Article 1/2 - Professional Ethical Therapeutic Management of Aggression (PETMA©)

In terms of history one could take a short trip back in time to the late 1990’s to discover that the concept of ethical behaviour management was a concern in the provision of health and social care. The “Macintyre Undercover” documentary (1999) exposing abusive practices in Brompton Care Home (UK) was the first time the author had seen this sort of inappropriate treatment so publicly exposed. Consequently there was increased attention paid to the training and supports provided to staff teams and services in these contexts. A “gap in the market” was spotted and subsequently flooded by numerous training models with widely varying degrees of understanding, competence and consideration for the individual and their story. This generated the phrase “The Behaviour Support Industry” to describe entities that have arisen and currently operate in this lucrative area of health and social care. Organisations spend literally hundreds of thousands of euros nationwide ensuring that their staff are trained in behaviour management approaches. Why?

• Is it because they have a statutory requirement to do so under SI 367 of Health Act (2007) (1)? “The person in charge shall ensure that staff receive training in the management of behaviour that is challenging including de-escalation and intervention techniques”.
• Is it because they recently had a serious incident and need to manage risks or reduce insurance costs?
•  Is it because they proactively desire a culture of understanding, respect and empathy?

Documentation entitled “behaviour management strategies”, crisis management plan”, etc. is often produced because of staff training that focuses behaviour management on the individual receiving care as the issue. There is a key consideration that is overlooked in that approach – Who is the client/customer/consumer? Crucially, we need to re-direct (nice behaviour management term) our services to concentrate on changing OUR behaviour – as a person, as a team, as an organisation. Models of support that focus on the “mediators” must be the preferred option in order to avoid a consistent theme in which individuals who experience behaviour interventions are often the wrong “target”. We must acknowledge that good practice involves addressing the practice of “significant others” rather than the individual themselves. We must focus on the individual, their story and where they fit in the “system”. As Paul Collins said “The problem with pounding a square peg into a round hole is not that the hammering is hard work…. it’s that you're destroying the peg” (2). People who may present with behaviours that challenge are simply asking services to listen, with our eyes and our ears when they try to tell us things:

1. “Somethings not right….I need you to help me with it” (Physiological)
2. “I am not being understood” or “I’m not understanding” (Communication)
3. “This is not the place for me. It could be if….” (Environment)
4. “I’d like to be supported by people that know me and want to support me and are being looked after also (Mediators)

If behaviour management training models are successfully able to communicate these concepts to services, then the need to reactively respond to behaviour should be reduced or as Albert Einstein put it – “A clever person solves a problem; a wise person avoids it”. Realistically however there is likely to always be a need for ethical reactive strategies particularly when there may be acute or exceptional circumstances when reactive interventions may be required as part of the supports for an individual. “Therapeutically we have a lot to help a lot of people but not enough to help all people” (Prof. David Allen, BILD Conference – Reducing Restrictive Practices & Changing Cultures of Care, May 2009). Whilst most organisations would like to eliminate the use of restrictive reactive interventions, they will often find that they are not able to discount the use of such interventions where they may be of benefit to the person who is affected by their behaviour, or provide protection for that person or others.

There are some key questions services need to consider before commissioning any behaviour management model:

• How do they ensure that the model is focused on the Irish context?
• How are they assured that the content, strategies, theories, attitudes and cultures are the right fit?
• How do they assure themselves that any physical strategies that may be taught are ethically sound and will keep the individual, and their carers, safe?
• How are they assured that various populations are suitably supported (e.g. children) and that there isn’t one generic model?
• Are internal trainers trained to a high level, vetted and audited regularly? Is the content and delivery consistent across trainers? Are they giving consistent advice? Is the content being diluted or distracted at any time?
• Is there an opportunity for participants to build both competence and confidence that the strategies they are taught (including defusing/de-escalating/verbal/non-verbal strategies) will work should they need them?
• How do they know they are getting value for money?

Currently there is only one Irish model that is accredited with the Restraint Reduction Network (an essential benchmark for quality). Uniquely for this field this model also retains accreditation as Guaranteed Irish. This model is called Professional Ethical Therapeutic Management of Aggression (PETMA©) and is being provided by the National Institute of Intellectual Disability Studies (https://niids.ie).

What does it mean to be accredited by the Restraint Reduction network?

Restraint Reduction Network Training Standards – “have been developed and apply to all training that has a restrictive intervention component and will provide a national and international benchmark for training in supporting people who are distressed in education, health and social care settings. These Standards will ensure that training is directly related and proportional to the needs of populations and individual people and that training is delivered by competent and experienced training professionals who can evidence knowledge and skills that go far beyond the application of physical restraint or other restrictive interventions”. (https://restraintreductionnetwork.org)

Professional Ethical Therapeutic Management of Aggression (PETMA©) is a model of behaviour management training for staff in health and social care services who strive to support individuals in an ethical, respectful and person-centred manner. By establishing itself as the first and only Irish behaviour management model to be accredited with the Restraint Reduction Network, as well as being BILD Certified, PETMA© can provide strong reassurances that individuals supported within the PETMA© framework will be confidently, competently and most importantly, respectfully supported.

Continued on Article 2 of 2. 

References:

1. Health Act (2007)
2. Not Even Wrong: Adventures in Autism - Paul Collins (2004)
3. Guidance on a Human Rights Based Approach in Health & Social Care Services (2021)
4. https://www.unitedresponse.org.uk/practice-leadership