Welcome to…
A WHOLE SETTING HOLISTIC TRAINING APPROACH
TO BEHAVIOUR SUPPORTS & INTERVENTIONS
Tutors:
Location:
Date:
Settling Notes:
Sign-in on the Sign-in Register
Please introduce yourself to your neighbours
Make a name label using the large flip chart pens
Read through Health and Safety Checklist
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Background
and
Course Structure
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Workbook Page 7
Introductions, Domestics and Course
Expectations
The Venue:
Toilets
Fire Drills
Refreshments and Breaks
Health and Safety Checklist
Mobile Phones
Confidentiality and Sensitivity
Introductions
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Workbook Page 8 and 9
The Team-Teach Aim
To provide an accredited training framework
designed to reduce risk and through working
together to help safeguard people &
services.
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Workbook Page 10
Why Team-Teach?
• Endorsed and used in a wide variety of
settings
• Holistic approach
• Increased safety for all
• Emphasis on de-escalation
• Research base
• Examples of ‘good enough’ paperwork
• Reduction in violence to staff
• Gradual and Graded responses
• Access to video techniques
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Workbook Page 10
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Course Objectives
• To develop shared values which promote the
attitudes, skills and knowledge needed to
implement Team-Teach in the workplace
• To develop positive handling skills in behaviour
management and support including verbal and
non verbal communication, diversion and deescalation and safe, effective, humane physical
interventions
• To develop skills in listening and learning
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Workbook Page 10
Relationships & Communication
Redirect V Reject
Teach a better way
V
Control
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Workbook Page 11
Risk Reduction
FORESEEABLE
RISK
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Workbook Page 11
Core Value Statements
Behavioural interventions which seek to only
control behaviour, rather than understand its
meaning are likely to prevent individuals from
making the most of their potential.
It is about how staff show restraint,
rather than apply it!
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Workbook Page 12
Core Value Statements
Challenging Behaviour is nearly always the result of a
breakdown in communication.
Staff teams involved in supporting individuals should aim
understand what function the behaviour serves and to
team-teach the individual a more socially acceptable
means of expressing their need for support.
The preference, is to use deescalation strategies and that these,
where possible, should account for at
least 95% of our responses.
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Workbook Page 12
Core Principles
 “I care enough about you not to let you
be out of control.”
 Emphasis on caring, protecting and
enhancing positive relationships.
 Staff safety and protection issues
addressed.
 Increased staff confidence
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Workbook Page 13
Core Principles
 Seeking help – a professional expectation and
strength “ Help protocol & Help Script”
 Advocacy, concern and complaints are all
taken seriously
 Understanding of the value of enhanced
communication skills and team work through
the role of “critical friends” & involvement of
key individuals and services.
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Workbook Page 13 and 14
Core Principles
 The physical techniques are based on providing
the maximum amount of care, control and
support.
 Staff numbers. (minimum of 2 involved)
 Minimum force and time & last resort (where
possible)
 Techniques that allow for verbal communication
13
& do not rely on pain or “locks” for control.
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Workbook Page 14 and 15
Core Principles
 Planned responses & techniques should be
written out and included in: Individual Behaviour
Support & Intervention (PHP’s) plans.
 Following a restraint there should be both a
support and reflective structure in place for both
staff and service users involved.
 All incidents using restraint should be reported,
recorded, monitored and evaluated.
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Workbook Page 15
Definitions: What is Positive Handling?
Positive handling describes the full range of
Team-Teach strategies used to de-escalate,
defuse and divert in order to prevent
violence and reduce the risk of injury to staff
and clients.
Positive Handling should be underpinned by
documentation which supports the child and
aims to provide security and safety, allowing
for recovery, repair and reflection for all
concerned.
Workbook Page 15
Definitions: Positive Handling
 Positive Handling – the full range of strategies
and interventions (physical and non-physical)
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Use of space
Changes to the environment
Stance and posture
Facial expressions
Intonation
Simple positive messages
Physical interventions
 Guides
 Controls
 Restraints
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Workbook Page 16
Restrictive Physical
Interventions
•Guides – minimal resistance
•Controls – moderate resistance
•Restraints – rigorous resistance
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Workbook Page 16
Guides
• “The positive application of force to overcome
minimal resistance prompting and encouraging
a person’s free movement . The purpose of its
application should be to safeguard the person,
other people or prevent significant damage to
property.
• Examples:
– Getting attention and encouraging a person with
Intellectual Impairment to move towards a door by
applying pressure to the upper arm just above the
elbow
– Putting an arm around a distressed young child and
encouraging him/her to stay inside a room
– Guiding a truculent youth away from the pool table by
applying pressure to the upper arms while using
diversion to avoid an escalation
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Workbook Page 15
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Controls
• “The positive application of force to overcome
moderate resistance, guiding and directing a person’s
free movement . The purpose of its application should
be to safeguard the person, other people or prevent
significant damage to property.
• Examples:
– Guiding a young person away from a potential
confrontation by applying force to overcome resistance
– Escorting an elderly person who offers resistance away
from a road
– Holding back or moving a young child away from
danger
– Moving an unruly student out of a classroom
– Escorting a resistant adult with Intellectual Impairment
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who has wondered outside in pyjamas Workbook Page 15
Restraints
• Restraint is the positive application of force by
staff, in order to overcome rigorous resistance;
completely directing, deciding and controlling a
person’s free movement. The purpose of its
application should be to safeguard the person,
other people or prevent significant damage to
property.
• Examples:
– One member of staff holding a young child who is
attempting to kick, bite and scratch
– Two members of staff holding a violent teenager in a
seated position to prevent her from fighting her way out
of the room to attack another girl
– Four members of staff holding a powerful, violent adult
on the ground to prevent him from causing further injury
as they wait for the police to arrive
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Workbook Page 16
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Restraints
 The proper use of restraint requires
knowledge, understanding, skill and
judgement.
 As a minimum standard, all restraints
should be reported, recorded and
reviewed.
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Workbook Page 16
Protective Isolation
• Withdrawing a person to a less stimulating or a
safer environment then containing them there
• The important thing is to conduct a risk assessment
• “The use of a room or area to physically contain a
person who is closely supported and monitored”
• Examples:
• A 19 year old woman with Intellectual Impairment and ASD
has been forcefully taken to a calming sensory room and is
then left on her own, as she has indicated previously that the
presence of other people distresses her. The staff remain
outside the room and can see her through an observation
panel
• A primary aged child who tries to kick staff whenever they
attempt to join him in the room is left alone to kick the door
instead. The staff are waiting outside the door until he stops
kicking and are ready to respond as soon as it is safe to do
so.
• Supporting and monitoring does not necessarily mean that
staff must be in range to be injured or even in the same room.
It means that they are close and able to respond immediately
should the situation change. Support and monitoring is the
vital element in this approach.
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Workbook Page 16
Team-Teach Values Activity
Photo Share
• What you think are the most important
values and key expressions when
thinking about supporting clients who
display challenging behaviour?
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Workbook Page 17
Training Safely
Safety on the Outside:
Watches, Jewellery, rings etc.
Safety on the Inside:
Chewing Gum, lollies, and
Emotional Opt out.
STOP! Signal
Instant & Delayed.
No unauthorised movements,
no unsupervised practice.
Stick to the script:
Dry run pace
Here to learn the mechanics,
Nothing to prove other than your safe
“Minimum force, maximum care”.
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Legal Framework and Good
Practice Guidance
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Workbook Page 17 - 22
Code of Practice
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Best interests of the service user
Minimum force for the shortest time
Prevent injury, pain and distress
Maintain dignity
Reasonable and Proportionate
Action should be necessary
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Workbook Page 17 - 18
Legal Principles
Best Interest
Reasonable, Proportionate and Necessary
Making Reasonable Adjustments
Duty of Care
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Workbook Page 18 - 19
Legal Framework
Common Law
Assault
Duty of Care
Occupational Health and Safety Legislation
Risk assessment and reduction
Employer and employee duties
Human Rights Legislation
Disability Discrimination Legislation
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Workbook Page 19 - 21
Asking the right questions
• How was this intervention in the best
interests of the client?
• Why was it necessary?
• How was it reasonable and
proportionate?
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Training Safely
Safety on the Outside:
Watches, Jewellery, rings etc.
Safety on the Inside:
Chewing Gum, lollies, and
Emotional Opt out.
STOP! Signal
Instant & Delayed.
No unauthorised movements,
no unsupervised practice.
Stick to the script:
Dry run pace
Here to learn the mechanics,
Nothing to prove other than your safe
“Minimum force, maximum care”.
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‘Good Enough’ Documentation
Employers & Staff Are Judged by:
What They Feel,
Think,
Say,
Do & DOCUMENT
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Workbook Page 22 - 25
Careful Language
• Keeping people safe
• Policy – how we keep people safe
• “Do you want us to keep the service user
safe?”
• Dynamic risk assessment results in a
decision to choose the safest option
• Take someone to a safer place
• Team Teach Policy Statement Regarding
Injury potential and Technique Application.32
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Policy and Guidance
 Should be value driven
 Should tell people clearly what they should
do
 Should explain how to do it
 Should be supported by training
where necessary
 Should be updated annually
 Should be supported by evidence
that staff have read and understood it
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Workbook Page 23
Where is the risk assessment?
• Formal Risk Assessments
– Activities
• Activities risk assessment file
– Environments
• Environments risk assessment file
– Individual clients
• Positive Handling Plans
• Dynamic Risk Assessments
• Serious incident records
• Policies
• Induction Handbook
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Workbook Page 24
Positive Handling Plans
 Should include risks assessments where necessary and
alert people to risks
 Should warn against strategies which have been
ineffective in the past
 Should include preferred strategies and suggest ideas
for the future
 Should bring together contributions from key partners
working in partnership and signed by all concerned
 Should be reviewed regularly
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Workbook Page 25
Records
 Should be completed after everyone has
recovered
 Should use structured recording forms
 Should include the 95%
 Should state briefly exactly what
happened
 Should be signed and dated
 Should be monitored and evaluated
 Should inform positive handling plans
 Should be archived along with the
current policy and guidance
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Workbook Page 25
Behaviours That
Challenge
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Workbook Page 25 - 30
Core Activity: Behaviours That Challenge
What presses
your buttons?
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Workbook Page 28 and 29
Look at the Feelings
•
•
•
•
•
•
•
We tend to focus on the behaviour
It is not driven by a desire to hurt us
There is no point in blaming
“Get out from under that desk – now!”
“Pull your hood down – now!”
“Stop being depressed - now!”
“Stop missing your Dad – now!”
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Conflict Spiral
STAFF REACTIONS
Staff reactions are
experiences feeding
the CONFLICT
spiral
BEHAVIOUR
negative behaviour
provoke negative
reactions for others
FEELINGS
negative thoughts
and emotions
drive behaviour
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EXPERIENCES
result from incidents
and perceptions
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Workbook Page 26 - 27
CALM Approach
ommunication
- stance - posture - gesture - facial expression
- intonation - scripts
wareness and Assessment
- reading behaviour - anticipating what might happen next
- knowledge of handling plans
istening
- give time and space - allow pauses for take up time
- give them a way out
aking Safe
- objects - space - hotspots - safety responses
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Workbook Page 27
Team-Teach Stages and Levels in a Crisis
Time
High Level
Risk
Crisis
Medium Level
Risk
Defensive
Escalation
Low Level
Risk
Anxiety
Need for
reassurance
, support
and
diversion
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Need for
diversion,
reassurance,
clear limits,
boundaries and
offering limited
choices
Possible
need for
physical
intervention
appropriate
to the client
Recovery
Need for
coordinated
letting go
and
reassurance
Depression
Need for
observation,
support and
monitoring
Follow Up
and
Observation
Need for
listening and
learning
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Workbook Page 30 - 33
Positive Handling and
De-escalation
Adopting a CALM Approach
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Workbook Page 34 - 39
Effective Communication
Script
Stance
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Sound
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Workbook Page 34 - 35
Space and Stance
Understanding The Importance of Space & Stance
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Fight
Flight
Freeze
Giggle
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Workbook Page 35
Help Script
 Connect by using the individual’s name.
 Recognise the difficulty
 Tell them that you’re there to help.
 Direct them to talk and say you will listen.
 Give direction and be positive about the management
of the difficulty.
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Workbook Page 35 - 36
Help protocol for staff
Being part of the solution rather than part of the problem..
Here to help….
Can you help by…
More Help is available….
What do you suggest?
How about if I…. But I will catch up with you
later…
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Workbook Page 3647
Sounds
The manner in which you deliver your verbal messages.
 Only 10-15% of our messages are perceived by the words
used.
 The inflection of your voice determines how a message is
perceived by nuances in tone, volume and cadence.
 What you say is not as important as how you say it.
Intonation is the quality of the “noise” people make when
they are speaking.
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Workbook Page 36
De-escalation Techniques.
Preferred and Documented
 Identify as many de-escalation
techniques as possible
 Share with the group
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Workbook Page 36 - 38
De-escalation Techniques.
Preferred and Documented
 Verbal advice, support, encouragement
& reassurance
 Reassurance (reminded of past
success)
 Humour
 C.A.L.M. body language &
Communication (Here to help)
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Workbook Page 36 - 38
De-escalation Techniques.
Preferred and Documented
 Distraction (Key word/object/job to do)
 Step Away (breathe in, breathe out, step
back- staff take up time!)
 Negotiation (Delayed compliance )
 Informed of desired behaviours.
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Workbook Page 36 - 38
De-escalation Techniques.
Preferred and Documented
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Contingent touch.
Change of task/assignment.
Time out. (Directed/asked for)
Remove the audience
Help Protocol / Critical Friends
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Workbook Page 36 - 38
De-escalation Techniques.
Preferred and Documented
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Reminded of, rights and responsibilities.
Reminded of rules, boundaries and limits.
Given choices, options & consequences
Positive Handling (including restraint)
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Workbook Page 36 - 38
Listening and Learning
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Workbook Page 39
Outcomes of a Crisis
Staff – Child/Client
Staff – Child/Client
Relationship Damaged
Relationship Unchanged
Staff – Child/Client
Relationship Improved
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Workbook Page 40
Listening and Learning
• Listen
– Active listening
• Link
• Learn
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Workbook Page 40 - 41
Structured Interviews- Restorative Practice (RP)
• RP is based on the philosophy and principles of
restorative justice. RP involves:
– Viewing wrongdoing through a ‘relational’ lens –
understanding that harm has been done to people
and relationships
– Understanding that when such harm is done it
creates obligations and liabilities
– Focusing on repairing the harm and making things
right
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Workbook Page 41
Listening and Learning - Restorative Practice
Key elements of good practice in the use of RP:
•Outcomes before strategy:
– What do we want them to understand about the
situation?
– What changes do we need to see in their behaviour?
– Will a punishment teach them to be more
thoughtful/reflective?
– What do we ant for the others involved? For ourselves?
Three golden rules:
– Reflect
– Repair
– Reconnect
•“In the end, it’s the relationships that matters”
Thorsborne and Vinegrad 2009
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Workbook Page 41 - 42
Listening and Learning - Restorative Practice
The Original Script
•What happened?
•What were you thinking about when you…?
•What have you thought about since?
•Did you make a good choice or a bad choice?
•Who’s been affected by your behaviour?
•What do you need to do to fix things up?
EY/ASD/II Modification
•What happened?
•When you … was that a good choice or a bad choice?
•How did you make … feel when you …?
•At school it’s not okay to … next time I want you to …
•To fix this up you need to …
Jane Langley
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Workbook Page 42
Objectives of the Process for Staff
 Discuss what happened in a non-blaming,
supportive, caring manner.
 Use crisis situation to clarify underlying causes,
issues and feelings.
 Examine what techniques were used to deescalate and/or physically manage the situation.
 Develop a strategy for the next time the
child/client begins to lose control.
 All items discussed concerning professional
practice issues should be documented
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Workbook Page 42
Elevated Risks
•
•
•
•
•
•
Pressure to the Neck
Prone Holds or Restraints
Supine Holds or Restraints
Seated Holds or Restraints
Standing Holds or Restraints
Extreme Exertion and Other
Factors
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Workbook Page 46 - 49
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Activity Team-Teach Test Quiz

Pre Quiz: We will go through this together and agree the
answers

When ready, as individuals, take the Post Quiz: The
questions will be similar although not identical. (Closed
book expectations)

When complete turn upside down in front of you and have
a short break…

We will then mark together
Workbook Page 50 62
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Team-Teach Organisation Structure
Risk Assessment Panel & Steering Group
Advanced Tutors,
HIGH RISK needs /
(4 Days) able to teach Adv.
Modules, 12 & 6 hour courses
settings require ADV hours
of teaching provided by an
Advanced Team teach tutor
Employers Tutors
MEDIUM RISK needs /
(5 Days) able to teach 12 & 6
hour courses and apply for
advanced tutor course
settings = Basic course 12
hours, then able to apply for
ONLY TO PEOPLE WITH THE
SAME EMPLOYER ON THE
PAYSLIP AND IN SAME DISTRICT
LOW RISK needs /
Recommended and
required reaccreditation
Dictated by
Risk Assessment
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Intermediate tutor course
settings = Foundation
course (6 hours)
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Workbook Page 51
Team-Teach Reaccreditation Timescale
Team-Teach COURSE
RECOMMENDED
REQUIRED
Every 2 Years
Every 3 Years
Every 1 Year
Every 2 Years
Intermediate
Instructor
(5 days)
Every 12
months
One Annual Reaccreditation
then Every 2 Years +
* 4 month grace period
Advanced Instructor
(4 days)
N/A
Every 12 months +
* 4 month grace period
6 Hours (Low Risk Service
Settings & individuals eg
Mainstream schools)
12 Hours (Medium to
Elevated Risk Service
Settings & individuals eg
“special” / homes / social
care / hospitals)
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Workbook Page 52
Core Activity: Issues Discussion
 What areas & issues needs to be
attended to and or developed?
 Ten Minute Discussion in small groups
 One scribe, notes to be made, collected
in and made available to Admin Team
 This will help develop an action plan.
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Workbook Page 52
A Tremendous Power
I’ve come to the frightening conclusion that,
I am the decisive element in the classroom.
It’s my personal approach that creates the
climate,
It’s my daily mood that makes the weather.
As a teacher, I possess a tremendous power,
to make a child’s life miserable or joyous.
I can be a tool of torture,
or an instrument of inspiration
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A Tremendous Power
I can humiliate or humour,
hurt or heal.
In all situations,
it is my response that decides,
whether a crisis will be escalated or deescalated,
and a child, humanised or de-humanised.
Haim Ginott
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