Delivering Clinical Holding Training

I think an obvious place to start would be to be clear on what I mean by Clinical Holding, so I wanted to include the definition that CPI uses in our programme of the same name:

Clinical Holding involves the restriction of movement to deliver essential care and treatment. Clinical holding can be used as a method of helping children or adults provided the individual consents to such action. Where an individual cannot consent due to lack of capacity, clinical holding may be used provided such action is in accordance with current legislation and guidance and is in the person’s best interest.

One of my early pandemic interactions with having to train clinical staff in Clinical Holding, was following the admittance of a young girl onto a paediatric ward for specialised care in relation to an eating disorder as all specialist treatment beds were full.

When I arrived, it was clear to me that staff were traumatised about having to hold this patient (having never received training on how to clinically hold) and specifically the number of staff involved in holding her.

They spoke about how they felt they were traumatising the patient, as well as any witnesses (other staff and hospital visitors), and how they were concerned that they could hurt her.

Having spent time with the team looking at the specifics around the essential treatment and customising an interventions plan, which decreased the number of staff involved by half, the training started to alleviate the worry the staff had in relation to hurting the patient; it seemed like a good morning's training.

Staff confidence increased

But did it work? Well, I happened to be on site the following day when clinical staff informed me that essential care went considerably more smoothly on the two occasions since the training, and their confidence in keeping the intervention safe was one of the areas they spoke to me about.

They felt that because they were confident in the treatment they felt less traumatised and, as a result, the patient struggled with the treatment less, hopefully causing less trauma to the patient as well.

These accounts have continued since, in relation to dealing with children and young people around anxiety, eating disorders etc.

Consider this in relation to almost 31,000 young people referred to CAMHS in England alone in 2020.

We have seen the same confidence in adult services, where interventions are more confident and smooth and hence lessening trauma of both staff and patients.

Clinical staff consistently report back to us is of increased confidence, smoothness and success of clinical intervention.

“I just thought I would let you know about a scenario which I was requested personally to deal with at the vaccine hub in Portsmouth.

A young adult with special needs attended with his carer for his vaccination and I was asked to ‘try’ to administer it. He displayed a lot of involuntary movement and was lashing his arms around. I showed two NHS Professional staff how to assist with clinical holding and we went into level two for his safety. I got it done!

This felt amazing for me that the skills of special care dental staff have been recognised and utilised. I have used the technique three times since the course with success.”

Considering trauma

I have mentioned trauma several times, and we must consider the trauma of staff in new situations which can be distressing for them but imperative for the care of the patient.
Trauma of patients who may not understand what or why an intervention is being done, or simply may not like it (eg. needle phobia), then there is the trauma of others who may witness the interventions such as other patients, parents or care givers.

In my experience the more organised an intervention, where professionals are confident and considered around planning and appropriate communication the less stress and trauma is caused by the intervention. This is what comes from training and practice around the specifics of an intervention when clinical holding is deemed necessary.

“Just finished the clinical holding course. It was fantastic – it was exactly what we needed and the trainers were excellent.

They gave us so much practise that it did feel like second nature by the time we were done – I really liked the way that each new skill was added in gently once we had gotten used to the last new skill – and by the end we were putting everything all together again and again.

I thought the pre course material was good too – didn’t take too long – and was entirely appropriate for a healthcare setting. Having had to de-escalate a lot of tense situations, it was good to see the strong emphasis on being supportive to the person in crisis/ listening/ understanding their perspective. Also good to see such a lot of emphasis on staff care and debrief after a crisis.”

Chris Anderson, Consultant Paediatrician, Salisbury NHS Foundation Trust

Person centred

When something is simple to apply because it is principle based rather than technique based, it can be applied to different situations in different settings both for children, young people and adults.

I have enjoyed working with many professionals who have found Clinical Holding to have enhanced their practice and understanding of how we can keep essential care and treatment safe, person centred and more successful for all concerned.

We were able to put the Clinical Holding training into practice recently at one of our special care dental clinics.  We have a patient, who in the past would struggle.

We are usually unable to conduct treatment without some form of holding from her father. She came in again with her father and we asked him if we could do the clinical holding we had been taught by CPI. We used a medium level with her father holding her head.

She let us hold her and it was the best outcome we have had with her. The training we received has already become a complete asset to us.”

Solent NHS Trust

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