This is an excerpt from our 18-page Case-Study about how we achieved significant Restraint Reduction outcomes with a Restraint Reduction Trainer Development. To read the case study and learn about the project, please visit our Restraint Reduction page.
The results of our recent Restraint Reduction Trainer Developmentproject with a small team of new trainers in Scotland have been very encouraging.
In October 2020, I was asked by a client to take three experienced care workers through an Restraint Reduction Trainer Development programme for their residential learning disability / mental health service for vulnerable adults.
The organisation, with about 220 staff looking after clients in a number of services, had been getting significant pressure from their inspectors to show not just that their teams were properly trained, but that the training programme was creating a culture where restraint was truly a ‘last resort’.
The incident recording system was showing significant numbers of restraints, and a notable amount of those were floor-based “prone” restraints, which were cause for concern from the inspectors.
The manager of the service was new in-post to the organisation and, responding to the inspectors’ concerns, carried out an internal audit of the training that was already in place.
During this process, it was felt that the programme of training in ‘Management of Violence and Aggression’ (MVA) provided only rare chances for staff to consider their service’s core values or to practice verbal skills for defusing situations, which would both underline a focus on preventing and de-escalating situations of conflict between staff and service users.
The manager, discussing this with our team, highlighted that the training programme in place seemed to be creating an atmosphere of fear – with a ‘hidden curriculum’ focussed on staff or patients being seriously injured or dying during incidents of violence which were poorly managed.
Problems with Training and Culture
The previous MVA training, using a Hampshire-based company’s system, was creating a culture of fear and stifling service improvement. The inspectors were not happy with either the high number of restraints that were happening, or the system of training in place. Management were now clear that the aim of a training system for staff in dealing with conflict, aggression and violence should be to reduce restraint indicents by focussing on prevention and that supporting the staff to be reflective in their practice would have to be core to this aim.
Something had to be done, and, through discussions with Dynamis about a Restraint Reduction Trainer Development programme which would focus on Dignity and Respect, Keeping Everyone Safe in the service and the use of only last-resort Physical Alternatives, it was decided that we would be engaged within the service to turn the culture towards the future.
We would provide a Train-the-Trainer programme which would cover:
- Non-Escalation skills for preventing everyday encounters turning to conflict
- De-Escalation skills to defuse encounters which had escalated
- Crisis Management strategies to deal with service users in crisis
- Self-Protection methods to increase staff confidence in injury prevention
- Team-based holding interventions without pain or the indignity of floor holds, wherever and whenever possible.
Restraint Reduction Trainer Development
Our experience in delivering Train-the-Trainer programmes is lesser-known (we have not shouted about it in the past) but nevertheless our expertise goes deep, and we designed a multi-stage approach to the project.
For example, we would:
- Pre-Load the instructor candidates using an on-demand, online video-based training, to introduce key concepts and give them a grounding in the methodology.
- Introductions – using remote meetings (Zoom) to get the team introduced to their mentor-coaches.
- A ‘transfer week’ – visiting in-person for face-to-face training which would give the trainer candidates both a chance to see the training system in-person and start to give them opportunities to take on the trainer role.
- A ‘projects week’ wherein the trainers would show their competence in the delivery of core components of the knowledge-based elements of the training system – mostly legal and guidance modules. This was completed remotely, again by Zoom – the technology worked well!
- A ‘co-delivery week’ where the trainers and the Dynamis mentor would co-teach a group of frontline staff, from scratch. The Dynamis mentor had responsibility for timing, session design and practice activities. The trainer-candidates had responsibility for small groups of learners, motivating them, giving feedback and assessing their level of attainment.
- A ‘remedial workshop’ whereby the trainer candidates could ask for deep-dives into areas where they felt they wanted to gain more confidence and to ensure that the right processes were in place for the trainers to get their programme rolling with the best chances of success.
The client agreed the plan and we were off to the races! We felt at this time that this multi-stage process, although somewhat extended was going to produce the best training team possible. At Dynamis we were determined that this was to be a Restraint Reduction Trainer Development programme rather than a trainer-certification course!
In this article series, we will explore the elements of that programme and show how we achieved the aims of the client terrifically well.
In the next blog post in this series, we will discuss the Training Needs Analysis process and what we discovered about why this service wasn’t running at full health, and how we decided to help them.
To read our 18-page Case-Study about how we achieved significant Restraint Reduction outcomes with this training programme, please visit our Restraint Reduction page.