Development of calming tools
Hunter New England Local Health District
Calming tools were developed to introduce collaborative trauma-informed practices in response to the high rate and frequency of use of coercive practices within the mental health unit.
Child & Adolescent Inpatient Mental Health Unit, HNELHD
How was the project embedded within practice?
The project team reflected on how well the service provided trauma-informed care and whether the facility was considered a safe environment to deliver care. It was evident on reflection that care provided was NOT informed by young person’s trauma as evident by the use of coercive practices like physical restraint, seclusion rooms, arbitrarily using the mental health act, medications to control behaviour and routine searches. Responding in this way was traumatising for young people and staff and did nothing to promote recovery. Care provided was envisaged to promote a culture of hope, partnership and self-determination for the young person seeking treatment.
The clinical team came to recognise that they could do better requiring a culture change and the support to do things differently. Leadership was important in providing direction and encouragement to make change happen. Everyone understood why making these changes were important. Staff needed considerable guidance and support to reduce coercive practices, including:
- six point plan to improve care (included leadership)
- data to inform practice (length of stay, seclusion and restraint, IIMS data and research findings)
- workforce development (prime driving factor in reducing coercive practices on the unit)
- seclusion and restraint prevention tools
- young person and family engagement models
Leadership were responsible to promote positive risk, supportive workplace cultures and governance structures; and to further encourage team contribution toward achieving ongoing organisational change.
Language that was entrench stigma, hopelessness and powerlessness was eliminated and replaced with person-centred optimistic language (promoting self-determination and meaningful engagement).
Individualised calming plans completed within 24-48hrs of admission. Calming tools (completed by the young person) were developed to gather information about the consumer’s predisposition towards tools that can help soothe and calm in times of increasing or mounting distress. This further served to empower the young person and their families to understand, appreciate and better manage the young person’s distress. Interventions that were listed to promote recovery include walking, taking with friends, ripping up paper, listening to music and listening to music really loud. Self-soothing strategies sought to minimise the use of coercive practices when employed at early warning signs of escalating distress and associated high risk behaviours (e.g. aggression, self-harm, violence, suicidal behaviour and absconding).
Information from the tool is available for all staff and is further provided to the young person.
The calming plan and ongoing work with the young person, family, and school are used to develop a safety plan for periods of extended leave and discharge. This is given to the young person, families, schools and community child and adolescent mental health service or private mental health providers on discharge.
What worked well?
Markedly reduced seclusion and restraint (below NSW state benchmark), incidents of aggression and readmission rates at 28 days as reported from benchmarking data.
Shift in team mentality from belief that their responsibility towards keeping young people safe equated with control, restriction and enforcing rules. Change to promoting collaboration, with a focus on strengths, self-determination and personalised care.
Focus changed from the young person with a problem to the young person and their strengths, hopes and dreams. The importance of the young person’s entire systems of support was recognised as a key element in the young person’s recovery (includes families, schools and their community supports such as sporting clubs).
Families were encouraged to visit the unit, stay overnight and participate in ward programs and treatment plans.
Consumer and family input was further encouraged by:
- Yes surveys
- Have your Say group
- Consumer and carer rounding
A sensory room instead of a seclusion room was provided when responding to self-strangulation without coercive intervention.
More nurturing and therapeutic treating environment with a focus on sensory based strategies (sensory room and chalkboards in all bedrooms to encourage expression) to promote recovery.