Restrictive Techniques

Outside Wrist Hold: Relaxed

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Service User Resistance	The service user may resist or pull away, increasing the risk of injury to the staff or service user.	Medium	High	Medium-High	Train staff to use calm, non-threatening body language and ensure a relaxed grip to reduce resistance.
Incorrect Grip	An improper grip (e.g., thumb not on top) may reduce control or lead to wrist strain for the staff member.	Medium	Medium	Medium	Practise correct grip techniques under supervision to ensure safety and effectiveness.
Loss of Coordination	Poor coordination between the two staff members may confuse the service user or result in inconsistent application.	Medium	Medium	Medium	Ensure staff communicate clearly and agree on their actions before implementing the technique.
Physical Strain	Prolonged application of the technique may cause strain to the arms or back of the staff members.	Low	Medium	Low-Medium	Rotate responsibilities between staff members where feasible and maintain proper posture throughout.
Injury to Service User	Improper arm positioning or excessive force could cause discomfort or injury to the service user's wrist or back.	Low	High	Medium	Ensure a gentle grip and avoid excessive force; monitor the service user for signs of discomfort.
Environmental Hazards	Obstacles in the environment may pose risks during the application of the technique.	Low	Medium	Low-Medium	Plan the environment in advance to minimise hazards and ensure a clear path.
Overall Risk Level					Medium

Outside Wrist Hold: Restricted

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Physical Injury	Improper arm positioning or excessive force could cause discomfort or injury to the service user's hips or lower back.	Medium	High	Medium-High	Train staff on proper arm locking techniques and ensure pressure is evenly distributed to avoid injury.
Loss of Balance	Incorrect hip or leg positioning may cause the staff member or service user to lose balance, increasing the risk of falls.	Medium	Medium	Medium	Practise proper stance and alignment during training to maintain stability for both staff and service user.
Coordination Issues	Lack of synchronisation between the two staff members could result in uneven pressure or an ineffective hold.	Medium	Medium	Medium	Ensure clear communication and coordination between staff before and during the intervention.
Service User Resistance	The service user may resist the restrictive hold, leading to potential injury to themselves or staff.	Medium	High	Medium-High	Train staff in de-escalation techniques and minimise the use of restrictive holds to last-resort situations.
Environmental Hazards	Obstacles, confined spaces, or uneven surfaces may increase the risk of injury during the intervention.	Low	High	Medium	Conduct an environmental risk assessment and clear obstacles prior to initiating the hold.
Fatigue in Staff	Holding the restrictive position for an extended period may cause physical strain or fatigue in staff members.	Low	Medium	Low-Medium	Provide opportunities for staff to rotate or release the hold safely if required during prolonged engagements.
Overall Risk Level					Medium-High

Inside Wrist Hold

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Incorrect Grip	Improper placement of the thumb or fingers may result in discomfort or loss of control.	Medium	Medium	Medium	Ensure staff are trained to maintain a secure but non-restrictive grip on the service user's wrist.
Overextension	Pulling the wrist too far or at the wrong angle may cause discomfort or injury to the service user's arm.	Medium	High	Medium-High	Train staff to move the wrist slowly and gently, ensuring the service user’s arm forms a right angle without strain.
Service User Resistance	The service user may resist or pull away, increasing the risk of injury to both parties.	Medium	High	Medium-High	Ensure staff are trained in de-escalation techniques and to apply the hold only in situations where resistance is minimal.
Loss of Coordination	Unclear communication or actions between staff members could result in inconsistent application of the hold.	Medium	Medium	Medium	Encourage clear communication and role clarification between staff during training and practice.
Physical Fatigue	Maintaining the hold for an extended period may cause fatigue or strain in the staff member's arm or hand.	Low	Medium	Low-Medium	Rotate responsibilities among staff if the hold must be maintained for longer periods, or release the hold safely if appropriate.
Escalation of Behaviour	Improper execution of the hold may provoke the service user, leading to escalation.	Low	High	Medium	Ensure the hold is applied calmly and confidently, with emphasis on maintaining a non-threatening posture.
Overall Risk Level					Medium

Cupped Fist

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Incorrect Grip	Failing to securely cup the service user’s fist or improperly transitioning between arms could result in a loss of control.	Medium	Medium	Medium	Train staff on maintaining a firm but non-restrictive grip during the transition between arms.
Overextension	Moving the wrist too far or at an incorrect angle may cause discomfort or injury to the service user's arm or wrist.	Medium	High	Medium-High	Ensure staff are trained to move the wrist gently and only to the point where the arm forms a natural right angle.
Service User Resistance	The service user may resist or pull away during the transition or hold, increasing the risk of injury to both parties.	Medium	High	Medium-High	Staff should use de-escalation techniques and only apply the hold in situations where resistance is minimal.
Loss of Coordination	Unclear communication or poor synchronisation between staff members may result in inconsistent application of the hold.	Medium	Medium	Medium	Promote clear communication and role clarification between staff during training and intervention.
Physical Fatigue	Maintaining the hold for extended periods may cause strain or fatigue in the staff member's arm or hand.	Low	Medium	Low-Medium	Rotate responsibilities or safely release the hold if required during prolonged engagements.
Escalation of Behaviour	Improper execution or excessive force during the hold may provoke the service user, leading to escalation.	Low	High	Medium	Apply the hold calmly and confidently, ensuring the movement is smooth and non-threatening.
Overall Risk Level					Medium

Straight Arm Lock: Relaxed

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Incorrect Grip	Improper grasp on the service user's wrist or bicep may result in a loss of control or discomfort for the service user.	Medium	Medium	Medium	Ensure staff receive proper training on secure yet gentle grip techniques for the wrist and bicep.
Overextension	Applying excessive force or guiding the wrist too far may cause strain or injury to the service user's arm.	Medium	High	Medium-High	Train staff to move the arm gently and only until it is comfortably straightened.
Service User Resistance	The service user may resist or pull away, increasing the risk of injury to both parties.	Medium	High	Medium-High	Ensure staff are trained in de-escalation techniques and avoid using the arm lock in situations where resistance is high.
Loss of Coordination	Poor execution or lack of synchronisation between staff members (if applicable) may lead to inconsistent application of the hold.	Medium	Medium	Medium	Encourage clear communication and role clarification during training and intervention.
Physical Fatigue	Maintaining the arm lock for extended periods may cause strain or fatigue in the staff member's arms or hands.	Low	Medium	Low-Medium	Provide opportunities for staff to safely release the hold or rotate responsibilities during prolonged engagements.
Escalation of Behaviour	Improper application of the technique may provoke the service user, leading to escalation.	Low	High	Medium	Apply the hold calmly and confidently, ensuring movements are smooth and non-threatening.
Overall Risk Level					Medium

Straight Arm Lock: Restricted

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Incorrect Grip	Failing to maintain a secure grip on the service user's wrist during the rotation may result in a loss of control or discomfort.	Medium	Medium	Medium	Train staff on proper grip techniques to ensure the wrist is held securely and comfortably during rotation.
Overextension	Extending the arm too far or applying excessive pressure during the rotation may cause strain or injury to the service user's arm or shoulder.	Medium	High	Medium-High	Ensure staff are trained to monitor the range of motion and apply movements gently, avoiding overextension.
Loss of Balance	Stepping backward improperly or failing to maintain stable footing during the rotation may cause the staff member or service user to lose balance.	Medium	Medium	Medium	Emphasise proper footwork and stable body positioning during training to maintain balance.
Service User Resistance	The service user may resist or pull away during the rotation, increasing the risk of injury to both parties.	Medium	High	Medium-High	Train staff in de-escalation techniques to minimise resistance and apply the rotation only when resistance is low.
Physical Fatigue	Maintaining the hold and performing the rotation may cause fatigue or strain in the staff member's arms, legs, or back.	Low	Medium	Low-Medium	Encourage staff to practise efficient movements and provide opportunities to release the hold safely if prolonged engagement is required.
Escalation of Behaviour	Improper or overly forceful application of the rotation may provoke the service user, leading to escalation.	Low	High	Medium	Apply the technique calmly and confidently, ensuring movements are smooth and non-threatening.
Overall Risk Level					Medium

Straight Arm Lock: Reversed

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Incorrect Grip	Improper grip on the wrist or bicep may result in a loss of control or discomfort for the service user.	Medium	Medium	Medium	Ensure staff receive training to maintain a firm but non-restrictive grip on the wrist and bicep.
Overextension	Moving the wrist too far or applying excessive pressure may cause strain or injury to the service user's arm, shoulder, or wrist.	Medium	High	Medium-High	Staff should be trained to monitor the service user’s range of motion and ensure movements are gentle and controlled.
Service User Resistance	The service user may resist or pull away during the movement, increasing the risk of injury to both parties.	Medium	High	Medium-High	Apply the lock only when resistance is low and complement it with de-escalation techniques to minimise resistance.
Loss of Balance	Incorrect body positioning or failure to stabilise the service user may result in loss of balance for either party.	Medium	Medium	Medium	Emphasise proper body alignment and positioning during training to maintain balance for both the staff and the service user.
Escalation of Behaviour	Improper or overly forceful execution of the lock may provoke the service user, leading to escalation.	Low	High	Medium	Ensure the technique is applied calmly and confidently, using smooth and non-threatening movements.
Physical Fatigue	Maintaining the hold for extended periods may cause fatigue or strain in the staff member’s arms, shoulders, or back.	Low	Medium	Low-Medium	Rotate responsibilities among staff members if possible, or release the hold safely during prolonged engagements.
Overall Risk Level					Medium

Figure of 4 Lock

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Incorrect Grip	An improper grip on the wrist or elbow may result in a loss of control or discomfort for the service user.	Medium	Medium	Medium	Ensure staff are trained to maintain a secure and non-restrictive grip on the wrist and provide appropriate support at the elbow.
Overextension	Guiding the arm too far towards the lower back or applying excessive force may cause strain or injury to the service user’s shoulder or arm.	Medium	High	Medium-High	Train staff to guide the arm gently and within the service user’s natural range of motion.
Service User Resistance	The service user may resist or pull away, increasing the risk of injury to both parties.	Medium	High	Medium-High	Apply the lock only when resistance is low and complement it with de-escalation techniques to minimise resistance.
Loss of Coordination	Improper timing or lack of synchronisation between hands during the transition may result in an inconsistent application of the lock.	Medium	Medium	Medium	Practise the technique to ensure smooth hand transitions and consistent execution of the lock.
Escalation of Behaviour	Improper application or excessive force may provoke the service user, leading to escalation.	Low	High	Medium	Ensure the lock is applied calmly, confidently, and with non-threatening movements.
Physical Fatigue	Maintaining the hold for extended periods may cause fatigue or strain in the staff member’s arms, wrists, or back.	Low	Medium	Low-Medium	Rotate responsibilities among staff members if possible, or release the lock safely during prolonged engagements.
Overall Risk Level					Medium

Seated Position: Single Chair or Bean Bag

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Loss of Balance	The service user or staff member may lose balance during the process of guiding the service user to sit.	Medium	Medium	Medium	Ensure staff are trained to use stable foot positioning and maintain control while guiding the service user.
Service User Resistance	The service user may resist sitting, leading to potential instability or escalation.	Medium	High	Medium-High	Use verbal de-escalation techniques and avoid forcing the service user to sit if they resist.
Injury from Misalignment	Improper guidance or positioning may cause the service user to miss the chair or bean bag, leading to a fall or injury.	Medium	High	Medium-High	Train staff to guide the service user slowly and ensure the seat is securely positioned before they sit.
Staff Strain	Lowering onto the knee without proper technique may cause strain or discomfort to the staff member.	Low	Medium	Low-Medium	Teach staff safe techniques for kneeling and encourage regular breaks to avoid fatigue.
Environmental Hazards	Objects or uneven surfaces around the chair or bean bag may create tripping hazards.	Low	High	Medium	Conduct an environmental check to clear obstacles and ensure the seating area is safe and stable.
Escalation of Behaviour	Improper disengagement or body language may provoke the service user after they are seated.	Low	High	Medium	Disengage calmly, facing the service user, and show open palms to communicate a non-threatening stance.
Overall Risk Level					Medium

Seated Position: Sofa or Bench

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Loss of Balance	The service user or staff member may lose balance while transitioning to the seated position, increasing the risk of falls or injury.	Medium	Medium	Medium	Train staff to maintain stable footing and body positioning while guiding the service user to the seat.
Incorrect Wrist Positioning	Improper placement of the service user’s wrist on their thigh may result in discomfort or reduced control.	Medium	Medium	Medium	Provide staff with training on correct wrist placement to ensure the service user remains comfortable and secure.
Overextension	Excessive pressure or poor alignment when sliding the staff member’s elbow between the service user’s arm and body may cause strain or injury.	Medium	High	Medium-High	Train staff to execute movements gently, ensuring natural alignment and avoiding unnecessary force.
Service User Resistance	The service user may resist the seated position or the grip, increasing the likelihood of escalation or injury.	Medium	High	Medium-High	Incorporate de-escalation techniques and apply the seated position only when resistance is minimal.
Escalation of Behaviour	Improper disengagement or body language may provoke the service user once seated.	Low	High	Medium	Disengage calmly while maintaining a non-threatening posture and instruct the service user to keep their hands on their thighs.
Environmental Hazards	Objects or uneven surfaces near the sofa or bench may pose tripping hazards.	Low	Medium	Low-Medium	Ensure the seating area is free of obstacles and assess the environment for potential hazards before engaging.
Physical Fatigue	Maintaining close proximity or holding the seated position for extended periods may cause strain or fatigue for the staff member.	Low	Medium	Low-Medium	Encourage staff to practise efficient movements and safely release the hold if prolonged engagement is required.
Overall Risk Level					Medium

Seated Kicking

Hazard	Potential Risk	Likelihood	Severity	Risk Level	Mitigation Measures
Physical Injury to Staff	The service user’s kicks may inadvertently strike the staff member, leading to bruising or other minor injuries.	Medium	Medium	Medium	Position staff safely to avoid direct contact with the kicking motion, and use the inner leg to deflect or absorb movement without force.
Overexertion in Service User	Prolonged kicking may cause fatigue or cramping in the service user, potentially leading to discomfort or distress.	Medium	Medium	Medium	Encourage calming strategies to reduce kicking duration and provide verbal reassurance to the service user.
Escalation of Behaviour	Restricting the service user’s kicking motion could provoke further aggression or resistance.	Medium	High	Medium-High	Allow the service user to continue kicking naturally while maintaining a safe and non-restrictive position.
Loss of Balance	Improper positioning of the staff member’s leg over the service user’s thigh could result in instability or loss of balance.	Low	Medium	Low-Medium	Train staff on proper leg positioning to ensure stability and avoid overextending.
Environmental Hazards	Objects or uneven surfaces around the seating area may create tripping or falling hazards for staff or the service user.	Low	High	Medium	Assess and clear the area of potential hazards before engaging with the service user.
Fatigue in Staff	Maintaining the leg-over position for an extended period may cause strain or fatigue in the staff member.	Low	Medium	Low-Medium	Encourage staff to alternate positions or disengage safely when necessary.
Overall Risk Level					Medium

Created: 3 December 2024

Last Modified: 3 December 2024

Author: Phil Newton

Version: Version: 1.05