Tony Flatley Associate Director of Nursing RMN, RNT, BA (Hons), Msc.

1. Tony Flatley Associate Director of Nursing RMN, RNT, BA (Hons), Msc. • Tony has worked in Sheffield services all his 34 year career. He worked predominantly with in patient services before taking a post as lecturer at Sheffield Hallam University for 4 years. On return he has managed a range of clinical services including In–Patient, Day Services and Community. He has led Risk, Practice Development, Governance and Training departments and has had an significant interest in the development of service user involvement. • Caroline Mackay RMN, Senior Practitioner and Lead for aggression and violence training. • Caroline has worked as an RMN since graduating from the Robert Gordon University in Aberdeen, Scotland in 2002. She has worked in a variety of clinical environments, high secure, medium secure and low secure settings in the NHS and in the private sector, primarily with people with a diagnosis of personality disorder. She has also worked in P.I.C.U. and acute in both England and in Scotland. Caroline has worked in Sheffield for almost five years and is currently the lead for violence and aggression.

2. Improving Practice Towards Responding to Disturbed/Challenging Behaviour in Mental health and Learning Disability Settings

3. Improving restraint practice at a local level; • Independent report from the MAAT Probe group. • Review of existing provision • Wide ranging consultation • Plan for change approved by Board

4. Improving restraint practice at a local level • What to measure? Audit of two years worth of seclusion use across four acute wards, an intensive treatment service (P.I.C.U.) and a low secure forensic service to provide a ‘baseline’ measurement. • Where to start? Introduction of a new model of training in January 2012.

5. New model of training: • The new model of training (RESPECT training solutions) emphasises the importance of trying to understand the aetiology of challenging behaviour in an individual; and to de-escalate wherever possible and safe to do so. • As well as delivering this training to all staff groups, the training team have also committed to engaging clinical teams regularly, actively seeking out any difficulties or barriers to implementation.

6. The training team respond within the same day to requests from staff teams for support/advice/guidance in how to care for and manage associated risks for complex and challenging individuals using the service. • Continue to collect data about the use of seclusion in services to compare against our baseline. • Any findings from the collection of this data is fed back to team managers with recommendations. • The training package does not include any instruction in the use of prone restraint. • Service users an integral part of training delivery.

7. No more prone restraint in SHSC: • Initial scepticism from staff. • Hearts and minds. • Proof is in the pudding!

8. What is ‘restraint’ and what forms does ‘restraint’ take?: • No increase in the use of rapid tranquillisation or seclusion use on any of the four acute wards or the forensic low secure ward. • No increase in the number of restrictions service users are subjected to. • Identifying and measuring other common forms of ‘restraint’.

9. The future: • Introduction of ‘Green Rooms’ and ‘Green Boxes’. • service users leading training. • service user involvement in the evaluation of incidents. • Service users pro-actively engaging with teams, identifying practice change through formal mechanisms • Responding to enquiries (National and International) from organisations seeking to employ the model.