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Contents

1. Statutory Framework
2. Underlying Principles
3. Risk Assessment and Planning
4. Training and Support
5. Non Approved Sanctions 
6. Approved Sanctions
7. Definition of Physical Intervention
8. Who may use Physical Interventions? 
9. Criteria for Using Physical Interventions
10. Informing Children 
11. When Sanctions may be Imposed
12. Monitoring and Recording use of Sanctions
13. Medical Examination
14. De-briefing

1. Statutory Framework

Residential services are required by Standard 22 of the Children's Homes National Minimum Standards 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, chapter 17 of the Children's Homes Regulations 2001 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 2002 to prepare  and implement a written policy on acceptable measures of control, restraint and discipline of children placed with foster parents.  Regulation 28 - Schedule 5 and Standard 9.4 of the National Minimum Standards for Fostering Services requires that it is made clear to foster carers that corporal punishment is not acceptable.  This is clearly set out in written information provided to foster carers and is part of the Foster Carer Agreement that all approved foster carers enter into with the CYPSC.

2.  Underlying Principles

It is the duty of Residential, Fostering and Family Placement service 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 must set and maintain safe, consistent and understandable boundaries for children in relation to acceptable behaviour. No two children or placement are identical and in applying this policy, both residential staff and foster carers will need to be mindful of the individual needs of specific children. 

It is unreasonable to expect children not to misbehave from time to time. Whether it is children exhibiting temper tantrums or direct challenges to a staff member's authority by an adolescent, there will be times when residential staff need to employ the use of control and discipline. Residential staff should regularly discuss boundaries, review the Individual Crisis Management Plan (ICMP) (this form can be found in the Forms Library) and risk assessment at least monthly and amend accordingly.  

With regard to a foster care placement, the assessing and supervising social workers must  consider with foster carers the implications arising from the foster carers views on methods of control and discipline to be used in the foster home.  Foster carers should regularly discuss how they apply boundaries with the child's social worker and their supervisory fostering officer.

Staff and carers should be aware that avoiding confrontation and rewarding good behaviour is often the most successful technique available for building positive behaviour, and is more successful than punishing difficult behaviour. See Therapeutic Crisis Intervention and Therapeutic Crisis Intervention Pocket Guide.

Staff and carers must respond positively to good behaviour.  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.

Where a child's behaviour is not acceptable staff/foster carers must give the child the opportunity to redress their actions and where appropriate encourage the child to apologise or make amends.  Disciplinary measures must be based on establishing positive relationships with the child, which are designed to help them.  Such measures must be fair and consistently applied.

Expectations of behaviour for staff, foster carers and children will be influenced by the care 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.  For example taking into account that unacceptable of challenging behaviour may be the result of illness, bullying or a disability that might impact on behaviour such as autism or communication difficulties. 

Relationships between residential staff, social workers, foster carers and children should be based on mutual respect and understanding and clear professional and personal boundaries must be in place, which are effective for all.  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 to provide 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)
• LCC complaints 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 for each child prior to moving into the placement which will include their propensity to difficult or challenging behaviour, and in very exceptional circumstances, whether restraint needs to form part of the care plan. 

The child's social worker must ensure that the placement has a copy of the Essential Information Record Part 1, the Placement Plan Part 1 and full LAC documentation. This information will include any prior knowledge about the child's behaviour.

Where children are referred to the Residential Homes for Children With Disabilities service, a Core Assessment is completed by the referring social worker.  Where children are referred to the Family Placement Professional Fostering Service, a Disabled Child's Integrated Needs Assessment is completed by the referring social worker (unless the placement is made in an emergency).  These assessments should indicate if a child is presently being restrained in home or school. (See Family Placement Service - Short Breaks for Disabled Children Procedure)

If the placement is planned (rather than made in a short timescale) a planning meeting will be held to share information, plan introductions and complete the LAC paperwork.  This is also an opportunity for residential staff and foster carers to be given any information known about the child.  Where relevant the Children's Learning Disability Nursing Team or CAHMS should undertake an assessment of the child and a strategy for behaviour management put in place.  See Therapeutic Crisis Intervention Pocket Guide.

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 of the child.

It should not be assumed that where a child has been restrained in other environments that this will be the case in any placement, residential or foster home.  Restraint may have been used inappropriately in the past.   Many children react differently in different environments and children must be considered within a therapeutic context.  The use of restraint within either a children's home or a foster home would be unusual and exceptional.

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

• A risk assessment.  Where the placement is a foster care placement , the risk assessment must involve the foster carers, professionals involved with the child and where possible, the child.
• All other interventions must be considered including involving the Children's Learning Disability nursing Team (for disabled children), the Therapeutic Social Work Team or CAMHS in making a behaviour management plan for the child. See Therapeutic Crisis Intervention Pocket Guide.
• Residential staff or foster carers having attended and passed the accredited TCI course, including the restraint element.
• Where the placement is a foster care placement agreement of the Head of Service must be obtained.

Children who are currently being restrained in the parental/primary caregivers home or at school would usually not be accepted as suitable for either the Family Placement Short Breaks service or the Sitting service. Other more appropriate services would be pursued.

Where risk is identified an action plan must be developed that addresses the following points:

• Identification of what the risks are
• Who is at risk?
• Could the risk be diffused and how?
• Do staff need to intervene or is there a walk away option?
• What are the specific situations which might trigger or heighten the  risk?
• What are the behaviour support techniques?
• Is there a behaviour management plan?
• Do other services need to be involved such as the Children's Learning Disability Nursing Team, the Therapeutic Social Work Team, or the CAMHS, Youth Offending Service, Education or Police
• Have staff or the foster carer had training at the appropriate level in behaviour management and therapeutic interventions?

3.2 After Placement Start

If the challenging behaviour develops in the placement a new risk assessment and action plan must be completed. 

There may be occasional exceptional situations where a child has to be restrained to stop them injuring themselves or others in a situation of immediate danger  (for instance a disabled child is about to run into a busy road, or a child is about to hurt another person).  A new risk assessment in respect of the child must be undertaken.

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 (ICMP) and risk assessments on a minimum of a monthly basis 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 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 fostering officer.

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.  If a child required restraint whilst on placement and this could not be replaced by other strategies the risk may be considered too high for the child to be able to continue with their Family Placement Short Break Service and alternative services may be considered.

The absence or existence of such a plan does not prevent  residential staff and foster carers from acting as they see fit when confronted with unforeseen and likely harm to the child or another person(s), so long as the actions taken are consistent with the principles and procedures contained in this chapter.

4. Training and Support

Training is provided to all residential staff and foster carers where they are told that it is not acceptable to restrain children or use any type of corporal punishment.  Handouts are given on strategies for de-escalating, avoiding or diffusing difficult behaviour. The training that is provided, is specific to the home environment that the staff member/carer is working in.

All residential staff attend an initial induction course and then there is a requirement for all residential staff  to attend and pass Therapeutic Crisis Intervention (TCI) training which addresses managing difficult behaviour.  All residential staff attend the refresher training as the programme states to ensure they meet the required competency in theory and practice.  Also see Therapeutic Crisis Intervention Training.

Foster carers attend an initial Skills to Foster preparation course which addresses managing difficult behaviour and the Family Placement service also hold regular preparation courses for short breaks carers for disabled children. All foster carers attend the mandatory Promoting Pro-Social Behaviour, which outlines strategies for de-escalating, avoiding or diffusing difficult behaviour.

Level four foster carers and those dealing with particularly challenging behaviour in foster children, will additionally attend the TCI course.

Residential staff and foster carers working with disabled children are offered training in specific areas such as autism and learning disability.  Courses are designed to help participants understand how some behaviours can be linked to a child's disability.  There is a requirement that staff who work with disabled children attend the one day disability TCI training as well as the full TCI programme.

The CYPSC Therapeutic Team offer regular consultation to staff and regular surgeries to foster carers where they can discuss concerns around a child's behaviour and the management of this.

5. Non Approved Sanctions

Certain sanctions must not be imposed upon children, in any circumstances, they are:

1. Any form of corporal punishment; i.e. any intentional application of force as punishment,      including smacking, slapping, shaking, punching, rough handling and throwing missiles.
2. Any sanction relating to the consumption or deprivation of food or drink.
3. Any restriction, other than one imposed by a Court, on a child's contact with his or her parents, relatives or friends; visits to the child by his or her parents, relatives or friends or anyone acting in an official capacity such as:
   • Any solicitor or other advisor or supporter acting for the child
   • Any officer of the Children and Family Court Advisory and Support Service appointed for them
   • Any social worker for the time being assigned to the child by their placing authority
   • Any person appointed in respect of any requirement of the procedure specified in the Representations Procedure (Children) Regulations 1991
   • Any person appointed as a visitor for them in accordance with paragraph 17 of Schedule 2 to the 1989 Act
   • Any person authorised by Ofsted for the purpose of inspection
   • Any person authorised by the local authority in whose area the child resides
4. Any requirement that a child wear distinctive or inappropriate clothes.
5. The use or withholding of medication or medical or dental treatment.
6. The intentional deprivation of sleep as a sanction.
7. The modification of a child's behaviour through bribery or the use of threats;
8. Any sanction used intentionally or unintentionally which may humiliate a child or could cause them to be ridiculed (for example standing children in the corner). 
9. The imposition of any fine or financial penalty, other than a requirement for the payment of a reasonable sum by way of reparation. 
   
   The Court may impose fines upon children which staff/carers should encourage and support them to repay.
10. Any intimate physical examination of a child.
11. The withholding of aids/equipment needed by a disabled child.
12. Any measure which involves a child in the imposition of any measure against any other child; or the Sanction of a group of children for the behaviour of an individual child.
13. Swearing at or the use of foul, demeaning or humiliating language or measures.
14. Locking a child in a room.
15. Any restriction on a child's access to any telephone helpline providing counselling for children.
16. The use of CCTV as a way of supervising a child within a foster home as part of a Safe Care Plan.  CCTV can only be used as a deterrent against criminal activity outside the foster carers home.

Nothing in the above should restrict the taking of any action by, or in accordance with the instructions of, a registered medical practitioner or a registered dental practitioner, which is necessary to protect the health of a child, or the taking of any action immediately necessary to prevent injury to another person(s).

6. Approved Sanctions

The forms of discipline and sanctions used in the different care environments will vary between the different children's homes and between individual foster carers and between foster placements.  It is for each care environment to use sanctions suitable to the individual needs of the children placed there.

Residential staff will develop sanctions for their children's home as a team and foster carers will discuss the sanctions to be used within their home with assessing and supervising fostering officers.

Discipline and sanctions for use in the Family Placement carer's home must also be discussed and agreed by the parent/primary caregiver and set out in the child's Safe Care Plan. 

Factors that need to be taken into account include:

• The usual forms of control and discipline that are permissible in children's residential care and staff experience of what works well with groups of children
• The usual forms of control and discipline used by the foster carer with their own children and their experience of what works well for them
• Foster carer's own experience of control and discipline as a child
• The age, ability and health needs of the child
• The child's history, including any experience of abuse/trauma
• Any needs of the child arising from a disability
• Religious and cultural issues

The following provides guidance on the sanctions that are generally acceptable in both children's homes and foster carer homes.  The list is not meant to be exhaustive, nor is it meant to imply that all these methods are appropriate and acceptable in all circumstances. Staff and foster carers must think carefully before employing any of these methods and if necessary seek further advice from the appropriate manager or social worker.

1. Delay of pocket money. Where the child's behaviour is very challenging pocket money may be delayed (up to a maximum of 48 hours) or need to be spent under supervision.
2. Withdrawal of Privileges. These may be withdrawn for unacceptable behaviour. This may include denial of recreational facilities and bus fares, but should not normally include denial of attendance at a regular out of school activity such as swimming lessons, children's clubs or brownies. Looked after children are often less skilled than their peers or socially isolated and the use of such a sanction may further disadvantage the child.
3. Early bedtime.  An early bedtime can be used positively in order for the child to reflect upon their behaviour. This should be no more than one hour before their regular bedtime.
4. Time out.  This should be used to affect positive change. It should be used as an opportunity to restore order in the child and home and to enable the child to reflect upon their behaviour.  It should be for limited timescales only and appropriate to the age of the child. 
   
   When used in a foster care placement this sanction can range from isolating a child within a room occupied by others to sending them to a room on their own.  Care must be taken to ensure the child's safety and carers will need to think through the potential impact of the child's previous experiences before placing a child in a particular room.  For example, a child who had been regularly abused in a living room should not be placed in the foster carer's living room.
5. Grounding can be used in a foster care placement where the child can be denied permission to leave the house for a set period of time or in specific circumstances.  As with withdrawing privileges, the foster carer may still need to ensure that the child is allowed to attend specific activities.
6. Restriction of access to personal belongings.  Children have a right to their own clothes, toiletries and other possessions. However, personal belongings may be removed temporarily if they are being misused and /or are likely to be damaged.  They should only be removed permanently where it is agreed they are harmful to the child.
   
   Access may be restricted in the use of personal possessions, for example a play station or personal stereo, as a sanction for a specified period. 
   
   Comfort items should never be removed from a child as a sanction.
7. Restricting mobility/locking doors.  Subject to the usual security measures of the household such as locking external doors at night, children should never be locked in the home.
   
   It may be appropriate to deny a child access to a particular room or a specific area such as the garden. This may be achieved in a number of ways such as verbal requests, temporarily locking doors, or standing in the way, while taking care to avoid the risk of a physical confrontation.

7. Definition of Physical Intervention

There are four broad categories of Physical Intervention:

1. Restraint: Defined as the positive application of force with the intention of overpowering a child. Practically, this means any measure or technique designed to completely restrict a child's mobility or prevent a child from leaving, for example:
   • any technique which involves a child being held (See Therapeutic Crisis Intervention Pocket Guide)
   • any technique involving the child being held by two or more people;
   • any technique involving a child being held by one person if the balance of power is so great that the child is effectively overpowered; e.g. where a child under the age of ten is held firmly by an adult.
   • the locking or bolting a door in order to contain or prevent a child from leaving.
   The significant distinction between this first category and the others (Holding, Touch and Presence), is that Restraint is defined as the positive application of force with the intention of overpowering a child.  The intention is to overpower the child, completely restricting the child's mobility.  The other categories provide the child with varying degrees of freedom and mobility.
2. Holding: This includes any measure or technique which involves the child being held firmly by one person, so long as the child retains a degree of mobility and can leave if determined enough.
3. Positive Touching:  This includes minimum contact in order to lead, guide, usher or block a child; applied in a manner which permits the child quite a lot of freedom and mobility.
4. Presence:  A form of control using no contact, such as standing in front of a child or obstructing a doorway to negotiate with a child; but allowing the child the freedom to leave if they wish.

8. Who may use Physical Interventions?  

Residential staff and foster carers should only use Physical Intervention if they have undertaken approved training. However, where residential staff and foster carers have not undertaken such training, the use of minimum force may be justified if it is the only way to prevent Significant Harm to the child or another person(s).

Where staff have not undertaken such training, the use of force may still be justified if it is the only way to prevent significant harm to the child or another person(s).  In these circumstances, staff must always act in a manner consistent with the values and principles set out in this manual.  Any intervention used must:

• Not impede the process of breathing
• Not be used in a way which may be interpreted as sexual
• Not intentionally inflict pain or injury or threaten to do so
• Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas
• Avoid hyperextension, hyper flexion and pressure on or across the joints
• Not employ potentially dangerous positions

9. Criteria for Using Physical Interventions

Please read this section very carefully as Leeds City Council has different policies for the use of restraint in residential care in comparison to foster care environments.  These differences are discussed in detail where they apply. 

There are different criteria for the use of Restraint and Holding, Touching and Physical Presence/proximity.

1. Restraint may only be used where there is likely significant injury to the child, someone else   or serious damage to property which could lead to someone being harmed.  Restraint must never be used:
   • To establish control over a child or to demonstrate who is in charge
   • To punish a child
   • In a situation where it is possible for the staff member or the foster carer to remove  the other children and themselves out of danger
   • As a way of restricting mobility (e.g. keeping a child in a wheelchair to prevent them from crawling or wandering)
   • To get a young person or child to comply
   • A TCI approach does not support the use of restraint to protect property unless the damage taking place will lead to someone being harmed
   • There are other situations where restraint should be avoided (See Therapeutic Crisis Intervention Pocket Guide)
2. Holding, Positive Touching or Presence are less forceful and less restrictive and may be used to protect children or others from injury which is less than significant or to prevent damage to property which is less than serious.
3. Before any other form of Physical Intervention is used, all of the following principles must be applied:
   • For the intervention to be justified there must be a belief that harm or injury is likely in the predictable future.
   • The intervention must be immediately necessary.
   • The actions or interventions taken must be a last resort.
   • Any force or intervention used must be the minimum necessary to achieve the objective.

10. Informing Children

Children 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. 

11. When Sanctions may be Imposed

Before any sanction is imposed staff/carers must be satisfied of the following:

1. That the child was capable of behaving acceptably and understands 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;
2. That other encouraging and rewarding strategies have not worked or would not work in the circumstances. The Family Placement care must be aware that avoiding confrontation and rewarding good behaviour is often the most successful technique for building positive behaviour and is more successful than punishing difficult behaviour.  They must be aware of the child's abilities and limitations and set tasks which are achievable.  Where appropriate, tasks must be broken down into smaller steps to avoid the child becoming frustrated or de-motivated. 
3. That the sanction imposed is relevant, fair and carried out as close to the time of the incident as possible.
4. That there is a view that the sanction may encourage acceptable behaviour or act as a disincentive to unacceptable behaviour.
5. That it will not be applied open-ended without effect. 
6. That the child understands the relevance of the sanction.

Only Approved Sanctions may be imposed.

Sanctions may only be imposed, as a last resort, where it is not possible to use other, more positive methods of control.

Caution should be exercised to ensure that sanctions are not imposed repeatedly, with little or no effect or where they may act as positive re-enforcement of unacceptable behaviour.

12. Monitoring and Recording

12.1 Residential care

Records of very difficult or challenging behaviour will be kept by the children's home in the young persons Individual Crisis Management Plan and Care Plan.

If a child or staff member sustains any injury the child's social worker 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.  The Principle Unit Manager and the child's social worker must be informed.

If a child is restrained in a residential placement a Restraint Information Recording Form (which can be accessed from the Forms Library) must be completed by staff and a copy kept on file. The

Principle Unit Manager and social worker must be informed.

All restraints logged in the children's home restraint record will be reported through the Key Performance Indicator monthly return and monitored within the monthly inspections made under Regulation 33.

All restraints made in children's homes will also be reviewed on a six monthly basis by the relevant Service Delivery Manager and TCI training team.  Where issues are identified an action plan will be agreed.  This will be reviewed at the subsequent meeting.

12.2 Foster care

Records of very difficult or challenging behaviour will be kept by the foster carer in their foster carer diary and discussed with the child's social worker and their supervising fostering officer who will keep appropriate records.

If a child or member of the household sustains any injury the child's social worker must be informed.

An Accident and Incident form (which can be found in the Forms Library)  will be completed by the foster carer and a copy given to the supervisory fostering officer 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.

13. 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.

14. De-briefing

De-briefing in a residential care setting

It is the role of the manager/ senior worker to take staff through de-briefing.  To explore the following:

• Staff feeling and experience
• Staff actions - did staff feel in control of the situation?
• What led up to the restraint - could the situation have been handled differently

For the child who was subject to the restraint a Life Space Interview should be conducted by the member of staff who carried out the physical intervention.

• Explore the child/ young person's feelings - fear, anger, loss of control
• Reflect on the situation - triggers
• Look at coping strategies/plan

The Restraint Information Recording Form (which can be found in the Forms Library) is used to record de-briefing where restraint has occurred. For violent incidents where restraint has not occurred, de-briefing is informal in nature and is recorded on form CF50a (which can be found in the Forms Library).

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