Physical intervention in schools: draft guidance

Physical intervention

49. Definition of physical intervention:

"A physical act carried out with the purpose of influencing, modifying or preventing the actions of a child or young person. Physical intervention includes direct physical contact and actions affecting the movement of a child or young person."

The use of physical intervention

50. The term physical intervention includes a wide range of practices (see Annex B): from non-restrictive support to restraint, which carries a risk of injury as well as having significant human rights and wellbeing implications. An example of an action affecting the movement of a child or young person would be a member of staff asking a child or young person to move to another space (i.e. staff-led withdrawal). Physical intervention can also be used in a variety of ways; from being an agreed support as part of a child's plan to decisions taken following a dynamic risk assessment in an emergency situation. Common factors in all of these decisions are the best interests of the child or young person and the duty of care education providers have to protect them and others from harm. This section outlines the different types of physical intervention that may be encountered in schools and the key considerations and safeguards that should determine their use.

Non-restrictive physical intervention

51. Physical contact between a member of staff and a child or young person for the purpose of education, communication, providing aid, reassurance or comfort where there is no element of restriction would not be considered restraint. An example may include giving a young child a hug if they are upset or a helping hand if they have fallen over. Non-restrictive contact may also be an important part of communicating with children and young people with complex speech and language communication needs. Such contact must always be in line with the principles of safeguarding and child protection; their use does not need to be recorded.

52. Considerations for using non-restrictive physical intervention are as follows:

• The level and form of contact would be determined by a dynamic risk assessment of the child or young person's education or wellbeing needs.
• Some children and young people may find physical contact with other people to be an additional and unnecessary cause of stress.
• For many children and young people this will form part of sensory integration and sensory learning programmes to support them to reduced sensory overload.
• Such contact would not require any follow up action or recording, unless any wellbeing concerns are identified, first aid is administered or there are any safeguarding or child protection concerns.

Pupil-led withdrawal

53. Definition of pupil-led withdrawal:

"Where a child or young person temporarily moves away, at their request, from a situation which they are finding challenging to a place where they have a better chance of regulating their emotions and behaviour."

54. A pupil-led withdrawal can be reactive, in response to an unexpected situation, or part of a planned approach. The child or young person is not prevented from leaving the space to which they have gone. It is therefore not considered a restraint and does not need to be recorded for the education providers' monitoring purposes, but should be documented within the establishment and added to any child's plan.

55. Considerations for using pupil-led withdrawal:

• The child or young person's wishes must be taken into account and, where possible, accommodated.
• The child or young person may have previously agreed safe spaces that they can withdraw to in their plan. This could be any safe and comfortable space (indoors or out) on the school campus.
• For some children and young people, a physical activity, such as a walk, may be more beneficial than calm space.
• Any planned use of pupil-led withdrawal must be fully documented as an integrated part of any child's plan, including a Co-ordinated Support Plan, describing the reasons and likely situations arising for use. If agreed, all staff should be made aware.
• The child or young person and their family should be active participants in the consideration of and planning for the use of pupil-led withdrawal.
• A risk assessment may be required to determine whether pupil-led withdrawal is a safe approach for the individual child or young person, should this become a recognised support. For example, this may not be a suitable option for a child or young person who is prone to running away.

56. Safeguards for using pupil-led withdrawal:

• Staff planning and facilitating a pupil-led withdrawal should be supported to be trauma-informed and trauma-responsive.
• The most effective way to monitor and support a distressed child or young person is often to be in the same room with them. There are however exceptions to this. For example, if a child or young person asks to be left alone or the proximity of another person is clearly distressing them, it might be more effective to allow them some appropriate space. It is important to consider that some children and young people may find the close proximity of other people to be an additional and unnecessary cause of stress. This is particularly relevant for children and young people who have previously experienced harm through relationships with adults.
• Even if not physically in the room with the child or young person, staff responsible must remain close enough to monitor the situation, offer immediate reassurance and support.
• The child or young person must be free to leave the space when they wish otherwise this would be categorised as seclusion.
• The child or young person should be supported to return to their class, once they are feeling composed, safe and ready.
• If the use of pupil-led withdrawal is considered, it is important to review the effectiveness of this on a regular basis. Reflective questions may include:
  • Does this approach offer a lower level of intrusion?
  • Does it help the child or young person to calm more effectively than other strategies?
  • Does it offer improved safety for those around?

Restraint

57. Definition of restraint:

"An act carried out with the purpose of restricting a child or young person's movement, liberty and/or freedom to act independently."

Identifying restraint

58. There are many forms of restraint, which is sometimes referred to as restrictive intervention. Restraint can involve direct physical contact (e.g. physical and mechanical restraint) or indirect acts such as seclusion. These types of restraint are defined in more detail below. This list is not exhaustive; it is intended to cover the types most likely to be encountered by school staff. Should there be any doubt whether an action is restraint, it is important to bear in mind that "the key issue is the nature of the act, not how it is described."^[35] Any act which restricts a child or young person's freedom to move or act could fall within the definition of restraint.

Legal framework for restraint in schools

59. The legal framework is outlined in Annex C.

General considerations and safeguards for using any form of restraint

60. While this guidance provides advice on the types of restraint most likely to be encountered in an education setting, all of the following general considerations must be satisfied in the event of any restraint.

• Restraint should only be used to avert immediate danger of physical injury to any person where no less restrictive option is viable. This reflects the principle of last resort.
• Education providers should be actively taking measures to reduce the use of restraint on all children and young people and eliminating its use for reasons relating to disability^[36].
• The use of restraint for reasons relating to disability without evidence of reasonable adjustments being made is unlikely to be considered proportionate.
• Restraint must never be used as a form of punishment or as a means of securing compliance.

61. General safeguards for using any form of restraint:

• Wherever possible, restraint is only used by staff who have been appropriately trained in its safe use.
• A planned or, in emergency situations, a dynamic risk assessment should always take place. This should consider:
  • the best interests of the child or young person;
  • the risk of injury posed to the child or young person and to others;
  • the age of the child or young person, physical health, additional support needs, disability and any known experience of trauma;
  • the least restrictive response available, including all viable alternatives, including de-escalation, and the option of not intervening.
• Where necessary, restraint should only be used for the shortest time and in the least restrictive manner possible.
• There must be a rational and proportionate connection between the method, severity and duration of the restraint, and the risk of injury posed.
• Every effort should be taken to protect the dignity of the child or young person being restrained, including taking account of their wishes and preferences.
• The child or young person's welfare should be closely monitored by an adult witness not involved in applying the restraint throughout the period of restraint and action taken to reduce the risk of injury.
• During the restraint, appropriate non-verbal communication should be used to convey a strong sense of care and concern. Increased verbal communication should be initiated when the child or young person is once again emotionally able to engage in order to end the restraint as soon as possible.
• Post-restraint:
  • support to the child or young person and all involved should be provided and learning reviews should always take place following the use of restraint.
  • this should always involve an immediate health, safety and wellbeing assessment of the child or young person who was restrained and anyone else who may have been injured. This may be led by the witness monitoring the incident, where available, or a member of the school leadership team.
  • where a child or young person has been physically injured or needs medical assistance, this should be sought immediately from the first-aider or, if appropriate, the relevant health service.
  • any specific post-restraint support identified in the child or young person's support plan should be followed as soon as possible after the restraint ends.
  • children and young people and staff may benefit from a learning review after the incident to support them to process the events. However, this should only happen when they feel composed and safe enough to participate. Additionally, some children and young people may not be able to participate in a reflective process due to their stage of cognitive development. See post-restraint support and learning review section.
  • if a child or young person has been physically injured or is considered to have suffered significant harm as a result of any form of the restraint, child protection procedures^[37] should be followed. Local disciplinary procedures may also run parallel to the child protection investigation.
  • preventative approaches must be considered following the use of restraint to ensure restraint does not become a frequent occurrence in a child or young person's school life.
  • if restraint is being used frequently, assessment of the child or young person's additional support needs and a review of the child's plan and support should be undertaken. Consultation with Educational Psychology teams should be considered.
  • parents and carers must be notified of the use of restraint as soon as possible after the incident and within 24 hours of the event.

Reporting, recording and monitoring restraint

62. All uses of restraint must be accurately recorded, monitored and reported (see recording and monitoring section). Following any use of restraint, post incident support and learning review should also take place (see post incident support and review section).

Physical Restraint

63. Definition of physical restraint:

"The use of direct physical force to restrict freedom of movement."

64. Considerations for using physical restraint:

• Physical restraint should only be used to avert immediate danger of physical injury to any person where no less restrictive option is viable.
• Physical restraint on a child or young person for any other purpose may be considered an assault.
• Physical restraint must never be used as a form of punishment or as a means of securing compliance.
• Physical restraints vary in severity, use of force and level of restrictiveness.
• Children are developing physically and psychologically, making them particularly vulnerable to harm from physical restraint.

Safeguards for using physical restraint

65. In addition to the general safeguards for using any restraint, the following specific safeguards apply to the use of physical restraint.

• A witness should be present to monitor the risk to the child or young person during the use of physical restraint, while ensuring the minimum number of staff attend that can safely support the child or young person.
• All physical restraint techniques must be risk assessed before use in school and again on their appropriateness for use on individual children or young people. Assessments should describe any specific risks which may be associated with the use of the agreed physical restraint techniques specified for use with any individual child or young person and how these should be minimised. These assessments and agreed approaches must be shared with all staff who may be required to use them.
• Certain types of physical restraint carry elevated risks such as prone, supine, basket holds, neck holds and techniques that involve the use of pain. These should not be used as they pose a higher risk of injury to children and young people. Holding children and young people in positions where their torso is heavily bent forward (hyperflexion) and/or their joints are taken to the end of their range of movement (locked out) must also be avoided.
• All steps should be taken by the person or persons applying the physical restraint and the witness monitoring, to minimise the risk of injury during the physical restraint, including using the minimum necessary force and ending it at the earliest opportunity possible.
• Where it is possible and is safe for them to do so, no other children and young people should be present when the physical restraint is occurring, for example, they may require to be moved to another area where they will be supervised.
• Where risk assessments indicate that distressed behaviour may be exhibited by a child or young person, a means by which a member of staff working with them can summon immediate support should be agreed.

Mechanical restraint

66. Definition of mechanical restraint:

"The use of equipment to restrict freedom of movement."

Recognising mechanical restraint

67. The provision of equipment that is used to increase the access to independence for children and young people with complex additional support needs is an essential component of an integrated health and social care service. Examples of such equipment include postural supports, headrests, wheelchairs to assist independent mobility and hoists to assist with moving and handling. Where the use of equipment involves an element of restriction of movement, for example a wheelchair strap, its use could be considered a mechanical restraint. It is therefore important that the safeguards highlighted below are in place to ensure the safety and wellbeing of children and young people at all times.

68. The use of seatbelts during transport is a precondition of safe travel. They would not be considered a mechanical restraint within the terms of this guidance.

Safeguards for using mechanical restraints

69. In addition to the general safeguards for using any restraint, the use of any equipment with a restrictive element should:

• form part of an agreed needs-based assessment, planning and implementation process and be regularly reviewed;
• only be used in accordance with its proscribed use and in the safest least restrictive manner;
• only be used by staff who have been appropriately trained in their safe use;
• be used with the consent of the child or young person, wherever possible;
• always be supervised.
• never be used as a form of punishment, securing compliance or as a response to distressed behaviour;
• always be proportionate and non-discriminatory;
• be reported, recorded and monitored if its use was unplanned or was used for a longer period of time or more frequently than prescribed.

Staff-led withdrawal

70. Definition of staff-led withdrawal:

"Leading a child or young person away from a situation which they are finding challenging to a place where they have a better chance of regulating their emotions and behaviour.

The child or young person is not prevented from leaving the space they are moved to."

71. Considerations for using staff-led withdrawal:

• Staff-led withdrawal is a restraint if:
  • it takes place against a child or young person's will;
  • the child or young person is prevented from re-joining their peers.
• Although initiated by staff, staff-led withdrawal can involve the consent of the child or young person, who may become responsive when they are engaged and able to participate in the decision of moving to another location or space. In these circumstances, staff-led withdrawal is not considered restraint.
• Staff-led withdrawal without the consent of the child or young person involved should only be used to avert immediate danger of physical injury to any person where no less restrictive option is viable.
• Withdrawal may be used as an alternative to seclusion. In some circumstances, it may be more appropriate for other children and young people to leave the learning environment so that it is less stressful for the distressed child or young person.
• The child or young person should be moved to a space that will help them regulate. This may involve undertaking a specific activity in this space. Both the space and the activity may be an agreed part of any child's plan.
• A staff-led withdrawal can be used in response to an unexpected situation, or part of an agreed approach in any child's plan.

72. In addition to the general safeguards for restraint, the following additional safeguards apply to the use of staff-led withdrawal.

• Staff planning and facilitating a staff-led withdrawal should be supported to do so in a trauma informed and trauma responsive way.
• Any room or area that might be used should be risk assessed to ensure it is safe, dignified and comfortable and would help co-regulation of the child or young person's emotions of behaviour and not add to stress levels.
• The child or young person should be communicated with before and throughout the period of withdrawal to ensure that their views can be taken account of and to help them to regulate their emotions or behaviour. Non-verbal communication is recommended as an initial means of communication.
• While staff may prevent the child or young person from re-joining their peers if the risk of injury to themselves or others remains high, the child or young person should not be prevented from leaving the space they are moved to or from moving to another space if it can be safely accommodated. If a child or young person is not allowed to leave, the staff-led withdrawal would escalate to seclusion.
• Any planned use of staff-led withdrawal must be fully documented as an integrated part of any child's plan describing the reasons and likely situations arising for use.
• Where a venue or area requires to be used regularly for withdrawal, that setting should be risk assessed.Spaces should be areas which are designed to keep children and young people safe in a supportive and reassuring way.
• Staff-led withdrawal should be used for the shortest possible time and end when the immediate risk of injury has passed.
• Staff-led withdrawal must be recorded to enable the monitoring of use, post incident reviews and future restraint reduction planning. This should involve the school leadership team and, where applicable, the education authority.

Seclusion

73. Definition of seclusion:

"An act carried out with the purpose of isolating a child or young person, away from other children and young people and staff, in an area which they are prevented from leaving."

Recognising seclusion

74. The following are key features of any seclusion.

• The child or young person cannot leave the space in which they have been secluded.
• Staff blocking an open door, or in any other way preventing the child or young person from leaving a room or space in which they have been moved to, would be considered seclusion.
• A child or young person's consent is not a feature of seclusion.
• If a child or young person is free to leave the space they have been moved to by staff, then this would be considered a staff-led withdrawal, rather than seclusion.

Restrictions of movement

75. When considering practice, it should be acknowledged that in the school context, as in other areas of children's lives, some restrictions of movement are normal and desirable; for example, in the interests of children's safety. Within a school context, these may include restrictions around leaving the school campus, break times and agreed parameters around the unsupervised activity of children. These types of restrictions, which are sometimes known as blanket restrictions, in that they apply equally to all children and young people, should always be proportionate and not discriminate against individual or groups of children and young people with particular protected characteristics^[38]. Such restrictions of movement would not amount to seclusion.

Implications of using seclusion

76. Seclusion, similar to other forms of restraint, places an additional level of temporary restriction on a child or young person's freedom of movement. However, the use of seclusion also carries the risk of depriving a child or young person of their liberty. There is no legal process for authorising a deprivation of liberty in a school context. This means that the use of any act which deprives a child or young person of their liberty would not be in accordance with the law, and the education provider may be legally challenged. The safeguards listed in this section will help support children and young people and reduce the risk of a deprivation of liberty occurring; however, this risk cannot be mitigated entirely if seclusion is used. In addition to human rights implications (outlined in Annex C), the use of seclusion can also cause harm to children and young people's health, wellbeing and dignity, particularly when prolonged and, or, frequently used.

77. In light of these risks, education providers should take legal advice, when reviewing and revising their physical intervention policies, on the implications of the use of any practices falling within the definition of restraint. As part of this process,it is important that schools and education providers reflect on the definition and key features of seclusion and review the use of any practice that could amount to seclusion.

The use of seclusion in schools

78. Seclusion is not recommended for general use in schools, either as part of routine practice or as a "default" response to distressed behaviour.

79. Seclusion should only ever be used in an emergency to avert an immediate risk of significant harm to the child or young person, or others, where no less restrictive option is viable. It should end as soon as the immediate risk is reduced. If seclusion is used in an emergency, the safeguards outlined below must be in place.

Safeguards for using seclusion

80. Before seclusion is used, the following safeguards should be in place.

• Seclusion should not form part of any child's plan. Staff may wish to review current plans and update where necessary to reflect this position.
• In emergency situations, a dynamic risk assessment should always take place. This should consider:
  • the best interests of the child or young person;
  • the risk of injury posed to others;
  • the age of the child or young person, physical health, additional support needs, disability and any known experience of trauma – some children and young people would find it excessively stressful to be secluded, which in some cases could cause panic attacks;
  • the least restrictive response available; and
  • all viable alternatives, which may include co-regulation strategies, staff-led withdrawal, and the risk of not intervening.
• Seclusion must never be used as a form of punishment or as a means of securing compliance.
• There must be a rational connection between the method, severity and duration of seclusion and the risk of injury posed.
• Any room or area that might be used should be subject to a dynamic risk assessment to ensure it is safe, dignified, comfortable and would minimise the distress that a short period of seclusion would bring.
• All staff should be made aware of the alternative, less restrictive approaches that should be considered ahead of emergency seclusion.

81. During seclusion, the following safeguards should be in place.

• Seclusion must only ever be used for the shortest possible time and in the least restrictive manner possible.
• Every effort should be taken to protect the dignity of the child or young person during seclusion.
• If staff consider there to be a strong justification of why it is essential for a child or young person to be confined to a space and prevented from leaving, staff should be asked to supervise the child or young person. A senior member of staff should also attend to undertake an additional dynamic risk assessment of the incident and the response.
• If seclusion involves a physical restraint, the safeguards outlined for physical restraint should be followed at the earliest opportunity.
• The child or young person must never be left unsupervised. Wherever possible, staff should remain in the same space as the child or young person to help them regulate their emotions and behaviour in order to bring the period of seclusion to an end.
• Efforts should be made to maintain positive communication with the child or young person for the duration of the seclusion.
• As soon as the immediate risk of significant harm has passed, the child or young person should be free to leave the space they are in and should be offered support to return to an appropriate space.

82. After seclusion, the following safeguards should be in place.

• Support should be provided and learning reviews must always take place following the use of seclusion.
• This should always involve an immediate health, safety and wellbeing assessment of the child or young person who was secluded by those involved. This may be led by the witness monitoring the incident.
• Where a child or young person or a member of staff has been physically injured or needs medical assistance, this should be sought immediately from the first-aider or relevant health service, if appropriate.
• Any specific post-incident support identified in any child's plan should be followed.
• While children and young people and staff may benefit from a learning review and support to process the events and make sense of them, this should only happen when they feel composed and safe enough to participate. Some children and young people may be unable to participate in this process due to their stage of cognitive development. See post-restraint support and learning review section.
• If a child or young person has been physically injured or is judged to have suffered significant harm as a result of the seclusion, child protection procedures^[39] should be followed. Local disciplinary procedures may also run parallel to the child protection investigation.
• All uses of seclusion must be recorded, monitored and reported. This includes reporting to parents at the earliest available opportunity.
• Preventative approaches must be considered following the use of seclusion to ensure it does not become a frequent occurrence in a child or young person's school life. Any use of seclusion could amount to a deprivation of liberty.
• If seclusion is being used frequently, an urgent assessment of the child or young person's support and a review of their plan should be undertaken to enable immediate steps to be taken to prevent its re-use. Consultation with Educational Psychology teams should be considered.

Seclusion versus time out

83. Seclusion does not prevent distressed behaviour from occurring, and should never be used as a form of punishment or as a means of securing compliance. Its aim is to reduce an immediate risk of injury. Time out, on the other hand, is a punitive behaviour change technique.

84. Definition of time out:

"The act of removing a child or young person from a space, or ending their participation in an activity, to disincentivise, and ultimately stop, an 'undesirable' behaviour from occurring."

85. The core expectations of the inclusive approach within Scottish education is that children and young people be present, participate, support and achieve. Time out is not considered to be an inclusive practice and its use should be minimised.

86. Should a child recognise that they benefit from time away from a group or on their own to help them regulate, then this would be pupil-led withdrawal. Should an adult recognise this and be supporting a child or young person to understand that this approach helps them, this would be staff-led withdrawal.

87. It is recognised that the term "time out" may be used to describe a range of practices within schools. It is recommended that any schools currently using a practice termed "time out" should review its use in light of this guidance. Irrespective of the name applied, if the practice involves any form of restraint, the safeguards outlined in this guidance should be applied.