Introduction

 

The DfE and Department of Health are consulting on draft guidance on reducing the need for restraint and restrictive intervention for children and young people with learning disabilities, autistic spectrum disorders and mental health needs. The draft guidance specifically applies to special schools and other health settings; however, it will also be of interest to maintained schools and academies.

The draft guidance defines restraint as using forces or restricting liberty of movement, and restrictive intervention as a deliberate act to restrict a person’s movement, liberty and/or freedom to act independently. There are also references to reasonable force, which means using no more force than necessary to either control or restrain a pupil.

The main aim of the guidance is to assist in eliminating the inappropriate use of restraint, by enabling special education and health settings to develop plans to support children and young people with behaviour challenges. The hope is that the risks associated with that behaviour will be reduced, and the safeguarding of children and young people cared for in settings will be enhanced. Trauma resulting from restraint can be damaging to children and young people who are still developing physically and emotionally.

Ofsted will have regard to the draft guidance when assessing institutions on the safety and suitability of the care they provide.

Special education settings have the responsibility to protect the welfare and safety of pupils in their care; sometimes restraint will be necessary and staff should use their professional judgement in each case to assess the risks, taking into account the needs of the pupil. This guidance will outline the various types of restraint, and provide means of approach that schools can use to reduce the need for using restraint.

Types of restraint

 

Restraint can take a number of forms, but any form must be lawful and based on individual circumstances. The following forms of restraint may need to be used in educational settings.

Physical restraint

 

Staff must not cause deliberate pain to pupils and restraint must be used as a last resort. Any period of restraint can be dangerous, especially when it occurs on the ground; care should always be taken to avoid restraining pupils in a way that may restrict their airways, breathing or circulation, e.g. covering their mouth or nose. Staff should release their hold or reposition into a safer alternative as soon as possible when a pupil is held on the ground.

Where physical restraint is necessary, a member of staff should continue communication with the pupil throughout the period of restraint to attempt to de-escalate the situation. Following any period of restraint, pupils should be monitored continually for signs of emotional or physical distress.

 

Mechanical restraint

The use of a device to prevent, restrict or reduce the movement of a pupil’s body with the aim of controlling their behaviour is known as mechanical restraint. This form of restraint should only be used to manage extreme violence directed towards others or to limit self-injurious behaviour and must not be a first response to managing challenging behaviour.

These situations are more likely to be encountered with small numbers of pupils who have severe cognitive impairments, and may require devices, such as arm splints or cushioned helmets, to protect them from the consequences of their behaviour. When devices are required, they must be put in place by people with the relevant qualifications, skills and experience.

 

Medication (chemical restraint)

Medication can be prescribed and administered for the purpose of quickly controlling or reducing violent behaviour. This is known as chemical restraint − this should not be confused with when medication is prescribed for the treatment of a formally identified physical or mental illness. Chemical restraint should not be used routinely or as a first response, but when a pupil is highly aroused, agitated, overactive, aggressive or is making serious threats towards others and being destructive. An antipsychotic or an antidepressant should not be prescribed as a response to challenging behaviour without an appropriate clinical reason.

Medication must be delivered by a qualified member of staff with the skills and experience to administer it.

 

Withdrawal and seclusion

Withdrawal involves removing a pupil from a situation which might cause them anxiety or distress, and taking them to a place where they feel safe and able to compose themselves. A member of staff should stay with the pupil to support and monitor them until they feel ready to resume their usual activities. Reasonable force can be used in order to protect the child from harm to themselves or others.

A pupil may choose to move to a quiet place for some time to calm down, usually due to the effects of their impairment or condition, thus avoiding any need for restraint. Schools should implement a system that allows pupils to move if they wish, allocating an area within the school that all pupils should be made aware of. Staff should support these pupils and monitor their progress; appropriate provision should be made in their support plan and kept under review. This would not usually constitute restraint.

When a pupil is supervised in containment and isolated away from others in an area they cannot leave, it is known as seclusion. Seclusion is designed to contain behaviour that may cause harm to others.

 

Blanket restrictions

Blanket restrictions, such as locked doors, lack of access to outdoor space or refreshments, or oppressive environments can have a negative impact on pupils’ behaviour, and may breach the requirements under the Human Rights Act 1998, e.g. relating to secure accommodation of children. If blanket restrictions are considered necessary, they should be governed by a clear policy that will demonstrate compliance with the Human Rights Act 1998. Reasons for the restrictions should be explained to pupils and their families as soon as possible.

 

Long-term segregation

When a child is prevented from mixing freely with other children or young people, this is known as long-term segregation. This technique should only be used for those who present an almost ongoing risk of harm to others, and where it is agreed segregation will benefit them. It must never take place outside of hospital settings.

 

Key actions

In order to eliminate the inappropriate use of restraint and minimise its use, special schools should have a positive and proactive approach to behaviour using the following:

 

Policies

All settings should have a clear policy that promotes positive relationships and behaviour, ensuring it is consistent with relevant standards and statutory guidelines. Wider local restraint strategies should be considered when schools are developing their own individual policies.

Policies should follow good practice and legal requirements; some of the elements that should be included are:

  • The measures that have been taken to encourage positive behaviour and effective communication. This would include any adjustments that have been made to the environment that help to reduce stress, anxiety and the potential challenging behaviour.
  • How the school involves pupils, and their parents, in supporting positive behaviour and the development of individual support plans.
  • Details of the circumstances in which it could be appropriate to use restraint.
  • The training that staff will receive to encourage positive behaviour, assess and manage risk and use restraint appropriately where necessary, and details how training will be monitored.

 

Governance

Clear arrangements for governance and accountability are vital in ensuring proper accountability and transparency regarding the use of restraint. These arrangements should include recording, monitoring and reviewing all uses of restraint, and the information obtained from reviews should be used to consider future measures to avoid incidents which may lead to its use. A lead person on a governing board should be identified as being responsible for the Behaviour Policy and strategy.

 

Involving pupils and their parents

The involvement of pupils and their parents in decisions about the pupil’s education ensures that they will receive support that is beneficial to their individual needs, and will allow them to achieve better outcomes.

Where a pupil has difficulties with speech, language and communication, limited speech or cannot speak, they will use different ways of communicating. It is important that they are involved in the decision making regarding means of communication, as they may have difficulties in understanding verbal de-escalation. Special schools should ensure both verbal and non-verbal strategies are used to allow pupils to understand what is happening.

 

Evidence based approaches

Effective behaviour strategies address how staff will be trained and developed, and include arrangements for individual support plans to be made. These strategies should continue to be monitored so that changes can be made depending on what has been effective. Schools may wish to develop their own restraint reduction programme; these will aid in the reduction of violent incidents.

Positive behavioural support can also be used; schools can develop a framework for understanding the context and meaning of behaviour to improve and introduce interventions that support individual pupils. This approach can enhance a pupil’s quality of life and limit challenging behaviours, reducing the need for restraint. Schools should ensure the framework is selected to meet the needs and circumstances of pupils, including person-centred planning, skilled assessments and individual behaviour support plans.

 

Staff training

Special schools should ensure that staff working with pupils whose behaviour challenges are trained in promoting positive behaviour, enabling them to provide the appropriate support. If approaches to behaviour are discussed with parents, staff can secure a consistent approach to behaviour in school and at home.

Training will vary depending on the setting as it should be tailored to the specific needs of the pupils being taught; however, it should always cover approaches to reducing and minimising the need for restraint. Staff should only use restraint techniques that they have been trained to perform; the school should keep records of all staff and the training they have received.

It is the school’s responsibility to ensure that the training they provide meets the needs of their pupils and the development needs of staff. Due diligence should be conducted to check training has been planned by experts with relevant skills and knowledge, and any restraint techniques promoted should be medically assessed to demonstrate their safety for use with children who are still developing. Frequent monitoring and reviews should be conducted to ensure the effectiveness of the training remains consistent.

 

Identifying and managing risks

Though most challenging behaviours can be planned for, it is not always easy to know when they will happen or the level of risk they might bring. To enable special schools to plan efficiently, they can:

  • Explore why pupils behave in ways that pose a risk.
  • Try to understand the factors that influence the behaviour.
  • Recognise early warning signs that might indicate challenging behaviour is beginning to emerge.
  • Develop the appropriate skills for managing difficult situations properly.

Individual circumstances and professional judgement should always be considered when making decisions about the use of restraint. Any use of restraint will carry risks, whether they are to the pupil themselves or other pupils, staff or property, and these risks need to be balanced against the risks associated with other courses of action, including taking no action at all.

Assessing risk is about trying to predict the situations that might involve risks; rational judgements should be made to estimate the likelihood of the potential harm that may occur, and how serious it could become. In assessing risk, decisions can be made that will limit the level of risk that pupils, staff and other pupils are exposed to, avoid unreasonable risks for the pupil or others and ensure the interventions are reasonable and appropriate for the risks presented.

There are several factors that should be considered when assessing risk, including the size, age and understanding of the pupil, relevant disability, health problems or medications, and the risks of not intervening.

Other options for reducing risks should always be explored and recorded; settings may wish to seek advice from others, such as the LA or medical advisers, when the considered restraint might heighten the risk to pupils or others. As mentioned, individual pupils should have their own support plan discussed with them and their parents; this plan should set out any identified risks.

 

Interventions

Interventions can be planned or unplanned. A planned intervention is when staff exercise the agreed approaches to challenging behaviour that are set out in a pupil’s support plan. Any action taken will be based on a risk assessment and an understanding of the pupil’s needs.

Unplanned interventions require professional judgement to be made in a situation that involves making split-second decisions to respond to unforeseen incidents where trained staff are not available. These decisions are known as dynamic risk assessments and they should be supported in staff training. Where there is a need for an unplanned intervention, staff should seek assistance from a trained member of staff (unless the situation is urgent) and any response must be reasonable and proportionate, using the minimum force necessary to prevent injury and maintain safety.

It is unlikely that pupils will require unplanned interventions as they are known to the school, and will have had their needs assessed and a behaviour support plan devised based on the outcomes of this assessment.

 

Safety of staff

Special schools have a duty under the Health and Safety at Work etc Act 1974 to ensure that the safety and welfare of their employees is safeguarded. Schools should:

  • Assess all risks to employees and others, including the risk of foreseeable violence, and implement steps to reduce the risks.
  • Provide adequate information, instruction, training and supervision to ensure the health and safety of employees.
  • Monitor and review the arrangements put in place to reduce the risks to ensure they are effective.
  • Establish transparent processes to acknowledge the hazardous nature of any foreseeable incidents and any restrictive interventions.

 

Records and reporting

Special schools should record occasions where restraint is used, whether planned or not. Ofsted will review the recording and decide if it meets the requirements of the relevant standards.

Non-residential special schools are not covered by any specific statutory requirement but must have behaviour policies within which procedures for recording and reporting on incidents involving reasonable force are detailed. Residential special schools are required to produce a written record for any use of reasonable force within 24 hours of the incident.

 

Post-incident support and review

After any incident involving restraint, all pupils and staff involved should be given emotional support and basic first aid for any injuries obtained. Immediate action must be taken for injuries that require more than basic first aid. All injuries should be recorded in accordance with the school’s procedure and to the HSE as appropriate.

Schools should provide a de-briefing and post-incident review of any use of restraint or restrictive intervention, ensuring that the appropriate lessons are learned. The member of staff involved in the use of restraint should be de-briefed as soon as possible after the incident by an appropriate senior leader; this will contribute to CPD and allow time for reflection. Staff and pupils involved should be given individual opportunities to reflect on the incident with a choice as to who helps them deal with this.

The families of pupils involved should be given the chance to participate in post-incident reviews. These may involve a staff team discussion about the warning signs of an impending incident, whether previously agreed behaviour plans were adhered to, what de-escalation strategies were used and their effectiveness, and what could be done differently in the future. 

A staff member who was not involved in the incident should also attend the review in order to gain an understanding, from the points of view of the pupil and their family, of whether or not the school took the appropriate action, what upset the pupil and how staff actions were helpful. If a pattern of restraint begins to form, the reviewer should consider and discuss, with the pupil and their family, the revision of their individual support plan.

 

Monitoring

The information collected from reviews should be used to consider improvements to the schools policies and practices, including the approach to reducing potential triggers of challenging behaviour. Where policies have been used for some time with no resulting improvements, school leaders should consider taking action to change the practices.

 

What’s next?

The full Restraint and restrictive intervention: draft guidance can be found on the government website.

The consultation is seeking views from health and care settings and special education settings on how well the draft guidance will help them to support children who are at higher risk of restraint. The consultation closes on 24 January 2018 and you can register any thoughts here.

We have created a Behaviour Policy Checklist that is compliant with legislation and covers vital aspects of pupil behaviour including rewards, teachers’ powers and ‘reasonable force’.

Created by our HR experts FusionHR, the Physical Restraint and Reasonable Force Policy presents guidelines for staff regarding the use of force to control or retrain pupils.

 

Bibliography

Department of Health & DfE (2017) ‘Restraint and restrictive intervention: draft guidance’ p.5-35

DfE (2013) ‘Use of reasonable force’ p.4

Health and Safety at Work etc Act 1974

Human Rights Act 1998

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