20 March 2024

Service Users Co-Production in Observation and Therapeutic Engagement Project in Forensics Directorate

By Emma Furlong, Sexual Safety Lead and QI Coach

A combined workgroup of services users (SU) and staff from the Forensic Directorate worked closely together on the Observations and Therapeutic Engagement QI Project.  Over the ensuing months, significant improvement has been achieved in staff completing observations and competencies, which fosters clear and effective communication between staff when handing over observations, and agreeing with service users what activities they would like to do daily in their most preferred time of the day. This is the Twilight Shift change idea, which proved to be significant and impactful for service users, ‘We can access the iPad to have a music appreciation group in the evening now, we have time to enjoy this, it’s great,’ said a service user and workgroup member in Victoria Ward, John Howard Centre.

Many service users from our medium and low secure services were actively engaged in this work.  Giving regular updates and feedback at our weekly workgroup meetings, actively taking part in PDSAs on the change ideas that we decided locally such the use of various night lights when staff do observations at night, for example as well as Trust-wide identified change ideas such as Board Relay, Recovery Worker Twilight Shift and Zonal Observations. Feedback from SU are integral in this project. SU from Loxford Ward in Wolfson House commented, ‘I didn’t like the bright torchlight being shined in my room at night, it traumatised me, I prefer one from when we did the PDSA, which we’re now using all the time now.’

The data from the wards have all shown an overall decrease in verbal and racial aggression because of the project as shown on Figure 1 and 2 below. There was high degree of belief that the change ideas tested throughout the project cycle have contributed to the reduction of incidents due to increased staff availability in clinical areas, early intervention, and proactive management of issues as they arise prior to them escalating into a more serious nature.

Figure 1. U Chart showing the number of incidents of verbal aggression each month


Figure 2. U Chart showing the number of incidents of racial aggression each month

As a result of our participation in this trust-wide QI project, we have firmly embedded competencies and training around Therapeutic Engagement within our service.  Service users are now able to rate their experiences of being observed by staff and give their feedback, which we take on board and act upon on a regular basis.  It is important for us to continue with this to ensure that we make observations, safe, effective and meaningful for both service users and staff in the forensic service.


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