Published Response to the Millfields Charter -Bernard Allen (thread renamed)

[andy]

It appears that the Charter has stirred up strong emotions in the EBD field. I was recently at the BILD conference and was given a nicely printed leaflet which explained why the charter was not a good idea. I actually applaud people who wish to have a debate.

For the record I am neither an idealist or irrational in my own personal beliefs. Prone restraint holds are in my view very risky.

We require a paradigm shift in certain areas of work in this country to get people to understand that such methods are unnecessary. I believe that the debate needs to reach a wide audience.

[forumAdmin]

the leaflet mentioned by andy

This form of the leaflet uses computer text recognition software
we have checked the document but as a disclaimer there may be slight text recognition issues in the content - please let us know if you find any and apologies in advance

Update added 01/06/06 Bernard has agreed that this is an accurate representation of the published leaflet
click here for the leaflet content (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharter.pdf)77kb (small) This is the easily downloadable readable transcript

The easiest way to view is by far the pdf above in blue text
below are scans of the original for those who wish to check the text
the size is a by product of making sure they are readable to be scrutinised

below is a scan of the original leaflet
PDF scan (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharterScannedOrig inal.pdf) of whole leaflet 5MB approx
Page1 (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharterScanned1.jp g) .jpg (1.5MB approx)
Page2 (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharterScanned2.jp g) .jpg (1.5MB approx)
Page3 (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharterScanned3.jp g) .jpg (1.5MB approx)

pdf as above (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharter.pdf) 77kb (small) This is the easily downloadable readable transcript

[anon_e-mouse]

It would be useful if someone contacted him for a proper copy of the text, i am sure he would reply positively. I had to read the document with my head tilted at the computer screen and its not easy!!!

I too think its a good start to the debate as there are overlaps and differences here and it would be interesting to explore these in more detail. I also think some of his points are good and well targeted.

One point that underpins this argument that i notice is each sides confidence in their particular techniques. This confidence then justifies the amount of risk being taken that is inherent in each PI method. The argument for keeping prone techniques also appears to be a lack of confidence in other techniques being suitable for all scenarios, therefore having this technique available for use - just in case- rather than banning it is suggested as a rational choice?........

This is progress.
The problem however comes back to using the least intrusive option and staff retention of skills.

- Staff cannot be expected to learn every type of restraint and also be expected to be competent at every one at all times and then make judgments, preferably beforehand in a pre planned response, to which one should be used at different stages of an escalating situation.. A compromise has to occur so that safe, easy to learn, effective, socially reponsive...etc techniques are learned within the context of avoiding incidents in the first place.

IMOHO is that a lack of confidence in other techniques that you do not understand completely is not the sound basis for keeping a more dangerous, more intrusive option.

People who attend the courses become confident with the techniques, i notice he has observed the courses but i can only say talking about it and watching it is not as useful as doing it.

[forumAdmin]

pdf as above (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharter.pdf) 77kb (small)

did this not work?

my browser was putting the scans upright automatically so I am sorry about the angle. This has been changed for the single page scans the pdf scan can be rotated in Adobe Reader.

[anon_e-mouse]

pdf as above (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharter.pdf) 77kb (small)

did this not work?

Always prefer the original source...

[forumAdmin]

That is why we put up the original so that it can be scrutinised
but the transcript has been checked several times.

[BorstalBoy]

Sorry,

Already mentioned this in another post. http://www.mindfreedom.org/ It's an American organisation against enforced inhumane practices in the world of mental health. Could be of use?

Ta.

[Bernard Allen]

These Anti-charterists sound like a weird group. What precisely are they plotting out there in schools?

(In fact I am a bit worried that I might be one, as I wrote the leaflet everybody has been trying to decipher)

I agree that prone restraints can be very risky. I think abuse is a bad thing. I don’t want people to be hurt or upset. I think everybody should be treated with dignity. I am fairly confident that a lot of incidents which end up with restraint could be avoided. In fact we all probably agree on the vast majority of issues. I agree with many of the statements in the Millfields Charter because it is padded out with lots of “hooray” statements about good things and “boo” statements about bad things, which no sane person would disagree with.

My problem with it is that once the emotive padding is taken out, the conclusions do not derive from the argument.

For the record I am both irrational and idealist in my personal views – I support Newcastle United!

When we are dealing with important professional issues, however, I think we have a duty to follow sound rational argument and consider all the evidence carefully. Careless thinking results in poor policy.



Yours expecting flack - Bern

[forumAdmin]

Thank you Bernard
we are interested in debate, not giving flack

we appreciate your views and thank you for joining our members forum

[andy]

First of all thanks Bernard for your post, you are very welcome. For the record I am a Newcastle United fan which makes me hardened to comments from peers. With regard to the charter, lets stick to prone holds and their risks. How much evidence would you require to be convinced that they should be banned in care environments? There are three areas which I would draw your attention to. First, the association of this posture with sudden deaths. (see the well doccumented stuff on website, Morrison 2003, Rocky bennett case, Hertford Courant)Second, there are some limited studies (granted mostly in psychiatry) that identify quite high levels of injury rates on training courses. Anecdotally, a number of my colleagues in the industry have reported expert cases where injuries on training courses related to prone holds have been an issue. Finally, service DO manage to not use these holds without apparent increased risks to staff.



Best wishes

Andy

[steveg]

I would also like to welcome Bernard to the forum and thank him for producing his leaflet - if for no other reason than it has got us to this point here on the forum!

Maybe at last we can actually push the debate along without the "emotive padding" as Bernard put it.

Both Andy's, Anon e Mouse and Bernards replies make valid points and i agree.

You said in your reply Bernard that you agree with a majority of issues and statements in the Millfields Charter, i and many others i'm sure would be interested which ones?

If professionals can agree on a number of issues then surely thats a step forward and narrows the debate down?

And come on people! Andy and Bernard are at the party! In would be nice to see others from the top table airing their views.

My only concern as a Liverpool fan that both Andy and Bernard are Toonies and therefore misguided from the start!

Then again, they be use to the struggle

:)

[Bernard Allen]

Misguided perhaps - but sadly no risk to anyone in the top 6 I fear

[Bernard Allen]

Many thanks for allowing an outsider onto your site.

I do think it is a positive step that we can talk these issues through. Convincing evidence results from attempts to test a theory by disproving it. Starting off with a belief and then looking for evidence to justify it leads people away from the truth, and the degree of passion with which a belief is held bears no relation to whether or not it is true.

My view is that all environments should be caring environments. If it is your proposition that all forms of prone hold constitute unreasonable risk, then I cannot see why you would not wish the ban to apply in all settings in which physical restraint may be used. This would include not only residential care setting, secure mental health settings and secure units for young people, but also the prison services, police services and armed services engaged in civilian security duties.

The evidence you cite is unconvincing because it does not support the case you are pleading. The case for banning prone restraints, as presented to me, is littered with errors. These include sample bias, small sample errors, unwarranted generalization, confusion of association and causation, ad hominem arguments, arguments by false association and numerous instances of begged questions.

In most cases of sudden death there are a number of contributory factors. I do not require convincing that sitting on people, kneeing on people, and hog ties are dangerous. Nor do I require convincing that exhausted, overheated people who are struggling to breathe are at extreme risk when placed in any position which compromises their breathing. I do not need to be convinced that it is possible to manage care settings without using prone restraints. I have managed a range of settings where prone restraint was not required.

I remain to be convinced that your ban will make people safer or that it is the best way to improve practice. Bans are seldom effective in achieving what the proponents hope for. You only need to look at the “ban” on Fox Hunting or the Welsh “ban” on prone restraints.

Perhaps the quickest way to eliminate me as an obstacle to your campaign is to meet up and demonstrate to me exactly what you mean when you say that safe and effective alternatives already exist. If you can overcome some of my technical concerns I would be happy to promote your techniques as an effective alternative to prone restraint. I just need you to demonstrate that what you say is true. We agree on all the issues regarding abusive cultures and the need to improve skills in the non physical aspects of behaviour management. The differences between us are technical and relate to only a small minority of high risk interventions.

[simonfinney]

ok this is tuesday after bankholiday monday and yes i have been to the pub but responing to the e-mail about our dear friend Bernard and his insistance were are nearly brothers!!! But it is ok to take people to the floor, 4 or 5 handed, lets talk about it!!!
Wot the F$&*k. is he on.
He quotes prison scenorios and adult mental health and care situatons. like thats ok!! like If they are big enough, lets force our will on them anyway!!! But we are talking about policy, no law, across a far reaching range of care situations.
i dont care if my dad is in prison , my mum in mental health care, my brother is in a school for autistic kids, my sister is blind, my aunt is old, my auncle has demensia.

you take em to the floor i will be pissed off.

As for his referal to no meaning alteranatives, where the hell has he been since the eighties, not even studio 3 would claim to be the originators of the only less aversive method of crisis managment. Has Bernard been on, or invited 2a studio 3 course?? what about the IABA and positive programing?? La vigna and Watts have done loads in this area and i love it!!

i think andy has done brilliantly and as a voice into governing bodies like bild he should be commended and encouraged. But Andy sets himself out as a target,to the miss informed.

I gotta say it seems to be an ethical and cultural thing which makes seeing eye to eye a problem with good old Bernard.

I gotta go to bed as the body is confusing lackof beer as tieredness.

i will comment more on this topic.

[anon_e-mouse]

I too welcome Bernard to the forum and what a good set of posts to start with! we now have a debate!
I look forward to the results of a technical discussion.
-excellent progress

If you can overcome some of my technical concerns I would be happy to promote your techniques as an effective alternative to prone restraint.
I just need you to demonstrate that what you say is true.
We agree on all the issues regarding abusive cultures and the need to improve skills in the non physical aspects of behavior management.
The differences between us are technical and relate to only a small minority of high risk interventions.What technical concerns? application? training methods, effectiveness? I believe that the restraint techniques have been examined using a variety of measures including social acceptability. demonstration is probably best done face to face maybe on a course then its in context. (anyone going to invite him along?)

The points raised about in which environments should they be banned is interesting also. one problem with just identifying care groups is that realistically it depends on the qualitative nature of the violence exhibited as well as the environment in which it occurs and the persons duty of care (or not) who is using the restraint procedure.

For clarification
A police officer arresting someone who is resisting arrest and carrying a weapon would argue their use of force differently to someone who is charged with a duty to care for someone with a learning difficulty who lashes out with a tea cup still in their hand. It still boils down to what others would believe is reasonable in the situation but breach of a legal duty to care provides care workers with another dimension to consider.

I would also welcome some opinion on the situation with regards to prison officers. Do they have a duty to care? Many of the techniques now used arose from demands from unions for the employer to take their duty of care toward their employees more seriously because many members of staff were getting hurt. I am sure that many people would agree that at that time any training was better than no training.

And to answer Simon's points directly Many care staff who use alternative forms of restraint in care setting are still acting in what they believe to be the most reasonable way they know. They may not have learned the procedures you (guess) have been taught.....yet....

Many of the "other" courses contain very similar content with regards to non physical methods for dealing with conflict, aggression or challenging behavior. Its not all bad. so lets look at the similarities and the differences and move forward. That is basically the point of the charter after all, isn't it?


(PS Bernard i am an outsider too and i have been made to feel welcome here also.....so far....)

[forumAdmin]

Just a point Simon.
we appreciate healthy debate and while your comments are invited it is important that the membership feel they can post without fear of ridicule or abuse. This should be an area where all feel free to join in the debate.
It is after all the outsiders such as Anon and Bernard who are valuable to our moving forward with the discussion.

This is not a warning but do consider it a nudge..............

I consider the content of this post a closed matter - please stay on topic.

[forumAdmin]

Just so we are all aware through one of our members we have had it agreed by Bernard that the PDF 77kb listed here again is an accurate representation of the published leaflet.

click here for the leaflet content (http://studio3.org/data/mill/BernardAllenResponseToMillfieldsCharter.pdf)

thank you anon...........................

[anon_e-mouse]

-er cheers?
I think its a good idea to rename the thread as the discussion was veering away from the emotional response to anti charterists in schools and now is looking at the detail in the difference of opinion. good job forumadmin.

I am sure that there are other potentially interested parties who could provide constructive input, i will dig out my black book, i would encourage others to do so too. The trouble with meetings to discuss this subject is that it can often get in the way of work (as many meetings do!) at least here it might focus people on the issue if they feel that they need to be measured and concise with their response.

[simonfinney]

I would like to say I do not intent to apologise for an emotive posting to what is an emotionally arousing topic. Saying that I am very pleased people from all standpoints on this subject are talking I really am, but this is a studio 3 web forum and most if not all our members have arrived at the same conclusion through their work experience and moral cogitations that there has to be another way than floor restraint which is the current sticking point.
I don’t see why Andy has to endure verbal hostility from anti millfield charterist, which he does most graciously, but a few comments from a pro charterist earns disapproval. Quiet honestly I thought there would be a more reactionary response from other members probably more eloquently worded but maybe I’ve embarrassed them and scared them off.
I think anon_e-mouse you have made a fair enough point. I would also like to look at similarities but I can’t help but feeling sooner or later that a moral and an informed decision based on what works and what is best for the service user will have to be made for everyone working in the various services. I don’t see the problem of Studio 3 saying as loudly as possible “hey there is another way, it works and its better”. Because it is and it does.
I hope we don’t let academia and history exclude people with a valid voice from making a contribution to the subject because history shows a poor performance for our human rights either in the cared for client’s environment or the penal environment. The Millfields Charter gives a voice to those who just want a change.
And a change is due!!!
I hope this post is on topic!!

[forumAdmin]

Thank you Simon - yes it is.......

[anon_e-mouse]

Just so we are clear.

I want floor restraint in residential care settings for children and young people and adults clearly identified as assault and stopped in the light of a less restrictive and more efficient and socially responsible pain free alternatives that do not have a side effect of death associated with them.

I am strongly in favor of the studio III walk around procedure.

I also want other experienced academics and training professionals to wake up and see the alternatives, as they are propagating in my opinion dangerous alternatives. many people especially staff do as they are told. There are some that don't. When they are being told to do something dangerous its gets tricky.

If trainers examined their consciences and looked at what studio III was offering my hope is that they would stop teaching techniques with a track record of death as a possible side effect.

I also think that there is often a great deal of useful information out there about conflict and crisis resolution as well as managing difficult situations and challenging behaviors which is useful.

But as many have said before "the physical doest match the rhetoric"