Guidance for Promoting Positive Behaviourand Appropriateuseofphysicalinterventioninchildren

April2016

GUIDANCE FOR PROMOTING POSITIVE BEHAVIOURAND APPROPRIATEUSEOFPHYSICALINTERVENTIONINCHILDREN’SHOMES

1.0Introduction

1.1Within residential services the aim is to create environments withineach home for children and young people where they can live togetheras comfortably and happily as possible and experience happy memories. Asinfamilies,ahappyhomeisbasednotonlyoncareandtrust,butalsoonunderstanding by all its members of the kinds of behaviour thatare acceptable and unacceptable and the response they can expectwhen unacceptable behavioursoccur.

1.2These guidelines are intended to assist residential staff in developingand sustaining a safe environment for children and young people within which the boundaries of behaviour are clearly defined andunderstood.

1.3It should be remembered that many children/young people in carehave been subjected to abusive and often inconsistent parenting in the past and this will strongly influence their response to boundaries given tothem whilst they are in ourcare.

1.4Atthesametimestaffshouldbeabletoshowaffectiontowardsachild based on what is acceptable within family homes such as comforting achild indistressorgoodnighthugs.Itisthereforeimportantthatcareistakento ensure that any physical contact is not misinterpreted. Arrangementsinrelationtosafe touchingshouldbeconsideredaspartoftheplacement planning for thechild.

1.5Where possible, staff should never use physical interventions, unless staffhave been provided with PRICE training and/or a child’s risk assessment states restraint, it should never beused.

2.0 Aim of thepolicy

2.1Every care home is required, by law, to have written policies and guidance onhowtomanagechallengingbehavioursdisplayedbychildren/youngpeoplewholiveinthe home. The aim of this policy is to give clear and thorough advice and guidance on how to promote positive behaviours and managing behaviours that can bechallenging.

2.2It also states whatare and are not acceptable ways of managingdifficult behaviours. Specific areas are covered in order to meet national standards -inparticular the homes’ philosophy; acceptable and unacceptable forms of behaviour management; permissible consequences; approved methodsof physical intervention; recording; training; and policeinvolvement.

2.3This policy should be read in conjunction with Residential Procedures- Bullying, Safeguarding andWhistleblowing.

3.0 Legislativecontext

3.1The legal framework surrounding issues of control and physical interventionwith children/young people in public care derives from the Children Acts 1989 and2004 and theChildren’s Homes (England) Regulations (2015): includingthequality standards, under the Care Standards Act (2000). This frameworkexists within the contextof the HumanRights Act 1998, the United NationsConventionontheRightsoftheChild(1991),plusthevariousguidance issuedbytheDoHunderSection7oftheLocalAuthorityandSocialServicesAct1970.

The Children Acts 1989 and2004

3.2Thesespecifythatalladultsworkingwithchildren/youngpeoplehaveadutyofcare towards them. Failure to take reasonable steps to protectchildren/young people from being harmed could open individuals to charges of negligence.Itsguiding principle is that the “welfare” of the child/young person is paramount- therefore it supports “any necessary action to preventinjury”.

3.3The guidance and regulations issued with the Children Acts 1989 (Volume5 Children’s Home) stated that “physical interventions to restrain orprotect childrenandyoungpeoplecanonlybejustifiedwithinacontextinwhichchildren are offered positive care that meets their individual needs and respectstheir personal integrity should be used rarely and only to prevent a child harminghimself or others”(2011).

3.4Thereisvariousguidanceissuedtoclarifyissuesaroundmanagingchallenging behaviour. Theseinclude;

• Permissible Forms of Control (DoH 1993): This is guidance issuedtosupplement Volume 4 Children Act Guidance. It suggested thatphysical restraint should be used “…when staff have good grounds for believingthat immediate action is necessary to prevent a child from significantlyinjuring himself or others.”(5.6ip10).

• Taking Care, Taking Control (DoH 11/96): This is a training manualfor children’s homes regarding physical intervention with an emphasis ondefusing situations, communication and post incident structure for children andstaff.

• The Control of Children in Public Care Interpretation of the ChildrenAct 1989: Herbert Laming (1997) made it clear that staff should take steps toprevent children/young people being placed at risk, suggesting that, onoccasion, proactive steps need to be taken immediately to prevent a child/youngperson from coming to harm later. Laming also suggested that “harm” should notbelimited to physical injury, and that a reasonable parent would act toprotect children from “moral harm” for example by preventing them putting themselvesat risk by indulging in criminalbehaviour.

Human Rights Act1998

3.5This Act states that any actions involving a physical intervention must be “absolutely necessary”, and protects the rights of individuals to; privacy, protection from degrading treatment, liberty, and security, amongstothers.

Children’sHomesRegulations2015:QualityStandards

3.6Thiscameintoforceon1April2015–aGuidetotheChildren’sHomes(England) Regulations2015(“theRegulations”)includingtheQualityStandardswasissuedbythe DepartmentforEducationinApril2015.Thisguidanceprovidesfurtherexplanationand information for everyone providing residential child care. The RegulationsQuality Standards set out the aspirational and positive outcomes that we expect homesto achieve. They also set out the underpinning requirements that homes must meet inorder to achieve those overarching outcomes. It means that by law every children’s homemust complywithaclearsetofnationalregulatoryQualityStandards.Standard6(Regulation 11): Positive Relationships contains a statement of the quality standards that must bemet in line with regulatorystandards.

3.7Inpromoting“positiverelationships”underStandard6thefocusison(a)mutual respectandtrust;(b)anunderstandingaboutacceptablebehaviourand(c)positive responsestootherchildrenandadults.Thestandardinparagraph(1)requirestheregistered person to ensure (a) that staff–

• (i) meet each child’s behavioural and emotional needs, as set out in thechild’s relevantplans;

• (ii) help each child to develop socially awarebehaviour;

• (iii) encourage each child to take responsibility for the child’s behaviour,in accordance with the child’s age andunderstanding;

• (iv) help each child to develop and practise skills to resolve conflicts positivelyand without harm toanyone;

• (v) communicate to each child expectations about the child’s behaviourand ensure that the child understands those expectations in accordance withthe child’s age andunderstanding;

• (vi) help each child to understand, in a way that is appropriate according tothe child’s age and understanding, personal, sexual and social relationships, andhow those relationships can be supportive orharmful;

• (vii) help each child to develop the understanding and skills to recogniseor withdraw from a damaging, exploitative or harmfulrelationship;

• (viii) strive to gain each child’s respect andtrust;

• (ix) understand how children’s previous experiences and present emotions canbe communicated through behaviour and have the competence and skills tointerpret these and develop positive relationships withchildren;

• (x) are provided with supervision and support to enable them to understandand manage their own feelings and responses to the behaviour and emotionsof children, and to help children to do thesame;

• (xi) de-escalate confrontations with or between children, or potentiallyviolent behaviour bychildren;

• (xii) understand and communicate to children that bullying is unacceptable;and;

• (xiii) have the skills to recognise incidents or indications of bullying and howto deal with them;and

• (b) that each child is encouraged to build and maintain positive relationshipswith others.

3.8In 2002 the DoH/DfES issued Joint Guidance ofPhysical Interventions (Guidance on Restrictive Physical Interventions for People with Learning Disability and Autistic Spectrum Disorder, in Health, Education and SocialCare Settings) which aimedto provide guidance concerning restrictivephysicalintervention by staff with service users (children and adults) in all settings.Although the title suggests that it only applies to people with a learning disability orautistic

spectrum disorder, it contains the clarification that it includes children/young

people with severe behavioural difficulties, and emotional and behavioural difficulties which result in them displaying extremebehaviour. For residential homes the guidance should be read alongside Permissible Forms of Control inChildren’s Residential Care (DoH1993).

3.9The joint guidance includes a number of definitions anddistinctions. Distinctions are madebetween:

• Non-restrictive physical intervention - intervention using bodilycontact, mechanical devices or changing theenvironment.

• Restrictive physical intervention - intervention using force torestrict movement or mobility, to control behaviour or to break away fromdangerous or harmful physical contact.

• Planned intervention - recorded strategies based on a riskassessment.

• Emergency or unplanned intervention - use of physicalintervention occurring as a response to unforeseenevents.

3.10The guidance emphasises preventative strategies and acknowledges thatthe proactiveuseofrestrictiveinterventionissometimesinthebestinterestsofthe child/young people and could form part of their care plan, but will always be alast resort.

3.11There is emphasis on strategies based on risk assessments and onjudging whether the risks involved in employing physical intervention are lower than those of not doing so. Any intervention must be proportionate to both the behaviour and the harm it maycause.

3.12Thereisarequirementincaresettingsthat,ifitisforeseeablethatachild

/young person user might require a restrictive physical intervention, it mustberecordedintheircareplan.Theplannedinterventionmustbebasedonarisk assessmentanddescribethespecificstrategiesandtechniquestobeemployed.

3.13The children’s residential service has adopted PRICE as its methodof behaviour management. PRICEtraining is BILD accredited Positive Behaviour Support and physical intervention training for schools, social care, and health settings.

4.0 Promoting positivebehaviour

4.1There are appropriate methods of developing and maintaining levels ofpositive behaviour. These are different depending on the ages, needs and abilities ofthe children and young people welook after. The emphasis is on helpinga child/young person to learn to manage his or her own behaviour, feelingsand anxieties.

• Establishing positive relationships with children/young people so they feelsafe.

• Developing a positive culture based on a clear understanding of rightsandresponsibilities for children/young people and staff. This shouldinclude respecting difference and challenging all form of discriminatory andoppressive behaviour.

• Planned structure of time and clear, consistentboundaries.

• Positive role modelling by staff and constant verbal reaffirmation of whatis

positivebehaviour.Thelanguageandbehaviourofstaffshouldatall times

reflect a positive attitude towards young people, and endorse a caring andsafe environment.

• Giving children/young people alternative strategies for coping withtheir feelings that are moreacceptable.

• Rewarding and praising children/young people for positive orwell- managed behaviour.

• Discussion and counselling on why certain behaviour is inappropriateandunacceptable, rather than a statement such as “…Don’t dothat”.

• A child/young person makes amends by an apology or change of attitude. It may also be appropriate for the member of staff to apologise if something went wrong.

• Opportunity for children/young people to discuss issues ofbehaviour, consequences, and disciplinary measures and their views recorded andtaken into account, using methods of communication they understand andfeel comfortable with.

• “Involvement” of staff with children/young people’s activities ratherthan “supervision”.

5.0Consequencesforunacceptablebehaviour

5.1Strategies usedto ensure that there areconsequences forunacceptable

behaviourshouldbefairandconsistentandencouragereparationandrestitution. They should be relevant to the incident, reasonable, age-appropriate, carried out

as soon as possible after the incident and last no longer than isabsolutely necessary.Theyalsoneedtobeflexibleenoughtobereviewedandrescindedat anytime.

5.2Children/young people should be informed about the range of consequencesthat may be imposed upon them and the possible circumstances which mayresult in consequences. This information may be supplied verbally and/or inthe children/young people’sguide.

5.3Before any consequence is given staff/carers must be satisfied of thefollowing:

• The child/young person was capable of behaving acceptablyand understands what was expected ofhim/her.

• Other encouraging and rewarding strategies have not worked or would notwork in the circumstances.

• There is a view that the imposed consequence may encourageacceptable behaviour or act as a disincentive to unacceptablebehaviour.

• The child/young person understands the relevance of thegiven consequence.

5.4It is important that an explanation is given to the child/young person as to whythe behaviour is inappropriate and why a consequence has been given.This should be when the situation has calmed down. If the child/young person wishestocontact their social worker, family or advocate to make a complaint, they needtobe given access to the telephone, or support is given to the young persontomake a complaint using the communication methods they feel comfortablewith.

5.5The emphasis should be on helping a child/young person manage his/herown behaviour, feelings and anxieties rather than on punishment. The self- respector

senseofresponsibilityofthechild/youngpersonshouldbesupportedratherthan undermined.

5.6Acceptable consequences to unacceptable behaviourare:

• Reproof: an explanation to a child/young person that theirpresenting behaviour is not appropriate oracceptable.

• Reprimand: as above with the explicit expectation that, if it is repeated,there will beconsequences.

• Reparation: this could be an activity, e.g. repairing damage, paintingetc.

• Restitution: this could be payment - full or partial depending oncircumstances and/or ability to pay - for damage caused or replacement oftheft.

• Grounding/time out: curtailment of leisure such as having to stay in, missingan outing or specific activity. The imposed consequence must be specific andtime limited and must not be given for more than one outing at atime.

• Early bed: This could be anything up to one hour early and only on the nightof the negativebehaviour.

• Withdrawal: Allow the child/young person to calm down in another room.This should only be for short periods of up to 10 minutes and the child/youngperson should be supervised by staff. For some individualsit

maybenecessarytobeleftaloneinaroomtocalmdown-inthisinstance staff must monitorclosely.

• Extra chores: The child/young person may be required to undertake these,or to carry out other suitable tasks. These must be reasonable giventhe child/young person’s age and their abilities and must not demean them orlead to prolonged isolation from peers or usualroutine.

• Extra supervision: The child/young person may be more fully supervisedby staffbothonandoffthepremises.Thismustbetimelimitedandreviewed weekly by staff, documented and signed by the manager or the deputy intheir absence.

• Removal of possessions: If a child/young person’s possessions, forexample, music systems, are used in a way that is disturbing to others, thepossessions may be removed for an appropriate length of time. Where possessionsare dangerous or used in a dangerous manner they should be removed andreturned to parents wherever possible. Where this is not possible, they need to be keptina safe place by staff with this recorded on the child/young person’srecord.

5.7Unacceptable behaviour can often be rewarded by attention causing ittobecome habitual. It is essential that staff do not reward negative behaviourbut give attention when the behaviour ispositive.

5.8It is important that any consequences are followed through.Children/young people learn that habitual tantrums become functional if it causes the carertoback down. It is the certainty and the consistency of the following through ofthe consequence, not the severity that mattersmost.

5 . 9 Consequences must be recorded, reviewedwithin 48 hours and revisedifappropriate. All consequences must be brought to the attention of theline manager; recorded in the child/young person’s case record; and recorded inthe consequences book which must be signed by the residential care manager, orthe deputy in the manager’sabsence.

6.0 Prohibited consequences and measures ofcontrol

6.1No given consequence must intimidate or frighten a child/young person. Certain consequences may not be given to children/young people, inanycircumstances. Theyare:

• Any form of corporal punishment; i.e. any intentional application of forceas punishment, including slapping, punching, rough handling and throwing items.It would also include punching or pushing, or similar behaviourin

response to violence from the child/young person. This is different tostaff’s right to defend themselves from physicalinjury.

• Any consequence relating to the consumption or deprivation of food ordrink.

• Any restriction on a child/young person’s contact with his or herparents, relatives or friends; or anyone acting in an official capacity e.g. socialworker, solicitor, advocate, independentvisitor.

PRACTICE GUIDANCE

Any intervention does not prevent contact or communication being restricted unlessin the exceptional circumstance where it is necessary to do so to protect thechild/young person orothers.

Anysuchrestrictionshouldbeenteredonthechild’sriskassessmentandcareplan.

• Any requirement that a child/young person wear distinctive orinappropriate clothes. This could be a badge, a hat, footwear or certainhairstyles.

• Wearing of nightclothes during the day: This is only acceptable wherethe child/young person is ill in bed or “tucked up” on thecouch.

• The use or withholding of medication or medical or dentaltreatment.

• Use of accommodation to physically restrict the liberty of any child/young person: This is unacceptable and only permitted in cases approved bythe Secretary ofState.

• Segregation and isolation. Children/young people should not be kept apart from agrouporforcedtobeontheirownforotherthanverybriefperiods,literally minutes, in order to “cool down” from disruptivebehaviour.

• The intentional deprivation of sleep as aconsequence.

• The change of a child/young person’s behaviour through bribery or the useof threats.

• Any consequence used intentionally or unintentionally whichmay humiliate a child/young person or could cause them to beridiculed.

• The imposition of any fine or financial penalty, other than a requirement forthe paymentofareasonablesumbywayofreparation.Thecourtmayimpose fines upon children/young people which staff should encourage andsupport them torepay.

• Anyintimatephysicalexaminationofachild/youngperson.Incaseswhereitis suspected that the child/young person is carrying drugs or an offensive weapona

search of their clothing and possessions is acceptable,if it isdeemed safetodoso,withanotherstaffmemberpresent.Howeverpriortothisstaff should request that the young person empties their pockets. This mustbe recorded in the room search book in line with National MinimumStandards.

• The withholding of aids/equipment needed by a child/young personwith disabilities.

• No other individual or group of children/young people should sufferthe consequences given to anotherindividual.

• Swearing at or the use of foul, demeaning or humiliatinglanguageor measures. An example would be making a child/young person strip theirown bed and wash the sheets following an incident of bedwetting.Humiliating someone, whatever his or her age is offensive, negative and damaging tothat person.

• Removal of liberty by locking in a room or any place except toprevent immediate harm to either themselves or otherpersons.

• Inappropriate bed times: This refers to children/young people being sent tobed during the day or straight after school. It also refers to a punishment of a seriesof earlynights.Ifthisisusedasamethodofdiscipline,thenitmustonlybeforthe night on which theymisbehaved.

• Baths on admission: As a matter of routine these are depersonalisingand offensive. Children/young people may choose to shower or have a bathon admission - that is their right, not to beenforced.

• The removal of photographs of family or comfort items such as teddybears