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.
STRESS TRAINING COURSES DEAL WITH ALL THESE ISSUES – IF YOU ARE NOT DOING STRESS TRAINING – YOU ARE NOT DOING TRAINING AT ALL!
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.