Show a little restraint;Behaviour management

Victoria Neumark

Teachers are crying out for proper training to help them cope safely with aggressive pupils. But are techniques designed to handle some of the UK's most violent and disturbed people really what they need? Victoria Neumark finds plenty who say they are, and meets the man who pioneered them.

A teenage boy sits at a table, colouring in with lavish strokes of purple crayon. The classroom is bright and airy, full of other pupils of similar age and ability. At the boy's sides sit two members of the teaching staff, their arms curiously entwined with his.

Suddenly, and without ceasing his crayon's slow circling, the boy whips his head around and tries to bite the man sitting on his left. At the same time, he twists and lashes his foot to strike a thumping blow on the shins of the woman on his right. He is smiling - he seems to be enjoying himself. A few of the other children look up, their eyes wide. As they see the situation is under control, they resume their activities, each keeping a wary eye on events.

The man and woman remain calm. They talk soothingly. "Now, that's not right, is it? No need for that," and maintain their firm and complicated grip, their legs also now entwined with his, their shoulders behind his.

As he struggles, wriggling fast, sliding down towards the floor then thrusting up above the table, the faces of the teaching staff grow red and sweaty. But they keep their hold, they are unharmed and, after a while, they rise, move out from behind the table and deposit the boy in the safety of a "time-out room". No harm done, no tempers lost. And the other children carry on working while the two adults sit down to take a breather.

This is a mythical school. But the situation and the "care and responsibility" methods, pioneered by occupational therapist Bill Thorpe and his team at the Centre for Aggression Management at Ashworth Special Hospital, Merseyside, are real.

They are so successful that Shelagh Coates, headteacher at Liverpool's Redbridge High School, took the unusual step of writing to The TES, with a request to publicise them. So successful, indeed, that all the recent teachers' conferences have heard calls for schools to enlist Bill Thorpe's help in dealing with savage and unruly youngsters. At the Association of Teachers and Lecturers conference last month, delegates warned that the policy of integrating children with emotional and behavioural difficulties into mainstream education was increasing the number of violent classroom incidents, and demanded that the Government offer training in safe methods of restraint at all schools.

Bill Thorpe's techniques were developed to deal with some of society's most dangerous and damaged people. Ashworth - home to convicted criminals such as Moors murderer Ian Brady - is a name that sends a chill down the spine. What can an officer from a high-security psychiatric hospital offer dedicated education professionals? Isn't Ashworth like a prison, and isn't prison about pain and control, while education is about nurture and development? Shelagh Coates agrees: "As well as being against the law, the use of pain in schools goes against everything education stands for. Bully-boy tactics only teach young people that the strongest or most violent person wins. But," she smiles, "Bill's techniques are not about that at all." Redbridge deputy head Bev Riley nods. "When I heard Bill was from Ashworth I thought 'Whoaaaa!'. But as soon as I heard him speak, I knew his philosophy was the same as ours. Forcible restraint was the last resort."

Ashworth has been in the news recently. Its personality disorders unit has been hit by scandal, and a series of reports since 1992 have yet to be fully implemented. An inquiry is currently hearing disturbing evidence about practices on the unit - Health Secretary Frank Dobson has called it "a mess". But this secure hospital is also a place where serious attempts are made to rehabilitate difficult, dangerous people.

In the mid-1980s Ashworth saw 2,000 violent incidents a year. The Centre for Aggression Management, founded in 1987 and since 1994 a fully-fledged training unit within the hospital, has reduced this number to fewer than 700.

Ashworth is home to about 450 of the United Kingdom's most anti-social men and women, committed for an average of seven years each (but many indefinitely) for violent offences including rape, robbery and murder. All are diagnosed with serious mental illness such as personality disorder or psychosis (in common parlance, not just bad but mad as well), so the reduction in violence is some achievement. And, Bill Thorpe explains with quiet satisfaction, he is even prouder of the fact that in 400 "high-level" incidents since 1994 in which weapons have been used, no staff or patients have been injured.

It was in 1986 that Bill Thorpe, then an occupations officer at Ashworth (formed when Park Lane and Moss Side were amalgamated in 1980) started researching methods of controlling aggression. He was unhappy with the prison-service model of using pain to restrain. "We have to work with our patients the next day," he says, "so we don't want to lose them through violent confrontation." With a lot of reading, visiting other institutions and roaming the Internet, he developed the idea of using the body's natural move-ment to limit aggression. That also meant looking at other non-verbal ways of defusing potentially violent situations.

"Sometimes," explains Mr Thorpe, "we would actually be the problem." Staff who had countered attacks with physical contact to delicate parts of patients' bodies or by using neck locks or kneeling on backs may have rescued themselves from immediate peril, but, he adds, "many years of a creative relationship can be lost in that minute".

With his staff of six, Bill Thorpe has so far trained more than 8,000 nurses, 100 clergy and a whole social services department as well as staff and parents in more than 20 schools in England and Gibraltar. Methods continue to develop. They are, says one satisfied user, headteacher Andre Baird of Foxfield School in the Wirral, "the very best available".

On-going training at Ashworth looks "at the whole concept of violent aggression", says Mr Thorpe, including how fear-fuelled over-reaction by staff can escalate situations. It's not just holds, it's also reflection, analysis and retraining.

Faced with crises of extremely challenging, terrifying behaviour, schoolteachers and support staff have found little help in last year's government guidelines on use of "reasonable force". Headteachers and governors, in turn, face pressure from the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1996, demanding that acts of "non-consensual physical violence done to a person at work" be reported.

A bulging log full of violent incidents does little for school morale. Publicity surrounding the murder of headteacher Philip Lawrence in December 1995 and injuries to teachers and social workers has also cranked up levels of apprehension. Most of all, the knowledge that there is no accepted way to cope, no shared training or plan, has left many staff - not just in special schools - walking a tightrope of anxiety.

It was worries about the risk to teachers and pupils that led Ken Jackson at the Wirral's Gilbrook Primary School to contact Bill Thorpe in 1995. Ashworth had just won the Department for Education and Employment's National and Regional Training Award, largely thanks to the efforts of the Centre for Aggression Management's work. Gilbrook educates children with emotional and behavioural difficulties. "Our problems were with children attacking each other, and sometimes staff," he says bluntly. "This training has cut the number of incidents."

John Williams, who works at Kilgarth School on the Wirral, says the dangers of inappropriate or poorly-executed restraint go beyond the risk of physical harm. His school caters for teenage boys with behavioural problems and he uses the Ashworth techniques regularly. But he says: "Other teachers may find themselves in such situations only once a term or less. It can terminate a career."

For a long time, staff in special schools have looked at why children become violent. Inconsistent, unskilled or hostile parenting, an inability to tolerate limits (tantrums on hearing "no"), the glorification of violence on TV, film and computer games, a general lessening of respect within society, extreme situations or their own disabilities or suffering have all been implicated. But knowing all of this does not make it any easier when Sharon, multiply abused and with learning difficulties, comes at you with a knife, or when Michael, hyperactive and just lost his mother, throws his desk at Lee. Nor is it necessarily any easier to know what to do, even if you do know violence breeds violence - or if you read DfEE circulars.

What teachers need, agree staff at Gilbrook, Redbridge and Foxfield, is a sure-fire routine: to hold and calm the children, to move them from the middle of the road or the corridor, through the door, away from the table. And to know colleagues are equally switched on.

Bill Thorpe's repertoire of holds reassuringly covers every possibility, from "locking" pupils in chairs so they can't get up to locking them up so they can't sit down. Four people can restrain someone prone on the ground holding only the legs, and supporting the head. Two can walk someone through a doorway without damage to child or door. Never apply your full weight, never put pressure on arteries or nerves, is Bill Thorpe's advice. Learn to prise mouths and teeth off flesh, hands out of hair, clawed nails away from faces. Be aware, always, of the terror fuelling aggressors. Talk to them, calm them down. Reassure them no one's going to get hurt - not me, not you.

The "tool-box" of holds and restrictions imparted on the training courses is only part of the care and responsibility package. Bill Thorpe trains staff to assess risk, defuse aggression, deflect violence and, finally, if need be, to contain it physically. It's an almost Zen way of stepping back to search out a situation's pressure points and find out how they can be released. "No more panic mode," says Bev Riley.

For teachers in north-west England, Bill Thorpe's caring control has been a godsend. At Foxfield School, where staff have been training with Bill since 1993, they are evangelical about his sensitivity to pupils' needs, his thorough research, and his willingness to put on workshops with parents, so they can experience the holds for themselves. Bill claims: "This training is giving children labelled as disruptive, as troublemakers, a chance in life, a chance to get an education."

A few days' training can, says Mike Sutton of the Link Centre in Birkenhead, give teachers "renewed confidence in themselves and their colleagues to resolve difficult situations". As many of the holds involve two, three or four people working together, the training is woven deeply into team-building; each time the holds are put into practice, the confidence of successful collaboration strengthens the team.

Andre Baird says: "As a result of the knowledge and skills Bill has given us, we have not only improved practice but also significantly reduced the number of injuries to staff and pupils." Although only a tiny minority of pupils with special needs present challenging behaviour, says Shelagh Coates, who first commended these methods to The TES, the issue looms large in staff consciousness. "You can find yourself worrying, 'Will it happen today, or won't it?'" But as Bev Riley says: "Now I know what to do, I am more confident about bringing children in who we would have had to turn away before."

Analysing the way dangerous situations build up, Bill Thorpe has identified a key list of triggers for aggression, signs of attack and non-verbal ways of defusing situations. Using psychology, observation and some knowledge of physiology, he has gone on to work out how to "isolate, close down and restrain" a range of muscle groups. His guiding principles have been the need to avoid pain, limit disturbance and foster co-operation. At all times, the aggressor's human dignity is recognised; at all times, staff safety is paramount.

Tony Newman, headteacher at Stanley School, Wirral, sees these twin focuses as revolutionary. Because the focus of care and responsibility training is the student, staff can make difficult situations "central to their professional role and not merely an annoying distraction. We can develop a culture in which teachers aim to avoid physical confrontation but, when it occurs, can manage it with the same degree of professional pride as they feel when teaching a child to read." Because the focus is also on safety, staff gain confidence and "relate much better with the client". Mr Newman adds, "Trained staff will begin to take risks (and broaden educational activities) knowing that if things go wrong they can handle it."

Care and responsibility training does not just free staff to be better teachers. It also briefs them on safe limits of touching, so they need not fear being accused of abuse when they have tried only to restrain. Parents, too, who have attended workshops and experienced the holds for themselves will understand that the safe teamwork of Mr Thorpe's toolbox is worlds away from any echo of physical or sexual abuse.

Ken Jackson speaks of his school's new "air of calmness". He says: "The children now know something positive is going to happen if they kick off." Care and responsibility is effective, he says, not just as crisis management but as a "a supportive tool to help a child gain control of the situation" and reduce levels of stress throughout the school.

Peter Smyth and Barry Nisbet, support staff at Redbridge High, talk about "asking someone to give a hand, and you know they know exactly what to do. You feel safe". Bev Riley says: "You know you've got as much time as you want, you can talk to the child. It's not restraint. It's isolating and supportive holding. It's transformed this job."

For more details contact: Bill Thorpe, Centre for Aggression Management, Ashworth Hospital, Beechway, Maghull, Liverpool L31 1HW. Tel: 0151 471 2343.

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Victoria Neumark

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