A service director the other day commented how it was only on Physical Intervention training that the staff start questioning to the Nth degree about scenarios and possible outcomes of events. She stated that it would not happen on a first aid course. Well I know a first aid trainer who would disagree, however I have been on a lot of training as a participant in the last year (see biog) and can agree her point is valid.
This led me to decide to write about this to consolidate some thoughts about the “what if” that facilitators receive in training. More specifically the point about people’s perception of things “not working” that leads them to ask the “what if” question.
It is very common on training to hear people mention about previous training that – “it doesn’t work”. This is an interesting phrase to me as we first need to discuss what the speaker means when they state this as an immutable fact. In essence our first port of call should be – how do we measure success?
For something to be "working" or "not working" we must have a clear understanding of how this statement can be verified or validated.
When discussing success must we have clarity around discussing de-escalation techniques versus physical techniques? Or do we need to separate these discussions at all?
Non Physical
Firstly non physical de-escalation techniques, including low arousal and other psychological principles. We have situations where a member of staff in a stressful situation makes a statement similar to “low arousal does not work with her” or “distraction does not work with him”. Usually when you see what the carer is actually doing it cannot be called de-escalation.
However the stress that the member of staff is under at that moment and the emotional aftermath create a reality that becomes their own. The human need to feel in control of a situation puts us in a position where for us as the carer the only acceptable outcome is the person doing what we think they should. We are therefore measuring success of an interaction by our emotional response to the outcome of how much in or out of control we feel.
Just as stress is not the event but how you feel about the event, so too is our belief around the success of an interaction. We first must understand our own emotional connection to the process to be able to effectively assist others with their distress.
“It’s not what happens to you, but how you react to it that matters”
— EPICTETUS
When a distractor does not work, this is not a failure of the system, it is because we have not found an effective enough item at that moment. De-escalation is about finding the tool that works, we should not claim the concept does not work because you have not found the right tool. An item that works well at one time may not at a different time.
Our work is about building relationships, better relationships make the de-escalation process easier. If we have not found an answer that gives this person an exit from their distress that they feel able to take, then by the attempt we have exhausted a single possibility. From this point we continue to “work the problem” and find other options rather than pack up and go home. Everyone is an individual, this leads to many different options under the de-escalation banner.
No training will give you answers to every conceivable situation, every course you attend increases your toolbox of options.
Physical
“That physical technique does not work!” This is a common statement and again worth further thought. If the instructor got the technique to work with the largest person in the room holding tight to prove it would not work then, is the technique to blame? The British Institute of Learning Disabilities (BILD) current code of Practice 2014 highlights the fact that not all participants will be competent at physical skills and therefore the discussion should occur – if we are being person centred around the individuals we work with, why do we think any member of staff should be competent just because they have been taught a skill for a few days? One size does not fit all. We need to be accepting the person cannot always do the skill, and be more supportive of this person centred stance as BILD now are in the 2014 code.
Physical skills are always a hot topic, but let us take a physical skill most of us are proficient in, or have at least attempted. Driving is a physical skill. People do a series of “courses”, they do not expect to get certificated in a day. They recognise the dangers of being in control of a weapon that weighs a tonne.
A friend of mine had a driving license and had been on insurance for years with no claims or points – she had not driven in a decade. The issue here is that she did not feel safe behind the wheel, she had no confidence about her ability to control the car. The question is, would you let her drive your car?
Not likely, and herein lies the issue. She had the certificate, she had passed the course, she was even insurable with no points on her license. However people don’t say “driving does not work”, they say, “I don’t drive!”
We have exactly the same issue in our industry. People say that skills do not work when they are missing the point that the individual is not working the skill.
When under pressure in stressful situations an individual’s ability to carry out a physical skill is altered. If they have practised using stress training they will be much more likely to be able to perform the same skill under pressure rather than falter consequently then blaming the skill. The military understand and use this stress training as do Arctic training and pilot training.
A few years back on the BBC documentary twins study, identical twins Chris and Xand van Tulleken were participants back then before going on to make the recent sugar vrs fat documentary. Both doctors, the twins were at one point subjected to placing their hand and forearm up to the elbow in iced water. While I am not sure on the actual lengths of time one twin lasted literally about 34 seconds before pulling his hand out in agony. The second twin had to be stopped by the researchers after over 7 minutes because they were concerned that about his arm if he continued. Why the huge difference in the ability considering they were twins? – The second twin having worked in the Arctic had received Arctic training.
And so we look at Arctic training, one of the things they do is drop you into freezing water, which puts your system into shock, you even find it hard to breath. However this shock and stress training does not end there, you get dry, warm and a cup of tea then they drop you back in the frozen water. Having had this shock 3 times in a day – for the next year you have control over the stress reaction to being dropped in frozen water. This stress training can save your life. If you watch Top Gear you may remember Jeremy Clarkson’s face when he was dropped into frozen water by an SAS survival guy for their polar expedition – priceless.
I once met a psychologist who could not be convinced there was any value in “role play”, I mentioned this on the next course where an x-sniper pointed out that would be like learning to be a sniper without real bullets.
Therefore
Do we need to separate the two discussions? It actually does not matter if you are talking about non-physical or physical. Success should be measured by a reduction in distress of the individual. To be calm under pressure and have the level head needed to carry out de-escalation, or physical, skills in a manner that will maintain or even build the relationship with those in distress we must move our thinking from “the skill does not work” to a stance of –
how can I work the skill?
Success can therefore be no one else getting hurt – even though the strategy does not involve controlling the person. The goal is to meet this individual’s need therefore reducing danger. If the individual has stopped lashing out and is not causing any physical danger, this should be seen as success. Yet if he is still screaming, and not physically being contained, our brain tells us we are not in control and therefore believe the skills we are doing do not work. This is an emotional response to feeling out of control and under stress. If you just show someone some skills without the emotional training component you can predict problems when things do not go the way those carers expect.
