Comparing the outcomes of the application of C&amp;R (general service) and SCIP in the management of disturbed behaviour in mental health care

Lee, Soo; Gray, Richard; Gournay, Kevin

doi:10.3109/09638237.2012.664299

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…Findings were often negative, irrespective of training intensity or study quality, with studies either reporting no effect on incident rate or severity, 25,34,36,41 or increases in aggression post-training (probably because of improved reporting post-training). 39 There was even evidence that de-escalation trained wards increased staff risk of exposure to being involved in an aggressive incident when compared with control and restraint trained wards, 35 but there was a high risk of other programmatic or organisational variables being responsible for this outcome. Again, there was evidence of a significant reduction in incident rates measured at ward level 26,31 in two studies of moderate quality, one of these demonstrating a medium effect size (ES = 0.64).…”

Section: Resultsmentioning

confidence: 99%

“…18,39 There were negative findings, including a non-significant increase in sick leave 34 and increased patient hospitalisation periods for de-escalation trained wards compared with control and restraint trained wards. 35 However, variation in programmatic or organisational variations between study sites limits the interpretation of these data. No moderators of organisational outcomes were identified.…”

Section: Resultsmentioning

confidence: 99%

“…18,27,[29][30][31][32][33][34] Where wards or units were the units of allocation and/or analyses, insufficient information was provided about the baseline equivalence of these. 35,36 A number of uncontrolled studies failed to report on possible population/organisational differences between pre-and-post-intervention periods. [22][23][24][37][38][39][40] The eight studies reporting participant withdrawals (Table 2) had a mean retention rate of 72.7% (s.d.…”

Section: Quality Appraisalmentioning

confidence: 99%

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Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression

Price¹,

et al. 2015

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BackgroundDe-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness.AimsTo conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training.MethodThe review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis.ResultsA total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and de-escalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results.ConclusionsIt is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Quality Appraisalmentioning

confidence: 99%

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Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression

Price¹,

et al. 2015

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“…One study measured impact of training on what they referred to as 'disturbed behaviour' (defined as any untoward incident involving patient behaviour that met the threshold for incident reporting) and found a non-significant negative effect of training between intervention and control wards. 35 The hazard ratio for staff assaults in the de-escalation training arm of the study was 48% higher than for staff in the usual care arm (control and restraint training). 35 One study found a significant, medium-sized effect (0.64) increasing rates of assaults post training, attributed to increased patient acuity in the follow-up period.…”

Section: Rates Of Conflictmentioning

confidence: 83%

Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial

Price,

Papastavrou Brooks,

Johnston

et al. 2024

Health Technol Assess

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Background Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training’s effectiveness. Objectives Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention’s preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Design Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Setting Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. Participants In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Interventions Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Main outcome measures Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient–Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Results Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Conclusions Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Limitations Uncontrolled design and self-selecting sample. Future work Definitive trial determining intervention effects. Trial registration This trial is registered as ISRCTN12826685 (closed to recruitment). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Context Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. ‘De-escalation’ is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use ‘containment’ interventions (measures to prevent harm through restricting a person’s ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient’s concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention.

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“…On the other hand, it was also found that patient outcomes (e.g. length of admissions, rates of incidents) were worse in a group of patients in which a program to reduce coercive measures (Strategies in Crisis Intervention and Prevention, SCIP) was implemented (Lee, Gray, & Gournay, 2012). Further literature reviews about the effectiveness of deescalation training in reducing the use of coercive measures propose that more evidence is needed to evaluate their effectiveness (Price et al 2015;Gaynes et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Is Deescalation Training Effective in Reducing Violent Incidents in Forensic Psychiatric Settings? – A Systematic Review of the Literature

Brenig

GADE

VOELLM

2022

Preprint

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Background: Inpatient violence is a relevant issue in forensic psychiatric settings. Coercive measures are used as a last resort to prevent further harm although they are often regarded as untherapeutic. In order to enable staff to intervene before inpatient violence or other serious incidents occur and thus to avoid coercion, deescalation training programs are being adopted in general as well as forensic mental health settings. There is growing evidence for the efficacy of de-escalation training in general psychiatry. However, there are no reviews evaluating the effectiveness of deescalation training in reducing violent incidents in forensic psychiatric settings. Here we present the first literature review on the effectiveness of de-escalation training in the field of forensic psychiatry.Method: We searched relevant databases for original research on the effectiveness of reducing violence in forensic psychiatric settings. Studies were included if they investigated staff training programs with deescalation techniques in forensic mental health settings.Results: A total of 6 relevant studies were identified. Only one study was a randomized controlled trial. Four studies were before and after comparisons without control group. A one group post-test-only design was used in one study. Methodological quality was low. The maximum sample size was 112 participants. Results indicated some impact of deescalation training on the rate of violent incidents in forensic-psychiatric wards. Moreover, staff felt safer following the training. However, results have to be interpreted cautiously due to methodological limitations. Discussion: Evidence for the effectiveness of deescalation training on violent incidents in forensic settings remains limited. However, positive changes are reported across a variety of outcome measures providing initial indications that deescalation training might contribute to a reduction in aggressive incidents in forensic psychiatry. High quality studies are required to add to the evidence base on this topic.

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Comparing the outcomes of the application of C&R (general service) and SCIP in the management of disturbed behaviour in mental health care

Cited by 4 publications

References 24 publications

Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression

Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression

Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial

Is Deescalation Training Effective in Reducing Violent Incidents in Forensic Psychiatric Settings? – A Systematic Review of the Literature

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