PMVA Training: Prevention and Management of Violence and Aggression
Training in PMVA
- Proactive strategies to prevent incidents of aggression or violence
- Retro-active strategies to defuse and de-escalate an emerging situation
- Reactive Strategies to minimise injury risk and regain control of a situation.
On completion of our PMVA training, Staff will be able to:
- Apply the legal principles of Reasonable Force to high-risk scenarios
- Apply the principles regarding Duty of Care to scenarios of high-risk
- Identify situations which may give rise to the risk of sudden death during restraint or of serious injury during an incident
- Understand that physical restrictive interventions are reactive strategies which are used in conjunction with proactive, preventative strategies
- Use tactics which encourage movement by prompting
- Use tactics which enable them to safely escort a compliant but unpredictable person from one place to another
- Employ control tactics for rapidly unfolding situations where they need to keep themselves and a vulnerable but physically-able subject subject safe from harm
- Employ control tactics in higher-risk situations where there is a risk that they might lose control and thereby allow harm to come to themselves, a colleague or the vulnerable (but physically capable) subject they are looking after
- record an incident clearly in a way that allows another person to understand their actions in the circumstances which faced them
- Communicate with their subject and with each other in a way which promotes the most positive outcomes in difficult and rapidly-unfolding circumstances
We provide a variety of tailored PMVA Training:
- Restraint Training in Care Homes
- Control and Restraint training in Mental Health
- Physical Intervention Training in Residential Care
- Patient Restraint Techniques for Ambulance and Secure Escort Services
- PMVA Restraint Training in Social Care
- Healthcare Restraint Training for Nurses
- Appropriate Restraint Training for Care Workers
- Less-Intrusive Restraint Training for Learning Disabilities
- …or tailored restraint training for any environment where there is a risk of violence and aggression.
PMVA Physical Interventions are Reactive Strategies.
Physical Interventions are what we do to reactively manage potentially harmful behaviour – when it happens – to keep people safe and get things back to a baseline level of communication and coping as soon as possible when a person becomes distressed. These reactive strategies are only ever used as a last resort and are used together with proactive interventions.
Proactive interventions are a range of changes we can make in the person’s environment, in the ways that we communicate, in staff attitudes and in risky situations to reduce the need for the behaviour through which the person is communicating. When considering using Reactive Strategies as a last resort, consideration should be given to using the Least Restrictive Options wherever possible and only for the amount of time they are needed for.
Where possible (in planned interventions) a thorough risk assessment must address:
- any physical health problems and physiological contraindications to the use of restrictive interventions, in particular manual and mechanical restraint
- any psychological risks associated with the intervention, such as a history of abuse
- any known biomechanical risks, such as musculoskeletal risks
- any sensory sensitivities, such as a high or low threshold for touch.
A restrictive intervention should also have a restrictive intervention reduction programme as part of a long-term behaviour support plan.
PMVA Skills Development:
- Duty of Care: Understanding where the duty begins and ends and who carries responsibility for restraint during an intervention.
- Breakaway / Restraint Use of Force Rules: Understanding Reasonable Force for Control and Restraint Interventions
- Risk Awareness: What are the risks of physical restraint intervention and how to reduce or avoid them
- Government Guidance: What is expected by the national authorities who advise on best practice for restraint interventions and restrictive practices (e.g. Department of Health, NICE Guidance, Relevant Codes of Practice)
- Teamwork: Working in cooperation with team-mates in high-risk restraint and non-restraint situations
- Physical Tactics: Reliable and Robust methods for last-resort physical intervention resolution of high-risk conflict situations
- Managing Proximity and Body Language Effectively (Proxemics)
- Low-Level Breakaway Skills from Common Assaults (grabbing)
- Functional Breakaway Skills from More Serious Assaults (impacts)
- Safe Prompting and Guiding Skills for use with unpredictable service users
- Control Tactics for early-stage engagement with a resistant or violent person
- Holding and Escorting Skills for use with disoriented persons
- Restraint Skills for more serious incidents requiring robust stabilisation (only where necessary)
- the use of restraint devices such as the Soft Restraint System (only where necessary)
PMVA Training Formats
IMPORTANT: To properly control risk and to manage your liability exposure as a responsible employer, the training you provide to your staff should match the needs of your teams and the levels of risk to which they are exposed.
At Dynamis, leveraging our online training system which has been successfully used since 2014 for a variety of teams, we can maximise the in-person contact time needed to create positive learning experiences for learners. We have, for example, been able to provide 2-, 3-, 4- and 5-day courses which develop broad competencies for PMVA and meet the specific needs of teams.
Broadly speaking, each core element of PMVA training should take one day of introduction and practice, interspersed with the knowledge and guidance elements of the course content:
- Conflict Management and Verbal Skills for Dealing with Distress/Aggression (1 day)
- Personal Safety/Breakaway Skills for disengagement from Violence (1 day)
- Interventions for Prompting, Escorting, Holding at a Lower Risk Level (1 day)
- Options for Holding, Control and Restraint at a Higher Risk Level (1 day)
- Control Tactics for High-Risk Contexts including Restraint Equipment (1 day)
Each stage of this training builds on the previous phase of training and experience in order to best contribute to overall performance capability, both in terms of the team and the individual.
For one-day courses, please see individual course webpages as follows:
Course Feedback from Dynamis course atendees for January-December 2016
Were your expectations about the course met?
Did the trainer observe good Health and Safety practices?
Yes (Y) 98.93%
Were exercises on your training course conducted safely?
Yes (Y) 368 98.66%
How did you rate the Dynamis instructor’s knowledge and competence?
Very Good 21.98%
Were all your questions answered comprehensively by your trainer?
Yes (Y) 98.39%
Was the training delivered using a mix of delivery styles which enabled you to learn effectively?
Yes (Y) 99.46%
Was the course of the right duration for you to gain the skills and knowledge you needed?
Slightly too long 10.99%
Just the right duration 72.12%
Slightly too short 13.40%
Were the techniques and tactics you learned appropriate to the real scenarios you will – or might forseeably – face in your work?
Yes (Y) 95.98%
Were the theory and knowledge components of the course helpful for you professionally?
Yes (Y) 98.93%
The Structure of Training in PMVA:
- Tiers of Training specific to staff role & exposure
- Placed within a Legal Context
- Based on Formal Assessments of Risk
- Identified using a Training Needs Analysis
- Learning Outcomes based on Identified Need
- Evaluated against Operational Effectiveness
1) Our approach to providing advice, training and consultancy in the prevention and management of violence and aggression (PMVA training) follows a three tier model as follows:
PMVA Primary Prevention: understanding the causes and triggers for challenging, risky or violent behaviour and attempting to change aspects of the environment in order to reduce the risk of their occurrence.
PMVA Secondary Prevention: selective interventions, mainly involving effective communication strategies which seek to prevent such situations, if they do occur, from escalating.
PMVA Tertiary Management: interventions, usually including some physical component, for mitigating and reducing risk if situations escalate to the point of violence or the possibility that serious harm or injury could occur.
Dynamis offers courses which cover all three phases of the model and which emphasise both Tier 1 and Tier 2 interventions wherever possible, in line with the wider movement towards Restraint Reduction Programmes.
2) All of the above activities must be carried out within a legal context for PMVA which governs the behaviour of Directors, Managers and Staff in a given organisation, so the relevant legislation and national guidance must be referenced in regard to any PMVA training interventions which are planned.
All Dynamis courses have a legal foundation which ensures their robust compliance with relevant legislation.
- Human Rights Act
- Health and Safety at Work Act
- Mental Health Act
- Mental Capacity Act
- Health and Safety Management Regulations
- Manual Handling Regulations
- RIDDOR 1995
- Employment Rights Act
…amongst other pieces of statute legislation, regulations and national-level guidance which applies to the specific area of work in which the PMVA training may be applied.
3) There is a clear responsibility – indeed a legal duty – on management of an organisation to ensure that hazards relating to PMVA are the subject of properly-constructed risk-assessments to a suitable and sufficient standard and that the appropriate ‘reasonably practicable’ controls such as training are put in place.
The 5-Step Risk Assessment Process
1) Look for the Hazards
2) Decide who might be harmed and how
3) Evaluate the Risks and the Controls
4) Record the Findings
5) Review the Assessment and Revise when Necessary
Dynamis offers clients our bespoke online Violence Risk Analysis tool for our PMVA training which assists with this process.
4) Often, training is identified as a required PMVA Risk Control Measure. In order to properly design and deliver a relevant and appropriate Training Programme, the organisation should carry out a Training Needs Analysis which outlines the business outcomes which are being sought and identifies the learning outcomes which will best support those outcomes.
Dynamis offers clients our bespoke online Training Needs Analysis tool which assists with this process.
5) Once training needs are identified, then the relevant and appropriate Duration and Learning Outcomes of the PMVA training can be agreed upon and the training programme can be set in motion. Sometimes, a trial of the final training programme design can be useful to refine the programme for best results.
Dynamis Learning Outcomes are linked to the National Occupational Standards for the Management of Violence at Work
6) Training should be evaluated, both for its utility and effectiveness at the level of the staff receiving it, and also for its achievement of the stated goals identified during the Training Needs Analysis phase. This can be accomplished in a number of ways, including auditing and reporting on a frequent basis against agreed benchmarks.
Dynamis offers clients our bespoke online evaluation system which gathers data from attendees and managers in regards to the efficacy and goal-achievement of the training programme.
PMVA Training helps to reduce the risks of violence and aggression by developing staff knowledge, skills and attitudes to effectively employ de-escalation skills, breakaway and disengagement tactics or control and restraint interventions appropriately within the context of their services. The training meets NHS Protect standards in conflict resolution and physical intervention.
Your team will learn to safely apply appropriate non-restrictive or (where necessary) restrictive physical interventions as alternatives to the primary non-escalation and secondary de-escalation strategies which we will help you to put in place.
The objectives of our PMVA course normally include:
UNDERPINNING KNOWLEDGE of RISK and LAW
- The Principles of Reasonable Force
- Common Law
- Criminal Law
- Care Legislation
- Care Act
- Mental Health Act
- Mental Capacity Act
- Decision-Making in regard to the Duty of Care
- Health and Safety at Work Act
- Management of Health and Safety at Work Regulations
- Health and Safety Offences and Corporate Manslaughter
- Manual Handling Operations Regulations
- Government and National Guidance
- NICE NG10
- NICE NG11
- NICE Violence: Short Term Management
- Positive and Proactive Care (Department of Health)
- Human Rights Act
- Article 2
- Article 3
- Article 5 and others
- Reducing the Risks of Sudden Death During Restraint
- Positional Asphyxia and Excited Delirium
- Recognising Warning Signs in Restraint Interventions
INCIDENT DECISION-MAKING for PMVA:
- Core Person-Centred Values for Dealing with Distressed, Resistant, Dangerous Behaviour
- Legal, medical and professional implications of incidents involving PMVA
- Risk assessment (both formal and informal) during episodes of PMVA
- Legal and medical implications
- Good practice following PMVA incident management
UNDERSTANDING DISTRESSED BEHAVIOURS
- The Kaplan/Wheeler Model of the Assault Cycle
- Brain function and Aggression/Stress
- Recognising the cues for Primal/Social behaviours
- The SCARF Model of influences on human behaviour
- 7-Phase model of incident management and recording
CONFLICT RESOLUTION for PMVA
- Treating every person with Dignity and Showing them Respect
- Having the correct attitudes needed for conflict resolution
- Initiating contact with patients service users, visitors and other staff in a non-escalatory way
- Discovering and Dealing with people’s communicated needs through listening and empathy
- Managing resistance through appropriate persuasion and influencing skills
- Deflecting and Redirecting verbal aggression through focus on key goals
- Working with the audience and bystanders to positively influence conflict
- Knowing when to disengage from conflict
PMVA PHYSICAL SKILLS
- Proxemics, Prompting and Escorting
- Fundamentals of Self-Protection
- Survival from Common Assaults
- Principles for Prompting and Escorting
- Less-Intrusive Holding and Restraint Principles
- More Restrictive Physical Restraint Interventions
- Disengagement Methods
- Advanced Control Tactics (for Higher-Risk environments)