forumAdmin
19-02-2008, 02:46 PM
STUDIO III POSITION DOCUMENT
Physical Interventions (.pdf at end)
The use of physical interventions in care environments should be viewed nearly always as a failure of a system.
A Person-centred approach to the teaching of physical Interventions
Using words like person-centred and physical interventions would appear to be a contradiction in terms in the same sentence. The Studio III approach has always been based on methods that are not only safe and effective but also socially acceptable (McDonnell et al 2008; McDonnell & Jones 1999; McDonnell & Sturmey 1994). To us, Physical Interventions should be designed within an ethical frame work
Staff training in physical interventions cannot solve all the problems of violence in care environments
Research demonstrates that staff training, on its own, is viewed as necessary but, not sufficient for behavioural change to occur (Cullen, 1993). Service policies and support services are a vital component of an effective training system. We believe that having a corporate policy with regard to training and challenging behaviour is essential.
Extreme situations make bad training policy
We are often as an organization presented with extreme scenario’s which do not have an obvious training solution. A danger is that these could then be used to determine a training syllabus.
Evidenced based training
What should we teach staff? There is simply no point in teaching staff responses to rare/low frequency assaults. There is a limited amount of time that can be devoted to training in any organisation. Our practice is to provide a base of core training in physical intervention skills that can be built upon to deal with more complex situations. Critical to this approach is the methods are evidence based. Violence varies dramatically from service to service and across client populations.
Bespoke Physical Interventions
The BILD Code of Practice on Physical Interventions (BILD 2002) advocates strongly that training in Physical Interventions be on a bespoke basis. We try to avoid teaching a large range of physical skills on our basic training courses; getting staff to learn and retain physical methods is not a straightforward process. There are other techniques taught by studio3 staff on a bespoke basis for specific high risk situations. These would be part of a reactive plan.
Poor skill retention
The evidence is fairly clear that staff retention of physical interventions is poor, especially on standardized training courses that teach too many physical techniques. Skill decay of physical interventions starts almost immediatelyafter training has ceased and the participant walks out of the room.
Applying physical interventions to ‘real world’ settings
It is our policy to teach the fewest intrusive intervention methods on basic training courses. We are very aware that physical interventions are often applied in highly aroused situations. Therefore, we actively promote the use of role play methods that evoke fear responses to situation in a safe and controlled manner. In our view, this is the only effective way to generalize these skills to real world settings.
Increasing carer confidence
Training can increase staff confidence in managing challenging situations (McDonnell et al 2008; Allen & Tynan 2000. We believe that staff who are confident in managing ‘high risk’ situations, are more likely to create meaningful opportunities for people. Confident staff are also less likely to use physical interventions. We believe that defusing high risk situations requires confident staff. Correspondingly, staff who are less confident are usually more fearful and likely to be less effective and safe in managing crises.
Teach fewer physical interventions
We found that teaching the few physical techniques that cater for the vast majority of care situations is the most practical way forward. In our view too many training courses contain far too many physical interventions.
Restricting physical interventions
Studio3 is unusual as an organization as we try to 'discourage' an A la carte approach to PI training. This can create some concerns among a minority of staff who do not like the feeling of being restricted about what they can do in crisis situations. It is understandable that people wish to have solutions for every possible situation; it is also highly impractical.
Avoid teaching high risk physical interventions
Some physical procedures do have an enhanced risk and we believe that we have a duty of care to
restrict their usage. There is a growing consensus in the field that we are heading towards restrictions of methods such as prone (face down) restraint holds (McDonnell, 2007. There are heated debates about the safety of these methods (Paterson, 2007; Leadbetter, 2007). We believe there is a real difference between training general crisis responses and the one-off crises that people often face.
Physical interventions as a genuine last resort.
The last resort can often become the first option in many services. Reducing the use of physical interventions in human services we believe requires staff to try all other options first. Keep physical interventions at the bottom of the ‘tool box’.
LEADERSHIP
Organisations require ‘top down’ as well as ‘bottom up’ pressure to reduce physical interventions. A culture of restraint reduction can be a powerful tool.
ACTIVE POLICY LIMITING RESTRICTIVE PRACTICES
Training programmes which actively avoid ‘A La Carte’ approaches.
ACTIVE MONITORING OF PHYSICAL INTERVENTIONS
Organisations should be clear about what should be recorded. Any restriction of an individual’s movement or choice of movement should be recorded as a restraint. Some services which claim to be ‘restraint free’, for example, do not include escort procedures.
Physical Interventions (.pdf at end)
The use of physical interventions in care environments should be viewed nearly always as a failure of a system.
A Person-centred approach to the teaching of physical Interventions
Using words like person-centred and physical interventions would appear to be a contradiction in terms in the same sentence. The Studio III approach has always been based on methods that are not only safe and effective but also socially acceptable (McDonnell et al 2008; McDonnell & Jones 1999; McDonnell & Sturmey 1994). To us, Physical Interventions should be designed within an ethical frame work
Staff training in physical interventions cannot solve all the problems of violence in care environments
Research demonstrates that staff training, on its own, is viewed as necessary but, not sufficient for behavioural change to occur (Cullen, 1993). Service policies and support services are a vital component of an effective training system. We believe that having a corporate policy with regard to training and challenging behaviour is essential.
Extreme situations make bad training policy
We are often as an organization presented with extreme scenario’s which do not have an obvious training solution. A danger is that these could then be used to determine a training syllabus.
Evidenced based training
What should we teach staff? There is simply no point in teaching staff responses to rare/low frequency assaults. There is a limited amount of time that can be devoted to training in any organisation. Our practice is to provide a base of core training in physical intervention skills that can be built upon to deal with more complex situations. Critical to this approach is the methods are evidence based. Violence varies dramatically from service to service and across client populations.
Bespoke Physical Interventions
The BILD Code of Practice on Physical Interventions (BILD 2002) advocates strongly that training in Physical Interventions be on a bespoke basis. We try to avoid teaching a large range of physical skills on our basic training courses; getting staff to learn and retain physical methods is not a straightforward process. There are other techniques taught by studio3 staff on a bespoke basis for specific high risk situations. These would be part of a reactive plan.
Poor skill retention
The evidence is fairly clear that staff retention of physical interventions is poor, especially on standardized training courses that teach too many physical techniques. Skill decay of physical interventions starts almost immediatelyafter training has ceased and the participant walks out of the room.
Applying physical interventions to ‘real world’ settings
It is our policy to teach the fewest intrusive intervention methods on basic training courses. We are very aware that physical interventions are often applied in highly aroused situations. Therefore, we actively promote the use of role play methods that evoke fear responses to situation in a safe and controlled manner. In our view, this is the only effective way to generalize these skills to real world settings.
Increasing carer confidence
Training can increase staff confidence in managing challenging situations (McDonnell et al 2008; Allen & Tynan 2000. We believe that staff who are confident in managing ‘high risk’ situations, are more likely to create meaningful opportunities for people. Confident staff are also less likely to use physical interventions. We believe that defusing high risk situations requires confident staff. Correspondingly, staff who are less confident are usually more fearful and likely to be less effective and safe in managing crises.
Teach fewer physical interventions
We found that teaching the few physical techniques that cater for the vast majority of care situations is the most practical way forward. In our view too many training courses contain far too many physical interventions.
Restricting physical interventions
Studio3 is unusual as an organization as we try to 'discourage' an A la carte approach to PI training. This can create some concerns among a minority of staff who do not like the feeling of being restricted about what they can do in crisis situations. It is understandable that people wish to have solutions for every possible situation; it is also highly impractical.
Avoid teaching high risk physical interventions
Some physical procedures do have an enhanced risk and we believe that we have a duty of care to
restrict their usage. There is a growing consensus in the field that we are heading towards restrictions of methods such as prone (face down) restraint holds (McDonnell, 2007. There are heated debates about the safety of these methods (Paterson, 2007; Leadbetter, 2007). We believe there is a real difference between training general crisis responses and the one-off crises that people often face.
Physical interventions as a genuine last resort.
The last resort can often become the first option in many services. Reducing the use of physical interventions in human services we believe requires staff to try all other options first. Keep physical interventions at the bottom of the ‘tool box’.
LEADERSHIP
Organisations require ‘top down’ as well as ‘bottom up’ pressure to reduce physical interventions. A culture of restraint reduction can be a powerful tool.
ACTIVE POLICY LIMITING RESTRICTIVE PRACTICES
Training programmes which actively avoid ‘A La Carte’ approaches.
ACTIVE MONITORING OF PHYSICAL INTERVENTIONS
Organisations should be clear about what should be recorded. Any restriction of an individual’s movement or choice of movement should be recorded as a restraint. Some services which claim to be ‘restraint free’, for example, do not include escort procedures.