There is much confusion in the social care sector, and in schools, about the meaning of physical intervention and the circumstances where it can be used. This applies equally to adult and children's social care.
From what I see, the problem is that staff, carers and service users are rarely provided with a clear policy; or the policy is just not workable e.g. where staff are told that there is a 'hands off' policy.
The latter, more than no policy at all, is simply wrong. People looking after vulnerable children or adults have a duty of care and everyone engaged in the work has to understand that use of physical intervention is sometimes necessary.
First, lets look at the definition of Physical Intervention: Some just refer to Restraint, covering all aspects of Physical Intervention, but they are wrong to do so. Restraint is a form of Physical Intervention, there are others including just holding, touching or guiding and use of physical presence only i.e. standing in a person's way to prevent them from leaving.
Holding, touch and presence are less restrictive e.g. you may place your hands on a person's shoulder to caution or guide them away from a potentially risky situation.
Restraint, on the other hand, is the definitive use of force designed to overpower the person; the Department of Health, way back in 1993, described it as the positive application of force designed to overpower. I believe this definition still stands.
What about circumstances where Physical Intervention may be used? The answer isn't simple, all circumstances are different; in a split second they can change and it requires a cool and well trained head to decide when to intervene or not. But these are the basic principles.
First, you have to determine that the child/adult, or another person (carer, staff member or other service user) is at risk of significant harm (some refer to serious injury but the former ought to be used because it can encompass forms of abuse such as sexual exploitation) or that serious damage might result. It isn't sufficient that a crime may be committed, crimes oftent don't result in harm or serious damage to property. It also isn't sufficient that a child is threatening to absent themselves i.e. run away, or that they are refusing to co-operate (even in schools despite the view taken by many teachers). You have to be able to argue that serious injury/serious damage to property is likely unless you act. NB this is often referred to as the principle of 'Last Resort'.
Second, you must argue/be satisfied that you/colleagues have tried everything you possibly can to avert the need for Physical Intervention; or that anything you might try will not work in the circumstances i.e. will not reduce the risk. In other words, you may not step in and use Physical Interventiion UNLESS your bag of tricks is exhausted or will be futile. There is much to be said about what this means e.g. using defusion, calming and negotiation skills - it's also about creating the right culture, where children/adult feel safe - but that is for another blog.
Third, you have to satisfy yourself that the harm/damage is likely in the predictable future.
You havent got time, usually, to break into groups and discuss it, you're on the spot, you have to make the decision. Not always, I admit, but this is often the case.
Back to predictable future, you won't get away with arguing "I thought s/he might seriously injure themselves a week next Thursday"; that's not what is meant. Unfortunately, what is meant is not as clear as day, but I believe predictable future means the next several hours.
Forth, that any action, especially use of Physical Intervention, is proportionate i.e. the least amount of force necessary to reduce or prevent the risk of harm/damage. Don't Restrain (i.e. overpower) if Holding will work, don't Hold if Touch will work and don't touch if use of your physical presence will work. Once you apply any form of Physical Intervention, keep (re)assessing the situation, and be ready to back off, reduce the amount of force used at any time; equally, be ready to apply more force if you are losing control (though not just becuase you are losing it) and this might result in a higher level of risk. Any use of force/Physical Intervention must only be used as long as necessary to reduce the risk.
Can you use Physical Intervention if you havent been trained? That's debatable, I'd say you can so long as you apply the principles above and the form of Physical Intervention used is applied safely, doesnt impede the process of breathing, isn't used in a way which may be interpreted as sexual, there is no intention to inflict pain, avoids vulnerable parts of the body, e.g. the neck and chest, avoids hyperextension, hyper flexion and pressure on or across the joints.
NB some forms of Restraint should never be used e.g. Prone/Facedown (see below).
Can you lock a door to prevent a child/adult from leaving? Another debatable point, once again, I'd say yes you can so long as the principles above are applied - especially the pricniple of proportionality. However, as is the case for any Physical Intervention, if it is necessary to apply it for long periods, or on multiple occasions without seeing a reduction or improvement, you have to question whether the child/adult is appropriately placed.
These, above, are all matters that ought to form the backbone of a policy in schools and homes. Unfortunately, too often, I see or hear that staff, carers and service users have no idea what the policy is on use of Physical Intervention, or are provided with a policy which just leaves them feeling unclear and vulnerable. We all know what this leads to.
I hope this blog will inform and stimulate debate amongst colleagues and I look forward to all comments and feedback.
It should be read in conjunction with Ban Prone Facedown
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well written and to the point
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