1.6.4 Physical Intervention |
RELATED CHAPTERS
Guidance on the use of Physical Intervention, including definitions of key terms such as ‘Last Resort’, is contained in Behaviour Management Guidance.
AMENDMENT
This chapter was significantly updated in October 2011 and should be read in its entirety.
Contents
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.
Children’s Homes 2011 National Minimum Standard 3: Promoting positive behaviour and relationships (para. 3.13-3.19) sets out the expectations in relation to the use of restraint (and of sanctions and other disciplinary measures).
If Physical Intervention may be necessary, the circumstances that give rise to it and the Strategies for managing it should be outlined in a Behaviour Management Plan or other plan/strategy (see final paragraph of this Section).
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 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 and the associated Guidance. See Behaviour Management Guidance and 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.
Re Plans: The existence or absence of a plan does not prevent Staff/Carers from acting as they see fit in the management of highly confrontational or potentially harmful behaviour. However, Staff/Carers 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 Intervention
There are four broad categories of Physical Intervention.
i. Restrictive Physical Intervention:
Physical Interventions are defined as ‘the use of force to restrict movement or mobility or the use of force to disengage from dangerous or harmful physical contact initiated by a service user’ (DoH and Department for Children, Schools and Families (known as the Department for Education since 12 May 2010).
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 involving the child being held by two or more people;
- Any technique which involves a child being held on the floor (note: Prone ‘face down’ positions must not be used in any circumstances);
- 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.
Physical Intervention can include Restraint, Holding, Positive Touch and Presence.
The significant distinction between Restraint and the other forms of Physical; Intervention (Holding, Positive Touch and Presence - defined below), is that Restraint is defined as the positive application of force with the intention of restricting a persons movement, which is maintained against resistance.
It is, therefore qualitatively different from other forms of physical contact such as manual prompting, physical guidance or simply support, which might be used in teaching or therapy.
NB. See the Children’s Homes Regulations 2011 as amended by the Children’s Homes (Amendment) Regulations 2011.
17A Restraint
(1) Subject to paragraph (2) a measure of restraint may only be used on a child accommodated in a children’s home for the purpose of:
- Preventing injury to any person (including the child who is being restrained);
- Preventing serious damage to the property of any person (including the child who is being restrained); and
- In the case of a child accommodated in a children’s home which is a secure children’s home, preventing the child from absconding from the home, and then only where no alternative method of preventing the event specified in sub-paragraphs (a) to (c) is available.
(2) Where a measure of restraint is used on a child accommodated in a children’s home:
- The measure of restraint must be proportionate, and
- No more force than is necessary should be used.
The other categories of Physical Intervention provide the child with varying degrees of freedom and mobility.
ii. Holding:
This includes any measure or technique that involves the child being held firmly by one person, so long as the child retains a degree of mobility and can disengage if determined enough.
iii. Positive Touch:
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. It is intended to reassure, redirect and support the child.
iv. Presence:
Is a form of control using no contact, but rather, the day to day ‘supervisory’ role of a Staff member. The presence of a Staff member may be used as a deterrent to misbehaviour. Control by physical presence involves emphasizing verbal instructions/directions gesturing or using visual aids such as pictorial cards . It may also include standing in the way of a child who is not responding to verbal instruction or is losing control, and is likely to cause injury without this intervention.
3. Who May Use Physical Interventions?
Staff and foster carers may only use Physical Intervention if they have undertaken approved 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.
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)
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 (including so called “nose distraction” technique).
- 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
4. Criteria for Using Physical Interventions
There are different criteria for the use of Restrictive and other forms of Physical Intervention, such as Holding, Touching and Physical Presence/proximity.
- Physical Intervention used with the intention of restricting a child’s mobility, may only be used where there is likely Significant Injury* or Serious damage to property. *The term 'Significant Injury' is defined in Behaviour Management Guidance
- Other forms of Physical contact, such as Holding, Positive Touching or Presence, are less forceful and restrictive than Physical Intervention 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 form of Physical Intervention is used, all of the following principles must be applied ( underlined terms are defined in Behaviour Management- Use of Restrictive Physical Intervention Guidance):
- For the intervention to be justified there must be a belief that Injury or Damage is likely in the Predictable Imminent 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
5. 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, or compromise health and safety.
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. Seclusion, 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 units, they must be set out in the Home’s Statement of Purpose or in Behaviour Management Plans for individual children
- In foster Homes, they must be set out in the Foster Care Agreement or in the Behaviour Management Plans for an individual child.
Seclusion is where a child is forced, by use of Physical Intervention, to spend time alone against their will, for example where a child is placed or made to remain in their bedroom. This should only be considered in exceptional circumstances and should always be proportional to the risk presented by the 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 Registered Nurse or 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 Registered Nurse or Medical Practitioner if there are any apparent or reported injuries.
The Registered Nurse or 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 Registered Nurse or Medical Practitioner must be recorded, together with the outcome.
If the child is placed in residential/respite care, the Children’s Home’s Registered Manager must be notified.
If the child is placed with an Independent Fostering Agency, the Registered Manager and Supervising Social Worker must be notified within 24 hours. The Social Worker for the child must be informed by the IFA in writing within 24 hours.
If the child is placed with a Lewisham Foster Carer, the Service Manager, Team Manager and Supervising Social Worker must be notified.
In all circumstances, the child’s Social Worker must be notified. Notifications should be made as soon as practicable but within 1 working day.
The Social Worker should make a decision about whether to inform the child’s Parent(s) and, if so, who should do so.
If incident(s) are persistent or serious, consideration should be given to reviewing the child’s plan and/or seeking specialist advice.
End