Use of Safety Interventions

For this policy, we are using the definitions of restrictive interventions as contained in Positive and Proactive Care: reducing the need for restrictive interventions (DH2014). 

Restrictive interventions are defined as:

Interventions that restrict an individual’s liberty, movement and/or freedom to act independently in order to:

• Take immediate control of a dangerous situation: and End or significantly reduce the danger to the person or others; and
• Contain or limit the child’s freedom for no longer than is necessary.

restrictions of liberty of movement, should be recorded as Restrictive Safety Interventions/ Restraint. See Section 13, Recording and Management Review.

Restrictive safety interventions, for the purpose of safety intervention is designed to restrict the child’ range of movement to manage the presenting risk. A non-restrictive safety intervention includes disengagement techniques which are designed to enable a person to move away to a place of safety.  Disengagements may be required due to a child holding onto someone without their consent and examples might be grabs to clothing, wrists, hair or bites.  

These skills are taught alongside the holding skills (restrictive safety interventions) as part of CPI Foundation training and are designed to manage crisis behaviours when a child is in distress.

These are less forceful and less restrictive than Restraint and may be used to protect children or others from injury, but must never be used to force compliance where there is not a risk of injury or damage to property nor as a form as punishment. These techniques are recorded as safety interventions.

The assessment and planning process for all children in residential care must consider whether the child is likely to behave in ways which may place them or others at risk of Injury or may cause damage to property. The impact of the child's arrival on the group of children/young people in the home should also be considered.

If any risks exist, strategies should be agreed to prevent or reduce the risk. These strategies must consider if safety intervention could be necessary. Staff should continually review any risk assessments. Risk Assessment and Planning Procedure.

Where safety Intervention is likely to be necessary, for example, if it has been used in the recent past or there is an indication from a risk assessment that it may be necessary, the circumstances that give rise to such risks and the strategies for managing it should be outlined in the child's care Plan and risk assessment.

In developing the child’s care Plan, consideration must be given to whether there are any health, or medical conditions which mean particular techniques or methods of physical intervention should be avoided. If so, any health care professional currently involved with the child should be consulted regarding appropriate strategies and this must be drawn to the attention of those working with or looking after the child and it must be stated in the child’s individual risk assessment, care Plan. If in doubt, medical advice must be sought.

All staff will be trained in methods of behaviour management, including the use of safety Intervention that are agreed by the Home. This training will be refreshed on an annual basis. CPI Safety Intervention™, formerly known as MAPA®, The purpose of this training is built of staff knowledge and skills to recognise, prevent, and when necessary, manage crisis behaviours using person centred and trauma informed responses. 

Advanced/Advanced & Emergency programmes are designed for organisations supporting individuals likely to demonstrate more complex or extreme risk behaviours. Such as Clayfield’s Secure Accommodation. It provides effective intervention options and decision-making skills to help staff manage higher risk situations.

This training must ensure that staff are able to:

• Manage their own feelings and responses to the emotions and behaviours presented by children;
• Manage their responses and feelings arising from working with children, particularly where children display risk behaviour or show distress behaviour that is a challenge for others to manage and puts the child or others at risk;
• Understand how children's previous experiences & trauma can result in difficulties regulating behaviours and emotions;
• Use methods to de-escalate confrontations or potentially violent behaviour to avoid the use of physical intervention and restraint.

The registered person is responsible for ensuring that all their staff have been adequately trained in the principles of safety interventions and any techniques are appropriate to the needs of the children the Home is set up to care for as defined in the Home's Statement of Purpose.

The registered manager is responsible for making sure that the rota is adequate, and staff are trained and competent to meet the needs of the children in the home.

 must be used only in strict accordance with the legislative framework to protect the child and those around them. All incidents must be reviewed, recorded and monitored and the views of the child sought, dependent on their age and understanding, and understood.

Restraint in relation to a child is only permitted for the purpose of preventing:

• Injury to any person (including the child);
• Serious damage to the property of any person (including the child); or
• A child who is accommodated in a secure children's home from absconding from the home.

'Injury' could include physical injury or harm or psychological injury or harm.

Restraint in relation to a child must be reasonable and proportionate.

It must be the least restrictive and for the least amount of time.

This does not prevent a child from being deprived of liberty where that deprivation is authorised in accordance with a court order. See Section 9, Deprivation of Liberty.

When restrictive intervention involves the use of force, the force used must not be more than is necessary and should be applied in a way that is proportionate i.e. the minimum amount of force necessary to avert injury or serious damage to property for the shortest possible time.

Restraint that deliberately inflicts pain cannot be proportionate and should never be used on children.

There may be circumstances where a child may be prevented from leaving the Home for example a child who is putting themselves at risk of injury by leaving the Home to carry out gang related activities, use drugs or to meet someone who is sexually exploiting them or intends to do so. Any such measure of restriction must be proportionate and in place for no longer than is necessary to manage the immediate risk.

In a risk situation, staff should use their professional judgement, supported by their knowledge of each child's risk assessment, an understanding of the needs of the child (as set out in their relevant plans) and an understanding of the risks the child faces. Professional judgements may need to be taken quickly, and staff training and supervision of practice should support this.

Approaches to safety intervention should recognise that children are continuing to develop, both physically and emotionally. Any use of Restraint should be suitable for the needs of the individual child. The context in which restrictive practice is used should also recognise that, because of past experiences, children will have a unique understanding of their circumstances which will affect their response to adults responsible for their care.

Trained staff should only use techniques that are approved by the Home. Approved techniques should comply with the following principles:

1. Not impede the process of breathing - the use of 'prone face down' techniques must never be used;
2. Not be used in a way which may be interpreted as sexual;
3. Not intentionally inflict pain or injury or threaten to do so;
4. Avoid vulnerable parts of the body, e.g. the neck, chest and sexual areas;
5. Avoid hyperextension, hyper flexion and pressure on or across the joints;
6. Not employ potentially dangerous positions.

Restrictive safety interventions or Restraint is making someone do something they don’t want to do or stopping someone doing something they want to do it happens when a person feels they have no choice but to comply. Different types of restraint are collectively referred to as restrictive practices.  In some cases, such as in residential special schools that are also registered children's homes or children's homes caring for children with complex care needs, Restraint may form part of their care plan and support needs used day to day to manage risk. A child's EHC plan, risk assessment or residential care plan may contain detail about planned and agreed approaches in the day-to-day routine of the child.

Homes that care for children where, safety interventions is a necessary component of their care should include information relating to this in the Statement of Purpose.

In some extreme cases where children have very complex care needs, a child may need to be restrained by mechanical or chemical means. Any use of such Restraint should follow a rigorous assessment process and, as with any Restraint, be necessary and proportionate. Wherever such Restraint is planned, it should be identified within a broad ranging, robust behaviour support plan which aims to bring about the circumstances where continued use of such Restraint will no longer be required.Likewise, chemical restraint (being medication not prescribed for the treatment of a formally identified physical or mental illness, but instead being prescribed for use “as needed” or “PRN - pro re nata”) should only ever be delivered in accordance with acknowledged, evidence-based best practice. The Home should employ staff who have the relevant qualifications, skills and experience to administer this type of restraint in line with NICE Guidelines on Managing Medicines in Care Homes and CQC and Ofsted joint Guidance on Registration of Healthcare at Children's Homes.

Any use of safety intervention carries risks. These include causing physical injury, psychological trauma or emotional disturbance. When considering whether Restraint is warranted, staff need to consider:

• The age and understanding of the child;
• The size of the child;
• The relevance of any disability, health problem or medication to the behaviour in question and the action that might be taken as a result;
• The relative risks of not intervening;
• The child's previously sought views on strategies that they considered might de-escalate or calm a situation, if appropriate;
• The method of Restraint which would be appropriate in the specific circumstances; and
• The impact of the Restraint on the carer's future relationship with the child.

Staff need to demonstrate that they fully understand the risks associated with any interventions used in the Home. Techniques used for safety interventions that may interfere with breathing and holds by the neck that may result in injury to the spine are not permissible in any circumstances.

Working together to Safeguard Children requires each Local Authority to have a LADO. In Nottinghamshire the role of the LADO is undertaken by the Managing Allegations Service.

The purpose of the LADO role is to address allegations/concerns made against adults working or volunteering with children in Nottinghamshire.

The responsibility of the employer/person receiving the complaint is to:

•  Ensure child is safe and refer to MASH/Police as appropriate;
•  Consider the actions required to safeguard this child and other children in the setting;
•  Refer to LADO using the LADO Online Contact Form (link below) providing clear details of the incident, the adult of concern (incl personal details to safeguard the adult’s own children, consider any additional voluntary roles the adult holds), details of the child and refers details.

LADO online Contact Form - Submit a LADO Contact Form

The LADO should be notified when:

• A child is injured or may have been injured because of appropriate/permitted restraint practice or actual/perceived use of excessive force;
• A child and/or parent/carer makes an allegation and/or complaint against a professional following a restraint of a child;
• A professional, other adult or child reports an observed or perceived inappropriate restraint of or practice with a child by another professional.

The locking of external doors, or doors to hazardous materials, may be acceptable as a security precaution if applied within the normal routine of the Home.

A deprivation of liberty may occur where a child is both under continuous supervision and control and is not free to leave the Home. The Home cannot routinely deprive a child of their liberty without a court order, such as an order under section 25 Children Act 1989 to place a child in a licensed secure children's home, or, in the case of young people aged over 16 who lack mental capacity, a deprivation of liberty may be authorised by the Court of Protection following an application under the Mental Capacity Act 2005.

Where restrictive safety intervention has been used, the child, staff and others involved must always consider if medical assistance or advice is required.  children must be given the opportunity to see a Registered Nurse or Medical Practitioner, if the wish to do so, even if there are no apparent injuries.

If a Registered Nurse or Medical Practitioner is seen, they must be informed that an incident has occurred involving physical Restraint.

Whether or not the child or others decide to see a Registered Nurse or Medical Practitioner it must be recorded, together with the outcome.

The registered person should regularly review the effectiveness and check the medical assessment of the system remains up to date.

If safety intervention is used upon a child, the Home Manager and child's social worker if allocated, must be notified within two working days. Parents and carers must also be informed.

If a serious incident or the police/emergency services are called, the relevant senior manager must be notified and consideration given to whether a Notifiable Event has occurred, if so, see Notification of Serious Events Procedure.

If a child is fully accommodated The social worker should decide about whether to inform the child's parent(s) and, if so, who should do so.

Records of safety intervention must be kept and should enable the registered person and staff to review the use of safety interventions to identify preventative strategies, effective practice and respond promptly where any issues or trends of concern emerge. The review should provide the opportunity for amending practice to ensure it meets the needs of each child. The child’s individual risk assessment must be reviewed following any safety interventions.

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Positive and Proactive Care: Reducing the Need for Restrictive Interventions - Department of Health and Social Care

Guidance: Positive Environments Where Children Can Flourish (Ofsted)