Framework for assessment of restraints and coercive methods in healthcare and social care

1. Framework for assessment of restraints and coercive methods in healthcare and social care Eve Pilt and Jooske Vos

2. Short History 1 • Paris -April 2012 start of EPSO working group: Presentation by Estonia: ‘Restraints in nursing care. How to improve working methods?’ Other EPSO-members were asked to join the working group

3. Short History 2 • After Paris – before Utrecht The EPSO working group was formed by Estonia, Flanders, IGZ and Vilans Netherlands, Northern Ireland and Denmark and EPSO secretariat Group started with a. Discussion on scope and purpose, b. Formulating the questionnaire on restraints and coercive methods, c. comparative study between EPSO members. -

4. Short History 3 • Utrecht Presentation of results of comparative study between EPSO members; Discussion about follow up; Working group was asked to continue and prepare for a broadening of the discussion on this topic. -

5. Short History 4 • After Utrecht Working group broadened scope by introducing: -Epso assessment framework (first draft) incl. : • organizational context to deliver good and adequate supervision on restraints and coercive methods; • minimum standards for health care providers; -CPT standards (second draft) including Human Rights aspects on using restraints from CPT standards as an added value. -

6. What is the aim of this Assessment framework? For supervisory or monitoring organisations : • Introduction of a broad definition of using restraints within the European legal context • an organizational context; • useful tool: set of criteria including minimum standards for healthcare providers

7. broad definition For supervisory or monitoring organisations : • Introduction of a broad definition of restraints within the European legal context including: Physical /Mechanical / Chemical, Technological and Psychosocial force.

8. Organisational context Introduction of a set of checkpoints / criteria regarding organisational aspects for supervisory or monitoring organisations

9. Useful tool/ Set of criteria For supervisory or monitoring organisations introduction of a set criteria: minimum standards for healthcare providers including standards derived from healthcare relevant CPT standards

10. Criteria for supervisory and monitoring organisation • Independence • Unlimited access to accommodations and documents and patients with their consent; • Provides solicited and unsolicited advice on using CPM and on alternatives to CPM • Has in its disposal sufficient enforcement measures • Reports publicly on deficiencies in law and other relevant deficiencies

11. Contributing to raising awareness • Is involved in raising awareness among health care providers; • Prompts government on the results of their work and initiates changes in the law or in practice if needed

12. Minimum standards for health care providers • Has clear vision and policy on using and/or preventing using of RCM based on broad definition on using restraitns • Works systematical with instructions and protocols • Has a register on using restraints and the cases documented inclient files • Exercises regular problem analysis of client cases

13. Minimum standards for health care providers • Provides that decision on using restraints is issued by a person authorised according to relevant country law and preferably made by multidisciplinary team ; • Obtains consent from a patient or the legal representative; • Makes sure that qualified staff is available; • Stops using restraints asap;

14. What does qualified staff mean? • Qualified staff knows how to: • Use the least restrictive methods first; • Are capable of applying de-escalation techniques; • Are aware and trained in how to prevent using CPM; • Are aware and trained in using alternative methods to reduce the need for CPM ;

15. Qualified staff and human rights Management makes sure that: • Honouring human rights is ordinary part of everyday routine; • The staff is aware of CPT standards on using restraints in psychiatric settings and understands their relevance in other health care settings.

16. How to proceed further? (1) fine-tuning the framework • Discussion in Brussels 18-04-2013 • EPSO members are asked to give comments on the content of the framework and sent to EPSO before august 2013;

17. How to proceed further? (2) Pilot ? • Which EPSO member wants to volunteer to a pilot with this Assessment framework? • If so a of pilot project will start in one or more countries.

18. How to proceed further? (3) After the pilot • Discussion in EPSO context ( one of the next conferences) • Amendments to the framework based on the results of the pilot project. • Final framework sent to all EPSo members for last comments

19. How to proceed further? (4) after a pilot • Communicating the final framework to governments, service providers and other interested parties. (as a useful tool to improve procedures and results in handling restraints in health care and social care)