Reducing Risk and Restraint

Nick Burnett

To physically intervene or not?

Background

• Values• Current Position– Asia Pacific– UK

Values

• Relationships and Communication– Redirect v Reject– Teach a better way v Control

• Risk Reduction– Foreseeable Risk

• Safety is Paramount– Safety of the child– Safety of the staff

Values

• “I care enough about you not to let you be out of control.”

• Seeking help – a professional expectation and strength

• It is about how staff show restraint, rather than apply it!

Physical Interventions

• Minimum force, time and last resort• Maximum amount of care, control and

support• Allow for verbal communication and do not

rely on pain or “locks” for control• Gradual and graded• For safety and to de-escalate a situation

Physical Interventions

• Responses should be jointly planned, written, agreed and included in Positive Handling Plans

• There should be a supportive and reflective structure in place for children and staff

• All incidents should be reported, recorded, monitored and evaluated

Current Position

– Asia Pacific• Australia• New Zealand• Hong Kong

– UK• BILD Code of Practice

Asia-Pacific

• Australia– Common Law– Varies from State to State– Western Australia – best developed

• New Zealand– Common Law– Education – nothing in place– Health and Disability Services (Restraint Minimisation and

Safe Practice) Standards• Hong Kong– Education – nothing in place

UK

BILD Code of Practice Best interests of the student Minimum force for the shortest time Prevent injury, pain and distress Maintain dignity Reasonable and Proportionate Action should be necessary

Collecting Data

• Hard • Soft• Audit tool

Reducing Risk and Restraint Audit Tool

• Background– Development– Use• Case Studies

Development• NFER review on how 10/98 On” The Use of Force to Control or Restrain

Pupils.” had impacted on services. • In addition, target objectives have been shaped by the guidance

produced by the DfES IRS Co-ordinators.• George Matthews providing expert witness reports related to

investigations into staff practice have helped determine the key areas that managers should be aware of related to risk and restraint.

• Thanks and Acknowledgements are due to: – the UK Team-Teach Steering Group – the Team-Teach Principal, Senior and Employers tutors– JBE training and Development– David Coulton Ph.D for producing a “Checklist for assessing Your

Orgainisation’s Readiness for Reducing Seclusion and Restraint”– Nick Burnett for changes for Team-Teach Asia Pacific.

How safe is your service/setting?

• Employer Strategy• Critical Friends• Risk Assessment• Incident reports• Positive Handling Plans• Complaint and Concern Procedures• Listening and Learning• Staff Training• Training Provider

Employer Strategy

• Is there a named person responsible for co-ordination, monitoring and evaluation of Positive Handling?

• Is this recognised in their job description and are they given time to achieve this?

• Is there a designated Manager to oversee this area?• Are Positive Handling issues on management and

staff meeting agendas?• Have Managers/Principals attended training?

Policy• Is there evidence available to demonstrate that staff have

read and understood their service setting Positive Handling policy?

• Does the policy define the relevant terms?• Are primary & secondary prevention strategies stated in

the Local Policy?• Is risk in relation to techniques mentioned? • Is staff entitlement to training which includes Positive

Handling mentioned?• Does the policy mention the entitlement of staff and

service users to a repair and reflection process?• Are Positive Handling Policies reviewed every 12 months?

Critical Friends

• Have relevant placing authorities received a copy of the service setting Positive Handling Policy?

• Have parents, children and young people been informed of the Positive Handling policy?

• Are the local police aware of the Positive Handling Policy & Practice?

Risk Assessment

• Is there a Risk Assessment Form that measures the risks presented by the students behaviours and as a result a planned risk reduction strategy is documented and developed?

• Has the training provider satisfied the employer & local manager that the standards achieved and the techniques taught are relevant to the risks presented by their service users and managed by their staff.

Incident Reports

• Does the incident report cover the key areas as stated in Federal/State Guidance?

• Are incidents recorded within 24 hours?• Does the incident form include the use of de-escalation

strategies prior to the physical intervention? • Does the incident form include information on the effectiveness

(safety and calming) of techniques? • Does the incident form include a data field regarding injuries to

students and staff arising from the use of particular techniques? • Is this information conveyed back to the District/Region/Placing

Authority?

Positive Handling Plans

• Is there a Positive Handling Plan in place for students who require this level of support?

• Has the student been informed and involved in the positive handling plan?

• Have the parents been informed and involved in the positive handling plan?

• When appropriate, does the Positive Handling plan state which techniques and strategies should not be used?

• Are environmental changes or primary strategies in place to reduce the likelihood / impact of dangerous behaviours?

Positive Handling Plans

• Are staff aware of the key de-escalation strategies and praise points of those students who require the highest level of Positive Handling support?

• Are strategies indicated in the plan to help the student learn alternative behaviours?

• Is their proposed plan documented and reviewed?

• When required has medical advice been sought regarding the proposed strategies?

Complaint & Concern, Listening and Learning Procedures

• Are students aware of the process by which they can raise their concern with regard to the operational use of Positive Handling strategies?

• Are staff aware of the process by which they can raise their concerns or complaints regarding application of Positive Handling?

• Is there a documented process of listening and learning for students and staff following a critical Positive Handling Incident?

Listening and Learning

• Life Space Interview• Restorative Justice• Views of Children

Is there a better way to hold?

Squeezing too tight

Staff Training• At interview, are prospective staff informed of the

policy, practice and expectation of staff in the application of Positive Handling?

• Are steps taken to consider the placement of staff in relation to the risks they face and the knowledge, skill and understanding they possess.

• Are new staff trained and authorised before being placed in foreseeable risk situations and circumstances?

• Is there a list available of staff who have been authorised and trained to use Positive Handling strategies?

Preferred Training Provider

• Has your preferred training provider achieved independent accreditation in relation to the training it provides?

• Does your training provider embed the physical Interventions within a framework of behaviour supports and interventions that are relevant and appropriate to your settings?

• Does the training provider understand the setting context into which the training is being delivered?

• Is the training delivered by tutors who have recent background and experience of working in that particular service setting?

Preferred Training Provider

• Does your preferred training provider subject the physical techniques to on-going review and a risk assessment process?

• Does the training provider insist on an initial visit/discussion to identify the training needs before delivering the programme?

• Does the training provider insist on quality control and assurance procedures with regard to reporting of injuries, operationally and in training?

Preferred Training Provider

• Does the training provider insist on feedback concerning the quality and outcomes of staff training?

• Does the training provider promote an “In House” trainer system for staff training and refreshers?

• Does the training provider issue a Code of Practice and Protocols indicating the respective responsibilities of “In House” trainers and employers?

Case Studies

• Broad Elms SEBD School• Kingstanding• Warrington PRU

Broad Elms SEBD School

• After implementing a whole school approach and using the audit tool to guide developments:– Designated a national centre of excellence for the

management of challenging behaviours.– resulted in serious incidents at the school being

reduced by over 90% – no fixed term exclusions for over a year.

Kingstanding

• “In September 2004 there had been 259 recorded incidents of challenging behaviour at Kingstanding Special School...one year later there were 48 recorded incidents...and by the beginning of this school year incidents were being recorded at less than 10 a year” 2009

• Offers outreach support to other settings

Warrington PRU• Warrington Horizons is a Pupil Referral Unit and therefore caters for

vulnerable and challenging young people. In September 2008, Ofsted reported that :

• “Students’ enjoyment of their education is outstanding as a result of the great gains in motivation and the very positive attitudes to learning which are established as soon as they join the unit”.

• “The pastoral care of students is very good. The strong commitment of all staff secures their enjoyment and promotes health and safety effectively. This supportive environment helps students to grow in confidence and motivation”

• In the 2 year gap between visits the need for handling reduced to 1 case only !

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A leadership and management team actively owning, committed and being accountable for the training.

Documentation that underpins practice: Local setting and organisational policies. Plans and risk assessments in place. Supportive and reflective structure in place for

students and staff

Characteristics of effective services for reducing risk

Where to from here?

• Increasing the shift from:– Not talking about restraint– How to restrain ‘better’– How to restrain ‘less’

• Increasing: – Accountability– Openness– Honesty

• Sharing effective good practice

The Focus on Rights

The Optimum

Holding does not always = wrong!

Keeping in touch!

• For a copy of the PowerPoint and/or Reducing Risk and Restraint Audit Tool, put your name on the sheet at the front or back of the room

• ‘Like’ me on Facebook – just search for Nick Burnett CCP

• ‘Follow Me’ on Twitter – nick_burnett• Buy my e-book! – www.myebook.com - search

for ‘Reducing Risk and Restraint’• Email me: nickburnett@me.com