Our consultancy services cover the legal, ethical, behavioural, tactical and medical aspects of safely managing challenging behaviour. We can provide consultancy and expert advice on matters relating to:
- risk assessment
- independent serious case review
- independent complaints and investigations review
- regulatory inspections
- curriculum and training design
- training needs analysis
- mechanical restraint
- less-lethal weapon advice and implementation
- policy advice and drafting
- reporting system support and analysis
- individual behavioural care plans
- organisational and individual behavioural management strategies
- conference speaking/Chairing
All organisations need to assess risk. Sometimes, this process is straightforward and few complications arise. Questions of risk relating to violence, aggression, challenging or disturbed behaviour and the corresponding use of restraint and other interventions are often complex and can give rise to many difficult questions. Determining what control measures might be appropriate to eliminate or minimise risk are equally complex. Organisations, policymakers and regulators seeking to prohibit certain kinds of intervention only serve to make this process more difficult, especially where your own internal experts oppose such restrictions. We have considerable experience in assessing risk and can provide an independent expert assessment of all kinds of risk relating to our areas of expertise.
Independent Serious Case Review
Where an incident leads to death, a Coroner (or Sheriff or Judge, depending on jurisdiction) may take action to prevent other deaths occurring in similar circumstances. This is known (in England and Wales) as Regulation 28 Report or a Report on Action to Prevent Future Deaths and sets out the concerns and requests that remedial action is taken. Coronial hearings relate only to deaths and there is no corresponding procedure in non-death cases. Deaths are only the tip of the iceberg and, although impossible to quantify, a considerably larger number of people are injured during restraint than those who die. Since the same intervention, omission or incident, could end without injury in one case but could seriously injure or cause the death of a person in another, many cases are never properly scrutinised. Often the end result is a matter of pure chance.
Based on the coronial Prevention of Future Deaths reports, we investigate cases where harm has been caused during a violent incident and present our findings in a Prevention of Future Harm report. By reviewing these reports, it is possible to see what common themes emerge and what steps can be taken to eliminate or minimise the harm caused and greatly improve lessons learned and ensure that actions taken are properly evidenced. These reports will also allay any oversight panel’s concerns that any potential failings have been properly investigated and evidenced by an independent panel of experts.
The reports will also be useful for organisations to be able to demonstrate to regulators and other investigators and stakeholders that they have incorporated the findings and recommendations into their own organisation’s practice.
Independent Complaints and Investigations Review
We can review your internal complaints and investigations on matters within our specialist areas of work and provide externality, independence and robustness to your process. The majority of our independent complaints and investigation review work is referred to us from Board level or by the organisation’s lawyers.
We can assist with your preparations for Regulatory Inspections, Post-Inspection and Quality-Improvement Action Planning and Improvement Strategies. We carry out on-site mock inspections to assess compliance against the Care Quality Commission Key Lines of Enquiry to assess whether your service is Safe, Effective, Caring, Responsive and Well-led. This is designed to ensure that you are able to evidence regulatory compliance. This process includes reviewing and updating your organisation’s key policies and supporting documents, and structures for organisational governance. This service helps you to be fully prepared and to take appropriate and positive action where gaps or issues are identified. We can then provide you with an action plan based on the outcome of the inspection visit.
Curriculum and Training Design
With a key focus on active prevention strategies, we will design a bespoke training programme for your organisation enabling your staff to deal with aggressive, violent or disturbed behaviour in a safe, professional and ethical manner. We have provided training to some of the world’s most high-profile organisations managing a diverse range of often complex behaviours and risks. Central to all of our work is the need to devise strategies that operate within an ethical and human-rights framework and within the legal boundaries of your operation. At the core of our work, we recognise the need for strategies to minimise violence and aggression and the need for staff to resort to the use of force or other coercive interventions.
We adhere strongly to the principle that physical interventions must only be considered when absolutely necessary and should form only a small part of the overall strategy to reduce aggression, violence and challenging behaviour. Predictive, preventative and de-escalation strategies must remain the overarching priority to eliminate the unnecessary use of force and the associated restrictions that are often associated with it.
We also recognise that, where necessary, an immediate resolution may be needed, typically in the form of a restrictive intervention. This may be necessary to preserve life or to prevent a significant risk of harm to self or others. For this reason, equal importance must also be given to the selection and assessment of the physical interventions, tactical equipment and medical/emergency responses that may be needed to manage the foreseeable risks within each population and service setting. Training in these interventions must be delivered in a way that bridges the gap between the training arena and operational setting. Far too many training programmes fail to do this, leaving staff and individuals unnecessarily exposed to risk.
We also provide the necessary and diverse range of expertise required to develop best practice materials such as training manuals, operational protocols, best-practice guidance, tailored training resources including video-based and blended learning.
With these principles in mind, we will work with you to establish your training needs analysis, design your own bespoke training programme and, if required, submit it for accreditation to one of many awarding organisations.
The use of mechanical restraint is greatly misunderstood and often unjustifiably maligned. Far from the barbaric devices seen in the asylums of the previous century, modern-day devices offer relatively comfortable and safe containment of the person and can aid effective de-escalation to bring the crisis to an end at the earliest possible opportunity. Appropriate mechanical restraint can also provide a greater degree of autonomy and recovery focussed pathways for the person(s) who may exhibit a consistent risk to themselves and others and may negatively react to being physically held and supported, allowing them to safely perform essential tasks, including opportunities to attend collaboratively planned ‘meaningful activities’ to improve ‘quality of life’, provide consistent access to essential medical services and treatments to improve health and well-being, attend to their daily basic needs, and promote social inclusion with their peers and wider communities. Thus, creating safe positive, caring and interactive experiences, that builds trust and enhances the therapeutic relationship.
From the legal perspective, physical restraint is a manual handling activity to which (in the UK) the Manual Handling Operations Regulations 1992, as amended by the Health and Safety (Miscellaneous Amendments) Regulations 2002, applies. Employers are required to fulfil a number of criteria to reduce the risk of manual handling accidents at work. These include a requirement for employers to avoid the need for staff to undertake any manual handling operations which involve a risk of their being injured and, where it is not reasonably practicable to avoid the need for staff to undertake any such manual handling operations, employers are required to make a suitable and sufficient assessment of all such manual handling operations to be undertaken by them and take appropriate steps to reduce the risk of injury to staff arising out of their undertaking any such manual handling operations to the lowest level reasonably practicable.
We have considerable experience in working with mechanical restraints and advising on whether they might be appropriate for your organisation and, if so, which are the most appropriate.
Between us, we have spoken at more than 400 conferences around the world, many of which we have been invited to chair. Contact us if you would like us to speak at, or chair, your conference. We can also organise your conference and select appropriate speakers.