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Reducing the Need for Restraint and Restrictive Intervention

Written by George Matthews

 With thanks and acknowledgement to Bernard Allen - Training Consultant, Principal TT Trainer & Expert Witness (Liability)

 

In my view this is a considerable improvement on its predecessor and it addresses many

of the points we have been making to the government and regulators over the past four years.

Simply pressuring providers to reduce the number of recorded incidents, regardless of

whether or not the interventions were necessary, was a bad policy. Good policy and practice

reduces the need for restraint and restriction but also acknowledges that there may be

circumstances in which restraint and restriction are necessary.

 

Good Points

 

• Para 16 reflects a more balanced approach. It states that commissioners have a duty

to ensure that providers of services have the necessary knowledge, skills and competencies

to effectively promote positive behaviour, reduce risk and so eliminate the unnecessary use

of restraint.

 

• Para 21 states that schools, children’s homes, NHS and local authority approved

providers of foster care have responsibilities to protect the welfare and safety of children

and young people in their care. That should be their paramount consideration.

 

• Para 22 states, “Sometimes restraint will be necessary. Staff must have reasonable

grounds for believing that restraint is necessary in order to justify its use. Staff will need to

use their professional judgement in each case, assessing the risks involved and taking

account of the needs and circumstances of the child or young person (as set out in

relevant support plans drawn up for them).”

 

• Para 49 states that commissioners of training in restraint should “conduct due

diligence before commissioning any training, including checking that the training has

been devised by experts with a successful track record of working in the relevant

specialism.

 

• Para 53 acknowledges that any use of restraint carries risks and states that, “those

risks need to be balanced against the risks associated with other courses of action,

including the risks of taking no action at all. Risks associated with applying restraint or

deciding not to do so include causing physical injury, causing a flight response,

psychological trauma, distress and emotional disturbance to the child or young person

and to staff.”

 

• Para 56 states that, “when considering whether to use restraint with a child or young

person, staff should ask themselves: “What would I want somebody to do in similar

circumstances if this was my child?”

 

• Para 62 acknowledges that, “unplanned interventions require professional

judgement to be exercised in difficult situations often requiring split-second decisions in

response to unforeseen events or incidents where trained staff may not be on hand. Such

decisions, known as dynamic risk assessments, will include a judgement about the capacity

of the child or young person at that moment to make a safe choice. Staff training and

supervision of practice should support dynamic risk assessment.”

 

• Para 94 correctly distinguishes between Withdrawal and Seclusion. It describes

withdrawal as, “removing a child or young person from a situation which causes anxiety

or distress and taking them to a safer place where they have a better chance of composing

themselves. Staff would normally stay with the child to support them and monitor their

progress until they are ready to resume their usual activities. The guidance makes clear

that this form of restraint could be regarded as a restriction of liberty but one taken under

a setting’s duty of care in order to protect the child from harm, or risk of harm, to

themselves and/or others. Reasonable force can be used by staff in those circumstances,

where it is necessary.” That is very helpful.

 

• Para 96 correctly describes the legal situation as regards to seclusion. Seclusion is

defined as, “supervised containment and isolation of a child or young person away from

others, in a room/area from which they are prevented from leaving. It is designed to

contain severely disturbed behaviour which is likely to cause harm to others. The courts

have found that seclusion could be used with a young person where it was necessary in

order to control aggressive behaviour but only for so long as was necessary, proportionate

“This form of restraint could be regarded as a restriction of liberty but one taken under a

setting’s duty of care in order to protect the child from harm, or risk of harm, to

themselves and/or others. Reasonable force can be used by staff in those circumstances,

where it is necessary.”

 

and the least restrictive option likely to succeed, and in accordance with a risk and

restraint reduction plan and support plan designed to safeguard their psychological and

physical health. For young people over 16, without mental capacity, use of seclusion which

amounts to a deprivation of liberty must be authorised under the Mental Capacity Act

2005.” That is an accurate summary.

 

Issues

 

There is much in this guidance that, if true, should be applied in other related guidance.

The way children and young people are treated should be determined by the risks they face,

or pose to others, not the place they happen to be, or the status of the person who happens to

be dealing with them. Teachers, carers, residential care staff, special school staff, mainstream

school staff, PRU staff, social workers, police officers and prison officers should all behave

towards children and young people in a similar way.

For that to happen they need to receive similar training.

For example:

• Para 23 states that, “The use of restraint should be consistent with clear values and

sound ethical principles, as well as complying with the relevant legal requirements.” That

is absolutely correct but it should apply to all settings. Other guidance for other settings,

not covered by this document, must be brought in line with these values and ethical

principles.

For example:

• Para 89 states that, “staff must not cause deliberate pain to a child or young person

in an attempt to force compliance with their instructions.” Yet some training organisations

delivering training in mainstream schools and PRUs (to which this guidance does not

apply) do promote and teach the deliberate application of pain. It is also taught in the

juvenile justice system.

 

• Para 94-96 correctly clarifies the distinction between Withdrawal, Seclusion and

Isolation. It emphasises that seclusion is not used as a punishment. Why then does the

guidance for mainstream schools and PRUs state that seclusion or isolation rooms can be

used as a disciplinary penalty. The phrase, “schools should ensure that pupils are kept in

seclusion or isolation no longer than is necessary” suggests they are being kept in the room

“…the use of restraint should be consistent with clear values and sound ethical principles,

as well as complying with the relevant legal requirements across all settings.” 

against their free will. The statement that “schools should also allow pupils time to eat or

use the toilet” suggests these are not short term safety measures.

 

Summary

 

Overall I think this is a very good document. In particular, I appreciate the way the

department went about the process and made an effort to obtain a broader range of views.

Annex B is particularly useful as it includes a variety of typical scenarios from across the

range of settings to which this guidance applies. It should give confidence to professionals

when they need to act in the best interests of children and young people and at the same time

encourage them to improve their policy and practice in this area