Physical Intervention

For a small minority of children/young people or at certain times in a child or young person's life, physical intervention or restraint may be needed. However, physical restraint should be avoided as far as possible and should only be used if there are good reasons for believing that immediate action is necessary to prevent a child or young person causing significant injury to themselves or to others, or causing serious damage to property. Other techniques should be used before physical constraint is considered.

The need for physical restraint may arise when a child is engaged in violence towards themselves and/or others, damage to property and if the child's behaviour is out of control and none of the other strategies are working.

It is important to be aware that use of restraint can pose risks to the safety of the child, to the safety of the carer applying it, and potentially to others who are present.

See also: Positive Relationships and Behaviour Management Procedure.

As part of the assessment and planning process for all children, consideration must be given to 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 be considered.

If such risks exist, consideration must be given to the Strategies that will be adopted to prevent or reduce the risk. These Strategies may include Physical Intervention. All Residential Staff are trained in Team Teach Techniques. Staff in the children's home should continually review the risk assessments.

If Physical Intervention may be necessary, the circumstances that give rise to it and the Strategies for managing it should be outlined in a relevant plan, such as a Short Break Plan, Positive Handling Plan, Care Plan or Placement Plan (*see note at end of this section).

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.

The techniques that are used must comply with the principles and procedures set out in this Chapter and the associated Guidance. See Section 4, Who may use Physical Interventions?

There are four broad categories of Physical Intervention:

1. Restraint: 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;
   • The locking or bolting a door in order to contain or prevent a child from leaving.
2. 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;
2. Holding: This includes any measure or technique involving the child being held firmly by one person, so long as the child retains a degree of mobility and can leave if determined enough;
3. 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;
4. Presence: 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.

Minimum force should be used and it should only be used for a short time period. It should be proportionate and the least restrictive to the child.

Foster carers and residential staff will receive appropriate training in safe use of restraint, including training on the applicable legislative framework. Any use of restraint must be consistent with this training, these procedures and must at all times be focussed on the need to protect the child and those around them.

Staff/carers may only use Physical Intervention if they have undertaken approved training. Staff in children's homes may only use restraint techniques that are approved by the home. Managers should ensure that new staff are trained in the home's approved techniques before they start working with children.

However, where staff/carers 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/carers should act in a manner consistent with other training or as they see fit.

In these circumstances, staff must always act in a manner consistent with the values and principles set out in the Behaviour Management Plans Guidance.

Any intervention used must:

1. Not impede the process of breathing;
2. Not be used in a way which may be interpreted as sexual;
3. Not intentionally inflict pain or injury;
4. Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas;
5. Avoid hyperextension, hyper flexion and pressure on a cross the joints;
6. Not employ potentially dangerous positions.

Restraint also includes restricting the child's liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. These should all be recorded as restraint.

There are different criteria for the use of Restraint and other forms of Physical Intervention, such as Holding, Touching and Physical Presence/proximity.

1. Restraint, which is the form of Physical Intervention used with the intention of overpowering a child, may only be used where there is likely SIGNIFICANT Injury or SERIOUS Damage to Property; Restraint, which is the form of Physical Intervention used with the intention of completely directing, deciding and controlling a young person's free movement, may only be used where there is likely Significant Harm or Serious Damage to Property;
2. Other forms of Physical Intervention, such as Holding, Touching or Presence, are less forceful and restrictive than Restraint 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 Restraint or any other form of Physical Intervention is used, staff must be satisfied that it is necessary because there is a risk of injury or damage to property and that:

1. It is in the best interests of the service user;
2. That minimum force is used for the shortest time;
3. Action taken prevents injury, pain and distress;
4. Action taken maintain dignity of the Young Person;
5. Reasonable and Proportionate;
6. Any Action should be necessary.

A child/young person can be prevented from the leaving the home if it is felt they are at significant harm in the following circumstances:

• Sexual Exploitation;
• Gang Related Activities/Criminal Exploitation;
• Use of drugs.

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 they wish 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 in foster homes, they must be agreed by the manager of the fostering service and set out in the Foster Care Agreement.

Apart from this, it may be reasonable to temporarily (see next paragraph) bolt or lock a door to contain a child or prevent a child from leaving. Such action would be a Restraint and therefore may only be used if there was a risk of Significant Injury or Serious Damage to Property.

Where the following measures are used, they must be formally approved and the arrangements for their use set out in writing. In Children's Homes, the arrangements must be set out in a Statement of Purpose. In Foster Homes, the arrangements must be set out in the Foster Care Agreement and Placement Plan for relevant children.

Seclusion is where a child is forced, by use of Physical Intervention, to spend time alone against their will, for example where a child is placed or made to remain in their bedroom.

Time out involves restricting the child's access to all positive 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 they can be continuously observed or supervised until ready to resume usual activities.

Any types of restraints or physical interventions which are in place to keep a child safe due to their behaviours and which restrict a child's liberty should be recorded on the child's placement plan and Educational Health Care Plan. For example wheelchair restraints to stop a child running off when they have no or little road safety sense.

For a young person who is over the age of 16 who has care and support needs, any restrictions or agreed interventions will need to be recorded and a Mental Capacity Act assessment/Best Interest decision will need to be completed.

If 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.

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.

All incidents of restraint will be reviewed, recorded and monitored. The child's social worker should also be informed.

An incident report detailing the circumstances around the incident is an important tool in understanding what has happened and why. The report should include what has happened, who was present, any triggers before hand, if any injuries occurred and what happened after the intervention. The views of the child must be sought, dependent on their age and understanding, and used in the process of reflecting, understanding and informing future practice.

The carer and the child should be supported after an incident has occurred.

Decisions will then be made about how any further situations need to be managed and risk-assessed.

If the police are involved, the Regulatory Authority must also be notified by the Agency. See Notifications of Significant Event Procedure.

Unless it has previously been agreed that it is not necessary to do so, the child's social worker (and manager, for children placed in foster care) must be notified as soon as practicable but within 24 hours if an Incident of Physical Intervention upon a child occurs. If an Incident of Physical Intervention upon a child occurs the children's   home staff must inform the child's parents. Depending on the seriousness of the Incident, other people/agencies may have to be notified.

The use of Physical Intervention is deemed to be an Incident, and must be recorded as such.

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.

The child's Positive Handling Plan or Short Break Plan should be reviewed to incorporate strategies for reducing or preventing future incidents. The Child must be encouraged to contribute to this review.

All Incidents involving Physical Intervention must be subject to a Management Review.

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Guidance: Positive Environments Where Children Can Flourish (Ofsted)