Learning Outcomes:

On completion of this PMVA training, your staff team* will be able to:

-Apply the legal principles of Reasonable Force to high-risk scenarios
-Apply the principles regarding Duty of Care to scenarios of high-risk
-Identify situations which may give rise to the risk of sudden death during restraint or of serious injury during an incident
-Understand that physical restrictive interventions are reactive strategies which are used in conjunction with proactive, preventative strategies
-Use tactics which encourage movement by prompting
-Use tactics which enable them to safely escort a compliant but unpredictable person from one place to another
-Employ control tactics for rapidly unfolding situations where they need to keep themselves and a vulnerable but physically-able subject subject safe from harm
-Employ control tactics in higher-risk situations where there is a risk that they might lose control and thereby allow harm to come to themselves, a colleague or the vulnerable (but physically capable) subject they are looking after
record an incident clearly in a way that allows another person to understand their actions in the circumstances which faced them
-Communicate with their subject and with each other in a way which promotes the most positive outcomes in difficult and rapidly-unfolding circumstances

*Please note that we do not run “open” courses for individuals to enrol on at the current time.

UNDERPINNING KNOWLEDGE of RISK and LAW
The Principles of Reasonable Force
Common Law
Criminal Law
Care Legislation
Care Act
Mental Health Act
Mental Capacity Act
DoLS
Decision-Making in regard to the Duty of Care
Health and Safety at Work Act
Management of Health and Safety at Work Regulations
Health and Safety Offences and Corporate Manslaughter
Manual Handling Operations Regulations
Government and National Guidance
NICE NG10
NICE NG11
NICE Violence: Short Term Management
Positive and Proactive Care (Department of Health)
Human Rights Act
Article 2
Article 3
Article 5 and others
Reducing the Risks of Sudden Death During Restraint
Positional Asphyxia and Excited Delirium
Recognising Warning Signs in Restraint Interventions

INCIDENT DECISION-MAKING for PMVA:
Core Person-Centred Values for Dealing with Distressed, Resistant, Dangerous Behaviour
Legal, medical and professional implications of incidents involving PMVA
Risk assessment (both formal and informal) during episodes of PMVA
Legal and medical implications
Good practice following PMVA incident management

UNDERSTANDING DISTRESSED BEHAVIOURS
The Kaplan/Wheeler Model of the Assault Cycle
Brain function and Aggression/Stress
Recognising the cues for Primal/Social behaviours
The SCARF Model of influences on human behaviour
7-Phase model of incident management and recording

CONFLICT RESOLUTION for PMVA
Treating every person with Dignity and Showing them Respect
Having the correct attitudes needed for conflict resolution
Initiating contact with patients service users, visitors and other staff in a non-escalatory way
Discovering and Dealing with people’s communicated needs through listening and empathy
Managing resistance through appropriate persuasion and influencing skills
Deflecting and Redirecting verbal aggression through focus on key goals
Working with the audience and bystanders to positively influence conflict
Knowing when to disengage from conflict

PMVA PHYSICAL SKILLS
Proxemics, Prompting and Escorting
Fundamentals of Self-Protection
Survival from Common Assaults
Principles for Prompting and Escorting
Less-Intrusive Holding and Restraint Principles
More Restrictive Physical Restraint Interventions
Disengagement Methods
Advanced Control Tactics (for Higher-Risk environments)

Our approach to providing advice, training and consultancy in the prevention and management of violence and aggression (PMVA training) follows a three tier model as follows:

PMVA Primary Prevention: understanding the causes and triggers for challenging, risky or violent behaviour and attempting to change aspects of the environment in order to reduce the risk of their occurrence.

PMVA Secondary Prevention: selective interventions, mainly involving effective communication strategies which seek to prevent such situations, if they do occur, from escalating.

PMVA Tertiary Management: interventions, usually including some physical component, for mitigating and reducing risk if situations escalate to the point of violence or the possibility that serious harm or injury could occur.

Dynamis offers courses which cover all three phases of the model and which emphasise both Tier 1 and Tier 2 interventions wherever possible, in line with the wider movement towards Restraint Reduction Programmes.

PMVA Physical Interventions are Reactive Strategies. 

Physical Interventions are what we do to reactively manage potentially harmful behaviour – when it happens – to keep people safe and get things back to a baseline level of communication and coping as soon as possible when a person becomes distressed. These reactive strategies are only ever used as a last resort and are used together with proactive interventions.

Proactive interventions are a range of changes we can make in the person’s environment, in the ways that we communicate, in staff attitudes and in risky situations to reduce the need for the behaviour through which the person is communicating. When considering using Reactive Strategies as a last resort, consideration should be given to using the Least Restrictive Options wherever possible and only for the amount of time they are needed for.

Restrictive Interventions

Where possible (in planned interventions) a thorough risk assessment must address:

any physical health problems and physiological contraindications to the use of restrictive interventions, in particular manual and mechanical restraint
any psychological risks associated with the intervention, such as a history of abuse
any known biomechanical risks, such as musculoskeletal risks
any sensory sensitivities, such as a high or low threshold for touch.
A restrictive intervention should also have a restrictive intervention reduction programme as part of a long-term behaviour support plan.

PMVA Skills Development:

Duty of Care: Understanding where the duty begins and ends and who carries responsibility for restraint during an intervention.
Breakaway / Restraint Use of Force Rules: Understanding Reasonable Force for Control and Restraint Interventions
Risk Awareness: What are the risks of physical restraint intervention and how to reduce or avoid them
Government Guidance: What is expected by the national authorities who advise on best practice for restraint interventions and restrictive practices (e.g. Department of Health, NICE Guidance, Relevant Codes of Practice)
Teamwork: Working in cooperation with team-mates in high-risk restraint and non-restraint situations
Physical Tactics:

-Reliable and Robust methods for last-resort physical intervention resolution of high-risk conflict situations
-Managing Proximity and Body Language Effectively (Proxemics)
-Low-Level Breakaway Skills from Common Assaults (grabbing)
-Functional Breakaway Skills from More Serious Assaults (impacts)
-Safe Prompting and Guiding Skills for use with unpredictable service users
-Control Tactics for early-stage engagement with a resistant or violent person
-Holding and Escorting Skills for use with disoriented persons
-Restraint Skills for more serious incidents requiring robust stabilisation (only where necessary)
-The use of restraint devices such as the Soft Restraint System (only where necessary)

PMVA Training Formats

IMPORTANT: To properly control risk and to manage your liability exposure as a responsible employer, the training you provide to your staff should match the needs of your teams and the levels of risk to which they are exposed.

At Dynamis, leveraging our online training system which has been successfully used since 2014 for a variety of teams, we can maximise the in-person contact time needed to create positive learning experiences for learners. We have, for example, been able to provide 2-, 3-, 4- and 5-day courses which develop broad competencies for PMVA and meet the specific needs of teams.

Broadly speaking, each core element of PMVA training should take one day of introduction and practice, interspersed with the knowledge and guidance elements of the course content:

Conflict Management and Verbal Skills for Dealing with Distress/Aggression (1 day)
Personal Safety/Breakaway Skills for disengagement from Violence (1 day)
Interventions for Prompting, Escorting, Holding at a Lower Risk Level (1 day)
Options for Holding, Control and Restraint at a Higher Risk Level (1 day)
Control Tactics for High-Risk Contexts including Restraint Equipment (1 day)
Each stage of this training builds on the previous phase of training and experience in order to best contribute to overall performance capability, both in terms of the team and the individual.

For one-day courses, please see individual course webpages as follows:

– Conflict Communications and Crisis Intervention

– Breakaway and Disengagement

– Physical Restraint Interventions