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PROactive Management of Integrated

Services & Environments


PROTECT - PROactive deTECTion

PROMISE Safety Framework (Download PDF)

PROTECT or Proactive detection is the PROMISE safety framework. Insights from the quantitative and qualitative research form the foundation of this training module.  Established therapeutic approaches from the realms of Cognitive Behaviour and Analytic Therapy, Mindfulness, Dialectical Behaviour Therapy and Mentalization based treatment are used to train professionals to engage patients and carers on a journey of guided and shared discovery of missed opportunities in the lead up to incidents.

The qualitative study reveals that distress draws out individualised repeating patterns, proactive identification of such patterns provides an opportunity to coproduce novel exits from the spiral of escalating distress. The study also highlighted the increased probability of incidents when various factors overlap. PROTECT provides a framework to understand and categorise the factors into those related to the patient, significant others like family and/or staff and the environment. Repeating patterns can be used to understand the predisposing, precipitating and perpetuating nature and how causal factors interact. Reinforcement of protective factors along with the insight to proactively uncouple causes will help mitigate and prevent incidents.

Patient stories from the PROMISE study bring forth the analogy of a wheel spinning in the mud, the more distressed one gets, the harder they press the accelerator and the faster the wheel spins, but the vehicle does not go anywhere, however with every revolution of the wheel, it sinks further . Doing more of the same does not and will not work. One needs to get out of the car, get help, perhaps stick wedges beneath the wheel and then the car might move forward. However this is easier said than done.

Looking Back to Look Ahead

Triggers are akin to a car’s ignition, an in depth understanding of what commonly sets the wheel spinning is essential for early detection.

Thoughts rising from unhelpful beliefs are like the foot on the pedal, accelerating the spinning wheel as it sinks into the mud of maladaptive coping.

Feelings form the fuel of the car, we are not a bottomless pit of emotional energy and when distressed we use up reserves rapidly. The challenge is to help patients visualise that when one is running low on fuel, extreme caution has to be exercised on how emotional energy gets burnt.

Modulation of the residual energy into braking, sometimes brings the car to a much needed halt and at others times travel at an appropriate speed.

Response following a look in the rearview mirror is often quite different to the one of a fast spinning wheel. In fact to get the best out of the PROTECT wheel one needs to the car into reverse, so starting from recent distress laden adverse responses patients and staff back track through opportunities for modulation, alternative feelings and thoughts to triggers.

Insight builds resilience and reinforces an individual’s agency. PROTECT has the potential to transform a rear wheel drive into a 4 by 4. At its very least it prospectively provides an alternative route for people who might have otherwise found their wheels stuck in mud.  

PROTECT seeks to slow down a rapid two stage trigger response process into a drawn out 5 stage process. This enables patients, professionals and carers to modulate their responses and change the trajectory of events by identifying exits from established patterns. It is important to emphasise that the safety planning needs to be done when distress levels are low and a journey of shared discovery can be realistically embarked on. Organising the many causal factors into a coherent patient held individualised PROTECT plan will enable advance prediction. Through experiential learning the one day training workshop  will provides the skills staff need to embark on this journey of ask and tell with patients and carers, a journey in which lies the anatomy of PROactive deTECTion.