Evaluation of a novel co-designed and co-delivered training package to de-escalate violence and aggression in UK acute inpatient, PICU and forensic mental health settings

Abstract

What is known on the subject?

• Clinical guidelines and staff training recommend using de-escalation over restrictive practices, such as restraint and seclusion
• Evidence suggests that restrictive practices continue to be used frequently despite training
• This suggests a lack of impact of existing staff de-escalation training.

What does this paper add to existing knowledge?

• The features of de-escalation training that are acceptable to staff and perceived to be impactful
• A co-designed and co-delivered training session on a trauma-informed approach to de-escalation on mental health wards was acceptable and perceived to be impactful
• Those attending training particularly valued how lived experience was incorporated into the training content and co-delivery
• The organizational and team context may need more consideration in adapting the training.

What are the implications for practice?

• De-escalation training that adopts a trauma-informed approach and considers the context of ward environments is acceptable to staff
• Co-delivery models of training to tackle restrictive practice can be acceptable and impactful
• Further research will show how clinically effective this training is in improving outcomes for service users in ward contexts.

Background

Evidence suggests a discrepancy between recommended and routine practice in de-escalation in mental health settings, suggesting a lack of impact of existing training.

Aim

To investigate the acceptability and perceived impact of a co-designed/delivered training intervention on a trauma-informed approach to de-escalation on mental health wards.

Methods

Trainees were invited to complete the Training Acceptability Rating Scale (TARS) post-training. Responses to the quantitative items were summarized using descriptive statistics, and open-text responses were coded using content analysis.

Results

Of 214 trainees, 211 completed the TARS. The trainees rated the training favourably (median overall TARS = 55/63), as acceptable (median 33/36) and impactful (median 23/27). There were five qualitative themes: modules of interest; multiple perspectives; modes of delivery; moulding to context; and modifying other elements.

Discussion

The EDITION training was found to be acceptable and impactful, with trainees particularly valuing the co-delivery model. Trainees suggested several ways in which the training could be improved, particularly around the need for further moulding of the intervention to the specific ward contexts/teams.

Implications for Practice

We recommend co-designing and co-delivering staff training to mental health professionals that tackles restrictive practices.

Relevance Statement

This research is relevant to lived experience practitioners who want to be involved in training mental health professionals around restrictive practices, demonstrating the value and importance of their voice. It is relevant to current providers of de-escalation training, and to staff receiving training, outlining a novel, but acceptable and impactful, form of training on a key area of mental health practice. It is relevant to anyone with an interest in reducing restrictive practice via co-delivered training.