Size:

Contents

Caption: Contents List

1.	Planning for Children
2.	Definition of Physical Intervention
	2.1	Restraint
	2.2	Holding/Safe 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.	Notifications
8.	Medical Examination
9.	After Applying Restraint – Recording, Review and Reporting
	Further Information

1. Planning for Children

Islington’s practice model promotes therapeutic, trauma-informed care. All foster carers are offered de-escalation training, PACE for Parenting training and the opportunity to attend a 6-week Nurturing Attachments course, based on attachment theory and an understanding of the impact of trauma on children’s development and security, in order to provide carers with an authoritative set of ideas for therapeutically parenting children.

Wherever possible, foster carers and/or residential care workers should manage behaviour using a positive and proactive relationship-based approach, backed up with clear expectations and predictable routines. Physical intervention, in the form of safe-holding is very much considered a last resort and should be fully considered as part of the assessment and planning process for all children before being used by the foster carer or residential worker.

If safe-holding 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 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.

Any deviation from an agreed plan or from the principles contained in this Chapter must be reported to the Service Manager and child's social worker as soon as practicable thereafter.

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 must 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/Safe 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 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 - the use of 'prone facedown' techniques must never be used;
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 hyperextension, hyper flexion and pressure on or across the joints;
6. Not employ potentially dangerous positions.

4. Criteria for Using Physical Interventions

4.1 Staff Training – in residential settings

All staff must be trained in methods of behaviour management, including the use of physical intervention and restraint, that are agreed by the Home.

This training must ensure 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 physical intervention and restraint.

4.2 Training for foster carers

As highlighted previously, Islington’s practice model promotes therapeutic, trauma-informed care. All foster carers are offered de-escalation training, PACE for Parenting training and the opportunity to attend a 6-week Nurturing Attachments course, based on attachment theory and an understanding of the impact of trauma on children’s development and security, in order to provide carers with an authoritative set of ideas for therapeutically parenting children.

Wherever possible, foster carers should manage behaviour using a positive and proactive relationship-based approach, backed up with clear expectations and predictable routines. Physical intervention, in the form of safe-holding is very much considered a last resort.

However, if safe-holding is agreed as part of the child’s Placement Plan to be occasionally necessary, the circumstances that give rise to it and the strategies for managing it should be clearly outlined in the 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. On these, very rare occasions, additional specialist training would need to be considered for the child’s foster carer/s.

4.3 Criteria for using Physical Interventions

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

1. Restraint, which is the form of Physical Intervention used with the intention of overpowering a child, may only be used where there is likely Significant Harm or serious damage to property;
2. Other forms of Physical Intervention, such as 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. Restraint may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely;
4. 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 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.

6. 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 Information Record) 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. Notifications

If Physical Intervention is used upon a child, the child’s social worker must be notified within one working day.

The child’s social worker should make a decision about whether to inform the child’s parent(s) and, if so, who should do so.

8. 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.

9. After Applying Restraint – Recording, Review and Reporting

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 Notification of Significant Events Procedure.

9.1 Recording

In children’s homes all forms of Physical Intervention should be recorded in the Restrain Log and an Incident Report must be completed.

This incident should be recorded in the Home’s Daily Log and on the Daily Record for the individual child(ren).

9.2 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.

In children’s homes incidents should be regularly reviewed 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.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Guidance: Positive Environments Where Children Can Flourish (Ofsted)

End