The following is an actual story about how to keep staff safe in learning disability services. The scenario which was reported to our training team in the sessions that we deliver for staff who look after vulnerable people in care. I believe that stories like this are generally representative of the kinds of conflict and violent incidents which occur with largely un-recognised frequency in learning disability services.
The staff member was working with a 16-year-old service user with complex needs and extreme challenging behaviour and who was allocated workers on a 2:1 basis. They were in a room in the day centre. The staff member’s colleague (who was the #2 on the two-person team) needed to use the toilet and left the room to do so. The staff member who was still with the client was assisting him with drinking, using a straw in a cup.
Without warning, the client punched the staff member in the face, which resulted in a black eye.
The staff member had been told that “because he is only 16 years old, we can’t restrain him” and so she backed away from him but didn’t not leave the room. She had been told that “you can not leave a client alone at any time”and so she decided not to leave the room, even though he threatened to punch her again.
This staff member had not received any conflict management, physical intervention or breakaway skills training at the time of the incident, even though she had been assigned to a client with a history of violent behaviour and who was on a 2:1 tarrif.
The situation resolved when her colleague came back to the room, however the staff member suffered bruising to her eye from the client’s punch.
Two days later the staff member was working with the same service user again. He punched her in the face again and spat in her face. The advice from managers had not changed in this time and at the point she attended our training course on Personal Safety (some weeks later) she had still not had, nor had been scheduled for, any form of self-protection / physical interventions training.
KEY ISSUES: How to keep staff safe in learning disability services
1) The Use of Reasonable Force - Legal Principles: Where the use of force in a given set of circumstances is both Necessary and Proportionate, for the purposes of preventing or terminating a crime or to stop unlawful physical force being used on any person, for example, then it will be Reasonable. There are no age-limits or restrictions for the use of force and any such suggestion is wildly inaccurate, regardless of how ethical, moral or values-based it might be.
2) Leaving and Withdrawing from an Unsafe Situation: Where a staff member finds herself in a situation which is inherently dangerous, then she must consider whether to leave the situation and "proceed to a place of safety" if that danger is unavoidable. [ Section 8 of MHS@WR1999 ] - "enable the persons concerned (if necessary by taking appropriate steps in the absence of guidance or instruction and in the light of their knowledge and the technical means at their disposal) to stop work and immediately proceed to a place of safety in the event of their being exposed to serious, imminent and unavoidable danger"
3) Duty of Care: It is surprising to see in this situation that there are two staff members assigned to the service user, due to his unpredictability and his history of destabilisation and potential violence, however the procedure when one staff member needs to use the toilet is such that it leaves the other completely vulnerable. This raises the issue of their "safe systems of work" and whether the management of this service have properly risk-assessed the roles and work-tasks of this team.
4) Risk Assessment and Training: While one unforeseen event, a true emergency, is perhaps acceptable, it is completely 'bonkers' that after the first incident (a 'Near Miss') where she was punched in the face, this carer was AGAIN placed in the same situation and AGAIN was physically attacked by the service user. Negligence? Unsafe working environment? It is quite likely that a court would find for the staff member and penalise the organisation for this kind of loose safety management. It is clear that this worker needs more in-depth training for her role [ Section 13 of the MHS@WR 1999 ] - "Every employer shall ensure that his employees are provided with adequate health and safety training"
If you wish to know more about how to keep staff safe in learning disability services, please visit this page or make contact and we will be delighted to have a conversation with you.
This leaves me totally unsuprised. A residential unit dealing with disturbed young people from a Welsh local authority instigated a reporting scheme for violent incidents or staff being verbally abused and threatened.
County hall was buried in a blizzard of paper and soon the councils H&S people were asking what exactly was being done by way of risk assessment, training etc to reduce the risk.
In a stoke of pure genius management went to the unit and took away the forms. The blizzard ceased.
Years later a member of staff came across a hybridised version of Bill O’Hanlons programme for managing defiant and oppositional young people. Violence at the unit has to all intents and purposes ceased.
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