PMVA Training

Prevention and Management of Violence or Aggression for Teams in NHS and Healthcare

Creating an Atmosphere of Non-Violence

Conflict Management and Verbalisation Skills

Personal Safety and Breakaway Skills

Last-Resort Physical Restraint Interventions

Teamwork for Incident Management

Restraint Reduction through Values

PREVENTION AND MANAGEMENT OF VIOLENCE AND AGGRESSION

Training in PMVA for Your Care Team

PMVA Training helps to reduce the risks of violence and aggression in your service by developing staff knowledge, skills and attitudes to effectively employ de-escalation skills, breakaway and disengagement tactics or control and restraint interventions appropriately within the context of their service users, residents, patients and clients. The training meets NHS Protect standards in conflict resolution and physical intervention.

Our PMVA courses develop three levels of prevention and management of violence and aggression:

- Proactive strategies to prevent incidents of aggression or violence

- Retro-active strategies to defuse and de-escalate an emerging situation

- Reactive Strategies to Minimize injury risk and regain control of a situation.

Your team will learn to safely apply appropriate non-restrictive or (where necessary) restrictive physical interventions as alternatives to the primary non-escalation and secondary de-escalation strategies which we will help you to put in place.

LEARNING OUTCOMES

Proactive, Reactive and Retroactive strategies

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)

THREE-TIER MODEL

Proactive, Reactive and Retro-Active Strategies to Manage Potentially Harmful Behaviour

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.

OUR PROCESS FOR WORKING WITH YOU

Communication Skills

Your teams will model and practice appropriate verbal skills for preventing and de-escalating conflict.

Behavior Awareness

Your team will develop their awareness of Behavior cues and the ways in which situations can trigger distress, anger or emotional disturbance.

Teamwork During Incidents

Your team will have to work together to solve problems, learning along the way how to think and to communicate as a team.

Self-Protection

Your team will be challenged to develop personal safety habits and perform robust, appropriate self-protection tactics in many different scenarios.

Legal Rules For Restrictive Practice

Your team will reflect on the legal basis for their actions, assisting in effective reporting.

Restraint Reduction Principles

Your team will be challenged to embody restraint-reduction principles in each scenario they work through.

Risk Awareness

Every restraint carries risk, so your team must learn how to navigate options and reduce the risk of adverse outcomes through serious injury or death.

Holding Skills

Your team will develop flexible skills to perform safe holding, control or restraint appropriately to the level of risk and the vulnerability of the person they engage with.

SKILLS

What skills are developed in PMVA training?

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)