text:
ORIGINAL RESEARCH article
Sec. Public Mental Health
An Evaluation of the Implementation of a “No Force First” Informed Organisational Guide to Reduce Physical Restraint in Mental Health and Learning Disability Inpatient Settings in the UK
- Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
Background: The use of physical restraint on vulnerable people with learning disabilities and mental health problems is one of the most controversial and criticised forms of restrictive practice. This paper reports on the implementation of an organisational approach called “No Force First” within a large mental health organisation in England, UK. The aim was to investigate changes in violence/aggression, harm, and physical restraint following implementation.
Methods: The study used a pretest-posttest quasi-experimental design. Recorded incidents of violence/aggression from 44 inpatient mental health and learning disabilities (including forensic) wards were included (n = 13,599). Two study groups were created for comparison: the “intervention” group comprising all incidents on these wards during the 24 months post-implementation (2018–2019) (n = 6,551) and the “control” group comprising all incidents in the 24 months preceding implementation (2015–2016) (n = 7,048). Incidents recorded during implementation (i.e., 2017) were excluded (n = 3,705). Incidence rate ratios (IRR) were calculated with 95% confidence intervals (95% CI). Multivariate regression models using generalised estimating equations were performed to estimate unadjusted and adjusted prevalence ratios (aPR) of physical restraint and harm, using type of wards, incident, and violence/aggression as key covariates.
Results: A significant 17% reduction in incidence of physical restraint was observed [IRR = 0.83, 95% CI 0.77–0.88, p < 0.0001]. Significant reductions in rates of harm sustained and aggression/violence were also observed, but not concerning the use of medication during restraint. The prevalence of physical restraint was significantly higher in inpatients on forensic learning disability wards than those on forensic mental health wards both pre- (aPR = 4.26, 95% CI 2.91–6.23) and post-intervention (aPR = 9.09, 95% CI 5.09–16.23), when controlling for type of incident and type of violence/aggression. Physical assault was a significantly more prevalent risk factor of restraint use than other forms of violence/aggression, especially that directed to staff (not to other patients).
Conclusions: This is a key study reporting the positive impact that organisational models and guides such as “No Force First” can have on equipping staff to focus more on primary and secondary prevention as opposed to tertiary coercive practices such as restraint in mental health and learning disabilities settings.
The assumption that conflict in mental health and learning disability settings is inevitable and could only be dealt with by force and physically or medically restraining service users has been challenged for decades in psychiatry (1). The use of physical restraint on people with learning disability and mental health difficulties is the most controversial and debated form of restrictive practice—it has no therapeutic value (2, 3) and it is against people's human rights (4–6). It can traumatise patients, lead to injuries and burnout for staff, frustration and reduced quality of life for carers (3, 7–10) and it can have significant negative economic impact on organisations (11, 12).
There is a major drive in mental health settings to consider the use of restraint as a treatment failure and change focus from containment/coercion to recovery (13, 14). Despite the evidence, lobbying, public policy and guidelines to minimise the use of these controversial practices, there is an indication that these are still commonly used in these settings. Globally, while the frequency of physical restraint on mental health inpatients differs from one country to another and one service to another, ranging from 3.8 to 51.3%, evidence suggests that this has been on the increase in the last decades (15–17). The use of restrictive practices in inpatient settings for people with learning disabilities has generated a lot of criticism and concerns about infringement of human rights and misconduct (18). Recent figures indicate that in England a patient with learning disabilities is restrained, on average, every 15 mins, and the frequency of restraint use has increased over the years (e.g., more than a 50% increase from 2016 to 2017 (19) and more than 70% from 2017 to 2019 (20).
The use of strategies and programmes to minimise the use of restraint has remained a priority both in the UK and internationally. Examples include UK policy documents such as Mental Health Units (Use of Force) Act 2018 (21) and the unanimous decision by the Council of Europe to adopt a resolution to an imminent transition to start eradicating coercive practices in mental health settings (22). There is a wide range of discreet interventions as well as complex programmes or strategies targeted at reducing restrictive practices with the potential to reduce conflict and harm in adult mental health and learning disabilities settings. Examples include the Safewards (23) and the RAID and Positive Behaviour Support (24) approaches developed in the UK and the Engagement model (25), Six Core Strategies (26) and “No Force First” (27) developed in the US.
Developed by Recovery Innovations, Inc., a nonprofit corporation operating a range of recovery-oriented programmes in the US, the “No Force First” model was developed in 2006. The philosophy of the “No Force First” model is that any act of coercion is detrimental to the ultimate recovery of the service user and that a fundamental change in practice and culture can transform an organisation's performance in this area (28). Using force and thus some forms of restrictive practices is incompatible with the values of recovery, such as choice, self-determination, and personhood (29, 30). Practices such as physical and chemical restraint should only be used as a last resort (13, 31–33). Programmes using the “No Force First” model/philosophy seek to transform the experience of service users by minimising and eventually eliminating the use of physical restraint, seclusion and rapid tranquilisation.
Research suggests that “No Force First” informed programmes can be effective in reducing the use of restraint on people with severe psychiatric disorders (27, 34), but more empirical, international studies are needed to strengthen the evidence, covering a wider range of populations, including learning disabilities. Research regarding the impact of this model developed in the US on the use of restrictive practices is limited to a few small-scale studies (14, 34). This study therefore addresses some of the gaps in evidence by reporting results regarding the implementation of a bespoke, person-centred and recovery focused restraint reduction program of interventions in a mental health organisation in the UK.
Aims and Objectives
The present study aimed to evaluate the impact following the implementation of a “No Force First” informed program of interventions (referred to as “the Guide” hereafter) within inpatient mental health and learning disability settings. These settings included: Adult Mental Health and Psychiatric Intensive Care Units (PICUs), Complex Care (older people), Forensic Mental Health, Learning Disabilities (LD) Services, and Specialist Services (addiction) wards. The specific objectives were to:
1. Investigate the changes in incidences of violence/aggression, changes in duration of physical restraint, number of people involved during a restraint event, type of restraining technique used, medication used during restraint and the method in which it was administered;
2. Examine the overall differences in incidence rates of physical restraint, aggression/violence, harm and medication used during restraint pre- and post-intervention; and
3. Estimate the prevalence of risk factors (i.e., type of violence/aggression, type of incident and type of ward) associated with the use of restraint and harm at population level.
Materials and Methods
Study Design and Participants
A pretest-posttest quasi-experimental design was used to examine whether incidents of violence/aggression, harm, and physical restraint were significantly reduced following implementation of the Guide. The posttest (“post-intervention”) group comprising all incidents of patient violence/aggression on these wards during the 24 months post-implementation of the Guide (January 2018—December 2019) was compared with the pretest (“pre-intervention”) group, comprising all incidents in the 24 months preceding implementation (January 2015—December 2016). Incidents recorded while the operationalization of the Guide was ongoing (i.e., January—December 2017) were excluded.
Adult (≥18 years old) male and female patients admitted on the 44 wards who had been involved in at least one incident of aggression/violence during the pretest and posttest periods and who had a formal primary diagnosis of a learning disability or mental health problem were included. Diagnosis was assessed using one of the two established diagnostic frameworks, the ICD-10 (35) or ICD-11 (36), the DSM-IV (37) or DSM-V (38).
The organisation provides specialist clinical inpatient and community mental health, learning disabilities, addiction and acquired brain injury services across 80 sites, mainly in the North West of England, serving a population of almost 11 million people. For the purpose of this study, inpatient wards (n = 44) covering the following services were included:
• Adult Mental Health: these include gender specific and mixed acute admission wards providing 24 hours assessment and/or treatment for people experiencing mental health difficulties, including adults detained under the Mental Health Act; long stay/rehabilitation focused wards for working age adults; and psychiatric intensive care wards (as below).
• Psychiatric Intensive Care Units (PICU): wards providing 24 h intensive and specialist care and treatment for service users whose risks and behaviours cannot be managed on an open acute ward.
• Complex Care (older people): mixed gender acute assessment wards for adults over 65 years, including specialist dementia inpatient wards and services for older people with functional severe and enduring mental health problem.
• Forensic Mental Health (high/medium/low secure): forensic inpatient services providing care for people detained under the Mental Health Act (39) and subject to different levels of security, depending on the level of assessed danger patients present to others or themselves.
• Learning Disabilities (LD) Services (low and medium secure units and support teams/ESS): provide treatment for adults (male and female) with a learning disability or other development disorder or autism.
• Specialist Services (addiction): these wards provide drug and alcohol medically managed detoxification for people who do not meet the criteria for community detox due to comorbid needs or pregnancy.
The Intervention: An Organisational Guide to Reducing Restrictive Practices
“No Force First” is the approach adopted by a large mental health organisation in the UK with the view to minimise the use of restrictive practices and improve health outcomes. In 2013, this National Health Services (NHS) organisation piloted “No Force First” informed interventions on three wards serving people whose needs included acute adult mental health, learning disability and women forensic medium secure services. The results of the pilot study showed positive results in reducing the use of restraint on these wards, incidents of violence/aggression and staff sickness (14, 18). Following this initial success, the organisation developed a “Guide to Reducing Restrictive Practice in Mental Health Services” (40) based on the underpinning philosophy of “No Force First” and focusing on co-production, values-based recruitment, trauma informed care, a recovery ethos, risk sharing partnerships and individualised care. This is achieved using six key bespoke interventions:
• “No Force First” engagement sessions—delivered in partnership with service users, healthcare teams are introduced to “No Force First” and hear accounts of people's experience of physical intervention;
• “No Force First” ward criteria and reviewing restrictive practice—encouraging clinical staff to listen to service users and removing or reducing restrictions and “blanket rules” that can cause frustration and conflict;
• Positive handovers—objective nursing handovers focused on recovery and understanding of past trauma in relation to triggers and behaviours that challenge;
• Healthy communities—giving service users the opportunity to be involved in decision making on how the unit functions, empowering them and giving them a sense of belonging;
• Individualised meaningful day—offering activities that suits service users' individual needs interests and aspirations/fulfilling occupation;
• Debriefing for service users and staff—giving service users and staff the opportunity to reflect on adverse events and identify areas for improvement and learning together.
The tools to support the implementation of these interventions are: the Dynamic Appraisal of Situational Aggression (DASA) (41); Care Zoning (42), One Page Plans, Zonal Observations, HOPE(S) Clinical Model of Care (43), and Safewards interventions (23). These interventions and tools can be used by healthcare teams to reduce conflict and the use of restrictive practices on the wards. While the Guide outlines the “No Force First” philosophy and the tools/interventions, there is flexibility in what healthcare teams use, in line with their population and their needs or setting. For example, the Specialist Learning Disabilities wards have implemented “Safewards” interventions, with “No Force First” as the overarching philosophy and strategy.
Data and Definitions
Data were extracted from the organisation's official electronic system where all incidents are recorded. Data on the use of restraint were recorded in line with UK reporting requirements (44). The following data were captured:
• Type of service/ward (as above)
• Type of patient violence/aggression (i.e., physical assault; harassment; sexual assault; threatening behaviour; verbal assault; other—including self-harm, hostage taking, play fighting, psychological abuse);
• Direction of violence/aggression (i.e., towards staff or other patients);
• Whether the incident resulted in harm and level of harm sustained (i.e., low/moderate/high);
• Whether the incident resulted in the use of physical restraint, defined by the British Code of practice: Mental Health Act 1983 (2015: 295) as “any direct physical contact where the intervener's intention is to prevent, restrict, or subdue movement of the body, or part of the body of another” (39).
• The position of restraint (i.e., prone, supine, side, standing, seated, kneeling, restrictive escort).
• Number of staff involved in restraint and whether medication was used during restraint;
• The way in which the medication was administered (i.e., by injection/rapid tranquilisation—intramuscular/intravenous; oral; other/nasal spray). It should be noted that PRN (pro re nata) medication would not have been recorded, as it is not officially categorised as a form of restrictive intervention in the UK; and
• Duration of restraint (minutes).
The explanatory variables in this study were incidents that were transformed into categorical variables that were divided into three categories:
i. type of wards: forensic mental health, adult mental health, complex care, forensic learning disability (“forensic LD”), specialist support teams learning disability (“specialist LD: ESS) and PICU;
ii. type of incident: physical assault, threatening behaviour, and verbal assault; and
iii. who was the aggression/violence towards (i.e., aggression/violence towards staff and aggression/violence towards patients).
These explanatory variables were used to estimate the prevalence ratios of physical restraint and harm (0 = no presence of outcome, 1 = presence of outcome).
Descriptive statistics (frequencies, crosstabs) were used to report on key characteristics of incidents pre- and post-intervention, such as: type of violence/aggression; proportion of violence/aggression incidents resulting in physical restraint and harm; proportion of restraint incidents resulting in the use of medication and the way the medication was administered; number of staff involved in restraint, position and duration of restraint.
The incidence rates (number of events/per 1,000 patient-days) of physical restraint, violence/aggression, harm sustained and medication used during restraint were calculated for both study periods. The rate difference between the two study periods were calculated using incidence rate ratios (IRRs) with 95% confidence intervals (95% CI).
To account for repeated observations and to provide a population-average interpretation of the results, Poisson generalised estimating equation (GEE) modelling was applied to model longitudinal outcomes in this population (45). An unstructured correlation matrix with robust variance estimator was applied to increase the correctly specified working matrix due to the variability of repeated observations among cases/patients. When this model failed to converge to provide parameter estimates, an exchangeable correlation matrix was applied instead. Bivariate Poisson GEE regression models were performed to estimate the unadjusted prevalence ratio of explanatory variables on physical restraint and harm pre- and post-intervention. Multivariate Poisson GEE regression were performed to estimate unadjusted and adjusted prevalence ratio (aPR) of explanatory variables associated with the two outcomes of interest pre-and post-intervention. Unadjusted and aPR were reported with their respective 95% confidence intervals (95% CI) and p values. Patients with missing data or unknown data in any of the variables considered were excluded only from those analyses involving that variable. Moreover, collinearity diagnostics (i.e., tolerance statistics and variance inflation factor) were examined to ascertain multicollinearity amongst the explanatory variables. Evidence of multicollinearity was found (i.e., tolerance statistics were >0.10 or variance inflation statistics were >10) before conducting the GEE regression models, thus some wards were combined with the highly correlated wards to improve statistical power of estimation of prevalence ratios, e.g., “complex care (older people)” wards were combined with “specialist services (addiction)” wards. All analyses were performed using SPSS version 26 (46).
The majority of patients admitted on the study wards during the time of investigation were male (n = 5,606, 63.1%), of a White ethnic background (n = 7,337, 82.6%) and reported to be Christian (n = 5,257, 59.1%). Just under two thirds of inpatients were comprised of young people aged 18–47 (n = 5,527, 62.2%), a quarter middle aged (48–63) (n = 2,152, 24.2%) and n = 1,191 (13.4%) elderly (64+ years old). A high proportion of participants disclosed being heterosexual (n = 5,134, 57.8%), but there is a significant amount of information missing or not being disclosed regarding the sexual orientation of participants (n = 3,337, 37.5%). For additional patient characteristics, please refer to Table 1.
A total of 2,038 inpatients were included in the regression analyses: pretest (n = 969) and posttest (n = 1,069).
Frequency, Characteristics, and Outcomes of Incidents of Violence/Aggression
There were 7,048 incidents of patient to staff or patient to patient violence/aggression incidents pre-intervention (2015–2016) and 6,551 post-intervention (2018–2019), with a total of 13,599 incidents recorded on the 44 wards. Incidents recorded while the operationalization of the Guide was ongoing were excluded (n = 3,705). The most frequent types of incident recorded in the pre-intervention period were physical assault (n = 2,772, 39.4%), threatening behaviour (n = 2,573, 36.5%) and verbal assault (n = 1,617, 23.0%). Post-intervention, incidents of threatening behaviour were slightly more frequent (n = 2,677, 40.9%) than physical assault (n = 2,561, 39.1%), and there was a decrease in incidents of verbal assault (n = 1,236, 18.9%).
As shown in Table 2 below, most incidents were recorded on forensic mental health wards (n = 5,717, 42%) during both pre- and post-intervention period, while adult mental health wards experienced the least number of incidents (n = 425, 3%). Majority of violence or aggression was directed to staff rather than patients in all types of services. There was a reduction in frequency of incidents of violence/aggression for all types of services, a part from PICU.
Just over a quarter of incidents of violence/aggression resulted in harm (n = 1,807, 25.6%) pre-intervention and this decreased to 21.8% (n = 1,428) post-intervention. The highest percentage of incidents of harm were classed as “low-level harm” for both pre- (n = 1,637, 90.6%) and post-intervention (n = 1,277, 89.4%). High level harm was recorded for a very small proportion of incidents for both periods under investigation (n = 6, 0.33% and n = 2, 0.14%, respectively).
Information on whether an incident of violence/aggression resulted in the use of physical restraint was missing for a large number of cases both pre- (n = 1,258, 17.8%) and post-intervention (n = 1,658, 25.3%). Recorded data on the use of physical restraint indicated that two thirds of incidents resulted in restraint pre-intervention and just under a third post-intervention (n = 1,890, 67.4% and n = 1,538, 31.4% respectively). In terms of restraining techniques, a standing position was most frequently recorded both pre- and post-intervention, followed by supine position. A prone position was used in 6.9% of restraint events (n = 129) pre-intervention and this decreased to 4.7% (n = 68) post-intervention. Two to three number of staff were most frequently involved in restraint for a duration of up to 5 mins, and in a small proportion of cases additional medication/rapid tranquilisation was used, although there were significant missing data for these variables. For a breakdown of results regarding characteristics of restraint see Supplementary Material.
Incidence Rate Ratios for Violence/Aggression, Physical Restraint and Harm
There were 456,487 patient days and 22,932 admissions during the pre-intervention period (January 2015—December 2016) and 449,827 patient-days and 21,062 admissions during post-intervention (January 2018—December 2019). Table 3 shows the number of events and incidence rates of physical restraint, aggression/violence, harm sustained, and medication used during restraint for both study periods. The overall incidence rate significantly decreased by 20% in patients who sustained harm when comparing the two study periods (IRR = 0.80, 95% CI 0.74–0.87, p < 0.0001). A lower, but still statistically significant reduction in incidence rates was found for aggression/violence (IRR = 0.94, 95% CI 0.91–0.97, p < 0.0001) and physical restraint outcomes (IRR = 0.83, 95% CI 0.77–0.88, p < 0.0001). Although there was a 11% decrease in the use of medication during restraint, this was found to be statistically insignificant (IRR = 0.89, 95% CI 0.79–1.00, p = 0.06).
Table 3. Incidence rates and number of events of physical restraint, aggression/violence, harm sustained, medication used during restraint.
Prevalence of Risk Factors Associated With Physical Restraint
Table 4 displays the bivariate and multivariate analyses of the factors associated with the prevalence of physical restraint pre- and post-intervention of the study. All explanatory variables were significantly associated with physical restraint pre-intervention except for complex care (PR = 1.76, 95% CI 1.01–3.06, p = 0.05). During pre-intervention, the most significant prevalent risk factor of physical restraint when controlling for covariates were patients being in forensic learning disability wards (aPR = 4.26, 95% CI 2.91–6.23, p < 0.0001) followed by PICU (aPR = 3.41, 95% CI 2.44–4.75, p < 0.0001) when compared to forensic mental health wards. Additionally, the prevalence of physical restraint was significantly lower in threatening behaviour (aPR = 0.66, 95% CI 0.49–0.88, p = 0.005) and verbal assault (aPR = 0.41, 95% CI 0.24–0.69, p < 0.0001) compared with physical assault. During post-intervention, patients being in forensic learning disability and specialist LD: ESS wards were 8.44 (95% 6.72–10.61, p < 0.0001) and 8.21 (95% CI 6.39–10.54, p < 0.0001) fold more prevalent than those in forensic mental health to be physically restrained. The prevalence of physical restraint when controlling for other covariates was highest in patients in forensic learning disability wards (aPR = 9.09, 95% CI 5.09–16.23, p < 0.0001), followed by specialist learning disability wards (ESS) (aPR = 8.25, 95% CI 4.67–14.56, p < 0.0001) and PICU (aPR = 7.30, 95% CI 3.63–14.69, p < 0.0001) when compared to forensic mental health wards. Whereas the prevalence of physical restraint was significantly lower in patients who engaged in verbal assault (aPR = 0.08, 95% CI 0.04–0.18, p < 0.0001) and behaved aggressively/violently towards other patients (aPR = 0.70, 95% CI 0.60–0.81, p < 0.0001) when compared to those who engaged in physical assault and behaved aggressively towards staff, respectively.
Prevalence of Risk Factors Associated With Harm
Table 5 displays the bivariate and multivariate analyses of the factors associated with the prevalence of harm pre- and post-intervention of the study. The estimated adjusted prevalence ratios during pre-intervention indicated that harm was significantly more prevalent in forensic disability wards (aPR = 7.24, 95% CI 2.43–21.57, p < 0.0001) compared to those in forensic mental health wards. Incidents of threatening behaviour (aPR = 0.48, 95% CI 0.34–0.68, p < 0.0001) and verbal assault (aPR = 0.67, 95% CI 0.55–0.81, p < 0.0001) were both significantly associated with a lower incidence of being harmed when compared to incidents that involved physical assault. Harm was significantly more prevalent in incidents of aggression/violence shown towards other patients (aPR = 1.26, 95% CI 1.01–1.57, p = 0.04) when compared to incidents of aggression/violence shown towards staff. Post-intervention multivariate analyses showed that all explanatory variables were significantly associated with patients being harmed. The prevalence of harm towards patients were highest in forensic learning disability (aPR = 38.48, 95% CI 25.01–59.20, p < 0.0001) and specialist learning disability (ESS) wards (aPR = 32.24, 95% CI 20.47–50.76, p < 0.0001) followed by adult mental health (aPR = 2.48, 95% CI 1.55–3.91, p < 0.0001) and PICU (aPR = 2.31, 95% CI 1.23–4.33, p = 0.01) when compared to patients in forensic mental health. Threatening behaviour (aPR = 0.59, 95% CI 0.48–0.72, p < 0.0001) was the least prevalent type of incident associated with harm when compared to physical assault. The prevalence of harm increased and remained significant in incidences of aggression/violence towards other patients (aPR = 1.47, 95% CI 1.33–1.61, p < 0.0001) when compared to incidences of aggression towards staff, even after controlling for other covariates.
This paper reports positive results regarding the implementation of a bespoke, person-centred and recovery focused “No Force First” intervention in a 'large mental health organisation in England, UK. In particular, a notable reduction in the use of restraint was found. The reduction of restrictive practices and containment such as restraint using organisational models of this sort has been reported elsewhere, both in the UK and globally. The Six Core Strategies for example have a strong and growing evidence base highlighting their impact upon restraint and seclusion reduction (9, 47, 63). The UK had also reported reductions in the use of physical restraint following the implementation of an adapted version of the 6CS called REsTRAIN Yourself (48) and similar positive results have been evidenced in a Finnish RCT (49). The positive results showed a reduction in the types of restraint used and their negative impact.
With regards to the type of aggression, the results indicate that incidents of violence/aggression were most frequent within forensic mental health settings. This could be due to most inpatients in these settings being male and/or involuntarily detained, which has been shown to be linked to higher rates of inpatient violence (50). Previous research indicates that, while incidence of violence is linked to ~20% of inpatients on (acute) adult mental health wards (50), these rates double for forensic mental health wards (51). Incidents ranged from verbal abuse and threatening behaviour to physical assault. Physical assault was found to be the most common type of violence/aggression on the study wards pre-intervention (39.4%), but this was reduced post-intervention, when the most frequent type of violence/aggression was threatening behaviour (40.9%). This is in comparison to research in the UK on acute mental health wards, where verbal aggression has been the most common type of aggression reported (51%) (52). The finding that the majority of incidents of violence/aggression were directed towards staff rather than patients is in keeping with the general literature irrespective of setting or type of incident (31, 53–55). When one looks at the consequences of violence/aggression around a quarter of incidents resulted in harm, mainly minor, implying that the incident required extra observation or minor treatment for one or more persons.
With regards to coercive practices, the proportion of incidents resulting in the use of restraint was on average 50% but decreased from 67.4% pre-intervention to 31.4% post-intervention. It is difficult to compare these results with previous research, given the variation in use of coercive measures and the way incidence of the use of physical restraint is measured. However, some evidence suggests that while approximately half of aggressive incidents result in the use of seclusion, only a small proportion target the use of restraint (56, 57). In contrast, other studies indicate that a higher proportion of incidents result in the use of manual or medical restraint (58–60) and only a fifth of incidents of aggressive behaviour are subject to seclusion (60–62). Previous research using “No Force First” informed interventions mirrors these positive results (34).
Results demonstrate that a standing position was the most frequently method of restraint throughout the duration of the study. This may be a reflection of the current trend to minimise and, some would argue eradicate, the use of prone restraint given concerns over its safety and subsequent changes in policy to avoid its use (31, 33, 64–66). Whilst prone restraint was still reported in this study, its use reduced from 6.9% pre-intervention to 4.7% post-intervention.
The prevalence of physical restraint and harm was significantly higher in inpatients on forensic learning disability wards than those on forensic mental health wards both pre- and post-intervention. Physical assault was significantly more of a prevalent risk factor of restraint use than other forms of violence/aggression, when this was directed to staff, and more of a risk factor of being harmed when the violence/aggression was directed to other patients. This is in line with previous research showing that aggression against others is strongly associated with restrictive practices, including restraint and seclusion (16, 67). The characteristics, culture and details of incidents can clearly play a role in whether a patient is restrained or there is harm as a result of violence/aggression. The use of debriefing has been promoted for some time now and is clearly an important tool in understanding the individual and organisational nature of and response to conflict in mental health settings (68).
Fundamentally, this study shows the positive impact that organisational models and guides such as “No Force First” can have on equipping staff to focus more on primary and secondary prevention as opposed to tertiary coercive practices such as restraint. We have been able to report upon that a significant 17% reduction in incidence of physical restraint following the introduction of “No Force First” in addition to reductions in associated rates of harm sustained and episodes of aggression and violence.
Strengths and Limitations
This is one of the few studies investigating the potential impact of a “No Force First” informed intervention in both mental health and learning disabilities settings. Current evidence was based on two studies: i) a small scale descriptive study conducted in one crisis centre for people with severe psychiatric disorders exploring results to do with the use of chemical restraint (34); and ii) a UK-based service evaluation (14). As data from an entire mental health organisation were included, this study has more power over those focusing on a single ward or unit. It is also assumed that seasonal or trend influences were eliminated given the data were collected over a four-year period. The strength of this study is the large sample size and number of incidents, including the use of GEE models for data analysis. GEE models are more robust and resilient to model misspecification and inferences about the population-average rather than individual-average can be made (69). To our knowledge, this type of analysis has not been reported previously on incidents of violence/aggression, physical restraint and harm in both mental health and learning disabilities settings.
Several caveats should be considered when interpreting the findings. Firstly, the under-reporting of both incidents of violence/aggression and the use of restrictive practices, despite national guidelines and requirements to report all incidents of physical and chemical restraint. It should also be noted that socio-demographics data for the patients could not be linked to the incident data. Therefore, these were not included in the GEE regression models. The lack of explanatory variables available and the variability of repeated measurements among the patients may have attributed to the wide confidence intervals in some of the findings.
Another limitation is linked to intervention fidelity. It was unknown to the researchers the precise timing of the implementation of the intervention and the extent to which components of the intervention were introduced, especially as healthcare teams had the flexibility to choose the most appropriate interventions for their ward/population. To minimise potential “contamination” between the two cohorts, data for the year in which the intervention was in the process of being implemented across the 44 study wards were excluded. This does not imply, however, that components of the intervention were not introduced at all during the pre-intervention period.
Finally, the absence of a control group in the study impacts on the internal validity and potentially reduces the robustness of our findings. However, this study pragmatically evaluated the implications of the Guide implemented by ward staff in real-world settings. There are ethical and practical challenges in mental health and learning disability settings with regards to patients' access to interventions aimed to reduce the instances of restrictive practices and thus impacting on their health, well-being and chances of recovery (especially if this access were denied). The pre-post design was thought to be more appropriate given these challenges. It is worth noting that no significant political, organisational and legal changes have been observed during the study period, a part from the implementation of the Guide within the entire organisation, which was the subject of our investigation.
Implications for Research and Practice
Further research should focus on investigating the way in which the intervention works in each setting and the degree to which key components of the intervention contribute to a reduction in restraint, violence or harm. It would also be useful to further investigate other characteristics that can determine whether incidents of violence/aggression on the wards are followed by physical restraint (with or without the use of medication) in both mental health and learning disabilities settings, for example patient and staff demographics, staff turnover and burnout, physical environment characteristics, or ward climate. A qualitative study exploring staff's decision to use restraint would also be useful to improve understanding regarding the decision-making process and support the development of preventative strategies.
Healthcare organisations should be more proactive and systematic in their data collection to enable such explorations, but also to support their quality improvement processes. Data on both physical and psychological outcomes following the use of restraint, including patient trauma and service satisfaction, staff post-traumatic stress and absenteeism, job satisfaction should be collected. This will enable a more comprehensive data informed strategy for the prevention and management of conflict in these settings.
Given that the most prevalent predictor of restraint was the nature/type of violence/aggression, healthcare teams should concentrate on both de-escalation during incidents and interventions that prevent violence/aggression from arising in the first place. Additionally, special attention should be paid to learning disabilities settings, as this research points to a significantly higher prevalence of physical restraint and harm in inpatients on forensic learning disability wards compared to forensic mental health wards.
This study addresses a gap in evidence regarding “No Force First” recovery focused interventions used to reduce the use of restraint in both mental health and learning disabilities settings. The successful translation and impact of a US approach to the UK is of key importance in addressing the reduction of restraint across international settings. Nationally and internationally, it is widely recognised that, in line with “No Force First” philosophy, restrictive practices should be the last option on a list of potential approaches or interventions to deal with distress or potentially threatening behaviour (13, 33). Services are encouraged to move away from coercion and containment towards a more recovery focused care (28). As stated by the developers of “No Force First”, “Force must be the last response considered, and its use implies a treatment failure” and “… the highest price of all is the price paid by the people who are restrained: recovery is stalled by a practice that can disempower them, break their spirit, and reignite a sense of helplessness” (34): 417. While there are still questions and concerns regarding the controversial use of restrictive practices, the implementation of recovery-based models targeted at reducing restraint show promising results.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by Health Research Authority (HRA), reference number: IRAS 277787. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
AH-D secured the funding for the study, was the principal investigator for the study, negotiated access to data, and drafted the manuscript. KG secured the ethical and governance approvals for the study, negotiated access to and collected data, and critically reviewed the manuscript. JD critically reviewed the manuscript. AT designed and wrote the statistical analysis plan, conducted the incidence rate ratio analyses and generalised estimating equations modelling, interpreted the results, participated in manuscript writing and critically reviewed all sections of the manuscript.
This work was supported by Mersey Care NHS Foundation Trust (Manchester Metropolitan University WorkTribe ref 230649).
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The authors wish to give special thanks to: Jennifer Kilcoyne, Danny Angus, Dave Riley, Leanne Franks, Pauline Parker from Mersey Care for their support and contribution regarding the research set up and delivery of the project; Jennifer Billingsley, Hayley Morgan, and Lesley Lucas from Mersey Care for their support regarding access to data; Mersey Care's Speech and Language Therapy (SaLT) team for their input regarding the ethics documents regarding people with learning disabilities; and Iris Benson for her valuable feedback at all stages of the research with regards to lived experience.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.749615/full#supplementary-material
1. McKeown M, Thomson G, Scholes A, Jones F, Downe S, Price O, et al. Restraint minimisation in mental health care: legitimate or illegitimate force? an ethnographic study. Sociol Health Illness. (2020) 42:449–64. doi: 10.1111/1467-9566.13015
3. Riahi S, Thomson G, Duxbury J. An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint. J Psychiatr Ment Health Nurs. (2016) 23:116–28. doi: 10.1111/jpm.12285
4. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Means of Restraint in Psychiatric Establishments for Adults. Strasbourg: Council of Europe (2017).
5. Equality and Human Rights Commission. Human rights framework for restraint: principles for the lawful use of physical, chemical, mechanical and coercive restrictive interventions. Equality and Human Rights Commission (2019).
6. Restrictive Practices in Mental Health Services. National Mental Health Consumer & Carer Forum Advocacy Briefs. Available online at: https://nmhccf.org.au/our-work/advocacy-briefs/restrictive-practices-in-mental- health-services?highlight=WyJzZWNsdXNpb24iLCJyZXN0cmFpbnQiLCJyZ XN0cmljdGl2ZSIsInByYWN0aWNlcyIsImluIiwibWVudGFsIiwiJ21lbnRhbC IsImhlYWx0aCIsInNlcnZpY2VzIiwicmVzdHJpY3RpdmUgcHJhY3RpY2VzI iwicmVzdHJpY3RpdmUgcHJhY3RpY2VzIGluIiwicHJhY3RpY2VzIGluIiwic HJhY3RpY2VzIGluIG1lbnRhbCIsImluIG1lbnRhbCIsImluIG1lbnRhbCBoZ WFsdGgiLCJtZW50YWwgaGVhbHRoIiwibWVudGFsIGhlYWx0aCBzZXJ2a WNlcyIsImhlYWx0aCBzZXJ2aWNlcyJd (accessed March 12, 2020).
7. Bonner G, Lowe T, Rawcliffe D, Wellman N. Trauma for all: a pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. J Psychiatr Ment Health Nurs. (2002) 9:465–73. doi: 10.1046/j.1365-2850.2002.00504.x
8. Sanders K. The effects of an action plan, staff training, management support and monitoring on restraint use and costs of work-related injuries. J Appl Res Intellect Disabil. (2009) 22:216–0. doi: 10.1111/j.1468-3148.2008.00491.x
9. LeBel Janice L, Duxbury Joy A, Putkonen A, Sprague T, Rae C, Sharpe J. Multinational experiences in reducing and preventing the use of restraint and seclusion. J Psychosoc Nurs Ment Health Serv. (2014) 52:22–9. doi: 10.3928/02793695-20140915-01
10. Strout TD. Perspectives on the experience of being physically restrained: an integrative review of the qualitative literature. Int J Ment Health Nurs. (2010) 19:416–27. doi: 10.1111/j.1447-0349.2010.00694.x
11. Lebel J, Goldstein R. The economic cost of using restraint and the value added by restraint reduction or elimination. Psychiatric services (Washington, DC). (2005) 56:1109–14. doi: 10.1176/appi.ps.56.9.1109
12. Goulet M-H, Larue C, Dumais A. Evaluation of seclusion and restraint reduction programs in mental health: a systematic review. Aggress Violent Behav. (2017) 34:139–46. doi: 10.1016/j.avb.2017.01.019
15. Zhu XM, Xiang YT, Zhou JS, Gou L, Himelhoch S, Ungvari GS, et al. Frequency of physical restraint and its associations with demographic and clinical characteristics in a Chinese psychiatric institution. Perspect Psychiatr Care. (2014) 50:251–6. doi: 10.1111/ppc.12049
16. Beghi M, Peroni F, Gabola P, Rossetti A, Cornaggia CM. Prevalence and risk factors for the use of restraint in psychiatry: a systematic review. Riv Psichiatr. (2013) 48:10–22. doi: 10.1708/1228.13611
17. Staggs VS. Trends in use of seclusion and restraint in response to injurious assault in psychiatric units in U.S. Hospitals, 2007-2013. Psychiatric Serv. (2015) 66:1369–72. doi: 10.1176/appi.ps.201400490
25. Borckardt JJ, Grubaugh AL, Pelic CG, Danielson CK, Hardesty SJ, Frueh BC. Enhancing patient safety in psychiatric settings. J Psychiatr Pract. (2007) 13:355–61. doi: 10.1097/01.pra.0000300121.99193.61
28. Repper J, Perkins R. The Team Recovery Implementation Plan: A Framework for Creating Recovery-Focused services. London: Centre for Mental Health and Mental Health Network, NHS Confederation. (2013).
31. National Institute for Health Care Excellence (NICE). Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings. NICE guideline [NG10] (2015). Available online at: https://www.nice.org.uk/guidance/ng10
33. Social Care Local Government Care Partnership Directorate. Positive and Proactive Care: Reducing the Need for Restrictive Interventions. Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/300293/JRA_DoH_Guidance_on_RP_web_accessible.pdf
34. Ashcraft L, Bloss M, Anthony WA. Best practises: The development and implementation of “no force first” as a best practise. Psychiatric services (Washington, DC). (2012) 63:415–7. doi: 10.1176/appi.ps.20120p415
35. World Health Organisation (WHO). International Statistical Classification of Diseases and Related Health Problems. 10th Revision (ICD-10), Vol. 2: Instruction Manual. (2010). Available online at: https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf
39. Department of Health. Mental Health Act 1983: Code of Practice. Norwich: The Stationery Office (2015). Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF
41. Ogloff JR, Daffern M. The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behav Sci Law. (2006) 24:799–813. doi: 10.1002/bsl.741
42. Ryrie I, Hellard L, Kearns C, Robinson D, Pathmanathan I, O'Sullivan D. Zoning: A system for managing case work and targeting resources in community mental health teams. J Mental Health. (1997) 6:515–23. doi: 10.1080/09638239718608
47. Wale JB, Belkin GS, Moon R. Reducing the use of seclusion and restraint in psychiatric emergency and adult inpatient services- improving patient-centred care. Perm J. (2011) 15:57–62. doi: 10.7812/TPP/10-159
48. Duxbury J, Baker J, Downe S, Jones F, Greenwood P, Thygesen H, et al. Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme ('REsTRAIN YOURSELF'). Int J Nurs Stud. (2019) 95:40–8. doi: 10.1016/j.ijnurstu.2019.03.016
49. Putkonen A, Kuivalainen S, Louheranta O, Repo-Tiihonen E, Ryynänen OP, Kautiainen H, et al. Cluster-randomised controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. Psychiatric Serv. (2013) 64:850–5. doi: 10.1176/appi.ps.201200393
50. Iozzino L, Ferrari C, Large M, Nielssen O, de Girolamo G. Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS One. (2015) 10:e0128536–e. doi: 10.1371/journal.pone.0128536
52. Renwick L, Stewart D, Richardson M, Lavelle M, James K, Hardy C, et al. Aggression on inpatient units: clinical characteristics and consequences. Int J Ment Health Nurs. (2016) 25:308–18. doi: 10.1111/inm.12191
54. Wilson C, Rouse L, Rae S, Kar Ray M. Is restraint a 'necessary evil' in mental health care? Mental health inpatients' and staff members' experience of physical restraint. Int J Ment Health Nurs. (2017) 26:500–12. doi: 10.1111/inm.12382
56. Abderhalden C, Needham I, Dassen T, Halfens R, Fischer JE, Haug H-J. Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland. Clin Pract Epidemiol Ment Health. (2007) 3:30. doi: 10.1186/1745-0179-3-30
58. Dowson JH, Butler J, Williams O. Management of psychiatric in-patient violence in the Anglia region: Implications for record-keeping, staff training and victim support. Psychiatric Bull. (1999) 23:486–9. doi: 10.1192/pb.23.8.486
63. Azeem MW, Aujla A, Rammerth M, Binsfeld G, Jones RB. Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. J Child Adolesc Psychiatric Nurs. (2011) 24:11–5. doi: 10.1111/j.1744-6171.2010.00262.x
67. Vruwink FJ, Noorthoorn EO, Nijman HLI, VanDerNagel JEL, Hox JJ, Mulder CL. Determinants of seclusion after aggression in psychiatric inpatients. Arch Psychiatr Nurs. (2012) 26:307–15. doi: 10.1016/j.apnu.2011.10.004
Keywords: restraint reduction, mental health, learning disabilities, no force first, violence and aggression, inpatient settings
Citation: Haines-Delmont A, Goodall K, Duxbury J and Tsang A (2022) An Evaluation of the Implementation of a “No Force First” Informed Organisational Guide to Reduce Physical Restraint in Mental Health and Learning Disability Inpatient Settings in the UK. Front. Psychiatry 13:749615. doi: 10.3389/fpsyt.2022.749615
Received: 29 July 2021; Accepted: 03 January 2022;
Published: 02 February 2022.
Edited by:Jorun Rugkåsa, Akershus University Hospital, Norway
Reviewed by:Erich Flammer, ZfP Südwürttemberg, Germany
Olav Nyttingnes, Akershus University Hospital, Norway
Copyright © 2022 Haines-Delmont, Goodall, Duxbury and Tsang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alina Haines-Delmont, firstname.lastname@example.org


text:
CLITHEROE DJ David Tupling has organised a special show at The Grand in aid of his best friend Sargeant Rick Clement, from Chatburn, who lost both legs in an explosion while serving in Afghanistan.
Tupling (pictured right), Tim Toil – a regular at the Beat Herder Festival – Hollywood Hills and Craig C are all playing for free, raising money for Rick’s charity, A Soldier’s Journey.
“We’ve been lifelong friends since we were at Chatburn Primary School together and Rick is one of the most inspirational people I’ve ever met,” said David. “He has fought back from a life-changing injury and he’s such an inspiration to so many people, and what he has achieved since the accident is truly remarkable.”
Rick had been serving in Helmand Province, Afghanistan, for less than a month when he was almost killed in the explosion.
David, who has been a DJ since 1995, added: “I want to use my music connections to help create awareness of Rick’s charity work. Also, he has proved that people can still live life to the full following a terrible accident like this. He has just returned from Australia where he swam with sharks. Rick is in great spirits and I know he has a lot more challenges lined up.”
David said he is hoping for a sellout crowd at The Grand, and said: “The Grand is a brilliant venue and the people of the Ribble Valley have always supported Rick. The show is to try and raise as much money as possible for his charity, but it is also a celebration of Rick’s bravery.
“It is a wonderful gesture that everybody is playing for free and Rick is very grateful.”
Charity DJ night for A Soldier’s Journey, The Grand, March 23rd, tickets £10. 01200 421599.
l There are still a few tickets left for Fence Records Night at The Grand on April 13th. Fence Records is a micro-indie music label in Scotland with a healthy assortment of musical styles and a huge cult following. The show features three key artists from the collective, James Yorkston, Pictish Trail and Seamus Fogarty. £14.

domain: news


Syrian-born Aya Attal finds success in Pittsburgh | The Refugee Center Online Hall of Fame
Yet a Teenager, Syrian-born Aya Attal is Finding Success in Pittsburgh
Hailing from Damascus, Syria Aya Attal and her family fled the country for their safety and arrived, as refugees in Pittsburgh, Pennslyvania in 2016. Quite simply, Attal explains her experience in America as a struggle.
Studying a college-level nursing course in the Carlow University’s High School to College program while a teenager, life wasn’t easy. While she graduated last year, Attal has had difficulties to fully understand English medical terms. Not to mention the prejudice she has faced in her school and community. Though she at one time felt like she was failing academically, she eventually graduated from the program at the top of her class and is currently enrolled at Carlow University as a pre-medical student.
Pittsburgh Mayor Bill Peduto originally planned to invite 500 refugees to the city of bridges two years ago.
However, about half this number was actually resettled. Mayor Peduto still extends his hand of welcome and often defends Pittsburgh’s refugees. Attempting to educate others about her experience, Attal attended a meet up with 8 other refugees to share her experiences in Pittsburgh with the mayor himself. Many refugees living in the area struggle financially and deal with a lot of discrimination on the basis of their faith. This discrimination is unfortunately very familiar to Attal.
While Attal’s experience is not that of a typical teenager, many young refugees arriving in America deal with similar stress. Speaking up about her concerns over the refugee experience in Pittsburgh, Attal cited lack of support as the main concern.
Unlike older generations, they have the chance to attend English classes and be mainstreamed into schools until they begin higher education. Using her arrival in Pittsburgh as a launching point for her bright future, Attal is a shining example of never giving up, no matter how hard the struggle to get there.
Find help near you
Search for programs and resources in your city.Start your search


text:
The work included in this project shows a selection of illustrations that I have worked on for the independent comic book series 'SNOW'.
SNOW 'The Dawn' is a 12 part series that follows the story of the protagonist James Snow. 'The Dawn' is to be the first of three seasons written by Nick Goode, and depending on the sucess of the series release in individal issues, we hope to form a graphic novel for each of the three seasons.
Below are a variety of the images I worked on within the comic and various character concepts that were refined to make the final cut. I will continue to add to this project as I continue to work on illustrating the story.
The catch of course is that I can't upload images of the comic with the captions and text, and I wont be uploading the series page by page, so if you want to find out what happens you will have to get hold of an issue!
Bag and Bored - http://bagandbored.net/2013/10/24/review-snow-the-dawn/
The Nerd Machine - http://www.thenerdmachine.com/snow-the-dawn/
Fantaffx IGN Blog - http://www.ign.com/blogs/fantaffx/2013/10/09/comixology-submit-reviews-december-11/
You can Purchase a Physical Copy through UK On Display
For more information and any news regarding SNOW; follow Nick on Twitter @goodie2212

domain: literature


text:
This post is a sponsored collaboration between Gothamist and the Starwood Preferred Guest® Credit Card from American Express.
If you could travel anywhere for the holidays, where would you go? Would it be domestic or international? With family or solo? Festive or beach-side? And how do you even pack for such a journey? With the help of SPG Amex, we asked six travel pros to share their holiday destination and how they'd stuff that carry-on—with room for sleigh bells or sea shells—for a few days away.
Ben Schlappig is the genius behind travel blog One Mile at a Time. He specializes in getting the most out of airline miles and credit card points, flying an average of 400,000 miles a year. Catch his work here!
Where are you going this year? This year I'm headed to Florida to see my parents for Christmas, and then am jetting off to the Maldives for New Year's. While I've done some big cities for New Year's in the past, I'm excited to have a relaxing New Year's on a secluded island for once.
And which bag do you choose to get the job done? With my Tumi Alpha carry on and a great weekender bag from Killspencer I can pack for any destination, and for any length of time. Since I live in hotels full time, those are the bags I quite literally "live" out of.
John E. DiScala is the man behind Johnny Jet, a portal for tips on travel that's economical, comfortable, efficient - and of course, stylish. Check out his work here!
Where would you go this year? I would go to Banff in Alberta, Canada for Christmas since your guaranteed a white Christmas and breathtaking scenery and then spend New Year’s Eve in Waikiki so you can watch the fireworks in shorts.
And which bag do you choose to get the job done? 98% of the time I only pack carry-on so I use a Roots Duffel Bag, a Briggs and Riley briefcase roller and a Scottevest jacket since it has 20+ pockets and acts as a third carry-on.
Kirsten is a professional photographer concentrating on travel and lifestyle for clients all around the world. After being nomadic for four years, she settled in NYC and when she's not on assignment in some foreign country, she enjoys documenting life in the concrete jungle. Follow her snapchat at kirsten.alana for daily adventures and elsewhere online as @kirstenalana. Check out her website here.
Where are you going this year? St. Regis Bora Bora.
And which bag do you choose to get the job done? A duffle from Alicia San Marcos. They're colorful and chic plus the company supports a good cause.
Jen Miner is one third of the Vacation Gals, award-winning travel writers who know all there is to know about family trips, girlfriend getaways, and romantic escapes. Check out their work here!
Where are you going this year? My family and I are fortunately able to go where I personally most want to vacation this Christmas: Hawaii Island, also known as the Big Island. It's been a few years since we've last been, and that time was notable mostly for its torrential rains. We're hoping for better weather this time! We're staying on Kona side, which generally has terrific weather. It's Hilo side which has often inclement weather, but, that's where Volcanoes National Park is, and Thurston's Lava Tube, and well...we'd love to explore those areas in the sunshine.
And which bag do you choose to get the job done? Even when we travel to multiple European countries in the summer, my family and I always manage to travel with carry-on luggage only. No exhausted waiting at baggage claim for us; we like to hit the ground running. Besides an large backpack (that I stuff my purse into at airport security to make that "two carry-on items only" limit), I fit everything I need into my Travelpro Platinum 7 Rollaboard Suitcase. It fits most airplane overhead bins—except for very small planes—and is rugged enough to easily tolerate the beatings I give my luggage.
Lee Abbamonte is the youngest American to visit every country in the world - that's 193 to be exact. Travel icon Arthur Frommer called Lee the "Marco Polo of the 21st Century." Check out his work here!
Where are you going this year? Being as though it's the holiday season and I've already visited the South Pole, I would like to visit the North Pole! I'm actually going there in April so hopefully Santa is fully rested by then!
And which bag do you choose to get the job done? I have been using my Osprey Meridian carry on for years and I couldn't imagine using a better carry on!
Summer Hull is the author of Mommy Points, a blog focused on family travel and getting creative to accrue the most travel points possible. Check out her work here!
Where are you going this year? While visiting family is of course paramount around the holidays, there are a couple others destinations we also enjoy. Visiting NYC from Thanksgiving to Christmas is really pure magic with the lights, window displays, ice skating, shows, and of course the real Santa at Macy's Herald Square! I also love heading to snow and the mountains for a ski trip as it is the perfect way to burn off some post-Christmas steam and ring in the New Years!
And which bag do you choose to get the job done? My absolute favorite carry-on is not a budget purchase, but it is so worth it if you can splurge. My Rimowa Salsa Deluxe Cabin Multiwheel IATA bag literally fits in every airplane sizer out there and even fits in the tiny overhead bins on regional jets, yet it can hold enough to literally take me around the world.
These six world travelers, also known as "SPG Amex Stars," took 70,000 Starpoints® and used them to book two nights at a Starwood hotel during the most wonderful (and also the busiest travel) time of the year. Whether traveling to the Sheraton Kauai Resort or the new Tribute Collection Portfolio in Florida, these Stars took on the Holiday Challenge and showed just how far Starpoints can go during the peak holiday travel season (check out their blogs to read about their travels!).
Become an SPG Amex Card Member and redeem Starpoints for free nights and flights—choose from over 1,100 hotels and resorts and 30 frequent flyer programs, with no blackout dates in sight. You'll earn one Starpoint for every eligible dollar spent on the Card and double Starpoints on stays at participating Starwood Hotels & Resorts. You’ll also enjoy no foreign exchange fees, complimentary Wi-Fi at Starwood hotels and complimentary Boingo, so you can stay connected wherever you go. Even better? The first year fee is free for new Card Members. Learn more and sign up today!

domain: geography


Goodvac.com is not affiliated with The Kirby Company and/or The Scott Fetzer Company. All manuals and maintenance tips for Kirby vacuum cleaners and repair manuals for Kirby model vacuums are authored by GoodVac.com and are not endorsed or approved by the Kirby vacuum manufacturer - Kirby Company and/or The Scott Fetzer Company. These materials should be only used at your own discretion and risk. .
Operation instructions are the same for all generation models:
Ultimate G Diamond Ed.(G7D or DE)
Ultimate G (G7 or UG)
Generation 6 (G6)
Generation 5 (G5)
Generation 4 (G4)
Generation 3 (G3)
Carry your Kirby vacuum like this. It will feel so much lighter
you won't want to put it down (smile)!


text:
Style Guides often have unique rules on to fomat. For APA check out this posting to make sure you are making appropriate changes.
Some article titles in EBSCO databases are capitalized in Headline style rather than Sentence style when imported into Endnote. All the words in the title are capitalized, rather than just the first word, as APA requires.
To fix this problem in Endnote X7, follow the steps below or view this EndNote video:
You will need to capitalize any proper nouns that were changed to lower case by changing the style.
To set up APA to provide sentence case:
EndNote comes with thousands of filters for importing records from various electronic journals and databases. Filters are used when importing saved records from a database search into Endnote. However, there are constant additions to the filter library on the EndNote website.
Open Style Manager
Styles Menu in EndNote
Style Manager with Ann Rev Neuroscience Selected
Occasionally you may need a style which EndNote does not supply, or need to modify an existing style to meet a specific need.
Style Window: Changing How Author Name Appears in Bibliography
Different journals have different standards for abbreviating journal names. For example, some styles may require "Proceedings of the National Academy of Science" to be abbreviated as "Proc. Nat. Acad. Sci.," "P.N.A.S." or "PNAS." EndNote's Journals term list provides a way for you import and store the accepted journal abbreviations in various disciplines, such as MLA, Medicine, Education, etc. for use in your bibliographies.
EndNote comes pre-loaded with a variety of journal term lists. These include the accepted journal abbreviations from the Modern Language Association (MLA) , the National Library of Medicine (NLM) and the American Chemical Society (ACS) among others. Directions for importing these lists into your journal term list within an Endnote Library are given below.
Importing a journal term list
Note: Check your Style to verify whether a journal abbreviation or full journal title is selected. Unless specified, the journal title will format as entered in the EndNote record itself.

domain: library


text:
The prospect of applying for a loan is often daunting and filled with uncertainty. Like walking on the edge of an abyss, one wrong move could either result in financial security or be your downfall into spiraling debt. The difference between poor credit loans and high-risk loans is vast, leading to different eligibility criteria that can have lasting implications. Understanding these differences can help individuals make more informed decisions when it comes to selecting the right loan option for them.
When looking at potential loan options, there are many factors to consider such as interest rates, terms and conditions, repayment schedules, fees, and penalties associated with the loan. Each type of loan has its own set of eligibility criteria which should be taken into account before making a decision. Poor credit loans usually require collateral from borrowers who may not necessarily qualify for other types of loans due to their bad credit score while high-risk loans typically come with higher interest rates but less stringent requirements.
It’s essential to weigh all available options carefully before committing to any particular loan and fully understand what each entails so that you don’t end up in a precarious situation further down the line. This article will outline the various eligibility criteria for both poor credit loans and high-risk loans so readers can gain an understanding of how they work and make an educated decision about which is best suited for them.
It is not uncommon to hear the terms ‘poor credit loan’ and ‘high-risk loan’, yet there seems to be confusion between the two. It should first be noted that these types of loans do have differences in their eligibility criteria, which can impact one’s decision on whether or not to take them out. However, it is important to understand what distinguishes a poor credit loan from a high-risk loan before making any final decisions.
When considering both options, it is essential to note that a poor credit loan typically requires more stringent qualifications than a high-risk loan. Poor credit loans are offered by lenders who specialize in providing financing for individuals with less-than-perfect credit scores. To qualify for this type of loan, borrowers must usually have an acceptable income and employment history as well as a good track record of paying bills on time. High-risk loans often require fewer qualifications but come at higher interest rates due to the additional risk incurred by the lender. These types of loans are generally only available to those with bad or no credit histories and may also include other requirements such as having collateral or needing a co-signer.
In order to make an informed decision regarding either option, it is imperative that potential borrowers become familiar with each type of loan and its unique set of requirements. By understanding how they differ in terms of qualification standards, fees, and repayment plans, individuals can make sure they select the best financial solution for their given situation. Furthermore, research into different lenders will help ensure that applicants get access to competitive offers so they can choose the most suitable product for their needs.
What Are Poor Credit Loans?
Recent studies show that more than one-third of all Americans have poor credit scores, with the average being 675. Poor credit loans are designed to help individuals who do not qualify for traditional bank financing due to bad or low credit scores. These loans provide an important service and can be beneficial for those looking for quick access to capital.
Poor Credit Loans typically require less documentation as compared to other loan products, such as high-risk loans. They also tend to come with higher interest rates than standard loans because they are considered riskier investments. Furthermore, most lenders will offer lower amounts of money on these types of loans; however, the maximum amount is generally determined by a borrower’s income and total debt obligations. In some cases, borrowers may need a cosigner in order to secure a loan if their own credit score is too low.
Due to the fact that banks and other financial institutions view poor credit loans as higher-risk investments, it is important for potential borrowers to understand what qualifies them for this kind of loan before applying. Understanding their eligibility criteria ahead of time helps ensure that applicants don’t waste time submitting applications that won’t get approved. Additionally, it is essential for borrowers to make sure they are aware of any fees associated with taking out a poor credit loan so they know exactly what they’ll be paying back over time when the loan is funded.
What Are High-Risk Loans?
High-risk loans are a type of loan that is offered to borrowers who have been deemed as having higher chances of defaulting on their payments. These types of loans usually require collateral, such as property or other assets, and often come with high-interest rates due to the lender’s perception of risk associated with the borrower. They can also be more difficult to obtain than traditional loans when it comes to paperwork and documentation requirements.
When considering taking out a high-risk loan, potential borrowers should:
• Research various lenders who offer this type of financing in order to find one that works best for them;
• Assess their ability to make timely repayments before signing any agreement;
• Be aware of all fees and charges related to the loan; and
• Make sure they understand all terms and conditions set forth by the lender.
High-risk loans can provide an opportunity for those individuals who may not qualify for traditional forms of financing. However, understanding how these loans work and what implications they could potentially have is essential in making an informed decision about whether or not they are right for you. Taking your time in researching the different options available and weighing up all pros and cons will help ensure that you choose the most suitable option for your individual situation.
Eligibility Criteria For Poor Credit Loans
Poor credit loans are a form of alternative lending available to individuals with low or bad credit scores. To be eligible, applicants must meet several criteria based on their financial situation and ability to repay the loan. These eligibility requirements can vary depending on the lender but typically include income verification, debt-to-income ratio, employment status, and other factors related to an individual’s creditworthiness.
For high-risk loans in particular, lenders may require additional documentation such as collateral or guarantors in order to mitigate their risk exposure. Additionally, some lenders may also impose higher interest rates for borrowers deemed more likely to default. It is important for potential borrowers to research different lenders offering poor credit loans and compare terms before committing to any agreement. By doing so, they can ensure that they receive the best rate possible for their specific circumstances.
Credit Score Requirements
The credit score requirements for poor credit loans may be a daunting task to tackle. However, with the right knowledge and guidance, one can easily navigate through this tricky situation. To put it in simpler terms: understanding what is required of you before applying for any loan is key, much like unlocking the door to success.
When considering a poor credit loan, applicants must meet certain criteria when it comes to their credit scores. Generally speaking, these scores need to be below 580 on the FICO scale- anything higher than that would not qualify as ‘poor’ by most lenders’ standards. In addition, those who are looking at high-risk loans will require an even lower threshold; often times around 550 or lower depending on the lender’s individual policies. Furthermore, other factors such as past payment history and income also come into play when evaluating eligibility for either type of loan.
It is important to keep in mind that while both types of loans provide potential borrowers with access to the financial assistance they otherwise wouldn’t have had, there are risks involved in taking out either form of debt – especially if repayment is not made according to schedule. Therefore, individuals should weigh the merits carefully and make sure they understand all requirements thoroughly prior to committing themselves financially.
Money matters matter when it comes to securing a poor credit loan or a high-risk loan. Income requirements are essential elements in the eligibility criteria of both types of loans, yet they differ significantly between them. Understanding these differences is paramount for those seeking either form of financing.
The income threshold required for obtaining a poor credit loan tends to be relatively low compared to that necessary for being approved for a high-risk loan. Poor credit loans may still require proof of some kind of regular employment and/or steady source of income, but lenders typically only demand borrowers have an annual salary above $20,000 per year before granting approval. On the other hand, lenders who offer high-risk loans often ask prospective borrowers to demonstrate they can make at least $50,000 each year with verifiable evidence.
Income levels aside, there are many additional factors that must also be considered before approval is granted on any type of loan. These include past payment history and current debt load as well as all available assets and liabilities held by applicants. Lenders will always take into account whether a borrower has the means to pay back their debts within an acceptable time frame according to the terms specified in the agreement. It’s important that potential borrowers understand what is expected from them before applying so they know exactly what documents will need to be submitted and how much money needs to be paid out if accepted for consideration.
Payment History Requirements
Payment history requirements are an important consideration when evaluating eligibility for poor credit loans and high-risk loans. Payment histories have a direct impact on loan approval, as they demonstrate the borrower’s ability to repay debt in a timely fashion. There are several aspects of payment history that lenders examine when determining whether or not to approve a loan application:
1) Consistency: This is measured by how often payments were made on time and if there was any delinquency shown during the past two years.
2) Amounts Paid: Lenders look at both the total amount paid over two years, as well as what percentage of each payment went towards principal versus interest.
3) Credit Utilization Ratio: This ratio looks at how much available credit has been used compared with what’s still owed. The lower this number, the better.
4) Types of Debt: Different types of debt can affect a person’s overall credit score differently; it helps to know which type of debt someone has before approving them for a loan.
Lenders also consider other factors such as income, employment stability, and assets when making their decisions about loan approvals. Understanding these criteria will help borrowers make informed decisions regarding their qualifications for different types of financing options. By understanding the details associated with payment histories, applicants can improve their chances of being approved for various types of loans regardless of their current financial situation.
The requirement for collateral is a key factor in the eligibility criteria when considering poor credit loans versus high-risk loans. On one hand, lenders are likely to require some form of collateral from borrowers before approving poor credit loan applications. This can include items such as real estate or other assets that have been pledged against the loan, with these being taken by the lender if payments are not made according to agreed terms. Conversely, applicants who are seeking high-risk loans may find it more difficult to obtain approval due to their financial situation; this often necessitates providing additional collateral beyond what would usually be expected.
Collateral requirements differ depending on the type of loan and the applicant’s circumstances:
•\tPoor Credit Loans:
o Borrowers will typically need to provide some form of the asset as security before they can access funds through this type of product.
o These could include cars, jewelry, or any other item of value which has been offered up as security should repayments fail to be met on time.
o Applicants may be asked for greater levels of security than those applying for a poor credit loan; this could involve putting down multiple assets up against the agreement.
o Lenders may also ask for higher rates of interest to compensate them for taking on increased risk with these types of agreements.
It’s clear that understanding how collateral works is essential when assessing both poor credit and high-risk loans – ultimately helping individuals make informed decisions about their finances and future borrowing needs.
Eligibility Criteria For High-Risk Loans
It may come as a surprise to some, but high-risk loans actually have eligibility criteria that must be met. Despite having a reputation for being more lenient and accessible than conventional loans, they still require certain conditions to be fulfilled in order for them to be approved. As such, it is important to understand the exact requirements before applying for one of these types of loans.
The first criterion used by lenders when evaluating an application for a high-risk loan is credit score. Generally speaking, applicants with lower scores are considered higher risk and will generally need higher interest rates or larger down payments in order to secure financing. In addition, income levels also play an important role in determining whether or not someone qualifies; those who do not make enough money to cover their monthly expenses can encounter difficulty obtaining approval regardless of their credit history. Finally, employment status plays a big part in the decision process; those without steady jobs may find themselves unable to obtain this type of loan since banks want assurance that borrowers are capable of making regular repayments on time.
In light of all this information, it stands to reason that meeting the eligibility criteria for high-risk loans requires careful thought and consideration from potential borrowers. Understanding how each factor affects one’s individual situation is key to successfully navigating the loan process and securing the funds needed.
Credit Score Requirements
When it comes to credit score requirements for high-risk loans, the eligibility criteria are not as stringent as those for poor credit loans. Offering a much-needed lifeline in times of financial hardship, lenders providing these loan options understand that an applicant’s circumstances may have changed since their last credit check. This is why they take into account other factors such as employment and income stability when assessing whether an individual qualifies for a loan.
To be accepted for a high-risk loan, applicants must generally meet certain basic conditions. These may include having regular income or being employed full-time, along with proof of address and valid identification documents. In addition, applicants should have no serious delinquencies on their records within the past 12 months, except for extenuating circumstances such as bankruptcy filings or foreclosure notices. Lenders will also typically require collateral if available in order to secure repayment of the loan amount.
Applying for a high-risk loan can provide individuals who might otherwise have difficulty obtaining financing access to funds at competitive rates. However, due diligence should still be exercised before taking out any kind of debt – even one that does not carry strict qualifications regarding credit score thresholds – so that borrowers are fully aware of all terms and conditions involved before signing up for the loan agreement.
According to research, around 40% of individuals in the US have bad credit scores. Income requirements for poor credit loans and high-risk loans are different depending on the lender’s policies.
When applying for a loan with bad credit, lenders will typically look closely at how much money an individual makes compared to their debt obligations. The higher the ratio of income to debt is, the better chance that person has of qualifying for a loan. In general, borrowers must be able to demonstrate they can afford their proposed monthly payments when looking into eligibility criteria:
• Poor Credit Loans:
-Must make enough income to cover existing debts plus any new loan payments
-Minimum annual income requirements may vary between lenders
-Those without full-time employment or steady income may still qualify if a co-signer is present
• High-Risk Loans:
-Income requirements are generally more lenient than other forms of lending
-Loan repayment terms are usually short (1 year) and small amounts are available
-Little to no proof of income needed; often secured against collateral such as car title or home equity
Overall, applicants should understand these eligibility criteria before applying for either type of loan. It’s important to review each lender’s specific requirements prior to submitting an application so that there are no surprises down the line. Lastly, although both types of loans come with certain risks, understanding what one qualifies for can help one find the best option for their particular situation.
Payment History Requirements
When it comes to taking out a loan, payment history requirements can be the difference between success and failure. With poor credit loans compared to high-risk loans, eligibility criteria for each type of loan have distinct differences regarding what is needed from applicants in terms of their payment history. Outlining these requirements with precision and accuracy is paramount for anyone looking to take on either form of debt. Absolutely staggering!
To begin with, when applying for a poor credit loan, lenders will typically require evidence that you have made all your payments promptly over a period of at least 6 months. This means having no outstanding debts or late payments during this time frame and having up-to-date balances across any accounts held.
In contrast, those seeking high-risk loans must demonstrate a higher level of reliability when it comes to paying back money owed. To qualify, applicants may need to show proof they are consistently meeting repayment deadlines by providing bank statements as well as pay stubs or tax returns verifying income stability over an extended period (e.g., one year). Furthermore, although not always mandatory, borrowers may also be required to provide letters of recommendation outlining their character and financial ability prepared by acquaintances who know them personally such as employers, friends, etc.
The following points help to summarize the differences between payment histories for each type of loan:
* Poor Credit Loan Requirements:
* No overdue payments within the last 6 months;
* Up-to-date balances across all accounts;
* High-Risk Loan Requirements:
* Consistently meet repayment deadlines;
* Show proof of income stability over 1+ years;
* Provide letters of recommendation (if applicable).
Knowing the specific details about both types of loans’ payment history requirements provides crucial insight into how best to approach borrowing money depending on individual circumstances. It, therefore, pays off handsomely in the long run if people do their due diligence before agreeing to enter into any kind of agreement related to debt.
Navigating the world of personal finance can be a daunting task, particularly when seeking out information about loans. When exploring different loan types, it is important to consider the collateral requirements for both poor credit and high-risk loans.
For individuals with less-than-ideal credit histories, there are still options available in terms of borrowing money. Poor credit loans may require additional security measures such as car titles or other property that can act as collateral if payments on the loan become delinquent. This type of loan will generally have higher interest rates due to the risk associated with providing capital without traditional payment history qualifications being met.
High-risk loans tend to involve greater amounts of security than those required by poor credit lenders. These loans typically involve large purchases like real estate investments and require items such as vehicles or jewelry to serve as backing should repayments not be made in full according to schedule. Interest rates on these kinds of loans often reflect the lack of assurance that repayment will occur, and thus are usually much higher than what one might expect from more conventional lending institutions.
Types Of Collateral Accepted
As the need for financial assistance increases, so does the importance of understanding collateral requirements. Collateral is an asset used to secure a loan and can often be substantial in determining eligibility criteria. Depending on the type of loan being sought, different types of collateral may be accepted; these include poor credit loans or high-risk loans.
When it comes to poor credit loans, common types of collateral accepted are personal assets such as vehicles or home equity. This allows lenders to recoup their money if payments are not made. Alternatively, mortgages and other secured debt instruments are also acceptable forms of collateral when seeking a poor credit loan. High-risk loans require more stringent forms of collateral that provide greater protection against defaults such as stocks, bonds, jewelry, works of art, real estate investments, and precious metals. These higher-value items provide additional security for lenders should borrowers default on their obligations.
Collateral must meet specific requirements set by each lender before they will approve a loan application; however, this is just one part of the overall process which determines whether applicants qualify for either poor credit loans or high-risk loans. Careful consideration must be taken into account when assessing all aspects of both eligibility criteria and related costs associated with any form of financing agreement before making any commitments.
Other Factors To Consider
When considering poor credit loans versus high-risk loans, it is important to recognize that there are other factors to consider beyond the types of collateral accepted. While these two loan options may appear drastically different on the surface, they do share some common eligibility criteria.
It is essential for borrowers to be aware of their own financial situation and understand how lenders will evaluate them before applying for either type of loan. With a poor credit loan, potential applicants must demonstrate an ability to repay the debt in full as well as show steady employment income or verifiable assets that can cover any missed payments. On the other hand, those seeking to obtain a high-risk loan should expect stricter lending standards than with traditional banks; lenders may require more detailed information about personal finances and repayment history. In addition, most lenders will look at an applicant’s credit score but also give special consideration to additional factors such as education and profession when evaluating whether or not to grant approval.
Ultimately, understanding both your individual needs and assessing all available options is crucial in making informed decisions regarding which type of loan ultimately best meets your requirements. It’s helpful to compare rates from multiple lenders as well as ask questions related to fees and terms so you can make sure you’re getting the right product for your unique circumstances.
Frequently Asked Questions
What Is The Interest Rate For Poor Credit Loans Vs? High-Risk Loans?
When it comes to interest rates for poor credit loans and high-risk loans, there are several factors at play. These include the borrower’s credit score, the loan amount, the type of loan, and the lender’s risk appetite.
Generally speaking, people with poor credit scores will likely face higher interest rates than those with good or excellent scores. This is because they present more risk to lenders due to their previous financial history. High-risk loans may also carry significantly higher interest rates depending on the lender as well as other factors such as the purpose of the loan. For example, payday lending tends to have much higher interest rates than conventional banking products.
In order to get an idea of what kind of rate one can expect when applying for either a poor credit loan or a high-risk loan, it is best to compare different lenders and see which ones offer competitive rates that fit within one’s budget. Additionally, borrowers should make sure that all terms associated with each product are fully understood before signing any contracts in order to ensure full transparency throughout the process.
### Are There Any Other Fees Associated With A Poor Credit Loan Or High-Risk Loan?
When considering a loan, it is important to consider not only the interest rate but also any associated fees that may come with the loan. Poor credit loans and high-risk loans are no exception so understanding what additional costs could be incurred is critical for making an informed decision.
In terms of poor credit loans, there may be other fees beyond just the interest rate. For example, some lenders will charge origination fees which can range from 1% to 5%, depending on factors such as individual creditworthiness or current economic conditions. Additionally, late payment penalties are common when taking out a loan with bad credit and these can vary significantly in size based on how much money was borrowed and the length of repayment time frame agreed upon by both parties.
It is similarly important to understand what extra costs might be incurred if you choose to take out a high-risk loan. While it may have a lower interest rate than traditional bank loans, many alternative lenders require collateral or guarantors before they provide funding. Furthermore, certain types of high-risk lending products usually involve higher upfront fees as well as processing charges and/or administrative expenses throughout the life of the loan that should all be taken into consideration prior to signing any contracts with a lender.
By carefully analyzing all potential fees related to each type of loan before agreeing to any financial agreement, individuals can make sure they are comfortable with their choice and ensure that they end up getting the best deal possible for their unique situation.
### Is There A Minimum Or Maximum Loan Amount For Poor Credit Loans Or High-Risk Loans?
When it comes to securing a loan, the most important element is understanding what you can qualify for. Many people think that poor credit or high-risk loans have fewer qualifications than traditional loans, but this isn’t always true. It’s vital to be aware of all eligibility criteria before applying for a loan as not meeting them may result in rejection and further damage your credit score. This article will focus on the minimum and maximum loan amounts associated with poor credit loans and high-risk loans.
It’s commonly assumed that lenders offering poor credit or high-risk loans are more lenient when it comes to loan amounts, however, this is inaccurate. In fact, many organizations that provide these types of financing products impose restrictions on loan limits based on the applicant’s individual risk profile, including their income and other obligations. For instance, individuals with bad credit may only be able to borrow up to $5,000 while those labeled as higher risk could receive up to $10,000 depending on their financial situation. Similarly, if an applicant has excellent credit they may be eligible for larger sums of money ranging from $15,000-$50,000 depending on available collateral security and other factors such as income levels and job stability.
The bottom line is that regardless of whether someone is seeking a poor credit loan or a high-risk one, there are still certain limitations regarding how much they can borrow which should be taken into consideration prior to submitting an application. Evaluating capital requirements against potential risks helps ensure borrowers don’t take out more than they can reasonably afford without overextending themselves financially—while also providing necessary funds for whatever purpose the borrower had intended them for in the first place.
### How Long Does It Take To Get Approved For A Poor Credit Loan Or High-Risk Loan?
Satire is often used to evoke emotion in an audience. When it comes to applying for a poor credit loan or high-risk loan, one may be tempted to feel overwhelmed and powerless. In reality, however, the process of getting approved can actually be fairly straightforward.
The eligibility criteria for both types of loans are quite similar: applicants must have a valid form of identification such as a driver’s license or passport; proof of income; and evidence that they can repay the loan on time each month. Generally speaking, it should take no longer than 24 hours for borrowers to get their applications processed and receive either approval or rejection from lenders. This timeframe could vary depending on factors like how many documents need to be verified by the lender, but overall the process does not usually take too long.
Applying for a poor credit loan or the high-risk loan doesn’t have to be an intimidating experience – with some preparation and research beforehand, anyone can make sure they meet all the necessary requirements quickly and easily. Understanding the basic guidelines will help ensure you’re able to secure financing when needed without any additional stress or hassle involved.
Are There Any Special Benefits Or Incentives For Opting For A Poor Credit Loan Or High-Risk Loan?
When it comes to taking out a loan, opting for either a poor credit loan or a high-risk loan can be quite daunting. But there are several special benefits and incentives that come with such loans which can help reduce the financial burden they may bring.
One example of this is an extended repayment period. With these types of loans, borrowers have greater flexibility in terms of when payments must be made each month as well as how much money needs to be paid off at one time. This means that if you find yourself struggling financially due to unexpected events, you won’t need to worry about paying back your entire loan quickly – instead, you can spread out your payments over a longer period of time.
In addition, some lenders also offer low-interest rates on loans taken out by people with bad credit or those deemed ‘high risk’. While not all lenders provide this type of incentive, finding one who will potentially save borrowers thousands of dollars in the long run. Furthermore, certain institutions may even waive fees associated with taking out such loans – something else worth looking into before signing any paperwork.
With so many options available regarding poor credit and high-risk loans, understanding the eligibility criteria and evaluating potential offers from different sources can seem like a difficult task. However, doing research and being aware of every detail involved in selecting the right lender will no doubt pay dividends down the line – both literally and figuratively speaking!
Research has indicated that poor credit loans and high-risk loans are available to individuals with a less-than-perfect credit score. The interest rate for these types of loan options can range from as low as 8% up to 36%. There may also be additional fees associated with these loan options, such as origination or processing fees. Generally speaking, the minimum loan amount for both poor credit loans and high-risk loans is $1,000; however, the maximum loan amount varies depending on the financial institution offering the loan option. Furthermore, the approval time frame often depends on which lender one chooses to apply through; but typically it takes anywhere from 24 hours to several business days.
In conclusion, understanding the eligibility criteria for poor credit loans vs. high-risk loans is essential in order to make an informed decision when selecting a loan product. Additionally, statistics have shown that approximately 10 million Americans use payday lenders each year. This statistic creates imagery in one’s mind regarding how many people rely on alternative financing sources due to their inability to obtain traditional bank loans. Therefore, if you find yourself in need of extra funds despite your less-than-perfect credit score there are still viable solutions available.

domain: finance