Leading the Reduction of Restrictive Practices and Occupational Violence in Education, Disability and Aged Care Sectors.

There has been a significant growth in conversations around reducing both restrictive practices and occupational violence in the last few years across a number of sectors in Australia and New Zealand. Often this can be seen as a binary choice between reducing restrictive practices for those being supported or reducing occupational violence that staff face.

The purpose of this blog is to identify how leaders and organisations might respond to both important issues, rather than feeling that a choice has to be made between them. We share models and frameworks to help you, whether you work in education, disability, aged care or health to keep everyone in your care safe, including your valuable staff members.

The current situation

Restrictive Practices

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and more recently the Royal Commission into Aged Care Quality and Safety both identified the overuse of restrictive practices. Therefore, there has been an increased focus on the reduction of restrictive practices which has also been picked up by all Australian state and territory education departments.

In New Zealand, there have been a recent focus on minimising the use of physical restraint in schools, alongside ongoing guidance to reduce restraint and seclusion through Ministry of Health regulations.

Occupational Violence

The Australian Principal Occupational Health Safety and Wellbeing Survey identified that 83% of school leaders continue to be subjected to at least one form of offensive behaviour in the last 12 months, and 37% of school leaders had been exposed to physical violence.

Researchers from RMIT University interviewed managers, nurses and personal care staff in Aged Care settings and found that 93 per cent of respondents had experienced physical violence at work, with 44 per cent reported being threatened with a weapon.

In New Zealand, there is very limited recent research into occupational violence but according to WorkSafe NZ, between one in five and one in three New Zealanders report bullying or harassment at work every year.

The problem with binary thinking

As humans, we often fall into the polarity trap of binary thinking where we create an unnecessary duality with?either/or?type thinking.

In many systems in Australia and New Zealand we’ve seen a tension between sections within the organisation whose focus is either on those being supported and care for and reducing restrictive practices; or on staff and reducing occupational violence. By the very nature of binary thinking this can appear to become a decision as to whose rights are more important.

In reality both have equal merit and are of equal importance. Leaders need to take organisations on a journey to shift the culture to one where there is a dual focus on the people being supported and the staff who undertake this rewarding but often challenging role.

Practical ways forward

Where leaders articulate a dual focus on those being care for and supported and those providing the care and support there is the creation of a positive and empowering culture where everyone feels valued and safe.

From our over twenty years of experience of supporting leaders and organisations to reduce risk and restraint we have found the following area and subsequent questions are important for leaders to consider:

1)?????Service/Employer Strategy - Does the service/employer have a named person responsible for the co-ordination, monitoring and evaluation of behaviour support training and its impact on reducing restrictive practices and occupational violence? Do they have a job description and time allocated to do the job? Have leaders and managers attended the training and have a good understanding of the issues?

2)?????Policy - The service policy should be value driven. It should tell people clearly what they should do and explain how to do it. Where necessary, there are statements regarding:

• Staff entitlement to training
• The focus on Tier 1 and Tier 2 or primary and secondary strategies
• Physical restraint techniques, if needed, have been independently medically assessed on a regular basis and staff are trained where there is a risk-assessed need
• Staff and service users have an entitlement to a listening and learning process
• Policies should be updated annually and a copy kept with all archived paperwork for the required timescales.

3)?????Critical Friends - Service users, Parents and placing authorities should be made aware of the services policy and procedures in relation to reducing restrictive practices and occupational violence. Additionally, members of the local community should be involved where possible.

4)?????Risk assessment, Incident Reports and Behaviour Support Plans - How well established and used is the paperwork side of reducing risk and restrictive practices? This is about ensuring staff are aware of and use the services agreed paperwork methods and that someone is responsible for monitoring and evaluating it. It is also about making sure that staff are using the agreed strategies where possible.

5)?????Complaint and Concern Procedures - Is there a complaint and concern procedures in place that service users, parents, placing authorities and staff aware of and use? Many concerns can be dealt with at an early opportunity if there is clear and transparent process available.

6)?????Listening and Learning Process - The opportunity for both staff and service users to debrief is an important one for two main reasons. Firstly, to try and reduce the likelihood of the incident happening again, and secondly, to offer support to both service user and staff through an opportunity to talk about the incident.

7)?????Staff Training - Research has shown that staff training is an important element in the occurrence, prevention, support, management and understanding of behaviours of concern that on occasions might be unsafe. An important element in preparing staff when facing a challenging situation is giving them the means to understand themselves and the people they care for.

8)?????Training Provider - Using an appropriate training provider who has external accreditation on all elements of their training is crucial in keeping service users, staff and organisations safe.

Leadership

The important elements that leaders need to contribute in making their services more effective in this field are:

• Actively owning, committed and being accountable for the training and support of staff and service users
• Ensuring that documentation that underpins practice
• Establishing appropriate and practical local setting and organisational policies.
• Implementing and reviewing behaviour support plans and risk assessments.
• Providing evidence of recording and reviewing of staff training & outcomes achieved.
• A commitment towards providing positive listening & de-briefing for staff and service users

How Team Teach training can support you

Our training solutions are built on a foundation of respect and are designed to foster cultures of support, helping individuals recognise the needs of those they work with and offer help where necessary. Our training emphasises team building, personal safety, communication, and verbal and non-verbal de-escalation techniques for dealing with behaviours of concern, all with the goal of reducing the need for physical interventions. For some settings, we can also teach physical interventions to resolve conflicts in ways that are safe and provide opportunities for repair and reflection for everyone involved.

At Team Teach, safety is our top priority. We are accredited by the Institute of Conflict Management and undergo bi-annual independent medical reviews of all physical techniques to ensure the safety of our participants and those they support. Our training programs are designed to provide the latest research findings in the areas of behaviour support, biomechanics and safe manual handling practices.

Our training is delivered by experienced and knowledgeable trainers who consider the needs of your settings, the nature of care you provide, and the common problems you encounter to deliver practical solutions that lead to real change. Our strategies lower risk and minimise the use of physical restrictive practices, and our framework is entirely compatible with Positive Behaviour for Learning (PBL and PB4L) in education services, Positive Behaviour Support (PBS) approaches for people with a disability, the focus on reducing restrictive practices in aged care, and reframing Occupational Violence and Aggression Training as Occupational Safety Training.

Conclusion

The risk of focusing on either reducing restrictive practices or occupational violence is that not everyone’s rights are being appropriately met and in doing so the setting is not creating a culture of safety, respect and dignity for everyone. When we focus on both then those we support and those supporting them feel valued and the organisation becomes both an exemplar of keeping service users safe and an employer of choice in a time where recruiting and retaining staff alongside significantly improved expectations of providing a quality service has never been more important.