CONTRAST Establishing components of interventions to reduce restrictive practices with children and young people: an evidence synthesis.


The aim of this study is to identify, standardise and report the effectiveness of components of interventions that seek to reduce restrictive practices in children and young people’s institutional settings. The study objectives are to:

  1. Provide an overview of interventions aimed at reducing restrictive practices with children and young people;
  2. Classify components of those interventions in terms of behaviour change techniques and determine their frequency of use;
  3. Identify the role of process elements in intervention delivery;
  4. Explore the evidence of effectiveness by examining behaviour change techniques and intervention outcomes;
  5. Compare the components of interventions in children and young people’s settings with those in adult psychiatric inpatient settings (HS&DR 16/53/17) and identify potential explanations for any differences;
  6. Identify and prioritise behaviour change techniques showing most promise of effectiveness and that require testing in future high-quality evaluations.


We will conduct an evidence synthesis of published and unpublished literature, including detailed coding of intervention content using the BCT Taxonomy. This will involve: identifying all interventions and extracting data about the characteristics of each including participants, setting, intervention type, outcome measures, fidelity, acceptability, recommendations and quality (Obj. 1 & 3); extracting intervention content to allow their components to be coded using the BCT taxonomy (Obj. 2 & 5); extracting information about the outcomes of the interventions coded for BCTs (Objectives iii & iv). We will then analyse the evidence to produce a synthesis of:

  • Intervention characteristics (Obj. 1).
  • Intervention components related to behavioural change techniques, both type and frequency (Obj. 2 & 5).
  • Description of intervention outcomes where BCTs have been identified (Obj.4).
  • Acceptability (Obj. 3).
  • Recommendations for future trials (Obj. 6).


Incidents involving harm to self or other people, distress, aggression and violence are a frequent occurrence in children and young people’s institutional settings in the NHS and beyond. They are often managed by use of restrictive practices such as restraint, seclusion, injection of sedating drugs and constant observation. Use of these practices carries significant risks, including physical and psychological harm to children and young people and staff. Numerous staff training interventions have been developed to try to reduce their use by seeking to modify practice using a variety of behaviour change techniques (BCTs). Research in this area is hampered by a lack of attention to their specific components. The MRC has supported work to develop a taxonomy of BCTs to improve the reporting of such interventions by providing a common language with which to specify the content and mechanisms by which behaviour is changed.