Restrictive Physical Intervention and Restraint

Children Always First does not condone the use of restraint/physical intervention with children and young people except in exceptional circumstances. Being able to promote positive behaviour and manage children's behaviour well is central to the quality of care provided in any foster home. Negative behaviour should usually be managed through building positive relationships with children. Foster carers need to be able to respond positively to each child or young person's individual behaviour and to be skilled at both diffusing difficult situations and avoiding situations escalating. The child's Placement Plan must set out any specific behavioural issues that need to be addressed or approaches to be used.

Children Always First does not condone the use of restraint/physical intervention with children and young people except in exceptional circumstances. It is always unlawful to use force as a punishment, and restraint that deliberately inflicts pain should not be used. Children Always First acknowledges the emotional impact that incidents can have on children, including long-term, adverse effects on their mental health.

Restraint must be used only in strict accordance with the legislative framework and the Agency policy to protect the child and those around them.

It is always unlawful to use force as a punishment, and restraint that deliberately inflicts pain should not be used. Children Always First acknowledges the emotional impact that incidents can have on children, including long-term, adverse effects on their mental health.

Children Always First takes all reasonable steps to ensure that:

1. No form of corporal punishment is used on any child placed with a foster parent;
2. No child placed with a foster parent is subject to any measure of control, restraint or discipline which is excessive or unreasonable; and
3. Restraint is used on a child only where it is necessary to prevent injury to the child or other persons, or serious damage to property.

Children Always First recognises the legal rights and duties of foster parents and their families in terms of protecting themselves and others and understands that in emergency and unpredicted situations foster parents may need to physically intervene. Where there are any instances of an unplanned response to prevent harm in an emergency, we expect an immediate review and safety plan that considers the use of proactive strategies and less restrictive options.

Every effort should be made to avoid the need for restraint, and foster parents must be absolutely clear that this is a last resort, only to be used when other attempts to address behaviour have been tried and failed, or are not appropriate, and that it is the only way to keep a person safe or to avoid significant damage to property. There is never any other justification.

Restraint is not a technique to be used to ensure compliance with expected norms, or as a disciplinary measure; neither can it legitimately or lawfully be used in the context of any kind of “holding therapy” (BAAF, 2006). We view any restraint or physical intervention as an action of good intent, offered with kindness through the relationship in a nurturing way to protect everybody in the fostering home.

We know that once restraint becomes acceptable it becomes more routine. Even with the criteria of harm to self, harm to others or serious damage it is too often easy to justify why the decision was taken when the culture fully expects restraint to happen. And that justification comes after the fact – by then the young person has already experienced restraint.

We know that injury can be caused to children when they are restrained and the plethora of training in restraint techniques that has arisen since the 1990’s is in an attempt to redress this. Such techniques need to be extensively taught and practised in order to be properly implemented within itself leads to the notion of restraint being highly profiled.

Any form of restraint is unlikely to improve the relationship between the adult and the child and will only divert the child’s attention from the behaviour onto the excessive force.

Physical intervention can take a number of forms. For the purposes of this policy, these are defined as physical presence, non-restrictive contact, and restraint:

• Physical presence - This is where a foster parent, through their physical presence, intervenes in order to influence a child or young person, but does not touch them or prevent them from leaving an area. This could include standing in their way or blocking an exit in order to try to engage in a conversation, but allowing the child or young person to pass if they insist;
• Non-restrictive contact - This refers to situations where a foster parent has physical contact with a child against their will, but where the child retains a large degree of freedom and mobility and can break away from the foster parent if they wish. They are not overpowered and have options to move away from the foster parent.
  This might include taking a child’s hand or putting an arm around their shoulder to physically guide them away from a situation, or pulling a child away from another child they are trying to hit in order to get between them;
• Physical restraint - Physical restraint refers to the foster parent using direct physical holding to prevent or significantly restrict the movement of a child or young person against their will. Restraint must only ever be used for the purposes of preventing harm to the person being restrained, harm to other people, or to prevent significant damage to property. It might be used in an unpredicted emergency or as part of an agreed plan with a particular child or young person. Physical restraint should never be used as retaliation for the child hitting out / kicking off. It is only to be use to prevent harm to themselves.

It is important to understand that babies and toddlers will be restrained by parents and foster parents in the course of normal family life. The most obvious example is using a car seat or booster chair to prevent injury to the child. On other occasions, a good parent will simply hold a small child securely for the purposes of keeping them safe. So restraint in the context of this policy does not include this normal age-appropriate parenting with babies and toddlers.

There are exceptional circumstances in which physical intervention is agreed as part of a child’s safety plan. All incidents of physical intervention require assessment and monitoring to ensure the restraint used was proportionate to the presenting risk and in line with any plan in place.

The Supervising Social Worker must consider 1:1 child-specific physical restraint training for the foster parent(s) where there is a risk of escalation to physical intervention within a fostering household.

When considering a physical intervention, the foster parent will need to make a dynamic risk assessment that considers:

1. The risk or potential risk identified, and the extent to which the outcome is imminent;
2. The range of opportunities available to minimise or negate that risk;
3. The risks inherent in intervening, and the risks inherent in not intervening.

Any decision about physical intervention must be proportionate, and the foster parent must use only the amount of holding necessary to achieve the desired outcome, and for the shortest period of time possible (Davidson et al, 2005; ADCS, 2009; Department for Education, 2014; Department of Health, 2014; Ministry of Justice et al, 2015; NICE, 2015). This means that, wherever possible, attempts should be made to use physical presence before any physical contact, and to use non-restrictive contact before moving to restraint.

If any form of restrictive physical intervention or restraint is used with a child, this should be reported to Children Always First immediately. If it is office hours and you are unable to get hold of your Supervising Social Worker, please call the office to speak to the duty worker or Team or Registered Manager.

The member of staff receiving the initial verbal report will create a Significant Event to log details of the incident and any action taken. The Supervising Social Worker will ensure that this is updated and the outcome is recorded.

The local authority of the child involved is communicated with at the earliest opportunity with the written confirmation of the incident.

The Team Manager and Registered Manager will be made aware of the Significant Event. If there is any concern that the restraint was not necessary or proportionate, a referral to the Local Authority Designated Officer is undertaken.

Children Always First liaise with the local authority regarding next steps which includes agreement on who is to discuss the incident of restraint with the child. Consideration is also given as to whether the Safe Care Plan/Risk Assessment should be reviewed.

All decisions and actions are recorded against the Significant Event and will be monitored by both the Registered Manager and Team Manager.

Foster carers are trained in de-escalation skills through the therapeutic training, which provides a range of measures that can be taken by the foster parent to minimise conflict and avoid behaviour becoming increasingly challenging:

The Nurturing Attachment 18-week course which is mandatory for all main carers covers much of this. It is split into 3 modules as follows:

• Module 1 – Attachment Theory & Therapeutic Parenting;
• Module 2 – The House Model of Parenting – Providing a Secure Base;
• Module 3 – Building Relationships & Managing Behaviour.

Children Always First will also arrange one-to-one bespoke training if a child is demonstrating challenging behaviour that is putting themselves or others at immediate risk of harm and where a restraint would be required to keep everyone safe. This training will be arranged to take place in the carers home and will provide training to the foster carers, their support network and Supervising Social Worker.

Examples of de-escalation strategies include:

• Foster parent remaining regulated themselves when helping to de-escalate a situation;
• Foster parent using sensory (Taste, touch, sound, sight, smell) intervention. (Appropriate healthy touch (hug), milky drink, soft music etc). Please refer to handout on sensory interventions;
• Using techniques for distraction and calming, and ways to encourage relaxation;
• Recognising the importance of personal space;
• Responding to anger in an appropriate, measured and reasonable way and avoid provocation;
• Communicating calmly and quietly; it is important that the child is kept informed of what is happening i.e. “I’m going to move your fingers away from the plug because you’re going to hurt yourself”;
• Actively listening to the child or young person;
• Knowing when to remain silent, and to delay or postpone addressing potentially difficult issues;
• Communicating in a style that is not verbose, preachy, confrontational, or argumentative;
• Using distraction or humour to diffuse a situation where violence or aggression look likely;
• Walking away from a discussion or situation where the child or young person is becoming agitated;
• Staying with the child or young person and just being present can also be helpful strategy. This is known as ‘Time in’. The foster parent is offering containment just by being present and keeping eye contact.

Traumatised children and young people are often responding to any triggers (stimulus) by using established defensive behaviours (known as adapted behaviours). It is important to remember that the thinking part of the brain is not assessable as the fight, flight, freeze response is being activated from the primitive (survival) part of the brain. This means, the person can not think at a time of high arousal. When a child is dysregulated, they need regulating with sensory interventions. Once regulation has occurred, then the foster parent can engage with conversation through relating.

Any restraint or physical intervention must not be used as a process of power or control and must offer clear reasoning and explanation.

We would also advise foster parents to get in contact with their Supervising Social Worker for advice and guidance in this area. It may be that if a child needs a specific physical intervention then a bespoke therapeutic plan can be designed alongside the child safe caring plan, which considers how this is undertaken (for example, the use of weighted blankets), and the context in which it should be used. We would also expect that, in many circumstances, a child’s needs change over time.

We should always question the use of any restrictions on children’s movement and/or intrusive observations. This will help us to understand whether this was the best and/or only way to support this child and keep them safe. It is important to consider what the least possible restrictions are to keep a child safe.

This information is to be read in conjunction with the Therapeutic De-Escalation, Dysregulation and Soothing handout and Therapeutic Sensory Intervention handout available to all Foster Parents and Staff and used alongside the Physical Intervention/Restraint Incident Reporting Form and Guidance.

• Remain calm;
• Prevention is better than confrontation;
• Remain in verbal contact with the child; explain what you are doing and why;
• Remain in control of yourself;
• Report the incident as soon as possible and make a written record.