Working with an organisation to change culture reducing physical interventions
The ‘Acres’ consisted of 5 houses in a residential close. Nearly all of the service users with intellectual disabilities had resided in a hospital environment. There were high frequency incidents that included assaults on staff and other service users
Studio 3 staff conducted an ‘on the ground’ assessment literally they worked with staff to gain a good impression of what it was like to be a service user in this place. They found highly regulated plans with many boundaries. It was clear that the place was a ‘pressure cooker.’
The general view was that the restrictive procedures and strongly ruled governed support plans developed in the hospital services, ha been transferred to this setting.
It was also observed that some of the most ‘difficult’ service users were formally diagnosed as being on the autism spectrum. Based on discussions with staff and direct observations there was little or no evidence of staff applying their knowledge of autism to these situations. There were no visual support schedules, little understanding of stress and a strong cultural belief that service users were in control of their behaviours. One person kept saying that one of the service users needed to learn ‘right from wrong’.
With regard to physical interventions, there were daily occurrences. Staff had also ‘lost faith’ in the Studio 3 physical interventions that they had been taught as they contained ‘no hold downs’, one person even said ‘we need a stronger form of restraint. Our response was to tell this person that the rules and structures of the service were part of the problem.
Our plan was to work on three levels
Training: We targeted training in low arousal approaches including teaching the existing physical interventions to a high standard to help build confidence in their effectiveness. We also provided autism training that focussed on real life examples presented by the service users.
On the ground support; Our staff worked with the staff on the ground to help build their confidence. We also concentrated on seeing the people they supported as ‘traumatised’ people and that this accounted for many of their behaviours of concern
Organisational change: We supported the management team to help support their distressed staff and to encourage positive risk taking. We even changed the focus of the organisation from incident monitoring to risk empowerment and recording success. We also encouraged this organisation to examine their recruitment approach. They actively sought out staff who would support a low arousal philosophy of support.
Over 2 years there has been over an 80% reduction in behaviours of concern. The atmosphere in the service is more relaxed and there are increases in community opportunities. In addition, the staff team have become expert in low arousal approaches and understanding autism.
(This is a real anonymised example)