An update to questions related to front-line staff who may have to consider the use of restrictive physical interventions in the workplace amid concerns about covid-19
Below are links to two recent publications which may be helpful. The first, from NHS England and NHS Improvement, provides information on what to do when assessing and treating a patient with a learning disability (intellectual disability) or with Autism who is suspected of having or is known to have coronavirus. Although this is guidance is aimed at healthcare professionals in England, it can be generalised to other professionals across a wide range of settings and other populations who may find it a struggle to cope with the current pandemic and subsequent social distancing and restrictions. For example, some of the practical tips would be applicable for people living with dementia, and people living with acute or enduring mental health problems, or people with acquired brain injury.
The second provides you with guidance from the Inter-Agency Standing Committee (IASC), Office of the High Commissioner for Human Rights (United Nations) Organisations and the World Health Organisation and gives brief advice on covid-19 and people deprived of their liberty. As well as custodial and other secure settings, persons deprived of their liberty are also supported across a wide range of other human services for example, long stay residential placements. In such settings, people might face higher vulnerabilities as the spread of the virus can expand rapidly due to the usually high concentration of persons living in and/or sharing communal facilities. The ongoing impact on social distancing and living in confined spaces where there may be restricted access to hygiene and health care, outdoor space and recreational activities during the current pandemic may create further challenges.
Following on from our last bulletin offering advice on whether front-line staff should use restrictive physical interventions if there is a risk of infection, it is helpful to remind staff that our values of Care, Welfare, Safety and Security enables organisations to uphold the rights of the people they support and helps ensure that restrictive interventions are eliminated or minimised where ever possible. We know that staff will continue to face crisis moments and as such, they remain concerned whether the use of restrictive physical interventions remain suitable, and/or if non-restrictive alternatives continue to maximise safety and minimise harm at the point of risk behaviour.
Below are a few suggestions to help staff connect to the CPI programme which we think may help with this complex decision making:
1. Now, more than ever is a good time to review all preventative approaches for each person staff support to ensure they are doing everything they can to avoid conflict and those situations they know increase anxiety and defensive behaviours. The CPI ‘My Safety and Support Plan’ helps staff to collaborate with each person to produce an individualised, person-centered approach which builds on the Crisis Development Model. Social distancing and other social restrictions have forced many staff to re-think how they go about their everyday life resulting in changes they may never have previously considered or thought possible. Who could have predicted that we would be standing outside in a calm, orderly queue before taking turns to enter supermarkets to buy groceries? Likewise, staff can use this time to re-think how they can accommodate each person they support and consider how they can make changes that reduce those factors that lead to conflict and crisis. It’s often easy to make impactful changes when we really need or have to.
2. The Decision Making Unit (unit 7) provides staff with a framework which can be used to assess risk so that they can make a considered response to any situation within the crisis cycle. With regard to the use of non-restrictive and restrictive practices (including physical interventions) staff understand they have a legal and professional ‘duty of care’ to ensure their decisions are in the person’s ‘best interests’ taking account the risks and benefits - in other words, a decision which considers the risks of doing something contrasted with the risks of doing nothing.
Given the current pandemic, staff will also need to consider the actions they take and the possible risk of infection they might face contrasted with the possible risks of infection should they not intervene. In communal or shared living environments, not restricting a person’s liberty may in fact increase the risk of infection to others. Deciding a course of action related to a complex issue will always be complex, so reminding staff that they should ‘act in good faith’ in a way that maintains everyone’s rights can often alleviate some of the concern they have. Part of every professional’s life involves making decisions that sometimes feel like ‘the best, worst outcome’. Whatever course of action staff choose, the outcome isn’t necessarily what they would want for the person in an ideal world. Staff must make reasonable compromises in their decision making so we would encourage you to remind them to share these complex decision across their team and with other professionals, commissioners, regulators and other specialists (e.g. infection control specialist) to help ensure such decisions are defendable.
3. When deciding to use restrictive interventions, remind staff that any such restriction must be a last resort, reasonable, and proportionate action. This could mean that instead of using restrictive physical interventions, a safer alternative may be to use other methods of restriction such as environmental restrictions or chemical restrictions. We are not suggesting that one approach is any better than another for the person affected, but the use of non-physical restrictions may represent a safer but no less palatable approach for the individual or staff. At the heart of all decisions is our desire to maintain the Care, Welfare, Safety and Security of everyone, staff as well as all those in our care.
The links and attachments with this briefing which may help you and your organisation in reaching an appropriate and safe decision.
BLOG POST | 01/04/2020 | CPI
Guidance to Certified Instructors: Responding to questions from frontline staff who may have to consider the use of restrictive physical interventions in the workplace amid concerns about Covid-19
Once again thank you for all your efforts. As I have previously said, CPI continues to take on the learning from the current crisis so that we can continue to operate effectively and adapt how we support you in the light of prevailing guidance on Covid-19.
Over the past week, more and more Certified Instructors have requested guidance from CPI about providing ongoing training to frontline staff. In our last email and on our website, we outlined various ways you and you organisation may offer training so that you can continue to ensure frontline staff acquire and maintain the knowledge and skills they need.
Some Certified Instructor have also been asking for advice on whether frontline staff should use physical interventions if there is a risk of infection. ‘How can staff safely intervene in a way that doesn’t place them at an increased risk of infection?’ is a question that I’m sure many of you have been asked or will be asked by your colleagues.
Firstly, any advice given to frontline staff on this matter should be authorised, approved and issued by your organisation in accordance with Public Health and Government guidelines on Covid-19. There is a lot of information circulating which is sometimes inaccurate or misleading causing unnecessary anxiety in staff teams. Having clear and consistent guidance from your organisation helps to avoid confusion and may ease staff anxieties especially if the advice given is based on information from a credible source such as a Government department, professional body or academic institution, published research, and/or guidance and advice from a recognised specialist (eg infection control specialist).
Secondly, it is important to remember that we at CPI are not occupational health specialists or specialists in infection control, so our advice to all customers is to review their own internal infection control procedures for all activities that involve direct physical contact or other close personal interactions, including the use of physical interventions, to ensure staff are provided with the right personal protective equipment (PPE) and are trained in its use.
Our curriculum is accompanied by an independent risk assessment which assesses the risks associated with the use of the physical interventions to staff and to the individual who is subject to such restrictions. This assessment is based on a ‘typical person’ because the independent assessor and external panel who reviewed the assessment, could not take account of each person’s unique physiological and psychological factors that may elevate the risks when used in a ‘real world’ event.
As such, the risk assessment should be used to guide further assessments staff undertake in their workplace. Staff are advised to use this assessment to help in the development of people’s individual support plans so that interventions can be authorised and approved which are specific to the individual thereby maximising safety and minimising harm for everyone. All staff have a duty of care to maintain the Care, Welfare, Safety and Security of everyone and any decision to use restrictive physical interventions with an individual who is known to or believed to have any communicable infection should take account of any suitable and appropriate PPE required to maintain staff safety aa well as identifying those interventions that are not appropriate and/or safe to perform.
With regard to specific advice related to the use of physical interventions with an individual who has an infectious disease (Covid-19 or other infection), then we would direct all Certified Instructors to their organisation’s policy on infection control and consider how safe infection control measures can be implemented. As previously stated, CPI is advising that any advice issued to staff regarding the use of physical interventions reflects the current guidance issued by the Government, public health and guidance provided by an infection control specialist.
There is little credible guidance or research on the use of physical interventions and infection control, or guidance specifically related to Covid-19. CPI is actively tracking any guidance or publications currently available and will ensure we keep you up to date as much as we can. The links and attachments with this briefing may help you and your organisation reach an appropriate and safe decision.
BLOG POST | 27/03/2020 | CPI
First, let me begin with a thank you! I am very proud of the CPI community and the role we are playing in responding to the current challenge which is affecting all our lives. Many organisations depend on CPI to provide training and we are proud to collaborate and be a part of a solution to ensure staff and users of services stay safe. That’s why we will continue to take on the learning and keep CPI operating effectively, adapting how we support you in the light of prevailing guidance.
As governments continue to increase the levels of social restrictions to protect the most vulnerable people in our communities, I wanted to provide an update as to how CPI is responding and update you on the measures we are taking to provide ongoing help and support.
Certified Instructor Renewals
We are excited to announce that from Monday April 6th
2020 we will start to offer a ‘Virtual Certified Instructor Renewal’ option to support you to maintain your certification so that you can continue to deliver training to staff in your organisation. We have postponed all face to face classroom-based renewals until at least the end of April 2020 and in their place developed a programme that will enable you to maintain your knowledge, skills and competencies as a Certified Instructor. The stages of the virtual renewal are:
Blue Card® Recertification (your staff refreshers)
- Register to complete your renewal.
- Complete your online programme to refresh your understanding of the core values, terms, concepts, principles and mental models within the programme.
- Take part in our online ‘virtual classroom’ to refresh your understanding and application of the key learning outcomes associated with the programme and revisit the connections between each unit to refocus your thoughts about training delivery.
- Participate in a live facilitated discussion with other Certified Instructors so you can prepare for your online exam and 1:1 coaching and assessment.
- Complete your online Certified Instructor exam.
- Complete your 1:1 coaching session with one of CPI’s professional instructors (GPIs). During this session you will be able to review aspects of the programme content and any issues related to training delivery. During your 1:1 coaching session you will be asked to share your own personal learning and reflections and will have the opportunity to demonstrate your understanding and application of the physiological principles that underpin the physical interventions.
- Your instructor will complete your competency assessment and then your progress will be documented by our Quality and Validation Team so you can receive your re-certification.
In accordance with best practice, CPI recommends that staff who have completed their initial training attend formal refresher training, as a minimum, every 12 months in order to maintain their competencies and to continue to build their knowledge and skills.
You and your organisations have been working hard to eliminate or minimise restrictive practices and, during the current pandemic, this may be a greater challenge than we have seen before as the increasing social restrictions impact on both staff and the people they support. With this in mind, CPI has taken some measures to help Certified Instructors consider how they can continue to deliver training to maximise staff competencies.
If you are looking to continue to deliver refreshing training to existing Blue Card®
holders, there are opportunities to do so while maintaining staff safety. Given your staff have previously completed the training and been assessed as competent, you should discuss and agree an approach with your organisation and, taking account of current guidance, choose to:
Blue Card® Certification (new staff)
- Use the CPI online programme instead of a classroom-based (face to face) refresher so that participants can revisit the core values, concepts, principles and mental models that underpin the programme. The online programme provides ongoing Blue Card® certification and can be accessed by each participant at a computer at home or at work.
- You can provide follow up support to staff who have completed the online programme by setting up virtual coaching events using skype, zoom or similar technology. Inviting staff to join meetings in small cohorts enables you to take participants through key aspects of the programme and support application in the workplace. This may be something you are less familiar with but, with a little practice, this can be effective especially if your organisation has decided to postpone all classroom-based training as a response to minimising close physical contact.
- To support this approach, we have created a range of videos that show the disengagement and holding skills. Following the completion of the on-line programme, you can show the videos to staff during your virtual coaching sessions and reinforce the safe use of physical interventions. This does not replace face to face instruction, supervision and assessment of competence, but in the current situation, does provide a level of governance to assure your organisation that those staff that have already received training have been ‘refreshed’ on their existing knowledge and skills. Once the current restrictions relax and it becomes safe to host classroom-based training you will want to bring participants back for short training sessions to give them the practical opportunity to check their competence in the use of the physical interventions under your instruction, supervision and assessment.
- Please note that the videos that we are making available to you were designed for the internal training of CPI Global Professional Instructors GPIs). They were not intended to be used for broadcast purposes nor do we consider them to be a substitute for live classroom training. That said, we are providing them as an interim way to ensure the Care, Welfare, Safety and Security of your staff members and the people in their care.
In accordance with best practice, staff who are working in settings where they face conflict and crisis behaviour and who may be required to use restrictive physical interventions should undertake certified training. This training should be in keeping with organisational governance, policies and procedures, legal or regulatory standards, professional guidelines, liability considerations related to preventing and managing conflict and crisis situations.
If you are looking to continue to deliver training to new staff in order to issue Blue Card®
certification there are opportunities to do so while maintaining staff safety:
Blue Card® Documentation (all staff)
- If your organisation has decided to continue to train new staff in the programme, you can use our online programme for this purpose. As with the refresher, participants access the course online and build up their knowledge and understanding of the core concepts, principles and mental models. If classroom-based training has been suspended, then the application aspects of the training can still be delivered via virtual coaching sessions. However, teaching the physical interventions in a virtual classroom does not work for new participants so you may want to seek specific guidance from your organisation about how best to manage this.
- If you are required to avoid face to face classroom-based training you can show the videos and talk participants through the safety aspects of the physical interventions so, at the very minimum, they are familiar with the range of interventions authorised and approved within your organisation and have a basic understanding of the risks should they see (or be asked to assist in) an incident in the workplace.
- As soon as the restrictions are lifted, we would recommend that you host face to face classroom-based sessions with participants to give them the practical opportunity to check their competence under your instruction, supervision and assessment.
- If your organisation requires you to continue to provide face to face training for all new staff, we suggest that your organisation seeks direct guidance and advice from the relevant public health authority in order to ensure the occupational health & safety risks are safely managed.
- If you are permitted to offer face to face training, we would advise delivering to smaller groups so social/physical distance and appropriate control measures for good health & hygiene are maintained.
- Unless specially advised by your organisation in line with the guidelines set by the government, we advise that any practice of physical interventions are omitted entirely.
We have set up our systems so that all our staff are now working from home and can continue to offer the same services for Blue Card®
documentation so that you can assess and record participant competencies, record online, issue Blue Cards®
and download certificates.
Videos for Physical Interventions
To support you to continue to provide flexible training solutions we have filmed our professional instructors demonstrating all the physical intervention skills. From next week, these videos will be placed in the Instructor Section of our website under the ‘My Account’ section.
- Currently these videos are not designed for the use in face to face classroom-based training - they are intended as helpful resource for you (the Certified Instructor) and will be especially helpful if you have not taught the programme for a period of time and need an aide memoir.
- You will be able to access the videos through the ‘My Account’ section of our website and can show these to participants who have done their online programme for the first time, and for staff who have done the online refresher via a virtual coaching session.
- It is important to remember that taking participants through these videos is helpful in highlighting what physical interventions are authorised and approved in your organisation and it enables you to talk through the application of the physiological principles and the associated risks.
- Remember using the videos will not enable participants to develop their competence. This needs to be done face to face under the direct instructor, supervision and assessment of a Certified Instructor.
- As stated above please note that the videos that we are making available to you were designed for the internal training of CPI Global Professional Instructors (GPIs). They were not intended to be used for broadcast purposes nor do we consider them to be a substitute for live classroom training. That said, we are providing them as an interim way to ensure the Care, Welfare, Safety and Security of your staff members and the people in their care.
In addition to all the existing materials designed to support your training, there are other resources you can share with participants including:
- Video on Demand
- eBooks, blogs, and podcasts
If you have questions or need help navigating through this information, please contact us on 0161 929 977.
We thank you and your organisation for you commitment to the Care, Welfare, Safety, and SecuritySM of those in your care.
BLOG POST | 18/03/2020 | CPI
The Crisis Prevention Institute’s Response to COVID-19, from Tony Jace, CEO
For 40 years the Crisis Prevention Institute (CPI) has been diligently serving thousands of customers, and millions of professionals, in managing life’s daily “crisis moments” as they occur in the workplace. Our core tenet of Care, Welfare, Safety and Security has never wavered, nor will it. Having served as the leader of CPI for the past decade, I can honestly say I have never been more proud, or honoured, to witness how the CPI team, and our customers / Certified Instructors, have responded to this unprecedented challenge. Some of you have identified the need for CPI training as more important than ever before, and we accept the responsibility to be with you every step of the way. Others of you have decided that at this time it is not appropriate for you to attend the training, as our society seeks to slow the COVID-19 transmission rate.
Over the past two weeks we have held all programmes as scheduled, either in our Open forum or Onsite at a customer’s location. We respect every person’s choice to attend, or postpone, given their specific situations and interpretation of the appropriate public health, government and WHO guidelines. Importantly, we’ve also been able to train new Certified Instructors, customers staff and renew current Certified Instructors, in these critical skills that are so crucial to managing the volume of patients entering our healthcare, social care and education system. Again, we can never be more proud to serve you.
As we embark on the next few months, and assess the latest changes in public health and government guidelines we have taken the following decisions:
- Beginning Monday March 23rd, 2020, and until at least the end of April 2020, all CPI International programmes will be postponed.
- We are looking at options to deliver Renewal programmes via “virtual training sessions” and are working to make this happen in the coming weeks. If you have already registered to attend one of our open or onsite renewal programmes, you will receive instructions from us on how we plan to go forward.
- All other programmes are postponed until at least the end of April 2020. There is no need for you to cancel - we will work with you to reschedule into an upcoming programme later in the year. We are actively pursuing virtual training options for all our programmes including Instructor Certification Programmes, Direct Delivery and Pivotal Education programmes and will update you on progress as and when we can.
- We also know that many of our Certified Instructors are seeking CPI’s guidance on alternative ways to renew their in-house “Blue Card” holders. We are planning on sending recommendations to Certified Instructors in the coming week or so to cover this.
Looking ahead we will continue to monitor public health and government policies and guidelines with regard to the safety of “gatherings”, and will reschedule programmes as soon as it is prudent to do so.
These are extraordinary times. The Care, Welfare, Safety and Security of all those we serve has always been, and will always be, our primary focus. We believe providing the safest possible training options is our responsibility and we will continue to evaluate and pursue every possible option. We will be communicating updates as frequently as necessary to keep you informed.
With utmost respect,