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Positive and Safe for Service U sers and Staff :

Positive and Safe for Service U sers and Staff : Managing the clinical challenge through a team-led Post Incident Reflective approach. Dr Steve Donaldson - Highly Specialist Applied Clinical Psychologist Tony Carroll – Post-Incident Rapid Reflection Champion, Ayckbourn Unit.

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Positive and Safe for Service U sers and Staff :

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  1. Positive and Safe for Service Users and Staff: Managing the clinical challenge through a team-led Post Incident Reflective approach. Dr Steve Donaldson - Highly Specialist Applied Clinical Psychologist Tony Carroll – Post-Incident Rapid Reflection Champion, Ayckbourn Unit

  2. Aims and Objectives.. • To share an approach to support teams to reflect following incidents. By the end of the workshop you will… • Have an awareness of the difference between defusing and debrief • Have an awareness of the pilot work undertaken in the Trust • Have had an opportunity to ‘have a go’ and use the tools • Have had time to reflect on how this approach might be applied to your work setting

  3. A brief history.. • Debrief has historically meant different things. • Usually led by a therapist/psychologist trained in this area • Time – significant limitation • However, there is a difference between debrief and defusing approaches • Models can help us understand the need • TIC, stress-vulnerability, theories from disaster work

  4. Decompression Model – 1 - 1½ Hours Introductions Setting the context And boundaries RE-ENTRY NORMALISATION FACTS TEACHING THOUGHTS FEELINGSAND SYMPTOMS

  5. Defusing.. • The term was introduced in 1983 (Mitchell & Everly) • Idea that a dangerous or difficult situation can be made ‘harmless’ • Evidence to suggest that larger debrief approach too close to event can cause harm – Trauma processing. • Goals • Rapid reduction of intense emotions • Normalising the experience • Empowerment and sense of mastery • Eliminate the need for debrief, enhance effectiveness of debrief

  6. National Context Positive & Safe • No deliberate use of Prone/face down restraint or pain compliance • Least restrictive/ last resort • Individualised behaviour support plans (PBS) • Board Level Support • Governance structures and policy development • Post incident analysis and debrief • Support plan Audit and internal data gathering • CQC compliance and assurance • Organisational restraint reduction plan

  7. Tewv’s Restrictive Intervention Reduction Plan • Using data to inform clinical practice • Supporting all clinical areas to adopt the Safewards model • Implementation of the Person centred Behaviour Support Framework across services • Providing support and review of incidents following displays of behaviours that challenge • Effective Use of Medication to support behaviours that challenge • Positive Approaches Training (PATT) • Safe and efficient us of Seclusion and calm down facilities

  8. Rapid reflection staff tool The tool should take no longer than 3 minutes. All staff involved should take part in the rapid reflection, with 1 member staff acting as the reflection facilitator • Are we all ok and safe? • Is there anything we would do differently next time? • What went well?

  9. Rapid Reflection Tool – Service Users • Are you feeling ok and Safe? • What can we do to help you feel safe? (Asked immediately following restrictive intervention) Questions to be asked within 24 hours (or as soon as possible/appropriate) • Do you understand why staff needed to use restrictive interventions? • What could we have done to support you better? • Is there anything you would do differently next time? Offer the opportunity to make a written account

  10. Rapid Reflection Pilot • 1 ward from Each Clinical Speciality • Pilot Period from January 1st – February 14th 2017 • Services reported between 3 -100 % Compliance • Positive Feedback for use of the staff tool • Limited use of Patient tool, further work to identify more effective use • Gradual introduction Trust wide from May 1st 2017

  11. Stepped Approach to Incident Management Critical Incident Is a Debrief required? YES Post-Incident Reflection Facilitated Debrief STAFF SUPPORT

  12. A Champions experience of applying post-incident reflections in practice Experience from practice

  13. Time to have a go…. • In small groups 3-4’s • Think of a mildly challenging event from your work experience – that you are safe to share • Pick one to work with • Use the Post-incident reflection tool • You have 3 minutes

  14. Timer…. • 3 minutes on the clock TIMESUP 1 Minute 2 Minutes

  15. Ideas of Scope and use in the Trust • Time to reflect on possible uses in practice. • How could this tool help you and your team • In-patients • Community • Supervision

  16. Conclusions and Final Thoughts

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