Restraint Reduction Network BILD Restraint Reduction Network Training

Restraint Reduction Network BILD Restraint Reduction Network Training Standards 2019 Glyn Connolly g. connolly@bild. org. uk

Restraint Reduction Network A Community of Practice with a collective vison to reduce the unnecessary use of restraint and all restrictive practices http: //restraintreductionnetwork. org/

Restraint Reduction Network 2019 - Opportunity • NHS-E National Reducing Restrictive Practices Programme • Now have Use of Force Act (2018) • CQC thematic review (2019)Significant opportunity to improve practice • Reduce prevalence of trauma caused by restraint • Positive change of culture in health and adult social care • Must seize this opportunity

Restraint Reduction Network • Lack of QA (or regulation) of training • Significant safeguarding risk • Too often training focuses on restrictive interventions without sufficient focus on prevention, de-escalation or use of non restrictive tertiary interventions. • Need to ensure staff have right tools in their toolbox (preventative not just reactive)

Restraint Reduction Network Scope of Standards • Best practice in training in supporting vulnerable people when distressed • Across Health & Social care sectors (not CJS) • Across mental health conditions, autism, learning disabilities and dementia services • Across UK (and RI) • Appendices focus on specific settings / populations

Restraint Reduction Network Development Process First Draft May/June 21 crit read thematic rev • • 2 nd Draft June/July 35 crit read Third Draft July/August Feedback ended in August Final Draft September Sign off in September / October 2018 Endorsement Nov/Dec 2018 Publication 2019 Standards themselves have been approved and signed off. Minor changes to presentation and to wording of introduction, appendices, glossary and acknowledgments were made before 1 st April 2019 to meet endorsing requirements now live and on RRN Website

Restraint Reduction Network • An emphasis on restraint reduction and human rights • Focus on prevention • Risk assessed techniques: • Lived experience and trauma-informed perspectives • Safety at the heart of restraint use; a dedicated standard relating to the management of medical emergencies http: //restraintreductionnetwork. org/wp-content/uploads/2019/01/RRN_Training_Standards_2019_DRAFTv 2. pdf

Restraint Reduction Network • The use of data to create a true learning culture, and reduce restrictive practices • Annual review of restrictive practices • Training organisations and commissioners working together to develop training needs analysis that are based on the needs of the people being supported • Trainers who are competent to teach more than physical interventions • Next edition will focus on: chemical interventions, more focus on clinical areas interest from emergency dept http: //restraintreductionnetwork. org/wp-content/uploads/2019/01/RRN_Training_Standards_2019_DRAFTv 2. pdf

Restraint Reduction Network Context: A Rights based framework • Developed by British institute of Human Rights (critically reviewed by Equality & Human Rights Commission) • A human rights approach to restrictive interventions • The relationship between the legislative frameworks involved in restrictive interventions • Being person centred to respect and protect human rights

Section 1: Pre-Delivery Processes Restraint Reduction Network pre-delivery • Based on training needs analysis (TNA) to ensure training appropriate and proportional to need (Needs of staff, needs of population and setting) • Authorising and approving curriculum content and delivery • Involving people with lived experience • Complaints, concerns process

Restraint Reduction Network Section 2: Curriculum Content 1. Within the rights based framework 2. Duty of care, duty of candour 3. Attitudes and attributions / use of language 4. Decision making 5. Preventative (proactive/preventative) working practices 6. Secondary (de-escalation) strategies 7. Tertiary strategies 8. Teaching tertiary strategies 9. Factors contributing to risk 10. Emergency protocols 11. Range of restrictive interventions 12. Recording, data collection, analysis & transparency 13. Post incident review – two components post incident support and post incident learning 14. Consideration of the impact of trauma 15. Restraint Reduction theory – 6 core strategies • Note: Pain can only be used for escape – no pain compliance

Section 3: Post Delivery Processes post-delivery • • • Assessment of competence by trainer Recording Reporting Concerns Evaluation and continues Improvement Quality Assurance Refresher Training Restraint Reduction Network

Restraint Reduction Network Section 4: Trainers • Evidence that trainer has (all three): • Training competence (appropriate qualifications, skills and experience) • Curriculum competence (ability to teach more than the use of restrictive interventions) • Relevant experience (of supporting the population group and understanding specific needs) • Evidence of commitment to ongoing CPD • Evidence of quality monitoring and regular feedback to support development

Restraint Reduction Network Appendices Focus on additional considerations for specific settings needs including: • • • MH LD/Autism Children Forensic & high secure services Services for older people Nations UK

Restraint Reduction Network Implementation • Requirement in NHS commissioned services • • • Commissioning (Spec Com) Reporting (NHS Digital) Regulation (CQC) • Statutory guidance linked to Use of Force Act • Commissioning guidance from Social Care for Children and ADASS Association of Directors of Adult Social Services in England

Restraint Reduction Network UKAS Accreditation • Certifying training as complying with RRN Training Standards • Certification independent of training provision and run on not for profit basis • Comply with ISO 17065 standards and approved by UKAS • 5 Pilots in progress (complete May) • Training organisations can now apply for certification (process takes 1 year to complete) • Commissioning requirement to use UKAS accredited training in restrictive practices in NHS Commissioned Services by 2020