Devon County Council

Training for physical interventions for learning disability services will be on a unit by unit basis, with training developed for each unit. This will be developed in conjunction with health service learning and development sections. Training will also be provided for Joint Agency Team workers where relevant, for example, for safe holding to avoid road accident injuries.

The BILD "Code of Practice for Trainers in the Use of Physical Interventions" (ISBN 1 902519 78 7 1) will be adopted to ensure appropriate standards of training. Congruence with this framework should ensure that DCC is in line with NHS Partnership Trusts.

The (suggested) approach for day centres is for staff to be trained:

• In risk reduction via control of environmental setting conditions. This means developing awareness of what triggers that particular service user.
• In de-escalation techniques, for talking down and preventing build-ups in the first place.
• In 'breakaway' techniques, to be used in conjunction with de-escalation where appropriate, for example, when a service user grabs hair, clothing, wrists and such like.  This is not to be confused with ''self-defence'' training. The difference is that in breakaway techniques there is no attempt to injure, only to escape from holds. It needs to be integrated with de-escalation.
• In 'safe' holds for immediate safety, for example, taking hold of a person's arm and elbow to prevent use, restraining arms, or holding a child at the side of a busy road in ways that are safe (for example no pressure on joints, no blocking of windpipe). Appropriate training will make such holds far safer. This needs to be when and as identified as a need by the service.
• In 'seating de-escalation' and similar techniques. Seated de-escalation has already been used at 'The Leaze'. Two members of staff each take an arm of the service user, and whilst talking for de-escalation, walk the person to a three-seat 'station' and stay with the service user until calm. This needs to be when identified as a need by the service.

This needs to be used in a 'gradient of control' where possible. However it needs to be recognised that some service users can be unpredictable, so there may be circumstances where breakaway techniques are needed urgently. Depending on the situation there can be a talking de-escalation to bring the service user to release a hold, before any breakaway technique needs to be used, sometimes while 'fixing the hold' to avoid injury.

The use of these techniques must not replace general good working skills for relating to service users, avoiding trigger situations, and minimising the need for physical interventions. However for certain service users the use of an intervention earlier, rather than later, could be at a lower level and avoid an almost inevitable escalation to a potentially difficult situation.

In the event of a service user becoming 'completely uncontrollable' and staff unable to cope, contact the police or ambulance staff, and / or somebody that the service user trusts and could influence behaviour at that stage. Given the chairs, tables, and other objects situated in day centres, and that there are other service users to consider, staff must not undertake prone restraint even if trained in using it, due to risk of injury / trauma. Remove staff and service users and wait for back-up, and attempt de-escalation if safe.