Behaviour that is Challenging and Physical Restraint Policy

Haresfield puts the care of our Young People at the centre of all that we do. In regards to behaviour we strive to promote positive behaviour and manage behaviour that is challenging, treating our young people with dignity, understanding, kindness and respect. In regards to behaviour that is seriously challenging, physical restraint will only be used when other less intrusive methods have been attempted or considered, and only in extreme situations and as a last resort to protect the young person or others from harm. It is our commitment as a Home to only use physical restraint when we have explored all other options.

The guiding principles in regards to this policy are;

• Ensuring that staff understand behaviour that challenges, is a way of communicating something, why it occurs and how to support young people effectively; Treating each young person with understanding, dignity, kindness and respect;
• Building, protecting and preserving positive relationships between each young person the other young people in the Home and the adults caring for them;
• Understanding each young person’s behaviour to allow their needs, aspirations, experiences and strengths to be recognised and their quality of life to be enhanced;
• Involving young people and relevant others (Social Workers and Parents) wherever practical in behaviour management planning;
• Supporting each Young Person to balance safety from injury (harm) with making appropriate
• Making sure the young person’s rights are upheld;
• Physical restraint will only be used when other less intrusive methods have been attempted or considered, and only in extreme situations and as a last resort;
• To administer physical restraint only when it is needed in order to protect either the young person him/herself, a member of the Home’s staff or any other person, from imminent and potentially serious physical harm; and
• To prevent or minimise any harm to the young person as a result of the use of physical restraint;
• Care and treatment offered will be lawful, legitimate, proportionate, and will be the least restrictive;
• We aim to minimise risks, to provide information, training and supervision to ensure the health and safety of our employees at work;
• All our staff will be trained in physical intervention techniques that meet the BUILD (British Institute of learning disabilities) accreditation scheme is outlined within the young peoples Placement Plans, Positive Behaviour Support plans and Safety Plans.

• Restrictive interventions - "deliberate acts on the part of other person(s) that restrict an individual’s movement, liberty and/or freedom to act independently in order to:
  take immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is undertaken; and End or reduce significantly, the danger to the person or others; and Contain or limit the person’s freedom for no longer is necessary" (Positive & Proactive Care: reducing the need for restrictive interventions. DoH. April 2014);
• Physical Restraint - “any direct physical contact where the intervener’s intention is to prevent, restrict, or subdue movement of the body, or part of the body of another person” (Positive & Proactive Care: reducing the need for restrictive interventions. DoH. April 2014).

• Challenging behaviours - “culturally abnormal behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to use seriously limit or deny access to and use of ordinary community facilities” (Emerson, 2001) Some of which are in the table below.

Haresfield will strive to promote positive behaviour by ensuring the Code of Conduct is understood and accepted by all. To this end, standards will be discussed and reviewed on a regular basis to adjust with changing times and situations.

Young people will be encouraged and helped to practice skills to build and maintain positive relationships, empowered to share their views and resolve conflicts positively. Young people will also be encouraged always to articulate their feelings rather than resort to physical expression or aggression.

The Home’s staff will work with young people in Link Work sessions, describing what is and what is not acceptable behaviour. Encouraging them to take responsibility for their behaviour, in a way that is appropriate to their age and abilities.

Acceptable behaviour will be encouraged by staff acting as good role models and using praise. Behaviour that is challenging will be handled with understanding, kindness and consistency, following agreed approaches to defusing tension and diverting aggression.

Positive Behaviour

The following points are a guide to positive behaviour;

• Emotional Intelligence: Managing feelings and behaviour (self-regulation), being able to express your emotions effectively, and being empathic towards others;
• Social Skills: Being able to form positive, respectful relationships;
• Cognitive Skills: Having self-confidence and self-awareness, and the ability to understand different feelings.

Although behaviour that is challenging is not always predictable and can happen anywhere and at any time, individual risk assessments may identify the possibility of such behaviour occurring, and the possible causes, or “trigger points”.

The most effective way of managing behaviour that challenges is to ensure that everyone receiving care has an individualised assessment which outlines their needs and aspirations and an individualised Placement Plan, Safety Plans and Positive Behaviour Support Plan that detail how they wish their services to be delivered.

The assessment should take account of any history of behaviour(s) which are challenging, should include a risk assessment, and should give clear guidance to staff about how to prevent and manage predicted behaviour(s) that are challenging. This “person-centred” approach should enable staff to deal more confidently with situations as they arise, with better results, providing greater confidence.

Haresfield commits to giving each young person a voice in the assessment process, the formulation of Placement Plans, Positive Behaviour Support Plans and Safety Plans and their review.  This process allows understanding not only of the “triggers” to behaviour that challenges, but also offers an understanding of the young person’s preferences as to how they wish such behaviour on their part to be handled. These interactions help put the young person at the centre of their support.

All situations in which behaviour that challenges will be handled with respect to the rights to safety, dignity, freedom and respect for those involved with any incident, including young people, staff and any others who may be directly involved.

All staff who are the subject of, or witness of behaviour that is challenging are required to deal with the matter at the time, in a calm and professional manner, by follow strategies outlined in their Placement Plans, Positive Behaviour Support Plans and Safety Plans. The first action will always be to try to de-escalate conflicts, so as to avoid greater harm. Further action will be in accordance with the severity of the event and physical punishment of any kind will never be used.

In all cases any measures taken to respond to behaviour that challenges will be appropriate to the age, understanding and individual needs of the young person and in line with their Placement Plans, Positive Behaviour Support Plans and Safety Plans. Taking into account that challenging behaviour may be the result that the young person is unhappy with or cannot understand the situation they are in and is having difficulty expressing their wishes and feelings or it could be due to illness, bullying, harassment, abuse, certain disabilities or communication difficulties, or previous events and trauma.

There may be occasions when the young person’s behaviour is so extreme that their actions may be a danger to themselves, or to others. In such cases staff may exercise some form of physical restraint.

In very rare cases some young people, usually as a result of an impairment or disability, may have restraint as a necessary component of their care. In such cases this will be recorded in their Placement Plan, Positive Behaviour Support Plan and Safety Plans.

An incident record will always be made of restraint in all circumstances.

The young person will be advised of the consequence of their behaviour that challenges only after a cooling down period, when the decision has been thoroughly discussed by staff.

Consequences must not be excessive or unreasonable or punitive. Measures taken to respond to behaviour that challenges must be appropriate to the age, understanding and individual needs of the young person.

The following Consequences may be considered on an individual basis:

• Delaying of activities;
• Removal to a safe environment;
• Restitution;
• Restorative work;
• Natural Consequences.

Notes

Delaying of activities

The delay should only happen if the activity is imminent so that the young person can link what is happened to the delay, or the delay can be until the young person has calmed down and can take part in the activity safely.

Removal to a Safe Environment - It might be necessary to remove the Young Person from an area where there are other people due to the behaviour that is challenging as it might cause harm to others. This is to be a temporary measure only, and not to be repeated on a regular basis.

Restitution - Where appropriate and with the Young Persons freely given consent and if the young person is able, restitution should be made. This means to makes good what has been done - effective debriefing where both parties are able to restore the relationship and or the environment.

Restorative work – Work is done with the young person to right what has happened. This can also include sitting with the person that was effected by the behaviour and talking through how it may have effected them.

Natural consequences - We explain natural consequences so that our Young People understand that their actions have repercussions. For example cleaning up something that has been spilt or waiting for something that has been damaged to be fixed or replaced.

Prohibited Measures 

Haresfield will use discretion at all times when applying consequences, in an attempt to engender positive and lasting improvements in behaviour. Extreme sanctions will never be used, including the following:

• Any form of corporal punishment;
• Any punishment involving the consumption or deprivation of food or drink;
• Any restriction, other than one imposed by a court on:
  1. A young person’s contact with parents, relatives or friends;
  2. Visits to the young person by the young person’s parents, relatives or friends;
  3. A young person’s communications with any persons listed in The Children’s Homes (England) Regulations 2015 regulation 22(1) (contact andaccess to communications); or
  4. A young person’s access to any internet-based or telephone helpline providing counselling for Young People;
• The use or withholding of medication, or medical or dental treatment;
• The intentional deprivation of sleep;
• Imposing a financial penalty
• Any intimate physical examination;
• Withholding any aids or equipment needed by a disabled young person;
• Any measure involving a young person imposing any measure against another young person; or
• Any measure involving punishing a group of young people for the behaviour of an individual young person.

The aim of Haresfield is to never use physical restraint but it is very likely that staff working within the home, as well as visitors will, on occasion, be involved in situations which meet or closely approximate to the definition of behaviour that challenges (as above in definitions) and handling such incidents appropriately and professionally is of considerable importance for both the young person and the employee. It is therefor our commitment to administer physical restraint only when it is needed in order to protect either the young person, a member of Haresfield’s staff or any other person, from imminent and potentially serious physical harm, and to prevent or minimise any harm to the young person as a result of the use of physical restraint.

Due to various factors stated within their plans some young people will have restraint measure/s documented in their Placement Plan, Positive Behaviour Support plans and Safety Plans. If physical interventions are prescribed, this will be clearly stated along with details of the restraint measure to be used in residents Care Plan and their Positive Behaviour Support plan. Staff must follow a gradient of support to always ensure least restrictive options are employed and always as a last resort.  

When Physical Restraint is Used:

As per regulation 20 of the Children’s Homes (England) 2015;

1. Restraint in relation to a child is only permitted for the purpose of preventing:
   1. Injury to any person (including the child);
   2. Serious damage to the property of any person (including the child); or
   3. A child who is accommodated in a secure children’s home from absconding from the home.
2. Restraint in relation to a child must be necessary and proportionate;
3. These Regulations do not prevent a child from being deprived of liberty where that deprivation is authorised in accordance with a court order.

Dealing appropriately with behaviour that is challenging calls for, amongst other things, understanding, patience, tolerance and appropriate expertise. Haresfield understands that any employee may be faced with dealing with such issues and commits to:

• Providing effective support, supervision, and Positive behaviour management training (annually), to all staff in order to ensure the best possible outcomes for the young people they support, and ensuring that staff understand that young people have the same rights as everyone else;
• As previously said - Ensuring that staff understand behaviour that challenges, is a way of communicating something, why it occurs and how to support young people effectively;
• Working with family members, Social Worker,Education or CAMHS where possible and applicable, so as to gain an understanding of the young person’s history of behaviour that is challenging (if any) and solutions/techniques that have been effective in the past;
• Liaising and communicating with local support groups, social workers, healthcare professionals etc. in order to gain greater understanding and knowledge of not only how to deal and manage challenging situations, but, more importantly, how they can be avoided. No single organisation possesses all the answers;
• Providing staff with guidance on dealing with behaviour that is challenging and flexible techniques, including non-aversive approaches, and proactive/reactive strategies;
• Sharing good practice through Team Meetings and Case Management reviews.
• Fostering a culture of team work, communication and consistency;
• Recognising when police involvement is necessary and supporting staff or teams to give statements or press charges;
• Recognising that although withdrawal of service is a last resort, it is sometimes the most appropriate course of action.

Staff will be supported with debriefs, regular supervision, and team meetings to manage their feelings and responses arising from working with children, particularly where children display behaviour that challenges or have difficult emotional issues. This support will include appropriate training/education in the root causes of behaviour that is challenging and its elimination, through appropriate and available means, and the use of restraint, which might include attendance on courses, e - learning etc.

Good reporting is essential, and the following must be followed.

• All incidents, near misses, ABC’s, accident reports and behaviour frequency charts (where appropriate) must be completed by the safe member who was involved in the incident, near miss or ABC. They must be completed comprehensively and accuratelyand should detail all aspects of the behaviour detailing what has happened and the reasons for the use of physical intervention, if required, before the end of their shift;
• A review and assessment will be made, (by whom) with due consideration of how the stressful situation might have been avoided at that time, and may be avoided in the future;
• Managers will give staff adequate training in the recording of incidents, including the
  detail needed within the recording;
• Staff willcontact the manager/s, social worker, and parents where appropriate when
  physical intervention has been use;
• An appropriate record of the debrief will be made by the senior member of the team and shared/stored appropriately;
• All consequences will be reported in the Consequence Log on Access (by whom);
• The Incident Report is on Access and will be cross-referenced with the Consequences Log. (By whom);
• Where physical restraint is used, then a record of the incident must be made in accordance with this policy. Most instances of behaviour that is challenging however may be handled without such restraint;
• A care worker who administers a restraint shall verbally inform the Home Manager as soon as practical that day and by written report by the end of their shift;
• The Home Manager shall inform the young person’s Social Worker and person with parental responsibility(where appropriate) of the use of physical restraint as soon as practical and by written report no later than three 48 hours following such use;
• The registered person or a person authorised by the registered person will have within 48 hours of the incident have spoken to the staff member/s about the measure and signed the record to confirm that it is accurate;
• The registered person or a person authorised by the registered person will have within 5 days have spoken to the young person about the measure and recorded this on the report.

Physical restraint reports must include:  

As per regulation 35 of the The Children’s Homes (England) 2015

3. The registered person must ensure that:
   1. Within 24 hours of the use of a measure of control, discipline or restraint in relation to a child in the home, a record is made which includes:
      1. The name of the child;
      2. Details of the child’s behaviour leading to the use of the measure;
      3. The date, time and location of the use of the measure;
      4. A description of the measure and its duration;
      5. Details of any methods used or steps taken to avoid the need to use the measure;
      6. The name of the person who used the measure (“the user”), and of any other person present when the measure was used;
      7. The effectiveness and any consequences of the use of the measure; and
      8. A description of any injury to the child or any other person, and any medical treatment administered, as a result of the measure;
   2. Within 48 hours of the use of the measure, the registered person, or a person who is authorised by the registered person to do so (“the authorised person”):
      1. Has spoken to the user about the measure; and
      2. Has signed the record to confirm it is accurate; and
   3. Within 5 days of the use of the measure, the registered person or the authorised person adds to the record confirmation that they have spoken to the child about the measure.
4. Paragraph (3) does not apply in relation to restraint that is planned or provided for as a matter of routine in the child’s EHC plan or statement of special educational needs.