Hampshire County Council

Executive Member, Social Care

23^rd November 2001

Training in the Prevention and Management of Challenging Behaviours, and the use of Physical Interventions, Adults with Learning Disabilities

Report by the Director of Social Services

Contact: Zoë Johnstone, Strategic Service Manager, Learning Disabilities, Ext: 5934

1. Summary

1.1. The following decisions are sought:

That approval be given to the variations to the current policy.

2. Reasons:

2.1. To ensure that partner organisations can respond consistently to the needs of people who challenge.

3. Other options considered and rejected:

3.1. To continue with current training provided through Hampshire Training Solutions.

To purchase one package of training for all in-house LD services, consistent with in-house child-care services (Team Teach). This does not enable local consistency with NHS Trusts.

4. Conflicts of interest declared by the decision-maker or a member for officer consulted

4.1. None

5. Dispensation granted by Standards Committee

5.1. Not applicable

6. Reason(s) for the matter being dealt with if urgent

6.1. Not applicable

Approved by:.............................................Date of Decision...............................

Councillor Felicity Hindson

Contact: Zoë Johnstone, Strategic Service Manager, Learning Disabilities, ext 5934

Summary

The purpose of this report is to seek a variation to the current policy on the provision of training in the prevention and management of challenging behaviours. The current policy is under review pending the completion of local research being carried out by SSRIU, Portsmouth University.

The current approved training for the use of Physical Interventions follows the Home Office "Control and Restraint" procedures.

Background

Staff are finding current training increasingly inappropriate for the following reasons:-

_ It does not provide training in the range of physical interventions which may be required.

_ It is not always possible to implement the interventions supported, because of operational constraints, and thus staff and users are put at risk

_ It is not always compatible with the training used by colleagues in Health Teams, who have a responsibility for advising SSD staff on working with individuals who may be challenging and/or aggressive. Staff are therefore not always able to follow the interventions advised.

_ Advice and support on the best approaches for working with individual service users is not available within the training.

The appropriate level of training (i.e. numbers of staff, and maintenance of skills via refresher training) is difficult to achieve, as this can currently only be provided through Hampshire Training Solutions, and appropriate opportunities are insufficient.

The Department of Health, in association with BILD (British Institute of Learning Disabilities) has recently produced, or is working on the following:-

_ Code of Practice for Trainers in Physical Interventions (completed)

_ An accreditation system for Trainers in Physical Interventions (under development)

_ Guidance for Local Authority Social Services Departments on the use of Physical Interventions. (under further development, following consultation on draft paper)

The three NHS Trusts who provide specialist Healthcare Services for Adults with Learning Disabilities in Hampshire currently use different training packages. However, all the training packages used have certain features in common.

_ They are recognised and used by organisations nationally

_ They comply with the Code of Practice

_ The approach taken is holistic and non-aversive, with an emphasis on a range of strategies for the prevention of challenging behaviour

_ The use of physical interventions is recognised as necessary, but should only be used after all possible prevention strategies have been used

_ Strategies for prevention of incidents, and for the use of Physical interventions should be devised to meet the individual needs and circumstances of each person who poses challenges

_ Included in each of the training packages is training for local staff members to become approved trainers for their employing organisation, thus enabling better access to training and refresher training, in ways that are focussed on local needs.

_ Training includes an assessment, and certification of the capability of each member of staff who has undertaken the training.

Proposal

It is proposed that the Department should approve the use of training which is congruent with that used by local NHS Trusts.

Currently these are as follows:-

_ West Hampshire NHS Trust:- Welsh Centre, provided through "Respond" and "Approach Training Ltd"

_ Portsmouth Healthcare NHS Trust:- S.C.I.P. (Strategies for Crisis Intervention & Prevention)

_ Surrey Hampshire Borders NHS Trust:- Studio III

All of these organisations subscribe to the Code of Practice.

It is also proposed that the potential for joint training is explored further - commissioning jointly with NHS Trusts, and potentially other local providers who specialise in services for people who challenge. This approach would be in line with the White Paper "Valuing People: a new strategy for learning disability for the 21^st century", and partnership working.

Consultations

These proposals have been discussed in principle with:-

_ NHS Trust colleagues

_ SSD staff and Unit Managers

_ Training Commissioning Team

_ Hampshire Training Solutions

Finance

The current investment in training for staff within the LD sector, on the Prevention and Management of Challenging Behaviour, and associated physical interventions is £18,646. This includes refresher courses.

This provides a total of 17 days training for a maximum of 16 people per day (details available of required).

It is proposed that this money be used to commission local training, consistent with NHS Trusts. An example of the cost of a 3 day course is £1,800 - 2,680, depending on numbers (14-18 people), with half day "refresher" at £550 (Studio III). These costs exclude venue, but are subject to negotiation.

Jointly commissioning training with NHS Trusts, and other local providers, would provide additional cost benefits. It will support joint working practices and address the issue of "wasted" places on training courses. To ensure that a course is economic to run, a minimum number of participants is required, and clearly if maximum numbers are achieved, this is more cost-effective. However, because it is not always possible to release sufficient numbers of staff, whilst meeting operational requirements, the numbers required currently are not always achievable. If courses are jointly commissioned, the numbers required from each organisation would be reduced, along with the costs to each organisation. Sharing the costs in this way would enable a greater number of courses to be run.

The potential for using the Health Act Flexibilities (e.g. Pooled Budgets) will also be explored further.

Recommendations

That the variation to the current policy proposed in paragraph 3 be approved.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

_ "Valuing People: a new strategy for learning disability for the 21^st century": DOH, 2001

_ Draft Guidance on the use of physical interventions for staff working with children and adults with learning disability and/or autism. DOH, 2000

_ Physical Interventions - A policy framework. BILD

_ Code of Practice for Trainers in Physical Interventions. BILD*

BILD - British Institute for Learning Disabilities