Changing Practice LCFT Self Injury Group Self Injury & - - PowerPoint PPT Presentation

LCFT Self Injury Group

Self Injury: Changing Practice

A Harm Minimisation Approach in Lancashire

Clinical Network Representatives Experts By Experience HEI’s Third Sector Organisations Service Users / Carers Academics / Training Consultants Other NHS services (A&E)

Self Injury & Research Interest Group

Objective of the Group

• To support and promote the adoption
• f an evidence based approach to self

injury & harm minimisation across all LCFT services and inpatient settings, so that every Service User / Patient can expect a consistent and helpful response from a supportive and confident member of staff.

What we have done so far?

• Self injury Conference in 2011
• Level one basic online learning package (1822 Hits)
• Level two intermediate face to face training (180 Staff)
• Knowledge file (Ref in: Safe and Secure DoH 2012)
• Self Help for Self Injury Resource Booklet

(Safe and Secure DoH 2012)

• Positional statement

That’s where the CLAHRC Evidence for change programme has helped

Dedicated time + Dedicated people + Dedicated support and experience + Rigour and validation to the process and the results. _______________ FOCUS ON ACTION

Drivers for Change

• Improved quality of care and experience
• Reducing restrictive practice
• Harm free care
• Violence Reduction CQUIN
• CQC Action Plans
• Staff Wellbeing
• Challenging health inequalities

Where do we start?

• 1. To accept alternatives to a purely preventative or

curative approach towards self injury.

• 2. To recognise and support the use of safer self injury /

harm minimisation approaches by staff, where such approaches have been assessed and identified as the most clinically, ethically and risk management appropriate intervention with clients.

• 3. To accept that for some individuals, self injury may

represent a long-term coping strategy that they may not wish to change, or be able to change in the short, medium

• r longer term.

• Coping strategy taken away
• Possessions/possible tools to

harm with removed

• Increase in distress, anger,

frustration, guilt, shame etc

• Use extreme lengths/methods
• f self injury
• Taking any and every
• pportunity to injure
• Battles with service users,

power and control

• “Them & us” poor

relationships

• Increased restraint episodes
• Risk of injury/assault
• Lack of certainty/confidence
• Poor morale/negativity
• Increased risk incident rates
• Staff sickness and turnover
• Increased length of stay
• Poor patient experience
• Financial impact (observations

and resources)

• Pressure on services

Costs of enforced harm cessation Benefits of harm minimisation

• Taking more responsibility
• Better relationships with

staff

• Not being restrained
• Feeling more empowered
• More opportunity to explore

alternative coping strategies

• Feeling understood &

listened to

• “Knowing where I stand”
• Consistency
• Good relationships with

service user

• Feeling useful/job satisfaction
• Increase in morale
• Confidence in intervening
• Increase in skills
• Less restraint
• Less violence/injury
• Less stress
• Reduced violent incidents
• Reduction in restraints
• Increased performance
• Patient satisfaction
• Reduced risk
• Staff morale, attendance and

retention increased

• Decreased sickness

Methodology and Work Focus

We came together regularly both virtually and in person to focus on a scoping review to inform:

• Development of Policy / Best Practice

Guidance

• Implementation Strategy / Business Case

Results

• We started to distil the knowledge and

evidence from the literature to create a policy to support a harm minimisation approach to Self Injury.

• We have produced a detailed review protocol.
• Provided evidence that the proposed change

in practice will provide a better experience for patients / Service Users.

• We identified further areas for research.

Challenges

• It’s a big task that needs strategic oversight with

dedicated support, commitment and leadership.

• We acknowledge that this remains a controversial and

easily muddled subject area and that developments will involve inevitable ongoing tensions and debates regarding duty of care, capacity and consent issues.

• There are some areas where a risk averse culture is
• evident. We need to challenge this by having clear

published policy, guidance and implementation plan.

What Next? Policy Implementation

Identify a cohort to follow in the implementation and measure the impact

• Advanced Learning and development for

specific practitioners around harm minimisation and formulation.

• Plan care using five P formulation to create

advance statements

• Self injury specialists / advisors in teams

support groups for family and friends