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3.9.1 Behaviour Support

SCOPE OF THIS CHAPTER

This chapter outlines the policy for Residential, Fostering and Family Placement services on acceptable forms of physical intervention and sanctions. It must be carefully read and retained by all staff and foster carers. The policy seeks to provide all parties involved with a framework within which necessary boundaries can be maintained, whilst safeguarding children, residential staff and foster carers.

The general approach and framework used by both the residential and fostering services is very similar. However, subtle differences apply in specific areas including training, recording and especially physical intervention and restraint. These differences are discussed in detail where they apply.

This policy aims to ensure that:

  • No form of corporal punishment, including humiliating treatment, is used on any child placed in a children's home or with a foster carer;
  • No child placed in a children's home or with a foster carer is subject to any measure of control, restraint or discipline which is excessive or unreasonable;
  • Physical intervention is used only where it is necessary to prevent likely injury to the child or other persons.

OTHER RELEVANT DOCUMENTS

Relevant Forms can be found in the Resources and Forms Library.

AMENDMENT

This chapter was substantially updated in December 2015 and should be re-read.


Contents

  1. Statutory Framework
  2. Underlying Principles
  3. Risk Assessment and Planning
  4. Training and Support
  5. Repair and Restore
  6. Physical Intervention
  7. Medical Examination
  8. Monitoring and Recording Use of Sanctions
  9. De-briefing - Post Crisis Response


1. Statutory Framework

Residential services are required to prepare and implement a written policy on acceptable measures of control, restraint and discipline of children placed in each children's home. Part 5, regulation 35, behaviour management policies and records of the Children's Homes Regulations 2015 clearly states the actions that staff may not take when managing the behaviours of children living at the home.

The fostering service is required by Regulation 13 of the Fostering Services Regulations 2011 and Standard 3.8 of the National Minimum Standards 2011 to prepare and implement a written policy for acceptable measures of control, restraint and discipline of children placed with foster carers. The requirement includes providing training to support positive behaviour, de-escalation of conflicts and discipline outlining that corporal punishment is not acceptable. Guidance is clearly set out in written information provided to foster carers and is part of the Foster Carer Agreement that all foster carers sign following approval with Leeds City Council Fostering Service.


2. Underlying Principles

It is the duty of Residential, Foster and Family Placement carers to ensure that children being cared for should have a positive experience of family life and be given the same access to opportunities and boundaries as other children. The setting of appropriate boundaries and good order is a necessary aspect of family life to enable children to develop in a safe and secure environment.

Residential staff and foster carers need to consider the individual needs of the children and young people maintaining safe, consistent and understandable boundaries encouraging positive behaviour. All children will be treated with understanding, dignity, kindness and respect. Carers will strive at all times to develop positive relationships recognising children’s unique needs, aspirations, experiences and strengths. Where possible, staff and carers will encourage children and young people to voice and influence their lives complying with the EU Convention on Human Rights at all times.

As part of Restorative Practice, staff and carers will work with our children and young people, building strong positive relationships, empowering children and young people to take responsibility for their actions. Where ever possible, repair and restore should be considered, allowing natural consequences to occur with less punitive action.

Expectations of behaviour for staff, foster carers and children will be influenced by the environment, be it a children's home or a foster home. In day to day decision making, staff or foster carers must demonstrate an appropriate balance between:

  • The needs of individual children;
  • The needs of the group of children residing in the children's home or foster home;
  • The protection of others (including the public) from harm; and
  • Specifically within a foster home setting, each member of the household's wishes and preferences.

Staff and foster carers must make clear to children the consequences of unacceptable behaviour. Any measure applied must be relevant to the incident, reasonable and carried out as close to the time of the incident as possible. The measures taken to respond to unacceptable behaviour must be proportionate and appropriate to the age, understanding and individual needs of the child. 

Relationships between children services staff, foster carers and children should be based on mutual respect and understanding. Clear professional and personal boundaries must be in place. All children must be treated equally, without favouritism or prejudice. Staff, foster carers and children must be aware that each individual has rights and responsibilities in relation to the others that they live with, and the wider community.

All children should be encouraged to develop an awareness of their rights and responsibilities and must be given information appropriate to their home environment. Specific information provided includes:

  • Children's Guide to Fostering or Family Placement Children's Guide;
  • Children's Guide to the Home (each children's home will have their own guide); including information on how to contact the Children Rights Director for England;
  • LCC complaints & compliments guidance / leaflet;
  • Leeds Children's Rights Advocacy Service and how to contact them;
  • Information on how to contact Ofsted (contained within the Children's Guides).


3. Risk Assessment and Planning

3.1 Prior to Placement Start

Prior to the placement all information available about the child, including information pertaining to behaviour and causes of any behavioural issues should be shared.

A risk assessment must be completed by the social worker for each child prior to moving into the placement which will include any difficult or challenging behaviour, and whether or not restraint needs to be considered in exceptional circumstances. When a child is moving into residential placement or foster care, a risk assessment must be undertaken by residential staff/foster carer and social worker to consider the impact of the child moving into the placement and the children living in the home.

When the placement is planned, a meeting will be held to share information, plan introductions and complete the CLA paperwork. This is also an opportunity for residential staff and foster carers to be given any information known about the child.

Where the placement has been made within a short time scale and a pre-placement meeting has not been held, a meeting must be held within 72 hours of the placement commencing.

If a child's behaviour regularly endangers them or others and physical intervention needs to be part of the plan for the child this must be subject to:

  • In residential, an Individual Crisis Management Plan is in place within two weeks of the child admission to the home;
  • Residential staff have attended and passed the accredited TCI course, including the restraint element. There are sufficient TCI certified staff on each shift;
  • Foster Carers are trained in TCI de-escalation strategies and techniques. For any physical interventions, it must be identified by foster carer, supervising social worker, fostering team manager, child’s social worker, TCI team and agreed by the head of service;
  • A foster care placement risk assessment as part of the household safe care plan must involve the foster carers and lead professionals involved with the child.

3.2 After Placement Start

If the challenging behaviour develops within a foster placement, an Individual Crisis Management Plan must be completed and reviewed to assess risk and to have an agreed plan of action.

In residential, an Individual Crisis Management Plan must be completed. The plan should outline the circumstances that may give rise to the use of physical intervention, the methods which are known or likely to be effective and other arrangements for its use. Residential staff should regularly discuss boundaries, review the Individual Crisis Management Plan and risk assessments on a minimum of a monthly basis (TCI recommends fortnightly) and amend accordingly with the necessary changes as they occur.

It is also important to determine whether there are any medical conditions which might place the child at risk should particular techniques or methods of physical intervention be used. If so, this must be documented and drawn to the attention of those working with or looking after the child. If in doubt, medical advice must be sought.

All foster carers must have a Safe Care Plan for their home and all the people living in it. Part of the plan must address how boundaries, discipline and behaviour will be managed in the foster home. The plan should be shared with the child (where age appropriate) before the placement commences and referred to in the Placement Agreement. The Safe Care Plan must be reviewed when a new child enters the foster home and, if the placement is permanent, the Safe Care Plan must be reviewed annually with the supervising social worker. If challenging behaviour escalates or changes significantly, the foster carer, supervising social worker and social worker should review the Individual Crisis Management plan.

Where the child is using the Family Placement Short Breaks service, the Safe Care Plan must be discussed and agreed with the child's parents/primary caregivers and the supervising social worker at the Placement Planning Meeting. Short break carers adhere to the foster care role and if there any physical interventions needed, alternative short break services must be considered.


4. Training and Support

Training is offered to all residential staff and foster carers. Residential staff and foster carers TCI manuals highlight strategies for de-escalating, avoiding or diffusing challenging behaviour.

Residential staff are responsible to renew their TCI certification every six months ensuring there are sufficient number of staff suitably qualified, competent and experienced. Once the certification is out of date, TCI cannot ensure that staff are using TCI techniques including physical restraints appropriately. Managers need to be aware of whose TCI certification is out of date as this will affect shift rotas.

All foster carers are offered training in positive care and control. TCI training highlights de-escalating strategies and foster carers must maintain certification every 18 months.

Residential staff, foster carers and supervising social workers working with disabled children are offered training specifically designed to meet the needs of disabled children and young people. Courses are designed to help participants understand how some behaviours can be linked to a child’s disability.


5. Repair and Restore

Where ever possible managers, staff, foster carers, children and young people should consider how to repair and restore any consequences of negative behaviour. Any sanctions used to address negative behaviour should be restorative in nature, to help children and young people recognise the impact of their behaviour on themselves, other children, the staff or foster carers caring for them and the wider community. Before any sanction is imposed managers, residential staff, supervising social workers, foster carers and social workers must be satisfied of the following:

  1. For children homes; adhering to Regulation 19 (2) detailing sanctions that are prohibited;
  2. Sanctions for challenging behaviour should not be punitive but should be restorative in nature;
  3. That the child was capable of behaving acceptably and understands (age appropriately) what was required of him/her. Short breaks carers must be aware of the impact of disability on the child's behaviour. Some conditions such as autism may predispose the child to misunderstanding social cues. Children with a learning disability may not understand abstract concepts and may need very clear and concise messages about what is required;
  4. Residential managers and supervising social workers must monitor all sanctions to ensure they are used appropriately. Where Restorative methods of resolutions have not been successful, any sanctions imposed are relevant, fair and carried out as close to the time of the incident as possible;
  5. Children and young people should be informed about the range of sanctions that may be imposed upon them and the possible circumstances which may result in sanctions. Sanctions must be set out in writing in the child's risk assessment and/or safe care plan as appropriate to the placement type;
  6. Residential homes agreements with their local police force procedures and guidance on police involvement with the home to reduce unnecessary police involvement in managing behaviour and criminalisation of behaviours. Children should not be charged with offences resulting from behaviour that would not lead to police involvement if it occurred in a family home.


6. Physical Interventions

Therapeutic Crisis Intervention is a restraint reduction programme. The programme is designed to maximise de-escalation techniques providing support to children and young people, minimising the likelihood of the use of a restraint.

The approach to a physical intervention or restraint must be informed by a physiological and psychological understanding and recognises that children and young people are continuing to develop and understand how they interpret expectations of their behaviour.

A physical intervention means any measure or technique designed to restrict a child's mobility or prevent a child from leaving, for example:

  • Any intervention which involves a child being physically held;
  • The locking or blocking an exit in order to contain or prevent a child from leaving.

Residential staff must attend TCI training every 6 months to maintain certification enabling to undertake a TCI physical intervention. Foster carers are not trained in TCI physical interventions, in extreme circumstances the head of service can agree an intervention enabling the TCI team to train the identified foster carer.

Physical intervention should only be used to ensure safety and protection. This should be specified as part of an Individual Crisis Management Plan. All situations involving violence must be risk assessed and appropriate action taken to ensure the situation is made safe. Failing to intervene could be deemed neglectful.

In some cases, behaviour necessitating the use of physical intervention or restraint may be due to a child’s impairment or disability. If children have a disability or special educational need, it is essential that staff identify and utilise existing behaviour support plans or techniques developed by the child’s family, school, child psychology or other agencies. The support techniques must be aligned with the Therapeutic Crisis Intervention programme and Restorative Practices.

In certain circumstances, approval from head of service must be obtained for actions that amount to a ‘deprivation of liberty’, please refer to the children home regulations 20 (3).

Children homes have a responsibility to protect children in their care. The Individual Crisis Management Plan should outline where it may be permissible to restrain a child if there is reasonable cause for believing this is the only way possible to prevent the child from being injured (e.g. to prevent the child from leaving the home to take drugs or put themselves as risk of sexual exploitation, or who is subject of a court order authorising a deprivation of liberty, from absconding into a risky environment).

When working with children with learning disabilities who have limited understanding, physical prompts may be used to assist the child or young person in everyday activities, where identified as a communication aid. If the child or young person goes into crisis, the identified TCI intervention and strategies should be used. Any physical interventions used from this point would be deemed as such.

A physical intervention may only be used where there is likely a significant injury to the child, someone else or serious damage to property which could lead to someone being harmed. A physical intervention must not be used:

  • To demonstrate authority;
  • To punish a child;
  • To get a young person or child to comply;
  • Please refer to your TCI manual for further explanations.


7. Medical Examination

  • In any care environment where Physical Intervention has been used, the child, staff/carers and others involved must be given the opportunity to see a medical practitioner, even if there are no apparent or reported injuries;
  • The medical practitioner, if seen, must be informed that any injuries may have been caused from an incident involving physical intervention;
  • Whether or not the child or others decide to see a medical practitioner this must be recorded, together with the outcome.


8. Monitoring and Recording

The TCI programme ensures risk assessments and individual crisis management plans take into account the child’s / young person’s individual circumstances including; age, size, disabilities, health, medication, risks factors, child’s opinions, relationships between carers and child, identified restraints to minimise any risks of injury.

8.1 Residential care

Records of challenging behaviour will be kept by the children's home in the young person’s Individual Crisis Management Plan and Care Plan.

If a child / young person or staff member sustains any injury, the child's / young person’s social worker and service deliver manager must be informed. An injury, dangerous occurrence or violent incident form must be completed by staff and a copy kept on the child's file.

If a physical intervention has taken place in a residential home, a CF50a, detailed recording and SS14 physical intervention recording form must be completed by staff and a copy kept on file. Please follow the Post Crisis Response Flowchart - to follow which states who needs to be informed.

Cornell University Family Life Development Centre reviews and assesses the safety of TCI interventions annually takes into account the care for children who are still developing, physically and emotionally. Leeds TCI team and critical incident meetings review and assess safety termly.

8.2 Foster care

The recording of challenging behaviour will be maintained by the foster carer in their foster carer diary and in daily and weekly recording sheets. This recording should be discussed with the child's social worker and their supervising social worker who will also maintain appropriate case recording. If a child or member of the household sustains any injury the child's social worker and supervising social worker must be informed.

An Accident and Incident form (which can be found in the Resources and Forms Library) will be completed by the foster carer and a copy given to the supervising social worker and the child's social worker if:

  • If a child or member of the household sustains any injury;
  • If a child is restrained in a foster care placement;
  • If a foster child causes damage to property.

Within the Family Placement Service any physical intervention or restraint must be recorded on a Family Placement Accident / Incident form. A copy of this must be given to the Family Placement Team manager and a copy retained on the carer's file.


9. De-briefing - Post Crisis Response

De-briefing in a residential care setting

Staff will perform a Life Space Interview with children to give an opportunity to debrief and talk through their experience of the incident and any restraint used.

Managers and senior team will support residential staff using TCI Post Crisis Response procedure. The critical incident committee meets 6 times a year to ensure incidents are reviewed.

Supervising social workers will support foster carers using TCI Post Crisis Response procedure.

Post Crisis Response will explore the following:

  • Staff / foster carers feelings and experiences;
  • Staff / foster carers actions - did the adult feel in control of the situation?
  • What led up to the physical intervention- could the situation have been handled differently?

Leeds City Council staff and carers can also access Care First, a confidential service which offers counselling from someone who is independent of the situation.

End