Accessible summary What is known on the subject? Seclusion and restraint still regularly occur within inpatient mental health services. The Council of Europe requires the development of a policy on for instance age limits, techniques and time limits. However, they only define the outer limits of such a policy by indicating when rights are violated. Within these limits, many choices remain open. Staff and service managers lack clarity on safe and humane procedures. Research literature provides limited and contradictory insights on these matters. What this paper adds to existing knowledge? The study resulted in 77 best practice recommendations on the practical application of restraint and seclusion as last resort intervention in inpatient youth and adult mental health services, including forensic facilities. To our knowledge, this is the first study in which the development of recommendations on this topic is not only based on scientific evidence, but also on an analysis of European human rights standards and consensus within and between expert‐professionals and experts‐by‐experience. This approach allowed to develop for the first time recommendations on time limits, asking for second opinion, and registration of seclusion and restraint. What are the implications for practice? The 77 recommendations encourage staff to focus on teamwork, safety measures, humane treatment, age and time limits, asking for second opinion, observation, evaluation and registration when applying seclusion and restraint as last resort intervention. The implementation of the best practice recommendations is feasible provided that they are combined with a broad preventive approach and with collaboration between service managers, staff (educators) and experts‐by‐experience. Under these conditions, the recommendations will improve safety and humane treatment, and reduce harm to both service users and staff. Abstract Introduction Seclusion and restraint still regularly occur within inpatient mental health services. Professionals lack clarity on safe and humane procedures. Nevertheless, a detailed policy on for instance age limits, techniques and time limits is required. Aim We developed recommendations on the humane and safe application of seclusion, physical intervention and mechanical restraint in inpatient youth and adult mental health services, including forensic facilities. Method After developing a questionnaire based on a rapid scientific literature review and an analysis of human rights sources stemming from the Council of Europe, 60 expert‐professionals and 18 experts‐by‐experience were consulted in Flanders (Belgium) through a Delphi‐study. Results After two rounds, all but one statement reached the consensus‐level of 65% in both panels. The study resulted in 77 recommendations on teamwork, communication, materials and techniques, maximum duration, observation, evaluation, registration, second opinion and age limits. Discussion Combining an evidence, human rights and consensus‐based approach allowed for the first time to d...

project number 12Z5119N -Cognitive skills and the gesture use and alignment in individuals with atypical development). We are very grateful to the FWO for their financial support. A special thank you to the children, parents, therapists, and teachers who made this study possible. There was no conflict of interest and there were no restrictions on the publication of results. The first author has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Theories of learning and engagement in persons with profound intellectual and multiple disability (PIMD) are essential as a basis for empirical investigations into the effectiveness or otherwise of educational and other interventions. In this paper, a selected descriptive analysis of observational data on the social and communicative experiences of a sample of eight school students aged between 5 and 13 with profound intellectual and multiple disability is reported. The observed frequency of various sociocommunicative phenomena as well as potential relationships amongst social groupings and communication indicators in two types of school settings are outlined. These results inform a concluding discussion of theoretical perspectives on the nature of inputs to, and responses indicative of learning in this population of individuals with high and complex support needs.

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