Breakaway training in care - an example of positive outcomes

At one point early in the training programme it becomes important to look at physical self-protection training, especially if the service data shows that some service users, when distressed,  target staff with violence by grabbing, hitting or throwing objects at them.

In the past, the staff were taught a very old and outdated system of training called ‘Breakaways’. This breakaway training in care dates from the early 1960s and was designed at that time to be learned and applied much like a martial arts class from that era – static line drills, trained to the count, and heavily choreographed.  In short, old-style breakaway training in care didn’t mirror real violence and don’t help the learner at all.

We set about changing this, by teaching a modern self-protection system for breakaway training in care which is based on concepts like ‘instinctive protection’ and ‘mental modelling’.  Our method is taught against a background of the ‘compound assault’ reflecting the fluid reality of a violent encounter and is rooted in human behaviour.

The result of this different approach to breakaway training in care is that it develops usable skill and confidence really quickly in staff. One of the big realisations, when we started using this new approach to self-protection with the team, was that team members would now press the ‘attack alarm’ less frequently, because they felt safer to persist with emergent situations by themselves (in small teams of 2 or 3 staff) rather than having to call the whole staff team into a ‘restraint’ of the individual.

With effective breakaway techniques, the number of restraint incidents in the care service would be reduced!

One of the key voices in our sector is lawyer and expert witness Eric Baskind, who, at a masterclass in 2020 determined that, based on the outcome of a series of court cases up to that time, the way in which training providers need to evidence that breakaway training in care learning outcomes were actually being met, would have to change.  He even coined the term which we use very often now – that “the choreographed dance is dead”.  

Static training experiences, where learners simply repeat techniques they were shown a moment ago in ‘walk-through’ fashion, would have to go. Instead, more engaging learning environments are needed, which bring the learners closer to the performance levels needed in their actual jobs, under the pressure and uncertainty associated with conflict in the real world.

This is why our SCENA approach for breakaway training in care programme design and delivery – a scenario-driven and task-focussed training approach – generates such engagement and results in such confidence from the teams who experience it.  SCENA ensures that learners (the staff) have many many opportunities to put their new skills and tactics to work in the training environment prior to returning to their workplace.

In these many opportunities to practice, staff develop their knowledge, understanding and skill level alongside the decision-making needed to be able to effectively deploy de-escalation or protective interventions needed in their services.

In the various ways in which SCENA-type training is formatted, it produces better, “near-transfer” effects. ‘Near-transfer’ means that the practice activities carried out in the classroom are easily related to situations in the real workplace which staff will face, rsulting in faster recignition of problems and more reliable and desirable problem-solving in the workplace.  After all, using this training approach means that staff have usually seen the same issues in the breakaway training in care as they face at work.

It is possible that a lot of generic, off-the self train-the-trainer packages result in far-transfer effects (a disconnection with the context and needs of the actual workplace) because of their main focus on getting the elements of the curriculum ‘correct’.  This is slightly myopic in that, what we have found is that clients want to see changes on the floor of their school / care service / hospital rather than simply a compliance ‘check’.

Coming back to our work with the team in Scotland, when we integrated verbal responses to abuse, intimidation and threats (from Vistelar) alongside the robust self-protection methodology we use (the 9 Attitudes/Dynamis method) we saw instant culture change within the team.

They saw immediately how the tactics would be used every day in their interactions with service users, and (figuratively) wrapped their arms around the approach.  This underlines one of the key mantras we use:

“Staff who are confident in their own personal safety are more resilient and more persistent during the verbal de-escalation phase, creating better outcomes” 

The evidence coming out of this service since we delivered the breakaway training in care suggests exactly this.

Staff are ‘staying with’ situations which are escalating and being more creative in their attempts to de-escalate the situation using words (listening, empathising, redirecting, persuading) and behaviour (reducing stimulation, modelling calmness, meeting urgent needs) instead of allowing the increasing risk and stress of the situation overwhelm them.

When staff know what they will do (using ‘when-then thinking’) then we find that they are more persistent in ‘staying with’ their service user and ultimately finding the ways to unlock distress, aggression and crisis rather than simply calling for backup and descending into a physical restraint situation.

Poor Breakaway Training = Fear of Assault by Care Staff

Morale at this service was particularly low.  The inspectors were putting pressure on management.  Management were putting pressure on the nurse manager.  The nurse manager was putting pressure on the care support staff, and the care support staff were on the floor with the service users, during covid lockdowns and with everyone looking at them!

Historically, training in the service had been carried out with a singular focus on the physical techniques of restraint and breakaway.  Unfortunately those techniques were mis-matched to the needs of most of the staff and service users in the service and this had caused a degree of ‘cognitive dissonance’ in the workplace.

Staff had no confidence that the breakaway tactics they had been taught would protect them from harm.  Conversely, staff also believed that the restraint and holding techniques were overly-robust and indeed likely to cause injury to the people they were supposed to be looking after.

There was very little input to the staff team about de-escalating high-stress enounters (or any encounters, in fact) and no opportunities to practice these or to get feedback from experienced colleagues or trainers about them.

Due to all of these factors, there was an inevitable problem with being asked to attend training!

Under the old regime, Training used to mean:

• being told what you shouldn’t do
• being told what you couldn’t do
• being told about the bad things that could go wrong 
• being told what would happen to you if things went wrong

Tactically, the breakaway training was very specific and required an attention to detail which would in all likelihood be very taxing in the midst of a high-stress incident in the care context.

The result of all of these complications was that people didn’t want to do ‘the training’ and didn’t think it was going to help!

There was quite a lot of initial resistance and reluctance to even the new models of training that the newly-qualified instructor team introduced, which in many ways was aimed at fixing the issues with the previous programme.

Happily though, with the new energy brought to the classroom by the newly-qualified training team and the new values-based training programme, the experience of the trainers was that their staff colleagues were experiencing a change of heart in the classroom.

“I’ve really enjoyed this. 

You said you would change my mind about training, and you did!”

Besides the restraint-reduction results, this team have reported a sea-change in the staff culture and attitudes, including a change of feelings about the value of the training in creating a different, safer environment for everyone in the service.

The instructors now report that, months after the programme was initiated:

• staff engage with a common values-set
• staff persist in de-escalation longer
• more incidents are resolved, more quickly
• far fewer incidents conclude in a physical intervention
• improved staff morale both ‘on the floor’ and in training
• more frequent post-incident debriefs
• better overall behaviour planning and insights
• consistent use of common language to describe behaviour
• inspections resulting in positive outcomes

Our friend and hugely experienced colleague Gary Klugiewicz from Vistelartells a story about how he once knew of a service in which everyone remarked on how dirty the physical environment was.  Everyone complained.  Staff blamed the service users – “they don’t clean up after themselves and dirty the whole place.

Service users blamed the staff – “they should arrange cleaning rotas, equipment and organise things for us”.

The management blamed the system – “we need resources and policies to get this place cleaned up!”

Gary’s lesson about this story is that “We ALL come together in this service – some of us to work, some to manage the work, some of us are the work – but if we don’t ALL agree that the condition of the environment is all of our problem, then we won’t get anywhere”.  He finishes the story by underlining that if senior leaders in an organisation send the message that they are watching a specific area or outcome, it will soon be addressed, all the way down through the chain of leadership to the shop-floor.  This is a powerful lesson about the need for top-down leadership in changing the nature of care in our services.

To read our 18-page Case-Study about how we achieved significant Restraint Reduction outcomes with this training programme, please visit our Restraint Reduction page.