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13.4 Physical Intervention (Restraint & Disengagement) in Residential Settings

AMENDMENT

In July 2015, this chapter was extensively updated and should be re-read throughout in line with the Children’s Homes Quality Standards.


Contents

  1. Purpose of this Policy
  2. Physical Intervention (Restraint)
  3. Values
  4. Legal Framework
  5. Principles
  6. Promoting the Best Interests of Children and Young People
  7. If Abuse by Other Staff is Suspected
  8. Physical Intervention and the Involvement of the LADO/Team of Officers
  9. Distinguishing between “Holding” and “Physical Restraint”
  10. Actions following a Physical Intervention
  11. Recording
  12. Staff and Training

    Appendix 1: Restraint Recording Form Sample


1. Purpose of this Policy

  • To outline the Authority’s position in respect of physical intervention;
  • To ensure that all workers in Children’s Social Care (CSC) understand the Authority’s position in respect of physical intervention;
  • To clarify which staff may use physical intervention techniques and when it is appropriate for them to do so.

All Children’s Social Care (CSC) workers have a duty to familiarise themselves with all policies related to their duty of care and their responsibility to safeguard the welfare of children and young people. As well as this policy, this includes, but is not limited to:


2. Physical Intervention (Restraint)

Physical intervention is defined by the Authority’s Management of Actual or Potential Aggression (MAPA) training as “the use or threat of force to help do an act which the person resists, or the restriction of the person’s liberty of movement, whether or not they resist”.

MAPA training must be refreshed every 12 months and MAPA trained workers are expected to be on duty at all times in residential settings where there is a reasonable likelihood that a physical intervention may be required.

Unless there are very exceptional circumstances, the Authority will only endorse physical intervention by workers trained through a recognised MAPA course. Should a person not trained in MAPA interventions undertake a physical intervention, this and reported to a senior manager with a full explanation of the underlying reasons.


3. Values

The values of Nottinghamshire County Council are reflected in the national guidance, which themselves are reflected in the MAPA training.

The relevant national guidance is located in the Children’s Homes Quality Standards and Regulations 2015 The Positive Relationship Standard:

  1. The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on:
    1. Mutual respect and trust;
    2. An understanding about acceptable behaviour; and
    3. Positive responses to other children and adults.
  2. In particular, the standard in paragraph (1) requires the registered person to ensure:
    1. That staff:
      1. Meet each child’s behavioural and emotional needs, as set out in the child’s relevant plans;
      2. Help each child to develop socially aware behaviour;
      3. Encourage each child to take responsibility for the child’s behaviour, in accordance with the child’s age and understanding;
      4. Help each child to develop and practise skills to resolve conflicts positively and without harm to anyone;
      5. Communicate to each child expectations about the child’s behaviour and ensure that the child understands those expectations in accordance with the child’s age and understanding;
      6. Help each child to understand, in a way that is appropriate according to the child’s age and understanding, personal, sexual and social relationships, and how those relationships can be supportive or harmful;
      7. Help each child to develop the understanding and skills to recognise or withdraw from a damaging, exploitative or harmful relationship;
      8. Strive to gain each child’s respect and trust;
      9. Understand how children’s previous experiences and present emotions can be communicated through behaviour and have the competence and skills to interpret these and develop positive relationships with children;
      10. Are provided with supervision and support to enable them to understand and manage their own feelings and responses to the behaviour and emotions of children, and to help children to do the same;
      11. De-escalate confrontations with or between children, or potentially violent behaviour by children;
      12. Understand and communicate to children that bullying is unacceptable; and
      13. Have the skills to recognise incidents or indications of bullying and how to deal with them; and
    2. That each child is encouraged to build and maintain positive relationships with others.


4. Legal Framework

4.1

The Legal Framework that underpins all practice within a registered Children’s Home is as follows:

  1. The Children’s Homes Quality Standard and Regulations 2015; and
  2. The Children’s Homes Regulations 2001 (Amended 2011)
4.2

Regulation 20 Use of Restraint - legally defines when restraint may be used as follows:

  1. Subject to paragraph (2) a measure of restraint may only be used on a child accommodated in a children’s home for the purpose of:
    1. Preventing injury to any person (including the child who is being restrained);
    2. Preventing serious damage to the property of any person (including the child who is being restrained); and
    3. Preventing a child who is accommodated in a secure children's home from absconding from the home.
  2. Where a measure of restraint is used on a child accommodated in a children’s home:
    1. The measure of restraint must be proportionate; and
    2. No more force than is necessary should be used.
 

Summary:

  • All social workers must familiarise themselves with the legal framework to determine whether a restraint incident was permissible;
  • Social workers should note that the legal framework for Education is significantly different. Any restraint that has occurred within a residential school, for example, if it involved care staff, can only occur within the framework outlined above;
  • The social worker should be informed of a Restraint - which must be written up by the Provider within 24 hours of the incident. The social worker may request that all incident reports are provided and this should occur ‘immediately’ upon request;
  • Social workers should ensure that they receive a copy of the full restraint incident form and this should be signed by a Manager within the home and any comments added. The views of the young person should also be included;
  • Any concerns should be discussed immediately with a Manager and advise sought from the Placements Team, if necessary;
  • If there are regular incidents of restraints, there is a requirement for the Provider to establish if there is a pattern of incidents. It is important to request a meeting to discuss a strategy for managing a child/young person’s behaviour if there has been frequent incidents;
  • If you are not receiving information promptly, or information is incomplete, the Placements Team should be notified.


5. Principles

A physical intervention may be planned or unplanned; both are managed in the same manner.

For each child or young person who presents a challenge there should be an individualised strategy for responding to incidents of violence and challenging behaviour. This must be recorded in written detail in the Care Plan, with clear agreement in advance by:

  1. The social worker;
  2. The key worker in the residential home;
  3. The person with Parental Responsibility.

Physical Intervention must only be used as a last resort, when a child or young person is presenting a significant risk to themselves and/or others. This includes serious property damage.

Physical intervention may only be used by a person appropriately trained in MAPA techniques, unless there are exceptional mitigating circumstances.


6. Promoting the Best Interests of Children and Young People

6.1 Best practice principles state that "physical intervention should only be applied when all other none physical interventions have been exhausted".
6.2 The application of any physical intervention must be proportionate to both the behaviour of the individual and the nature of the risk they may pose.
6.3 Only the minimum necessary force should be used and the techniques deployed should be those taught on a MAPA training course; the least amount of restriction for the minimum amount of time.
6.4 Staff should always consider the ‘opt out’ strategy to avoid prolonged use of physical intervention. More importantly, they should be considering strategies to promote positive behaviour and engagement with the child or young person should encourage them to become more able to control and manage their level of aggression or resolve issues that trigger their challenging behaviour.


7. If Abuse by Other Staff is Suspected

7.1 Workers should be familiar with the policy "Staff: Statement of Primary Responsibilities", which details the process if abuse by other staff is suspected.
7.2 Physical contact may have many meanings according to the people and the situation. Children and young people require protection from the excesses of, or inappropriate use of, staff affection and anger. Staff require protection from unfounded or exaggerated allegations. The only real protection lies in all staff acting in a professional and responsible manner.
7.3 Children’s Social Care therefore advocates that all residential workers:
  7.3.a Risk offending other staff by honest openness, rather than allowing difficulties to develop through silence.
  7.3.b Recognise when a child or staff member is having difficulty by immediately and honestly conveying anxieties to that person or other staff, as appropriate, and always to the Registered Manager.
  7.3.c Ensure that physical contact (although possibly spontaneous in origin) is expressed as a considered reaction that can be understood by the child or young person and seen to be understood by others, as part of the caring task of staff.
  7.3.d Inform the Registered Manager when physical contact of a notable, ambiguous or ill-considered nature occurs, inside or outside the home, particularly if no other member of staff was present. Where this is the Registered Manager, the Service Manager (Residential Homes) should be informed.
  7.3.e Where a child has not lost self-control, but is simply directing aggression as a threat to your dignity or self-control, seek the intervention of other staff and remove themselves from the situation. Managers and individual staff need to recognise the potential for sexual attraction between staff and young people and to address this in induction, supervision and training.


8. Physical Intervention and the Involvement of the LADO/Team of Officers

8.1

Following a restraint there may be an allegation that a staff member(s) involved caused physical or psychological injury or pain to the young person.

If a young person or a member of staff raises an allegation or concern then the Registered Manager must consider reporting the matter to the Local Authority Designated Officer (LADO)/Team of Officers. If there is no direct complaint but there are serious injuries or concerns about the nature and proportionality of the restraint then the Registered Manager should consider discussing the matter with the child’s team manager and LADO/Team of Designated Officers.

The criteria for referral to the LADO/Team of Designated Officers are fully explained within the Nottinghamshire and Nottingham City Safeguarding Children Boards’ Safeguarding Children Procedures but essentially are: where there is an allegation that a member of staff has or may have committed a criminal offence against a child, harmed a child or behaved in a manner that indicates they are unsuitable to work with children.

Depending on the level of concern, the LADO/Team of Officers may then have strategy discussions with the Employer, the LAC Team Manager and possibly the Police with regard to the adult of concern. A decision will be made by the CSC team manager and Police as to whether or not the matter should be investigated under Section 47 and if S47 agreed then whether this will be a single or joint investigation. Child protection processes should be followed in this scenario, which will sit under the managing allegations process. A strategy meeting may also be required under the managing allegations procedures to co-ordinate activity. Depending on the level of concern, there may be actions required by one, two or all of the employer, the police or children’s social care.

There is an expectation, regardless of whether or not the matter is being investigated under Section 47 that the young person is seen by a social worker independent of the residential unit (after a restraint has been reported) to seek their views.

If a child has sustained an injury then medical attention/advice needs to be sought.

It is important that the child/young person’s social worker reads all restraint reports sent to them. Even in the absence of any complaint or concern being raised, they should be mindful that there may be occasions when restraints are inappropriate and not in line with either national guidance and/or the young person’s risk assessment or care plan. It is important that more generally, the social worker discusses restraints with the young person to gauge their views and experience; some young people will normalise restraints and not recognise when they are inappropriate. If the social worker has any concerns, they should discuss them with their manager and consider a referral to the LADO/Team of Designated Officers.

It is important that there is full recording around any investigation on the social work, residential childcare and employee files.
8.2

OLA LAC placed in private provider units within Nottinghamshire

Where the above allegations or concerns arise but the children are the responsibility of another Local Authority, there is still a responsibility on the host authority (Nottinghamshire) to assess if the young person is a child in need of protection under Section 47. Clearly this must be discussed with the placing authority; if they are immediate neighbours (as per current Child Protection Procedures) it is likely that they placing authority will lead on the Section 47 investigation. This needs to be agreed at team manager level. The matter will need to be referred to the MASH by the LADO/Team of Designated Officers, child’s social worker or the residential unit as agreed during the initial referral stage.

There will then need to be a strategy discussion for both the adult of concern and the child with the MASH /CAIU to determine if the concern should be investigated under Section 47 and the managing allegations procedures and who will see the child or young person. Communication with the placing authority is essential.
8.3

Where there is CCTV

Where there is an allegation or concern raised and there is CCTV the Registered Manager (or their deputy) should view the CCTV footage. If the allegation is unfounded beyond any doubt then the allegation should be reported to the social worker, explained to the young person (and perhaps show them the footage) that their complaint is not upheld and record appropriately. It is still advisable for the young person’s social worker to speak to the young person and view the CCTV so that there is an independent record but this will be a judgement call depending on the level of the concern. This situation need not be reported to the LADO/Team of Designated Officers.

If there is a serious allegation or injury to the young person then it would be wise to consider referring this to the LADO/Team of Designated Officers and the child’s social worker via a telephone call, to allow for there to be some independent scrutiny.

Where there is not clarity then there should be a telephone call to the LADO/Team of Designated Officers to discuss.


9. Distinguishing between “Holding” and “Physical Restraint”

9.1 It is important to distinguish between "holding" and "physical restraint":
  9.1.f "Holding" differs from "physical restraint" in the degree of force and the manner of intervention; it discourages but is not in itself enough to prevent.
  9.1.g Physical restraint is the positive application of force with the intention of restricting movement.
9.2 A distinction should be made between the use of a "one-off" physical restraint appropriate to particular circumstances, and using it repeatedly as a regular feature of a regime; the latter is specifically not allowed by the Authority.
9.3 Staff should consider whether the physical intervention is likely to resolve the situation safely or is likely to result in more immediate damage or danger for the young person or other people. Sometimes staff have little choice other than to intervene because of an immediate and obvious danger


10. Actions Following a Physical Intervention

10.1 Following any incidence of intervention, there is a clear process to be followed:
  10.1.h The child or young person and the staff member should be provided with medical assistance, if necessary.
  10.1.i Both child or young person and the staff member should be debriefed by a senior manager.
  10.1.j The views of the child or young person and the staff member towards the incident and the intervention should be recorded.
  10.1.k The child or young person and the staff member should be supported to complete a reflective log.
  10.1.l The daily care plan and the risk assessment for the child or young person should be reviewed to ensure it remains appropriate.


11. Recording

11.1 Attached is a copy of a recording sheet for the Authority’s residential units; a slightly different version may appear at Clayfields in order to comply with Youth Justice Board (YJB) requirements.


12. Staff and Training

12.1 The Authority requires that all workers who may be required to engage in physical intervention be MAPA trained and that this training is refreshed annually.
12.2 All staff are encouraged to monitor physical interventions and report incidents giving rise to concerns.
12.3 Staff should only employ MAPA physical intervention policies they have been trained to use.
12.4 Staffing rotas should ensure that MAPA trained workers are available to respond where physical intervention could reasonably be expected to be required.
12.5 To protect the best interests of the child or young person, it is good practice to ensure that the intervention plan of the child or young person is approved by those with parental responsibility.


Appendix 1: Restraint Recording Form Sample

Click here to view Appendix 1: Restraint Recording Form Sample

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