dynamis training and insight

Couple on Trial for Ill-Treatment of Care Home Residents

noreply@blogger.com (www.dynamis-insight.com) — Mon, 23 Jan 2012 12:43:00 +0000

A nursing home manageress and her care worker husband are on trial for allegedly ill-treating vulnerable elderly residents.

Michelle and Malcolm Cramp are accused of mistreating pensioners who have dementia at Brockshill Woodlands home, in Oadby, between February 2009 and January 2010.

It is alleged that Mr Cramp, a night shift carer, tied the same woman into her chair with a blanket on at least three occasions and also tucked her into bed so tightly she could not get out.

Mrs Cramp (43) is accused of swearing at an 82-year-old man and shoving him into her office. She also shouted and swore at a 97-year-old woman, Leicester Crown Court was told.

The court heard he also pushed her into her chair.

Other incidents involving Mr Cramp (52) included forcing an 85-year-old woman into her bed – again, tucking her in too tightly – on several occasions, forcing an 81-year-old woman out of her chair and making an 86-year-old woman go to bed against her will, the court heard.

All four women suffered from Alzheimer's disease.

The defendants, of Ervins Lock Road, Wigston, deny the allegations, saying they never acted inappropriately.

Adam Feest, prosecuting, told the jury: "During 12 months, both defendants, in separate ways, ill-treated residents. They failed to give the care to which each of the residents was entitled."

Mr Feest said Mrs Cramp "assaulted by pushing" the 82-year-old man, who was "frail and vulnerable".

He said the four elderly women mistreated by Mr Cramp had mental disabilities and "needed full-time care".

"Mr Cramp would force residents to go back to bed against their wishes and tuck them in so tightly with their bed clothes he was effectively using them as a restraint."

Mr Feest claimed the 86-year-old woman was pulled so forcefully by Mr Clamp that her chair was "dragged a metre or so" across the floor.

"Mrs Cramp showed little more regard for their dignity and respect," Mr Feest said.

Some of the alleged incidents were said to have been witnessed by other members of staff, who have been giving evidence for the prosecution.

In interview, Mrs Cramp said she never used swear words in front of the residents.

Mr Cramp told the jury other staff resented him being married to the boss.

He said it was "total rubbish" to suggest he forced residents to bed or got them up as early as 4am.

"They had the choice what time to go to bed or get up," he said.

Mr Clamp told the court he voiced his opinion when other staff did not pull their weight.

The home, run by Prime Life, houses up to 30 residents.

The defendants were questioned and charged following an anonymous complaint to the Care Quality Commission.

Mrs Cramp has pleaded not guilty to the ill-treatment of a person who lacks capacity and not guilty to common assault.

Her husband has pleaded not guilty to nine counts of ill-treatment to a person who lacks capacity, in relation to the four female pensioners.

The trial continues.

(Courtesy of the Leicester Mercury www.leicestermercury.co.uk)

Questions Are Raised on Restraint Training: California

noreply@blogger.com (www.dynamis-insight.com) — Thu, 19 Jan 2012 17:25:00 +0000

From the New York Times:

"Corporal punishment is illegal in California public schools, but physically restraining unruly students is not. As incidents of restraint, seclusion and other emergency interventions have soared in recent years, schools have relied on training programs and physical restraint protocols developed by private companies that in many cases appear to have few qualifications."

UK Manual Handling (back safety) requirements would likely rule out this 'method' completely.

Handle With Care’s literature says its restraint technique is “versatile, effective, painless, safe and easy to apply.”

"School districts are required to have some kind of training program for the use of restraints, and state Department of Education policies specify that only properly trained personnel should use restraint and seclusion. But there are no rules governing the training programs or what restraint techniques are recommended."

“Right now, there isn’t any oversight of whether the districts are using a good company or they are following up on their training,” said Connie Cushing, a special-education consultant for the Mount Diablo Unified School District.

“Tragically, we have seen that restraint and seclusion can get out of hand. Children have died and have been traumatized as a result of being locked away in a closet,” said Mr. Miller, his party’s ranking member of the House Education and the Work Force Committee. “Clearly, training is a very important component of this. I don’t think that it is sufficient.”

Health Worker Sexual Assault Trauma

noreply@blogger.com (www.dynamis-insight.com) — Tue, 17 Jan 2012 13:39:00 +0000

Trade union UNISON has called for extra vigilance by employers to avoid health workers being exposed to sexual assaults by patients.

The call comes after a 58-year-old received compensation after she was sexually assaulted at James Cook University Hospital in Middlesbrough when she was helping a patient in the shower in June 2009.

The assault, which has left the union member suffering psychological distress, could have been avoided had a risk assessment been carried out.

The patient, who was in his 50s, had a history of assaulting members of staff but the UNISON member was not warned and was left alone with the man.

While her back was turned he grabbed her indecently, causing her pain and discomfort. Although she was forced to take several weeks off work and suffered from nightmares, counselling has enabled her to return to her job as a health care assistant. She still suffers from flashbacks when dealing with certain situations.

She said: “I find it difficult talking about the attack because it left me so distressed. I still suffer from flashbacks when I’m at work and I have to take a step back to get myself under control. If I had only been warned about this patient’s history I could have avoided getting myself into a dangerous situation.”

Following the incident she contacted UNISON which instructed its lawyers Thompsons Solicitors to pursue a claim for compensation against the hospital.

The hospital admitted liability and the case was settled for £3,500.

A spokesperson from UNISON said: “This is another example of our members suffering just for doing their job. Sexual assaults against our members are far too common and too many, like this one, could be prevented with better communication and procedures in place.

“We will continue to campaign for better protection for our members at work and zero tolerance of sexual assaults against staff.“

Diane Davison from Thompsons Solicitors in Middlesbrough added: “This was a horrific incident which badly affected this member. Unfortunately we see many similar attacks in the health service and employers must work harder at basic health and safety to avoid this type of incident happening again in the future.”

Omission of Restraint Training Cost NHS Hospital £195,000

noreply@blogger.com (www.dynamis-insight.com) — Thu, 12 Jan 2012 13:00:00 +0000

A nurse has received £195,000 in compensation more than seven years after he was badly injured by a patient at North Tyneside Hospital. The UNISON member suffered a frozen shoulder and psychological trauma after an incident in October 2003 when a patient became violent as the nurse attempted to clean him. Staff had asked for training in restraining patients since 1996 but had never received any.

Despite suffering from pain the member continued to work for the hospital until shoulder surgery was unavoidable in 2006.

The operation left the nurse with limited movement in his arm and when the hospital announced plans to move him to a different ward, where he would need to use his shoulder more, he was forced to sign off sick.

North Tyneside Hospital refused to accept liability for the member’s accident and Thompsons pursued the case to court. In 2008 a judge said the hospital should have provided training in restraint and control techniques for its staff but the judgment on compensation was not until January 2011.

Just four days before the damages hearing in January 2011 the hospital settled the case.

The 49-year-old has now taken ill-health retirement and must take strong painkillers to help the pain in his shoulder.

He said: “I am relieved that this case has come to an end and that my employers have finally paid me damages. I’m unable to work due to the constant pain I am in and this money will help me live some kind of life."

Hazel Webb from Thompsons Solicitors added: “We had no choice but to take North Tyneside Hospital to court because it refused to accept responsibility."

Bouncers deny 'excessive force' used before nightclub death

noreply@blogger.com (www.dynamis-insight.com) — Sun, 08 Jan 2012 14:32:00 +0000

A man who died after he was thrown out of a Lincoln nightclub and restrained by bouncers was unlawfully killed, an inquest has found.

William Pleasants, 23, from Barrington, Cambridgeshire, stopped breathing outside the Engine Shed at the University of Lincoln in 2008.

A nine-day inquest heard how he was thrown out of the Engine Shed in the early hours of October 4, 2008 after an altercation on the dance floor.The inquest heard Mr Pleasants, who was visiting from Cambridgeshire with friends to celebrate his girlfriend's 21st, struggled violently as he was led out of the venue and stopped breathing as he was held face down on the ground. He died in intensive care three days later.

The hearing was told Mr Pleasants, who had a pre-existing heart problem. He was also under the influence of ketamine, benzylpiperazine and alcohol at the time of the incident. The cause of death was starvation of oxygen to the brain arising from a cardiac arrest during restraint.

Home Office pathologist Guy Rutty said William Pleasants, 23, died as a result of a lack of oxygen to his brain following a cardiac arrest. Mr Rutty said: "The restraint is the underlying cause that resulted in his cardiac arrest that caused his death.

"Without the restraint he would not have had the cardiac arrest and he would not have died."

Summing up, Deputy Coroner Richard Marshall said that although the 23-year-old had been under the influence of alcohol and drugs it was the compression which was most likely to have led to the cardiac arrest, and "sealed his fate".

Police called to the scene found him lifeless and immediately summoned an ambulance.

The inquest heard one of the door staff told an officer: "This one's a lively one. You'll need to handcuff him."
The officer replied: "Actually, he's unconscious."

Six bouncers arrested over the death were subsequently released without charge.

Shane Gostelow told an inquest at Lincoln Magistrates' Court the restraint used had been "necessary, not excessive". He also denied Mr Pleasants had been "crushed" by one of his colleagues.

The door staff first encountered Mr Pleasants on the dance floor in an "aggressive and agitated" state with his fists raised. There was an impact, a collision and struggle between the man and the security staff. They then fell through a fire exit and on to the street outside as other colleagues rushed to help.

"There was nobody laid with their body weight on anybody."

Head doorman Neil Burnett told the court how Mr Pleasants went "crazy" at one point and was "fighting and punching". He said: "I had hold of his feet, somebody had his legs and someone had his top half."

Mr Pleasants' girlfriend, Victoria Nichol, has told the inquest that she saw bouncers kneeling on top of her boyfriend as he was face down on the ground.

Another witness described:

"He had stopped breathing. His veins seemed to be bulging out of his forehead. I could hear him gasping for air. He was making a rasping noise."

Miss Nichol, who was studying criminology at the university, said it was when she knelt down next to him that she thought he was having trouble breathing.

"His face was grey and his lips were blue," an emotional Miss Nichol said. "His eyes were rolling around in his head and going backwards.

"I couldn't feel that he was breathing."

Miss Nichol, who spent three years as a St Johns Ambulance volunteer, said as she became more concerned she told door staff "they'd killed him" and asked for Will to be put in the recovery position - but this was not done until the police arrived.

BBC news following this story here: http://www.bbc.co.uk/news/uk-england-lincolnshire-15829829

New Self Defence DVD out now...

noreply@blogger.com (www.dynamis-insight.com) — Mon, 28 Nov 2011 17:12:00 +0000

Did you know that you can't be dismissed or disciplined by your employer for defending yourself at work?"

Your rights to self defence cannot be taken away by a contract of employment, and this is important for both the employee and the employer to know. Failing to understand this can leave employes suffering from work related stress and the employer open to an industrial tribunal.

At the extreme end an employer could also be held liable under the Corporate Manslaughter and Corporate Homicide Act 2007 as well as the new key amendment to the Work-Related Deaths Protocol (WRDP) which came into effect on the 1st October if a death results in a breach of the duty of care owed to it's staff under health and safety legislation.

This new Dvd is packed with information to help you (as a member of staff or as a private citizen) understand the law in relation Self Defence and in doing so understand exactly 'What Self Defence is', and has been designed to keep you safe by letting you know what your legal rights to self defence are.

It will also help destroy the myths and misconceptions that abound in relation to Self Defence.

Click Here to learn more about the new NFPS “What is Self Defence?” DVD

SCWIS Guidance: “Ensure staff know safe means of applying restraint”

noreply@blogger.com (www.dynamis-insight.com) — Mon, 21 Nov 2011 17:11:00 +0000

SCWIS have issued guidance on restraint in Adult services, in a document called the Scottish Commission for the Regulation of Care, Adult Services Regulation, Guidance on the regulation and the use of restraint.

The purpose of this guidance is to highlight current legislation and best practice on the consideration and use of restraint in care services. It outlines the role of the Care Commission and service providers in relation to this.

You can download a copy of this guidance from our recommended reading gallery here

NEW Challenging Behaviour Trainer Course for Elderly Services

noreply@blogger.com (www.dynamis-insight.com) — Mon, 14 Nov 2011 17:10:00 +0000

Dynamis, working in cooperation with its local authority and private care home provider partners and based on work with thousands of care home staff over several years, is planning a rollout of a certified Train-the-Trainer course for Managing Challenging Behaviour in Elderly Services.

Based largely on our highly popular Managing Challenging Behaviour in Dementia and with Older People training course, this NFPS trainer certification is tailored to the needs of carers and management in the care of older people sector.

The learning outcomes cover:

Restraint minimisation strategies
Understanding the precedents and triggers for challenging behaviour
Disengagement Strategies appropriate for older-person services
Physical ‘safer’ holding strategies appropriate for older-person services

This 3-Day trainer course has completed design and development and is currently in delivery with select client teams.

Dynamis and NFPS will offer this course in Scotland in 2012 to an open audience in the care sector, when demand from private and local authority services is expected to be very strong indeed.

We anticipate that many care home providers will want to educate and certificate specialists in their services who will be able to:

- champion person-centred approaches to challenging behaviour issues

- deliver broad-based training to staff in how to manage challenging behaviour

- provide legally sound advice and consultation within their services about behaviour management and restraint

- take responsibility for both wider policy decisions and individual care-planning

Keep an eye on our newsletters to find out about dates when these courses will be running in 2012!

See our 5-day fully-certificated restraint trainer’s course here

“Chemical Cosh” in Elderly Services

noreply@blogger.com (www.dynamis-insight.com) — Sat, 05 Nov 2011 15:16:00 +0000

MP and MInister for Care Services Paul Burstow has warned doctors that the use of anti-psychotic drugs with dementia patients may result in criminal prosecutions.

Last year, Mr Burstow set a target to reduce the number of elderly care home residents and dementia patients routinely prescribed the drugs from the current 180,000 to around 60,000 by the end of this month. However, early signs are “not encouraging” and evidence suggests that the target has been missed, he said.

Unless the current “consensual” approach cuts prescriptions by two thirds, the Government will reform the law so that the prescription of antipsychotic drugs must comply with deprivation of liberty safeguards, under the Mental Capacity Act

In 2008, strong opinions on this topic were voiced in a study called “Always a Last Resort - Inquiry into the prescription of antipsychotic drugs to people with dementia living in care homes” by the All Party Parliamentary Group on Dementia:

“There are serious concerns that there is widespread inappropriate prescribing, for example, antipsychotics are being used for people with dementia who have mild behavioural symptoms and prescribing is often continued for long periods of time.

This is despite the fact that antipsychotics have limited benefit for people with dementia, particularly when prescribed for long periods, and despite the serious side effects associated with their use. Side effects include excessive sedation, dizziness and unsteadiness, which can lead to increased falls and injuries, as well body rigidity and tremors. Research shows that there is almost a doubling in the risk of mortality and an increase the risk of stroke by up to three times.”

Consequently, in his own publication, called “Keep Taking the Medicine 4 - The scandal of the inappropriate medication of older people in care”, Mr. Burstow says:

“Inappropriate and abusive prescribing is an infringement of human rights and should be prosecuted under the Mental Capacity Act as assault, ill treatment or wilful neglect.”

Research referred to in his paper, about prescribing levels in nursing homes in Glasgow found that behaviours for which antipsychotics are considered inappropriate are wandering, poor self care, restlessness, impaired memory, depression without psychosis, uncooperativeness and agitation that is not dangerous. Yet these are often the very reasons they are prescribed!

He goes on to say that, based on research carried out by the Alzheimer’s Society, the alternative of a people centred approach to dementia patients within care homes is a viable, affordable option, and has proven to be a successful option.

Keep Taking the Medicine (link)

Keep Taking the Medicine 4

All Party Parliamentary Group Report “Always a Last Resort”

↓ Download this file.

TRAINING FOR YOUR STAFF

Management of Challenging Behaviours in Dementia Care is a course Dynamis developed to meet the needs of a Local Authority client to up-skill their care staff who work with older people with Dementia. It incorporates information from a variety of disciplines and viewpoints to give staff a broad perspective on the issues they and their clients face.

RISK ASSESSMENT AND SHARING INFORMATION

noreply@blogger.com (www.dynamis-insight.com) — Wed, 19 Oct 2011 15:28:00 +0000

Past history of violent behaviour is the strongest predictor of future violence.

A news article in the Sunday Telegraph in 2009 described a reporter's experiences while spending a weekend on the road with a London Ambulance Service crew. Amongst descriptions of paramedics being shot and being shot at, about the violence and aggression he witnessed against these staff, the reporter mentioned a very special list, maintained by LAS. There exists a list of 1400 addresses in the London area which, if the emergency services are called and an ambulance is required to attend those addresses, certain precautions must be taken. The paramedic crew must stop on the way to the location and put on their stab-proof vests. On arrival, they must then await and assure police escort before going into the address.

Now, this list sounds very interesting. If I was a criminal justice social worker, or a district nurse or a children's dental health worker for example, I would probably want to know that this list (for example) was being shared with my team...just in case I be asked to visit one of these addresses by myself!

Practice differs. One local authority we work with keeps a definitive record of potentially adverse incidents and marks them on it's database of service users. They do this probably in line with the NHSs published guidance on Violence Warning Markers. This guidance published in 2010, makes clear that information pertaining to past and therefore potential future violence by service users can be recorded and shared in certain broad circumstances. However we are also aware of one local authority who 'burned' their entire violence warning marker database in response to a perceived legal threat about breach of confidentiality or privacy. Unsurprisingly, when we ask care staff if they would want to work for an organisation that had essentially blinded itself to violence risks, we don't get many volunteers!

Some disagree with Violence Warning Markers, stating the need for care workers to be non-judgemental, respecting diversity and equality. Of course this is a legitimate aim, however respecting diversity is more appropriate to issues of race, gender, ethnicity. Being non-judgemental is appropriate to issues of lifestyle, relationships, culture and choice. Some even state that warning a care worker about a service users proven history of violence will make them over-cautious and therefore cold towards the client, thereupon bringing even more risk of an incident occurring! These arguments, while well meant, can not stand the scrutiny of one who holds one overriding public interest in their mind: the protection of life. We will return to this issue shortly - first let's finish addressing the issues of the RCN survey.

More than one in ten physical assaults against lone working staff in the community were being reported to a line manager! The risk here of course is that one persons "shoved out the door of the house" becomes the next person's punch in the face, becomes the next persons....well, who knows? Certainly, if staff don't feel the need to report assaults, then there is something very wrong. Firstly, staff should feel the responsibility of protecting their co-workers and others who interact with their clients. If their client has assaulted them, then the client could assault another person and there would seem to be a clear moral duty to warn of the danger. Sometimes though, over years of practice, staff with this keen sense of warning others have it worn down to a blunt edge. They write incident reports, discuss issues with their line managers and await the directives to come back down the chain of responsibility...to no result. Why should they spend the time to write reports when the reports aren't seen to be actioned?

Another reason for lack of reporting can be that staff become convinced that being assaulted is part of their daily expected workload, and therefore does not warrant special mention in an incident report. Sometimes, we have heard of managers coercing staff not to report certain incidents because of the paperwork generated. Worse still, upon receiving a report of an incident occurring, the manager initiates an interview with the worker about how they must have been at fault for causing the service user to be so aggressive! This will not encourage reporting!

So now we can see, until we are supervising workers adequately, putting safe systems of work in place, recording and sharing information about danger, treating the problem seriously and having adult discussions about risk, then we won't be able to stop the tragedies from happening.

AWARENESS AND AVOIDANCE

noreply@blogger.com (www.dynamis-insight.com) — Wed, 12 Oct 2011 15:27:00 +0000

AWARENESS AND AVOIDANCE STRATEGIES

In discussing this topic, I want to first turn our attention to a Royal College of Nursing study, published in 2007 and dealing with the issues of lone working and personal safety. The survey was very comprehensive and asked about 1500 nurses who work in the community about their experience of such. I want to pick out a few of the more salient points before we go ahead and discuss some of the issues raised.

- almost two-thirds of staff said that their employers did not know their whereabouts on a given day while they are at work.

- almost 40% of staff said that they rarely, never or only sometimes carried out risk assessments prior to a client visit

- over 75% of staff said that they wished they had more information about their service users, to enable them to work safely with them

- only 86.5% of physical assaults were reported to a line manager.

We have met home care staff who might visit up to 14 people in one day while they are at work. My question to them is always: if I walked in to your supervisor's office one day while you are at work and asked, "where is Mary right now, and is she safe?" then what quality of answer would I get?

Depending on the team we are working with, the answers vary hugely. Criminal Justice teams tend to be very aware of the risk their workers may face. Home Care staff tend to be left to their own devices - there are so many of them, and they are generally unqualified and therefore not 'core' resources, perhaps?

Teams manage whereabouts using a variety of methods. In/out boards are a favourite. Workers write down their itinerary for the day, who they are visiting and when, what time they expect to finish the visit. People at the office can check, if asked, and then make a phone call to confirm whereabouts and safety. Asked if they ever receive "just checking you're okay" phone calls, though, the answer reflects a general sense that this is a less than robust safety system.

Workers sometimes visit with their clients out of hours. No one is at the office to check the in/out board. The receptionist (or the person delegated as such) leaves at 4pm. There is an on-call manager but he is only to be called in emergencies. Visits happen all the way up to 10pm and beyond sometimes for some teams...

The burning question, which as we shall see, should be keeping those responsible for managing safety up at night, is: "are you supervising the work that is going on in your team adequately, and is the system you have put in place robust?"

Another way to put this, perhaps in less stark terms is: "if one of your staff feels unwell, faints and collapses in a clients home, then when do we find out she needs help, and how?". If the answer is not a comprehensive one, and one that people can have confidence in, then perhaps it is time to review and tighten those systems.

The common joke we hear from staff, hiding a dark reality, is that the alarm would be raised when their family is sat around their dinner table, "wondering where that woman who cooks dinner is?"

Recently an entire industry has come of age to support the responsibilities of managers in adequately supervising lone working teams. Devices using mobile phone and messaging technology, gps tracking, process management software and alarm-receiving call centres are now available which can significantly increase the level of supervision and support offered to staff.

Safety Frameworks

noreply@blogger.com (www.dynamis-insight.com) — Thu, 06 Oct 2011 15:27:00 +0000

Meeting and discussing issues of safety with staff from all over the country over the past several years, we have heard so many stories regarding the perils of lone working:

- the risk of verbal aggression from frustrated service users

- the risk of physical violence from people with mental health problems

- the risk of physical harm from confused or anxious people with learning disabilities

- the risk of being refused exit from a home during a moment of tension

- the risk of needing to control a potentially dangerous situation in the community (such as a service user who tries to run across a busy road)

...all this while delivering specialist or general care to vulnerable people! In a group of 12 experienced social or healthcare lone workers, for example, we would find it quite normal for at least one worker to relate a story about being barricaded in by their service user, at least one story about a physical assault, at least one story about a weapon being present during an interaction, and countless stories about verbal aggression.

Over the years, staff have asked us about notes for our courses, to take away and use as a reference. This has always seemed to be a singularly odd request, in that,during any persons moment of crisis, faced with an angry or frustrated human being, where tensions and heart rates rise, quite possibly the last thing on one's mind will be "where have I left those notes about what to do next?".

Personal safety is a practice, much the same as social care or health care specialists must practice in order to incrementally improve and gain experience in the best way to handle the realities of their profession, they must also, we contend, practice personal safety. This is particularly pertinent to those who work alone in our communities, visiting the vulnerable.

THE FRAMEWORK

Before delving into the various practice areas themselves, we would like to outline a simple framework for staff and management to begin thinking about personal safety issues. This framework allows us to take a bigger, wider view of the issues involved and to formulate strategies based on the broad domains which exist within it.

The personal safety framework:

Awareness and Avoidance

Defuse and Disengage

Protect and Prevent

In discussing these issues with staff around the country, we have found that most teams in social and health care have developed or discussed some of these domains very well, but inevitably their approaches show weakness in one or more of the areas. This is a problem - we cannot afford to have ambiguous or confusing approaches to any one of these three domains, lest we actually increase risk or fail to address it.

AWARENESS AND AVOIDANCE

This first domain is all about seeing the problems and issues which may arise as soon as possible and devising sensible precautions against them. Formally, this means exercising the obligations placed on management by the health and safety statute and it's regulations. Informally, and usually where the formal systems in place have failed to address a specific risk, it means allowing staff the confidence and support to weigh and consider dynamically evolving situations and to formulate their own strategies to stay safe, based on what instinctively feels right to them in the decisive moment.

DEFUSE AND DISENGAGE

Where the primary strategy of awareness and avoidance has failed, then our staff will be suddenly aware that they are in a high-risk situation and will need to act quickly, through their behaviour, communication and tactical decisions, to reduce risk. Faced with a suddenly upset service user, for example, who has never displayed such behaviour before and who is normally very pleasant, there may have been little history to be aware of and therefore little opportunity to avoid it.

Standing in the service users front room, having somehow triggered aggression in the service user, the staff member must think and act quickly to recognise the change in temperature of the interaction, discover the triggering stimulus and then work, through their behaviour, to reduce any risk of escalation, if possible.

PROTECT AND PREVENT

In the infrequent but nevertheless certain occurrence where the worker's efforts to defuse and disengage are unsuccessful, and the person they are working with is extremely aggressive to the point of physical violence, then it may be necessary for the worker to physically protect themselves from attack. The law allows for the use of force to protect against physical violence, and social care or healthcare workers are not excepted from this. However, the tacit decision-making which is involved in using force to restrain or to break away from another person may be clouded by rumour, hearsay and inference, usually derived from popular media stories which often obfuscate the issues. Care workers in particular are susceptible to erroneous beliefs about their rights to protect themselves and prevent their clients coming to harm.

See more about our courses for personal safety on our website: www.dynamis-insight.com

Dynamis Lone Worker Training

noreply@blogger.com (www.dynamis-insight.com) — Wed, 24 Aug 2011 15:06:00 +0000

Dynamis has been providing Lone Worker Personal Safety training to a large Social Care Department of a local authority. Attendees come from the Home Care, Occupational Therapy, Social Work, Criminal Justice, Crisis Care, Residential Care and other sections within the department. The training focusses on raising the awareness of staff and helping them to improve their personal safety practices. It also enables them to confront many issues about personal safety which require thoughtful reflection, action and mature discussions about safety with managers and supervisors.

Our most recent course was held on monday the 22nd of August and we thought to present some of the feedback from this course on the blog:

“I feel more confident and better informed. I experience aggression from my client group regularly and now I think I can approach it differently. Excellent approach, I had fun in the afternoon session!”

Criminal Justice Social worker

“Easily the best course I have been on since starting with the council and before - 10 years ago! I cannot remember being on a better course - and I have been on many! Interesting, balanced between discussion and lecture and FUN! Thanks!”

Adult Care Social Worker

“Very knowledgeable on subject and able to translate to practice easily, using examples to illustrate points. Practical session very beneficial. Excellent course, will be recommending it to colleagues! Feel more safe in the workplace as now have strategies to put into place to ensure safety is not compromised”

Occupational Therapist

“Really liked the method of training and the course notes - really kept you on your toes! Fantastic training! ery informative, practical and useful. Delivery was excellent!”

Criminal Justice Project Social Worker

“I am a qualified teacher of adult education and I was very impressed by Gerard’s skills. The course is perfect!”

Social Worker

“This has been a fabulous course! Would like to learn more as it would help all aspects, both inside and outside of work”

Residential Worker

dynamis insight developed this 1-day course in response to a number of clients - including NHS Trusts, Housing Organisations and Local Government Departments - who needed a training course which comprehensively addressed the needs of Lone Working in the Community.

For more information about our courses, please visit: www.dynamis-insight.com

Newly Qualified Self-Defence Instructors offer their feedback...

noreply@blogger.com (www.dynamis-insight.com) — Wed, 03 Aug 2011 11:51:00 +0000

Our Dynamis Self Defence Instructor Certification 2011, in partnership with NFPS Ltd, was completed on the 29th July with a new cadre of Self-Defence Instructors graduating from the programme.

The instructor candidates came from the areas of Community Safety, Prison Services, Health Services, Mental Health Services, Victim Support and the self-defence community.

Each candidate had to complete an extensive programme of online learning about the Law, Managing Training and the Science and Psychology of high-stress encounters before attending the 3-day course. All this online learning and course content was provided by the National Federation for Personal Safety (NFPS Ltd.) as part of the BTEC certification requirements.

Once on-site, the candidates submitted their completed course workbook and engaged in classroom discussions of the pre-learned materials, which culminated on the second day with a written knowledge-check and on the third day with peer feedback on their presentations.

Meanwhile, world-class self-protection coach Tony Torres spent hours and hours with the group, imparting his highly effective and practical approach to breakaway, disengagement and self-defence. For many, his ‘behavioural’ approach to self-protection, based on the natural behaviours and attitudes of humans in conflict, opened up many new perspectives on how they could enable and empower their learners to be safer.

At various points in the training, to increase comfort and safety for the candidates, the lead trainers incorporated the use of impact-reduction training equipment from Spartan Training Gear, most notably the Hoplite Vest torso protector. Using this equipment allowed the training to become more dynamic and was instrumental in pointing out how intensity could be incrementally added to a training programme safely.

The training venue itself was selected to give the candidates a visceral experience of training in self-defence, as the physical skill development sessions were carried out in a full scenario-area designed to replicate a typical Scottish street scene. This level of 'training fidelity' with the real world was a central theme of the course.

Lead Trainer Gerard O’Dea prompted discussions in the classroom about the relevance of this behavioural method for instructors, providing commentary from the point of view of programme design and development with an eye to the legal and liability issues which may arise where behavioural issues are not incorporated into modern training.

The mix of theory, practice and high-level discussion was a great success and candidates remarked on many occasions that the course carried a very positive energy throughout.

The candidates offered their feedback in formal reflective submissions at the end of the course. A selection of their comments follows:

“Thoroughly enjoyed the course. It gave me numerous ideas and drills I can start to use with my students. Teaching standard was excellent and I’m very keen to attend future courses”

- Martial Arts Instructor, Edinburgh University

“Course provided me with knowledge, tools and skills I will take away and use. By the end I felt confident that I was going to be able to structure, design and give a class. The presentation to peers was actually very helpful in pulling it all together”

- Self-Defence Course Leader, HM Treasury

“A greatly presented course with a high standard throughout. Thoroughly enjoyed training with Gerard O’Dea and Tony Torres”.

- Martial Arts Instructor, London

“Found both Tony & Gerard to be very professional and highly competent. Behavioural Self-Protection concepts were new to me - enjoyed learning them and training them. Very impressed by these 3 days. Thanks”

- Martial Arts Instructor, Glasgow

“Tony and Gerard were very helpful. Would attend again!”

- Team Member, Community Safety Team

“The course was very well run, pitched at the right level for the candidates. I found the whole course interesting - the easy way in which the techniques move into one another was particularly interesting. The coaches were helpful and very professional.”

- Physical Intervention and Breakaway Instructor, NHS

“All parts fitted well together with the video/online presentations supporting the physical skills aspect. Both trainers were very knowledgeable, enthusiastic and related well to the delegates. Course is excellent in this format.”

- Martial Arts Instructor, Stirling

“The course was run very professionally and both instructors were able to answer all questions. The physical skills part was most interesting - thank you very much for spending the time to help us.”

- Prevention and Management of Violence and Aggression Lead, NHS

“The course was well structured and full of information and practical practice. It has been one of the most beneficial courses for self-defence for me”

- Senior Control & Restraint Instructor, Prison Service

“Thank you both very much! I found the course really stimulating and empowering!

- Conflict Management Trainer, Private Company

“I would like to thank Gerard and Tony on the excellent delivery of the most knowledgeable and interesting course I have attended”

- Team Member, Community Safety Team

“Fantastic course, engagingly delivered - many thanks!”

- Mental Health Nurse and Violence & Aggression Management Lead

Dynamis, in association with NFPS Ltd., will be offering future Instructor Qualification courses in Physical Intervention, Restraint, Breakaway and Self-Defence.

If you are interested to gain a BTEC vocational qualification and all of the knowledge which is incorporated on these courses, make sure to register your interest by e-mailing [gerard@dynamis-insight.com] to be notified of future training and certification opportunities.

www.dynamis-insight.com

Sacked School Worker Wins £70,000 Compensation From Tribunal

noreply@blogger.com (www.dynamis-insight.com) — Thu, 14 Jul 2011 09:33:00 +0000

As reported in the Paisley Daily Express, Jun 21 2011

The former Head of Care at a school for unruly kids has won more than £70,000 in compensation after a tribunal ruled that bosses were wrong to sack him for grabbing hold of a troublesome teenager.

David Hutton was fired from his job over the way he tried to control the boy, who had previously attacked staff at the school.

An employment tribunal heard that Mr Hutton, of Linister Crescent, Howwood, had taken the boy by the arm after he vandalised a door, set off a fire alarm and hurled verbal abuse at Seafield School, in Ardrossan, in November 2009.

The 13-year-old schoolboy – described as a known troublemaker – had also been accused of bullying another pupil.

However, Mr Hutton’s bosses claimed his method of restraining the boy was “inappropriate” and that recent training should have equipped him with alternatives. After being sacked, Mr Hutton took Bridge of Weir-based charity, Quarriers – who run the school – to a tribunal, claiming unfair dismissal.
No Wrongdoing

However, a tribunal hearing in Glasgow ruled that there was “no wrongdoing” and he has been awarded a total of £70,950 in compensation. The tribunal was told how Mr Hutton – also an ex-deputy principal at the school – had been alerted after the boy involved kicked in an office door.

It had also been reported that the teenager had been bullying another youngster. When Mr Hutton went to confront the boy, he was met with foul-mouthed abuse. The pupil then set off a fire alarm and attempted to activate another before he was taken by the arm and led downstairs by Mr Hutton.

Later, bosses challenged Mr Hutton about his decision to intervene that day.

"Inappropriate" Action?

It was claimed his actions were “inappropriate” and that recent training should have “refreshed and equipped” him with other ways to control the unruly youth.

Mr Hutton argued that, if he had let the boy go, the youngster may well have fallen down the stairs.

Management said Mr Hutton had been given a final warning in 2006 after he brought another boy down from a six-feet-high fence, citing that as an “unacceptable intervention”.

Mr Hutton was sacked after being told the most recent incident and the one three years earlier were similar.

In a letter of dismissal, he was told: “This incident is an example of your reaction to certain situations which have resulted in physical intervention, which you have been advised against, and therefore there is a pattern by you of this kind.”

Suggestion By Employer Not Defensible

However, in a written ruling, employment judge Hugh Murphy said:
“There is a suggestion that the claimant was guilty of an error of judgment in intervening but it is doubtful whether any such suggestion is defensible.

“We only heard the claimant’s events and that disclosed no wrongdoing at all."
“We are not satisfied that any reasonable employer would have concluded that the incidents of 2006 and 2009 were truly similar.”

Employers Need To Know The Law

This case highlights a number of issues, namely that if employers are going to make decisions on 'physical intervention' then they need a very clear understanding of the law in relation to the use of force and not make decisions on subjectivity and personal interpretation alone.

'Technically Driven' Courses Fail

It also raises another interesting point. If you are trained in a system of intervention or restraint does that mean that you can only use the techniques you are taught and not something else? Well the answer illustrated by this case is obviously no. Training cannot equip someone with a physical technique for every situation, and this is where 'technique driven' courses fail.

'Principles' are Universal

However, teaching 'principles' provides a much more flexible, practical and pragmatic approach to how physical intervention training should be taught. Principles are universal and can be applied in a number of differing circumstances, whereas techniques alone are limited to the number of techniques taught. Yet students on courses are still being told that; "these are the only techniques you can use, and if you use anything else then you could be disciplined". Well, as this case shows, that is most certainly not the case, especially if what you do is reasonable in the circumstances.

For more information about Dynamis courses in personal safety, physical intervention and restraint, visit our website at [www.dynamis-insight.com] Our thanks to Mark Dawes of NFPS for his additional comments on this case.

Stress Exposure Training - Part 5

noreply@blogger.com (www.dynamis-insight.com) — Fri, 01 Jul 2011 12:48:00 +0000

Stress Exposure Training is Event-Based

Thought-leaders in the field of SET or SIT recognise that the best way to design a training programme is to look at the types of scenarios in which our trainees may be faced with a performance challenge, and then place those scenarios at the very center of our thinking.

In this way, we ensure that the SET programme of training is relevant, effective and contextualised to provide the greatest benefit to the trainees when they need to put the skills they are being trained in, to use.

Event based training: the event itself becomes the curriculum.

An event is defined as:

“a specific task procedure with corresponding performance conditions. Events may be discrete and singular or they may be multiple events connected into a series representing a longer scenario. Events are defined to represent real world events and contextual demands.”

At Dynamis, we often run scenario-replications in order to crystallise our trainee’s knowledge skill and judgement. For example, care staff at a residential facility or hospital will be asked to respond to an alarm call at a room. When they arrive, they may see a man who either:

is lost and needs to be given directions
is behaviourally disturbed and is damaging equipment
produces a knife and tells the staff he is going to kill them with it

All three scenarios suggest very different responses and desired outcomes, however they follow the rule of Event Based Training

The events on which we build our training programme should:

Be Realistic
Allow for multiple responses
Unfold over time and do not require perfect training fidelity.

"training fidelity refers to the extent to which the characteristics of the training environment are similar to the characteristics of the criterion setting"

In event-based training, events are embedded into training to achieve desired training objectives and provide opportunity for the trainee to apply skills in an environment representative of real world operational conditions.

Ideally, the more fidelity the scenario exercise has with reality, then the better the result of our training, however it is possible to overwhelm the trainees with too high a level of fidelity and so cautious planning about the thresholds to which the training should not cross are set in advance.

As we have already discussed in this series of articles, our use of Hoplite Training Armour allows us to drastically improve and increase our level of training fidelity with role-players who can move naturally, broadcast congruous body-language and cues and then who can be impacted and controlled at close to full speed and full force by our trainees. This level of fidelity could not be possible without the use of such robust and specially-designed gear.

How to do Event-Based Training

The first step in designing event-based training is a traditional task-analysis for learning needs. Then, there follows a development of specific events called trigger events or scenarios which should be embedded into the training, these can come from critical incident data or from subject matter experts.

One example from our training experience at Dynamis is that many organisations in Health and Care are not training their staff to deal with the threat of being punched, even though a significant amount of published data actually supports the fact that at least 30% and more often 50% of assaults in these settings are actualy impacts (punches or slaps or kicks).

Want to know more?

All of our Dynamis Training Courses incorporate these advanced concepts in training for confrontation management.

We will be running the BTEC Level 3 Self-Defence Instructor Accreditation course on July 27th - 29th, 2011. The course will provide progressive self-defence, breakaway and officer safety instructors of all kinds with a framework for teaching self-defence which is legally sound, risk-aware and has a basis in the science and psychology of inter-personal conflict as discussed here on the Dynamis Insight Blog.

Dynamis is the UK Authorised Dealer for Spartan Training Gear and the Hoplite Training Armour.

Stress Exposure Training - Part 4

noreply@blogger.com (www.dynamis-insight.com) — Wed, 29 Jun 2011 12:47:00 +0000

Proficiency is hard enough, proficiency under stress is another thing entirely.

Here are some of our training team’s notes from one of our core textbooks for instructor development at Dynamis: PERFORMANCE UNDER STRESS (Hancock and Szalma 2008) CH. 14 Stress Exposure Training: An Event-Based Approach (Driskell, Salas, Johnston, Wollert)

We must understand that there is significant difference in what it takes to perform a task in a benign environment and what adequate performance requires in a hazardous or high-demand environment (such as the use of physical intervention or protection skills during a confrontation).

The difference in the effectiveness of an individual’s training is how the contextual environment impacts on performance.

"consideration of the contextual factors that impinge on task performance is critical to maintaining effective performance in real-world settings"

The distinction between effective training and less-effective training, then, is the extent to which the training attends to these contextual factors which are (quite literally) part of the furniture in real-world scenarios.

We would argue that the primary goal of any training programme is skill acquisition and retention, however high-stress environments include specific task conditions and require specific responses which differ from those found in the classroom environment.

Furthermore, at Dynamis we have written here previously about how a focus on the retention of skills seems to be only managed by providing ‘regular’ refresher training and not in fact ‘designed in’ to the systems of training in the first place. One need only look at the results of Paterson and Rogers’ NHS studies to see evidence of this.

The primary purpose of having a focus on stress exposure training (as opposed to training shich does not incorporate an understanding of stress and its effects on performance) is to enable an individual to maintain effective performance in a high stress operational context.

Driskell and Johnston have developed an approach called Stress Exposure Training which closely follows that of Meichenbaum’s Stress Inoculation Training:

Stress Exposure Training phases:

Enhance familiarity with the task environment
Impart high-performance skills
Practice skills and build confidence

Readers who have followed our explanation of the SIT approach on this blog will recognise the three-phase approach.

Want to know more?

All of our Dynamis Training Courses incorporate these advanced concepts in training for confrontation management.

Dynamis is the UK Authorised Dealer for Spartan Training Gear and the Hoplite Training Armour.

Stress Exposure Training - Part 3

noreply@blogger.com (www.dynamis-insight.com) — Mon, 27 Jun 2011 12:45:00 +0000

Training Armour

Hoplite Training Armour allows us introduce contact in a gradual, sensible and realistic way so that people can conduct those ‘personal experiments’ which are referred to by the SIT methodology. Incorporating equipment such as the Hoplite Training Armour allows us to drastically increase the intensity of our training sessions compared to what we could achieve without it.

We can gradually build up the intensity of the confrontation experience for our trainees, while maintaining a low-risk training environment. Using our Hoplite Training Armour let’s us take the theoretical guesswork out of the training, SAFELY.

Even where we work low-intensity training sessions, with for example trainees who will have only one day with us, we can begin to give them closer-to-real-life experience of what it feels like to make aggressive contact with another human being. This is something that many people have never experienced and which is deeply challenging for them. Phase One and Phase Two of the SIT approach provide excellent preparation for this phase, even given just a couple of hours with the trainees.

Incorporating contact during training, which the Hoplite Armour allows us to do, has significant benefits. It allows trainees who have never struck another person in anger, to do so for the first time. The trainee can then go on to experience that moment again, and again. Each time, she will ‘groove’ her response a little deeper, re-inforcing the decision she made, the tactical needs in the situation, the physical sensation of initiating a strike and the results it produced. She will also be ‘grooving over’ any residual doubt, hesitation, fear or panic which she may have brought to the situation.

Specific to the Hoplite Armour, we can say with some authority that it allows the average person to use most of their capacity in delivering a strike to another person with a very high degree of safety for the person inside the armour. A full Hoplite suit covers the whole body and allows maximum movement potential in all three combative dimensions - standing, clinched or grounded.

Training according to this SIT model benefits when the role-player inside the Armour can closely replicate the behaviours that will be seen in reality (‘training fidelity’ which I will address in a following article), including the pre-assault behaviours and in responding with realism when impacted by the other role-players in the exercise.

Hoplite Armour in particular allows the role player to broadcast pre-assault behaviours and impact behaviours extremely well because it is a lightweight, low-bulk suit which transmits small tell-tale body-language which are being broadcast. This is highly important because our trainee needs to be able to react and respond to the earliest signs of confrontation (as shown by body language changes in the aggressive person) and also to the earliest cues of a physical assault when initiated.

By experiencing the uncertain, spatially chaotic and rapidly-unfolding nature of high-speed scenario replication, the trainees become inoculated, to an appropriate degree relevant to the depth of their training, to it. This is particularly successful if they are guided and mentored through the exercises by an experienced trainer who can use coaching methods to motivate them to persevere.

Want to know more?

All of our Dynamis Training Courses incorporate these advanced concepts in training for confrontation management.

Dynamis is the UK Authorised Dealer for Spartan Training Gear and the Hoplite Training Armour.

Stress Exposure Training - Part 2

noreply@blogger.com (www.dynamis-insight.com) — Thu, 23 Jun 2011 12:44:00 +0000

Applying the SIT model to Self-Protection and Confrontation Management

Phase One of training has to do with having trainees confront their own understandings of the nature of conflict and how they deal with it. A trainer may provide some exercises for the trainees - ‘thought experiments’ - regarding some conflict scenarios and garner the trainee’s response to this. Commonly, for example, a trainer might ask the trainees how they would deal with a much stronger opponent, with tattoos and scars and who looks ‘hard’, in order to provoke a discussion about the nature of intimidation.

This phase encourages the visualisation of conflict scenarios and the development of mental models, decision-making strategies and personal internal commitments to the issue of conflict. In our experience at Dynamis, a discussion of the law in regard to reasonable force and the case-law from that field offers an excellent vehicle for this phase of training as it has much to do with how emotional-cognitive decisions are made.

Phase Two of training has to do with skill development, at an intensity which gradually builds competence with the skills required to persevere and successfully manage the confrontation. Trainees are provided with relevant and effective skills which are comparitively easy to acquire given the amount of time they can devote to the training. We have written at length about the issues with much self-defence and breakaway training and the over-complexity, under-relevance of it here on this blog previously.

During this phase the trainees have the opportunity to rehearse the coping/confronting skills, re-imagining the process of the confrontation from one with a negative outcome to one with a positive outcome - reversing the ‘prey’ role which can crystallise in high-stress moments.

Trainees re-structure they way in which they approach the confrontation, using their internal dialogue and their internal associations differently now. Trainees develop, with time and opportunity, new problem-solving abilities which give them more options and alternatives during a confrontation - they begin, in short, to think more tactically about situations, because their level of stress-arousal is reducing as the problem becomes clearer and more familiar.

Phase Three of training provides the trainees with the opportunity to now apply their new skills in (again, gradually) increasing levels of intensity, although at this time the trainer should be focussing on bringing not just intensity but reality into the training. The focus here is on providing a variety of opportunities for the trainee to experience the entirety of the preparation which has gone before.

For example, in our training at Dynamis, the trainee will be placed in situations where they must now make decisions and take action based on their own beliefs and in accordance with Use of Force law, personal Duty of Care or Task Role, Risk Assessment, their ability to verbally manage the confrontation and then finaly their physical capacity to protect themselves or another. Running these scenarios can take from 15 seconds to 90 seconds to complete, depending on the amount of pre-assault verbal dialogue and the motivation/aggression level of the role-players.

The use of training armour can significantly effect the fidelity of this Phase Three training. At Dynamis, we use Hoplite Training Armour. In our next article we will discuss how the Hoplite Armour assists us to provide Stress Inoculation and Stress Exposure to our trainees.

Want to know more?

All of our Dynamis Training Courses incorporate these advanced concepts in training for confrontation management.

Dynamis is the UK Authorised Dealer for Spartan Training Gear and the Hoplite Training Armour.

Stress Exposure Training - Part 1

noreply@blogger.com (www.dynamis-insight.com) — Tue, 21 Jun 2011 12:44:00 +0000

Training people to deal with the stress of a violent confrontation can benefit from the methods used in some psychotherapy.

This article deals with the use of Stress Inoculation Training to guide Self-Protection and Physical Intervention trainers in the development of robust training programmes which will be resilient in the face of intense confrontations.

Stress is a process whereby environmental demands evoke an appraisal process in which perceived demand exceeds resources, and that results in undesirable physiological, psychological, behavioural or social outcomes."

Salas, Driskell and Hughes, 1996

Stress Inoculation Training (SIT) emerged out of an attempt to integrate the research on the role of cognitive and affective factors in coping processes with the emerging technology of cognitive behavior modification (Meichenbaum, 1977). SIT has been employed to help individuals cope with the aftermath of exposure to stressful events and sometimes it has even been used on a preventative basis to "inoculate" individuals to future and ongoing stressors.

In order to enhance individuals' coping repertoires and to empower them to use already existing coping skills, the SIT model uses a three-phase approach.

SIT Phase One - Breaking Down the Problem

Regardless of the particular stressor which we are trying to prepare them to deal with, trainees are encouraged to view perceived threats and provocations as ‘problems-to-be-solved’ and to identify those aspects of some situations and their own reactions that are under their internal control and those aspects that are not under their control or influence.

This is the first step in breaking-down a stressor which at first seems overwhelming.

The clients are taught how to breakdown these ‘global stressors’ into specific short-term, intermediate and long-term coping goals. The trainees’ response to the stressor is re-packaged as being made-up of different components that have been identified and examined in detail. The trainee builds an understanding of each thing that needs to happen for the stressor to become overwhelming.

High-stress situations tend to go through predictable phases and so the trainee who will be successful should go through a process of preparing, building up, confronting, and reflecting upon their reactions to stressors also.

SIT Phase Two - Developing Skills to Deal with the Problem

The second phase of SIT requires focus on skills acquisition and rehearsal and it follows naturally from the initial conceptualization phase which came before it. The coping or confronting skills that are taught and practiced in the training setting are then gradually rehearsed ‘in vivo’ and are tailored to the specific stressors trainees may have to deal with.

SIT Phase Three - Exposure to the Problem

The final phase of training and preparation provides opportunities for the clients to apply the variety of skills they have learned to deal with the problem across increasing levels of intensity. This is where the inoculation concept - as used in medical immunization - becomes evident. Techniques such as imagery and behavioral rehearsal, modeling, role playing, and graded in vivo exposure in the form of "personal experiments" are used during this phase to increase the trainees competence.

Want to know more?

All of our Dynamis Training Courses incorporate these advanced concepts in training for confrontation management.

Dynamis is the UK Authorised Dealer for Spartan Training Gear and the Hoplite Training Armour.

Care worker ʻnight of terrorʼ

noreply@blogger.com (www.dynamis-insight.com) — Sat, 11 Jun 2011 16:10:00 +0000

With the clear direction imposed by Health and Safety statute and regulations, employers whose workplaces have risks of violence or aggression to staff are compelled to assess those risks, document the assessment process and its outcomes, create a policy and relevant procedures which detail risk-control measures which can include a wide variety of actions, including staff training.

Regulations also make it clear that employees must be authorised to stop work and withdraw from circumstances where it would be unsafe to continue or stay. They may also be prevented from resuming work where that serious or imminent danger persists.

Lord Skelmersdale stated in his comments to the DHSS Advisory Committee on Violence to Staff:

“Where violent incidents are forseeable employers have a duty under section 2 to identify the nature and extent of the risk and to devise measures which provide a safe workplace and a system of work”

Now consider the news story from last week, which is a very pertinent counterpoint to the Winterbourne abuse scandal from the previous week....

Care workerʼs ʻnight of terrorʼ at hands of disturbed patient her bosses failed to warn

her about

31/05/2011 (http://www.mirror.co.uk/news/top-stories/2011/05/31/)

A CARE worker has told how she feared for her life after being attacked by a disturbed patient who bosses had failed to warn her about.

In what she describes as a “night of terror”, Loraine Morgan, 42, was set upon by a woman with a history of assaulting nursing staff. Mrs Morgan was attacked from behind, but her colleague was unable to stop the beating because he hadn't been trained in the correct restraint techniques.

She ended up barricading herself into a box room for nine hours.

Hurt, bruised and scared, Loraine made frantic phone calls to her bosses, but was told to stay put until morning. She wedged herself against the door to prevent the patientʼs attempts to break in.

Loraine said: “It was terrifying and I thought I was going to die.

“She was on top of me, beating me and throttling me. I thought Iʼd never get out alive.”

She has just won an out-of-court compensation claim against her private employers, Cartrefi Cymru, after a campaign by Unison.

Union leaders fear cutbacks in both the public and private sector will stretch nursing services so much that such attacks will become commonplace. Recalling the 2006 terror attack, Loraine said: “The patient wasnʼt allowed to smoke and when I told her she jumped me from behind and started beating me.

“It went on for ages and she was screaming as she hit me.”

Loraine forced the woman out of the room, locked the door and called her bosses. She was told to stay in the room until morning.

She said: “It was awful. I was scared and my employers were doing nothing. They just told me to lock the door and stay put. The woman kept trying to break in. “She barged and kicked the door so hard that the lock came off, so I had to force my back against the door all night to keep her out. The attacks went on for ages.”

Loraine, from Bridgend, South Wales, spent the night in the room with no toilet facilities until the 7am shift turned up. In the morning when Mrs Morgan answered the door to a colleague, who was taking over the shift, she was attacked for a second time. The colleague also had not been trained in the restraint techniques needed, but he stepped in to help her.

Horror Film

Kirstie Ellaway, from Thompsons Solicitors, in Cardiff, who successfully filed for compensation on her behalf, said: "Mrs Morgan’s experience sounds like something out of a horror film. The situation she was put in was unacceptable by any standards. The care industry has lost a devoted and capable member of staff."

DYNAMIS LONE WORKER TRAINING for CARERS

Our training team has been engaged in a number of Lone Worker Training engagements throughout this year, providing training to teams who regularly field Lone Workers. Whether Local Authority Social Care workers or Voluntary Organisations whose workers provide support in their clients’ homes, the issues faced are often the same.

Our course endeavours to provide, over the space of a single day, a foundation for both managers and workers themselves to:

- Explore a framework for Personal Safe Practice

- Understand the legal implications of violent incidents at work

- Re-affirm the principles of Health & Safety best practice

- Explore the roots of aggression and spotting the danger signs

- Examine the Physiology of Fear and Aggression

- Add new communication tactics and strategies to their toolbox

- Discuss escape and exit tactics which are appropriate and usable

The course has been a staple of our training provision since our company's inception and continues to develop and evolve with the involvement of practitioners who take part in our sessions.

Some feedback from one of our recent attendees:

“All very valuable - particularly the legal aspects and the communication strategies. Thank you for such an excellent and informative day - this guy knows his stuff!”

More information on our Lone Working Course can be found here

A View on Winterbourne

noreply@blogger.com (www.dynamis-insight.com) — Thu, 02 Jun 2011 11:04:00 +0000

Panorama’s expose this week of the level of abuse being carried out at Winterbourne View private hospital for vulnerable adults has been attracting huge attention in the days since it was aired.

Castlebeck, the employer, has suspended 13 staff. Police in Bristol have arrested 4 people based on the evidence of improper and needless restraint, cruel and unnatural treatment and assault.

Most people’s response has been: how can this be happening? Well, predictably, we have seen that “warnings were ignored”. The original whistleblower reported his deep concerns about the levels of abuse happening in the hospital to his employers, however no action was taken.

He also sent the report of abuse he had seen to the Care Quality Commission, the body responsible for regulating and inspecting care services throughout the UK. Their regional director has gone on record stating that “an opportunity to prevent the abuse was missed”.

While watching the piece, one can’t help but ask where the supervision and oversight of the un-qualified care support staff was? Then, at later points in the unfolding story, we do indeed see the nurse in charge coming to the scene of one of these torture-moments. Any sense of relief, or that the staff would be set right, disappears as these ‘supervisors’ ineffectually seem to sanction what is happening and go back to the office. Incredible scenes.

Restraint Issues

Our team noted, amidst the many examples of value-less practice and the absence of any sense of ‘care’ for the vulnerable residents of the unit, that the restraint methods (though they could hardly be called that) being used were highly, highly dangerous. We observed immediate and needless ‘flooring’ of subjects, when it is acknowledged in any competent training programme that floor-based restraint should be avoided in all but the most extreme of circumstances. We observed staff placing pressure on the neck in more than one instance, either by their forearm or their knee and shin, which constitute a threat to life, borne out by long and tragic experience of sudden deaths during restraint recorded for the past 20 years or more. We observed all kinds of other practices...none of which have any place in a care environment.

We wonder what, if any, training was being carried out with this staff team? It seems that, because of dwindling budgets where staff may be left to their own devices and be ‘making up restraint techniques’, there can easily develop a clear threat to life. Employers have a serious obligation to make sure that their staff know what they are doing, understand the decision-making framework they should be adhering to and understand the consequences of their actions.

Next steps?

One wonders where this story may go next. Whatever about the culprits of these abuses, we, as usual, lift our heads and focus our view on management and regulators, and surmise at what incentives the legal system may create for the leadership involved in this story to improve outcomes in the future.

Under health and safety law, the employer has a duty to ensure that people are not put at risks to their health and safety through the activities of the work being undertaken. There is a duty to supervise work effectively so that it is carried out safely.

Under Human Rights law, a government agency which permits the cruel and unnatural treatment of a person could potentially be in breach of Article 3 of the human rights act, known as the ‘prohibition of torture’. ‘Torture’ was a word used by one commentator when viewing the footage captured by the Panorama investigator and certainly it seemed apt.

Our team will be following this story and the resulting cases with great interest.

In the meantime we continue to offer accredited training courses for staff teams. Our courses include:

- BTEC L2 Intermediate Award in Physical Restraint (Older People)

- BTEC L2 Intermediate Award in Physical Restraint, Care and Control for staff working with Children and Young People

- BTEC L2 Intermediate Award in Breakaway and Self Defence

Dynamis completes BTEC Mental Health training for Nursing Staff

noreply@blogger.com (www.dynamis-insight.com) — Wed, 11 May 2011 14:28:00 +0000

In January 2011, after a long collaboration, Dynamis completed its first run of vocationally accredited training for nursing staff at a psychiatric unit in the middle east.

Staff at the unit undertook three days of intensive training which covered basic elements of mental health first aid, values-based practice and the recovery approach to mental health.

Dynamis had established a collaborative working relationship with Health in Mind, an Edinburgh-based charity which delivers a mix of services, including training, to promote positive mental health and wellbeing in Scotland. This professional relationship bonded Dynamis’ relationship with the client and its knowledge of the accreditation processes for vocational qualifications with the extensive experience and professionalism of the trainers from Health In Mind to create a bespoke training programme for the client organisation.

The client, a 400-bed hospital in the middle east, has a dedicated behavioural sciences institute where patients who are trying to recover positive mental health can attend to have professional assistance and help. In order to continually professionalise this service, the management team sought to have the staff undertake training in the most modern and effective approaches to nursing mental health and wellbeing.

Dynamis, with extensive experience in the Gulf region and a knowledge of the particular challenges of training in a cross-cultural environment, designed and developed a training programme which would address some of the gaps in the staff team’s knowledge base and professional practice.

The training team from Health in Mind then produced a detailed training course which would specifically challenge and develop the staff team’s attitudes and working practices in a most positive way.

Topics covered on the course included recognising the tell-tale signs of certain kinds of mental health conditions and the recommended interventions for them. The staff also spent much time discussing their own approaches and values-base in caring for their patients, along with an examination of the 10 essential shared capabilities for mental health workers as recommended by the United Kingdom Department of Health.

The Dynamis-Health in Mind team then visited to deliver the training programme - which took two weeks to deliver in its entirety - at the institute in January 2011.

The Nurse Manager of the institute was tremendously happy with the result of the training, noting that a number of staff were approaching their work in new and fresh ways, helping their clients to achieve wellbeing, adding that “The feedback from the training was very positive and I feel that it had a great impact on our nursing staff”. Follow-on training has been recommended to senior management at the hospital, to capitalise on the progress made with the staff team.

The training team also learned many valuable lessons about the similarities and differences which people with mental health issues face in a traditional Arabian Gulf society, compared to people in the United Kingdom.

The course designed and developed by Dynamis and delivered by Health In Mind trainers is entitled “Promoting Positive Behaviour in Mental Health Care” and is vocationally accredited with Edexcel as a BTEC Level 2 Intermediate Award.

For more details, contact Gerard O’Dea at Dynamis on 07814 980 348 or by emailing him at [info@dynamis-insight.com].

More information about our Gulf and Middle East experience is available at: http://www.dynamis-insight.com/International_Projects.html

Dynamis Completes BTEC Vocational Training for Care Homes in Scotland

noreply@blogger.com (www.dynamis-insight.com) — Wed, 04 May 2011 14:27:00 +0000

In March 2011, Dynamis completed a series of trainings in collaboration with WEA Scotland to deliver vocationally-accredited training to the care community in Ayrshire.

Staff from a number of care homes in the area undertook intensive training in the issues of restraint with older people and learned how to safely deal with the sometimes physically violent behaviour of some residents in care homes.

Dynamis experience in this sector underlines the need for this training, with almost 100% of staff in care homes experiencing physical violence from residents and with the high-profile news stories about abuse of restraint interventions in care homes for older people.

Dynamis, a preferred supplier in this specialised training for a number of care home groups and the ‘voice of the sector’ Scottish Care, has been delivering courses in understanding restraint since 2006, however the growth in demand for accredited training has been very strong recently.

Dynamis, with extensive experience in the sector and a knowledge of the particular challenges relating to restraint in the older-person care environment, designed and developed a training programme which would address some of the gaps in the average staff team’s knowledge base and professional practice. This course was submitted to the educational-standards and awarding body Edexcel and achieved accreditation in 2007.

More than 50 staff who accessed this programme of training in our recent programme through WEA were awarded the BTEC Level 2 Intermediate Award in Physical Restraint Practice (Older People), accredited by Edexcel and approved by the National Federation for Personal Safety. As such, they return to their workplaces as ‘specialists’ in the area of restraint.

During the course, the staff are introduced to UK law and guidance on the restriction of liberty, the use of force in defence of self or others and learn about the health and safety requirements for managing violence at work. The course is designed to help them to make good decisions, based on sound judgement, aboutt how to deal with challenging behaviours they encounter in their work.

One of the first things an attendee learns on the course is how to define actions which may be regarded as restraint. Some are surprised to learn that they regularly restrain their residents without consciously knowing it! Staff also discuss and explore modern approaches which some organisations are taking to minimise the degree to which their residents are restrained or have their liberty restricted.

Our ultimate goal in providing this training to the community is to make sure that staff are supported and enabled to work in safety while respecting the rights and experiences of the older people they care for.

Our standard course in Understanding Restraint and Safe Holding for care homes who look after older people lasts one full training day and is delivered on-site to your staff team at a competitive rate. For more details, contact Gerard O’Dea at Dynamis on 07814 980 348 or by emailing him at [info@dynamis-insight.com]

Learning Outcomes are online at http://www.dynamis-insight.com/Safe_Holding.html

Desirable Difficulties in Training : Bjork

noreply@blogger.com (www.dynamis-insight.com) — Wed, 27 Apr 2011 10:56:00 +0000

As physical skills trainers, is there something we can learn from Robert Bjork?

Much training in physical intervention skills focusses on a linear learning process which starts with 'the basics' and progresses along through 'intermediate' skill performance until full competency is reached. For example in a Breakaway training package studied by one researcher, the list of techniques taught was long and the training day was short, so the trainees were able to practice each of the many techniques for an average time of just over 6 minutes each. Six minutes to reach competency in a potentially life-saving skill!

Bjork, an educational researcher, has suggested that we make life more difficult for our learners in order to give them the best chance of competent levels of recall later on.

Here are some of Bjork's findings:

"Conditions of instruction that make performance improve rapidly often fail to support long-term retention and transfer"

...whereas

"Conditions of instruction that appear to create difficulties for the learner, slowing the rate of apparent learning, often optimize long-term retention and transfer."

In particular, Bjork has found that the use of what might be described as novel teaching models - which seem to be against common models in use - actually produce better results in the learners. (Our

BTEC Level 3 Self-Defence Instructor Accreditation course on July 27th - 29th, 2011 will be presenting drills and exercises such as these which you can use in your training)

In order to create the best long-term retention of the content in question, Bjork is suggesting that the best strategy would be to, at times, make it difficult for the learner to acquire the learning, perhaps using a
training exercise which becomes
progressively hard to accomplish or progressively randomised.

Bjork introduced the term “Desirable Difficulties” but it is important to emphasize that the difficulties introduced must be "desirable"; there are many difficulties that are undesirable both during and after learning.

Successful retrieval of information under conditions of Desirable Difficulties can be considerably more potent than, for example, an additional opportunity to study the same material again. This is because retrieved information becomes more recallable in the future than it would have been without having been re-accessed. The act of retrieving information is itself a potent learning event.

"Desirable difficulties are desirable because r
esponding to them successfully engages processes that
support learning, comprehension, and remembering."

They become undesirable difficulties, however, if the learner is not equipped to respond to them successfully. For example, we know of one training organisation whose training approach in scenario based training is to focus on correctness of technique performance, instead of an operational task-success focus. The learners are 'beasted' during the scenario training. Those we have met who have been through this process only recall the feelings of inadequacy and failure which the training experience left them with!

This kind of undesirably difficult training environment creates negative motivational issues for the learners involved and can therefore critically impact on the operational effectiveness of the training programme. Our colleague Mark Dawes at NFPS is currently developing training on the psychological preparation for operational use of force and we look forward to his always-acute insight into these issues.

Bjork again:

“it is also desirable to induce successful access to knowledge and procedures in a variety of situations that differ in the cues they do and do not provide.”

This may then have an impact upon our teaching practice for Physical Intervention and Self-Defence. We visited recently with a training cadre of instructors who had eliminated all role-play and scenario-training from their programme because they saw it as having increased risk of training injury, however during the discussion we had with them it became obvious that the instructor team actually valued the implicit learning which was occurring when they were putting their learners through scenarios which:

- required information retrieval in the form of use-of-force decision-making
- elicited operational levels of stress along with the physiological changes which happen in conflict
- gave the learners a chance to experience levels of difficulty which they had not yet experienced in 'static' training

Using scenario training, role-playing and introducing the concept of Desirable Difficulties into our training design allows us to improve the development of decision-making competency and both the physical and mental resources needed to successfully navigate unknown and unknowable future confrontations. Desirable Difficulties may help us to ensure long-term competence and therefore the safety of those who need to perform the skills we teach.

In a future blog entry here at www.dynamis-insight.blogspot.com we will address some other aspects of teaching practice which improve performance of physical intervention skills, such as how to incorporate progressive intensity into the training experience.

Want to know more?

We will be running the BTEC Level 3 Self-Defence Instructor Accreditation course on July 27th - 29th, 2011. The course will provide progressive self-defence, breakaway and officer safety instructors of all kinds with a framework for teaching self-defence which is legally sound, risk-aware and has a basis in the science and psychology of inter-personal conflict.