AWARD WINNER 2014-15: Now a MAPPA Co-ordinator with the National Probation Service, and described in his nomination as “a dedicated and highly resilient individual”, David wins an Award for his work as a Probation Manager, in turning around a failing Approved Premises in the Avon and Somerset area, and ensuring the effective and compassionate management and care of those residents with mental health issues.

David Miners works as part of the Probation Service with one of the more difficult and complex problems in the system: people in Approved Premises (AP) who may have been deemed to be some combination of high-risk, violent, and addicted. As a manager, he took over an AP in the St Paul’s area of Bristol when staff morale had been particularly affected by the death of a young resident.

He soon identified a series of issues in both the culture and approach to residents, and that the complex needs of those who staff were responsible for included a high incidence of personality disorders, a demanding cluster of problem behaviours including, for example, paranoia and psychopathy.

As well as bringing decades of managerial experience and talent to bear – he started in the service in 1986 – David felt very strongly that it was important to develop an approach which would help staff “consider the person behind the label.”

“Residents,” he says, “have usually been assigned several labels such as ‘high risk’, ‘personality disorder’ or ‘drug addicts. This can lead to unhelpful preconceptions about their likely attitudes and behaviour.”

While acknowledging that the overriding priority of an Approved Premises is to provide public protection, in David’s view “this goes hand in hand with, and is enhanced by, a sensitive understanding of the individual behind the label.”

With a longstanding interest in mental health, David was instrumental in helping transplant a pioneering approach from the Mental Health sector into the Criminal Justice system. ‘Team Formulation’ brings together staff, mental health experts, and any other relevant partners who wish to be involved (for example the police), in order to create an agreed assessment concerning the drivers behind an individual’s behaviour.

The structured meetings use psychological evidence and the reflections and insights of team members to create an individual intervention plan. By building a shared understanding across staff, and taking into account feelings and reactions, David has helped deliver dramatic improvements in morale, teamwork, as well as measured outcomes for residents.

Sally Lewis OBE is Chief Executive of the Avon and Somerset Probation Trust and is impressed by David’s combination of creativity and professional skills in turning around an inherently difficult setting. Because Approved Premises are 24/7 operations, she notes, delivering consistency is inevitably more difficult – a problem made even more challenging by the need to engage with multiple partner agencies and a difficult and demanding population of residents.

Sally describes David’s work as providing an “immensely improved and purposeful new approach”, with beneficial impacts on conflict avoidance and reduction, improved compliance with rules and requirements demanded of residents, and in their successfully moving on. “Ultimately,” she adds, “this contributes to better levels of public protection for our communities.”

Sally’s describes David as “a dedicated and highly resilient individual.” David himself clearly sees his work as creating a setting, through his managerial leadership, in which his own staff can achieve, in turn, improvements in their own skills and resilience.

The impact on residents has also been remarkable, as captured through their own feedback. In just six months, measured improvements of between a fifth and a half have led to an impressive array of 100% feedback scores on residents’ initial impressions; their sense that they were helped when they didn’t understand rules; finding keywork helpful and positive; feeling they were treated fairly; and feeling they got help in managing ‘life problems’, including their own behaviour.

With talent, dedication, empathy, and an appetite to tackle difficult challenges, David’s work has had an impact on the lives of residents and staff alike, as well as providing a more intelligent approach for other agencies dealing with some of the more problematic lives in the system.

IN THEIR OWN WORDS

[David Miners gives his account of the work for which he won his Award]

In October 2011, following concerns about performance, I was directed to undertake an internal review of the operations at Brigstocke Road Approved Premises. I interviewed all staff, reviewed processes and analysed the evidence in order to produce a detailed report with a series of recommendations for consideration by my Chief Executive Officer. I subsequently took over as the Manager in January 2012. I introduced several significant process changes to Brigstocke Road’s operations. However, I was aware that changing the staff culture was the key to improving the Approved Premises’ performance and in particular its management of up to 28 high risk of harm residents. The negative staff culture presented itself to me via the overt and covert resistance I encountered from the several of the staff team. It became clear to me that there was both a fear of change and a fear that their views would not be respected in any change process. Although the team included competent and perceptive individuals they were neither confident in their abilities or that they would be respected by other professionals. It became clear to me that to change the culture the team’s self-esteem needed to be improved and a more confident and professional approach adopted.

I subsequently approached a Clinical Psychologist who was working with the Probation Service and discussed the idea of introducing Team Formulation meetings at Brigstocke Road. The aim would be to improve the management of high risk of harm residents and to help address the negative culture in the team. Due to my longstanding interest in mental health, I was aware that Team Formulation was a relatively recent but increasingly popular approach in psychiatric services. In essence, a formulation is a shared hypothesis or ‘best guess’ about the reasons for a person’s mental health difficulties or offending behaviour, in the context of their life events. It is based on psychological evidence, and its main purpose is to produce an individualised plan for intervention. In a Team version, a group or team of staff takes part in a structured and facilitated meeting in order to develop this shared understanding about a particular resident. It is a collaborative and reflective process in which awareness of staff feelings and reactions plays a key part. Research in mental health settings suggests that this approach is highly valued by staff, and the benefits can include the following:

• achieving a consistent team approach to intervention
• helping team, service user and carers to work together
• gathering key information in one place
• generating new ways of thinking
• dealing with core issues (not just crisis management)
• understanding attachment styles in relation to the service as a whole
• supporting each other with service users who are perceived as complex and challenging
• drawing on and valuing the expertise of all team members
• challenging unfounded ‘myths’ or beliefs about service users
• reducing negative staff perceptions of service users
• processing staff counter-transference reactions
• helping staff to manage risk
• minimising disagreement and blame within the team
• increasing team understanding, empathy and reflectiveness
• raising staff morale
• conveying messages to staff about hope for positive change
• facilitating culture change in teams and organisation

At Brigstocke Road, the meetings were open to all professionals working with the resident, including, wherever possible, the police and the current probation officer. The formulation, written up and circulated by the clinical psychologist, formed the basis of the management plan. As well as improving the management of the resident, the Team Formulation meetings had a positive impact on the general culture of the team. Within the context of the meeting staff members knowledge and experience was listened to and their insights valued. They worked overtly as part of a multi- disciplinary team and the improvement in self esteem and team identity was very evident, The changes also allowed staff members to reflect on the context of the residents’ difficulties and on their relationships with them. This led to a more positive team atmosphere and improved staff/resident relationships.

From the start team members valued the Team Formulation meetings highly. The approach had the advantage of being both simple and complex. At one level, formulating is something that we all do as human beings; we try to make sense of people’s relationships, feelings, behaviours and motives. This makes it very easy for staff of all levels of training and experience to contribute to a team formulation meeting. There is no such thing as a ‘wrong guess’, and the hunches of a newly-arrived student or staff member are likely to be at least as valuable as the opinions of the highest-status staff. All professionals are implicitly formulating in their work, and the process is perhaps most acceptable to them if described as a more explicit, structured and shared version of what they are doing already. The staff group’s enthusiasm for the meetings combined with the contributions that they made were clear evidence of increased confidence and a more professional culture. This changed in culture continued as the meetings developed and the plan derived from the meetings became the central point of reference for the management of the resident in the Approved Premises and it was incorporated into all risk management planning.

The introduction of a more positive culture and regime at Brigstocke Road, of which the Team Formulation approach was a part, resulted in an improved experience for the residents. Many of them are directed to live at Brigstocke Road, so developing good professional relationships is key to managing them effectively.

It resulted in a calmer and more reflective atmosphere which meant that the staff were able to manage incidents such as self-harm and abusive behaviour more effectively. Indeed the staff team became more confident and resilient in the face of sometimes very challenging situations.

The more positive working culture improved the risk management of offenders. The shared understanding acquired through the Team Formulation process resulted in a more sophisticated and individualised understanding of an individual’s risk triggers as well as identifying the relevant actions that could be taken. Staff members were more able to recognise the crucial role of their interactions and relationships with residents, and consequently felt more confident in addressing risk.

More effective management of some of the most challenging and high-risk offenders in the local community has obvious public benefits, especially in relation to a large Approved Premises. There have been moves to implement formulation-based approaches in other areas of the Criminal Justice system , and I am pleased that Brigstocke Road was able to pioneer this approach. The aim was to have a formulation completed for every resident within their first month of arrival and this was achieved within 3 months of commencing the meetings.

During the three years that I was the manager at Brigstocke Road Approved Premises I introduced several changes to practice that had a direct impact on the culture of the team. Some of these changes by necessity, had to be directed. The significance of the introduction of Team Formulation meetings was that they were introduced following consultation and directly appealed to team members’ professionalism. As a result they were able to identify its relevance to their work and this motivated them to actively embrace the change in practice. Probation practice in recent years particularly in relation to the residents of Approved premises, has focussed on the risk of harm and the offending histories of the residents. This is of course essential but by using the Team Formulation approach, it enabled the team to have an understanding of the person behind the label and this inevitably enhanced both the management of the resident in the Approved Premises but also the management of the individual’s risk generally. By providing structure, containment and emotional support the introduction of the Team Formulation approach was therefore the most influential practice change I introduced and it helped to fundamentally change the working culture at Brigstocke Road.