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63 <h1 class="h1">
63 Use of Restraint and Physical Intervention
63 </h1>
64 <div class="scope_box" style="padding-bottom: 0px; padding-top: 15px;">
65 <h2 class="h3">
65 REGULATIONS AND STANDARDS
65 </h2>
66 <p>
66 <a
href="http://qualitystandards.proceduresonline.com/homes/p_quality_standards.html#positive
" target="_blank">
66 The Positive Relationships Standard
66 </a>
66 <br />
67 Regulation 11
67 </p>
68 <p>
68 <a
href="http://qualitystandards.proceduresonline.com/homes/p_quality_standards.html#protection_c
h" target="_blank">
68 The Protection of Children Standard
68 </a>
68 </p>
69 <p>
69 <a href="http://www.legislation.gov.uk/uksi/2015/541/regulation/19/made" target="_blank">
69 Regulation 19 – Behaviour Management and Discipline
69 </a>
69 </p>
70 <p>
70 <a href="http://www.legislation.gov.uk/uksi/2015/541/regulation/20/made" target="_blank">
70 Regulation 20 – Restraint and Deprivation of Liberty
70 </a>
70 </p>
71 </div>
72 <h2 class="h2_underlined">
72 <br />
73 Contents
73 </h2>
74 <ol>
75 <li>
75 <a href="#planning">
75 Planning for Children
75 </a>
75 </li>
76 <li>
76 <a href="#definition">
76 Definition of Physical Interventions
76 </a>
76 </li>
77 <li>
77 <a href="#physical">
77 Who May Use Physical Interventions
77 </a>
77 </li>
78 <li>
78 <a href="#criteria">
78 Staff training and Criteria for Using Physical Interventions
78 </a>
78 </li>
79 <li>
79 <a href="#locking">
79 Locking or Bolting of Doors
79 </a>
79 </li>
80 <li>
80 <a href="#notifications">
80 Notifications
80 </a>
80 </li>
81 <li>
81 <a href="#medical">
81 Medical Assistance and Examination
81 </a>
81 </li>
82 <li>
82 <a href="#recording">
82 Recording and Management Review
82 </a>
82 </li>
83 </ol>
84 <h2 class="h2_underlined">
84 <br />
85 1.
85 <a name="planning" id="planning">
85 </a>
85 Planning for Children
85 </h2>
86 <p>
86 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.
86 </p>
87 <p>
87 If any risks exist, strategies should be agreed to prevent or reduce the risk. These Strategies
may include
87 <a href="http://trixresources.proceduresonline.com/nat_key/keywords/phys_intervention.html"
target="_blank">
87 Physical Intervention
87 </a>
87 . Staff in the children's home should continually review any risk assessments.
87 </p>
88 <p>
88 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 Placement Plan.
88 </p>
89 <p>
89 In developing the Placement Plan, 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 Placement Plan. If in doubt, medical
advice must be sought.
89 </p>
90 <table title="Note" width="95%" border="1" cellspacing="0" cellpadding="5">
91 <tr class="table_row_lightblue">
92 <td class="table_row_even">
92 <p class="bold">
92 NOTE
92 </p>
93 <p>
93 The absence of a strategy in the 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 it was not sufficient to prevent injury or damage
to property.
93 </p>
94 <p>
94 Any deviation from an agreed plan or must be reported to the Home Manager and child's
social worker without delay.
94 </p>
94 </td>
95 </tr>
96 </table>
97 <h2 class="h2_underlined">
97 <br />
97 2.
97 <a name="definition" id="definition">
97 </a>
97 Definition of Physical Interventions
97 </h2>
98 <p>
98 There are four broad categories of Physical Intervention:
98 </p>
99 <ol>
100 <li>
100 <span class="bold">
100 Restraint
100 </span>
100 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:
101 <ul>
102 <li>
102 Any technique which involves a child being held on the floor;
102 </li>
103 <li>
103 Any technique involving the child being held by two or more people;
103 </li>
104 <li>
104 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;
104 </li>
105 <li>
105 Restraint also includes restricting the child's liberty of movement. This can include
changes to the physical environment of the home, 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.
105 </li>
106 </ul>
107 </li>
108 </ol>
109 <blockquote>
110 <p>
110 The significant distinction between the first category,
110 <a href="http://trixresources.proceduresonline.com/nat_key/keywords/restraint.html"
target="_blank">
110 Restraint
110 </a>
110 , 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;
110 </p>
111 </blockquote>
112 <ol start="2">
113 <li>
113 <span class="bold">
113 Holding
113 </span>
113 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;
113 </li>
114 <li>
114 <span class="bold">
114 Touching
114 </span>
114 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;
114 </li>
115 <li>
115 <span class="bold">
115 Presence
115 </span>
115 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.
115 </li>
116 </ol>
117 <h2 class="h2_underlined">
117 <br />
118 3.
118 <a name="physical" id="physical">
118 </a>
118 Who May Use Physical Interventions
118 </h2>
119 <p>
119 Trained staff should only use techniques that are approved by the home. Approved techniques
should comply with the following principles:
119 </p>
120 <ol type="a">
121 <li>
121 Not impede the process of breathing - the use of 'prone face down' techniques must never be
used;
121 </li>
122 <li>
122 Not be used in a way which may be interpreted as sexual;
122 </li>
123 <li>
123 Not intentionally inflict pain or injury or threaten to do so;
123 </li>
124 <li>
124 Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas;
124 </li>
125 <li>
125 Avoid hyperextension, hyper flexion and pressure on or across the joints;
125 </li>
126 <li>
126 Not employ potentially dangerous positions.
126 </li>
127 </ol>
128 <h2 class="h2_underlined">
128 <br />
129 4.
129 <a name="criteria" id="criteria">
129 </a>
129 Staff Training and Criteria for Using Physical Interventions
129 </h2>
130 <h3 class="h3">
130 4.1 Staff Training
130 </h3>
131 <p>
131 All staff must be trained in methods of behaviour management, including the use of physical
intervention and restraint that are agreed by the Home.
131 </p>
132 <p>
132 This training must ensure that staff are able to:
132 </p>
133 <ul>
134 <li>
134 Manage their own feelings and responses to the emotions and behaviours presented by children;
134 </li>
135 <li>
135 Manage their responses and feelings arising from working with children, particularly where
children display challenging behaviour or have difficult emotional issues;
135 </li>
136 <li>
136 Understand how children's previous experiences can manifest in challenging behaviour;
136 </li>
137 <li>
137 Use methods to de-escalate confrontations or potentially violent behaviour to avoid the use of
physical intervention and restraint.
137 </li>
138 </ul>
139 <h3 class="h3">
139 4.2 Criteria for using Physical Intervention
139 </h3>
140 <p>
140 There are different criteria for the use of Restraint and other forms of Physical Intervention,
such as Holding, Touching and Physical Presence:
140 </p>
141 <ol>
142 <li>
142 Restraint - Regulation 20 sets out the only purposes for which restraint can be used:
143 <ul>
144 <li>
144 Preventing injury to any person (including the child who is being restrained);
144 </li>
145 <li>
145 Preventing serious damage to the property of any person (including the child who is being
restrained); or
145 </li>
146 <li>
146 Preventing a child who is accommodated in a secure children's home from absconding from
the home.
146 </li>
147 </ul>
148 </li>
149 <li>
149 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 less serious
injury or damage to property;
149 </li>
150 <li>
150 Restraint may not be used to force compliance or as a punishment where Significant Harm or
serious damage to property are not otherwise likely;
150 </li>
151 <li>
151 <a name="para_4_2_4" id="para_4_2_4">
151 </a>
151 A child/young person can be prevented from the leaving the home if it is felt they are at risk
of Significant Harm due to:
152 <ul>
153 <li>
153 Child Sexual Exploitation;
153 </li>
154 <li>
154 Gang Related Activities;
154 </li>
155 <li>
155 Misuse of drugs.
155 </li>
156 </ul>
157 </li>
158 </ol>
159 <p>
159 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 any
incident they clearly outline all the steps taken to prevent the need to restrict the child's
liberty using physical means.
159 </p>
160 <p>
160 If a young person continually requires this level of intervention to help them to remain safe, a
planning meeting should held with the placing authority to consider the appropriateness of the
placement.
160 </p>
161 <p>
161 When strategies to manage behaviour are agreed in placement plans, they will be subject to a may
be recognised that this is a process of 'testing', and as such the effectiveness of any
strategies will need to be reviewed in conjunction with the local authority. The review should
be clearly documented and any agreement must not conflict with regulations regarding
'Deprivation of Liberty'.
161 </p>
162 <h2 class="h2_underlined">
162 <br />
163 5.
163 <a name="locking" id="locking">
163 </a>
163 Locking or Bolting of Doors
163 </h2>
164 <p>
164 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.
164 </p>
165 <p>
165 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.
165 </p>
166 <p>
166 It is also acceptable to lock doors to physically restrict the normal movement within or from
the home to reduce the risk of Significant Injury or Serious Damage to Property and so long as
the criteria set out above (
166 <a href="#para_4_2_4">
166 Section 4.2 (4): Criteria for Using Physical Intervention
166 </a>
166 ) are met i.e. where the injury or damage to property is likely in the predictable future, that
the locking of the door is immediately necessary, used as a last resort and for the minimum
amount of time necessary to de escalate the situation*. If such methods are used in the home,
the following must apply:
166 </p>
167 <ol type="a">
168 <li>
168 The home's Statement of Purpose must clearly state the policy and strategies for using such
methods;
168 </li>
169 <li>
169 Placing Authorities must have their attention drawn to the use of such methods and the
individual Placement Plans for Children should refer to them and describe the circumstances
where such strategies may be used;
169 </li>
170 <li>
170 Such restrictions for one child do not impose similar restrictions on other children.
170 </li>
171 </ol>
172 <p>
172 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.
172 </p>
173 <p>
173 There are some limited circumstances however, where doors may be and possibly should be locked:
173 </p>
174 <ol>
175 <li>
175 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;
175 </li>
176 <li>
176 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;
176 </li>
177 <li>
177 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.
177 </li>
178 </ol>
179 <p>
179 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.
179 </p>
180 <p>
180 *If such strategies are used upon a child on a frequent or extended basis, it may be a form of
restriction of liberty, which is not acceptable; therefore, the social worker must be notified
give consideration to an application being made for a Secure Accommodation Order.
180 </p>
181 <h2 class="h2_underlined">
181 <br />
182 6.
182 <a name="notifications" id="notifications">
182 </a>
182 Notifications
182 </h2>
183 <p>
183 If Physical Intervention is used upon a child, the Home Manager and child's social worker must
be notified within one working day.
183 </p>
184 <p>
184 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
184 <a href="p_notif_events.html">
184 Notification of Serious Events Procedure
184 </a>
184 .
184 </p>
185 <p>
185 The social worker should make a decision about whether to inform the child's parent(s) and, if
so, who should do so.
185 </p>
186 <p>
186 A children's home cannot 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.
186 </p>
187 <h2 class="h2_underlined">
187 <br />
188 7.
188 <a name="medical" id="medical">
188 </a>
188 Medical Assistance and Examination
188 </h2>
189 <p>
189 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.
189 </p>
190 <p>
190 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.
190 </p>
191 <p>
191 Whether or not the child or others decide to see a Registered Nurse or Medical Practitioner it
must be recorded, together with the outcome.
191 </p>
192 <p>
192 The Registered person should regularly review the effectiveness and check the medical assessment
of the system remains up to date.
192 </p>
193 <h2 class="h2_underlined">
193 <br />
194 8.
194 <a name="recording" id="recording">
194 </a>
194 Recording and Management Review
194 </h2>
195 <p>
195 If a child has an Education Health and Care plan in which a specific type of restraint 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 us, the
restraint used must be recorded. Any other restraint used must always be recorded.
195 </p>
196 <h3 class="h3">
196 8.1 Recording
196 </h3>
197 <p>
197 All forms of Physical Interventions should be recorded in the Restraint Log and an Incident
Report must be completed.
197 </p>
198 <p>
198 The incident should be recorded in the Home's Daily Log and on the Daily Record for the
individual Child(ren).
198 </p>
199 <h3 class="h3">
199 8.2 Management Review
199 </h3>
200 <p>
200 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.
200 </p>
201 <p>
201 The Manager of the Home 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.
201 </p>
202 <p>
202 Ideally within 24 hours (and no more than 5 days) the child involved in the restraint should be
able to express their feelings about this experience and should be encouraged to record their
views to the record of restraint.
202 </p>
203 Within 48 Hours the use of intervention, staff should have discussed the incident with a senior
member of the team. This is to ensure that any issues can be identified and any learning be acted
upon to prevent, where possible, the need for further instances.
205 <p>
205 <br />
206 <br />
207 </p>
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219 <div class="footer_box">
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