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Contents

1. Planning for Children 
2. Definition of Physical Interventions 
3. Who may use Physical Interventions 
4. Criteria for using Physical Interventions
5. Locking or Bolting of Doors 
6. Seclusion, Time-out and Withdrawal  
7. Medical Examination 
8. Notifications 
9. Recording and Management Review 

1. Planning for Children

As part of the assessment and planning process for all children, consideration must be given to whether Physical Intervention may be necessary in managing behaviour.

If Physical Intervention may be necessary, the circumstances that give rise to it and the Strategies for managing it should be outlined in a relevant plan, such as a Care Plan or Placement Plan

This plan should outline the circumstances which may give rise to the use of Physical Intervention, the methods which are known or likely to be effective and other arrangements for its use. 

It is also important to determine whether there are any medical conditions which might place the child at risk should particular techniques or methods of physical intervention be used.  If so, this must be drawn to the attention of those working with or looking after the child and it must be stated in the child’s plan. If in doubt, medical advice must be sought.

Those techniques which are used must comply with the principles and procedures set out in this Chapter and the associated Guidance.  See Section 3, Who May Use Physical Interventions

*Re Plans: The existence or absence of a plan does not prevent staff/carers from acting as they see fit in the management of highly confrontational or potentially harmful behaviour.  However, staff/carers may only deviate from agreed plans where they are able to demonstrate that that the plan would not be sufficient to prevent Injury or Damage to property and the alternative actions they take are consistent with the principles contained in this Chapter.  Any deviation from an agreed plan or from the principles contained in this Chapter must be reported to the manager and child’s social worker as soon as practicable thereafter.

2. Definition of Physical Intervention

There are four broad categories of Physical Intervention. 

Restraint: Defined as the positive application of force with the intention of overpowering a child.  Practically, this means any measure or technique designed to completely restrict a child’s mobility or prevent a child from leaving, for example:

• Any technique which involves a child being held on the floor (note: Prone ‘face down’ positions may not be used in any circumstances);
• Any technique involving the child being held by two or more people;;
• Any technique involving a child being held by one person if the balance of power is so great that the child is effectively overpowered; e.g. where a child under the age of ten is held firmly by an adult.;
• The locking or bolting a door in order to contain or prevent a child from leaving.;

The significant distinction between the first category, Restraint, and the others (Holding, Touch and Presence), is that Restraint is defined as the positive application of force with the intention of overpowering a child.  The intention is to overpower the child, completely restricting the child’s mobility. 

The other categories of Physical Intervention provide the child with varying degrees of freedom and mobility.

Holding: This includes any measure or technique which involves the child being held firmly by one person, so long as the child retains a degree of mobility and can leave if determined enough. 

Touching:  This includes minimum contact in order to lead, guide, usher or block a child; applied in a manner which permits the child quite a lot of freedom and mobility.

Presence:  A form of control using no contact, such as standing in front of a child or obstructing a doorway to negotiate with a child; but allowing the child the freedom to leave if they wish. 

3. Who may use Physical Interventions

Normally, staff may only use Physical Intervention if they have undertaken approved training. Where staff have not undertaken such training, the use of force may still be justified if it is the only way to prevent injury or damage to property.  In these circumstances, staff must always act in a manner consistent with the values and principles set out in this manual.  Any intervention used must:

1. Not impede the process of breathing
2. Not be used in a way which may be interpreted as sexual
3. Not intentionally inflict pain or injury
4. Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas
5. Avoid hyperextension, hyperflexion and pressure on or across the joints
6. Not employ potentially dangerous positions

In any case, the use of force must reflect the values and principles set out in this Chapter.

4. Criteria for using Physical Interventions

There are different criteria for the use of Restraint and other forms of Physical Intervention, such as Holding, Touching and Physical Presence/proximity.

Restraint, which is the form of Physical Intervention used with the intention of overpowering a child, may only be used where there is likely SIGNIFICANT injury.

Other forms of Physical Intervention, such as Holding, Touching or Presence, are less forceful and restrictive than Restraint and may be used to protect children or others from injury which is less than significant or to prevent damage to property which is less than serious.

1. Before Restraint or any other form of Physical Intervention is used, all of the following principles must be applied
   1. For the intervention to be justified there must be a belief that injury or damage is likely in the Predictable Future
   2. The intervention must be Immediately Necessary
   3. The actions or interventions taken must be a Last Resort
   4. Any force or intervention used must be the Minimum Necessary to achieve the objective

5. Locking or Bolting of Doors

It is acceptable to use mechanisms or modifications to a children’s home or foster home which are necessary for security, for example on external exits or windows, so long as this does not restrict children’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 are not normally expected to gain access.

If such mechanisms are used in foster homes, they must be agreed by the manager of the fostering service and set out in the Foster Care Agreement.

Apart from this, it may be reasonable to temporarily (*See next paragraph) bolt or lock a door to contain a child or prevent a child from leaving.  Such action would be Restraint (defined above)and therefore may only be used if there was a risk of Significant Injury (also see above).

*Temporarily means that the child may only be contained or prevented from leaving until the risk of Significant Injury has diminished.  As soon as the risk diminishes, the door must be unlocked or unbolted.  However, staff/carers may still impose less intrusive forms of Physical Intervention upon a child if it is necessary to prevent Injury.

For example, staff/carers may closely supervise or otherwise use their presence whilst remonstrating with or using other verbal techniques to calm a child sufficiently to re-join a group or activity or to block a child to give other staff/carers time to remove a group or other stimulus.

Where the locking or bolting of a door extends beyond a reasonable timescales or the risks to the child, staff or others become too great, staff/carers should consider asking the Police for assistance. See Contacting the Police Procedure.

6. Seclusion, Time-out and Withdrawal

Where the following measures are used, they must be formally approved and the arrangements for their use set out in writing.  In Children’s Homes, the arrangements must be set out in a Statement of Purpose.  In Foster Homes, the arrangements must be set out in the Foster Care Agreement and Placement Plan for relevant children.

Seclusion is where a child is forced, by use of Physical Intervention, to spend time alone against their will, for example where a child is placed or made to remain in their bedroom.

Time out involves restricting the child’s access to all positive reinforcements as part of a behavioural programme.

Withdrawal involves removing a child from a situation, which places the child or another person at risk of injury or to prevent Damage to Property, to a location where s/he can be continuously observed or supervised until ready to resume usual activities.

7. Medical Examination

If Physical Intervention has been used, the child, 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.

The Registered Nurse or Medical Practitioner, if seen, must be informed that any injuries may have been caused from an incident involving Physical Intervention.

Whether or not the child or others decide to see a Registered Nurse or Medical Practitioner must be recorded, together with the outcome.

8. Notifications

Unless it has previously been agreed that it is not necessary to do so, the child’s social worker (and manager, for children placed in foster care) must be notified as soon as practicable but within 24 hours if an Incident of Physical Intervention upon a child occurs. 

The social worker should make a decision about whether to inform the child’s parent(s) and, if so, who should do so.

Foster carers involved in such incidents must also inform their supporting social worker or in their absence, the fostering duty worker.

It is essential that the child's social worker is informed by an independent provider of care if such an incident takes place.

9. Recording and Management Review

The use of Physical Intervention is deemed to be an Incident, and must be recorded as such. 

All Incidents involving Physical Intervention must be subject to a Management Review. 

End