4.4.2 Physical Interventions |
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.
If Physical Intervention may be necessary, the circumstances that give rise to it and the strategies for managing it should be outlined in a relevant plan, such as a Care Plan or Placement Plans/Placement Information Records.
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 Section 3, Who May Use Physical Interventions?
The existence or absence of a 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 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.
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 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, Restraint, and the others (Holding, Touch and Presence), is that Restraint is defined as the positive application of force with the intention of controlling a child. The intention is to control the child, completely restricting the child’s mobility.
The other categories of Physical Intervention provide the child with varying degrees of freedom and mobility.
2.2 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 leave if determined enough.
2.3 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?
Normally, staff may only use Physical Intervention if they have undertaken approved training. Where staff members have not undertaken such training, the use of force may still be justified if it is the only way to prevent Significant Injury or Serious 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:
- Not impede the process of breathing
- Not be used in a way which may be interpreted as sexual
- Not intentionally inflict pain or injury
- 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
- Not involve any attempt to hold children who are on the floor, or not upright.
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).
4. Criteria for Using Physical Interventions
There are different criteria for the use of Restraint and other forms of Physical Intervention, such as Holding, Touching and Physical Presence/proximity.
- Restraint, which is the form of Physical Intervention used with the intention of controlling a child, may only be used where there is likely Significant Injury or Serious Damage to Property.
For guidance on what constitutes Significant Injury or Serious Damage to Property, see Behaviour Management Guidance - Other forms of Physical Intervention, such as Holding, Touching or Presence, are less forceful and restrictive than Restraint 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 Restraint or 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.
5. Locking or Bolting of Doors
It is acceptable to use mechanisms or modifications to a children’s home 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 they wish to do so. It is also acceptable to lock office or storage areas to which children are not normally expected to gain access.
Apart from this, it may be reasonable to bolt or lock a door to contain a child temporarily or prevent a child from leaving. Such action would be a Restraint and therefore may only be used if there was a risk of Significant Injury or Serious Damage to Property.
Meaning of Temporarily
Temporarily means that the child may only be contained or prevented from leaving until the risk of Significant Injury or Serious Damage to Property has diminished. As soon as the risk diminishes, the door must be unlocked or unbolted. However, staff/carers may still impose less intrusive forms of Physical Intervention upon a child, if it is necessary to prevent injury or damage to property.
For example, staff/carers may closely supervise or otherwise use their presence whilst remonstrating with or using other verbal techniques to calm a child sufficiently to re-join a group or activity or to block a child to give other staff/carers time to remove a group or other stimulus.
Where the locking or bolting of a door extends beyond reasonable timescales, or the risks to the child, staff or others, become too great, staff/carers should consider asking the Police for assistance. In relation to Looked After Children, see Contacting the Police Procedure.
6. Seclusion, Timeout and Withdrawal
Where the following measures are used in foster homes, they must be appropriately recorded. Where these measures are used regularly they need to be agreed as part of the Placement Plans/Placement Information Records.
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.
Time out involves restricting the child’s access to all positive 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
If restraint 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 restraint.
Whether or not the child or others decide to see a Registered Nurse or Medical Practitioner must be recorded, together with the outcome.
8. Notifications
Unless it has previously been agreed that it is not necessary to do so, the child’s social worker (and the foster carer’s supervising social worker for children placed in foster care) must be notified as soon as practicable but within 24 hours if an incident of restraint upon a child occurs.
The 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, Designated Managers Appendix, describes who should be notified.
9. Recording and Management Review
The use of restraint 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.
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