The following extract is from a practitioner article by Studio 3 practitioner John Moriarty, which discusses experiences of crisis management training using an anonymised case study.
In many care settings, physical skills may be needed to keep people safe, and when this is the case, physical methods should be taught to a high standard and with clear guidelines around their use. These restrictive practices are designed to be used only when individuals in crisis are at risk of causing harm to themselves or others. At Studio 3, we believe in teaching physical interventions only on an individualised basis and after a Training Needs Analysis has been carried out.
When crisis management training is delivered and implemented appropriately, these practices can help ensure that safeguarding practices are upheld. When this training is not taught or implemented appropriately however, it can have the opposite effect and incite toxic cultures of restraint and seclusion.
Many training courses in crisis management, to this present day, unfortunately can convey quite mixed messages. Training providers do often teach staff de-escalation strategies, but they also may teach physical restraint techniques alongside this. Some training courses don’t even provide any de-escalation strategies whatsoever. What message is this conveying to staff teams?
Experiencing Crisis Management Training as a Consumer
As workers in the care sector, we have a responsibility to take every precaution necessary to ensure the safety and uphold the well-being of ourselves and those we support. In order to keep our approach adaptive to our environment and the needs of those we support, learning from what does/does not work, we must engage in reflective practice. The case study below describes the experiences of ‘Sarah,’ a pseudonym representing accounts from a number of practitioners, which have been pulled together to demonstrate some common real-life experiences of receiving crisis management within care settings.
Anonymised Case Study
The Work Environment
At Sarah’s place of work, physical intervention training is required for all members of staff to help protect themselves and those they support in crisis situations. Though ‘mandatory,’ this training was held infrequently at set dates and times. As a result, many members of staff did not have any training for long periods of time (e.g., 6-8 months), Sarah included. When she would remind her manager of this, Sarah would be to blame for working on the floor without restraint training.
“I felt scared to work,” she said. “Someone may get hurt if I don’t intervene and someone may get hurt if I do.” Sarah was worried that if she intervened incorrectly, as she hadn’t had training, she may unintentionally cause harm. Evidence suggests that emotions can be contagious and cause mind and body arousal (Schachter and Singer, 1962). As people “tend to mimic the facial expressions, vocal expressions, postures, and instrumental behaviours of people around them”, they can “’catch’ others’ emotions as a consequence” (Hatfield, Cacioppo, and Rapson, 1993). This phenomenon is known as emotional contagion.
Sarah’s stress spread to her staff team which, in turn, was inevitably felt and adopted by those that they supported, too. This created a negative cycle of care where staff were now increasingly responsible for the behaviours they were managing. This is not good safeguarding practice nor does it create a sense of a ‘home’ environment. In practice, Sarah reported seeing staff utilise a ‘zero tolerance approach’ to managing behaviours that challenged. If a service user ‘misbehaved’, for example, that was often enough for staff to go ‘hands-on.’ This is not person-centred or trauma-informed practice: it is abusive practice.
Contrasting with a ‘zero tolerance approach,’ which imposes punishments for people’s misbehaviour, a ‘Low Arousal Approach’ is a person-centred, non-confrontational method of managing behaviour which adopts a humanistic view of people. An underlying theme of the approach is the avoidance of using punishment in response to behaviours of concern. Low Arousal means tolerating behaviours that you may be inclined to want to change, and accepting that the first priority is often not the behaviour of concern itself, but the underlying causes such as stress and trauma. It also acknowledges that emotions and stress are transactional in nature, as previously addressed, and therefore emphasises the importance of appearing in a state of low arousal, even when we feel stressed or anxious. This will help lower arousal levels of others.
The Crisis Management Training
When Sarah finally received restraint training many months after starting, there was no teaching of de-escalation strategies. Sarah and her team were taught a wide range of restraint techniques over the span of two consecutive days. According to McDonnell (2022), intense training such as this can lead to forgetfulness:
“In many cases, even those who have received training in physical interventions are taught such a vast range of physical methods in such a short period that they forget these skills as soon as they leave the classroom.”
Confusingly, and dangerously, one of the restraint techniques that Sarah was taught how to use was a floor hold restraint technique that staff had been told not to use anymore as it was too dangerous. The training was also made ‘fun,’ perhaps to be engaging, with many laughs throughout. This training was valid for one year, but many members of staff did not receive it, working for many months with expired training.
Reflecting on Sarah’s Crisis Management Training
Good crisis management training is about ensuring that everyone is kept safe. When staff are untrained or wrongly trained, those who receive the support will more likely be victims of abusive practices. Continue reading...
Written by John Moriarty
Studio 3 Assistant Psychologist