are available, although stakeholders sometimes face similar situations. They may have witnessed home-made restraint or isolation methods used by families to cope with problematic situations experienced with their child. These methods, however, involve physical and psychological risks, which are often unknown to the families. Stakeholders must therefore raise awareness and inform families about the exceptional use of control measures and assist them in the process of finding alternative measures. 

Faced with this observation of current practices and lack of guidelines, the protocol for the application of home control measures (physical restraint and isolation) was drafted in 2013. It is largely inspired by what is recommended in institutions, but takes into account specific criteria related to the living environment and the clientele. This protocol provides guidelines for occupational therapists and psychosocial workers in the context of safe delivery and quality of care and services, with respect and dignity for the person. 

Training was organized to disseminate the protocol. It is an adaptation of the departmental training “Towards a change of practice to reduce the use of physical restraint and isolation”. The definitions, guiding principles, intervention contexts, clinical approach, and new roles to play in the team were presented and subgroup work was done on clinical vignettes to incorporate the concepts learned. The training was given to the stakeholders of the Family-Childhood-Youth DI-TED-DP and 0-4 years teams, as well as to certain members of the Youth Mental Health Team and to occupational therapists from CRDITED Normand-Laramée. 

The family has a great responsibility in the process of exceptional use of control measures. Whether it is describing the problematic behaviour or testing alternative measures or, as a last resort, using a control measure, the family must be able to observe the situation, report facts and apply the strategies agreed upon with the occupational therapist. To do this, stakeholders make sure to explain to the family the positive and undesirable effects of the various solutions considered and to demonstrate the use of equipment when required. Written information is also provided so that the family has access to a checklist. In addition, a reassessment is always provided for in the intervention plan. 

Application of the exceptional use of control measures protocol ensures the safety of the user while providing support to the family and a better understanding of the situation. 

Contact: 

Title: Clinical Consultant, Multidisciplinary Services and Care and Service Partnership Directorate 

Email: iroberge.csssl@ssss.gouv.qc.ca

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