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What is SPRAG?
Throughout several of these videos, Laura and Cecile refer to SPRAG, the Scottish Physical Restraint Action Group. SPRAG is a member-led group bringing together people with care experience, practitioners, service leaders, policy colleagues and researchers to support work to reduce and, where possible, eliminate harmful physical restraint.
SPRAG is hosted by CELCIS and has representation from more than 70 organisations. Find out more about SPRAG on the CELCIS website (opens in a new tab).
Privacy, cookies and your data
Understanding cookies and web analytics
Transcript
When you visit the Holding Differently website, you may see a choice about analytics cookies. You do not need to accept these in order to take part. If you choose not to allow analytics, you can still use the website and complete the questionnaires normally. If you do opt-in, the analytics simply help us understand general patterns of website use, such as whether pages are working well and which parts of the site people are using. That helps us maintain and improve the website.
The website analytics are separate from the questionnaire itself and are not part of the survey response data collected through Qualtrics. Therefore, they do not form part of the research data.
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About Holding Differently
How did Holding Differently get started?
Transcript
So do you want to tell us a bit how Holding Differently started? Yeah, early days before you even moved up to Scotland, the Scottish Physical Restraint Action Group was formed and one of our very earliest pieces of work was to develop a research agenda about what we felt like we really needed in terms of an evidence base to address physical restraint and restraint reduction in residential child care.
That led on to a small pilot study where, and this was linked to a lot of members were saying, you know, we collect data on every restraint that happens, but we don't collect data on restraints that were avoided or averted and like, how can we learn more about that? And there's probably some really valuable data in there. So we, Sarah Deeley, had the brilliant genius idea to do an appreciative inquiry, which is philosophically an orientation around studying what's going well and learning from that.
Because it was only a pilot study with a teeny little bit of funding, we went into two different study sites, residential child care settings, and did a deeper dive with some interviews and focus groups around their use, but reduction of the use of physical restraint in one of them.
In the other, we did dyadic interviews with two people, care experienced adults who chose a person that had cared for them when they were a young person, and it was again in relation to their experiences of kind of no longer needing to be physically restrained. And so those were the two settings, the way we approached the research.
We learned a lot from that, and actually then that's The policy and practice landscape has been very active around physical restraint so that made a lot of things possible including the Scottish Government being able to prioritise funding the project though to be honest in the middle of our negotiations around the size and scope of the project there was this massive cut to the Scottish Government budget and that really made it challenging for them to still secure that funding and we're really grateful and relieved that it was still able to go ahead so that's really kind of the roots of Holding Differently.
I think we know there have been so many names used to talk about physical restraint, is it a hole, is it a safety intervention, you know that and it kind of comes a bit in the name of the project as when Holding Differently, isn't it? We've had questions about and even some challenges. Is this just another euphemism for physical restraint? But a lot of thought was behind that name. And holding differently refers to something beyond just physical holding.
It might involve physical holding, but it refers to what might be easiest as understood as holding environments. And these are environments that ideally enable the elimination of physical restraint, and that's a really important aspect of the elimination of restraint. Environments that have the kind of rhythms, routines, processes of care, and maybe most importantly, relationships that hold people through sometimes their most difficult moments, ideally without recourse to the need for physical restraint.
Containment theory is also kind of embedded in this, and it's another challenge for some people, like just keeping a lid on things or just keeping people in their place. And actually what we mean by containment, and this is quite the opposite, it's processes that enable people to think more clearly, that enable people to make sense of their experience and their emotions and to be able to manage all that better.
I'm deliberately saying people, this isn't just for children and young people or for patients in a different setting or other people who have experienced being physically restrained. This is for everybody. And if we're going to help people through their most difficult moments, perhaps when they are posing serious imminent danger to themselves or someone else, the people who are doing that process also need to be able to think clearly, to be able to manage the reactions that they're having.
And so this holding environment isn't just for the children and young people in residential child care. Adults need to be held well for them to be able to hold children well. Again, holding meaning in relationship, in rhythms and routines, in processes of care. And so that's really what this project is focusing on first to find out about what's going on and what kind of environments are happening around physical restraint. Are they moving more toward holding environments?
But also then the learning resources and just the invitation to think differently about physical restraint may have an impact again toward improving our capacity to hold one another in ways that are less brutalizing and more conducive of healing and development, whether you're a child, an adult, whatever. So we've got our first blog post out on the website and that goes into our website
About Holding Differently
Why research physical restraint in Scotland?
Transcript
[Music] You've been involved in researching physical restraint for a very long time, but why do you think it's important to research that topic and why in Scotland? Yeah, so the work of SPRAG has been going on for, I don't know, five, six years and before that I've been doing research in residential child care, in physical restraint, and still I don't think we know what's actually happening out there. When the physical restraint is happening, people's experience are very, very different.
We need to have everybody's answer and everybody's experience in this because we want to be able to really map out what's happening across Scotland and we won't be able to do that if we don't have everybody's contribution to it because to it, because there will be gaps. And so one of the important elements of creating those holding environments you're talking about is that actually to really pay attention to everybody's experience.
And some people may experience quite a lot of distress, for other people it may be something that is, they have a different relationship to, but actually to know of all those things is important.
And that's why residential child care workers, every single residential child care worker in Scotland will be asked to do that, whether or not they work in a service that doesn't authorise the use of physical restraint, whether they work in a service where physical restraint has not been used for a long time, this is still important because that's this kind of accumulation of all those individual experience that will And the data that exists now doesn't allow to do that.
We just know there were such and such, how many-- the number of physical restraint in one year across Scotland, but we don't know much else. Yeah.
Actually, I think that's a really important point that you're making about-- that people need to know is that if you work in a place where physical restraints do happen, or you work in a place where they're not authorised, if you're a manager and you're not working directly with children at all versus-- so the questionnaire is designed for all workers and managers in residential child care. And the questionnaire will take you to the questions that are relevant to you based on how you answer as you go.
It'll take you to the right questions. And so, yeah, if you're working in a place where restraints are authorised, definitely we still really want to hear from you. I think the other piece I think the other piece is that it may be that typically the type of people who are willing to answer a questionnaire might have some different characteristics than people who don't tend to answer questionnaires. And so if you're a person listening to this and thinking, you know, why should I do this?
It fits with what you were saying. It's like the more people who answer, we'll get the wider range of experience.
About Holding Differently
How will research create positive change?
Transcript
[Music] Often residential child care workers ask me, working on another project, but how do we know? Why do we focus on physical restraint? Because all the work we do before to avoid restraint, how can we find out more about that? And I think that's very much the focus for the second part. Yeah, definitely. It's not just about the restraint. Actually, the entire project isn't just about physical restraint. And that'll come clear when people start answering the questions. It's about the conditions around that. Yeah.
But so, what's the purpose? What are we trying to do with holding this one case? From a research perspective, we're trying to deepen our understanding of what's happening, but I think more significantly, using that knowledge to continue to have a positive impact on the use and reduction in some places of the need for physical restraint, which I guess brings us to the third part of the project, which involves the development of some resources.
Again, there'll be a co-productive element to that, just like with the development of the questionnaire that Cecile mentioned, that we'll be developing some resources based on the learning from the two parts of the research, the two phases of the research. These will be made freely available to the sector and to other sectors for that matter on our website that will hopefully help implement some of that learning.
People can implement it in the ways that they see fit, but it'll also be built by people who will be using it, not just by a couple of academics in an ivory tower. tower. physical restraint does address physical hold. It does address to a certain extent the kind of emotional landscape within which physical restraint happen. But our experience and other project that we've worked on shows that actually a lot of attention needs to be put to that.
And so we hope that some of the information that we gather will allow us to create resources so that residential care workers can receive the training, the education, but also the kind of creating reflective practice spaces where their experience and the impact that physical restraint has on them as people can be addressed and can be taken into account because I certainly really believe that that has a huge impact in them being able to be emotionally present in situations where children and young people are distressed and that is what makes it possible to respond to that distress.
That makes it possible to respond to that distress without being punitive, controlling, which are the situations that lead to difficult restraint. Yeah. I think the other thing, a couple of things, one is the co-productive nature of at this point creating the questionnaire so we ask the right questions in the right way.
There'll be further co-production in the development of the resources so that the people who actually need to use this will, you know, people in roles of the people who actually need to use this will have informed the creation of that and I think that raises the likelihood of making a positive difference in relation to this.
And then I think there are other things that contribute to physical restraint that we might suspect but we don't necessarily have clear data about is really getting at that, about what affects people's confidence and being able to find ways of avoiding restraint and what gets in the way of that.
So, we may find important data around what people need to be equipped from a training perspective, from other forms of support that need to happen in the daily fabric of people's work life, like reflective spaces and being able to get a better handle on some of the wider influences may help create better learning resources.
It might also be important for policy makers to know some of these things as well in charting the course for making things better, that this isn't just about what happens between adults and children, this is multilayered if we're really going to get this right for kids in residential
About Holding Differently
How is Holding Differently independent?
Transcript
[Music] One of the things that is quite important as well, we talk about holding differently, being independent. What does that mean? Because that's quite important for the people who will answer the survey. I think that probably says that in the information sheet. And so you're right, probably explaining that a little bit.
It is funded by the Scottish government, but the buck stops with us, and the buck really stops with me, in terms of what goes into the reports, the report from the first stage of the study, the report from the second stage, what goes into those resources. And we are collaborating with the likes of CELCIS. We are being funded by Scottish government, but it's up to us what goes in those reports.
So people may get the link and the invitation to fill out the questionnaire from the SSSC, but the SSSC only has access to the wording of that email that they send out. They don't have access to the data. Once, you know, people will be sent this link and that's a link that's generated by software that is part of the university. So it's part of the kind of setup of the university. And once the survey is closed, we will download all the data and that will be then kept only on the university server.
And I think we want to take care in how we're going to analyse those answers and how we're going to speak about that as well. Because that's quite important how it's being perceived and also in terms of making sure that when we tell that story, of how residential care workers across Scotland, and that's why it's really important that every single residential care worker answers the questions, because we want to hear from everyone. That will then add to the story.
And people may have questions about CELCIS's role, and CELCIS is a collaborator in the project, but in the final analysis, it's you and I in terms of the decisions about what goes into the reports and into the learning resources. And so CELCIS provides support, but it is independent. And if there needs to be difficult conversations toward the end, being funded by the Scottish government, or our connections with CELCIS, they will be had.
But we will do our very best to represent the data fairly, represent people's experiences and fidelity to what they had to say even if sometimes it's difficult
About the workforce survey
Holding Differently Workforce Survey: We Want to Hear From You
Transcript
what are we trying to do with Holding It Differently? - The questionnaire is designed for all workers and managers in residential childcare, and it speaks to how we understand physical restraint, which happens within relationships, but it also happens in relationship to these other conditions that workers are being asked about.
And then we are reporting on this in relationship to all of that. - One of the things we've done in terms of designing the survey was to pay a lot of attention to how people will feel as comfortable as possible to really tell us what's going on for them, no matter how difficult it is. And one of the things that's really important is that the survey is anonymous, which means that we won't be able to know who gave that answer.
Software is set at a setting that doesn't track IP addresses, and that is because we really think that will help people - So we are part of this web of accountability in what and how we present the findings, both in terms of making things better and getting things right where maybe we haven't always, but also not misrepresenting and not sensationalizing and not, yeah, not doing further damage to a sector that has been pretty beleaguered, to be quite frank, both in terms of current recruitment and retention crisis and in terms of an ongoing history of residential childcare being treated as a last resort service.
If you work in a place where physical restraints do happen or you work in a place where they're not authorised, if you're a manager and you're not working directly with children at all, definitely we still really want to hear from you. So please click the link and answer the survey. And if you don't have the link from the triple SC or from your manager, please contact us at the Holding Differently email address and we'll get you sorted out. This is Laura
About the workforce survey
How the workforce questionnaire is delivered
Transcript
My name is Bill Woodside and I support the technical side of the Holding Differently research project, including the website, and the way the questionnaire is delivered. If you're thinking about taking part, we know that some of the questions may touch on difficult or personal experiences. Because of that, we have tried to make the whole process as straightforward as possible. We use the well established survey platform Qualtrics to provide a secure and reliable way of collecting responses.
For this project, we have also set the questionnaires up carefully with privacy and anonymity in mind, so that the focus stays on the information people choose to share.
About the workforce survey
Designing the questionnaire experience
Transcript
A lot of the work behind the questionnaires has really been about one simple thing - making it as easy as possible for people to take part. We know that some of the topics may be personal and it's completely understandable that people may want to feel confident about how the process works and how their information is handled before deciding whether to respond. So we have tried to keep the whole experience straightforward, respectful and focused on what people choose to share.
Ultimately, all of these decisions were made to give people a clear and reassuring way to contribute their experiences and views to the research.
About the workforce survey
Why is the questionnaire on the website?
Transcript
When you open the questionnaire from the invitation link, it appears within the Holding Differently website rather than as a completely separate looking survey page. The questionnaire itself is still delivered through Qualtrics, but we have integrated it into the project website so that the experience feels familiar and joined up. That means the questionnaire keeps the same Holding Differently look and feel, helping to make the process clearer and more consistent from the outset.
The aim is simply to make taking part feel as straightforward and comfortable as possible.
Taking part
What if I change my mind?
Transcript
We've spoken about how important it is that the questions are anonymous, but also as people go through the survey and they see the question, even after they've answered the survey, they might say, "Oh, actually, I'm not quite sure and I'd like to retract my answers and I no longer want to be considered for the research." And they can do that.
At the beginning of the survey, they'll be given an ID number, and it's really important to keep track on those and to keep that because that will allow us to then go through rather than have a name and say, "It's so-and-so in that site. We don't know any of that." We'll just be able to go, "Oh, that's that number," and then we can delete the answer that are linked to that number. So there is a possibility to say,
Taking part
What do I need to do?
Transcript
[Music] And maybe the last thing is what people need to do now if they've listened and they want to complete the questionnaire. Next steps. They need to go in their email inbox and they will have an email from the triple C because the triple C has a register of every residential child care worker and it may be in them in their spam.
In the inbox, hopefully, we will have the employers, we'll also have information about the questionnaire so they can have it through there, but just once they get the link, they need to click and fill in and their answer will help us to kind of build a national picture of what's happening on the ground about physical restraint.
I wonder too if we might add to that what we would say to a person who hasn't received an email from the triple SC or from their manager or from their service about the project with the link to being able to answer the questionnaire. What would you advise? So we are working with people that volunteer to be champions to the project and those people are frontline workers, managers across Scotland. We've got people in the Highlands. We've got people in Aberdeenshire. We've got people in Glasgow.
Lots of different services and they are there. They have had a briefing with us so they can answer questions about the survey and they will be able to give the link. They can also email the project to get the link. What's the reason why we don't share the link more widely is that because this is purely for residential child care workers so if we were to put it out more we may have answers from people who would not be qualified
Taking part
Can I use a shared computer or survey link?
Transcript
You may be completing the questionnaire on a shared computer or another device that other people use. That is absolutely fine. The same invitation link can be used for multiple responses, including from the same computer. So you do not need your own individual or personalised survey link. We have tried to keep this side of things as simple as possible, particularly for people who may be taking part from a workplace or shared device settings.
The aim is simply to make the questionnaire easy to access and straightforward to complete.
Privacy, cookies and your data
How is Anonymity Supported?
Transcript
We know that feeling confident about how your information is handled is an important part of deciding whether to take part. Anonymity has therefore been considered carefully in the way the questionnaires have been set up. The surveys are configured so that Qualtrics does not retain the respondent's IP address and everyone uses the same invitation link rather than receiving a personalised survey link.
The questionnaires are also designed so that people can share their experiences and views without needing to provide information that identifies who they are. These are deliberate design choices we have made so that the researchers can focus on what you have chosen to share.
Privacy, cookies and your data
Understanding cookies and web analytics
Transcript
When you visit the Holding Differently website, you may see a choice about analytics cookies. You do not need to accept these in order to take part. If you choose not to allow analytics, you can still use the website and complete the questionnaires normally. If you do opt-in, the analytics simply help us understand general patterns of website use, such as whether pages are working well and which parts of the site people are using. That helps us maintain and improve the website.
The website analytics are separate from the questionnaire itself and are not part of the survey response data collected through Qualtrics. Therefore, they do not form part of the research data.
Privacy, cookies and your data
What happens to my responses?
Transcript
Once you submit a questionnaire, your responses are securely held within Qualtrics, so that the research team can work with the information people have chosen to share. Qualtrics provides the secure survey environment used by the project to collect and store those responses. We have also set the questionnaires up with anonymity in mind, including making sure that respondents' IP addresses are not retained.
The important thing is that the questionnaire is there to collect the information needed for the research, while avoiding unnecessary information about the person taking part.