000 Holding Safely Introduction
- 1. HOLDING SAFELY A Guide for Residential Child Care Practitioners and Managers about Physically Restraining Children and Young People. Edited by Jennifer Davidson, Dennis McCullough, Laura Steckley and Tim Warren
- 2. © The Scottish Institute for Residential Child Care 2005 Published by the Scottish Institute for Residential Child Care Scottish Institute for Residential Child Care University of Strathclyde 76 Southbrae Drive Glasgow G13 1PP All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher and the copyright owners. The Ministerial foreword and the Scottish Executive and Social Work Inspection Agency logos are © Crown Copyright 2005. They may not be used without express prior permission from the respective parties. ISBN-1 900743 28 0 Designed by Tom Malone, Learning Services, University of Strathclyde
- 3. Holding Safely Ministerial Foreword Our vision is for a Scotland where all our children and young people are safe, nurtured, healthy, achieving, active, included, respected and responsible. In trying to achieve this vision, we face many challenges, but we must be prepared to overcome them. In the spring of last year the Scottish Institute for Residential Child Care was asked to take on the difficult task of producing guidance on the restraining of children and young people in residential establishments. I welcome this important guidance. Residential child care is intensive and at times very difficult work. Staff in residential childcare, therefore, need training, advice, supervision and support in undertaking this demanding work, since they are often doing the hardest of social care jobs. This good practice guidance has been commissioned to assist practitioners in working out policies and practices for restraining children and young people where no other appropriate options are available. This guidance offers what might for some seem a radical approach to the care of children, based on a partnership between staff and children and young people, to ensure that those children and young people are safe and able to develop constructive ways of living. And this guidance will help people in residential child care across Scotland, with the appropriate training, to review if, when, why and how they restrain children, and to arrange matters so that the welfare of those children and young people is always given paramount importance, even and especially when they are likely to harm themselves or others. My thanks go to the many experts who have given so generously of their time, who have managed to deliver such helpful guidance. But more especially my thanks go to the young people whose sobering voices we heard in Letʼs Face It! They showed great courage in speaking out about their experiences of being restrained and we appreciate all that we have learned from them. I recommend this guidance as good practice, and I hope that all residential childcare homes and schools will apply this document rigorously, to develop the quality of care and restrain children safely. Euan Robson MSP Deputy Minister for Education and Young People I Click here to go to Contents Click here to go to Contents
- 4. Holding Safely II Click here to go to Contents Click here to go to Contents
- 5. Holding Safely SIRCC Foreword Residential child care practitioners are often doing the most difficult jobs: they work closely with children and young people who face significant challenges and express intense emotional reactions, and in this environment their patience, skills and personal strength are regularly tested. And yet the children under their care can also be creative, caring and capable, and practitioners must engage with them in ways that help them grow to their full potential. The weight of these responsibilities is heaviest when a child or young person is most distraught and violent, and if they cannot be calmed, staff must be prepared to intervene effectively and safely. Employers and managers are responsible to ensure that they are indeed prepared, through training, advice and supervision, to undertake this aspect of their demanding work. Yet despite the level of these responsibilities, there is a general absence of recent good practice guidance on the topic of physically restraining children and young people. This lack of guidance is just one good reason to develop Holding Safely. There are others: In the Who Cares? Scotland report, Letʼs Face It! young people themselves have said how important it is that the staff caring for them know (1) how to restrain them properly, (2) what are the right reasons, and (3) how to listen genuinely to their views. In their recent review of childrenʼs rights in the United Kingdom, the United Nations monitoring body for the Convention on the Rights of the Child monitoring body called for the United Kingdom to review its use of physical restraint. We need to pay more attention to both the young peopleʼs, and the UNʼs concerns. When the Scottish Institute for Residential Child Care was asked by the Scottish Executive Social Work Services Inspectorate (now the Social Work Inspection Agency) to produce this guidance, we were both honoured and daunted by the task. We were daunted, because we recognised that guidance which focuses on physically restraining young people will isolate restraint from the critical de- escalating interventions which must surround it. We were concerned that by producing guidance which focuses on physically restraining young people, some readers might interpret this as an encouragement to use physical restraint. We are fully aware of the importance of considering physical restraint in the broader context of ethos and de-escalation interventions. We have no intention of encouraging the restraint of young people where it is not absolutely necessary. We believe that directly addressing the restraint of children and young people emphasizes the need for practitioners to have the right skills, knowledge and attitudes. Taking account of this guidance should reduce those occasions when you need to restrain a young person, and prepare you for the times when this is absolutely necessary. continued III Click here to go to Contents Click here to go to Contents
- 6. Holding Safely I have referred to ʻweʼ, as this document was created by a committed and passionate group of managers, practitioners and experts in the field, and informed by young people and staff who have spoken candidly about their experiences of being restrained and restraining. We thank the writers for all their hard work and the young people for their courage in speaking out about their experiences of being restrained. This guidance could not have existed without their willingness to share their experiences, time and vast knowledge. Our hope is that this guidance will take us one step closer to more effectively meeting children and young peopleʼs needs and upholding their rights in Scotland. Jennifer Davidson Director, Scottish Institute for Residential Child Care IV Click here to go to Contents Click here to go to Contents
- 7. Holding Safely Membership of the working group This guidance has been put together by the Scottish Institute for Residential Child Care (SIRCC). They invited the following to assist them in producing this good practice guidance on restraining children in residential child care. Jane Arrowsmith, Head Teacher, Oakbank School Ian Beattie, Principal Officer Child Care, Renfrewshire Council Social Work Department Jennifer Davidson, Director, Scottish Institute for Residential Child Care Denis Ferrie, Head of Education, St Philips School Clare Gent, Project Manager, NCH Scotland. Di Hart, Principal Officer – Children in Public Care, National Childrenʼs Bureau Andrew Hosie, Lecturer, Scottish Institute for Residential Child Care Andrew Kendrick, Professor of Residential Child Care, Glasgow School of Social Work Meg Lindsay, Quality of Care Consultant, CareVisions Eddie McCaffrey, Head Teacher, Seafield School Dennis McCullough, Former Head of the Department of Social Work, University of Strathclyde Janet Miller, Learning and Development Adviser, Scottish Social Services Council Brodie Paterson, Lecturer, University of Stirling Janis Ringrose, National Advocacy Manager, Who Cares? Scotland ey , Laura Steckley,, Lecturer, Glasgow School of Social Work Tim Warr en, Inspector of Social Work, Social Work Services Inspectorate Jane Weir, Care Commission Officer, Scottish Commission for the Regulation of Care Thanks to Paul Tweedie of the Scottish Executive for his spreadsheet skills and patience. V Click here to go to Contents Click here to go to Contents
- 8. Holding Safely Status of this guidance It may be useful to clarify that this guidance aims to set out current best practice on restraining children. As such it does not impose legal obligations nor is it an authoritative statement of the law -- these are essentially matters for the courts, who will always look at the individual circumstances of each case. You should always reflect on whether the particular situation you find yourself in can be answered with reference to this guidance alone and consider seeking further advice. This said, Holding Safely could potentially be referred to in legal proceedings, and if residential child care practitioners and managers follow it, it could help to avoid an adverse judgement by a court. VI Click here to go to Contents Click here to go to Contents
- 9. Holding Safely Contents Glossary Page viii Preface Page xi One: Definition and Introduction Page 1 Two: Creating the Right Conditions Page 9 Three: Training for the Physical Restraint of Children Page 19 Four: Risk Assessment and Care Planning Page 25 Five: The Practice of Restraining Children Page 35 Six: Ending the Physical Restraint of a Young Person Page 45 Seven: Learning from Events Page 53 Eight: Recording the Event and Letting Others Know Page 59 Nine: Monitoring the Restraint of Young People Page 67 Ten: Areas of Danger and Concern Page 75 Recommended Further Reading and References Page 78 Appendix 1: Flow Chart of Key Considerations When Restraining a Child Page 82 Appendix 2: Example of Risk Assessment Form Page 84 Appendix 3: Report for Recording Incidents Where You Restrain a Child Page 89 Appendix 4: Legal Issues Page 95 VII
- 10. Holding Safely Glossary We have written this guide for a professional audience who may already be familiar with many of the terms which we have listed in this glossary. However, we felt it would be helpful to be clear about the meanings we give to certain terms when we use them in this guide. assault See box at 1d4 and appendix 44 See box 1d4 Appendix bed-night a way of measuring the number of children in residential care where one child staying for one day is described as ʻone bed nightʼ. child in this guidance we use the terms child and young person loosely. Many if not all adolescents resent being called or thought of as children, and so we have not followed strict legal meanings of ʻchildʼ or ʻyoung personʼ. All children and young people have the right to care and protection. Sometimes we write ʻchildʼ or ʻchildrenʼ; other times we write ʻyoung personʼ or ʻyoung peopleʼ. Please note, everything we say applies equally to children and young people in residential child care – nothing we say applies only to children nor only to young people. child-centred an approach to assessment, planning and action in which we put the child at the centre. de-escalation a process by which the thoughts, feelings and behaviours which were leading to danger are reduced in intensity and threat. duty of care See box at1d4 and appendix 4 See box 1d4 Appendix 4 flashpoint something which triggers an immediate and strong reaction. hyperflexion a seated or kneeling hold in which a child is bent forward at the waist. physical an action involving using a workerʼs body, for example blocking the path of a child intervention or any guiding him or her away from a harmful situation. It includes physical restraint. physical restraint/ an intervention in which staff hold a child to restrict his or her movement and restraining a child should only be used to prevent harm. We have largely avoided simply using the term restraint and instead have referred to restraining a child as just that – restraining a child. We deliberately chose to change this language to avoid losing sight of the child, who might otherwise be overlooked by the more clinical and depersonalised use of the term ʻrestraintʼ. power play a frequently occurring dynamic between staff and children seen through actions that are usually unhelpful, where the aim is to win power over the other person or people involved. Naming this dynamic makes it possible to address it, reflect upon it, and raise it in supervision. VIII Click here to return to Contents Click here to return to Contents
- 11. Holding Safely self-mastery possessing confidence, self control and a sense of personal capability, and taking responsibility for your own actions. service provider any organisation providing residential care for children and young people, including local authorities, voluntary organisations and independent providers. SSSC Scottish Social Services Council, which was established in October 2001 by the Regulation of Care (Scotland) Act 2001. Its main purpose is to regulate the social service workforce and their education and training. we members of the SIRCC working group. young person see child. IX Click here to returnto Contents Click here to return to Contents
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- 13. Holding Safely Preface There are exceptional situations in residential establishments when physically restraining a child is necessary and the most appropriate action to take. It is important that you feel confident about this aspect of your work. If you restrain children when there are other workable, less restrictive options available to them, children are hurt, their rights are breached, the focus remains on behavioural issues rather than the whole child and their needs, and civil or criminal proceedings could also result. However, you should be aware that if you do not restrain a young person in situations when it is needed, it can be dangerous to them and to others. Restraining a child at the right time, in the right way, for the right reasons, can be a better thing to do than failing to restrain them. This guide is intended to assist in building your confidence about when and how to restrain a child. Physically restraining children is something which causes many staff, as well as children, a lot of anxiety. As it should – even when done properly it can be a traumatising experience for children and staff alike. As a result, some people may not want to be explicit about restraining children, and instead emphasise only the positive experiences of children in residential care. We donʼt believe this is good enough. Many staff rarely if ever have reason to restrain children or young people in residential care. We see restraining children as a last resort. This means that children should only be restrained when restraining them cannot be avoided and restraining them is necessary because of your duty to care to the child or others. This handbook provides guidance for managers and practitioners about physically restraining children and young people. While it would perhaps make sense to offer a handbook for practitioners only, since they are the ones who respond to the needs of children on a daily basis, we have not done so. Children and young people are always restrained within an organisational context, and decisions on when and how to do so are influenced by many different factors, some of which are in the control of managers and not practitioners. We recognise this in our choice of readership for this document. This guide is for: • practitioners (including teachers) working with children accommodated in residential child care establishments; • managers working in residential child care establishments; • other managers in organisations which provide residential child care establishments. You can use the guide for a range of purposes, including: • staff induction; • in-service training; XI Click here to return to Contents Click here to return to Contents
- 14. Holding Safely • individual and group supervision; • deciding on and developing good practice; • developing policy and procedures; • review and quality assurance. We could have written much more about creating the conditions to make sure that children are restrained very rarely, and about the strategies workers should use to defuse potentially dangerous situations without restraining them. While these conditions and strategies are not the focus of this publication, we certainly see them as critical to good care. There are other areas we have also chosen not to focus on: the use of chemical and mechanical restraint is not covered here—these are for very particular cases and require other specialised training. The rights of staff to complain to the police when assaulted also fell beyond the core remit of this guidance. Also, we recognise that different child care agencies use different methods of restraining children and we do not suggest that any one method is better than the others. Instead, we provide advice on choosing methods, and further advice and recommendations for best practice, whichever method you use. The right amount of training in the appropriate methods is absolutely essential. You may have noticed already that we have avoided simply using the term restraint and instead have referred to restraining a child as just that – restraining a child. We deliberately chose to change this language to avoid losing sight of the child, who might otherwise be overlooked by the more clinical and depersonalised use of the word restraint. We aimed to be thorough, which explains the documentʼs length. There is some repetition so that once you have read the whole document and are happy that you understand it, you can use the different sections one at a time. However, you should be aware that these separate issues are all closely linked. It is only possible to restrain children appropriately if you do the other important care tasks well. We hope that you find this guide clear and simple to use. Sections one and two provide a summary of some of the main issues about physically restraining children and the ways in which it is possible to create the conditions so that restraining a child is hardly ever needed. Section three provides advice about training for physically restraining children. Section four considers the place of physical restraint in a childʼs care planning process as well as provides advice on risk assessment. Sections five and six describe how and when (and when not to) restrain a child and offers practical advice. The ways in which we reflect on, record, and monitor how and when we restrain children are significant for improving practice. We look at these in sections seven, eight and nine. XII Click here to returnto Contents Click here to return to Contents
- 15. Holding Safely Physically restraining children always carries the risk of harm, and section ten highlights some of these risks. A number of quotations from the National Care Standards have been inserted as boxes into the guidance, highlighting specific areas of practice where Care Standards may apply. These have all been drawn from Care Homes for Children and Young People. Other standards also may apply, such as the School Care Accommodation Services, and these use the same or very similar forms of words. The Standards have been written from the perspective of the service user, setting out what they can expect from their care home. The individual care standards should be understood in the context of the main principles (Dignity, Privacy, Choice, Safety, Realising Potential, Equality and Diversity). The National Care Standards are published by Scottish Ministers, and the Care Commission must take them into account when making its decisions. We have also provided examples and checklists at various points in the guide. Wherever appropriate we have phrased the material as direct advice to practitioners, managers or both. Practice examples are specific and illustrative, and you should only generalise from them with great care. We have included a flowchart at appendix 1 that summarises the steps that front line staff need to think through when considering restraining a child. This visual summary does not cover all the issues, only the key ones. It should help you find the relevant sections of the document easily and you must not look at it in isolation from the rest of the guidance. We have provided space in the binder to allow you to add other advice and guidance from your employer. We hope this guidance supports your learning and your establishmentʼs development, and enables you to become more confident and competent in the rare situations when restraining a child is absolutely necessary. XIII Click here to returnto Contents Click here to return to Contents
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