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.
Page 28 of 36
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.
Page 30 of 36
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
Page 31 of 36
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
Page 32 of 36
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.
Page 36 of 36
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