Recently I was lucky enough to attend the latest BILD seminar entitled
Attachment Trauma & Relationships
D.ESCAL8 has, from its inception, focused on attachment, trauma and resilience in relationships and in our main course titled – “Developing Positive Relationships with Individuals in Distress”. I was therefore interested in this seminar in particular and was able to swing my timetable to go in the last few days prior to the event.
Brodie Patterson was the host and first speaker, having not met Brodie before I was interested in the content he would cover as he is well known in the industry.
BRODIE PATTERSON
Integrative Practice
In terms of best practice Brodie gave a broad spectrum talk, covering all the basics needed to engage in the discussion at hand.
we are collections of emotions and relationships
Brodie discussed:
PBS and the relationship or lack of relationship to ABA.
How relationships should be part of any PBS approach.
An overview of PBS through the 10 points of PBS.
An interesting example of procedural memory and scripts.
A discussion about integrative vrs isolated thinking
empathy, compassion, value and social roles must take into account attachment
you cannot respect an individual and not take into account their relationships (therefore acknowledge their attachment)
Social ecological model by Bronfenbrenner, highlighted how interconnected within those systems we are and how we need to take into account the influences when working with an individual.
Many links back across the subject relating to attunement and attachment
As a concept, what has the person not learned, was a nice shift in thought relating to this subject.
Brodie prefers behavioural distress and as per my post last year on why challenging behaviour is an outdated term, I explain my view there and agree we need to have some better terminology
JAKE LUKAS – NOVALIS TRUST
attachment based trauma – informed care, finding sanctuary
I was glad to experience this talk as I have completed a MSc in Psychology and so the other talks were interesting but not, for me, ground breaking. Jake Lukas gave me lots of new thoughts on the subject, its implementation with staff and those they care for in the real world.
Jake is the CEO at a school in the Cotswolds. He gave a frank account of the issues the school has gone through with the local community. This led to discussing trauma as an organisation and on to attachment and trauma work in the real world.
It was great to hear how an organisation had worked through or were on a path to managing the issues that the children and organisation were experiencing.
We were entertained with stories of the progress the school had made using the sanctuary model of recovery and about meeting Sandra Bloom who has written books on the subject. This for me was very interesting and leads me to want to look further at this subject.
Jake explained about the school following the Rudolf Steiner system and provided an overview of that system.
ACES
The most interesting part of the day for me was the research on the Adverse Childhood Experiences Study ACES. I knew, of course, that trauma can effect long term health, however I was not aware of this research on this subject and the replication in the UK. It was great information and the ability to bring it into staff support and staff understanding of the people we care for was superb. I am always looking for information like this that backs up the subject D.ESCAL8TM is focussed on.
This talk was mentioned on the subject.
staff support
Jake basically had too much content for the allocated time, I would be interested in more information on the areas of real world supporting and working with staff. D.ESCAL8TM has always promoted that, to assist carers in supporting those they care for who display their distress, we must support staff to build and maintain those important relationships. I was therefore left wanting more from this talk.
We (humans) seem to have a default setting when we come into care, meaning a lot of D.ESCAL8TM’s work is challenging those staff perceptions around the work and opening their eyes to the fact they are carers and not parents controlling naughty children. I would have therefore enjoyed more time to hear about how they had worked with carers around supporting development of those relationships with individuals in distress.
if you don’t train your staff – they will make it up on the day. Staff need a model.
He spoke around discussions to have with new staff, this gave me another discussion linking with ACES.
since often the way we work with children has been influenced by the way we were brought up, I wonder what growing up was like for you?
ALAN MORRIS
A carers perspective on attachment and supporting a child with challenging behaviour
Alan gave us a frank conversation about some interesting very personal real world situations, which I feel I should not discuss here. Thank you for sharing.
DR ALLAN SKELLY
staff training and the conditions for security
While Brodie had mentioned Bowlby in the discussion, Allan mentioned Ainsworth which was another person embedded in my memory of my MSc.
Allan discussed:
attachment hostility
disorganised attachment
integrating assessment and treatment
Relational Risk Questions
The set of risk related questions were a useful resource and starts with a question that was relevant to a relationship an individual has with their carer whom I am supporting. Sometimes it is up to us to be the adult in the relationship and take an objective questioning longer view. It is great to have a list of questions around the relationship that focusses us on seeing the risks.
Quoted at the start of the day by Brodie, Allan finished with
They have behaviour, we have relationships?
Beth Greenhill 2011
NIGEL BEAIL – RELATIONSHIPS AT WORK AND INTEGRATIVE APPROACHES TO REALISING POSITIVE BEHAVIOUR SUPPORT
to examine the role of relationships in PBS
Nigel took us back through some history covering Freud and the morphing from hypnosis to talking therapy. It was funny to think of the patients asking Freud to “shut up and let me talk”.
He discussed:
what PBS is
qualities at the heart of PBS
concept of the working alliance
counter transference, which I remembered about from CBT training.
Nigel discussed the fact that the major therapies listed by the British Psychological Society and the Royal College of Psychiatrists, which were on a slide, are all complimentary to PBS.
In CBT etc the main factor in effectiveness is the relationship between the person and their therapist – why should it be different in PBS – it is not the therapist – it is the relationship that is key.
All of them have the relationship with the therapist at their core. Therefore we can use these complimentary therapies in PBS.
It is clear that the relationship with the therapist is more important than the therapist or therapy. Therefore we have another banner for the relationship being core to the work we have in PBS.
By far the most interesting part of Nigel’s talk for me was the conversations about staff emotional understanding and support. Again this is so complimentary to the D.ESCAL8TM model that I was re-assured that we are on the same path.
issues relating to feelings
we need to be open and not ignored
we need an open and honest culture
how much of our feelings should we use in our work?
who is at the point of maximum anxiety (client or us)?
how do we monitor the impact over time?
who is supporting us?
PBS needs explicit recognition about relationships in all 10 areas
without that recognition barriers get in the way
END OF DAY
the day was finished off with Brodie giving a great example of how to explain trauma using something most of us can relate to at some point in our lives – Alcohol
Thank you BILD for putting on the day.
Get in touch to discover how we can reduce interventions and develop healthy relationships in your service
Challenging Behaviour is a term the healthcare sector has misused for years. When the term was originally introduced, it was an attempt to move away from the then widely used term "behaviourally disturbed". The healthcare sector recognised that the term had become associated with some very negative connotations and therefore should not, in good conscience, be given to an individual.
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.
From Inception D8 was formed as a method of getting high quality training to those who care for individuals in distress. Part of that concept involves smaller companies and individuals who find accessing training prohibitive for various reasons. Apart from the obvious cost implications with running a full training course there are also the implications regarding closing a business to release staff for the course to occur.
When under pressure we respond in a small number of differing ways. These tend to be in 2 main camps. Those who feel the need to control and those who have a more relaxed attitude. The question is which has a better effect on the person in distress? Picture this, you are under pressure and in distress and you shout at your partner "just get me my dinner!" and your partner replies "No, you will not talk to me in that manner! ENOUGH now."
Over the last few years we have had a terrific response in terms of de-escalation with our course incorporating Affect Labelling. Emotions arise to make us pay attention to our environment. The more emotional our experience, the less we can think clearly, resist impulses, and engage in constructive problem-solving. By creating even the simplest label, we learn to express what we are experiencing. At a rudimentary level, we think about what is causing us to feel emotion and take action to experience either more or less of the emotion, depending on the situation.
The mind shift almost always travels from introductions where people say / imply things that contradict the basic philosophy of the course to an ending where people state publicly (or privately to me) how they always thought like this. Usually adding something like - “it is great that a training like this exists so that all those other people I work with whose attitude needs adjusting can access it”.
The Assumption about Physical Intervention Training
What would you do? This seems to be an innocent question with a straight forward answer. However, when asked by someone who works in healthcare industry, assumptions take over and most people are convinced they know exactly what that entails – lets look at the options
The term debriefing is an industry-used term. In our industry while useful it is often misunderstood when talking about application at ground floor or grassroots level. When discussing the term de-briefing we @de-escalate.com have separated the term debriefing into different areas. I will discuss one of these here.
If there is any indication or suspicion that anyone has suffered an injury or psychological trauma following the incident / use of physical intervention they must receive treatment and support as soon as is reasonably possible. Debriefing is misused as a term, and while analysis is important in a Positive Behaviour Support framework, your D.ESCAL8™ facilitator discussed these two areas and the differences between debriefing and offloading.
Teaching different groups can lead to predictable responses. When you teach a group where half the participants work with younger kids (under 11 ish) and the other half work with young people (teens) there is a clear dichotomy in their attitudes and responses around problem behaviour. It all comes back to the issue around the distractor versus the reinforcer.
I have wanted to do a post about Hanlon's Razor for a while and the mask issue has led to me combining that here. Our non verbal communication being misinterpreted or misunderstood should not be considered intentional.
This is a series of images sent to me by the area boss. It's not merely about the evaluations people provide at the end. It’s about the deeper consolidation achieved through meaningful conversations within the team. These conversations foster understanding, collaboration, and alignment, which are far more impactful than numerical scores or rankings. The true value lies in engaging dialogue that strengthens bonds and resolves challenges. Success stems from shared insights and collective growth within the team. Conversations truly matter in building trust and unity.