York 2009: BILD sets new mission to challenge restrictive practices
Report on the BILD Positive Behaviour Support Conference,
York 7 - 8 May 2009
The
9th Positive Behaviour Support conference was hosted by BILD in York over the 7
- 8 May 2009. Attracting just over 100 delegates the event focussed on
highlighting positive approaches to supporting individuals who challenge
services and reducing the use of restrictive practices. The conference was
addressed by Ann Williams, National Director for Learning Disabilities.
Opening Remarks
The event opened with the welcome return to the event and key note speech
from Professor David Allen: Identifying Important Issues Now. The paper
discussed:
• The historical background related to behavioural support
• Achievements in the field to date
• Where the agenda is currently and the challenges
• Future agenda and work to be undertaken
Acknowledging
the achievements of BILD to date Professor Allen identified the publication a ‘A
Policy Framework’, Harris et al (2006), first published in 1996 as an important
milestone. As a result of the publicity surrounding the Macintyre Undercover
programme the work of BILD was furthered. The ‘BILD Code of Practice’ was
published in 2001 and the Physical Intervention Accreditation scheme was
launched shortly afterwards. Professor Allen suggested that although this work
was important, and had an impact on the field it may have also resulted in some
‘unpleasant’ side effects:
• Reactive management has become the focus for many organisations
• The proliferation of training providers in the field of restrictive physical
interventions
• The focus is in fact how to ‘restrain better’
In itself this may not be helpful in supporting services to become more
person-centered and may reinforce the reactive nature of service delivery.
Professor Allen stated that the focus must be ‘how to restrain less.’ This can
be achieved by focussing on aspects of service delivery that are identified in
restraint reduction, ensuring the focus is on positive behaviour support as a
service system and supporting staff to develop skills. In his summary Professor
Allen also highlighted other related topics that had not received as much
attention as they ought including mechanical restraint, support for families,
the use of ‘calming rooms’ and medication. The lack of robust research remains a
concern in this field and was highlighted throughout his key note.
Professor Allen emphasised the need for strong leadership in the field.
In
reply to the opening key note Keith Smith, Chief Executive of BILD shared his
pride in what had been achieved over the past 10 years, in which BILD's
expertise had contributed positively to policy development and the improvement
of practice through the Code of Practice and the Policy Framework. However,
Keith asked the question as to whether BILD was now providing answers, or had we
become part of the problem. By focussing on training around physical
interventions, had we contributed to their use being seen as a justifiable
response?
He acknowledged
that BILD had reassessed the agenda in the field of positive behaviour support
and as a result had ensured that one of its new key development manager
positions be in the field of Positive Behaviour Support.
Keith Smith then challenged the conference by outlining the key areas that BILD
will now be addressing, including:
- providing leadership in this field, being clear about what is good and bad practice
- being ambitious for the seldom heard - it was simply not good enough to control and contain people in residential placements, we should be concentrating on people 'getting a life' and we should be concentrating on behavioural change, risk reduction and improving the quality of of people's lives.
- focussing on positive behaviour support
- learning how not to 'restrain better' but 'restrain less'
- challenging dangerous practices, and making sure that BILD champions positive practices.
He also launched BILD’s new Positive Behaviour Support Mission statement:
It is BILD’s mission to:
| 1. | Make sure that all people with learning
disabilities can exercise their human rights and be valued members of their local communities. |
| 2. | Focus on vulnerable and disadvantaged
groups including: - People with complex needs - People from black and minority ethnic communities - People with autism - Offenders and those in the judicial system |
| 3. | Work in partnership with families, carers, friends and the key individuals in people’s lives. |
| 4. |
Ensure that people’s individual communication needs
are positively |
| 5. | Develop and promote an evidence base for practice. |
| 6. | Develop a framework of good practice guidance that focuses on positive behaviour support and person-centred planning. |
| 7. | Identify, disseminate and promote good practice in reducing the use of restrictive practices and the implementation of positive behaviour support. |
| 8. | Educate all stakeholders that the use of restrictive practices is potentially dangerous. |
| 9. | Eliminate the use of unnecessary restrictive and aversive practice. |
| 10. | Ensure that appropriate training and learning opportunities are available for all staff and supporters. |
He discussed some of the achievements for BILD over the past 10 years or so
in the field. Keith also acknowledged some of the issues highlighted by
Professor Allen in his key note and gave a commitment to drive the agenda
forward. Restrictive Physical interventions must be a small part of the agenda,
not become ‘the agenda.’
BILD intends to take this agenda forward - the mission statement is the
public statement of that intention.
Further Key Note speakers
Professor
Robert Heron is Director for Learning and Development and the Centre of
Excellence for Behavioural Support at the University of Queensland. The centre
provides state leadership in policy, research; evidence based practice and
provides opportunities for learning and development.
BILD
Trustee and Clinical psychologist Professor Nigel Beail addressed delegates on
the topic of trauma-informed care for people with intellectual disabilities. The
co-author of the first published paper on the topic in 1995, he identified that
the impact of early life trauma as a result of abuse is the same for people with
intellectual disability as in the rest of the population. In addressing
delegates Professor Beail stated that in the absence of any evidence, and
especially where a person has difficulty in communication, support teams should
make an assumption that a person may have experienced early life abuse and
trauma as a result of this.
BILD
Development Manager for Human Rights, Liz Brooks spoke to delegates on the
Thursday highlighting the implications of the Mental Capacity Act 2005 and the
recently implemented Deprivation of Liberty Safeguards. The keynote gave an
overview of both Acts and stressed the issues which were of relevance to
behaviour support and restrictive practices. Defining the use of restraint as:
‘The use or threat of force to make someone do something they are resisting or
restricting a person’s movement’, Liz also stressed that appropriate restraint
falls short of deprivation of liberty, this was a issue which was also raised in
workshops and there was much discussion amongst delegates on the topic of how
one can make a judgement about what may be appropriate and that guidance in this
area is still very sparse.
Mixit up into a moveable feast of entertainment
Throughout
the conference the entertainment was laid on by 'Moveable Feast' who
provided great delight at lunchtime on Day 1 in setting out how one member could
be completely 'care packaged' - including post-it note mask and red tape hat!
In
the evening, now as 'Mixit', they provided a fast-paced show of music and
dancing. Faced with a stream of pop anthems and club classics some delegates
couldn't keep off the dance floor, even though they were warned - begged in some
cases - not to.
Information about
Mixit can be found at: www.mixitmusic.co.uk
Leadership Key Note
The
event's leadership key note address was given this year by Anne Williams,
National Director for Learning Disabilities. Anne spoke to delegates and was
clear that the objectives of Valuing People Now will ensure that everyone is
included, especially people described as having complex needs, including those
people who challenge services. Others who are identified as people whose needs
must be addressed include those who offend, including those in custody, people
on the autistic spectrum and people with complex needs. Ann stressed the
importance for services to be ready to respond to the needs of people with
learning disabilities including global services such as acute healthcare
services and GPs.
In turning a vision into real practice Anne stressed that services must know the needs of the people they are supporting, ensure that organisations work in cooperation with each other to provide person-centred services and identify the resources necessary. In ensuring person-centred approaches, Ann drew delegate’s attention to the real meaning of the word, ‘it’s not a document or review’, and gave some real life examples of how important it is to work with people and support them to achieve the life they aspire to have.
To turn the vision into reality we must:
• Lead the vision of rights, independent control and inclusion
• Develop joint commissioning strategies
• Be aspirational
• Ensure services for children work to support transition
Concluding Key Note
The
concluding key note was given by Dr Andy McDonnell who kindly took the place of
a speaker who was unable to attend. Addressing delegates on the topic of applied
behaviour analysis and the use of positive behaviour support, Dr McDonnell added
a note of caution stating that support must be more than just a grand title but
had to consist of appropriate and individualised strategies aimed at enabling
the person to have the life they aspire to. In opposition to services being led
by fashion or fad Dr McDonnell highlighted the lack of relative research in the
field and the need for effective leadership within organisations that support
people.
Workshops
Over the past 10 years the workshops at behaviour support conferences have
proved to be exceptionally popular with delegates. This year was no exception
with a delegate commenting:
‘the workshops I attended this year were the best I have attended, having
attended 4 previously.’
One
of the most popular workshops was delivered by service user Paul Moores, a
published author, he spoke about his experiences of self injurious behaviour and
why he pursued this behaviour. Of primary importance Paul told people that he
found it difficult to speak to people about how he felt. Paul told delegates he
had both witnessed and been the victim of domestic abuse. This experience had a
significant impact on how he felt about himself as a person and often couldn’t
express himself. He found that if he resorted to self-injury people would
respond to him. He also spoke poignantly about the negative attention this
behaviour would attract, both from other services users and staff who were
supporting him. This also had an impact on Paul, causing him to feel ‘worthless
and stupid.’
Two workshops explored supporting families and carers, this is a very current topic. One, presented by Simon Kemp discussed relevant research and how we might better respond to families in crisis.
The
second, presented by Elizabeth Watkins-Groves and Mark Wakefield discussed the
development of the recent BILD publication Supporting Parents and Carers and how
it is being used by family carers.
On the theme of families, Alison Cowen gave a helpful insight into the use of an individual budget to support people in creating a life for themselves and their families!
Other workshops explored how the use of restrictive practices could be reduced, by delivering a range of training opportunities to staff teams and changing the frameworks within which people work.
Workforce
development was the topic of a workshop delivered by Edwin Jones; this stressed
the importance of skills development for the whole team. The workshop was
supported with materials from the distance learning project developed by Edwin
and his colleagues.
With an emphasis on reducing the use of restrictive practices
John Glover and Bert Lawrie delivered two workshops that explored different models for achieving this goal in services for children and young people. Both workshops emphasised the importance of introducing behaviour support strategies and the challenges they faced in introducing new approaches.
Anne Williams highlighted the problems many people with learning disabilities experience in accessing healthcare; Debbie Townsend presented a workshop which explored how people could be supported to access healthcare using an appropriate framework, underpinned by the mental Capacity Act. The workshop gave consideration as to when it may be necessary to use physical intervention to support access to healthcare and identify good practice.
Conference Summary
Sharon
Paley, Development Manager for Positive Behaviour Support at BILD gave a short
concluding summary. BILD has used this event to launch a new strategy in
relation to behaviour support; this will be implemented immediately with the
launch of the new behaviour support website. Emerging themes from the event
included:
• The importance of effective communication in supporting individuals
• Workforce development
• The emphasis on reducing restrictive practices
• The importance of leadership in services
In the next 12 months BILD will
• Publish and launch ‘Ethical Approaches to Physical Interventions, Vol II’
• Review and publish a new Code of Practice
• Launch work on restraint reduction
• Convene a research group
• Update relevant publications and add new publications
• Update the behaviour support factsheets on the BILD web site
• Deliver a new series of Positive Behaviour Support events
• Deliver the second annual leadership event in December 2009
• Host the first International Positive Behaviour Support Event
Sharon believed this change in direction will reenergise interest in the work of
BILD and take the agenda forward. She called for delegates to sign up to the
mission and support BILD in taking the agenda forward.
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Page ref: 'York conference report' Owned by: enquiries@bild.org.uk Last updated: 06/05/2010