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PROactive Management of Integrated

Services & Environments


Stream 1: Quantitative Enquiry - Service Evaluation

We are in the process of quantifying and qualifying into themes all episodes of physical interventions that took place within Cambridgeshire and Peterborough NHS Foundation Trust in 2014. The data will provide us our PRO-LINE (Baseline) and the intelligence we need to better understand the challenges we face, set the goals and the agenda for change. We are at the verge of completing this piece of work.

Stream 2: Qualitative Exploration - Research Study

PROMISE qualitative strand: an exploration of staff and patient experience of physical intervention on mental health wards and their suggestions for reducing its use

Introduction: There are fundamental contradictions at the heart of mental health, between care and control, risk and recovery. It can be argued that there is no place for force in supporting an individual’s recovery journey, however many aspects of the work of front-line mental health practitioners in reality involves the control and containment of people who may pose a risk to themselves or others. Thus the use of physical restraint, albeit viewed by most as a practice incompatible with the vision of recovery, carries on. Guidelines issued from the Department of Health in the “Positive and Proactive Care: reducing the need for restrictive interventions” document sets out the expectations for services, however there is very little guidance/evidence for what proactive care entails at the frontline. The present research study aims to bridge this knowledge gap by exploring staff and patient experiences of physical restraint, their suggestions for reducing restraint, and their suggestions for promoting proactive care in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) mental health services.

Methods and analysis: The current project will use a participatory qualitative approach to explore:

1. the experience of physical intervention in mental health wards from the perspective of patients and frontline ward staff within CPFT and

2. CPFT patient and staff suggestions of how to reduce restraint in mental health wards.

Study participants will take part in one-to-one semi-structured interviews which will aim to explore and answer the following questions:

 What are patient and staff experiences of physical intervention?

 What impact has physical intervention had on patients and staff?

 What do patients and staff perceive as alternatives to physical intervention?

 What does a service that does not use physical intervention look like to staff and patients?

 What are staff and patients’ views on proactive management of services?

 How can services meet Department of Health guidelines to reduce reliance on physical intervention?

Interviews will be digitally voice-recorded, transcribed verbatim and analysed using thematic analysis to bring out key themes to answer the research questions.

This study is based on a partnership model in which the key stakeholders, service users, and staff, play a full and active role. Working with key stakeholders as co-researchers ensures that the perspectives and expertise of service users and professionals are all influential throughout the research and development process.

Dissemination: The findings of the study will inform the development of a proactive care framework aimed at reducing the need for physical intervention. This framework will influence training of CPFT staff and staff practice development. The findings of this study will feed in to the framework alongside other strands of the PROMISE project. In addition to informing a framework, findings will be shared through the publication of papers in peer-reviewed journals and presented at conferences, seminars and workshops on the reduction of restraint in mental healthcare.

Stream 3: Mapping Frontline Initiatives

Striking the balance between care and control, risk and recovery is an everyday concern for staff at the frontline. Individual practitioners and teams within CPFT have come up with imaginative ways to meet this challenge. Through the mapping of frontline initiatives, we want to capture, share and celebrate these small but significant changes that have a big impact on day to day care.  

For the Mapping Frontline Initiatives work stream Lorna is meeting with frontline staff to:

 Explore their understanding of proactive care.

 Capture what is good.

 Harness new ideas.

 Identify barriers and wish lists.

 Replicate and celebrate frontline initiatives.

The overarching aim of PROMISE is to produce a proactive care framework that supports staff and service users on the journey towards eliminating reliance on force in mental health services. This framework will provide a variety of resources to support and inspire positive and proactive care, including a model for organisational change and descriptions of proactive initiatives from frontline ward staff.  

In order to provide a useful resource that supports the day-to-day reality of implementing positive and proactive care it is essential to engage with frontline staff to recognise and share their ideas and experiences.  The Mapping Frontline Initiatives project draws on the wealth of experience at the frontline by collating details of new and longstanding proactive initiatives.  It will contribute to the proactive care framework by:

 Collating details of initiatives to facilitate the sharing of ideas.

 Exploring ways new ideas can be developed, supported and shared.

 Recording the benefits of current initiatives.

 Recording practical difficulties and the ways in which these can be overcome.

 Providing useful details to consider when implementing an initiative e.g. the time and resources required.

 Highlighting initiatives that are unique to specific client groups and those which work well across wards.  

 Providing insight into organisational/cultural change.

Progress & Next Steps

So far Lorna has met with ward managers from 16 CPFT wards.  The next steps are to:

 Speak with staff who have led proactive initiatives

 Create and theme a portfolio of current proactive initiatives.

 Work with staff and service users to develop this information into a practical and supportive resource.

We will continue to update this page with progress from the mapping project.  You can read summaries of some current initiatives here.  

If you have any ideas or proactive initiatives (new or longstanding) that you would like to tell us about please do get in touch by email: lorna.rouse@cpft.nhs.uk or phone: 07519735137.

Stream 4: In depth Case reviews

PROMISE has shown us that a small proportion of patients may be at the receiving end of a large proportion of incidents of restraints. An in depth understanding of these individual cases could provide us with unique insights into what we could have done differently. Often the minor changes which can make a major difference to the trajectory of a patient cannot be identified in the heat of the moment. With the benefit of hind sight we hope to identify the missed opportunities so that we can learn and try out something in someone who might be experiencing distress similar to the cases we have done a deep dive into.

Work Streams