Article 2 of 2 - What’s included in the PETMA© framework?

PETMA© Instructor Certificate Course offers a suite of 6 modules that cover a wide range of issues to ensure that participants are enabled to support an individual within a holistic framework. This is an NMBI Approved Category 1 Programme with 35 CEU’s:

Module 1: Foundation PETMA© programme

This module provides learners with a human rights-based approach to supporting people who may engage in behaviours of concern from time to time. It will provide learners with the skills, competency, knowledge and attitudes to prevent, predict, assess, engage and manage risks associated with behaviours of concern. It provides learners with a range of highly useable practical skills and tools to develop positive support.

Module 2: De-escalation Skills

This module explores in depth a range of best practice responses to support a person to come to a calmer state. Empathy, compassion respect, non-verbal, para-verbal communication strategies, preventative strategies and a good understanding of the impact of trauma informed care are the tools developed in this module

Module 3: Decision to use Restrictive Practice

This module explores the Irish legal, regulatory, ethical and professional issues relevant to supporting people whose behaviour may pose a risk to themselves or others. It prepares learners to develop a skill set which can be utilised in practice to support the implementation of interventions which provide an appropriate balance between safety and human rights approaches. In particular it will examine the relationship between Positive Behaviour Support planning, risk assessment, least restrictive practice and physical intervention risk reduction planning. This module will also, help learners to develop a greater understanding of debriefing and the use of data-driven interventions

Module 4: Disengagement Skills / Physical Intervention Skills

PETMA© provides a suite of physical skills designed to manage the risks associated with actual or potential verbal or physically distressful behaviour. All techniques are designed to respect the individual in distress whilst meeting the needs of staff working in care settings with vulnerable clients. The skills are graded to equip staff with an appropriate level of response using the least restrictive intervention when the client’s behaviour is at risk to either themselves or others.

Module 5: Teaching and Assessing

This module award is to equip the learner with the knowledge, skill and competence to deliver, assess and evaluate the PETMA© foundation programme.

Module 6 Practicum – PETMA© Certified Instructor

This module will focus on learners developing a deep understanding of subject matter and apply the learning objectives of the different stages of training delivery and assessment. Learners will understand the critical role of workplace training as an ongoing process to ensure verbal, physical and restrictive interventions are applied as part of a least restrictive practice and as ethically and safely as possible. Learners will be required to complete and submit a portfolio of evidence of their teaching capability, to be entered onto the BILD Certified Instructor list as a PETMA© Certified Instructor. This portfolio will be developed during a 3-month probation period which occurs directly after the teaching component.

Additionally the NIIDS offers PETMA© courses in a 2- or 4-day format which can focus on either child or adult specific interventions. These programmes are designed to provide learners with the basic professional, ethical and therapeutic competence, knowledge, skill and attitudes required to support children/adults when they become distressed, and facilitate them to a calmer state, whilst ensuring the safety of all concerned. These programmes aim to provide learners with the relevant skills in prevention, prediction and recognition of situations which are escalating and the ability to manage actual or potential verbal or physical distressful behaviour.

Throughout the PETMA© framework there is an emphasis on recognition of stress and distress with an acknowledgement that behaviours of concern are often a manifestation of these aspects of the person. Assertions that ‘behaviours that challenge are manifestations of stress’ is often countered with ‘Sure how could “they” be stressed? Isn’t everything provided for “them”?’. The fact is, in a lot of cases, they are stressed because their access to a ‘good life’ is being impeded. The packages aren’t working for them. Maybe they’re not being heard. Maybe they’re lonely. Maybe they have limited choice. Maybe they’re unwell. Maybe there are many other reasons that would cause any of us to be greatly distressed. We should acknowledge that when we work with people who are highly stressed and traumatised, who are often frightened and scared, we should focus on making them feel safe and less stressed rather than “targeting behaviours. This is a focus of the PETMA© Framework.

All too often the emphasis is on supporting the person when they are in crisis. Using what we often term as “Last Resort” Strategies including how to restrain safely or how to physically disengage safely. A large component of the PETMA© philosophy is on supporting the person when they are not in crisis or as John F. Kennedy said – “repairing the roof while the sun is shining”. PETMA© strongly emphasises the use of 1st Resort Strategies such as engaging, connecting, interacting, reinforcing, praising, communicating, involving, building a therapeutic relationship, making positive behaviour more useful than behaviours that challenge, improving Quality of Life.

PETMA©’s philosophy is also entirely in keeping with Safeguarding Ireland & HIQA’s 2021 document entitled Guidance on a Human Rights Based Approach in Health & Social Care Services (3) in which it is recognised that “health and social care staff encounter complex situations in practice, where many factors need to be considered, for example an individual’s will and preferences and their right to autonomy versus the risk of harm from a particular decision. In some situations there may be competing human rights, and staff need to consider the applicability and weighting of each right within that situation and their duty of care to ensure safety and fairness for all people using services”.

As a final consideration – please don’t be fooled into thinking that ticking the box on “staff training” alone is the solution. It really isn’t. “If the team providing support cannot get training (including hands-on training), or if the training they are receiving is not followed up with good Practice Leadership, then the difficulties they will face in trying to support individuals with more complex needs are likely to wear away at their ability to sustain their performance” (4). Training does not vaccinate human services against issues. In numerous abuse scandals that followed on from the Brompton Care Homes case the staff were trained. Health and social care provision is about people - not models, methodologies, packages etc. therefore training delivery, trainers delivering and models employed are critical elements to get right. The individuals in our care absolutely deserve the right person teaching the right things to the right people. This, alongside considerate and compassionate practice, are key pillars in PETMA©’s approach to the support of individuals who may present with behaviours that challenge.

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