Moving to MAPA

What prompted the change?

• High level of restrictive interventions• Use of supine restraint• All staff trained to the highest level• Culture of the norm in regard of

restraint• Lack of staff confidence in managing

challenging behaviour• Lack of advice regarding specific

challenges2

Why MAPA

• Suitability to meet needs across ASD spectrum

• Comprehensive workbook for staff• Prioritising student’s individual needs• Used with adults and children• Quality Assurance Measures• BILD Accreditation

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Behaviour Support Committee

• Review of Behaviour Policy• Oversight of Trends across the schools• Driver of change from previous system to

MAPA• Review of all documentation• Development of Behaviour Leads in schools• Dedicated full time Trainers to advise

schools• Review of new legislation

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MAPA Foundation

• MAPA foundation level has been designed to enhance understanding and management of disruptive, aggressive and/or violent behavior.

• This approach aims to ensure that everyone involved in crisis situations which include disruptive, challenging or violent behavior can maintain the care, welfare, safety and security of all involved.

First Impressions are important• All Managers to attend Foundation

training – giving them the ability to feed back positive information on the change.

• Plan in place to train the Care and Education Team – Teachers and Assistant Team Managers

• Countdown to MAPA – Staff• Move to a restraint free environment• Change of culture

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MAPA Skills – More in your tool box• The MAPA programme aims to ensure that

the necessary foundation skills will reduce the likelihood of risky or dangerous behavior occurring in the first place.

• As well as to manage such behavior when it does occur, using a range of MAPA physical interventions that aim to minimize risk without damaging the professional and supportive relationships between individuals.

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Map out plan for school

• SMT meeting to discuss initial thoughts having completed the foundation training

• Meeting with full MDT and behaviour support team looking at individual students and which MAPA skills we ‘think’ will work.

• Risk assessment of environment – seating internal / external

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CPI assessment of ‘individual’ needs• CPI consultancy was accessed to meet

exceptional individual needs.

• CPI assessment concluded that additional training was required at Level 3, adding a 3rd person, and Level 4, emergency floor hold.

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Documentation

• Change all documentation to support the MAPA approach – Individual Behavioral Risk AssessmentBehaviour Support PlanStudent GuidelinesIncident FormPhysical Intervention Log

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Staff Needs

• Managing staff expectations of support and how it is provided – Care Get Together Days

• Detailing agreed approach for student -IBRA/BSP maintaining an individualised approach

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Case Study - Luke Luke displays self-injurious behaviour including

headbutting and biting his hand, and physically harmful behaviour towards others including hitting, headbutting and biting.

Sometimes it is necessary for staff to physically intervene to support Luke to ensure he does not seriously harm himself or others

Luke uses the soft play room as an area to calm, often pacing and taking time away

If Luke’s challenging behaviour escalates staff would physically support Luke to calm, including a three person supine intervention with up to three more staff supporting

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Luke

This intervention ensured rapid safe control of the situation however Luke was not always able to calm whilst supported in a three person supine intervention and would require time away to continue the de-escalation period

Luke would headbutt the floor whilst supported in this intervention

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Luke

During December 2013 Luke had 47 incidents and 30 required a three person supine intervention, plus additional staff support

Luke began putting himself into the supine position, and when staff disengaged his behaviour would escalate

MAPA was introduced during January 2014, and a transition period started

Initially Luke was unsure of the intervention, therefore he still required a three person supine support, however each month this frequency reduced – transition was gradual.

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Luke Luke began to understand the new MAPA

intervention and adapted his behaviour

Staff developed a consistent approach using MAPA interventions that best suited him to successfully calm. The medium standing/transition hold is less restrictive and intrusive

Since March 2014 Luke has not been supported with a three person supine, and medium MAPA continues to be successful for his needs

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Graph 1

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Graph 2

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Continuous Improvement

• Monitoring of individual students incidents• Quality Assurance standards for training• Centre Accreditation• MAPA trained Behaviour Leads in all

schools• Monitoring of schools incidents and

support to achieve a restraint free environment.

• Continuous revisiting core principles18