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Contents

1. Planning for Children
2. Definition of Physical Interventions
3. Who may use Physical Interventions
4. Staff Training and Criteria for using Physical Interventions
5. Notifications
6. Medical Assistance and Examination
7. Recording and Management Review

1. Planning for Children

As part of the assessment and planning process for all children, consideration must be given to whether the child is likely to behave in ways which may place him/herself or others at risk of Injury or may cause Damage to Property. The impact of the child’s arrival on the group of children/young people living in the home should be considered.

If such risks exist, consideration must be given to the Strategies that will be adopted to prevent or reduce the risk. These Strategies may include Physical Intervention. Staff in the children’s home should continually review the risk assessments.

Where Physical Intervention may be necessary, for example, if it has been used in the recent past or there is an indication from a Risk Assessment that it 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.

In developing such a plan, consideration must be given to 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, any health care professional currently involved with the child, should approve strategies and this must be drawn to the attention of those working with or looking after the child and it must be stated in the Placement Plan. If in doubt, medical advice must be sought.

NOTE The existence or absence of a Placement Plan or other behaviour management 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 Home Manager and child's social worker as soon as practicable thereafter.

2. Definition of Physical Interventions

Restraint also includes restricting the child’s liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. These should all be recorded as restraint.

There are four broad categories of Physical Intervention.

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 overpowering a child. The intention is to overpower 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. 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;
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;
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

Trained staff may only use techniques that are approved by the home; such techniques should comply with the following principles:

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. Staff Training and Criteria for using Physical Interventions

4.1 Staff Training

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 Criteria for using Physical Intervention

Restraint also includes restricting the child’s liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. These should all be recorded as restraint.

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

1. Restraint, which is the form of Physical Intervention, may only be used where there is likely Significant Harm to themselves or others or Serious Damage to Property;
2. Other forms of Physical Intervention, such as Holding, Touching or Presence, are less forceful and restrictive than Restraint, and may 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 Restraint or any other form of Physical Intervention is used, staff must be satisfied that it is necessary because there is a risk of injury or damage to property and that:
   1. the injury or damage is likely in the Predictable Future;
   2. the intervention is Immediately Necessary;
   3. the actions or interventions taken will be as a Last Resort;
   4. that any force or intervention used is the Minimum Necessary to achieve the objective.

A child/young person can be prevented from the leaving the home if it is felt they are at significant harm in the following circumstances:

• Sexual Exploitation;
• Gang Related Activities;
• Use of drugs.

A children’s home can not routinely deprive a child of their liberty without a court order, such as a section 25 order to place a child in a licensed secure children’s home or in the case of young people aged 16 who lack mental capacity, a deprivation of liberty may be authorised by the court of protection following an application under the Mental Capacity Act 2005.

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.

5. Notifications

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

If a serious incident or the police/emergency services are called, the Designated Manager (Restraint) must be notified and consideration given to whether a Notifiable Event has occurred, if so, see Notification of Serious Events Procedure.

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

6. Medical Assistance and Examination

Where Physical Intervention has been used, the child, staff and others involved must be able to call on medical assistance and children must always be given the opportunity to see a Registered Nurse or Medical Practitioner, even if there are no apparent injuries.

If a Registered Nurse or Medical Practitioner is seen, they 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 it must be recorded, together with the outcome.

7. Recording and Management Review

7.1 Recording

All forms of Physical Interventions should be recorded in the Physical Intervention Log and an Incident Report must be completed. Any injuries should be recorded in the Accident Book.

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

7.2 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.

The Home’s Manager should regularly review incidents 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.

End