Measures of Control, Restraint and Discipline

REGULATIONS AND STANDARDS

The Positive Relationships Standard
Regulation 11


Contents

  1. Planning for Children
  2. Definition of Physical Interventions
  3. Staff Training and Criteria for using Physical Interventions
  4. Post Crisis Response / Medical Assistance and Examination
  5. Locking or Bolting of Doors
  6. Notifications
  7. Recording and Management Review


1. Planning for Children

The assessment and planning process for all children in residential care must consider 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. The impact of the child’s arrival on the group of children/young people living in the home should also be considered.

If any risks exist, strategies should be agreed to prevent or reduce the risk. These strategies may include Physical Interventions. Staff in the children’s home should continually review any risk assessments.

Where physical intervention is likely to 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 such risks, and the strategies for managing it, should be outlined in the child's Placement Plan.

In developing the Placement Plan, consideration must be given to whether there are any medical conditions which mean particular techniques or methods of physical intervention should be avoided. If so, any health care professional currently involved with the child be consulted regarding appropriate strategies and this must be drawn to the attention of those working with or looking after the child and it must be stated in the Placement Plan. If in doubt, medical advice must be sought.

The emphasis within each home should be on encouraging and supporting positive behaviour from young people. This approach is consistent with and, builds upon the mandatory training in Therapeutic Crisis Intervention (TCI).

When there is a need to respond to inappropriate and negative behaviour from young people this should be done in constructive and proactive ways.

What constitutes acceptable and unacceptable behaviour should be understood and negotiated within staff supervision and team meetings. Staff should help young people develop acceptable behaviour through communication, negotiation and consistency of approach.

All staff should receive training on positive approaches to care and control issues. It is a legal requirement to receive training in Control and Restraint and this is provided as part of the TCI. This training will continue to be a mandatory training requirement. Staff may only use techniques approved by the home. Restraint may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely.

In day to day decision making staff should demonstrate an appropriate balance between:

  • Each young person’s wishes and preferences;
  • The needs of individual young people;
  • The needs of the resident group;
  • The protection of others (including the public) from harm.
All young people within the home should be looked after without favouritism or antipathy.

NOTE

The absence of a strategy in the Placement Plan or other Behaviour Management 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 it was not sufficient to prevent injury or damage to property.

Any deviation from an agreed plan or must be reported to the home’s manager and child's social worker without delay.


2. Definition of Physical Interventions

Physical Restraint: The use of trained staff members to hold a young person in order to contain acute physical behaviour.

Acute Physical Behaviour: Behaviour likely to result in physical injury.

The young person, other clients, staff members or others are at imminent risk of physical harm:

  • Physical interventions to contain and/or control the behaviour of children and young people who are looked after should only be used to ensure safety and protection, unless otherwise stated as part of an Senior management agreed and approved I.C.M.P. Physical interventions should only be used as a safety response to acute physical behaviour and their use is restricted to the following circumstance: The child/young person, other clients, staff members or others are at imminent risk of physical harm;
  • As any physical intervention involves some risk of injury to the young person or staff, staff must assess this risk against the risks in failing to physically intervene. The physical intervention should never increase, or create more, risk than the behaviour it is trying to contain;
  • Physical intervention must never be used to:
    1. Punish or discipline;
    2. Enforce compliance;
    3. Inflict pain or harm;
    4. Demonstrate authority.

Physical restraint is a last resort and should only be used after less intrusive approaches (such as behaviour support techniques, crisis co-regulation or verbal interventions) have been unsuccessfully attempted, or where there is no time to try such alternatives.

Physical intervention must only be employed for the minimum time necessary. As soon as the young person is judged to be safe and no longer at risk of harm to themselves or others, the intervention must cease.


3. Staff Training and Criteria for using Physical Interventions

Physical intervention may only be undertaken by staff who have undertaken and successfully completed Therapeutic Crisis Intervention course that covers:

  1. Crisis definition and theory;
  2. The use of de-escalation techniques;
  3. Crisis communication;
  4. Anger management;
  5. Physical intervention techniques;
  6. Decision making related to physical intervention;
  7. Warning signs during restraint.

Staff must also have demonstrated competency in performing the intervention techniques, which is measured and documented by residential services.

All staff involved in an incident of physical restraint must have successfully completed the same training program, endorsed and implemented by residential services, been assessed as competent in the use of physical interventions, and have also successfully completed a skills review within the previous six/twelve months.

Only the physical intervention techniques and the decision making processes that are taught in the Therapeutic Crisis Intervention Course may be used. All the techniques must be applied according to the guidelines provided in the training and this policy.

Where possible, staff members must consult with colleagues including managers/assistant managers prior to initiating any physical intervention.

 Two or more staff members should be involved in any physical intervention to help ensure safety and accountability.

If physical intervention is immediately necessary the force used must be the minimum necessary to achieve the objective. The minimum necessary means exactly that:

  • The amount of force used must be commensurate with the desired outcome and the specific circumstances in terms of intensity and duration.

For example, it may be necessary to hold or restrain a child for a short period whilst s/he calms down sufficiently to re-join a group or activity; or to temporarily block or prevent a child from leaving the home to give staff/carers time to divert the child's attention from absconding.

It may also be appropriate for a person to block or prevent a child's mobility or movement using Restraint whilst help is summoned, then giving the opportunity for the intervention to be reduced when they arrive.

In all cases, the measures must be used for the minimum or shortest time necessary; and the amount of force used must be the minimum that is necessary. The possible adverse affects associated with the measures used be less severe that the adverse consequences which may have occurred without it.

The minimum necessary may mean that proximity or use of physical presence will work in the circumstances; and that it will not be necessary to use more intrusive forms of Physical Intervention.

However, where the risks are greater, and other less intrusive interventions have failed or would not work, holding or restraint may be the minimum that is necessary to achieve the objective.

In any case, caution should be exercised in releasing or reducing interventions too early; to do so may escalate rather than calm the situation. Disengagement should normally be undertaken in a planned and controlled manner.

If it is not possible to consult others before acting, the onus is on adults, on the spot, to decide what level of intervention is appropriate in the circumstances; considering, for example:

  1. Any agreed strategy or plan that may exist for managing a given situation;
  2. The age, size and ability of the child and person managing the behaviour;
  3. The understanding of the child and ability to make informed decisions;
  4. Any disabilities or medical conditions the child may be suffering;
  5. The abilities, skills of the person(s) managing the incident, and the training they have undertaken;
  6. The emotional and mental state of the child; and whether the child is under the influence of alcohol, drugs or other substances;
  7. The child's background, history of using violence etc.

Whatever interventions or measures are taken, the adults must not place themselves in a position where anyone's safety is seriously compromised. In such circumstances they should call for help, maybe from the police, or retreat if that is the only safe option open to them.


4. Post Crisis Response / Medical Assistance and Examination

Following any incident involving physical restraint, children’s services must ensure that there is a post incident medical and post crisis response is offered to the child/young person and staff members and any other people involved in or witnesses of the episode. Staff members should provide the child/young person with an explanation for the intervention and offer the child/young person an opportunity to express their views of what transpired through the Life Space Interview.

All incidents of physical intervention must be recorded on an incident form and in the physical intervention book, the narrative description must include, the people involved, de-escalation and preventative techniques that were used, the actual physical intervention techniques used, any injuries that were sustained by either young people or staff and the content and outcome of L.S.I and Post Crisis Response provided by the unit. All content of such should be reviewed by unit management, senior management who should then action further appropriate action if needed, who in turn will action any follow up needed, e.g. skills update, Ofsted notifications or further action.


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.

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.

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 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.

A children’s home cannot 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.

There are some limited circumstances however, where doors may be and possibly should be locked:

  1. Where it is immediately necessary to prevent harm to any person or serious criminal damage. This action must be only for a reasonable and limited period of time e.g. until the risk has passed or alternate and more appropriate control measures have been organised. In such circumstances there must be a clear record of action taken and justification for those actions;
  2. To prevent access of any unauthorised persons wishing to gain access to young people or the premises for illicit or illegal purposes, for instance issues relating to child sexual exploitation or abuse, bullying, threatening behaviour etc. This action must be only for a reasonable and limited period of time e.g. until the risk has passed or alternate and more appropriate control measures have been organised, such as calling the police for assistance. In such circumstances there must be a clear record of action taken and justification for those actions;
  3. During the hours of dusk to dawn, as a reasonable security/safety measure. NOT in order to restrict the free movement of resident young people in or out of their unit/home, nor as a method of control. There may however, be significant risks in allowing young people to leave the unit/home at night without staff knowledge and therefore supervision. As such, young people wanting to leave at night will need to ask a member of the residential staff team or waking night care assistants to open the external door. These staff, having where necessary consulted the senior on duty, will then decide whether to let the young person leave or not based on the risk assessments on file or an impromptu additional risk assessment made owing to any presenting unforeseen circumstances. In such circumstances there must be a clear record of action taken and justification for those actions.

It is important that staff decisions to lock doors are in keeping with and guided by each young person’s Placement and Behaviour Management Plans, risk assessments and have line management approval. Prior approval should be sought where possible and where this is not possible, immediate retrospective approval for them to remain locked or a decision made to unlock them.

*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 give consideration to an application being made for a Secure Accommodation Order.


6. Notifications

If physical intervention is used upon a child, the home’s manager and the child's social worker must be notified within one working day.

If a serious incident or the Police/emergency services are called, the relevant senior manager must be notified and consideration given to whether a Notifiable Event has occurred, if so, see Notification of Serious 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. Recording and Management Review

If a child has an Education, Health and Care Plan 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 use, the restraint used must be recorded. Any other restraint used must always be recorded.

7.1 Recording

All forms of physical interventions should be recorded in the Restraint 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).

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.

7.2 Management Review

The child's Placement Plan should be reviewed to incorporate strategies for reducing or preventing future incidents. The child must be encouraged to contribute to this review and, if a health care professional is involved with the child, any new strategies must be approved by that person.

The manager of the home should regularly review incidents and examine trends and 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.