1. Positive and Safe for Service Users and Staff:
Managing the clinical challenge through a team-led Post Incident Reflective approach.
Dr Steve Donaldson - Highly Specialist Applied Clinical Psychologist
Tony Carroll – Post-Incident Rapid Reflection Champion, Ayckbourn Unit

2. Aims and Objectives..
To share an approach to support teams to reflect following incidents.
By the end of the workshop you will…
Have an awareness of the difference between defusing and debrief
Have an awareness of the pilot work undertaken in the Trust
Have had an opportunity to ‘have a go’ and use the tools
Have had time to reflect on how this approach might be applied to your work setting

3. A brief history.. Debrief has historically meant different things.
Usually led by a therapist/psychologist trained in this area
Time – significant limitation
However, there is a difference between debrief and defusing approaches
Models can help us understand the need
TIC, stress-vulnerability, theories from disaster work

4. Decompression Model – 1 - 1½ Hours
Introductions
Setting the context
And boundaries
RE-ENTRY
NORMALISATION
FACTS
TEACHING
THOUGHTS
FEELINGS AND SYMPTOMS

5. Defusing.. The term was introduced in 1983 (Mitchell & Everly)
Idea that a dangerous or difficult situation can be made ‘harmless’
Evidence to suggest that larger debrief approach too close to event can cause harm – Trauma processing.
Goals
Rapid reduction of intense emotions
Normalising the experience
Empowerment and sense of mastery
Eliminate the need for debrief, enhance effectiveness of debrief

6. National Context Positive & Safe
No deliberate use of Prone/face down restraint or pain compliance
Least restrictive/ last resort
Individualised behaviour support plans (PBS)
Board Level Support
Governance structures and policy development
Post incident analysis and debrief
Support plan Audit and internal data gathering
CQC compliance and assurance
Organisational restraint reduction plan

7. Tewv’s Restrictive Intervention Reduction Plan
Using data to inform clinical practice
Supporting all clinical areas to adopt the Safewards model
Implementation of the Person centred Behaviour Support Framework across services
Providing support and review of incidents following displays of behaviours that challenge
Effective Use of Medication to support behaviours that challenge
Positive Approaches Training (PATT)
Safe and efficient us of Seclusion and calm down facilities

8. Rapid reflection staff tool
The tool should take no longer than 3 minutes. All staff involved should take part in the rapid reflection, with 1 member staff acting as the reflection facilitator
Are we all ok and safe?
Is there anything we would do differently next time?
What went well?

9. Rapid Reflection Tool – Service Users
Are you feeling ok and Safe?
What can we do to help you feel safe?
(Asked immediately following restrictive intervention)
Questions to be asked within 24 hours (or as soon as possible/appropriate)
Do you understand why staff needed to use restrictive interventions?
What could we have done to support you better?
Is there anything you would do differently next time?
Offer the opportunity to make a written account

10. Rapid Reflection Pilot
1 ward from Each Clinical Speciality
Pilot Period from January 1st – February 14th 2017
Services reported between % Compliance
Positive Feedback for use of the staff tool
Limited use of Patient tool, further work to identify more effective use
Gradual introduction Trust wide from May 1st 2017

11. Stepped Approach to Incident Management
Critical Incident
Post-Incident Reflection
Is a Debrief required?
YES
Facilitated Debrief
STAFF SUPPORT

12. Experience from practice
A Champions experience of applying post-incident reflections in practice

13. Time to have a go…. In small groups 3-4’s
Think of a mildly challenging event from your work experience – that you are safe to share
Pick one to work with
Use the Post-incident reflection tool
You have 3 minutes

14. Timer….
3 minutes on the clock
TIMES UP
1 Minute
2 Minutes

15. Ideas of Scope and use in the Trust
Time to reflect on possible uses in practice.
How could this tool help you and your team
In-patients
Community
Supervision

16. Conclusions and Final Thoughts