Purpose The purpose of this paper is to identify what key factors multi-disciplinary teams (MDT) deem as most important when making the decision to move service users from one level of security (including low, medium and high secure services) to another. The researchers used the findings from this study to further develop a tool; the assessment for level of security tool (ALS), which aims to structure and streamline this decision-making process. Design/methodology/approach Data from 18 interviews (MDT staff) were analysed using the Delphi technique (Dalkey and Helmer, 1963). This revealed a range of factors discussed when considering service users moves. Participants were asked to rate these factors in accordance with the Delphi which resulted in the removal of certain less important factors based on their scores. The researchers then compared these factors of relevance with a checklist of 16 items previously proposed by a consultant psychiatrist within the trust. This comparison allowed the researchers to highlight any similarities and differences present. Findings Findings from staff interviews revealed a range of 20 clinical factors perceived as essential to this process including procedural, relational and physical security aspects. However, variations were evident between the MDT priorities (20 items) and the originally proposed list. This emphasised the need for a tool which facilitates a holistic and streamlined approach. Practical implications The findings from this research have resulted in the development of the ALS tool comprising of 18 key factors. Originality/value It is envisaged the development of the ALS tool will not only facilitate and structure the decision-making process but also ensure a person-centred approach. This is because the ALS allows for a holistic approach based on an array of factors deemed important to that particular service user. Furthermore, the ALS tool contributes towards the paucity of published structured professional judgement tools needed to make such decisions.

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Purpose The purpose of this paper is to evaluate whether an example of Seclusion Room Contactless Monitoring Technology (VitalGuardTM) is able to accurately detect the presence of life in a ward seclusion room ensuring patient wellbeing, without interference from background “living noise” (e.g. voices) or “electronic noise” (e.g. other systems). Design/methodology/approach The authors assessed the system’s ability to monitor movement caused by human respiration through its ability to discriminate false positives (i.e. presence of an inanimate object ± movement or noise, in the absence of a person in the seclusion room) and false negatives (i.e. failure to detect a human presence) in a ward setting. Findings The system displayed 100 per cent validity in terms of determining false positives (six conditions, each n=5) and the system did not alarm under either of the two false negative conditions tested (each n=5). Research limitations/implications These findings demonstrate that this example of technology is able to monitor movement caused by human respiration and can accurately and reliably detect the presence of life in seclusion rooms, in the ward setting, without interference from background noise (living and electronic). This was a small evaluation study and further research on its effectiveness in practice would be beneficial in both the intellectual disability forensic setting and other settings of segregation and isolation. Originality/value This study suggests that the use of technology in a seclusion room setting can be used as a reliable tool to enhance patient observations and assist in the delivery of care in a safe and unobtrusive manner.