Who are St Andrew’s Healthcare?
St Andrew’s Healthcare provides specialist mental health care for people with challenging mental health needs across a range services, including men’s mental health, women’s mental health, child and adolescent mental health services (CAMHS), neuropsychiatry, autistic spectrum disorder and learning disability.
They care for patients with extremely complex clinical needs—people who cannot, in many cases, be treated elsewhere. Many of St Andrew’s patients have been in the criminal justice system and are among the most vulnerable people being treated anywhere in the health service.
develops innovative ways to help patients recover, creating a personalised package of care designed around each individual, which focuses on their physical and spiritual wellbeing as well as mental health.
Three years ago, following the publication of the government’s guidance on reducing restrictive practices, and backed by their board of directors and leadership team, St Andrew’s embarked on a journey to implement a Positive and Safe Service across their entire organisation to eliminate unnecessary restrictive practice and ensure that physical interventions are only ever used as a last resort.
Historically, the charity had used the PMVA/C&R curriculum for staff training but felt that it no longer fit in terms of supporting organisational cultural change. Following a procurement process, St Andrew’s entered into partnership with CPI to design, implement and support the wider culture change programme across the charity—the focus of which was to embed the values of Care, Welfare, Safety, and SecuritySM for all members of the St Andrew’s community. Culture change was achieved via the rollout of CPI’s MAPA® (Management of Actual or Potential Aggression) development programme.
The MAPA® programme launched in January 2016, delivered by an internal training team. One of the team members, a peer support worker, was a former patient of St Andrew’s, emphasising the charity’s approach towards co-production.
The programme scope included training for all staff, students and volunteers, with the first implementation phase focused on the adolescent service. Initial roll-out consisted of the MAPA® five-day programme for all clinical staff, and the MAPA® one-day programme for non-clinical staff on induction to the charity.
In addition to aligning with the organisation’s cultural vision, MAPA® training was flexible enough to enable St Andrew’s to review the plan and agree a number of changes in delivery to meet the available learning and development needs of the staff working across the charity.
The initial training phase was completed in December 2017, during which a total of 2,588 staff received the MAPA® five-day programme (representing 92% of clinical staff). A further 1,273 non-clinical staff (97%) completed the one-day course.
The essential skills refresher training commenced January 2018, two years after the partnership began.
MAPA® training and techniques readily complement the other aspects of St Andrew’s Positive and Safe Service, including:
- An eLearning module that provides and introduction to the guiding principles of positive behavioural support (PBS).
- An increase in the rollout of RAID (Reinforce Appropriate, Implode Disruptive) training, a three-day course delivered by the Association of Psychological Therapies (APT) that promotes the proactive management of risk behaviours.
- The introduction of Safewards, which identifies a range of interventions proven to make a difference in the day-to-day management in mental health and learning disability settings.
Outcomes and Results
St Andrew’s has seen significant results from its partnership with CPI and the introduction of MAPA® to the staff training programme. Backed by the leadership team, MAPA® has become as a key part of the charity’s culture change and is viewed as necessary for ongoing organisational and professional development.
MAPA® is about developing the workforce, not re-training them, which has helped embed and enhance the other interventions (mentioned above). The common language that MAPA® teaches is consistent throughout the organisation, and the techniques it teaches have been embraced at all levels from leadership through to therapists, clinicians and other nursing staff.
St Andrew’s approach to culture change has been a success for a number of reasons—all of which can be mapped to the Six Core Strategies for Reducing Restraint (as developed by Dr Kevin Huckshorn).
Core Strategy One: Leadership and Organisational Change
The thrust of organisational change was led from the very top of the organisation, with St Andrew’s board of directors and leadership team not only recognising the need for change, but also actively driving that change by implementing excellent training as part of an ongoing process.
Core Strategy Two: Use of Data to Inform Practice
Data-informed decision making for continuous improvement has had the biggest impact on culture change, and that has contributed to a reduction in incidents of restraint.
Core Strategy Three: Workforce Development
As indicated above, MAPA® training runs through all levels of the workforce.
Core Strategy Four: Personalised Support
The adaptability of the MAPA® programme means training is relevant and specific to all St. Andrew’s staff.
Core Strategy Five: Communication and Customer Focus
MAPA® has introduced a common and consistent language that has helped to embed the other training interventions introduced as part of the Positive and Safe Service. This, in turn, has helped improve communication both internally and externally, and has assisted a move towards a more customer-focused approach.
Core Strategy Six: Continuous Improvement MAPA®
is seen as ongoing organisational and professional development rather than staff re-training. It’s a process rather than a ‘box-ticking’ exercise, which is why St Andrew’s has seen such success.