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Reducing the need for restraint and restrictive intervention

The draft replacement for the 2002 joint guidance for special schools has been released and is currently subject to an online consultation on the Department of Health website until the January 24th 2018.

Team Teach fully supports and endorses the views expressed by Bernard Allen, Training Consultant, Principal Team Teach Trainer & Expert Witness (Liability). Further information can be found below.

We encourage all trainers, service managers and employers to respond to the consultation. Only by expressing your opinions about what is positive in the guidance and therefore more likely to stay and what areas could be improved, will your voices and opinions be heard and listened to.

With thanks and acknowledgement to Bernard Allen – Training Consultant, Principal Team Teach 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 reduce 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.

03 Jan 2018
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