Search results

The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the national Positive and Safe programme.

The strategy was comprised of three primary interventions – Safewards, positive behavioural support and data-informed practice – and utilised a programme management approach to ensure effective delivery. Baseline measures were collected from 12 months of data prior to implementation of the programme and the frequency of each category of restrictive intervention was then measured prospectively on a monthly basis throughout the duration of the programme.

Upon completion of the programme the following results were achieved: elimination of prone restraint – elimination of mechanical restraint – 42 per cent reduction in general use of restraint – 42 per cent reduction in use of seclusion – 52 per cent reduction in rapid tranquilisation.

The paper adds to the growing body of evidence that carefully designed interventions can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the need for a stable workforce is considered.

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

Sensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users and potentially avoid the necessity for coercive practices such as seclusion and restraint. Despite the growing use of this intervention, there has been limited research exploring the implementation of sensory modulation at an organisational level, both internationally and within the New Zealand context. The purpose of this study is to investigate the implementation of a sensory modulation programme in two New Zealand inpatient mental health services using an exploratory organisational case study design.

Organisational case study design methodology was used to explore the implementation of a sensory modulation programme in two New Zealand acute adult inpatient mental health services. This study explored how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation. Cases were described and examined the pattern of findings.

Strategies found to support implementation were identified at environmental, organisational, group and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility and leeway in staffing levels to support training attendance and responsiveness to crises.

The facilitators and strategies highlighted in this study may be used to support the design and implementation of future sensory modulation programmes in New Zealand and internationally.

The complexity of factors that influenced the implementation of the sensory modulation approach within an inpatient setting made determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.

Disruptive and potentially unsafe classroom behaviours such as threatening, bullying, verbal and/or physical assaulting present challenges not only for teachers, aides and other students in the classroom, but potentially for all others in the building as well as the families of those students/pupils involved. These behaviours can greatly influence a student's ability to achieve academic success as well as place undue stress and risk on others in the milieu.

Discovering the cause for the behaviours and then developing a plan to help these young people succeed emotionally will greatly increase the probability for improved academic achievement. This chapter will examine the core principles of the Therapeutic Crisis Intervention for Schools (TCIS) programme and present a range of evidence-based responses designed to help build upon and further develop staff skills in preventing disruptive behaviours, de-escalating potential disruptive behaviours, and teach students how to develop less disruptive and more appropriate responses to their lack of or inability to self-regulate.

This chapter will contend that the foundation for all interventions and responses presupposes an accurate assessment of risk for the youth(s), the adults, and the environment. That any risk assessment must consider the internal (effects of trauma, ability to self-regulate, cultural issues) and external (organizational culture/climate, level of restrictiveness, caring community, quality of instruction) setting conditions for the youth.

The TCIS programme is embedded in the five domains for effective crisis management; leadership and building support, social work and clinical services participation (social workers, psychologists, therapists, nurses), building administration and post crisis response, training and competency standards, and data-driven incident monitoring and feedback.

Traditional methods of addressing workplace violence have relied almost solely on reactive measures. Methods of de‐escalation, strategies to calm the already distressed person down by means of positive communication, or responding to an actual or potential act of violence by means of physical control have formed the focus of training initiatives provided for staff. This approach has suggested an acceptance of the premise that violence in certain services is an inevitable problem that must be managed. This paper proposes that many incidents can be prevented and outlines the emerging evidence to support a structured, holistic approach. Additionally, it provides an overview of the recent policy agenda, the evidence base and examples of some recent and ongoing development work that attempts to change practice.

A small but significant number of people die during restraint by hospital staff, police or prison officers. One possible mechanism for this has been termed ‘positional asphyxia’. There is literature to suggest that deaths that occur in circumstances involving restraint may be related to certain positions, but early research has been contested. This article presents a balanced review of the literature and findings and concludes that the evidence remains unclear. However the literature does point to practical measures that should be adopted by those whose work is likely to require restraint of extreme violence, to avoid risk of death. These are summarised.

There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices, there is very limited literature looking at the impact the use of mechanical restraints has upon service users and support staff using them. The aim of this study was to ascertain the experiences of support staff who apply the restraints to the people they support.

Qualitative methodology was utilised. A semi-structured interview was conducted with nine support workers who: directly worked with a client with intellectual disabilities who engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and they had to have been directly involved in the application and removal of the mechanical restraints in the last week. Content analysis utilising emergent coding was used to analyse the data.

All participants described using mechanical restraints as having a negative impact upon them. Participants said they manage the negative impact by reframing, inhibiting their emotions, following support plans closely and gaining support from other staff. Participants described concerns and unmet needs regarding whether they were applying the restraints correctly, the responsibility of teaching others to use restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints is not talked about. Recommendations for practice are made.

This is the first study to explore the views of care staff who are required to use mechanical restraint. It provides insight on the impact of this on them.

Tackling the problem of aggression and violence in health care is high on the agenda for healthcare professionals. In an endeavour to protect both patients and staff alike when managing aggressive behaviour, the use of physical restraint is under scrutiny, particularly as a result of the reported deaths of a number of patients whilst being restrained. The challenges of employing this type of intervention, implications for safe and effective practices and the need for the suitable training of staff are explored in this paper.

The study examines the experiences of physical restraint procedures reported by nursing staff in a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Nursing staff reported a range of emotional responses to the use of restraint procedures. They included anxiety, anger, boredom, distress and crying. In some cases these responses were confirmed by descriptions from patients.Staff coped with the emotional responses to restraint in a variety of ways. Some staff discussed the ‘stigma’ attached to showing feelings to other staff. They described how laughter was used to reduce stress following an incident and how distressing emotions had to be taken home. Some staff described how they had become ‘hardened’ to the experience of restraint. A substantial proportion of staff suggested that they had ‘no’ emotional reactions and many reported ‘automatic’ responding during a restraint event in which they did not feel any emotion.Possible implications of these responses and clinical practice are discussed.

The purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and alternatives to seclusion.

A questionnaire was circulated to mental health inpatient staff. Data from the Ministry of Health for seclusion numbers and rates for Ma¯ori and non-Ma¯ori were also collected.

The major barriers to reducing the use of seclusion related to staffing issues, a lack of management and medical support, and physical characteristics of the facility. Data from the Office of the Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion events, the number of patients secluded, and the percentage of total patients secluded. However, the percentage of Ma¯ori secluded compared to the total number of patients secluded showed little change from 2007 to 2013.

Further analysis of the nurse’s responses showed that four of the six least-used strategies incorporated Ma¯ori cultural approaches. The authors surmise that an inability to provide culturally sensitive care, either through staffing or education factors, may be implicated in the lack of change in the seclusion rates for Ma¯ori. This may also be pertinent to seclusion rates for indigenous peoples in other countries.