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Like-minded organisations in pursuit of restraint-free services

Reflections from a trainer: Lee Hollins

I have delivered training to learning disability settings for over 20 years. This has included sessions covering primary proactive preventative measures as well as secondary reactive reductive interventions aimed at calming and de-escalating people who are experiencing rising distress. I have also delivered sessions covering tertiary protective interventions. These sessions cover the use of physical techniques which are only deployed as a last resort when all other strategies have failed, and even then only to keep people safe from harm.

The length of time I have been involved in delivering such training means I have spent a significant amount of time operating in a space without a national set of training standards. In this time, I have come across many different attitudes to commissioning and delivering training. I have been privileged to work with commissioners committed to giving their staff the knowledge and skills they require to practice safely, ethically, skilfully and supportively. Likewise, many training providers of high integrity.

That being said, I have also come across those who haven’t placed value on training, and the absence of training standards has meant they can operate in a fast and loose way with the specification. The two most common refrains amongst such commissioners have been: “I just need my staff to be taught restraint techniques” and “I can only spare a day…. So I want everything you’ve got in 6 hours!”

In both cases, in the absence of any recognised training standards, the ‘market’ has determined what the training vendor supplies. Many high-integrity training providers would not operate on these terms. But some will. And some have. It would seem to me that every organisation that has taken such short cuts on training, by either cramming so much into a day as to be useless, or by only teaching staff how to get ‘hands on’, is storing up trouble for themselves. Staff will either lack the knowledge and skills required to support individuals who may become distressed or the only answer they have to someone revealing that distress through their behaviour is to restrain them.

This is why the Restraint Reduction Network Training Standards are so welcome. The advent of the new Standards establishes a fundamental baseline. It insists that a whole swathe of key topics must be covered during a training session. These topics include the importance of person centredness, the need to practice in a way that upholds an individual’s human rights, restraint reduction theory, trauma informed care, debriefing, recording and reporting as well as data analysis. Further to the theory there are stipulations on the physical skills that are taught. There is a need to justify the inclusion of any physical skills in a training syllabus, and also to ensure all techniques are fully and thoroughly risk assessed by a competent individual. The ongoing inclusion of such techniques in a syllabus must be regularly reviewed. The Standards mean that physical restraint can’t be taught in isolation and that staff are provided with a broad knowledge base.

Anything that enables thoughtful and measured practice must surely be welcome progress.

Lee Hollins, lead assessor and member of the Restraint Reduction Network

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