Positive Intervention and Restraint

1. Planning for Children

As part of the assessment and planning process for all children, consideration must be given as to whether the child is likely to behave in ways which may place themselves or others at risk of injury or may cause damage to property. The impact of the child's arrival on the group of children/young people living in the home should also be considered.

If such risks exist, strategies should be adopted to prevent or reduce the risk. These strategies may include Physical Interventions. Staff in the children's home should continually review any risk assessments.

Where physical intervention may be necessary, for example, if it has been used in the recent past or there is an indication from a risk assessment that it may be necessary, the circumstances that give rise to such risks, and the strategies for managing it, should be outlined in the child's Placement Plan and a Positive Handling Plan completed.

In developing such a plan, consideration must be given to whether there are any medical conditions which might place the child at risk should particular techniques or methods of physical intervention be used. If so, any health care professional currently involved with the child should approve appropriate strategies and this must be drawn to the attention of those working with or looking after the child and it must be stated in the Placement Plan. If in doubt, medical advice must be sought.

2. Definition of Physical Interventions

Restraint also includes restricting the child's liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. These should all be recorded as restraint.

There are three broad categories of physical intervention.

1. Restraint: is defined as the positive application of force with the intention of overpowering a child. Practically, this means any measure or technique designed to completely restrict a child's mobility or prevent a child from leaving, for example:
   • Any technique which involves a child being held on the floor;
   • Any technique involving the child being held by two or more people;
   • Any technique involving a child being held by one person if the balance of power is so great that the child is effectively overpowered; e.g. where a child under the age of ten is held firmly by an adult;
   • The locking or bolting of a door in order to contain or prevent a child from leaving.

The significant distinction between the first category, Restraint, and the others (holding, touch and presence), is that restraint is defined as the positive application of force with the intention of overpowering a child. The intention is to overpower the child, completely restricting the child's mobility. The other categories of physical intervention provide the child with varying degrees of freedom and mobility;

2. Holding: includes any measure or technique which involves the child being held firmly by one person, so long as the child retains a degree of mobility and can leave if determined enough;
3. Touching:  includes minimum contact in order to lead, guide, usher or block a child; applied in a manner which permits the child quite a lot of freedom and mobility.

3. Who may use Physical Interventions

Trained staff may only use Team Teach techniques that are approved by the home. Such techniques should comply with the following principles:

1. Not impede the process of breathing - the use of 'prone face down' techniques must never be used;
2. Not be used in a way which may be interpreted as sexual;
3. Not intentionally inflict pain or injury or threaten to do so;
4. Avoid vulnerable parts of the body, e.g. the neck, chest and genitals;
5. Avoid hyperextension, hyper flexion and pressure on or across the joints;
6. Not employ potentially dangerous positions.

4. Staff Training and Criteria for using Physical Interventions

4.1 Staff Training

All staff must be trained in Team Teach methods of behaviour management, including the use of physical intervention and restraint, that are agreed by the home. Team Teach Training for refreshers is one-day training every 2 years and for those that have not been trained before, it is a 2 full day training session.

This training must ensure that staff are able to:

• Manage their own feelings and responses to the emotions and behaviours presented by children and understand how past experiences and present emotions are communicated through behaviour;
• Manage their responses and feelings arising from working with children, particularly where children display challenging behaviour or have difficult emotional issues;
• Understand how children's previous experiences can manifest in challenging behaviour;
• Use methods to de-escalate confrontations or potentially violent behaviour to avoid the use of physical intervention and restraint.

4.2 Criteria for using Physical Interventions

Restraint also includes restricting the child's liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. These should all be recorded as restraint.

There are different criteria for the use of restraint and other forms of physical intervention, such as holding, touching and physical presence which is the form of physical intervention used with the intention of over powering a child may only be used where there is likely Significant Harm or serious damage to property:

1. Other forms of physical intervention, such as holding, touching or presence, are less forceful and restrictive than restraint, and may be used to protect children or others from less serious injury or damage to property;
2. Restraint may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely.

Before restraint or any other form of physical intervention is used, staff must be satisfied that it is necessary because there is a risk of injury or damage to property and that:

1. The injury or damage is likely in the predictable future;
2. The intervention is immediately necessary;
3. The actions or interventions taken will be as a last resort;
4. That any force or intervention used is the minimum necessary to achieve the objective.

A child/young person can be prevented from leaving the home if it is felt they are at risk of Significant Harm due to:

• Child sexual exploitation;
• Gang related activities or radicalisation;
• Substance misuse.

5. Locking or Bolting of Doors

It is acceptable to use electronic mechanisms or other modifications which are necessary for security, for example on external exits or windows, so long as this does not restrict children's mobility or ability to leave the premises if they wish to do so.

A children's home cannot routinely deprive a child of their liberty without a court order, such as a Section 25 order to place a child in a licensed secure children's home or in the case of young people aged 16 who lack mental capacity, a deprivation of liberty may be authorised by the court of protection following an application under the Mental Capacity Act 2005.

Locking of external doors, or doors to hazardous materials, may be acceptable as a security precaution if applied within the normal routine of the home.

It is also acceptable to lock doors to physically restrict the normal movement within or from the home to reduce the risk of significant injury or serious damage to property and so long as the criteria set out above (Section 4.2, Criteria for Using Physical Intervention) are met i.e. where the injury or damage to property is likely in the predictable future, that the locking of the door is immediately necessary, used as a last resort and for the minimum amount of time necessary to de-escalate the situation*. If such methods are used in the home, the following must apply:

1. The home's Statement of Purpose must clearly state the policy and strategies for using such methods;
2. Placing authorities must have their attention drawn to the use of such methods and the individual Placement Plans for children should refer to them and describe the circumstances where such strategies may be used;
3. Such restrictions for one child do not impose similar restrictions on other children.

* If such strategies are used upon a child on a frequent or extended basis, it may be a form of restriction of liberty, which is not acceptable; therefore, the social worker must be notified give consideration to an application being made for a Secure Accommodation Order.

6. Notifications

If physical intervention is used upon a child, the home's manager and the child's social worker must be notified within one working day.

If a serious incident or the Police/emergency services are called, the Registered Team Manager must be notified and consideration given to whether a Notifiable Event has occurred, if so, see Notification of Serious Events Procedure.

The social worker should make a decision about whether to inform the child's parent(s) and, if so, who should do so.

7. Medical Assistance and Examination

Where Physical Intervention has been used, the child, staff and others involved must be able to call for medical assistance, and children must always be given the opportunity to see a Registered Nurse or Medical Practitioner, even if there are no apparent injuries.

If a Registered Nurse or Medical Practitioner is seen, they must be informed that any injuries may have been caused from an incident involving physical intervention.

Whether or not the child or others decide to see a Registered Nurse or Medical Practitioner it must be recorded, together with the outcome.

8. Recording and Management Review

If a child has an Education, Health and Care Plan in which a specific type of restraint is used as part of the day to day child's routine, the home is exempted from the recording requirement. Where these plans provide for a specific type of restraint that is not for day to day use, the restraint used must be recorded. Any other restraint used must always be recorded.

8.1 Recording

All forms of physical interventions should be recorded in the Physical Intervention Book and a Serious Incident Form must be completed.

The incident should be recorded in the home's Daily Log and on the Daily Record for the individual child(ren).

Ideally within 24 hours the child involved in the restraint should be able to express their feelings about this experience and should be encouraged to record their views to the record of restraint.

After any physical intervention or restraint, staff will complete a Restorative Conversation with the child or young person. This conversation will be fed back on to the serious incident form. Particular attention will be given to feedback from the child or young person regarding whether an alternative form of de-escalation would have been helpful or more effective.

8.2 Management Review

The child's Placement Plan should be reviewed to incorporate strategies for reducing or preventing future incidents. The child must be encouraged to contribute to this review and, if a health care professional is involved with the child, any new strategies must be approved by that person.

The manager of the home should regularly review incidents and examine trends and issues emerging from this to enable staff to reflect, learn and inform future practice and, where necessary, should ensure that procedures and training are updated.