SCOPE OF THIS CHAPTER
This Guidance is applicable to Children's Homes and Foster Homes.
It should also be read in conjunction with the following procedures:
- Encouraging and Rewarding Children
- Planning for Success
- Reminders and Making it Right
- Physical Intervention (including Restraint)
- Flowchart: Encouraging and Rewarding Success
- Flowchart: Reminders and Making it Right
- Appendix 1: Making it Right Form
1. Encouraging and Rewarding Children
Whilst children bring their own values and behaviours to placements, staff and carers play a key role in influencing children. The culture of the home, generated by the adults living or working there, is crucial. Foster carers/staff are expected to understand, manage and deal with young people's behaviour including encouraging children to take responsibility for their behaviour and help them to learn how to resolve conflict. A restrictive, unsupportive, discouraging and punishing culture will result in instability, hostility and possibly severe disruption.
Where children live in homes which have clear, fair boundaries, where they feel safe, encouraged and appropriately rewarded, they will thrive and do well. Such homes will also experience less instability and disruption.
It is for each home, primarily the people working or living in them, to create their own culture, for example through the use of restorative approaches. The following may be helpful.
- Listen to and empathise with children, respect their thoughts and feelings and take their wishes into consideration;
- Look for things that are going well, or any step in the right direction, and appropriately reward it;
- Rewards should be used in a creative and diverse way, specific to children's needs, capabilities and interests;
- This may mean that children are rewarded with toys, games, activities or monetary rewards;
- But all 'tangible' rewards should be accompanied by use of 'non tangible' encouragement and support - by staff and carers demonstrating to children that they have done well;
- Such 'non tangible' rewards include praising, smiling, touching and hugging children;
- Children usually benefit, early on, from rewards which may appear to outweigh that which is expected. This is normal; over time rewards can be more relevant as children's self esteem and skills improve;
- For example:
- Children who have few social or life skills and whose self esteem and confidence is low may require forms of encouragement and reward which are intensive, frequent or even excessive in order to help/remind them that they are doing well and appreciated;
- A child who has previously been unable to get up for school may be offered an expensive present or activity for getting up on time for a few days.
- Over time, as children achieve what is expected, such rewards should be reduced or children should be expected to achieve more for the same or a similar reward.
2. Planning for Success
Where behaviour is the cause for concern it is critical that plans are established to manage and hopefully change the behaviour.
Consistency is the key, where staff/carers manage behaviour inconsistently, little if any progress will be made; it may result in more disruption.
Where staff/carers work together, improvements will be made.
The setting of objectives or expectations must not be ad hoc or unplanned. It should be part of a Strategy, depending on children's assessed needs, interests and capabilities.
Planning is critical; particularly where children's behavioural needs are complex or where behaviours give rise to serious concern, such as violence, drug or substance misuse, self harming, bullying.
In such situations a Behaviour Management Plan must be drawn up and incorporated into children's Placement Plans.
Behaviour Management Plans should summarise how behaviours should be managed, including the Strategies that will be adopting in managing the behaviours; they should also state how acceptable behaviours will be encouraged and promoted.
These Strategies can include the Restorative Approach, Therapeutic Interventions, Physical Interventions, Sanctions and other measures; for example the use of incentive or reward programmes charts etc.
If the Behaviour Management Plan cannot be incorporated into the Placement Plans, it can be formulated separately and be an addendum of it.
Children should be involved in drawing up Behaviour Management Plans and should understand the relevance of them; though this may not always be possible, for example, where the child has severe learning disabilities.
Children should be also be capable of achieving what is expected; maybe with help or support from an adult or mentor, which may include another child.
Expectations placed upon children should never be beyond their capabilities; start small and encourage steps in the right direction.
Over time, children should be encouraged and supported to acquire the skills and level of responsibility and freedom which is within their capabilities and understanding; in turn, this will improve their self image and confidence.
If children are capable of it, they must be involved in monitoring and reviewing their plans - and in agreeing new objectives and strategies.
3. Reminders and Making it Right
Whilst it is important to reward acceptable behaviour, it is also critical to manage unacceptable or disruptive behaviour in the same, positive and consistent manner.
Matters of concern must be raised and discussed with the child, with a view to making it right - with support and encouragement and following restorative approach practices.
If misbehaviour is persistent or serious, strategies such as restorative conferences will be adopted; but minor or non-persistent behaviours should result in staff/carers engaging in restorative approaches:
- What happened?
- What were you thinking?
- How were/are you feeling?
- Who do you think has been affected?
- What needs to happen/do you need to do now?
Any step in the right direction must be approved of and rewarded whilst mistakes or problems should be openly discussed and strategies for change identified and encouraged.
The overall strategy should be to help the child do well.
4.1 Guidance on use of Sanctions
Sanctions can be very effective but, before imposing them, think about it.
Most looked after children have come to view themselves, and are often viewed by others, as failures.
They have had their fill of sanctions, usually imposed inconsistently, unfairly or as acts of revenge.
Before imposing sanctions, adults should do all they can to support and encourage children to do well.
If children do not behave acceptably, strategies should be adopted that are encouraging and rewarding.
Rather than noticing and sanctioning misbehaviour it is always better to notice and reward good behaviour - or any step in the right direction.
For example, it may be more effective to allow a child to have use of a video or TV at bedtime for getting up on time, rather than taking the TV away for getting up late. Same deal, different meaning!
The former is discouraging and causes resentment; the latter is encouraging, can improve self-esteem and relationships between children and staff/carers.
Be creative, think outside the box!
If children continue to behave in unacceptable ways, they should be reminded about what is expected and given further encouragement to get it right.
If misbehaviour persists or is serious, effective use of reprimands can act as a disincentive or firm reminder. If this does not work, or may not, sanctions may be effective.
Where sanctions are used they must be reasonable and the minimum necessary to achieve the objective. Also, there should be a belief that the sanction will have the desired outcome - increasing the possibility that acceptable behaviour will follow.
If sanctions are imposed, adults should apply the following principles:
- Sanctions must be the exception, not the rule. A last resort;
- Sanctions must not be imposed as acts of revenge or retaliation;
- Think before imposing the sanctions; don't apply it in the heat of the moment;
- Sanctions may only be imposed upon children for persistent or serious misbehaviour; where reminders and reprimands have already failed or are likely to fail;
- Sanctions should only be used if there is a reasonable chance they will have the desired effect of making the point and in reducing or preventing further unacceptable behaviour;
- Before applying any sanction, make sure the child is aware that his/her behaviour is unacceptable and, if possible, warn him/her that sanctions will be applied if the unacceptable behaviour continues;
- It is the certainty not the severity of sanctions that is important;
- Sanctions should only last as long as they need to, allowing the child the opportunity to make a fresh start as quickly as possible.
4.2 Approved Sanctions
The following restrictions, if placed upon a child, are deemed to be a sanction and must be recorded as such:
- Confiscation or withdrawal of a telephone or mobile 'phone in order to protect a child or another person from harm, injury or to protect property from being damaged. Any restriction on sending or receiving letters or other correspondence.
Apart from the above, it is for each home to develop Approved Sanctions suitable to the type of children placed there.
These sanctions must be approved by the Designated Manager and set out in Statements of Purpose, Staff/service Handbooks and Children's Guides or Placement Plans for individual children.
4.3 Non-Approved Sanctions
The following sanctions are non-approved, which means they may never be imposed upon children:
- Any form of corporal punishment; i.e. any intentional application of force as punishment, including slapping, punching, rough handling and throwing missiles.
- Any sanction relating to the consumption or deprivation of food or drink;
- Any restriction on a child's contact with his or her parents, relatives or friends; visits to the child by his or her parents, relatives or friends; a child's communications with any of the persons listed below; or his or her access to any telephone helpline providing counselling or advice for children;
- This does not prevent contact or communication being restricted in exceptional circumstances, where it is necessary to do so to protect the child or others.
- Any requirement that a child wear distinctive or inappropriate clothes;
- The use or withholding of medication or medical or dental treatment;
- The intentional deprivation of sleep;
- The modification of a child's behaviour through bribery or the use of threats;
- Any sanction used intentionally or unintentionally which may humiliate a child 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 which staff should encourage and support them to repay.
- Any intimate physical examination of a child;
- The withholding of aids/equipment needed by a disabled child;
- Any measure which involves a child in the imposition of any measure against any other child; or the Sanction of a group of children for the behaviour of an individual child;
- Swearing at or the use of foul, demeaning or humiliating language or measures.
The persons with whom the child may have contact, in relation to c) above, are:
- Any solicitor or other adviser or Advocate acting for the child;
- Any officer of the Children and Family Court Advisory and Support Service appointed for the child;
- Any social worker for the time being assigned to the child by his placing authority;
- Any person appointed as an Independent Person in respect of the Complaints Procedure;
- Any person appointed as an Independent Visitor;
- Any person representing the National Care Standards Commission;
- Any representative from the local authority in whose area the children's home is situated;
- Any person with delegated authority from the Secretary of State to conduct an inspection of the children's home and the children there.
5. Physical Interventions (Including Restraint)
This guidance should be read in conjunction with Physical Interventions Procedures.
Physical Interventions are interventions that employ a level of physical force to protect a child or others from injury or to protect property from being damaged.
5.1 Definition of Physical Interventions
Restraint also includes restricting the child's liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. This should all be recorded as restraint.
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;
- 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 involving 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.
5.2 Who may use Physical Intervention
Staff/carers may only use Physical Intervention if they have undertaken approved training. Staff in children's homes may only use restraint techniques that are approved by the home. Managers should ensure that new staff are trained in the home's approved techniques before they start working with children.
However, where staff/carers have not undertaken approved 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/carers should act in a manner consistent with other training or as they see fit.
In these circumstances, the interventions used must consistent with the procedures outlined in this manual - and the guidance set out in this chapter.
Whenever possible, the techniques used should reflect the person's previous training in the appropriate use of physical interventions.
In any case, the techniques used should:
- Not impede the process of breathing;
- Not be used in a way which may be interpreted as sexual;
- Not intentionally inflict pain or injury;
- 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.
5.3 Planning Ahead - Care and Placement Planning
It is accepted that Physical Intervention will often be used reactively, by adults faced with situation posing potential risks of injury or damage to property.
However, research evidence shows that injuries to adults and service users are more likely to occur when Physical Intervention is used to manage
Events which have not been foreseen, and for this reason great care should be taken to avoid situations where unplanned Physical Interventions might be needed.
As a matter of routine, preferably at point of referral or placement or as soon as possible thereafter, managers must conduct Risk Assessments to tease out whether the child's placement poses any risk of injury or damage to property - to the subject child or others living in the home.
Alternatively, such risk assessment and planning should occur after incidents where Physical Intervention may have been applied.
If continuing risks exist, managers must establish a plan outlining the Strategies to be adopted to reduce or prevent the behaviour occurring.
As far as possible, as described elsewhere in this manual, those strategies must avoid the use of Physical Interventions.
For example, the best way of helping a child to tolerate other children without being violent may be for an adult or mentor (another child, for example) to 'shadow' the child to help him/her.
However, such plans should include contingencies outlining whether Physical Intervention should be used; and advising the adults which techniques may be beneficial.
These plans and strategies, if possible, should be shared with the child concerned and should be reviewed - either routinely or after serious incidents have occurred.
5.4 Justification for using Physical Intervention
Restraint also includes restricting the child's liberty of movement. This can include changes to the physical environment of the home or removal of physical aides. These should all be recorded as restraint.
Restraint, which is the form of Physical Intervention used with the intention of completely directing, deciding and controlling a young person's free movement, may only be used where there is likely Significant Harm or Serious Damage to Property.
Other forms of Physical Intervention, which are less intrusive by degrees, such as Holding, Touching and Presence, may be justified to prevent Injury or damage to property which is less than significant or serious; which is also defined below.
Before Restraint or any other form of Physical Intervention is used, staff must be satisfied that it is necessary because there is a risk of injury or damage to property and that:
- It is in the best interests of the service user;
- That minimum force is used for the shortest time;
- Action taken prevents injury, pain and distress;
- Action taken maintain dignity of the Young Person;
- Reasonable and Proportionate;
- Any Action should be necessary.
A child/young person can be prevented from the leaving the home if it is felt they are at significant harm in the following circumstances:
- Sexual Exploitation;
- Gang Related Activities;
- Use of drugs.
5.5 The meaning of (Significant) Injury and (Serious) Damage to Property
There are differing justifications for the use of Restraint and other Physical Interventions.
Restraint is a form of Physical Intervention used to overpower a child, and should therefore only be used where the likely injury is SIGNIFICANT or the likely damage to property is SERIOUS.
Other forms of Physical Intervention - which are less intrusive by degrees, such as Presence, Touching and Holding - may be justified where the likely injury or damage to property is less significant or serious.
It is not possible to provide an exhaustive definition given the variety of situations that adults may face or how they should act. It is for the adult(s) on the spot to decide themselves and act accordingly - in keeping with procedures and guidance set out in this manual and the training they have received.
However, Injury and Damage (which is not significant or serious) may justify less intrusive Physical Interventions such as Presence, Touching or Holding include the following:
- Minor injuries caused to the child or others;
- Wilful or reckless behaviour which may result in the child/others being at risk of harm;
- The likelihood of criminal offences not involving violence or potential risk of injury;
- Minor drug or alcohol misuse;
- Minor damage to property belonging to the child, the authority or others.
For Restraint to be justified (the use of Physical Intervention with the intention of overpowering the child) the likely injury must be significant and the likely damage must be serious.
Significant Injury is broadly defined as actual or grievous bodily harm, physical or sexual abuse, risking lives of or injury to, the self or others by wilful or reckless behaviour and self-poisoning. This may include the following:
- Actual and grievous bodily harm or more serious violent offences;
- Attempted suicide or death;
- Contact with known or suspected Risk to Child Offender;
- Injury requires medical attention;
- Serious drug or alcohol misuse;
- Sexual exploitation, including sexual abuse or child pornography;
- Theft/being carried in a stolen vehicle, or other criminal offences of a serious nature;
- Serious damage to property.
For any form of Physical Intervention to be justified those using it must firstly believe that injury or damage is likely in the predictable future.
5.6 The meaning of 'Predictable Future'
For any form of Physical Intervention to be justified, there must be a risk the injury or damage is likely in the predictable future.
The fact that injury or damage has already occurred would not be a justification for Physical Intervention UNLESS there is a risk that further injury or damage would follow if adults did not act. For example, a child may break a small window, which may be interpreted as a minor misdemeanour and unlikely to be repeated; therefore Physical Intervention may not be justified.
However, if the child is likely to use fragments of the glass as a weapon to cause significant injury to him/herself or another person, the use of physical intervention, even restraint, may be justified in order to protect the person(s) and confiscate the glass.
Adults must not only believe that the injury or damage is likely in the predictable future but also that action is immediately necessary.
5.7 The meaning of 'Immediately Necessary'
Immediately Necessary means that staff/carers believe it is necessary to act, at the time, to prevent a child or others from being injured or to prevent property from being damaged at some time in the Predictable Future.
If at all possible, all the adults caring or the child should consult each other before acting; even if there is an agreed plan or strategy in place to manage the behaviour.
However, if this is not possible, the adults must act as they see fit on the spot - as far as possible within the parameters of the child's Care Plan, Placement Plan or other plan in place.
If no plan/strategy is in place, the adults must act as they see fit within the procedures and guidance in this manual and the training they have received.
Before acting, the adults must satisfy themselves that their actions are necessary as a Last Resort.
5.8 The meaning of 'last resort'
Last resort means:
- That all other non-physical methods of persuasion or control failed;
- That all available non-physical methods would not work in the circumstances.
The other methods, which may work in the circumstances, can include less intrusive Physical Interventions. However, adults may not use any Physical Interventions unless they are satisfied that non-physical interventions have failed or would not work in the circumstances.
If possible, adults must adopt verbal and non-verbal skills, engaging children, calming, reaching; using humour, the intervention of colleagues; negotiating, listening, ignoring or leaving the situation if it works.
If these actions are not working (or adults believe they would not work if tried) they may use Physical Interventions.
However, adults who use Physical Intervention before trying or considering non physical methods leave themselves open to criticism and could be subject to complaint, disciplinary action, involvement of the Police or Child Protection agencies.
Also, if Physical Intervention is required, adults may only use the minimum force necessary to achieve the objective.
5.9 The meaning of Minimum Force
If Physical Intervention is immediately necessary (see Section 5.7, The meaning of 'Immediately Necessary'), as a last resort (see Section 5.8, The meaning of 'last resort'), the force used must be the minimum necessary to achieve the objective.
The minimum necessary means exactly that:
The amount of force used must be commensurate with the desired outcome and the specific circumstances in terms of intensity and duration.
For example, it may be necessary to hold or restrain a child for a short period whilst s/he calms down sufficiently to re-join a group or activity; or to temporarily block or prevent a child from leaving the home to give staff/carers time to divert the child's attention from absconding.
It may also be appropriate for a person to block or prevent a child's mobility or movement using restraint whilst help is summoned, then giving the opportunity for the intervention to be reduced when they arrive.
In all cases, the measures must be used for the minimum or shortest time necessary; and the amount of force used must be the minimum that is necessary. The possible adverse affects associated with the measures used be less severe that the adverse consequences which may have occurred without it.
The minimum necessary may mean that proximity or use of physical presence will work in the circumstances; and that it will not be necessary to use more intrusive forms of Physical Intervention.
However, where the risks are greater, and other less intrusive interventions have failed or would not work, holding or restraint may be the minimum that is necessary to achieve the objective.
In any case, caution should be exercised in releasing or reducing interventions too early; to do so may escalate rather than calm the situation. Disengagement should normally be undertaken in a planned and controlled manner.
If it is not possible to consult others before acting, the onus is on adults, on the spot, to decide what level of intervention is appropriate in the circumstances; considering, for example:
- Any agreed strategy or plan that may exist for managing a given situation;
- The age, size and ability of the child and person managing the behaviour;
- The understanding of the child and ability to make informed decisions;
- Any disabilities or medical conditions the child may be suffering;
- The abilities, skills of the person(s) managing the incident, and the training they have undertaken;
- The emotional and mental state of the child; and whether the child is under the influence of alcohol, drugs or other substances;
- The child's background, history of using violence, etc.
Whatever interventions or measures are taken, the adults must not place themselves in a position where anyone's safety is seriously compromised. In such circumstances they should call for help, maybe from the police, or retreat if that is the only safe option open to them.
5.10 Use of Physical Intervention as a Sanction
Physical Intervention may not be used as a sanction.
5.11 Using Physical Interventions to prevent children being Absent
Also see West Mercia Missing Protocol.
Using restraint to prevent a child from leaving
Restraint may be used to prevent a child from absenting him/herself in the following circumstances:
- To prevent any child from leaving where there is a likelihood of Significant Injury (see Section 5.5, The meaning of (Significant) Injury and (Serious) Damage to Property) at some time in the predictable future;
- To prevent a child who is remanded or otherwise lawfully detained in local authority accommodation from leaving, if the offences for the remand/detention are serious, for example, of a violent nature.
A child/young person may also be prevented from the leaving the home if it is felt they are at significant harm in the following circumstances:
- Sexual Exploitation;
- Gang Related Activities;
- Use of drugs.
Restraint may include the locking of a door temporarily to prevent a child from leaving; further guidance on such measures, are contained in Physical Intervention Procedure.
Using other, less restrictive forms of Physical Intervention to prevent a child from leaving
Physical Interventions which fall short of Restraint, such as holding, touch or presence, may be used to prevent a child from leaving where the risk of injury is not significant or the risk of damage is not serious.
These measures can include the bolting of a door temporarily to restrict a child's mobility or win time to call for help from others.
Such measures may be appropriate in the following circumstances:
- Where a child aged 11 or 12 persistently attempts to leave the home in the evening against the instructions of the adults, where these instructions are based on a considered and reasoned view that the child's welfare is likely to be prejudiced or s/he is likely to come to harm;
- Where a teenager is known to be engaged in vice or criminal activity or otherwise known to be under negative influence or be at risk of harming him/herself or others.
In these and other similar circumstances which do not necessarily constitute Significant Injury or Serious Damage to Property (see Section 5.5, The meaning of (Significant) Injury and (Serious) Damage to Property) adults must first try to reassure, set clear limits, boundaries and choices to prevent children from leaving; but if these actions fail or it is believed they would fail adults can use their presence, touch or holding to prevent children in these circumstances from leaving.
It may also be reasonable for adults to bolt a door temporarily to restrict a child's mobility, or in order to win time, slow a child's progress or call for help from others.
However, the Physical Intervention used must be used as a Last Resort (see Section 5.8, The meaning of 'last resort') and must be proportional to the risks.
If the child persisted in the circumstances and there was no risk of significant injury or serious damage to property the adult may have to allow the child to leave.
5.12 Forcing compliance
Physical intervention may not be used simply to enforce compliance or in response to challenging behaviour unless the behaviour gives rise to the expectation of injury or damage to property.
For example, if a child was arguing or being offensive toward another child or others including the adults looking after them, it may be appropriate to remonstrate, caution or reprimand the child; it may be appropriate to impose a sanction.
It may also be appropriate to use such measures if a child was refusing to comply with a reasonable instruction, such as a request to leave the room, get up in the morning or retire at night.
Such measures as reprimands and sanctions may be appropriate if other, more encouraging measures are unlikely to work in the circumstances.
However, it would not be appropriate to use Physical Intervention unless injury or damage was also likely.
Therefore, if a child was refusing to leave a room, and the adults suspected that if the child did not leave, injury or damage to property would follow in the predictable future, they may be justified in using their presence or other less intrusive forms of physical intervention to guide or coerce the child into doing as required.
An alternative would be to ask colleagues to remove or withdraw the other children present.
The same principles may apply in getting a child up in the morning. Physical Intervention would not be justified simply to get a child out of bed if there were no likelihood of injury or damage to property in the predictable future. However, it may be reasonable to take such action if doing so prevented disruption leading to injury or damage to property within a predictable timescale.
In all these and other similar circumstances adults should discuss such issue and plan ahead; preferably setting out the strategies to be used in the child's Placement Plan.
5.13 Locking of Doors
Procedures on Locking or Bolting of Doors, are contained in Physical Intervention Procedure.