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5.5.4 Restrictive Physical Intervention in Residential Care

SCOPE OF THIS CHAPTER

This chapter refers to the management of the behaviour of every Child Looked After. Whilst the use of restrictive physical intervention tends to relate to a small group of children in residential care, all staff and carers should be familiar with this procedure.

AMENDMENT

This chapter was reviewed in April 2017 and slightly amended to reflect local processes.


Contents

1. Planning for Children
2. Definition of Physical Intervention 
2.1 Restraint
2.2 Holding
2.3 Positive Touching 
2.4 Presence 
3. Who may use Physical Interventions? 
4. Criteria for Using Physical Interventions
5. Locking or Bolting of Doors
6. Timeout and Withdrawal
7. Medical Examination


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 the child’s Placement Information Record (PIR).

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 child’s Placement Information Record (PIR). 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 - see Section 3, Who may use Physical Interventions?

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 Intervention

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 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 this first category 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 provide the child with varying degrees of freedom and mobility.

2.2 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. 

2.3 Positive 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?

Staff should only use Physical Intervention if they have undertaken approved Team Teach training. However, where staff/carers have not undertaken such training, the use of minimum force may be justified if it is the only way to prevent injury or damage to property.

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 extending the joints beyond the normal limits or range of motion (hyperextension or hyperflexion), and pressure on or across the joints;
  6. Not employ potentially dangerous positions.


4. Criteria for Using Physical Interventions

There are different criteria for the use of Restraint and Holding, Touching and Physical Presence/proximity.

  1. Restraint may only be used where there is likely significant injury or serious damage to property;
  2. Holding, Positive Touching or Presence are less forceful and less restrictive 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 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 it is safe for them 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 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.


6. 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 (as part of the Placement Information Record (PIR)) for individual children;
  • In foster homes, they must be set out in the Foster Care Agreement or in the Behaviour Management Plans (as part of the Placement Information Record (PIR)) for an individual child.

Time out involves restricting the child’s access to all 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 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 medical practitioner if there are any apparent or reported injuries.

The 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 medical practitioner must be recorded, together with the outcome.

End