A system which has helped reduce restraints from 76 in a 12 month period to just 7, increased attendance to 86.5% in a school for Looked After Children where previous attendance of individual students was often less than 10% and totally eliminated the need for exclusion.*

RESTRAINT REDUCTION TRAINING with ZEB GLOVER

All school settings should aim to develop proactive strategies which help reduce the likelihood of behaviours that challenge, leading to the use of restrictive interventions and focus on improving the safety and well-being of vulnerable childrenand young people. Such strategies should be based on a good understanding of learning disabilities, autistic spectrum conditions and mental health difficulties and of how children and young people affected by them are at heightened risk of displaying behaviours that challenge. Effective behaviour strategies address how school staff will be trained and developed in providing positive behavioural support.  That includes contributing to behaviour support plans which should be carefully crafted for individuals whose behaviour challenges. It is essential that strategies and staff practice are kept under review so that changes can be made based on evidence of what has worked and what has not worked in practice.

Some schools have shown that it is possible to achieve significant reductions in the need to use restraint and restrictive intervention through targeted reduction programmes. More and more services are reducing the incidence of aggressive behaviour with less restrictive approaches.  Teams should consider developing their own detailed restraint reduction programmes as part of their wider approach to behaviour strategies and, as part of those programmes, should give particular attention to securing appropriate training and development for staff.

There is a popular and recommended “Six Core Strategies” framework for reducing physical restraint in an organisation.  The Six Core Strategies are:

• Leadership toward organisational change;
• Using data to inform practice;
• Workforce development;
• Using prevention tools;
• Service user involvement;
• Post-incident debriefing and review.

I recently spoke to Restraint Reduction lead trainer and veteran Conflict Management trainer, Zeb Glover, and asked him about the goals for restraint reduction training. 

“Restraint reduction training leads to a movement within an organisation to reduce restraints.  Another way of putting that would be that we want to effect a change of focus, emphasising prevention rather than accepting that our people simply react to behaviour  and where we normalise confrontation and the management of the resulting physical risks.”

Staff who work with vulnerable children or adults often develop tacit knowledge about what the triggers for distressed behaviour are and the changes the people they look after go through when they are no longer coping with a situation. One key aspect of restraint reduction is in capturing that knowledge and converting it into useful information for other members of the team to use.  They can then make changes to the person’s care and environment, to reduce behaviours of concern.

“We want to try to prevent the people we look after from being triggered in the first place.  The focus of restraint reduction training is on understanding the cause and the effect, whereby unmet needs are at the very core of the behavior.”

Staff are often really good at spotting service users’ emotional state and behaviour – the unmet needs, the feelings and behaviour engendered by those unmet needs, the triggering event(s) and the observable cues which are the ‘tell’ to what might be going on.

Zeb is very clear that the focus of the Restraint Reduction approach must dive deep enough into the needs of the individual, so that the fundamental, core drivers for the behaviour we see can be understood by staff and clearly explained, so that we can approach those needs as a team and work in the direction of meeting those needs.

Prevention – Better than Cure

Once we have identified the person’s core needs, we have a much better chance of then pre-empting these high-stakes situations without the need to use protective physical interventions.

“We are looking deeper into the causes of distress, to try to prevent conflict from originating in the first place. At the moment there’s a very current need for this type of training. On the one hand, some staff are perhaps too ready to use physical restraint – because it is their most trusted measure to control risk.  The focus of this training intervention, and the implementation of the system, is that we want to try to take a broad view, to prevent the distressed behaviour from happening in the first place.”

Physical interventions carry high risk from several points of view.  Recent exposés have uncovered toxic work cultures among teams for whom physical restraint becomes an accepted norm.

However, a standards-linked process can help managers to map their frontline staff day-to-day activity with regular reviews of the frequency and severity of restrictive practices.  Restraint Reduction training offers a systematic approach to effective problem-solving and authentic documentation of the effort going in to such preventative measures.

Standards-linked paperwork and collaborative sleuthing, to uncover the roots of behaviours contribute to the main goals of the programme.

“We simply don’t want things to get physical – incidents that escalate into the violence phase aways carry elevated risk.   Several standards were updated in 2019  – from Ofsted, from the RRN.  What inspectors and regulators want to see is evidence, a strong auditable paper-trail of how we are managing challenging behavior incidents, and what we are doing to prevent those incidents from happening in the first place. Restraint Reduction training offers a systematic way for efforts in reducing restrictive practices to be tracked and mapped across to those standards.” 

For years my team and I have taught a 7-phase model, based on the original Kaplan-Wheeler Assault Cycle and originally inspired by the work of Ellis Amdur, infused with concepts from brain-based coach David Rock, for conceptualising the timeline of a violent incident.

There may be a missing piece on the standard model though, which I often illustrate by scrawling a huge, expansive bubble on the left of the graph, with the word “context” within it – this time inspired by our deep-linked partnership with global conflict management experts at Vistelar and their 6xC model, which starts always with a prompt for the frontline staff to consider Context.

Context can mean traumatic events in the person’s past.  It can mean adverse childhood experiences.  It asks about attachment difficulties.  It sometimes points to a chaotic home environment, including the Toxic Triad. It begs a need for our training interventions to be Trauma Aware and to understand the issues around Compassion Fatigue for carers and frontline workers too.  It may even pose a question about the physical environment.

Understanding Needs and How the Person Seeks to Have their Needs Met

Looking at individual service users specifically, Zeb is guided by principles from renowned conflict mediator Marshall Rosenberg.  

“Marshall Rosenberg directs us to understanding that conflict arises from unmet needs and that these needs are Universal.  It isn’t the needs that are the problem… as we all have similar needs at certain points of our lives.  Conflict is normally focused around the Solutions to how we try to meet our needs.  It’s the strategies of meeting needs that we may disagree upon with each other, not the actual needs themselves!  I find his work really helps people dis-tangle the chaos of communication and conflict, to better understand it, which in turn helps us prevent conflict in the first place and reduce the incidents of restraint.”

Once a team has Context and starts to see these core unmet needs, they may start to work “Left of Bang”.

Working Left of Bang

We’re trying to work as far left of the “bang” moment as possible. Being left of bang is doing what is needed before the crunch moment happens (“bang!!!”) and reduce the chance that we will arrive there at all. A lot of training necessarily focuses on what happens after the “bang” moment. The escalation into a physical confrontation – and of course some training will have to address that – but there are big opportunities to prevent and defuse those decisive moments before they arrive. This training encourages teams to explore the space as far “left” in the timeline as possible, so that the very origins of why this behaviour is happening in the first place can be better understood. The result is an alternative to just reacting to crisis behaviour with a kind of war mentality of “us” versus “them”. Instead we encourage teams to dig deeper into understanding the cause of that behavior and those unmet needs.  This shift is so important if we want to reduce the frequency of crisis behaviour. I am fascinated with the left of bang concept – it asks of us that we read the indicators in people’s behavior, looking for signs which can warn us of where a situation is leading to, and additionally exploring the impact factors which far precede that moment, to discover “what caused this in the first place?” 

Our mission at Dynamis is to contribute to our clients’ services and help them in Keeping Everyone Safe, particularly where there are high-stakes, frontline encounters which could impact on the wellbeing of every person and stakeholder involved.

Keeping everyone Safe therefore means we must extend our focus to the Contextual impact factors of conflict, distress or dangerous behaviours, to better understand them and to enable your team to create supportive atmospheres where incidents of concern happen less often, and with less risk.

www.dynamis.training/restraint-reduction

*with thanks to Nichola Lochery

The ABC System of Restraint Reduction has produced the following results:

“It reduced restraints from 76 in a 10 month period to 7, increased attendance to 86.5% in a school for LAC where previous attendance of individual students was often less than 10% and totally eliminated the need for exclusion”

Shazia Sawaar Azim, Headteacher Meadows School.

“What you have brought to the table at Eden has reduced the total of physical interventions by 86.7% and increased the overall attendance from 65% to 87.9% whole school.”

Chris Ford, Behaviour Lead, Eden School.

“We were able to reduce the number of bedwatch officers on the ward from 8 to 1 within 3 months of introducing the training in the behaviour management system. Ward staff were much more confident and able to manage the challenging behaviours presented to them by patients.”

Tommy Higgins ASMS Security and Car Parking Manager, Manchester Foundation Trust.