What is Frontline?
Frontline is a computer-based learning tool for people whose jobs involve a high degree of face-to-face contact with clients who are ‘difficult’ as people.
Clients may be difficult in different ways. What is difficult for one person may not be so for another. Some difficulties go with the territory. Your ‘difficult’ client may be quite specific to the setting in which you work. Some people, however, work in settings where a wide variety of clients appear. These people may have difficult clients who share few similarities beyond being experienced as difficult.
Frontline helps you develop skills for dealing with a wide range of people in different settings who pose a variety of challenges on account of their behaviour. You might experience the behaviour of such people as: intrusive, rude, aggressive, violent, unpredictable, withdrawn, attention-seeking, or even seductive.
Frontline promotes greater engagement with people who are hard to engage. In doing so it allows more people to access the help or service you provide, but also gives you more job satisfaction. Your workplace will almost certainly benefit as a result of your new knowledge, skills and attitudes. And the resulting benefits to service users should be significant.
Frontline focuses on improving communication between you and your clients through helping you to understand better your relationship with them. It also aims to increase your awareness of the relevance and importance of other people’s jobs, those who work closely with you and those who may work with your client elsewhere, or might potentially do so.
Who is Frontline for?
Frontline is designed for health, social care, and criminal justice professionals who:
- May have no formal professional qualification
- Have limited access to training opportunities as a result of their frontline role
- Are likely to benefit from skills in dealing with people who present with challenging behaviour
- Are likely to respond well to a relevant ‘hands-on’ learning package
- Welcome the chance to develop their skill other than ‘on the job’—away from the coalface
- Want to develop skills and capabilities that can:
- improve their practice
- form a basis for further career development
- improve the service to their clients
- increase their job satisfaction
The intended training audience for Frontline is:
- Primary care staff, for example:
- Healthcare assistants
- A&E frontline workers
- GP receptionists
- Staff in acute psychiatric units
- Social services staff, for example:
- Social workers
- Key workers
- Criminal justice staff, for example:
- Police officers
- Probation officers
- Prison officers
- Hostel and housing staff
- Local authority staff
- Voluntary organisations, especially mental health service providers
Why has Frontline been developed?
Frontline has been developed to address gaps in individuals' and teams' awareness and skills in relation to interacting with and managing people with a Personality Disorder.
For decades, people with Personality Disorder, despite experiencing considerable distress and many other problems, have been excluded from mental health services in this country because their condition was not considered treatable. In January 2003, the Government, via the National Institute of Mental Health in England (NIMHE), published policy implementation guidance on good practice entitled Personality Disorder: no longer a diagnosis of exclusion. This document aimed at transforming the way in which the needs of people with Personality Disorder are met.
The policy implementation guidance has important implications for those involved in the planning and delivery of specialist Personality Disorder services and training. At the time of publication, the then Health Minister Jackie Smith remarked that “it will no longer be acceptable for Trusts to argue…that people with Personality Disorder are not the business of specialist mental health services. The treatment and management of Personality Disorder is part of the legitimate business of mental health.”
Training the mental health workforce in relation to Personality Disorder to reflect the shift in emphasis in Personality Disorder: no longer a diagnosis of exclusion is a huge job. But we need to start somewhere. We believe that Frontline is relevant to and a useful resource for staff working at all levels in all organisations that may deal with clients with challenging behaviour including Personality Disorder.
However, perhaps the most pressing need is to engage staff working at the lower levels of the ‘NHS skills escalator’. This is because it is often staff who are the least ‘qualified’ (in a traditional sense) who have the highest levels of contact with service users. These staff are usually clients’ first point of contact with the health and social care or criminal justice ‘system’. This initial contact is a crucial moment when the client forms an initial impression of the service offered. Even greeting a client in a certain way can make a huge difference. Clients’ experience at this moment might influence their perceptions of subsequent interactions and treatment.
Frontline has been developed as a computer-based tool available on the Internet so that it can be used by people in their own time—before work, between shifts, or even at home. This flexibility is important because staff at lower levels of organisations tend to have the greatest difficulty accessing training resources, even if these are available, as a result of their working patterns and care responsibilities.
When we consulted staff in assistant, support or auxiliary roles, the message from them was clear:
“Rather than see ourselves as irrelevant or peripheral to the clinical care that clients receive, we are part of, and our work is critical to, a “community of care” that involves other specialists and other teams.
We recognise that consistency of care is important, and are keen to strengthen skills that allow us to take our place within this community. We acknowledge that we have an important role to play.”
What are Frontline’s learning objectives?
Frontline’s learning is organised around four key competencies. When we consulted with a range of professionals and potential users of Frontline, these competencies emerged as being important to their ability to interact with ‘difficult’ clients in an effective, meaningful and rewarding way.
- Understanding communication - The ability to communicate with your client in a way that is effective, meaningful and rewarding for both of you
- Understanding the client – The ability to consider what your client may be feeling in a given situation and how this affects what they feel, say and do
- Understanding yourself – The ability to consider what you may be feeling in a given situation and how this affects what you feel, say and do
- Understanding the system - An awareness of the relevance and importance of other areas of the care system, including other professionals who work closely with you and those who may work with your client elsewhere
For more information about key capabilities and competencies in relation to the treatment and management of people with a Personality Disorder, please see the Personality Disorder Capabilities Framework.
The multiple choice questions in each learning scenario allow you to demonstrate your competence against the four competencies above. As you progress through the questions, you will be given a score. This score relates to your ability to answer each question with the ‘preferable’ course of action. You have three attempts to get the question right. At the end, you will be given an overall score, as well as a summary of the key things you have learned in that scenario.
How does Frontline help you learn?
Frontline uses interactive multimedia ’scenarios’. These scenarios are ‘real life’ situations with you at the centre of the action. Each scenario challenges you to think about what is happening in that moment and what you should do.
Frontline enables you to rehearse and reflect upon the skills, attitudes and values that will help you manage difficult situations in your work. At the same time, Frontline helps you understand the potential consequences of your actions on yourself, your clients, your colleagues, and the wider system in which you work.
Because Frontline is on the Internet, you can use it on your own in your own time at any time of day or night. Teams may also wish to incorporate Frontline into their group-based training. A group-based approach provides opportunities for discussion with other people, which may add even more richness to the learning experience.
Who has developed Frontline?
The team that has developed Frontline is a multi-disciplinary mix of university, clinical and service delivery professionals, including agencies working on the ground in London with people with challenging behaviour and Personality Disorder.
Members of the consortium are senior practising clinicians and/or educators within the following organisations:
- Division of Forensic Psychiatry, St. George’s, University of London (SGUL)
- Department of Mental Health Studies, London South Bank University (LSBU)
- Henderson Hospital Services, South West London and St. George’s Mental Health NHS Trust
- SUN (Service User Network) Project (NIMHE funded PD site), South West London and St. George’s Mental Health NHS Trust
- Department of Psychotherapy, Broadmoor Hospital, West London Mental Health NHS Trust
- Shaftsbury Clinic Medium Secure Unit, South West London and St. George’s Mental Health NHS Trust
- St. Mungo’s (London’s largest homelessness organisation)
- The Homelessness Training Unit, South London and Maudsley NHS Trust
- Independent group of ex-service users who are expert by experience
- SHM, an independent consultancy, which has expertise in health policy, strategy and innovation, organisational change, and knowledge and technology transfer.
Several members of the consortium were members of the Expert Advisory Group advising Government in relation to development of the Personality Disorder policy implementation guidance No longer a diagnosis of exclusion, and the Personality Disorder Capabilities Framework, Breaking the Cycle of Rejection.
The consortium was originally established in October 2002 in anticipation of these publications, and further membership was selected later to reflect a wide range of interest and expertise in working with people with Personality Disorder.
Frontline has also benefited from the views of service users and ex-users of a range of services. These people have enriched the learning experience by providing insights into what situations feel like from their perspective. These insights have been incorporated into the content, which, as a result, is more authentic.
Frontline has been designed in association with: