1.4.9 Restrictive Physical Intervention

Contents

1. Planning for Children                                   
2. Definition of Physical Interventions                          
3. Who may use Physical Interventions                      
4. Staff Training and Criteria for using Physical Interventions              
5. Locking or Bolting of Doors                                   
6. Notifications
7. Medical Assistance & Examination
8. Recording, Support Processes and 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 Restrictive Physical Intervention in exceptional circumstances and only as a last resort.

Where Restrictive 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 Individual Crisis Management Plan (ICMP).

When completing an ICMP, 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. The organisations core restrictive physical intervention risk assessments provide guidance to this. Where a child has a rare or unusual condition specific medical advice should be sought.. If in doubt, medical advice must be sought.

Note The existence or absence of an ICMP, Placement Plan or behaviour management plan does not prevent staff from acting as they see fit in the management of highly confrontational or potentially harmful behaviour which would be deemed as an exceptional circumstance. 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 Home Manager and child's social worker as soon as practicable thereafter.

2. Definition of Physical Interventions

There are four broad categories of Physical Intervention.

1. Restrictive Physical Intervention: Defined as the “positive application of force intentionally to restrict a child’s movement against her will”,

The significant distinction between the first category, Restrictive Physical Intervention, and the others (Holding, Touch and Presence), is that Restrictive Physical Intervention 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: 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.
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.
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

Staff may only use techniques that are part of the CIP training or have specifically been agreed by the Operations Director; such techniques should comply with the following principles:

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 pressure on 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.

4. Staff Training and Criteria for using Physical Interventions

4.1 Staff Training

All staff employed by the organisation receive CIP training which focuses heavily on de-escalation, communication and behaviour management techniques. The objective of CIP is to reduce the requirement for restrictive physical intervention.

This training ensures 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 restrictive physical intervention.

4.2 Criteria for Using Physical Intervention

1. Restrictive Physical Intervention may only be used where there is likely Significant Harm or Serious Damage to Property.
2. Restrictive Physical Intervention may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely.
3. Before Restrictive 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 least restrictive using the minimum amount of force.

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 4.2, 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*. In such situations the Regional Manager needs to give approval and comprehensive risk assessments need to be in place. 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 Restrictive Physical Intervention is used upon a child, the Home Manager and child's social worker must be notified within one working day. 

If a serious incident or the police/emergency services are called, the On call Manager (Restrictive Physical Intervention) must be notified and consideration given to whether a Notifiable Event has occurred, if so, 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 & Examination

Where Restrictive 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, Support Processes and Management Review

8.1 Recording

All forms of Restrictive Physical Interventions should be recorded in the Restrictive Physical Intervention Log and an Incident Report must be completed.

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

8.2 Support Processes

Following the application of restrictive physical intervention the child should be de briefed through the implementation of a Life Space Interview (LSI) this process is non blaming, allows reflection and supports the development of alternative coping mechanisms for difficult feelings. The child should also be supported to speak to someone independent of the home regarding the incident.

In order to support staff effectively, line managers should ensure they implement a debrief as soon as possible following a restrictive physical intervention incident to ensure they receive appropriate support, recognise any causes and triggers to the incident, commend good practice.

8.3 Management Review

The child's ICMP and Behaviour Management Plan should be reviewed on a regular basis to incorporate strategies for reducing or preventing future incidents.

The Manager of the Home should regularly review incidents and examine trends through the regulation 34 process any 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.

8.4 Critical Incident Monitoring

Copies of all regulation 34 reports and restrictive physical intervention recordings (including de-briefs) must be sent to the CIP panel on a monthly basis for critical incident monitoring.

End