Guidance for Behaviour Management and the use of Physical Intervention in Childrens Homes

April2016

Author: Reviewed by Ruth France

Last updated: 30th April 2016

Next update: April 2017

Page 1 of 29

GUIDANCE FOR BEHAVIOUR MANAGEMENT AND THE USE OF PHYSICAL INTERVENTION IN CHILDRENS 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. 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 handling in the past and this will strongly influence their response to controls imposed on 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 When examining or planning for the behaviour management and use of physical restraint it is imperative that they meet Regulation 35/20 and that measures of control take into account with the understanding, dignity, kindness and respect each young person should receive. Positive relationships should always be maintained.

1.6 No restraint shall be used unless identified within individual relevant plans and risk assessments agreed by the Registered Manager.

1.7 Regulation 20, Childrens Homes (England) Regulations 2015 outline incidences where restraint can be used, however this is subject to the risk assessment and the ethos of the home is to encourage positive relationships and decrease any inappropriate behaviour.

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 deal with behaviours within care homes in Knowsley.

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 - prevention of bullying in residential care.

3.0Legislative 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 Childrens Homes (England) Regulations (2015) 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.

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 or serious damage to property.

3.3 The guidance and regulations issued with the Children Acts 1989 (Volume 4 Residential Care) stated that physical restraint should be used rarely and only to prevent a child harming himself or others or from damaging property. Force should not be used for any other purpose, or simply to secure compliance with staff instructions. (DoH 1991 p15).

3.4 Since then there has been 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, or causing serious damage to property.(5.6i p10).

Taking Care, Taking Control (DoH 11/96): This is a training manual for Childrens homes regarding physical intervention with an emphasis on defusing situations, communication and post incident structure for children and staff.

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).

3.7 Regulation 20 sets out clear advice as to when a restraint could be used within a childrens home. The Quality Care Standard positive relationships.

3.8 Any measure of constraint should be proportionate. The Guide to Childrens Home Regulations including Quality Standards (2015) should be read, understood and adhered to by all staff members.

3.9 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 Control in Childrens Residential Care (DoH 1993).

3.10 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 force occurring as a response to unforeseen events.

3.11 The guidance emphasizes preventative strategies and acknowledges that the proactive use of restrictive intervention is sometimes in the best interests of the service user and could form part of a therapeutic strategy.

3.12 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.

3.13 There is a requirement in care settings that, if it is foreseeable that a service 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.

3.14 The childrens residential service has adopted Protecting Rights in the Care Environment (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.

4.0Day to day behaviour management

4.1 Due to the ethos which Knowsley childrens homes and the use of behaviour management, no child should be restrained. Staff should only use techniques in which they have received relevant training, such as PRICE. If the Registered Manager believes restraint is required, staff should be trained before any admission.

4.2 There are appropriate methods of developing and maintaining levels of acceptable 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 behaviour.

Establishing positive relationships with children/young people.

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 behaviour.

Planned structure of time and clear, consistent boundaries.

Positive role modelling by staff and constant verbal reaffirmation of what is acceptable behaviour. The language and behaviour of staff should at all times reflect a positive attitude towards young people.

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 Dont do that.

A star/points reward system to allow the child/young person to earn points in order to achieve their goals, for example, buying certain clothes or other items; or taking part in a particular activity.

The child/young person can also earn extra points, money or vouchers towards a reward or other treats for exceptional behaviour.

A child/young person makes amends by an apology or change of attitude. It may sometimes 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 taken into account.

Involvement of staff with children/young peoples activities rather than supervision.

5.0Consequences for unacceptable behaviour

5.1 Measures 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 peoples guide.

5.3 Before imposing a consequence to behaviour, staff must consult their senior colleagues and relevant children/young people.

5.4 Before any consequence is imposed, staff/carers must be satisfied of the following:

The child/young person was capable of behaving acceptably and understands what was required 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.

The child/young person understands the relevance of the imposed consequence.

5.5 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.

5.6 The emphasis should be on helping a child/young person manage his/her own behaviour rather than on punishment. The self-respect or sense of responsibility of the child/young person should be supported rather than undermined.

5.7 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 specific and time limited and must not be imposed 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 persons 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.

Removal of possessions: If a child/young persons 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 persons record. At no point should possessions be removed if they have significant reference to the identity of the child.

5.8 Unacceptable behaviour can often be rewarded by attention causing it to become habitual. It is essential that staff do not reward negative behaviour but give attention when the behaviour is positive.

5.9 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.

5.10 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 persons case record; and recorded in the consequences book which must be signed by the residential care manager.

6.0Prohibited consequences and measures of control

6.1 No imposed consequence must intimidate or frighten a child/young person. Certain consequences may not be imposed upon 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 staffs 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 persons contact with his or her parents, relatives or friends; or anyone acting in an official capacity e.g. social worker, solicitor, advocate, independent visitor.

PRACTICE GUIDANCE

This does not prevent contact or communication being restricted 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 childs 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 modification of a child/young persons behaviour through bribery or the use of threats.

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. This must be recorded in the room search book in line with National Minimum Standards. Any search of a child/young persons body orifices should only be undertaken in exceptional circumstances, and by a registered medical professional and with the consent of the child/young person. If the child/young person has secreted drugs and does not give consent then the police must be informed.

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

Any measure which involves a child/young person in the imposition of any measure against any other child/young person; or a group of children/young people suffering the consequences for the behaviour of an individual child/young person.

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.

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.

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.

7.0Managing challenging behaviour

7.1 In managing challenging, aggressive or violent behaviour the ethos of Knowsley homes is that of:

Prevention

De-escalation

Reflection / learning.

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.

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.

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 spelled out and limited choices given.

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 re-assurance and be aware that the child/young person still presents a risk in this stage and could go back into crisis. Be wary of touch at this stage.

Depressive Stage: Child/young person is upset by incident. De-escalation strategy: Support, therapeutic 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.

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

Change of task

Negotiation (delayed compliance)

Contingent touch (hand on shoulder, guide away)

Removal of the audience

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.

8.0Behaviour 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 The behaviour management plan will be different for each child, depending on the childs background and needs. 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

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 childs behaviour.

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 approved PRICE techniques 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 implications. 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 persons social worker to ensure that the behaviour management plan is sent out with all completed 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 weekly basis and any amendments agreed by the manager, stating the reasons why. The behaviour management plan will also be reviewed at the statutory review.

9.0Restrictive 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 or may cause damage to property. 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.

PRACTICE GUIDANCE

In 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.

Risk assessments

9.2 Whatever the situation staff need to make a risk assessment. This means being aware of the child/young persons:

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.

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.).

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, or from causing damage to property. 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 persons behaviour management plan for de- 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 therapeutic programme 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 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.

Definition 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 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 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 homes

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 or damage to property. 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.

9.8 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.

9.9 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.

9.10 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.

9.11 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. Wherever possible the kitchen should be locked if it becomes necessary to hold a child in order to prevent any injury from equipment, hot liquids, cookers etc.

Criteria for using physical interventions

9.12 Before any form of physical intervention is used, all of the following principles must be applied:

There must be a belief that injury or damage is likely in the predictable future.

The intervention must be immediately necessary.

The actions or interventions taken must be a last resort and after de-escalation techniques have been attempted.

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

Locking and bolting doors

9.13 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 peoples 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.

9.14 If such mechanisms are used they must be outlined in the homes Statement of Purpose and staff must be briefed on the arrangements for their use.

Notifications

9.15 If physical intervention is used upon a child/young person, the Registered Manager and the child/young persons social worker 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.

9.16 The social worker/staff in the home should make a decision about whether to inform the child/young persons parent(s) and, if so, who should do so.

Recording

9.17 Every incident of physical intervention must be documented in the child/young persons 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:

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.

9.18 Completion of the relevant paperwork should occur as soon as possible after the incident.

10.0Post-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 childs behaviour should be considered.

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 Registered Manager or senior principal 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 Registered Manager should review and sign the record.

10.4 The member(s) of staff involved will be de-briefed by the Registered Manager. The session will be recorded and placed on the staff members 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 Registered 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.

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.

10.9 Counselling should be made available for any member of staff or young person requesting it.

11.0Barricading

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.

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 persons co-operation 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, damage to property or 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.

11.6 If possible, the child/young persons 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 Registered 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 persons 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 persons 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 Registered Manager and child/young persons social worker must be notified as soon as possible or on the next working day.

11.10 The child/young persons social worker should decide whether to inform the childs parent(s) and, if so, who should do this.

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

12.0Training and monitoring of staff performance

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 a year 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 Registered Manager, Senior Principal Manager and staff member. 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.

13.0Police involvement

13.1 This section should be read in conjunction with the Crown Prosecution guidance regarding the Prosecution of Offending Behaviour in Childrens Homes (2006).

13.2 It is the policy of Childrens 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 manage 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 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). 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 Registered 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 persons social worker and child/young persons family, where appropriate.

13.8 In some circumstances the Registered Manager or responsible individual may need to inform the police on the persons 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 Registered 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 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

Substantial damage to property

Significant disorder with 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 home manager who will decide the appropriate course of action. Should the home 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 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 head of service for children in care and the health and safety officer.

13.14 If the police do become involved, a copy of the child/young persons 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.

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