SCOPE OF THIS CHAPTER
This guidance describes what is meant by restraint and physical intervention and gives examples of the methods which trained staff may need to use on occasion to protect children and others from possible harm. It also covers the recording, review and notification processes which must be followed when restraint or another physical intervention has been used.
The Light House Community Support Team provides activity support to Children and Young People with a moderate to severe learning disability. All children and young people require a minimum of 1:1 staff ratio to ensure they; staff and members of the public are safe when accessing activities. All young people have a care plan and a how to work with me guide. There may be other relevant documentation including risk assessments. Using a restraint or physical intervention would always be the last resort and would only be used when other methods have been exhausted.
This chapter was added to the procedures in September 2018.
- Planning for Children
- Definition of Physical Interventions
- Who may use Physical Interventions
- Staff Training and Criteria for using Physical Interventions
- Medical Assistance and Examination
- Recording and Management Review
1. Planning for Children
The assessment and planning process for all children who receive community and home support must consider whether the child is likely to behave in ways which may place themselves or others at risk of injury or may cause damage to property. If any risks exist, strategies should be agreed to prevent or reduce the risk. These strategies may include Physical Interventions. Staff should continually review any risk assessments. It is good practice to explain physical interventions to parents/carer’s gain their consent and ensure that this is written into the plan for the young person.
The manager should continually ensure that the risk assessments are reviewed.
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 risk assessment, Care Plan and 'How to Work with Me' Guide.
Consideration must be given to whether there are any medical conditions which mean particular techniques or methods of physical intervention should be avoided. If so, any health care professional currently involved with the child be consulted regarding appropriate 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 Care Plan. If in doubt, medical advice must be sought.
The absence of a strategy in either the Care Plan or 'How to Work with Me' Guide 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 it was not sufficient to prevent injury or damage to property.Any deviation from an agreed plan must be reported to the manager, parent and /or child's social worker without delay.
2. Definition of Physical Interventions
There are four broad categories of physical intervention.
- Restraint: is 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;
- 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;
- Restraint also includes restricting the child's liberty of movement. This can include changes to the physical environment, the removal of physical aides or the locking or bolting of a door in order to contain or prevent a child from leaving. These should all be recorded as restraint.
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;
- Holding: 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;
- Touching: 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;
- Presence: is 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 should only use techniques that are approved by the service. Approved techniques should comply with the following principles:
- Not impede the process of breathing - the use of 'prone face down' techniques must never be used;
- Not be used in a way which may be interpreted as sexual;
- Not intentionally inflict pain or injury or threaten to do so;
- Avoid vulnerable parts of the body, e.g. the neck, chest and genital areas;
- Avoid hyperextension, hyperflexion and pressure on or across the joints;
- 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 support, including the use of physical intervention and restraint that are agreed by the service.
This training must ensure that staff are able to:
- Manage their own feelings and responses to the emotions and behaviours presented by children;
- 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 Interventions
There are different criteria for the use of restraint and other forms of physical intervention, such as holding, touching and physical presence:
- Preventing injury to any person (including the child who is being restrained);
- Preventing serious damage to the property of any person (including the child who is being restrained); or
- Preventing a child from absconding from the service. Children accessing the service are vulnerable due to the level of learning disability.
When restraint involves the use of force, the force used must not be more than is necessary and should be applied in a way that is proportionate i.e. the minimum amount of force necessary to avert injury or serious damage to property for the shortest possible time.
- Other forms of physical intervention, such as holding, touching or physical presence, are less forceful and restrictive than restraint, and may be used to protect children or others from less serious injury or damage to property;
- Restraint may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely.
The 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 any 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, a planning meeting should held with parents to discuss the appropriateness of the service.
If a physical intervention is used upon a child, the manager and the child's social worker must be notified within 1 working day. The parent would be notified immediately.
If a serious incident or the Police/emergency services are called, the relevant senior manager must also be notified.
6. Medical Assistance and Examination
Where Physical Intervention has been used, the child, staff and others involved must be able to call for medical assistance. Parents need to be advised that their child has been involved in a restraint and recommend they see a Medical Practitioner, even if there are no apparent injuries.
If a 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 visits a Medical Practitioner it must be recorded, together with the outcome.
7. Recording and Management Review
All forms of physical interventions should be recorded in the Restraint Log and an incident report must be completed. The incident report is to be sent to Derby City Council Health and Safety Team for review.
The incident should be recorded in the child's file.Within 24 hours the child involved in the restraint should, if appropriate, be able to express their feelings about this experience and should be encouraged to record their views to the record of restraint.
7.2 Management Review
The child's Care Plan and 'How to Work with Me' Guide should be reviewed to incorporate strategies for reducing or preventing future incidents. Parents and any other professional involved should contribute to this review, if appropriate the child should also attend.
The manager of the service should review all incidents, debrief staff and young people 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.