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282 <h2>
282 Restrictive Physical Intervention
282 </h2>
284 </div>
287 <div id="scope_box">
288 <h3>
288 SCOPE OF THIS CHAPTER
288 </h3>
289 <p>
289 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.
289 </p>
290 </div>
291 <div id="sections">
293 <h3 id="sections_list">
293 Contents
293 </h3>
294 <ol>
295 <li class="sub_list">
295 <a href="#planning">
295 Planning for Children
295 </a>
295 </li>
296 <li class="sub_list">
296 <a href="#definition">
296 Definition of Physical Intervention
296 </a>
296
297 <ol>
298 <li class="sub_list">
298 <a href="#restraint">
298 Restraint
298 </a>
298 </li>
299 <li class="sub_list">
299 <a href="#holding">
299 Holding
299 </a>
299 </li>
300 <li class="sub_list">
300 <a href="#touching">
300 Positive Touching
300 </a>
300 </li>
301 <li class="sub_list">
301 <a href="#presence">
301 Presence
301 </a>
301
301 </li>
302 </ol>
303 </li>
304 <li class="sub_list">
304 <a href="#who_may_use">
304 Who may use Physical Interventions?
304 </a>
304 </li>
305 <li class="sub_list">
305 <a href="#criteria">
305 Criteria for Using Physical Interventions
305 </a>
305 </li>
306 <li class="sub_list">
306 <a href="#locking">
306 Locking or Bolting of Doors
306 </a>
306 </li>
307 <li class="sub_list">
307 <a href="#timeout">
307 Timeout and Withdrawal
307 </a>
307 </li>
308 <li class="sub_list">
308 <a href="#medical">
308 Medical Examination
308 </a>
308 </li>
309 </ol>
310 <h3 id="planning">
310 1. Planning for Children
310 </h3>
311 <p>
311 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.
311 </p>
312 <p>
312 If Physical Intervention may be necessary, the circumstances that give rise to it and the
strategies for managing it should be outlined in the child's Placement Information Record.
312 </p>
313 <p>
313 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.
313 </p>
314 <p>
314 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 Placement Information Record. If in doubt, medical advice must be sought.
314 </p>
315 <p>
315 Those techniques that are used must comply with the principles and procedures set out in this
chapter - see
315 <a href="#who_may_use">
315 Section 3, Who may use Physical Interventions?
315 </a>
315 </p>
316 <p>
316 The absence or existence of such a plan does not prevent staff/carers from acting as they see fit
when confronted with unforeseen likely injury or damage to property, so long as the actions taken
are consistent with the principles and procedures contained in this chapter.
316 </p>
317 <h3 id="definition">
317 2. Definition of Physical Intervention
317 </h3>
318 <p>
318 There are four broad categories of Physical Intervention:
318 </p>
319 <h4 id="restraint">
319 2.1 Restraint
320 </h4>
321 <p>
321 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:
321 </p>
322 <ul>
323 <li>
323 Any technique which involves a child being held on the floor ('Prone Facedown' techniques may
not be used in any circumstances);
323 </li>
324 <li>
324 Any technique involving the child being held by two or more people;
324 </li>
325 <li>
325 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;
325 </li>
326 <li>
326 The locking or bolting a door in order to contain or prevent a child from leaving.
326 </li>
327 </ul>
328 <p>
328 The significant distinction between this first category 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 provide the child with varying degrees of freedom and
mobility.
328 </p>
329 <h4 id="holding">
329 2.2 Holding
330 </h4>
331 <p>
331 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.
331 </p>
332 <h4 id="touching">
332 2.3 Positive Touching
333 </h4>
334 <p>
334 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.
334 </p>
335 <h4 id="presence">
335 2.4 Presence
336 </h4>
337 <p>
337 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.
337 </p>
338 <p>
338 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.
338 </p>
339 <p>
339 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.
339 </p>
340 <p>
340 If a child has an 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.
340 </p>
341 <h3 id="who_may_use">
341 3. Who may use Physical Interventions?
341 </h3>
342 <p>
342 Trained staff should only use Physical Intervention if they have undertaken approved training.
However, 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 damage to property.
342 </p>
343 <p>
343 Where staff have not undertaken such training, the use of force may still be justified if it is
the only way to prevent injury or 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:
343 </p>
344 <ol style="list-style-type:lower-alpha">
345 <li>
345 Not impede the process of breathing;
345 </li>
346 <li>
346 Not be used in a way which may be interpreted as sexual;
346 </li>
347 <li>
347 Not intentionally inflict pain or injury or threaten to do so;
347 </li>
348 <li>
348 Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas;
348 </li>
349 <li>
349 Avoid extending the joints beyond the normal limits or range of motion (hyperextension or
hyperflexion), and pressure on or across the joints;
349 </li>
350 <li>
350 Not employ potentially dangerous positions.
350 </li>
351 </ol>
352 <h3 id="criteria">
352 4. Criteria for Using Physical Interventions
352 </h3>
353 <p>
353 There are different criteria for the use of Restraint and Holding, Touching and Physical
Presence/proximity.
353 </p>
354 <ol>
355 <li>
355 Restraint may only be used where there is likely significant injury or serious damage to
property;
355 </li>
356 <li>
356 Holding, Positive Touching or Presence are less forceful and less restrictive 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;
356 </li>
357 <li>
357 Before any other form of Physical Intervention is used, all of the following principles must be
applied:
358 <ol style="list-style-type:lower-alpha">
359 <li>
359 For the intervention to be justified there must be a belief that injury or damage is likely
in the predictable future;
359 </li>
360 <li>
360 The intervention must be immediately necessary;
360 </li>
361 <li>
361 The actions or interventions taken must be a last resort;
361 </li>
362 <li>
362 Any force or intervention used must be the minimum necessary to achieve the objective.
362 </li>
363 </ol>
364 </li>
365 </ol>
366 <p>
366 A child/young person can be prevented from leaving the home if it is felt they are at significant
harm in the following circumstances:
366 </p>
367 <ul>
368 <li>
368 Sexual Exploitation;
368 </li>
369 <li>
369 Gang Related Activities;
369 </li>
370 <li>
370 Use of drugs or other illicit substances.
370 </li>
371 </ul>
372 <p>
372 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.
372 </p>
373 <p>
373 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'
373 </p>
374 <h3 id="locking">
374 5. Locking or Bolting of Doors
374 </h3>
375 <p>
375 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 it is safe for them to do so.
375 </p>
376 <p>
376 It is also acceptable to lock office or storage areas to which children are not normally expected
to gain access.
376 </p>
377 <p>
377 If such mechanisms are used they must be outlined as follows:
377 </p>
378 <p>
378 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
Handbook.
378 </p>
379 <p>
379 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.
379 </p>
380 <p>
380 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.
380 </p>
381 <h3 id="timeout">
381 6. Timeout and Withdrawal
381 </h3>
382 <p>
382 Where the following measures are used in children's homes or foster homes, they must be approved
and set out in writing.
382 </p>
383 <ul>
384 <li>
384 In children's homes, they must be set out in the home's Statement of Purpose or in Behaviour
Management Plans (as part of the Placement Information Record) for individual children;
384 </li>
385 <li>
385 In foster homes, they must be set out in the Foster Care Agreement or in the Behaviour
Management Plans (as part of the Placement Information Record) for an individual child.
385 </li>
386 </ul>
387 <p>
387 Time out involves restricting the child's access to all reinforcements as part of a behavioural
programme.
387 </p>
388 <p>
388 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.
388 </p>
389 <h3 id="medical">
389 7. Medical Examination
389 </h3>
390 <p>
390 In children's homes where Physical Intervention has been used, the child, staff/carers and others
involved must be given the opportunity to see a medical practitioner, even if there are no
apparent injuries.
390 </p>
391 <p>
391 In other settings, where physical intervention is used, the child, staff/carers and others
involved should be given the opportunity to see a medical practitioner if there are any apparent
or reported injuries.
391 </p>
392 <p>
392 The medical practitioner, if seen, must be informed that any injuries may have been caused from an
incident involving physical intervention.
392 </p>
393 <p>
393 Whether or not the child or others decide to see a medical practitioner must be recorded, together
with the outcome.
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