All staff who have contact with patients and service users should be trained so they are equipped to recognise, prevent and manage challenging behaviour. This applies to any healthcare setting. The level of training they should do depends on their specific roles and responsibilities. Qualified and experienced staff may already have much of the core knowledge and skills required, but they will benefit from understanding more about challenging behaviour and learning about specific tools (such as ABC analysis) and strategies. Staff in support roles (e.g. care, domiciliary or portering roles) also need to have awareness and some understanding of challenging behaviour so that they can recognise and reduce the risks it poses to patients, service users and themselves.

Training can be considered at three levels:

1. Core learning needs

It is important that all staff who interact directly with patients or service users, including non-clinical staff, have a basic level of awareness of challenging behaviour and the importance of individualised strategies to prevent and manage it. They should also receive conflict resolution training (CRT), which must be delivered via face-to-face sessions. Guidance on conflict resolution training is available from NHS Protect.

 2. Role-specific training 

Role-specific training may be needed for managers, doctors, nurses, HCAs, allied healthcare professionals, security officers, response team members, ambulance and police services. It should be relevant to the specific job roles performed by the participants, in particular where there are defined responsibilities for the prevention and management of challenging behaviour (e.g. clinical assessments, care planning and special observations). Role-specific learning could be included in induction and refresher training, or incorporated into existing pre- and post-registration training.

3. Targeted training and support 

Additional training and support may be needed for staff in areas where there is a higher prevalence of challenging behaviour or where the risk of harm is higher. This may include practical instruction on assault avoidance, disengagement, containing, guiding and/or re-directing skills. For some (e.g. response teams and nurses in specialist settings) it may also cover holding skills to allow essential treatment and care or to manage an individual who presents a serious physical risk to themselves or others.

Learning outcomes

There should be specific learning outcomes for each level of training. Please see this table for some recommended learning outcomes.


A series of training videos have been produced to be used as part of core learning. The videos are designed to be either standalone or integrated into a training package. For further information on Training, please refer to the full guidance document.