4.5 Physical Intervention

Contents

1. Planning for Children
2. Definition of Physical Interventions
3. Who may use Physical Interventions
4. Staff Training and Criteria for using Physical Interventions
5. Locking or Bolting of Doors
6. Notifications
7. Medical Examination
8. Recording

1. Planning for Children

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.

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.

Where Physical Intervention may 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 it and the Strategies for managing it should be outlined in the child’s Placement Plan.

In developing such a plan, consideration must be given to 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 Placement Plan. If in doubt, medical advice must be sought.

Note:

The existence or absence of 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 the plan would not be sufficient to prevent injury or damage to property and the alternative actions they take are consistent with the principles contained in this Chapter.

Any deviation from an agreed plan or from the principles contained in this Chapter must be reported to the manager and child's social worker as soon as practicable thereafter.

2. Definition of 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 ('Prone Facedown' techniques may not be used in any circumstances)
   • 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

   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 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
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

3. Who may use Physical Interventions

Normally, staff may only use Physical Intervention that are approved by the home if they have undertaken approved training, (see The Positive Options website).

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:

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 or threaten to do so
4. Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas
5. Avoid hyperextension, hyper flexion and pressure on or across the joints
6. Not employ potentially dangerous positions

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 Guidance - to follow).

4. Staff Training and Criteria for using Physical Interventions

4.1 Staff Training

All staff must be trained in methods of behaviour management, including the use of physical intervention and restraint, that are agreed by the Home.

This training must ensure that staff are able to:

• Manage their own feelings and responses to the emotions and behaviours presented by children and understand how past experiences and present emotions are communicated through behaviour;
• Manage their responses and feelings arising from working with children, particularly where children display challenging behaviour or have difficult emotional issues;
• Understand how children’s previous experiences can manifest in challenging behaviour;
• Use methods to de-escalate confrontations or potentially violent behaviour to avoid the use of physical intervention and restraint.

4.2 Criteria for Using Physical Intervention

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

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
2. 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 Injury which is less than Significant or to prevent Damage to Property which is less than serious
3. 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. The injury or damage is likely in the Predictable Future
   2. The intervention is Immediately Necessary
   3. The actions or interventions taken will be as a Last Resort
   4. That any force or intervention used is the Minimum Necessary to achieve the objective

The terms 'Predictable Future', Immediately Necessary', 'Last Resort' and Minimum Necessary' are defined in Behaviour Management Guidance - to follow.

5. Locking or Bolting of Doors

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 they must be outlined in the home's Statement of Purpose.

Apart from this, it may be reasonable to bolt or lock a door to contain a child or prevent a child from leaving but only where there is a risk of Significant Injury or Serious Damage to Property and so long as the criteria set out above (Section 4 (3): Criteria for Using Physical Intervention).

The social worker must be notified in these circumstances or where the locking or bolting of doors is used frequently as a strategy to protect the child or others; and the social worker should then give consideration to an application being made for a Secure Accommodation Order.

6. Notifications

If Physical Intervention is used upon a child, the Manager and child's social worker must be notified within one working day or as soon as practicable thereafter, unless it has previously been agreed that it is not necessary to do so. The Manager should notify the home's Line Manager if the incident was serious or a Notifiable Event occurred. See Notifiable Events Procedure.

The social worker should make a decision about whether to inform the child's parent(s) and, if so, who should do so.

7. Medical Examination

Where Physical Intervention has been used, the child, staff and others involved must be given the opportunity to see a Registered Nurse or Medical Practitioner, even if there are no apparent injuries.

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.

Whether or not the child or others decide to see a Registered Nurse or Medical Practitioner it must be recorded, together with the outcome.

8. Recording

The child's social worker must be notified in writing and a record must be kept in a hard back book of any physical intervention.

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.

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.

End