14.1 Physical Intervention |
Contents
1. Introduction
This section provides some general guidance on matters of physical intervention of children (i.e. a person aged 0 – 18 years). It also provides some guidance for foster care settings. It also references the St Christopher’s procedural manual dealing with intervention in Children’s Home or receiving a service. It also sets out the policies/procedures used in the Ramsey Respite Centre and Braddan Community Hub for children with complex needs.
2. General Provisions
Relationships between staff and children should be based on mutual respect and understanding and clear professional and personal boundaries should be in place, which are effective for both.
Carers should set and maintain safe, consistent and understandable boundaries for children in relation to acceptable behaviour.
Expectations of behaviour for both carers and children should be clearly understood and negotiated by those living in the home or receiving a service, including exercising appropriate control over children in the interests of their own welfare and the protection of others.
In day to day decision making, carers should demonstrate an appropriate balance between:
- Each member of the households wishes and preferences;
- The needs of individual children;
- The needs of the group of children resident at the time;
- The protection of others (including the public) from harm.
All children in the home or receiving a service must be looked after without favouritism or antipathy towards any individual or group within the home or receiving a service.
Where children require personal care, their choices of which carer (where more than one) provides that care should be maximised and within appropriate boundaries.
Carers should respond positively to acceptable behaviour, and where the behaviour of children is regarded as unacceptable, it should be responded to by constructive, acceptable and known disciplinary measures in line with this policy.
Measures of control and disciplinary measures must be based on establishing positive relationships with children which are designed to help the child.
Such measures must be fair and consistently applied. They should also encourage reparation and restitution and reduce the likelihood of negative behaviour becoming the focus of attention and subsequent disruption to the placement.
Carers should make clear to children the consequences of unacceptable behaviour and any measures applied should be relevant to the incident, reasonable and carried out as contemporaneously as possible.
Any measures taken to respond to unacceptable behaviour must be appropriate to the age, understanding and individual needs of the child, for example taking into account that unacceptable or challenging behaviour may be the result of illness, bullying, certain disabilities such as autism, or communication difficulties.
Sanctions and physical intervention must not be excessive or unreasonable and physical intervention must only be used:
- To prevent likely injury to the child concerned; or
- To others; or
- To prevent likely serious damage to property.
Intervention must not be used as a punishment, as a means to enforce compliance with instructions, or in response to challenging behaviour which does not give rise to reasonable expectation of injury to someone or serious damage to property.
Children should be assisted to develop socially acceptable behaviour through encouragement of acceptable behaviour and constructive adult response to inappropriate behaviour.
Children should be encouraged to develop a proper awareness of their rights and responsibilities. Carers and children alike must be clear that each individual has rights and responsibilities in relation to those who live in the home or receiving a service and people in the community.
Where there has been physical intervention, the child will have the right to be examined by a registered nurse or medical practitioner within 24 hours.
All children must be given an opportunity to discuss incidents and express their views.
When disciplinary measures or intervention are used, children should be encouraged to write or have their views recorded and sign their names against them if possible in the records kept by the carer.
3. Physical Intervention (Foster Care)
There are many circumstances when it would be appropriate to intervene physically to prevent behaviour that is prejudicial to the child or others. Examples of such circumstances might include:
- To prevent one child attacking another;
- A younger child refusing to dress appropriately, such as refusing to wear shoes to go outside;
- A child refusing to leave another person's room;
- To prevent a young child from running away.
In such circumstances physical intervention without contact, such as standing in the way of some forms of intervention with contact such as holding the child's hand or placing a hand on her/his shoulder, may well be appropriate.
Indeed some forms of physical intervention may have a positive impact on the child such as holding or cuddling a distressed child or holding a child for their own safety.
In themselves, none of the above interventions require any particular recording although carers must always be mindful of the circumstances of their intervention and if in doubt follow the instructions below for recording physical constraints.
Physical intervention is a more substantive intervention. By definition it will be against the child's stated will. Its aim is to take control from the child, to stop them from doing whatever they are doing, using the minimum amount of force and therefore the minimum amount of time necessary.
Physical intervention must only be used if a child is in immediate danger of harming themselves, others or causing significant damage to property.
It is acceptable to defend self and others from physical violence or threatened violence.
Physical intervention should ideally involve more than one carer, even if the second carer does not physically intervene but witnesses the intervention.
Carers should always seek to avoid the need for physical intervention through dialogue and diversion. The use of intervention is a last resort.
If intervention is necessary, a child should, where possible, be pre-warned that a intervention might take place if their behaviour continues.
Carers must have sound reasons for believing that other methods of intervention would not be appropriate or would fail. Sometimes this will necessitate carers not intervening physically immediately, but attempting other interventions or assessing the situation (even risking that the situation may worsen).
In assessing the situation, due consideration to the age and understanding of the child must be taken into account.
Disability and cultural factors might also be significant in determining the type of intervention.
Carers must at all times be mindful of a child's previous experiences. A child who has been physically or sexually abused may experience any form of physical contact differently from how it was intended.
Carers should not attempt any intervention if they do not think it is achievable.
Consideration should be given to the involvement of the emergency services.
If possible, consideration should be given to the timing and place of the intervention, paying attention to minimising the involvement of other children, as to witness a intervention may be distressing for any child.
There may be occasions when physical intervention is necessary to remove either a weapon or a dangerous substance from a child. This, however, does not include either physical or intimate searches of a child such as searching any clothing that they are wearing.
Intervention must not be used to force compliance or when there is no immediate risk involved, or as a means of punishment.
Carers should verbally advise the child's social worker, or the duty social worker of the use of an intervention within one working day at the latest.
Any use of de-escalation or restraint should be recorded.
Standard 3.8 of the FNMS 2011 states that all carers should receive training in positive care and control of children, including training in de-escalating problems and disputes.
4. Children’s Home
For full details of St Christopher’s policies on this matter, click on the link: \\reiltys\iomgroot\DeptShare_DSC\Protocol Useful Links\Procedures Manual_001.pdf
Ramsey Respite Centre and Braddan Community Hub for Children with Complex Needs
The behaviour policy set out below provides clarity and fairness to all children, carers, guardians, visitors and members of the public.
It is based on these key principles:
- Staff praise good, acceptable behaviour;
- Staff never ignore children’s behaviours – all staff are responsible for the behaviour of any young person at any time;
- Staff support inappropriate behaviour of any young person in an atmosphere of kindness, patience and understanding;
- Staff regularly inform parents/carers about the behaviour of their children;
- Staff actively support the principle of inclusion.
The majority of staff within the Ramsey Respite Centre is trained by Team Teach to use Positive Handling Techniques and de-escalation strategies for certain situations within and away from the centre.
All positive handling incidents must be recorded on the ‘Statutory Notification of Events’ forms. The completed form must then be given to a senior member of staff where they will put their comments onto the incident. This form will then be sent to the Registration and Inspection Unit, social worker and a copy stored on ICS.
A copy is to be held in the ‘Significant Events’ folder.
Parents/Carers must be informed if these techniques have been used.
Team-Teach techniques seek to avoid injury to the young person, but it is possible that bruising or scratching may occur accidentally, and these are not seen necessarily as a failure of professional technique, but a regrettable and infrequent side effect of ensuring the young person remains safe.
An effective risk assessment procedure, together with a well-planned behavioural plan (which should include strategies) should help keep emergency use of restrictive physical interventions to an absolute minimum. However, staff should be aware that in an emergency, the use of force can be justified if it is reasonable to use it to prevent injury or serious damage to property.
5. Recording
All incidents involving physical intervention (wherever they take place) must be recorded as detailed above.
Carers will need to exercise their own judgement as to when other forms of control and discipline warrant recording.
Some of the issues carers need to take into account include:
- Did the child view the action taken as fair and appropriate?
- Was the action taken discussed with and/or witnessed by others?
- Was the action taken part of an agreed action plan and/or agreed by the child’s social worker and/or birth parents?”
- Could any other party misconstrue the action taken or view it as inappropriate?
If the carer is in any doubt about whether any action taken should be recorded or not, then this is probably an indication that it should. When physical intervention has taken place it must be recorded and shared with the child’s social worker within 24 hours.
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