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18 Restrictive Physical Intervention
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136 <h1>
136 Restrictive Physical Intervention
136 </h1>
141 <div class="well">
142 <p class="bold">
142 SCOPE OF THIS CHAPTER
142 </p>
143 This chapter refers to the management of the behaviour of every Child in Care. 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.
144 </div>
151 <div class="section">
151 <h2 id="planning">
151 1. Planning for Children
151 </h2>
152 <p>
152 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.
152 </p>
153 <p>
153 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.
153 </p>
154 <p>
154 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.
154 </p>
155 <p>
155 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.
155 </p>
156 <p>
156 Those techniques that are used must comply with the principles and procedures set out in
this chapter - see
156 <a href="#who_may_use">
156 Section 3, Who may use Physical Interventions?
156 </a>
156 </p>
157 <p>
157 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.
157 </p>
158 </div>
159 <div class="section1">
159 </div>
165 <div class="section">
165 <h2 id="definition">
165 2. Definition of Physical Intervention
165 </h2>
166 <p>
166 There are four broad categories of Physical Intervention:
166 </p>
167 <h3>
167 2.1
167 <a id="restraint">
167 </a>
167 Restraint
167 </h3>
168 <p>
168 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:
168 </p>
169 <ul>
170 <li>
170 Any technique which involves a child being held on the floor ('Prone Facedown' techniques
may not be used in any circumstances);
170 </li>
171 <li>
171 Any technique involving the child being held by two or more people;
171 </li>
172 <li>
172 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;
172 </li>
173 <li>
173 The locking or bolting a door in order to contain or prevent a child from leaving.
173 </li>
174 </ul>
175 <p>
175 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.
175 </p>
176 <h3>
176 2.2
176 <a id="holding">
176 </a>
176 Holding
176 </h3>
177 <p>
177 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.
177 </p>
178 <h3>
178 2.3
178 <a id="touching">
178 </a>
178 Positive Touching
178 </h3>
179 <p>
179 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.
179 </p>
180 <h3>
180 2.4
180 <a id="presence">
180 </a>
180 Presence
180 </h3>
181 <p>
181 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.
181 </p>
182 <p>
182 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.
182 </p>
183 <p>
183 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.
183 </p>
184 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.
184 </div>
185 <div class="section1">
185 </div>
191 <div class="section">
191 <h2 id="who_may_use">
191 3. Who may use Physical Interventions?
191 </h2>
192 <p>
192 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.
192 </p>
193 <p>
193 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:
193 </p>
194 <ol>
195 <li style="list-style-type:lower-alpha">
195 Not impede the process of breathing;
195 </li>
196 <li style="list-style-type:lower-alpha">
196 Not be used in a way which may be interpreted as sexual;
196 </li>
197 <li style="list-style-type:lower-alpha">
197 Not intentionally inflict pain or injury or threaten to do so;
197 </li>
198 <li style="list-style-type:lower-alpha">
198 Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas;
198 </li>
199 <li style="list-style-type:lower-alpha">
199 Avoid extending the joints beyond the normal limits or range of motion (hyperextension or
hyperflexion), and pressure on or across the joints;
199 </li>
200 <li style="list-style-type:lower-alpha">
200 Not employ potentially dangerous positions.
200 </li>
201 </ol>
202 </div>
203 <div class="section1">
203 </div>
209 <div class="section">
209 <h2 id="criteria">
209 4. Criteria for Using Physical Interventions
209 </h2>
210 <p>
210 There are different criteria for the use of Restraint and Holding, Touching and Physical
Presence/proximity.
210 </p>
211 <ol>
212 <li>
212 Restraint may only be used where there is likely significant injury or serious damage to
property;
212 </li>
213 <li>
213 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;
213 </li>
214 <li>
214 Before any other form of Physical Intervention is used, all of the following principles
must be applied:
215 <ol>
216 <li style="list-style-type:lower-alpha">
216 For the intervention to be justified there must be a belief that injury or damage is
likely in the predictable future;
216 </li>
217 <li style="list-style-type:lower-alpha">
217 The intervention must be immediately necessary;
217 </li>
218 <li style="list-style-type:lower-alpha">
218 The actions or interventions taken must be a last resort;
218 </li>
219 <li style="list-style-type:lower-alpha">
219 Any force or intervention used must be the minimum necessary to achieve the objective.
219 </li>
220 </ol>
221 </li>
222 </ol>
223 <p>
223 A child/young person can be prevented from leaving the home if it is felt they are at
significant harm in the following circumstances:
223 </p>
224 <ul>
225 <li>
225 Sexual Exploitation;
225 </li>
226 <li>
226 Gang Related Activities;
226 </li>
227 <li>
227 Use of drugs or other illicit substances.
227 </li>
228 </ul>
229 <p>
229 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.
229 </p>
230 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'
230 </div>
231 <div class="section1">
231 </div>
237 <div class="section">
237 <h2 id="locking">
237 5. Locking or Bolting of Doors
237 </h2>
238 <p>
238 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.
238 </p>
239 <p>
239 It is also acceptable to lock office or storage areas to which children are not normally
expected to gain access.
239 </p>
240 <p>
240 If such mechanisms are used they must be outlined as follows:
240 </p>
241 <p>
241 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.
241 </p>
242 <p>
242 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.
242 </p>
243 <p>
243 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.
243 </p>
244 </div>
245 <div class="section1">
245 </div>
251 <div class="section">
251 <h2 id="timeout">
251 6. Timeout and Withdrawal
251 </h2>
252 <p>
252 Where the following measures are used in children's homes or foster homes, they must be
approved and set out in writing.
252 </p>
253 <ul>
254 <li>
254 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;
254 </li>
255 <li>
255 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.
255 </li>
256 </ul>
257 <p>
257 Time out involves restricting the child's access to all reinforcements as part of a
behavioural programme.
257 </p>
258 <p>
258 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.
258 </p>
259 </div>
260 <div class="section1">
260 </div>
266 <div class="section">
266 <h2 id="medical">
266 7. Medical Examination
266 </h2>
267 <p>
267 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.
267 </p>
268 <p>
268 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.
268 </p>
269 <p>
269 The medical practitioner, if seen, must be informed that any injuries may have been caused
from an incident involving physical intervention.
269 </p>
270 <p>
270 Whether or not the child or others decide to see a medical practitioner must be recorded,
together with the outcome.
270 </p>
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