Mr. Pat Bergin:

I will work my way through those questions and begin by making some points on the management of actual or potential aggression approach. I describe MAPA as a tool in the box of approaches that our staff can use. Overall, we have a behaviour management approach. Under the behaviour management approach on admissions we talk about how we gather information on young people. We talk about young people understanding the routines and what is expected of them. We look at the key worker allocated to the young person and the engagement the key worker will have. We talk about what the expectation will be and contact with family etc. A range of elements form our behaviour management approach.

Let us consider the scenario where the young person is not managing well. We try to talk it through before a young person gets into a situation where there is a difficulty to ensure the person understands the rules and what is expected. We talk of an individual crisis management plan. In that way we are ahead of the posse in respect of being able to work through the possible challenges with the young person. That is not always possible, but it is the focus.

We say 80% of the MAPA approach is around de-escalation. We talks about looking at triggers, managing the environment and using minimum force and maximum care. We consider who the triggers might be. It might be me and I may need to move away and let someone else deal with the situation. In that sense 80% of MAPA is around that engagement. The remaining 20% of MAPA is around physical intervention.

Reference was made to how a staff member can be trained and can put his hand in a particular place and do this and that and so on. Then, more often than not, some errors arise and the young person is not going to stand in a particular position. That means it will not happen the way it should. It is like any training. We set out what we normally want people to do and we advise people to stick to that as best they can. However, situations will arise when people will deviate from that, but they need to bring it back. One relevant example is the question of moving young people when we restrain them. The MAPA approach and all physical interventions talk about not moving people from such a situation. Young people should not be picked up because of the physical impairment that may result. Let us suppose someone deals with a situation, picks up a young person and carries him from A to B. Then, there is a question of that staff member creating a level of risk. The restraint applied in that case may not be exactly how MAPA is expected. The staff member is safe in doing that and has not gone beyond some of the key principles that exist for any physical intervention.

Previously, there was a therapeutic crisis. Reference was made to the Crisis Prevention Institute and the range available. They all hold the same principles, that is to say, engage, provide options, use the relationship and risk-assess. If a staff member is going to physically intervene, then he should ensure that it is safe to do so, that the right people accompany him and that they are working together. The idea is that there is no broad scenario in which a person is caught up as a consequence of which people get hurt.