Restrictive Physical Intervention and Restraint

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 whenever possible. It should only be used if there are good reasons for believing that immediate action is necessary to prevent a child or young person from 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 the use of restraint can pose risks to the child's safety, to the carer applying it, and to others present.

See also: Positive Relationships and Behaviour Support Procedure.

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 the child's placement information record.

Staff caring for disabled children or children who communicate nonverbally have a responsibility to understand each child’s communication style. They can then help children develop communication skills, enabling them to more effectively express their feelings and views regarding the use of restraint and restrictive practices.

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 any medical conditions might place the child at risk if particular techniques or methods of physical intervention are 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.

Those techniques that are used must comply with the principles and procedures set out in this chapter - see Section 4, 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. 

There are four broad categories of Physical Intervention:

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

In emergencies 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 persons or 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 extending the joints beyond the normal limits or range of motion (hyperextension or hyperflexion), and pressure on or across the joints;
6. Not employ potentially dangerous positions.

There are different criteria for the use of Restraint and Holding, Touching and Physical Presence/proximity.

1. Restraint may only be used where there is likely significant injury or serious damage to property;
2. 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;
3. Before any other form of Physical Intervention is used, all of the following principles must be applied:
   1. For the intervention to be justified, there must be a belief that injury or damage is likely in the predictable future;
   2. The intervention must be immediately necessary;
   3. The actions or interventions taken must be a last resort;
   4. Any force or intervention used must be the minimum necessary to achieve the objective.

A child/young person can be prevented from 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 or other illicit substances.

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 recording this incident, they clearly outline all steps taken to prevent the need to restrict the child's liberty by physical means.

If a young person continually requires this level of intervention to remain safe, there must be clear evidence of a planning meeting with the placing authority to assess the appropriateness of the placement. It may be recognised that this is a testing process, and an agreement on strategies will be established 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'.

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. 

It is also acceptable to lock office or storage areas that children are generally not expected to 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 specified in the home's Statement of Purpose, and the arrangements for their use must be specified in the home's Staff Handbook.

In foster homes, if any such mechanisms or modifications are used, they must be agreed to by the manager of the fostering service and set out in the Foster Care Agreement.

Locking external doors or doors to hazardous materials may be acceptable as a security precaution if used as part of the home's routine.

Where the following measures are used in children's homes or foster homes, they must be approved and set out in writing.

• 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;
• 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.

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 that places them or another person at risk of injury, or from a situation that could cause property damage, to a location where they can be continuously observed or supervised until they are ready to resume their usual activities.

Any restraints or physical interventions in place to keep a child safe due to their behaviours, and that restrict a child's liberty, should be recorded in the child's placement plan and Educational Health Care Plan. For example, wheelchair restraints are used to prevent a child from running off when they have little to no road safety awareness.

For a young person aged 16 or over with care and support needs, any restrictions or agreed interventions must be recorded, and a Mental Capacity Act assessment/Best Interest decision must be completed.

In children's homes where Physical Intervention has been used, the child, staff/carers and others involved must be allowed to see a 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 allowed to see a medical practitioner if there are any apparent or reported injuries.

If seen, the medical practitioner must be informed that any injuries may have been caused by an incident involving physical intervention.

Whether the child or others decide to see a medical practitioner, and the outcome, must be recorded.

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

Regulations require providers to record written information to explain:

• The reason for using restraint or restrictive practice;
• The manager’s response;
• Communication with the child.

An incident report detailing the circumstances of the incident is an important tool for understanding what happened and why. The report should also include what occurred, who was present, any preceding triggers, whether any injuries occurred, and what happened after the intervention. The child's views and experiences must be sought, depending on their age, understanding, and the staff’s responses. This information should be used to reflect on, understand, and inform future practice. Record-keeping is important; staff should also focus on how well children’s behaviour is supported and ensure their personal development is nurtured.

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

Decisions will then be made on how to manage any further situations and assess associated risks.

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

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Guidance: Positive Environments Where Children Can Flourish (Ofsted)

Restraint and restrictive practices: positive environments for children – Ofsted: social care