Restrictive Practices in Irish Disability Services: Regulations and Staff Training

Restrictive practices in Irish disability services are regulated, monitored by HIQA, and a recurring subject for staff training. The short answer for providers is that the 2013 regulations require staff to be trained in managing behaviour that challenges, including de-escalation, require any restrictive procedure to be applied in line with national policy and evidence-based practice, and require appropriate training and supervision as part of staff development. This guide summarises what the regulations and HIQA's guidance say, for providers, persons in charge and trainers in Dublin and across Ireland. It covers regulatory and training duties only and gives no clinical advice. For the safeguarding context, see our guide to safeguarding vulnerable adults training in Ireland.

The regulations that apply

The relevant law for designated centres for children and adults with disabilities is S.I. No. 367/2013, the Health Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children and Adults) with Disabilities) Regulations 2013. We read the as-made text on irishstatutebook.ie. Check for later amendments before relying on it in a policy.

Regulation 7 is headed "Positive behavioural support". As written, it provides that:

• the person in charge must ensure staff have up-to-date knowledge and skills, appropriate to their role, to respond to behaviour that is challenging and to support residents to manage their behaviour;
• staff must receive training in the management of behaviour that is challenging, including de-escalation and intervention techniques;
• where required, therapeutic interventions are implemented with the informed consent of each resident or their representative and are reviewed as part of the personal planning process;
• where restrictive procedures, including physical, chemical or environmental restraint, are used, they must be applied in accordance with national policy and evidence-based practice; and
• where a resident's behaviour requires intervention, every effort must be made to identify and alleviate the cause, all alternative measures must be considered before a restrictive procedure is used, and the least restrictive procedure for the shortest duration necessary must be used.

Regulation 16 covers training and staff development. It requires the person in charge to ensure that staff have access to appropriate training, including refresher training, as part of a continuous professional development programme, that staff are appropriately supervised, and that staff are informed of the Act and any regulations and standards made under it. Copies of the Act, the regulations, relevant HIQA standards and relevant guidance from statutory and professional bodies must be made available to staff.

What HIQA's guidance says

HIQA's Office of the Chief Inspector publishes restrictive practice guidance for designated centres for people with disabilities. The guidance document we read is marked as effective from June 2023, and HIQA's webpage for it shows an "Updated on" label without a date. HIQA's page says the guidance is intended to help providers and staff focus on quality improvement, promote a care environment free from restrictive practice, and review current use with a view to reducing or eliminating it. It includes a self-assessment questionnaire and a quality improvement plan, which the page says does not have to be submitted but will be reviewed during inspection. The page also refers to a restrictive practice thematic inspection programme.

The guidance, citing the 2013 regulations, describes restrictive practice as the intentional restriction of a person's voluntary movement or behaviour. The programme it describes covers physical restraint (including mechanical restraint) and environmental restraint, together with social or "rights" restrictions such as limits on access to cigarettes or the internet. The guidance describes chemical restraint as outside that programme, although Regulation 7 itself names chemical restraint. It also notes that a person can experience restriction through inaction, meaning that the care and support they need for normal daily activities is not provided within a reasonable timeframe.

What providers are expected to have in place

The HIQA guidance sets out expectations that go beyond the wording of the regulation. As we read it, these include:

• A policy committing to a restraint-free environment, with assessment, monitoring and governance arrangements, reviewed every three years.
• Multidisciplinary assessment of practices, including those already in place on admission, with ongoing review.
• Consent and decision support: seeking informed consent, consulting a legal representative or decision supporter where needed, and facilitating access to the Decision Support Service.
• Rights-based practice: restrictions used only when necessary and proportionate, reduced or removed where possible, with positive risk-taking supported.
• Recording and review: each use recorded and reviewed, data analysed for trends, and less restrictive alternatives trialled.
• Training: staff trained in prevention, alternatives and de-escalation, with restraint applied only by competent staff.
• De-briefing after any unplanned use.
• Leadership: a senior manager or committee assigned to reduce and eliminate restrictive practices.

The consent and capacity dimension is covered in our guide to the Assisted Decision-Making (Capacity) Act 2015 and staff training.

What inspectors look for

According to the guidance, inspectors look for evidence that residents' human rights are upheld, that their voices are heard and that they can live according to their choices. The evidence sources it lists include observation (for example locked doors or alarms), care plans and risk assessments, the restrictive practice register, complaints logs, de-briefing records, training records and staff knowledge of individual residents. For how inspectors test training more generally, see our post on HIQA inspections and staff training.

Building a staff training plan

The following is our suggestion, not a legal requirement. A training plan for a disability service could be organised around the duties above:

• Induction: the service's restrictive practice policy, the definition HIQA uses, and where the register and records are kept.
• Role-based training: training in managing behaviour that challenges, including de-escalation, matched to the role and the people supported, with refresher dates recorded.
• Rights and consent: how decisions are made with the person, who must be consulted, and how the Decision Support Service fits in.
• Recording: what must be logged each time, who reviews it and how patterns are analysed.
• Reflection: a de-briefing routine and a way for staff to raise concerns about a practice.

Keep attendance records, who delivered the session, and the date of the next refresher. Because the guidance lists training records and staff knowledge as inspection evidence, tie training to the individuals your staff actually support, not only to generic content.

What we could not confirm

We did not read the HSE's own policy on restrictive practices, so we have not described it. We read the regulations as made and did not check for amending regulations. HIQA's guidance page shows no publication date, so we relied on the effective date shown in the document itself. HIQA's thematic programme and webinar materials may have changed, so check HIQA's current pages.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Do the regulations require staff training on challenging behaviour?

Yes. As made, Regulation 7 of S.I. 367/2013 says staff must receive training in the management of behaviour that is challenging, including de-escalation and intervention techniques.

Does the law say restrictive procedures are banned?

The regulation we read does not ban them outright. It says that where they are used they must follow national policy and evidence-based practice, that alternatives must be considered first, and that the least restrictive procedure for the shortest duration necessary must be used.

Is refresher training required?

Regulation 16 refers to access to appropriate training, including refresher training, as part of a continuous professional development programme. It does not set an interval, so set and record your own.

Does HIQA guidance cover chemical restraint?

The guidance we read describes chemical restraint as outside its thematic programme, but Regulation 7 names chemical restraint among restrictive procedures. Check HIQA's current position.

Where do I find the latest guidance?

Use HIQA's disability services pages and irishstatutebook.ie for current text, and confirm with your registered provider's governance team.

In short, tie your training to the regulation's wording, the HIQA guidance and the people you actually support, and keep the records that show it.