title: Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression.
abstract: BACKGROUND
  De-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness.
  
  
  OBJECTIVE
  To conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training.
  
  
  METHODS
  The review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis.
  
  
  RESULTS
  A total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and deescalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results.
  
  
  CONCLUSIONS
  It is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects.
authors.affiliation: Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Price
authors.affiliation: Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK.
authors.forename: John
authors.initials: J
authors.lastname: Baker
authors.affiliation: Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Bee
authors.affiliation: Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007318:Inservice Training; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010549:Personal Satisfaction; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult