Physical interventions: Code of practice
Sharon Powell
(published as "A New Code for Physical Interventions" in Learning Disability Practice, Vol 5 no 5 2002, with permission)
I trained as a nurse for people with learning disabilities in a Lincolnshire
hospital in the mid 1980’s. The management of people with ‘challenging
behaviour’ was barely covered in my training, in fact I distinctly remember just
one specific lecture, delivered by a particularly energetic clinical tutor who
in his enthusiasm to gain our attention managed to pull a curtain from it’s
rail!
I don’t recall any specific lectures detailing the management of aggression,
prevention and responses to it or the use of physical intervention when all
positive management strategies had failed. This experience is also reflected in
the recent UKCC consultation document, Therapeutic Management of Violence and
Aggression, 32% of respondents reporting that they had received training in
breakaway techniques during pre registration education.
What I do recall as a young inexperienced student nurse was both witnessing
violence and aggression and becoming involved in incidents in which nurses
forcibly held residents. There was very little discussion following such
incidents and the recording was minimal. I don’t recall witnessing purposeful
poor practice or abuse of people, but I certainly wouldn’t argue that many of
these responses were examples of best practice or an individualised response
which had been appropriately risk assessed.
In the intervening years the approaches to the support of people who have
challenging behaviour have developed and changed to include functional analysis,
proactive approaches to individual support and behaviour management strategies.
There has also been pressure from researchers, trainers, professionals and
service users to develop framework with reference to the use of Physical
Interventions in learning disability services. In 1996 BILD published Physical
Interventions a Policy Framework, this rapidly became a best selling
publication, it offered a framework for the development of policies relating to
the use of physical interventions and outlined an appropriate values base. Real
momentum was added to the development of a framework following the broadcast of
an undercover film exposing the abusive treatment of people with learning
disabilities in their own home, (MacIntyre 1999)). BILD continued to develop the
framework and was working on developing a Code of Practice for trainers in
Physical Intervention.
The work which BILD was undertaking was assisted by funding from the Department
of Health and Department for Education. The Department of Health also
financially assisted in the publication of Training Carers in Physical
Interventions, Allen (2001).
In October 2000 the draft guidance for the use of physical interventions was
published for consultation with the consultation process finished, the guidance
is eagerly awaited as another component of the emerging framework. BILD launched
the Code of Practice for trainers in Physical Interventions in April 2001. The
Code outlines the responsibilities of both trainers in physical interventions
and commissioning services. It is anticipated that the wide spread
implementation of the code will lead to:
Greater consistency in approaches to training
Higher standards in the delivery of training
More effective monitoring of training
Increased clarity in the responsibilities of both trainers and commissioners.
It is also expected that the following benefits will emerge:
Improved training outcomes
Increased staff skills and confidence regarding the use of physical interventions
Decreased injuries to service users and staff
A reduction in the use of physical interventions
The Code of Practice is explicit in detailing what is regarded as best
practice, it is important to note however, there is a need to improve the
quality of our knowledge base concerning reactive behaviour management (Allen
2001)
BILD has continued to build on the principles within the Code of Practice in
developing the emergent Accreditation process that will accredit training
organisations that deliver training in physical interventions. Organisations
that place a submission before the BILD accreditation panel will have to submit
sufficient evidence to prove that they operate within the standards of the code
through:
Written submission
Pre-panel assessment
Oral presentation
Questions and answers
Written submission requires the organisation to submit information in 8
sections. In formation required includes the historical development of the
training model, including the rationale for the physical component, including
reference to the evidence baser which has informed the development of the
programme. Organisations are also expected to provide evidence of an appropriate
values base and the context in which the physical component is delivered, for
example how much of a 5 day course is balanced between theory and practical
taught element. Organisations must also prove that they are continually auditing
the training provided and developing the training offered in light of such
evaluation.
The pre-panel assessment follows the criteria specified within the BILD Code of
Practice and is undertaken during a training course. The internal assessor,
employed by BILD, will follow a set of criteria which will provide evidence that
the organisation is delivering training within the standards in the Code of
Practice. The criteria include elements of monitoring and performance,
professional conduct as well as best interest criteria.
At the Panel Meeting all applicants will deliver a 10 minute presentation which
outlines how the BILD Code of Practice is incorporated to the Training
Organisations Programme. The panel will consist of a minimum of 4
representatives; there will also be BILD employees in attendance as well as
observers form DoH and DfES. The panel meeting will also be an opportunity for
panel members to ask questions of the applicant on the whole submission.
The criteria within the accreditation process are taken directly from the Code
of Practice enabling the emerging framework to be consistent it’s approach to
the training in the management of challenging behaviours. Organisations will be
found to either meet or fail to meet the criteria. Any organisations that do not
meet the criteria will be able to re-apply within 12 months. Importantly there
is an appeals process in place and training organisations can appeal against the
panels decision.
It is hoped that the development of the emerging accreditation system will
enable commissioners to make a more informed choice when commissioning training
in physical interventions as well as improving the overall quality of training
offered. With increased standards and a process for monitoring the delivery of
training in the management of people who challenge services, it is also
reasonable to argue that this process should have a direct effect on practice
and impact on the lives of people with learning disabilities, autism, special
educational needs and emotional and behavioural difficulties.
As a profession we are now in a position to discuss, influence and change
approaches in training staff in the management of aggression, it is vital that
the debate surrounding this ethically difficult area continues if we are to
influence research and practice in the future.
References
Allen D (2001) Training Carers in Physical Intervention: Research towards
evidence-based practice. Kidderminster BILD.
MacIntyre D. (1999) MacIntyre Undercover.One Man Four Lives. London BBC
Harris et al (1996) Physical Interventions a Policy Framework. Kidderminster
BILD
Code of Practice for Trainers in Physical Interventions (2001) Kidderminster
BILD.
The Recognition, Prevention and Therapeutic Management of Violence in Mental
Health Care; a consultation document. Professor Keving Gournay CBE. U.K.C.C
London.
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