4.4.3 Physical Intervention |
AMENDMENTS
This chapter was slightly amended in September 2011, See Section 3, Who may use Physical Interventions? and Section 4, Criteria for Using Physical Interventions.SCOPE OF THIS CHAPTER
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.
This chapter should be read in conjunction with Behaviour Management - Use of Restrictive Physical Intervention Guidance.
Contents
1. Planning for Children
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.
If Physical Intervention may be necessary, the circumstances that give rise to it and the Strategies for managing it should be outlined in a Behaviour Management Plan which is part of the child’s Placement Plan/Placement Information Record.
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.
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 plan. If in doubt, medical advice must be sought.
Those techniques that are used must comply with the principles and procedures set out in this Chapter and the associated Guidance. See Section 3, Who may use Physical Interventions?
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.
2. Definition of Physical Intervention
There are four broad categories of Physical Intervention.
2.1 Restrictive Physical Intervention
Physical Interventions are defined as ‘the use of force to restrict movement or mobility or the use of force to disengage from dangerous or harmful physical contact initiated by a service user’ (DoH and DfES, 2002).
- 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
The significant distinction between the first category, and the others (Holding, Positive Touch and Presence), is that Restrictive is defined as the positive application of force with the intention of restricting a persons movement, which is maintained against resistance. It is, therefore qualitatively different from other forms of physical contact such as manual prompting, physical guidance or simply support, which might be used in teaching or therapy.
The other categories of Physical Intervention provide the child with varying degrees of freedom and mobility.
2.2 Holding
This includes any measure or technique that involves the child being held firmly by one person, so long as the child retains a degree of mobility and can disengage if determined enough.
2.3 Positive Touching
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. It is intended to reassure, redirect and support the child.
2.4 Presence
Is a form of control using no contact, but rather, the day to day ‘supervisory’ role of a staff member. The presence of a staff member may be used as a deterrent to misbehaviour. Control by physical presence involves emphasizing verbal instructions/directions gesturing or using visual aids such as pictorial cards. It may also include standing in the way of a child who is not responding to verbal instruction or is losing control, and is likely to cause injury without this intervention.
3. Who may use Physical Interventions?
Staff may only use Physical Intervention if they have undertaken approved training. In children’s homes, staff may only use restraint techniques that have been approved by the home.
Where staff/carers have not undertaken such training, the use of minimum force may be justified if it is the only way to prevent Significant Harm or serious damage to property.
In any case, the use of force must reflect the values and principles set out in this Chapter and the associated guidance (see Behaviour Management - Use of Restrictive Physical Intervention Guidance).
4. Criteria for Using Physical Interventions
Restraint may not be used to force compliance or as a punishment where Significant Harm or serious damage to property are not otherwise likely.
There are different criteria for the use of Restrictive and other forms of Physical Intervention, such as Holding, Touching and Physical Presence/proximity.
- Physical Intervention used with the intention of restricting a child’s mobility, may only be used where there is likely Significant injury or Serious damage to property. For guidance and examples of what may constitute Significant Injury or Serious Damage to Property, see Behaviour Management - Use of Restrictive Physical Intervention Guidance
- Other forms of Physical contact, such as Holding, Positive Touching or Presence, are less forceful and restrictive than Physical Intervention 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
- Before any other form of Physical Intervention is used, all of the following principles must be applied:
- For the intervention to be justified there must be a belief that Injury or Damage is likely in the Predictable Future
- The intervention must be Immediately Necessary
- The actions or interventions taken must be a Last Resort
- Any force or intervention used must be the Minimum Necessary to achieve the objective
Any techniques that may interfere with breathing are likely to present an unacceptable risk and should never be used. Holding a child by the neck carries a risk of suffocation or restricting blood flow to the brain, as well as a risk of spinal injury and on no account should neck holds be used as a way of restraining children or young people. So called “nose distraction” technique will inflict pain and is not proportionate, as it will involve unnecessary force. These techniques, therefore, are unacceptable and should never be used on children in any children’s homes, including in secure children’s homes.
Any technique which involves the child being held on the floor may not be used in any circumstances. This includes prone and face down positions
5. Locking or Bolting of Doors
It is acceptable to use mechanisms or modifications to a children’s unit 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.
It is also acceptable to lock office or storage areas to which children are not normally expected to gain access.
If such mechanisms are used they must be outlined as follows:
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.
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.
6. Timeout and Withdrawal
Where the following measures are used in children’s units or foster homes, they must be approved and set out in writing.
- In children’s units, they must be set out in the home’s Statement of Purpose or in Behaviour Management Plans for individual children
- In foster homes, they must be set out in the Foster Care Agreement or in the Behaviour Management Plans for an individual child.
Time out involves restricting the child’s access to all reinforcements as part of a behavioural programme.
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.
7. Medical Examination
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 Registered Nurse or Medical Practitioner, even if there are no apparent injuries.
In other settings, where physical intervention is used, the child, staff/carers and others involved should be given the opportunity to see a Registered Nurse or Medical Practitioner if there are any apparent or reported injuries.
The Registered Nurse or Medical Practitioner, if seen, 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 must be recorded, together with the outcome.
8. Notifications
If the child is placed in residential/respite care or foster care, the home’s manager (Foster Care: Supervising Social Worker) must be notified. In all circumstances, the child’s social worker must be notified. Notifications should be made as soon as practicable but within 1 working day.
The social worker should make a decision about whether to inform the child’s parent(s) and, if so, who should do so.
Depending on the seriousness of the Incident, other people/agencies may have to be notified, Designated Managers Appendix describes who should be notified.
9. Recording and Management Review
The use of Physical Intervention is deemed to be an Incident, and must be recorded as such. Please see Incidents Guidance, which contains details of the records that must be completed.
All Incidents involving restraint must be subject to a Management Review. See Incidents Guidance, for guidance on conducting Management Reviews.
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