Please note: All members' discussions at our forums are a “sharing experiences opportunity” and not to be taken as guidance, the recordings below are members discussions intended to be supportive to one another and offer peer support which can be considered, or not within your own workplace - no recommendations have been endorsed by NAFP.
Thoughts from Catherine…
What is your understanding of physical intervention - is there ever a time when it is ok?
Do you specifically train your carers (those identified due to needs of children) to “hold” children as safely as possible, or is it a no at all costs
Are all carers expected to undertake de-escalation training and if so do they repeat this as part of your compulsory training - most are likely to be involved in PACE or DDP training etc
When you know that some children might be at risk of hurting themselves or others, is there ever any agreement with the LA in the risk reduction plan that talks of physical intervention to ensure children are safer in extreme situations
If this is agreed are you worried it gives a licence to use it , which of course we know is not acceptable
If you do train a few and those carers identified - what do you use, who do you use and how is this monitored and supported within the agency
Do you have someone trained within your organisation - licensed to oversee this risky area
How do you monitor physical interventions and what packages do you put in as a de-brief and reflective piece of work where it has happened as a last resort - recorded and management oversight over the situation etc
Additional thoughts from NAFP
● Firstly a need for policies to be clear on how to define what is meant by PI
● Equipment (i.e car seats that a child cannot undo themselves ) could be a physical restraint.
● Different levels of PI need to be recognised. From a guide to a hold.
● A need to be realistic. To recognise that PI is a permitted intervention in exceptional circumstances when all other options have been tried or are not possible in the time available. Ie a child running out into the streets.
● To prevent immediate harm to self or others (don’t just say people as preventing harm to animals is a valid reason).
● Harm to property is something which must be justified. This can be a contentious area in my experience.
● Minimum time and minimum force principles must apply
● Well recorded, including the lead up to the incident.
● Debriefs: Child’s views recorded - who, when and how to do this. Usually best to be a separate person.
● Carer views to be recorded too.
● Lessons learned to be captured.
● Must be a huge focus on de-escalation and prevention. Working on supporting the child to find alternative strategies to cope with their emotions. (However this can take years).
● Age, size and physical abilities of the child must be taken into account. Ie it may be safe for a single carer to physically hold a very young child back from physically attacking another child. However if the child is larger, older, stronger then no hold would be safe if performed by a carer on their own. Basket holds would not be safe.
● High quality training is key. I have some links somewhere if needed but am sure others will too
● Residential homes can manage services in a way that ensures there are always 2 people present. This is an unlikely scenario in foster care so the high likelihood of 1:1 is what makes unsafe PI in foster care a higher risk.
● Key problems arise when carers cannot keep a child and others safe. Either because the child’s behaviour is far more dangerous than envisaged (not assessed adequately or not captured on a referral) or because the child has become older, larger, stronger and holds are becoming unsafe. Or because carers have physical limitations making holds unsafe.
● If a hold is warranted and cannot be carried out in a safe way then for me this is the area of greatest concern. I worry that LAs (and maybe sometimes providers) are not always being responsive enough in a timely way. In these situations there either needs to be ways of ensuring there are two trained adults available to the child at all times whilst the child is in foster care (challenging scenario) or the arrangement must come to an immediate end and a safer alternative residential solution is found.
● Finally the importance of management oversight. Ensuring someone senior in the organisation is reading every single incident form where PI took place or where it was narrowly avoided. That lessons learned are captured and there is evidence of continuing improvement. Especially with regards to how PI can be avoided where that is possible. But also as to how children and carers are kept safe and feel well included in discussions and are heard when PI has been needed.
Members' discussion
● Some agencies do train specific foster carers team reach - external training if last resort not a strategy we adopt
● De-escalation training - all agencies undertake this (without the hold)
● To prevent harm - used where this has been fully explored and within risk plans where children may pose a risk to themselves or others - eg running across a road
● Level 1 - training is 6 hours training, Level 2 - 12 hours - this is a worker trained to deliver and then delivered to specific carers with lots of review and support, monitoring
● Step down from residential fostering service - part of model team teach to level 2 and monitored - if no concerns keep carers at level 1 - 2 members of staff trained in team teach resi - 95% de-escalation and 5% in safe hold
● 1800 per person - so this is not about training carers direct - it is committing to someone in the team to deliver and take responsibility for monitoring and supporting
● After 12 months expectations that workers have refreshers
● Licences - belongs to the person in the agency and not about them using this elsewhere - it belongs to their role whilst in the agency and cannot be used outside of this - stipulated in the licence
● Many examples of being a Therapeutic agency
● Positive parenting policy
● Updated every 3 years or as required
● SHADES - Derek Raynor - more info http://shadestraining.com/
● Safe handling and de-escalation
● Safe cuddles and open hands
● One to one sessions Where situation more risky
● If need to use restraint discussion with LA and agreed support plan /authorisation
● Monitoring to see progress in interventions - reductions through alternative strategies - there is so much to do before physical intervention is resorted to● Examples provided strategies and safer ways - one was around a child biting an arm and how E.g. natural it is to withdraw the arm, Move arm in and child opens mouth, Did reduce bites - however, do not adopt examples without support to know how to do things safely
● Another example around Kicking - positioning self to side
● Techniques to avoid being hurt - Derek Raynor
● Distraction techniques
● All agreed at times / extremes children may lash out, It does happen - strategies for management
● Proactive rather than reactive - and considering the strategies prior to the event rather than permissions in the moment which rarely happen - discussion re if you have time to gain permission then PI is not required as PI often happens in a moment, reactive, and possibly lost control of a situation
● Matching stage - an agency brought in the support of Derrick (shades) to discuss how this child could be supported
● Show preventative and how into placement planning
● Don’t always know at matching stage, there is often things not included in the referral
● Example of a child couldn’t keep themselves safe - running into traffic - triggers - explore the prior to, during and after and some debrief - see if there is triggers that can be seen prior to and then de-escalate or distraction techniques helpful
● Risk assessment process and all knowing triggers and concerns that can be thought about in risk plans and my safety plans for children
● Aftermath of what we do - in hours or out of hours - reporting and recording and levels of notifications - sch 6 and sch 7 reporting - and reporting to LADO
● De-brief alongside SSW and FC - go out on same or next day with the RM who takes the lead on the incident report
● Support worker takes child out - to free up the carer for the debrief and also offers an opportunity for the child perspective
● Triggers - what has happened for the child to to come off their baseline
● Rationale - why carers thought ok to get on so hands on
● Example of danger - a child with a Pole - smashing everything in room - sometimes things escalate quickly and cannot be contained - often results in endings
● LADO - and differing thresholds
● Incident form - carers complete with SSW and then RM goes through this
● Fear of carers - moment touch child as soon as touch carers worry this could be de-registration for them and things are stressful and heightened for them - fear
● So this has sometimes led to carers “allowing” self to get kicked in a corner -this is not good
● Incident reports - anticipate the Q that LADO may also ask
● An agency shared that Ofsted said can’t have a no restraint policy expectation to hold to stop coming to harm - CL to discuss further with ofsted - as also seem many reports that talk of expectations around preparing carers to support children if required but only those that have fully considered at risk and not all carers
● Continually monitoring those carers where this is a risk● All get de-escalation and ‘next stage’ - how safely to do - but not specifically about PI
● When asked FC if want the training around this - don’t want it
● Child led
● Used as infrequently as possible
● Some agencies have a no restraint policy - some agencies don't have a policy at all but talk of de-escalation
● Comprehensive step down programme
● Have residential homes within their services and sometimes support from staff in the residential support foster carers and sometimes foster carers do some supportive work in the residential setting - consistency in both
● Parenting therapeutically
● Team around the child meetings - FC led and all attend
● Hugging therapeutically - some children want to be held - feel secure
● Changes in body language - for children who are non verbal - difficult to understand the distress levels - require a trained team around the child and not guess work
● Restrictive - discussion re what restrictive PI is - and the difference between PI where it is safe holding and prevention ie pinning a child down and sitting on them
● When it is a guide - steering
● Then into a hold and becomes PI - this is still PI and needs to be recorded and monitored and debrief
● Working with school - working closely together - good consistency re strategies
● Planning and being ahead
● Empowering FC to love children and not always a breakdown of love and care and seen purely negative but exemptions where in interest
● If time to ask if appropriate - then it’s not appropriate
● There can be a lot of guilt, shame around PI and how carers are emotionally involved, love children and the difficulties for children where this can reinforce trauma for children - this is why some agencies have therapists attached to ensure support for children and carers is followed through
● PI can be part of the journey - can it ?
● Recordings - need to be accurate and descriptive
● Several steps and time full reflection was discussed
● Removing items so children don't get hurt - example of child who ingests it or takes to use later - serious concerns in how this can be supported in the home and risk proofing everything - all too much for the family
● Needs to be consistency, needs to be reflected in risk process and collaborative working - which is not always evident - LA changes of workers and how difficult this can be when they do not know the child and the worries
● Stability meetings and action plans
● My safety plans - and encouraging children to be involved in what they think is acceptable attempts to keep them safer - not all agencies do this - NAFP to consider this more as a future piece of work
● Discussion re knowing the child and their levels of understanding - of “banter” of being “tactile” or not etc - their thoughts and feelings - do children want direct touchor not - and if so how can this be explored in a safer way - the importance of safer caring - what we suggest to keep you “safer”
● Younger children - cards and images - for example around road safety and dangerous objects etc
● Within children’s understanding
● When children are in a calm period - reflection - some children have said they want a hug from their special carers when feeling heightened - how this is considered
Work to consider/lead from NAFP…
● What is Physical intervention
● What is Restrictive physical intervention
● What is not physical intervention
● Reporting and monitoring - sch 6 and when is it a sch 7
● De-briefs and what this looks like, when best undertaken
● Children being involved in safety plans
● NAFP has guidance from 2017 - to consider the value of this and updates
● Some work re pulling together how young people are communicated with on this issue. NAFP work to take this one step further when we have this intel and consult with some care experienced people - Catherine to speak further with members about this and the above in the near future
