Use of Restraint and Physical Intervention

The assessment and planning process for all children in residential care must consider 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 also be considered.

If any risks exist, strategies should be agreed to prevent or reduce the risk. These Strategies may include Physical Intervention. Staff in the children's home should continually review any risk assessments.

Where Physical Intervention is likely to 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 such risks and the strategies for managing it should be outlined in the child's Positive Behaviour and Support Plan (PBSP). This plan should be made available to the child in a format they can understand.

In developing the PBSP consideration must be given to whether there are any medical conditions, disabilities, or ACES which mean particular techniques or methods of physical intervention should be avoided. In the first instance the Home Manager should share the PBSP with a Principle Safe and Sound Instructor for approval. It is then the responsibility of the Home Manager to ensure that the PBSP is kept under review (see Positive Relationships and Behaviour Management Policy). This includes the section in relation to physical intervention; where necessary they should consult with a Principle Safe and Sound Instructor who can seek professional medical advice if required.

The application of physical techniques can only be used when other methods of incident management not involving force have been tried and failed; or judged unlikely to succeed.

Physical Intervention may only be used when a young person’s behaviour poses a threat of imminent, serious physical injury to self-and/or others, or serious damage to property of any person (including the young person involved).

Staff working within residential children’s homes are governed by law to apply techniques taught these laws are:

Common Law

A person may use such force as is reasonable in the circumstances for the purposes of: self-defence; or defence of another; or defence of property; or prevention of crime; or lawful arrest.

In relation to the Use of Force, there is an established common law.

A person has the right to act in defence of themselves or others. The Use of Force in such circumstances will be justified provided that the individual considered the use of force to be reasonable in the circumstances at the time.

Criminal law

Any person may use such force as is reasonable in the circumstances in the prevention of crime, or in the effecting or assisting in the lawful arrest of offenders or suspected offenders unlawfully at large.

Physical intervention is limited to the use of such reasonable force as may be necessary to protect a young person or other person(s) from assault or imminent serious physical injury.

Physical intervention may not be used as a response to disruptive behaviour or verbal threats, which do not constitute a threat of imminent serious injury.

Physical intervention may never be used as a means of punishment. All staff are taught to understand what is meant by the term Coercion and that Physical Intervention will never be used to gain compliance.

Trained staff should only use techniques that are certified within the Safe and Sound package. Approved techniques comply with the following principles:

1. Not impede the process of breathing - the use of 'prone face down' 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.

This includes actions to restrict a child’s liberty or freedom of movement, whether or not that child resists. Indeed, some children will not offer any objection and may even agree to their movement being restricted in this way.

A deprivation of liberty may occur where a child is both under continual supervision and is not free to leave the home. Modifications to the home’s environment could also mean that residents are deprived of their liberty.

In the case of young people aged 16+ who lack capacity, a deprivation of liberty may be authorised by the Court of Protection following an application under the Mental Capacity Act 2005.

There may be circumstances where the plan for a child under the age of 16 involves their having to be cared for under circumstances in which a court order would also need to be obtained to authorise a deprivation of liberty. The court order sets out the conditions and requirements placed on staff, these conditions and requirements will be added to the PBSP so that all staff are clear on what they are expected to do.

It is acceptable to use electronic mechanisms or other modifications 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.

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.

There are some limited circumstances however, where doors may be and possibly should be locked:

1. Where it is immediately necessary to prevent harm to any person or serious criminal damage. This action must be only for a reasonable and limited period of time e.g. until the risk has passed or alternate and more appropriate control measures have been organised. In such circumstances there must be a clear record of action taken and justification for those actions;
2. To prevent access of any unauthorised persons wishing to gain access to young people or the premises for illicit or illegal purposes, for instance issues relating to child sexual exploitation or abuse, bullying, threatening behaviour etc. This action must be only for a reasonable and limited period of time e.g. until the risk has passed or alternate and more appropriate control measures have been organised, such as calling the police for assistance. In such circumstances there must be a clear record of action taken and justification for those actions;
3. During the hours of dusk to dawn, as a reasonable security/safety measure. NOT in order to restrict the free movement of resident young people in or out of their unit/home, nor as a method of control. There may however, be significant risks in allowing young people to leave the unit/home at night without staff knowledge and therefore supervision. As such, young people wanting to leave at night will need to ask a member of the residential staff team or waking night care assistants to open the external door. These staff, having where necessary consulted the senior on duty, will then decide whether to let the young person leave or not based on the risk assessments on file or an impromptu additional risk assessment made owing to any presenting unforeseen circumstances. In such circumstances there must be a clear record of action taken and justification for those actions.

It is important that staff decisions to lock doors are in keeping with and guided by each young person’s placement and behaviour management plans, risk assessments and have line management approval. Prior approval should be sought where possible and where this is not possible, immediate retrospective approval for them to remain locked or a decision made to unlock them.

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

If a serious incident or the police/emergency services are called, the relevant senior manager 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.

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.

If at any stage during intervention a young person displays symptoms or signs of any medical difficulties distress staff must immediately release or modify their holds as far as practicable to achieve an immediate reduction in any restriction of the young person’s ABCs (airways, breathing and circulation) or to deal appropriately with a medical emergency.

A Safer Health Report will be completed following any intervention where a young person has displayed signs and symptoms of medical distress and can only be completed by the Home/Deputy Manager or Principle Safe and Sound Instructor. Any outcomes from this report must be reflected within the PBSP.

A staff member who administers an intervention shall verbally inform the Home/Deputy Manager/On-call Duty Manager as soon as practical that day and by written report no later than within 24 hours (reports completed on Charms).

The Home/Deputy Manager/On-call Duty Manager will direct homes staff if not themselves to verbally inform the young person’s representatives of the use of physical intervention as soon as practical within 24 hours.

The home will maintain records of all uses of physical intervention that meet requirements under Regulation 35 (Section 3) – Policies and Records. After any physical intervention or restraint, staff will complete a Restorative Conversation with the child or young person, (recorded as De-Brief - Child on Charms). This conversation will feed back into the child or young person's safe care plans. Particular attention will be given to feedback from the child or young person regarding whether an alternative form of de-escalation would have been helpful or more effective.

(3) The registered person must ensure that:

1. Within 24 hours of the use of a measure of control, discipline or intervention in relation to a child in the home, a record is made which includes:
   1. The name of the child;
   2. Details of the child's behaviour leading to the use of the measure;
   3. The date, time and location of the use of the measure;
   4. A description of the measure used;
   5. Details of any methods used or steps taken to void the need to use the measure;
   6. The name of the person using the measure (“the user”), and of any other person present when the measure was used;
   7. The effectiveness and any consequences of the use of the measure; and
   8. A description of any injury to the child concerned or any other person and any medical treatment administered, as a result of the measure.
2. Within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (“the authorised person”):
   1. Has spoken to the user about the measure; and
   2. Has signed the record to confirm it is accurate; and
3. Within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure.

Following the use of a physical intervention, a young person’s debrief is completed by a staff member who was not directly involved in the incident.

The Home Manager/Deputy Manager or authorised person will meet with the young person to address the behaviour which prompted the intervention, and will also review the incident with the staff members who were involved and determine whether follow-up is needed for the young people who may have witnessed the incident.

Alongside the Independent Person during monthly Independent Visits (Reg 44); these reports are submitted to Ofsted and made available to external agencies.

The Home / Deputy Manager will analyse patterns of physical intervention involving any individual staff, particular young people thematically against all methods of behaviour management during the completion of Quality of Care (Reg 45) evaluation report. This report is submitted to Ofsted and used to develop the homes internal strategies.

The Safe and Sound Lead will collate incidents of physical intervention taking place in all homes by means of a monthly report run from CHARMS. This information then formulates the statistical review for the Operational Governance meeting.

The Safe and Sound Governance Meeting now forms part of a Monthly Operational meeting and this is to review the use of physical intervention across all Homes2inspire Homes. Recommendations stemming from the meeting will be shared with all Home Managers and cascaded throughout the organisation. A bi-annual meeting will be held with all trained physical intervention instructors to review training programme; learning outcome and any specific practice issues raised to instructors at their homes.