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1.5.5 Physical Interventions

AMENDMENT

This chapter has been updated in March 2016 in line with the Children’s Homes Regulations including Quality Standards (2015) – in particular ‘restraint’. (See Section 2, Definition of Physical Interventions and Section 4, Criteria for using Physical Interventions.)


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

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 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. 

Restraint also includes restricting the child’s liberty of movement. Restriction on liberty of movement can involve adaptations to the environment such as using high door handles or removing physical aids, but it also refers to behaviour support strategies such a requiring a child to take ‘time out’ in a specific area of the home, asking a child to spend time away from the group to regain control of their behaviour (i.e. if a child is struggling to maintain a socially acceptable level of behaviour at the meal table, asking them to move away from the group to another area, can be defined as restricting their liberty of movement). Where there is no need to use restrictive physical intervention (i.e. the child goes willingly once instructed to do so) a record of the incident must still be recorded (see recording and reporting). This is to ensure the intervention can be monitored and to ensure that children are not be scapegoated or unduly being isolated from the group.

Where the likely application of this strategy is a reasonable assumption due to a child’s previous behaviour or level of emotional needs, this should be included in the ECH plan/Care plan. This should be monitored as part of the normal review process. This strategy should be clearly recorded on the child’s Individual Behaviour Support Plan. In this instance, there is no requirement to complete an incident report, unless the behaviour displayed is new, unusual or falls under any other category of incident.

If a child has an Education, Health and Care Plan or Statement of Educational Need in which a specific type of restraint/ physical intervention 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.


3. Who may use Physical Interventions?

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.

A child/young person can be prevented from leaving the home if it is felt they are at significant harm in the following circumstances:

  • Sexual Exploitation;
  • Gang Related Activities;
  • Use of drugs or other illicit substances.

This restriction of a young person’s liberty should be for the minimum amount of time possible and in response to immediate danger. Staff will need to ensure that in the recording of this incident they clearly outline all the steps taken to prevent the need to restrict the child’s liberty using physical means.

If a young person continually requires this level of intervention to help them to remain safe, there must be clear evidence of a planning meeting with the placing authority to consider the appropriateness of the placement. It may be recognised that this is a process of testing and an agreement regarding strategies will be set and reviewed in conjunction with the local authority, this will need to be clearly documented and any agreement must not conflict with regulations regarding ‘Deprivation of Liberty’.


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.

A children’s home can not 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.

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.

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.


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.

The Registered person should regularly review the effectiveness and check the medical assessment of the system remains up to date.


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

If a child has an Education, Health and Care Plans or statement of educational need 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 us, the restraint used must be recorded. Any other restraint used must always be recorded.

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.

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.

End