April 2016

Author: Reviewed by Ruth France Last updated: 13th March 2017Next update: April 2018

Guidance

forPromoting Positive

Behaviour and the use of Physical Intervention in

Children’s Homes

GUIDANCE FOR PROMOTING POSITIVE BEHAVIOUR AND THE USE OF PHYSICAL INTERVENTION IN CHILDREN’S HOMES

1.0 Introduction

1.1 Within residential services the aim is to create environments within each

home for children and young people where they can live together as

comfortably and happily as possible and experience happy memories. As in

families, a happy home is based not only on care and trust, but also on

understanding by all its members of the kinds of behaviour that are

acceptable and unacceptable and the response they can expect when

unacceptable behaviours occur.

1.2 These guidelines are intended to assist residential staff in developing and

sustaining a safe environment for children and young people within which

the boundaries of behaviour are clearly defined and understood.

1.3 It should be remembered that many children/young people in care have

been subjected to abusive and often inconsistent parenting in the past

and this will strongly influence their response to boundaries given to them

whilst they are in our care.

1.4 At the same time staff should be able to show affection towards a child

based on what is acceptable within family homes such as comforting a

child in distress or goodnight hugs. It is therefore important that care is

taken to ensure that any physical contact is not misinterpreted.

Arrangements in relation to safe touching should be considered as part of

the placement planning for the child.

1.5 Where possible, staff should never use physical interventions, unless staff

have been provided with restraint training and/or a child’s risk assessment

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states restraint, it should never be used.

2.0 Aim of the policy

2.1 Every care home is required, by law, to have written policies and guidance

on how to manage challenging behaviours displayed by children/young

people who live in the home. The aim of this policy is to give clear and

thorough advice and guidance on how to promote positive behaviours and

managing behaviours that can be challenging.

2.2 It also states what are and are not acceptable ways of managing difficult

behaviours. Specific areas are covered in order to meet national standards

- in particular the homes’ philosophy; acceptable and unacceptable

forms of behaviour management; permissible consequences; approved

methods of physical intervention; recording; training; and police

involvement.

2.3 This policy should be read in conjunction with Residential Procedures - Counteracting Bullying , Safeguarding and Whistleblowing.

3.0 Legislative context

3.1 The legal framework surrounding issues of control and physical intervention

with children/young people in public care derives from the Children Acts 1989 and 2004 and the Children’s Homes (England) Regulations (2015): including the quality standards, under the Care Standards Act (2000) . This framework exists within the context of the Human Rights Act 1998 , the United Nations Convention on the Rights of the Child (1991) , plus the various guidance issued by the DoH under Section 7 of the Local Authority and Social Services Act 1970 .

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The Children Acts 1989 and 2004

3.2 These specify that all adults working with children/young people have a duty

of care towards them. Failure to take reasonable steps to protect

children/young people from being harmed could open individuals to

charges of negligence. Its guiding principle is that the “welfare” of the

child/young person is paramount - therefore it supports “any necessary

action to prevent injury”.

3.3 The guidance and regulations issued with the Children Acts 1989 (Volume 5 Children’s Home) stated that “physical interventions to

restrain or protect children and young people can only be justified within a

context in which children are offered positive care that meets their

individual needs and respects their personal integrity should be used rarely

and only to prevent a child harming himself or others” (2011).

3.4 There is various guidance issued to clarify issues around managing

challenging behaviour. These include;

Permissible Forms of Control (DoH 1993) : This is guidance issued to

supplement Volume 4 Children Act Guidance. It suggested that physical

restraint should be used “…when staff have good grounds for believing

that immediate action is necessary to prevent a child from significantly

injuring himself or others.”(5.6i p10).

Taking Care, Taking Control (DoH 11/96): This is a training manual for

children’s homes regarding physical intervention with an emphasis on

defusing situations, communication and post incident structure for children

and staff.

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The Control of Children in Public Care Interpretation of the Children Act 1989: Herbert Laming (1997) made it clear that staff should take steps

to prevent children/young people being placed at risk, suggesting that, on

occasion, proactive steps need to be taken immediately to prevent a

child/young person from coming to harm later. Laming also suggested that

“harm” should not be limited to physical injury, and that a reasonable

parent would act to protect children from “moral harm” for example by

preventing them putting themselves at risk by indulging in criminal

behaviour.

Human Rights Act 1998

3.5 This Act states that any actions involving a physical intervention must be

“absolutely necessary”, and protects the rights of individuals to; privacy,

protection from degrading treatment, liberty, and security, amongst others.

Care Standards Act (2000)

3.6 This came into force on 1 April 2002. It means that by law every care home

must comply with a clear set of national minimum standards. These

standards were issued by the Secretary of State for Health under

Section 23 (1) of the Care Standards Act 2000 (CSA). These were

amended in April 2011. The Department of Health’s document, titled

‘Children's Homes Regulations ’, contains a statement of the national

minimum standards set by the Secretary of State.

3.7 One area referred to in the Act is “promoting positive behaviour and relationships” under Standard 3 the focus is on children/young people

“children develop and practice skills to build and maintain positive

relationships, be assertive and resolve conflicts positively” (page 113.5).

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“Staff understand and 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 behavior”

(page 11 3.9).

“Expectations of behaviour for both staff and children are clearly

understood and negotiated by those working at the home, including

exercising appropriate control over children in the interest of their own

welfare and the protection of others” (21.3).

“All staff understand, share and implement the home’s ethos, philosophy

and approach to caring for children” (page 11 3.4).

“There is an environment and culture to promote models and support

positive behaviour that all staff understand and implement” (page 11

3.2).

“Methods to de-escalate confrontation or potentially violent behaviour are

used wherever appropriate to avoid the use of physical restraint. Restraint

is only used in exceptional circumstances, to prevent injury to any person

(including the child being restrained” (page 12 3.13).

“Where children homes use physical restraint, staff are trained in the

use of physical restraint techniques and only use the homes agreed

techniques. Training is regularly refreshed” (page 12 3.15).

“Each home regularly reviews incidents of challenging behaviour,

examines trends or issues emerging from this, to enable staff to reflect

and learn to inform future practice” (page 12 3.20).

“Restraint is not used as a punishment, nor to force compliance with

instructions where significant harm are otherwise likely” (page 12

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3.14).

“All children and staff are given the opportunity to discuss incidents of

restraint they have been involved in, witnessed or been affected by, with a

relevant adult” (page 12 3.17).

3.8 In 2002 the DoH/DfES issued Joint Guidance of Physical Interventions

(Guidance on Restrictive Physical Interventions for People with Learning

Disability and Autistic Spectrum Disorder, in Health, Education and Social

Care Settings) which aimed to provide guidance concerning restrictive

physical intervention by staff with service users (children and adults) in all

settings. Although the title suggests that it only applies to people with a

learning disability or autistic spectrum disorder, it contains the

clarification that it includes children/young people with severe

behavioural difficulties, and emotional and behavioural difficulties which

result in them displaying extreme behaviour. For residential homes the

guidance should be read alongside Permissible Forms of Co nt ro l in Chil d

re n’s Re s id e nt ia l Care ( DoH 1 9 9 3 ) .

3.9 The joint guidance includes a number of definitions and distinctions.

Distinctions are made between:

Non-restrictive physical intervention - intervention using bodily contact,

mechanical devices or changing the environment.

Restrictive physical intervention - intervention using force to restrict

movement or mobility, to control behaviour or to break away from

dangerous or harmful physical contact.

Planned intervention - recorded strategies based on a risk assessment.

Emergency or unplanned intervention - use of physical intervention

occurring as a response to unforeseen events.

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3.10 The guidance emphasizes preventative strategies and acknowledges that

the proactive use of restrictive intervention is sometimes in the best

interests of the child/young people and could form part of their care plan,

but will always be a last resort.

3.11 There is emphasis on strategies based on risk assessments and on judging

whether the risks involved in employing physical intervention are lower

than those of not doing so. Any intervention must be proportionate to both

the behaviour and the harm it may cause.

3.12 There is a requirement in care settings that, if it is foreseeable that a child

/young person user might require a restrictive physical intervention; it

must be recorded in their care plan. The planned intervention must be

based on a risk assessment and describe the specific strategies and

techniques to be employed.

3.13 The children’s residential service has adopted PRICE as its method of

behaviour management. PRICE is accredited by BILD (British Institute of

Learning Disabilities) and is a structured staff development programme that

provides a range of effective and flexible supports for children with

challenging behaviour aimed at reducing the probability of behaviour

escalating towards violence - the emphasis being on diffusion and de-

escalation.

4.0 Promoting positive behaviour

4.1 There are appropriate methods of developing and maintaining levels of

positive behaviour. These are different depending on the ages, needs and

abilities of the children and young people we look after. The emphasis

is on helping a child/young person to learn to manage his or her own Page 8 of 36

behaviour, feelings and anxieties.

Establishing positive relationships with children/young people so they feel

safe.

Developing a positive culture based on a clear understanding of rights and

responsibilities for children/young people and staff. This should include

respecting difference and challenging all form of discriminatory and

oppressive behavior.

Planned structure of time and clear, consistent boundaries.

Positive role modelling by staff and constant verbal reaffirmation of what is

positive behaviour. The language and behaviour of staff should at all times

reflect a positive attitude towards young people, and endorse a caring and

safe environment.

Giving children/young people alternative strategies for coping with their

feelings that are more acceptable.

Rewarding and praising children/young people for positive or well-

managed behaviour.

Discussion and counselling on why certain behaviour is inappropriate and

unacceptable, rather than a statement such as “…Don’t do that”.

A child/young person makes amends by an apology or change of attitude.

It may also be appropriate for the member of staff to apologise if

something went wrong.

Opportunity for children/young people to discuss issues of behaviour,

consequences, and disciplinary measures and their views recorded and Page 9 of 36

taken into account, using methods of communication they understand

and feel comfortable with.

“Involvement” of staff with children/young people’s activities rather than

“supervision”.

5.0 Consequences for unacceptable behaviour

5.1 Strategies used to ensure that there are consequences for unacceptable

behaviour should be fair and consistent and encourage reparation and

restitution. They should be relevant to the incident, reasonable, age-

appropriate, carried out as soon as possible after the incident and last

no longer than is absolutely necessary. They also need to be flexible

enough to be reviewed and rescinded at any time.

5.2 Children/young people should be informed about the range of consequences

that may be imposed upon them and the possible circumstances which

may result in consequences. This information may be supplied verbally

and/or in the children/young people’s guide.

5.3 Before any consequence is given staff/carers must be satisfied of the

following:

The child/young person was capable of behaving acceptably and

understands what was expected of him/her.

Other encouraging and rewarding strategies have not worked or would not

work in the circumstances.

There is a view that the imposed consequence may encourage acceptable

behaviour or act as a disincentive to unacceptable behaviour.

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The child/young person understands the relevance of the given

consequence.

5.4 It is important that an explanation is given to the child/young person as to

why the behaviour is inappropriate and why a consequence has been

given. This should be when the situation has calmed down. If the

child/young person wishes to contact their social worker, family or advocate

to make a complaint, they need to be given access to the telephone, or

support is given to the young person to make a complaint using the

communication methods they feel comfortable with.

5.5 The emphasis should be on helping a child/young person manage his/her

own behaviour, feelings and anxieties rather than on punishment. The self-

respect or sense of responsibility of the child/young person should be

supported rather than undermined.

5.6 Acceptable consequences to unacceptable behaviour are:

Reproof: an explanation to a child/young person that their presenting

behaviour is not appropriate or acceptable.

Reprimand: as above with the explicit expectation that, if it is repeated,

there will be consequences.

Reparation: this could be an activity, e.g. repairing damage, painting etc.

Restitution: this could be payment - full or partial depending on

circumstances and/or ability to pay - for damage caused or replacement of

theft.

Grounding/time out: curtailment of leisure such as having to stay in,

missing an outing or specific activity. The imposed consequence must be

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specific and time limited and must not be given for more than one outing at

a time.

Early bed: This could be anything up to one hour early and only on the

night of the negative behaviour.

Withdrawal: Allow the child/young person to calm down in another room.

This should only be for short periods of up to 10 minutes and the

child/young person should be supervised by staff. For some individuals it

may be necessary to be left alone in a room to calm down - in this

instance staff must monitor closely.

Extra chores: The child/young person may be required to undertake

these, or to carry out other suitable tasks. These must be reasonable

given the child/young person’s age and their abilities and must not

demean them or lead to prolonged isolation from peers or usual routine.

Extra supervision: The child/young person may be more fully supervised

by staff both on and off the premises. This must be time limited and

reviewed weekly by staff, documented and signed by the manager or the

deputy in their absence.

Removal of possessions: If a child/young person’s possessions, for

example, music systems, are used in a way that is disturbing to others, the

possessions may be removed for an appropriate length of time. Where

possessions are dangerous or used in a dangerous manner they should

be removed and returned to parents wherever possible. Where this is not

possible, they need to be kept in a safe place by staff with this recorded on

the child/young person’s record.

5.7 Unacceptable behaviour can often be rewarded by attention causing it

to become habitual. It is essential that staff do not reward negative Page 12 of 36

behaviour but give attention when the behaviour is positive.

5.8 It is important that any consequences are followed through.

Children/young people learn that habitual tantrums become functional if

it causes the carer to back down. It is the certainty and the consistency

of the following through of the consequence, not the severity that matters

most.

5 .9 Consequences must be recorded, reviewed within 48 hours and revised

if appropriate. All consequences must be brought to the attention of the

line manager; recorded in the child/young person’s case record; and

recorded in the consequences book which must be signed by the

residential care manager, or the deputy in the manager’s absence.

6.0 Prohibited consequences and measures of control

6.1 No given consequence must intimidate or frighten a child/young person.

Certain consequences may not be given to children/young people, in any

circumstances. They are:

Any form of corporal punishment; i.e. any intentional application of force

as punishment, including slapping, punching, rough handling and throwing

items. It would also include punching or pushing, or similar behaviour in

response to violence from the child/young person. This is different to

staff’s right to defend themselves from physical injury.

Any consequence relating to the consumption or deprivation of food or

drink.

Any restriction on a child/young person’s contact with his or her parents,

relatives or friends; or anyone acting in an official capacity e.g. social Page 13 of 36

worker, solicitor, advocate, independent visitor.

PRACTICE GUIDANCEAny intervention does not prevent contact or communication being restricted

unless in the exceptional circumstance where it is necessary to do so to protect

the child/young person or others.

Any such restriction should be entered on the child’s risk assessment and care

plan.

Any requirement that a child/young person wear distinctive or

inappropriate clothes. This could be a badge, a hat, footwear or certain

hairstyles.

Wearing of nightclothes during the day: This is only acceptable where the

child/young person is ill in bed or “tucked up” on the couch.

The use or withholding of medication or medical or dental treatment.

Use of accommodation to physically restrict the liberty of any child/young

person: This is unacceptable and only permitted in cases approved by the

Secretary of State.

Segregation and isolation. Children/young people should not be kept apart

from a group or forced to be on their own for other than very brief periods,

literally minutes, in order to “cool down” from disruptive behaviour.

The intentional deprivation of sleep as a consequence.

The change of a child/young person’s behaviour through bribery or the use

of threats.

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Any consequence used intentionally or unintentionally which may

humiliate a child/young person or could cause them to be ridiculed.

The imposition of any fine or financial penalty, other than a requirement

for the payment of a reasonable sum by way of reparation. The court

may impose fines upon children/young people which staff should

encourage and support them to repay.

Any intimate physical examination of a child/young person. In cases where

it is suspected that the child/young person is carrying drugs or an offensive

weapon a search of their clothing and possessions is acceptable,

if it is deemed safe to do so, with another staff member present.

However prior to this staff should request that the young person empties

their pockets. This must be recorded in the room search book in line with

National Minimum Standards.

The withholding of aids/equipment needed by a child/young person with

disabilities.

No other individual or group of children/young people should suffer the

consequences given to another individual.

Swearing at or the use of foul, demeaning or humiliating language or

measures. An example would be making a child/young person strip their

own bed and wash the sheets following an incident of bedwetting.

Humiliating someone, whatever his or her age is offensive, negative and

damaging to that person.

Removal of liberty by locking in a room or any place except to prevent

immediate harm to either themselves or other persons.

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Inappropriate bed times: This refers to children/young people being sent to

bed during the day or straight after school. It also refers to a punishment of

a series of early nights. If this is used as a method of discipline, then it

must only be for the night on which they misbehaved.

Baths on admission: As a matter of routine these are depersonalising and

offensive. Children/young people may choose to shower or have a bath on

admission - that is their right, not to be enforced.

The removal of photographs of family or comfort items such as teddy

bears or blankets.

Strict routine: Homes need to have routines. However, there needs to be

flexibility to meet the needs of all children/young people living here.

Routine should not be enforced as a punishment or for the benefit of staff.

7.0 Supporting positive behaviour

7.1 In managing challenging, aggressive or violent behaviour the ethos of

Knowsley homes is that of:

Prevention

De-escalation

Reflection / learning.

Respect

Support

Safe/caring environments.

7.2 Prevention: The need for interventions should be minimised by preventative

strategies.

Ensuring appropriate numbers of staff who are trained and confident in

their abilities.Page 16 of 36

Identifying and helping children and young people avoid situations which

may provoke violent or aggressive behaviours.

Engaging children and young people in meaningful and interesting

activities and structuring their time.

Involving children and young people in planning for their care and

behaviour management.

Systems in place for rewarding positive behaviour.

Ensuring care plans are in place to support young people with their

feelings and anxieties.

7.3 De-escalation: It is important to remember that how a situation is responded

to can cause it to either escalate or de-escalate (the conflict spiral). The

assault cycle’ (Kaplan & Wheeler 1983) describes six stages of a violent

incident:

The Trigger Stage: Child/young person is anxious. The trigger for an

incident might not be apparent; it may be one small thing in a chain of

experiences or may be a feeling or thought. It is important for staff to

notice and recognise changes in the children/young people e.g. eye

contact, breathing rates. De-escalation strategy: Staff need to intervene

by reducing the anxiety using diversion, support and reassurance. It is

important to remember that how staff respond to a crisis situation can

cause it to either escalate or de-escalate. This is the optimum time to intervene to prevent escalation of an incident.

Escalation Stage: Child/young person is more forceful, challenging others

to a confrontation, shouting, low destruction of property or alternatively

withdrawal or refusal to speak. De-escalation strategy: Using diversion

and reassurance, clear limits and boundaries need to be set and the

child/young person reminded of rights and responsibilities. Consequences

to actions need to be explained and limited choices given.

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Crisis Stage: Child/young person becomes a risk to themselves or others.

De-escalation strategy: Possible need for physical intervention based on

risk assessment.

Recovery Stage: Child/young person has stopped being violent. De- escalation strategy: Staff need to give support and reassurance and be

aware that the child/young person still presents a risk in this stage and

could go back into crisis, staff need to respect the young person’s space

and to be aware of their body language and the consequences of touching

a young person to comfort them.

Depressive Stage: Child/young person is upset by incident. De- escalation strategy: Support, review and forward planning. The negative

feelings produced as a result of an incident could damage the child/young

person further and become part of the conflict spiral. Relationships with

the staff involved could also be damaged unless there is a process of

repair and reflection so that all parties can learn from the incident, and

move forward.

Learning Stage: Staff and children/young people reflect on the incident

and learn from it through team meetings and supervision.

7.4 De-escalation strategies include:

Verbal advice, support, encouragement and reassurance (reminding of

past successes)

Distraction (activity, key word, job to do)

Humour if appropriate

Change of task

Negotiation (delayed compliance)

Contingent touch (hand on shoulder, guide away)

Removal of the audience

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Inform of desired behaviour

Remind of targets for reward system

Remind of rights and responsibilities

Remind of rules, boundaries and limits

Give choices, options and consequences (get out with dignity clause)

Offer of withdrawal

Physical intervention - including withdrawal (moving away from situation)

and holding

Change of face.

8.0 Behaviour management plans

8.1 For every child/young person living in a residential home who needs an

individual behaviour management plan, the plan should be based on a

risk Assessment and be developed in conjunction with their placement

plan. In the behaviour management plan, known behaviours and patterns of

behaviours should be recorded as well as known triggers for the

behaviour and the appropriate de-escalation strategies which have been

found to be the most effective in supporting the individual to manage their

behaviour.

8.2 Each child/young person is an individual and their plans should reflect this.

However, it is expected that any of the following identified behaviours will

feature in a behaviour management plan:

Running away

Anxiety or withdrawal

Bullying or other similar behaviours

Challenging behaviour

Drug or substance misuse

Lack of awareness of personal safety

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Offending or offensive behaviour

Prostitution

Self-harming behaviour

Sexually exploitative or inappropriate sexual behaviour

Violence or aggressive behaviour.

8.3 The child/young person, their family and staff involved in the planning

process will provide specific input to the behaviour management plan. The

plan must:

List the behaviours causing concern and the strategies to be adopted by

staff/carers to manage the behaviour(s) from the least intrusive to the

most restrictive.

Highlight whatever is likely to trigger the child’s behaviour.

Child/young person’s qualities.

8.4 Where the same behaviour is exhibited outside the placement, e.g. at school,

it is the responsibility of staff/carers and other professionals to work in

partnership to ensure consistency where appropriate.

8.5 Only techniques approved by PRICE must be agreed. Under no

circumstances should any methods/actions be agreed that are not

approved within this policy.

8.6 Every effort must be made to involve the child/young person, their family

and other professionals in the compilation of the behaviour management

plan and the social worker/carer should ensure that the child/young person

understands its contents. The plan should be read by all staff and should

be discussed at team meetings.

8.7 It is the responsibility of the child/young person’s care home to ensure that

the behaviour management plan is sent out with all completed Page 20 of 36

documentation from the placement planning meeting to relevant agency

representatives.

8.8 The manager must oversee and sign the plan and agree its contents

and strategies.

8.9 The plan must be reviewed on a six monthly basis or if a significant event

has occurred and any amendments agreed by the manager, stating the

reasons why. The behaviour management plan will also be reviewed at the

statutory review.

9.0 Restrictive physical intervention

9.1 As part of the assessment and planning process for all children/young

people, consideration must be given to whether the child/young person is

likely to behave in ways which may place him/herself or others at risk of

injury. If such risks exist, consideration must be given to the strategy that

will be adopted to prevent or reduce the risk. These strategies may include

physical intervention.

Risk assessments9.2 Whatever the situation staff need to make a risk assessment. This means

being aware of the child/young person’s:

Personal history

Individual education plan and care plan

Height, weight, level of aggression, potential for violence

Level of understanding

Medication and/or drug use

Characteristic ways of responding to stress and authority

The presence of other children and availability of other staff.Page 21 of 36

9.3 If it is assessed that physical intervention is necessary staff should:

Stay calm: Staff should approach situations where physical Intervention

may be needed in a calm and professional manner. It may be necessary

to take a step back and take a breath before action is taken.

Keep talking to the child/young person using strategies adopted at earlier

stages (supportive, reassuring, rights & responsibilities etc.).

PRACTICE GUIDANCEIn developing strategies, consideration must be given to whether there are any

medical conditions which might place the child/young person at risk should

particular techniques or methods of physical intervention be used

Request other adult support if not already present.

Remove other children from room if possible.

9.4 There are certain points to consider when making a decision to

physically intervene:

As part of an emergency response staff should have grounds to believe

that immediate action is necessary to prevent a child/young person from

significantly injuring themselves or others. Any intervention should be

reasonable and use the minimum force required.

Before using restrictive physical intervention, the member of staff should

be sure that the possible adverse outcomes from the intervention (e.g.

injury, distress) will be less severe than the adverse consequences

occurring without intervention.

As a planned response to known behaviour all the recognised strategies

recorded on a child/young person’s behaviour management plan for de- Page 22 of 36

escalation and diversion need to have been tried and failed before using

physical intervention. Occasionally, the plan may be for early physical

intervention in order to prevent known escalation of behaviour as part of a

care plan of behaviour management. This must be agreed and recorded

by all concerned (parents, young person, social worker etc.)

The child/young person should always be advised that they will be held

until they calm down. They should be given a sense of reassurance and

safety by the member of staff continuing to talk calmly and deliberately to

the person all the way through the intervention.

Staff members should remain calm and confident throughout the

intervention.

Restrictive physical intervention should last for the least amount of time

that is necessary to calm the child/young person down.

Children/young people should be held in a way as to expose them to as

little risk of injury as possible.

Staff should be sensitive to, and respect any cultural issues around

physical contact, wherever possible.

Restrictive physical intervention should never be used as an act of

retribution or punishment or as a means of exercising authority.

Restrictive physical intervention must not be used purely to force

compliance with staff instructions when there is no immediate risk to

people or property.

The minimum amount of force must be used in order to prevent injury or

damage to property. Any intervention must be reasonable and

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proportionate to both the behaviour and the harm it may cause. The

person being held should not be in pain or be injured as a consequence of

the holding.

Every effort should be made to secure the presence of other staff before

carrying out a restrictive physical intervention. These staff can assist or

observe and act as “critical friends”.

As soon as it is safe the intervention should be de-escalated to allow the

child/young person to regain self-control and allow the staff to disengage

in a structured and safe manner.

Consider the appropriateness of certain staff to deal with any escalating

situations e.g. appropriate gender. Any physical intervention should avoid

contact that might be misinterpreted as sexual.

Explanation of physical intervention

9.5 Physical intervention, including the use of ‘safe holding’ techniques, requires

a degree of restrictive physical action. Such interventions should be the

last resort and may be as little as a guiding gesture to communicate

meaning.

Holding: This includes any measure or technique which involves the

child/young person being held, so long as the child/young person retains a

degree of mobility and can leave safely if determined enough.

Touching: This includes minimum contact in order to lead, guide, usher or

block a child/young person; applied in a manner which permits the

child/young person quite a lot of freedom and mobility.

Presence: A form of control using no contact, such as standing in front of a Page 24 of 36

child/young person or obstructing a doorway to negotiate with a child/young

person; but allowing the child/young person the freedom to leave if they wish.

9.6 The appropriate holds should be employed dependent on the circumstances.

Whatever hold is used the child/young person needs to be advised what

will be happening and staff need to talk to the child/young person and each

other throughout.

9.7 There are a range of holds that can be implemented as part of PRICE

planned or emergency physical intervention strategies:

9.8 It is recognised that there may be certain situations when a child/young

person may drop to the floor e.g. if they go ‘dead-weight’. In such cases

the members of staff should support the child/young person to the floor

and then disengage in a safe manner.

9.9 Staff using physical intervention techniques should be trained in their use.

Relevant staff will receive training in physical intervention techniques as set

out in the home’s Statement of Purpose. Where staff/carers have not

undertaken such training, there is a “duty of care” to prevent injury either to

the child/young person or to others. The use of physical intervention may

still be justified if it is the only way to prevent injury. In these

circumstances, it is advisable for intervention to be undertaken in the

presence of a colleague. Any intervention used must:

Not impede the process of breathing

Not be used in a way which may be interpreted as sexual

Not intentionally inflict pain or injury or threaten to do so

Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas

Avoid hyperextension, hyper flexion and pressure on or across the joints

Not employ potentially dangerous positions.

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9.10 Physical Intervention should only be used if it is safe to do so. If

staff/carers believe their actions may escalate the situation or place

anyone at unacceptable risk, they must seek assistance from a

colleague/manager or the police.

9.11 It is not recommended that staff attempt to hold a child who is

significantly larger than they are. In this circumstance the member of staff

must call for help from colleagues in order to help calm the child down.

9.12 It is only appropriate for a member of staff to employ a single person hold

or escort for a short time in order to move a child away from a situation or

whilst they call for assistance. Staff should not be using the hold or

technique for any length of time.

9.13 The kitchen is a high-risk area and therefore physical intervention should be

avoided in this area. If a crisis is developing it may be necessary for

safety reasons to escort a child out of the kitchen.

9.14 Within P RICE there are techniques to adopt in separating young people

involved in fights. Staff must respond to a fight without putting themselves

at risk of being harmed. Staff may call or go for extra help whilst

encouraging the young people to stop fighting. It is important to tell the

young people involved to “stop”. The techniques taught require two

members of staff working as a team. The young people can be moved

away using the a “single embrace”.

Criteria for using physical interventions

9.15 Before any form of physical intervention is used, all of the following

principles must be applied:

There must be a belief that injury is imminent.Page 26 of 36

The intervention must be immediately necessary.

The actions or interventions taken must be a last resort and after de-

escalation techniques have been attempted and failed

Any force or intervention used must be the minimum necessary to achieve

the objective.

Locking and bolting doors

9.16 It is acceptable to use mechanisms or modifications in the home which

are necessary for security, for example on external exits or windows, so

long as this does not restrict children/young people’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/young people are not normally expected

to gain access.

9.17 If such mechanisms are used they must be outlined in the home’s

Statement of Purpose and staff must be briefed on the arrangements for

their use.

Notifications

9.18 If physical intervention is used upon a child/young person, the manager and

the child/young person’s social worker and parents must be notified

within 24 hours or as soon as practicable, unless it has previously been

agreed that it is not necessary to do so.

Recording

9.19 Every incident of physical intervention must be documented in the

child/young person’s case record on a significant incident record and in

the restraints book which is separate from the consequences book. The

entry must be signed by all members of staff involved in the restraint

and by the home manager. The record must include the following:Page 27 of 36

The date/time of the incident

The establishment/address and the location of the incident

The name of the child/young person

Names of staff and others present, including other children/young people

The events which led up to the need for the physical intervention

An exact description of the actions taken by staff, the nature and level of

the physical intervention used and its effectiveness

The outcome of the physical intervention including any injuries caused to

or reported by a child or young person

How the incident was eventually resolved

Risk assessment updated.

9.20 Completion of the relevant paperwork should occur as soon as

possible after the incident.

10.0 Post-incident support for staff and child

10.1 If physical intervention is used with a child/young person it is important that

both staff and the child/young person receive the necessary support

following the incident. The focus here is on reflection, repair and

change. Triggers for the incident and whether there were any alternative

methods of managing the child’s behaviour should be considered.

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10.2 All interventions must be recorded in the appropriate record book and in

the handover book. The child/young person must also be encouraged to

give their version of what has happened and their feelings about it. The

manager or deputy manager must be informed as soon as possible. If

outside office hours, the out of hours service should be informed as soon

as it is reasonable to do so.

10.3 Once the record is completed the manager should review and sign the

record.

10.4 The member(s) of staff involved will be de-briefed by the manager. The

session will be recorded and placed on the staff member’s supervision file.

10.5 At an appropriate time the incident needs to be reflected upon and

everyone given the opportunity to be de-briefed. The de-briefing session

should be undertaken by the manager and involve the member of staff and

child/young person where possible.

10.6 If the child/young person wants to make a complaint, the complaints

procedure should be followed.

10.7 Where physical intervention has been used, the child/young person,

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. Children and young must be asked twice would they like medical

treatment this needs to be immediately after the event and several hours

after.

10.8 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.

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10.9 Counselling should be made available for any member of staff or

young person requesting it.

11.0 Barricading

11.1 If children/young people lock or barricade themselves in a room to prevent

access by those caring for them, the actions taken in response will depend

on the risks posed, to the young people and others present.

Low risk

11.2 If the risks are low, which means that there is no perceived risk of injury,

damage to property or of any offence being committed, the situation

should be monitored and efforts made to obtain the child/young person’s

cooperation for a satisfactory resolution.

11.3 The strategies that should be adopted will depend on the age, level of

understanding of the child/young person and other circumstances on

the day. However, staff should do what they can to maintain a low risk,

and not to escalate the situation.

High risk

11.4 If there is a risk of injury, of an offence being committed, the action

taken should depend on the immediacy and seriousness of those risks.

11.5 The strategies that should be adopted will depend on the age, level of

understanding of the child/young person and other circumstances on the

day. However, staff/carers should monitor the situation, doing what they

can to reduce the risks.

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11.6 If possible, the child/young person’s social worker should be consulted

before actions are taken. However, it is for staff on the spot, to decide

what actions are necessary, having considered all the risks and

strategies that are available to them.

11.7 If at all possible, staff must act to prevent the situation escalating. If the

risk does escalate to an extent that physical intervention is required, staff

should not act alone and should consider the involvement of police

assistance to avoid physical assault or damage after consulting with the

manager.

Notifications

11.8 If the occurrence is concluded with the co-operation of the child/young

person and no force has been used, the child/young person’s social worker

must be notified at the first opportunity. Staff must evaluate the

occurrence, including whether any inappropriate activity took place

leading up to or during the barricading and record the outcome of the

evaluation on the child/young person’s case record.

11.9 If staff have to use forced entry or physical intervention, or the police

are called for assistance, it is deemed to be an incident and the

manager and child/young person’s social worker must be notified as soon

as possible or on the next working day.

11.10 The child/young person’s social worker should decide whether to

inform the child’s parent(s) and, if so, who should do this.

11.11 Where incidents are serious, the service manager must also be notified.

12.0 Training and monitoring of staff performance

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12.1 Everyone reacts differently to violence and aggression. Staff should be

given opportunities, beginning with the induction process and followed

up in supervision, to reflect on their personal responses to violent

situations and to develop appropriate strategies for dealing with the

feelings involved.

12.2 It is important that all staff receive physical intervention training at least

once every two years as a minimum requirement. The training

incorporates:

Creating a positive child care setting

Involving children and young people themselves in discussing the

issues of acceptable behaviour and control

Dealing with hostility constructively to prevent a situation escalating

Defusing aggression

Managing violence.

12.3 Specific scenarios should be discussed during team meetings whenever

issues arise. Any concerns over practice will be addressed individually with

staff in supervision or by a three-way meeting involving the manager,

deputy manager and RCCO. Areas of concern would be any members of

staff perhaps not intervening when appropriate; intervening too often and

not using other strategies first; or someone not offering help and support to

a colleague.

12.4 Incident records will be reviewed annually to determine if there any

implications for training.

13.0 Police involvement

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13.1 This section should be read in conjunction with the Crown Prosecution

Guidance regarding the Prosecution of Offending Behaviour in Children’s Homes (2006).

13.2 It is the policy of Children’s Residential Services to develop

cooperative relationships with the police and to seek their advice on

matters of concern, security and crime prevention where appropriate. It

is expected that local authority residential care establishments will develop

a close working relationship with the local Police.

13.3 The best way of working with children in residential care is to prevent

criminalising them through the involvement of the police and the justice

system, wherever possible. Illegal behaviour should not be condoned, but

it is important to be mindful of our duty to consider the overall welfare of

children/young people, which may mean recognising that illegal activity is

taking place and working to minimise risks and consequences.

13.4 Where there are concerns that a child/young person is engaged or likely to

be engaged in offending behaviour, actions must be taken to reduce or

prevent this behaviour. This may require involving other agencies,

including the police, to do this. If necessary the placement plan should

indicate whether and in what circumstances the police should be

contacted should suspicions arise about offending behaviour.

13.5 It is recognised that many of our children have difficulty with anger

management and expressing their feelings, as a result of their life

experiences and disruptive family life. Staff are expected to do all that is

reasonable to support children/young people looked after by them, which

includes the management of confrontational and disruptive behaviour.

Staff must do all they can to create a safe and positive living

environment for children/young people and every effort must be made to

help the child address their anger management through direct work and Page 33 of 36

involvement of outside professional agencies where appropriate. Despite

such difficulties it is not acceptable for residents to assault members of

staff or each other.

13.6 Where a child or young person has been violent/ aggressive for the first

time, it may be appropriate to consider different ways of dealing with

this. For example, structured direct work sessions on a one to one

basis; or input from other agencies (Youth Service, YOT, YISP). The

police will not normally be contacted unless the violence is serious,

persistent and/or life/limb are endangered, or the victim wishes to make a

complaint to the police.

13.7 Where a member of staff has been physically or sexually assaulted, then

contacting the police and pressing charges is an option for that individual.

However, it is important that the manager is informed as soon as possible

so that support can be offered. The manager will also inform the

fieldwork manager and/or child/young person’s social worker and

child/young person’s family, where appropriate.

13.8 In some circumstances the manager or principal manager may need to

inform the police on the person’s behalf, for example if the person has

had to leave site. It will be the responsibility of the member of staff

who has been assaulted to make their statement to the police and to

give the manager a copy of the statement.

13.9 It is always important to look at each case individually and to make an

informed decision based on the circumstances surrounding the incident;

previous incidents concerning the child/young person; and possibly

mitigating factors for the child/young person. It is also important to obtain

the views of the member(s) of staff concerned.

13.10 Whether to involve the police and how to involve the police will depend on Page 34 of 36

the immediate seriousness of the situation:

Urgent serious incidents:

Incidents of violence where children/young persons or staff are at risk of

immediate serious physical harm

Significant disorder within the home.

In such situations a member of staff should contact the police using the 999

system.

Non urgent serious incidents:

Assaults or damage has occurred and there is no risk of reoccurrence/

significant harm to people

Incidents of theft.

The incident should be reported to the Registered Manager who will decide the

appropriate course of action. Should the Registered Manager decide, and/or the

victim wishes, that police be involved, where possible this should be through the

Neighbourhood Policing Team.

13.11 If there is a suspicion that a child/young person may be engaged or

likely to be engaged in any criminal activity including theft or malicious

damage, staff must act to reduce or prevent the behaviour. This may

include taking steps to recover, repair or restore the property rather than

contacting the police.

13.12 Where a child/young person has damaged Knowsley Borough Council

property (criminal damage), it is the decision of the manager whether or

Page 35 of 36

not the police should be involved. With regard to damage to personal

property this decision rests with the individual concerned.

13.13 All decisions must be recorded together with the reasons for that decision

being made. Where the police have been involved in an incident, any

incident record should be copied to Ofsted and notification should also

be sent on the incident/accident report form to the service manager and

the health and safety officer.

13.14 If the police do become involved, a copy of the child’/young person’s

individual risk assessment and behaviour management plan should be

made available (and sent electronically wherever possible). They should

also be made aware if the child/young person concerned may have acted

inappropriately due to illness, bullying, or a disability such as autism,

ADHD or communication difficulties.

13.15 If a child/young person is arrested and charged, the Registered Manager

must decide whether the return of the child/young person to the home

would pose any risks to other children/young people in the home and

must request bail conditions accordingly. However it is Knowsley Borough

Council’s ethos within its residential homes to support each young person

as an individual and this is through difficult as well as positive times, and

giving up on our young people is not an option.

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