Restrictive Physical Intervention and Restraint
SCOPE OF THIS CHAPTERThis chapter refers to the management of the behaviour of every looked after child. 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.
AMENDMENTIn October 2022 this chapter was given a general refresh.
For a small minority of children/young people or at certain times in a child or young person's life, physical intervention or restraint may be needed. However, physical restraint should be avoided as far as possible and should only be used if there are good reasons for believing that immediate action is necessary to prevent a child or young person causing significant injury to themselves or to others, or causing serious damage to property. Other techniques should be used before physical constraint is considered.
The need for physical restraint may arise when a child is engaged in violence towards themselves and/or others, damage to property and if the child's behaviour is out of control and none of the other strategies are working.
It is important to be aware that use of restraint can pose risks to the safety of the child, to the safety of the carer applying it, and potentially to others who are present.
2. Planning for Children
As part of the assessment and planning process for all Looked After 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 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 child's Placement 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 - see Section 4, 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.
3. Definition of Physical Intervention
There are four broad categories of Physical Intervention:
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 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.
Minimum force should be used and it should only be used for a short time period. It should be proportionate and the least restrictive to the child.
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.
3.3 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.
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. It also refers to behaviour support strategies which may be employed 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). 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. 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 need to use restraint is a reasonable assumption due to a child's previous behaviour or level of emotional needs, this should be included in the child's Education Health and Care Plan/Care plan. This should be monitored as part of the normal review process. The strategy agreed for managing behaviour 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 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.
4. Who may use Physical Interventions?
Foster carers and residential staff will receive appropriate training in safe use of restraint, including training on the applicable legislative framework. Any use of restraint must be consistent with this training, these procedures and must at all times be focussed on the need to protect the child and those around them.
In emergency situations 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 persons or 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:
- Not impede the process of breathing;
- Not be used in a way which may be interpreted as sexual;
- Not intentionally inflict pain or injury or threaten to do so;
- Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas;
- Avoid hyperextension, hyper flexion and pressure on or across the joints;
- Not employ potentially dangerous positions.
5. Criteria for Using Physical Interventions
There are different criteria for the use of Restraint and Holding, Touching and Physical Presence/proximity.
- Restraint may only be used where there is likely significant injury or serious damage to property;
- 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;
- Before any other form of Physical Intervention is used, all of the following principles must be applied:
- For the intervention to be justified there must be a belief that injury or damage is likely in the predictable future;
- The intervention must be immediately necessary;
- The actions or interventions taken must be a last resort;
- 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/Criminal Exploitation;
- 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'
6. Locking or Bolting of Doors
It is acceptable to use mechanisms or modifications to a children's unit 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.
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.
7. Timeout and Withdrawal
Where the following measures are used in children's units 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 Plan) 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 Plan) 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.
8. Children and Young People with Extra Support Needs
Any types of restraints or physical interventions which are in place to keep a child safe due to their behaviours and which restrict a child's liberty should be recorded on the child's placement plan and Educational Health Care Plan. For example wheelchair restraints to stop a child running off when they have no or little road safety sense.
For a young person who is over the age of 16 who has care and support needs, any restrictions or agreed interventions will need to be recorded and a Mental Capacity Act assessment/Best Interest decision will need to be completed.
9. 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.
10. After Applying Restraint
All incidents of restraint will be reviewed, recorded and monitored. The child's social worker should also be informed.
An incident report detailing the circumstances around the incident is an important tool in understanding what has happened and why. The report should include what has happened, who was present, any triggers before hand, if any injuries occurred and what happened after the intervention. The views of the child must be sought, dependent on their age and understanding, and used in the process of reflecting, understanding and informing future practice.
The carer and the child should be supported after an incident has occurred.
Decisions will then be made about how any further situations need to be managed and risk-assessed.
If the police are involved, the Regulatory Authority must also be notified by the Agency. See Notifications of Significant Event Procedure.