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CPU European conference 2014


CPU European conference 2014 SAFER services: Defining our own pathways to reduction goals. Karl Tamminen Humber Trust So where do we start? Owning change? – PowerPoint PPT presentation

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Title: CPU European conference 2014

CPU European conference 2014
  • SAFER services
  • Defining our own pathways to reduction goals.
  • Karl Tamminen
  • Humber Trust

Practice innovation.
  • What is this presentation about?
  • Dispelling a few myths.
  • Challenging a few assumptions.
  • Not about teaching people how to suck eggs, but
    discussing alternative perspectives.
  • Ideas for changes in the ways service users and
    staff work together.
  • A pathway to closer, more productive working
    relationships between service users and staff
    which serves to reduce engagement in restraint .

.But first a couple of questions.
Question 1
What do the following things have in common?
What do the following have in common?
  • Question 2

What do these people have in common?
What do these people have in common?
The quiz answersWhat do they have in common?
  • Answer one These are all reasons people have
    been restrained,

Answer two These are all people who have
tragically died, following restraint (initiated
for the above reasons).
Was that a surprise?
Which are valid reasons to engage in restraint?
What do these people have in common?
Myth or true?
  • Restraint and seclusion are never used as
  • Restraint and seclusion are always used as a last
  • Restraint and seclusion are a valid treatment
  • Restraint and seclusion are the main tools we
    have to maintain a safe environment.
  • When we utilise restraint or seclusion we are
    always acting within the legislation.
  • Professional practice is about developing and
    improving the way we use restraint and seclusion.
  • There is no evidenced based alternative to
    restraint and seclusion

who Age/ when where why outcome
Adam Rickwood 14 (2004) Hassockfield Secure Training Centre in County Durham UK. Refused to move from the table he was sitting at with friends Psychological impact of restraint. Nose punch technique. Terrified child. Found dead by hanging in his bed space after resolution of restraint/ seclusion.
Angelika Arndt 7. (2006) Children's Hospital in Minneapolis (US) Refused to stop gargling milk. Fell asleep in seclusion, restrained to ensure she learned her lesson Restraint as a consequence. Restraint to reinforce positive behaviour and disincentives negative complications from chest compression asphyxiation and said the restraint hold used by the staff at the centre may have contributed to her death.
Gareth Myatt. 15 (2004) Rainsbrook Secure Training Centre (UK) Refused to clean out a toaster when directed by prison staff Positional asphyxia
who Age/ when where why outcome
David (Rocky) Bennet 41 (1998) UK Altercation with fellow patient around phone use. Racist language used ." Mr Bennett's capacity to breathe was restricted and the restraint "continued for substantially longer than was safe".
Jacob Michael 25 (2011) UK Called police for support, he refused to come out of his bedroom and threatened when police responded Up to eleven police personnel. Pronounced dead when taken into custody. Verdict misadventure
Faith Finlay 17 (2008) US Damaging her own property in her own room Prone restraint. Positional asphyxiation
Edith Campos 15 (1998) US Refused to hand over family photograph (personal possessions against policy) Positional asphyxiation
What are the facts in the British cases?
  • The People Who Died
  • ? The people who died ranged in age from 9 to 95
    years old.
  • ? Nearly one-third of those who died were over
    the age of 65, with 14 seniors over the age of 80
    at the time of their deaths.
  • ? The four youngest children to die in restraints
    were 9 years old.
  • ? Almost three-quarters of those who died were
  • ? Nearly 75 of those who died had a psychiatric
    history, with the most common known diagnoses
    being schizophrenia, other psychotic disorders
    and mood disorders.
  • ? More than half of those individuals admitted
    with a psychiatric diagnosis had been admitted
    for psychiatric treatment on three or more prior
  • ? Twenty-five percent of those who died had a
    history of intellectual disabilities, learning
    disorders or other developmental disabilities.
  • ? Nearly half of those who died had limited or no
    communication skills, due to medical
    circumstances that limited their awareness or
    The Lethal Consequences of Restraint (2011))

The IAP reported that between the 1st January
1999 and the 31st December 2009, there were 6,151
deaths in state custody in all services. In 22
of these cases, restraint was involved Table 1
Deaths by age range
setting No of restraint related deaths Age range 11-20 21-30 31-40 41-50 51-60 61-70 71-80
prisons 1 0 1 0 0 0 0 0
Secure Young Peoples estates 1 1 0 0 0 0 0 0
Immigration Removal Centres 0 0 0 0 0 0 0 0
Police 15 0 1 6 3 2 1 1
In-pt mental health setting 5 0 2 3 0 0 0 0
TOTAL 22 1 4 9 3 2 1 1
(No Transcript)
Why do we need to change?
  • People die whilst being secluded and restrained.
  • People are injured whilst being restrained and
  • People suffer harmful psychological affects
    whilst being restrained and secluded.
  • People have flash backs about restraint and
  • For the main part neither staff or service users
    like to engage in restraint or seclusion.
  • Restraint and seclusion, as a measure of risk,
    can keep people in Mental Health services longer.

I am here today to talk about the ingredients of
a restraint and seclusion reduction programme.
  • Restraint and seclusion is seen as a normal,
    expected and natural part of every day life
    within a mental health unitdo you think that is
    how it has to be?

What is the current and predominant approach to
  • 1. Have we trained people correctly to avoid
    injuries and to give people the tools to maintain
    a safe and effective working environment?
  • 2.Do we have the paper work necessary for
    defensible practice?
  • In short do we do it right and can we evidence it
    was done correctly?
  • Thats fine as far as it goes, but what we
    seldom ask is why did we end up restraining in
    the first place?

Challenging the status quo?
If the training and the paper work is correct
  • Is this a case of its not broke so dont fix it?

  • No. It cant be.

People ask me the same question
  • You know about restraint and seclusion Karl, got
    any tricks we could use to change the patients

The answer?
  • The trick, if there is one, is to change the
    question, its not about changing the way patients
  • ..Its about changing the way we behave.

Is there another way?
  • Yes

Who has written about other ways?
  • Dr Bennington Davis and Dr Tim Murphy pathway to
    restraint free services (engagement and
    empowerment model)
  • Dr Sandra Bloome finding sanctuary (recovery
    focussed model)
  • Ann Alty and Tom Mason break with the past
  • Joy Duxbury,

Empowerment and engagement model is used in the
Salem Hospital Oregon and the recovery focussed
models are used across all the hospitals in
Pennsylvania and Oregon.
Salem hospitals They attempted to reduce across
both fronts
The changing trend from 1994
The Salem Oregon project
Pennsylvania across all hospitals and fronts
area one
Area two mechanical restraints
Area three physical restraint
So where do we start?
  • Owning change?
  • Who needs to own it?
  • Trust board? Clinicians? Service Users? Families
    and carers?
  • In short..We all need to own it and champion it
    in what ever way we can. If we dont all make the
    process of change our ownthen it will not happen.

Identifying the layers of change
  • Policy and procedure (embedding change)
  • Daily rituals of practice
  • Engagement of staff and service Users
  • Approaches to restraint
  • Avoiding inappropriate restraint
  • Remaining empowered to restrain as a last resort
  • Utilising data to inform practice
  • Education and training
  • Support and reflection
  • Creating a learning, sharing system

Pathway to restraint free serviceswhat are the
  • Reclassify restraint and seclusion are not
    treatment options they represent treatment
    failures and breakdowns
  • Intensify Scrutinise restraint. (use evidence
    and data to learn/ develop improve) feed that
    data into practice.
  • Choices Give staff alternatives and service
    users more meaningful choices.

Pathway to restraint free serviceswhat are the
ingredients? Cont.
  • Clinical focus engage with Service Users and
    Care plan for a restraint and seclusion free
    therapeutic environment.
  • Practice focus examine the daily lives of our
    service Users, identify points of avoidable
    conflict and develop new ways of running wards
  • Operational focus directors and managers need to
    get behind the change, own it and support it.
  • Reflect and relearn Where it does happen, learn
    from it and plan try different approaches to
    avoid in the future. (restraint and seclusion
    reduction group)
  • Break the mould Dare to be different.

Pathway to restraint free serviceswhat are the
ingredients? Cont.
  • Reinvent Be the pioneers for services by
    introducing innovative, ground breaking, evidence
    based approaches to violence and aggression
    management which sets the tone for all other
  • Archaeology Take up the challenge to unearth the
    evidence and generate the evidence that this
    approach works.

Pathway to restraint free serviceswhat are the
ingredients? Cont.
  • Support Management and clinical leads need to
    support staff in innovative approaches as
    alternatives to restraint and seclusion.
  • Empower Empower and engage with service users in
    new and innovative ways which do not blur
  • New philosophy Move away from staff total
    control to shared responsibility for maintaining
    a safe environment. (within the professional
    envelope we retain responsibility for)

Why us? Why here?
  • There is at least twenty years of evidence out
    there that the foundations of and the ingredients
    to alternative approaches which we have discussed
    here is sound.
  • Its not easy, there are no magical solutions,
    successes are born out of hard work, positive
    risk taking, making mistakes, learning from them
    and addressing the challenges again and again

Why us? Why here?
  • There is no step by step guide that cam take us
    through each aspect on a guaranteed pathway to
    seclusion and restraint reduction and
    elimination.. but there is a framework.
  • We have the skills to do this.
  • We are ready for the challenge.
  • We are ready for change.

So what about the Humber Centre project?
  • We know where we want to get to the position
    where seclusion and restraint are indeed a last
    resort intervention.
  • We want to minimise last resort scenarios
  • We know where the evidence is of what works and
    we will use it to build our new approach.
  • We want to work collaboratively with our service
    users to develop new approaches which are
    embraced by staff and service users, and are
    effective for us.

We are treading our own pathways to restraint and
seclusion free services.can you see yours?
  • Any questions?
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