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Contents

1. Planning for Children
2. Definition of Physical Interventions
3. Who may use Physical Interventions?
4. Criteria for using Physical Interventions
5. Locking or Bolting of Doors
6. Seclusion, Timeout and Withdrawal
7. Medical Examination
8. Notifications
9. Recording and Management Review

1. Planning for Children

As part of the assessment and planning process for all children, consideration must be given to whether Physical Intervention may be necessary in managing behaviour.

If Physical Intervention may be necessary, the circumstances that give rise to it and the Strategies for managing it should be outlined in a Relevant Children's Plan.

For all Looked After Children, these strategies must be incorporated into a Behaviour Management Plan which is part of the child's Placement Plan.

This plan should outline the circumstances that may give rise to the use of Physical Intervention, the methods which are known or likely to be effective and other arrangements for its use. 

It is also important to determine 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, this must be drawn to the attention of those working with or looking after the child and it must be stated in the Behaviour Management Plan or another relevant plan. If in doubt, medical advice must be sought.

Those techniques that are used must comply with the principles and procedures set out in this Chapter and the associated Guidance. See Section 3, Who May Use Physical Interventions? below.

The absence or existence of such a plan does not prevent staff/carers from acting as they see fit when confronted with unforeseen likely Injury or Damage to Property, so long as the actions taken are consistent with the principles and procedures contained in this Chapter. 

2. Definition of Physical Interventions

There are four broad categories of Physical Intervention. 

2.1 Restraint:

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 involving the 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 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.

2.2 Holding:

This includes any measure or technique that 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.

2.3 Touching: 

This 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.

2.4 Presence: 

A form of control using no contact, such as standing in front of a child or obstructing a doorway to negotiate with a child; but allowing the child the freedom to leave if they wish. 

3. Who may use Physical Interventions?

Normally, staff/carers may only use Physical Intervention if they have undertaken approved training. Staff in children's homes may only use restraint techniques that are approved by the home in which they are working. Staff should be trained in the home's approved techniques before they start working with children.

Where staff/carers have not undertaken such training, the use of force may be justified if it is the only way to prevent Injury or Damage to Property.

In any case, the use of force must reflect the values and principles set out in this Chapter and the associated guidance (see Behaviour Management Guidance).

4. Criteria for using Physical Interventions

There are different criteria for the use of Restraint and other forms of Physical Intervention, such as Holding, Touching and Physical Presence/proximity.

1. Restraint, which is the form of Physical Intervention used with the intention of overpowering a child, may only be used where there is likely SIGNIFICANT injury or SERIOUS damage to property;
   
   See guidance and examples of what may constitute Significant Injury or Serious Damage to Property, which is contained in Behaviour Management Guidance;
2. 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 Injury which is less than significant or to prevent Damage to Property which is less than serious;
3. Before Restraint or any other form of Physical Intervention is used, all of the following principles must be applied:
   1. For the intervention to be justified there must be a belief that Injury or Damage is likely in the Predictable Future;
   2. The intervention must be Immediately Necessary;
   3. The actions or interventions taken must be a Last Resort;
   4. Any force or intervention used must be the Minimum Necessary to achieve the objective.

5. Locking or Bolting of Doors

It is acceptable to use mechanisms or modifications to a children's home or foster home 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.  It is also acceptable to lock office or storage areas to which children are not normally expected to gain access.

If such mechanisms are used they must be as outlined as follows:

In children's homes, if any such mechanisms or modifications are used, they must be set out in the home's Statement of Purpose and the arrangements for their use set out in the home's Staff Handbook.

In foster homes, if any such mechanisms or modifications are used, they must be agreed by the manager of the fostering service and set out in the Foster Care Agreement.

Apart from this, it may be reasonable to bolt or lock a door to contain a child temporarily or prevent a child from leaving. Such action would be a Restraint and therefore may only be used if there was a risk of Significant Injury or Serious Damage to Property.

6. Seclusion, Timeout and Withdrawal

Where the following measures are used in children's homes or foster homes, they must be approved and set out in writing.

• In children's homes, they must be set out in the home's Statement of Purpose or in Behaviour Management Plans for individual children;
• In foster homes, they must be set out in the Foster Care Agreement or in the Behaviour Management Plans for an individual child.

Seclusion is where a child is forced, by use of Physical Intervention, to spend time alone against their will, for example where a child is placed or made to remain in their bedroom.

Time out involves restricting the child's access to all positive reinforcements as part of a behavioural programme.

Withdrawal involves removing a child from a situation, which places the child or another person at risk of Injury or to prevent Damage to Property, to a location where s/he can be continuously observed or supervised until ready to resume usual activities.

7. Medical Examination

In children's homes where Physical Intervention has been used, the child, staff/carers and others involved must be given the opportunity to see a Registered Nurse or Medical Practitioner, even if there are no apparent injuries.

In other settings, where Physical Intervention is used, the child, staff/carers and others involved should be given the opportunity to see a Registered Nurse or Medical Practitioner if there are any apparent or reported injuries.

The Registered Nurse or Medical Practitioner, if seen, 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 must be recorded, together with the outcome.

8. Notifications

Unless it has previously been agreed that it is not necessary to do so, the manager and child's social worker must be notified as soon as practicable but within 24 hours if an Incident of Physical Intervention upon a child occurs. The social worker should make a decision about whether to inform the child's parent(s) and if so who should do so.

Depending on the seriousness of the Incident, other people/agencies may have to be notified, Appendix 1, Designated Managers, describes who should be notified.

9. Recording and Management Review

The use of Physical Intervention is deemed to be an Incident, and must be recorded as such. Please see Incidents - General Guidance, which contains details of the records that must be completed.

All Incidents involving Restraint must be subject to a Management Review. See Incidents - General Guidance, for guidance on conducting Management Reviews.

End