3.4.3 Physical Intervention and Restraint

SCOPE OF THIS CHAPTER

This 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.

AMENDMENT

This chapter was refreshed in December 2022.

1. Introduction

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.

See also: Positive Relationships and Behaviour Management Procedure.

2. 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 a Behaviour Management Plan which is part of the child's Placement Plan. See Behaviour Management Plans Procedure.

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, disabilities, injury or pregnancy 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 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 significant Injury or serious 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.

Caption: contents list
   
3.1 Restrictive Physical Intervention
3.2 Physical Contact - Holding
3.3 Physical Contact - Positive Touching
3.4 Presence

3.1 Restrictive Physical Intervention

Restrictive 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' (DHSC and Regulatory Authority, 2002 (archived)).

  • 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 significant distinction between the first category, and the others (Holding, Positive Touch and Presence), is that Restrictive 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.

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.

The other categories of Physical Intervention provide the child with varying degrees of freedom and mobility.

3.2 Physical Contact - 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.

3.3 Physical Contact - 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. It is intended to reassure, redirect and support the child.

3.4 Presence

Is a form of care and 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.

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, but it also refers to behaviour support strategies 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, can be defined as restricting their liberty of movement). 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 (see recording and reporting). 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 likely application of this strategy is a reasonable assumption due to a child's previous behaviour or level of emotional needs, this should be included in the ECH plan/Care plan. This should be monitored as part of the normal review process. This strategy 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 (EHC plan) or Statement of Educational Need 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 Restrictive 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 significant and/or sustained Damage to persons or Property.

In any case, the use of force must reflect the values and principles set out in this Chapter and the associated guidance (see Positive Relationships and Behaviour Management Procedure).

5. Criteria for Using Physical Interventions and Physical Contact

There are different criteria for the use of Restrictive and other forms of Physical Contact Intervention, such as Holding, Touching and Physical Presence/proximity.

Caption: different criteria for use of physical intervention
  1. 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;
  2. 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;
  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 Significant Injury or Serious 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.

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 of Doors

It is acceptable to use mechanisms or modifications to children's homes 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 Induction Process.

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

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 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.

Time out involves allowing the child to regain control and collate their thoughts. Allowing time for reflection could be a positive part of a behaviour management programme. For children with disabilities and children in receipt of Short Term Breaks, Time out will be Supervised time out.

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 Restrictive 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.

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.

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.

11. Informing Others

If the child is placed in residential or foster care, the home's manager (Foster Care: Supervising Social Worker) must be informed. In all circumstances, the child's social worker must be notified. Notifications should be made as soon as practicable but within 1 working day.

In mainstream residential care, the senior on duty/manager should take the decision whether to inform the parent. In short break provisions there should be a communication method which facilitates this flow of information.

For foster care, the supervising social worker should make a decision about whether to inform the child's parent(s) and, if so, who should do so.

Depending on the seriousness of the Incident, other people/agencies may have to be notified.

12. Recording and Management Review

The use of Restrictive Physical Intervention is deemed to be an Incident, and must be recorded as such. Please see Incidents Guidance, which contains details of the records that must be completed.

All Incidents involving restraint must be subject to a Management Review. See Incidents Guidance, for guidance on conducting Management Reviews.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Guidance: Positive Environments Where Children Can Flourish (Ofsted)