2.3.4 Physical Intervention

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. Notifications
7. Medical Assistance and Examination
8. Recording
9. Management Review

1. Planning for Children

As part of the assessment and planning process for all children, consideration must be given to whether the child is likely to behave in ways which may place him/herself or others at risk of Injury or may cause Damage to Property.

If such risks exist, consideration must be given to the Strategies that will be adopted to prevent or reduce the risk. These Strategies may include Physical Intervention.

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 it and the Strategies for managing it should be outlined in the child's Behaviour Management Plan.

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, 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. If in doubt, medical advice must be sought.

NOTE The existence or absence of a plan does not prevent staff from acting as they see fit in the management of highly confrontational or potentially harmful behaviour.  However, staff may only deviate from agreed plans where they are able to demonstrate that that the plan would not be sufficient to prevent injury or damage to property and the alternative actions they take are consistent with the principles contained in this Chapter.  Any deviation from an agreed plan or from the principles contained in this Chapter must be reported to the manager and child's social worker as soon as practicable thereafter.

2. Definition of Physical Interventions

There are four broad categories of Physical Intervention. 

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 which involves a child being held on the floor ('Prone Facedown' techniques may not be used in any circumstances);
• 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.

Holding

This 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. 

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.

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

Staff may only use techniques that are approved by the home; The method for restraint within Castle Care at this time is Team-Teach. All staff must undertake a basic 12 hour intermediate course followed by a 3 hour advanced module preferably within 3 months of their start date and be refreshed in both every 12 months. Team-Teach is a 'Holistic Approach' which includes de-escalation, diffusion, verbal and non-verbal communication skills, as well as, where necessary, physical intervention. Team-Teach recognises that minor injuries to children may occur during physical intervention such as scratches, bruising, etc., but this is not to be seen as evidence of malpractice or a failure in the techniques, but an unfortunate and infrequent side effect of keeping children, staff and others, safe.

Where staff have not undertaken such training, the use of force may still be justified if it is the only way to prevent injury or damage to property.  In these circumstances, staff must always act in a manner consistent with the values and principles set out in this manual. Any intervention used must:

1. Not impede the process of breathing
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 sexual areas
5. Avoid hyperextension, hyper flexion and pressure on or across the joints
6. Not employ potentially dangerous positions

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.

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.
2. Other forms of Physical Intervention, such as Holding, Touching or Presence, are less forceful and restrictive than Restraint, and may 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. Restraint may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely.
4. 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

The terms 'Predictable Future', Immediately Necessary', 'Last Resort' and Minimum Necessary' are defined in Section 5, Physical Intervention - Behaviour Management Guidance.

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.

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 4.4: 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 and should give consideration to an application being made for a Secure Accommodation Order.

6. Notifications

If Physical Intervention is used upon a child, the Manager and child's social worker must be notified within one working day or as soon as practicable thereafter, unless it has previously been agreed that it is not necessary to do so.  The Manager should notify the home's Line Manager if the incident was serious or a Notifiable Event occurred. See Notifiable 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 on 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

Restraint and for other, less restrictive, forms of Physical Intervention, should be recorded in different ways:

8.1 Restraint

All Incidents involving Restraint must be recorded in the Restraints Log and Daily Log kept in the home, noted in the child's Daily Record and recorded in detail in an Incident Record.

8.2 Other Physical Interventions

All other incidents of Physical Intervention, not including Restraint, must be recorded in the Incidents Log and Daily Log kept in the home, noted in the child's Daily Record then recorded in detail in an Incident Record.

9. Management Review

All Incidents involving any form of Physical Intervention, including Restraint, must be subject to a Management Review as set out in Section 5, Management Reviews of Incidents - General Guidance.

End