Physical intervention in schools: guidance

Physical intervention, restraint and seclusion

53. Definition of physical intervention:

“Physical contact carried out with the purpose of providing support to or preventing the actions of a child or young person.”

The use of physical intervention

54. The term physical intervention includes a wide range of practices (see Annex B): from non-restrictive support to restraint, which has significant human rights and wellbeing implications. Physical intervention can be used in a variety of ways; from being a strategy agreed in a support plan to decisions taken following an immediate risk assessment in an emergency situation. This section outlines the different types of physical intervention that may be encountered in schools and the key considerations and safeguards that should inform decisions about their use.

Non-restrictive physical intervention

55. 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 restraint would be considered a non-restrictive physical intervention. An example may include giving a young child a hug if they are upset or a helping hand if they have fallen over or are crossing the road. Physical 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.

56. Considerations for using non-restrictive physical intervention are listed below:

• The level and form of contact may be determined by a 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.
• 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.

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 types of restraint, which is sometimes referred to as restrictive practice. Restraint can involve physical contact (e.g. physical and mechanical restraint) and acts such as seclusion. Specific 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 keep in mind that any act which restricts a child or young person’s freedom to move or act could fall within the definition of restraint. Where staff have identified a possible restraint, its use should be reviewed in line with the advice in this guidance.

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 the following general considerations must be satisfied in the event of restraint being used.

• Restraint should only be used to avert immediate risk of physical injury to any person^[1] where no less restrictive alternatives are viable. This reflects the principle of last resort.
• Restraint must never be used as a form of punishment or as a means of securing a child or young person’s compliance.
• Education providers should be actively taking measures to minimise the use of restraint on all children and young people, eliminate its misuse and use for reasons relating to disability.
• The use of restraint for reasons relating to a child or young person’s disability without evidence of reasonable adjustments being made is unlikely to be considered an appropriate response to distressed behaviour.

61. General safeguards for using any form of restraint:

• Restraint should only be used by staff who have been appropriately trained in its safe use (except in emergency situations where no trained staff are available).
• A risk assessment should always take place. This should consider:
  • o the best interests of the child or young person;
  • o the risk of injury posed to the child or young person and to others;
  • o the age of the child or young person, physical health, additional support needs, disability and any known experience of trauma;
  • o the least restrictive response available and all viable alternatives including co-regulation, de-escalation and the option of not intervening.
  • o Restraint should only be used for the shortest time necessary and in the least restrictive manner possible.
  • o The method, severity and duration of restraint must be proportionate to 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.
• Where possible, an adult witness (someone not involved in applying the restraint) should be present to monitor the wellbeing and risk of injury to the child or young person during the use of restraint, while ensuring the minimum number of staff attend that can safely support the child or young person.
• During the restraint, every effort should be taken to convey a strong sense of care and concern. Verbal and visual stimuli should be minimised. Increased verbal communication should only be initiated when the child or young person is once again emotionally able to engage. Following the use of restraint, the steps in the post-incident support and review section should be followed.

Physical Restraint

62. Definition of physical restraint:

“The use of direct physical force to restrict freedom of movement.”

63. In addition to the general considerations for using any restraint, the following specific considerations apply to the use of physical restraint:

• 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

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

• All physical restraint techniques must be risk assessed before use in school and again on their appropriateness for use on individual children and young people. Assessments should describe the specific risks associated with physical restraint techniques and how these can be minimised. These assessments and any agreed approaches must be shared with all staff who may be required to use them.
• Certain types of physical restraint must never be used as they carry higher risks:
  • o Holding a child down on the floor, either in a face down (prone) or a face up (supine) position;
  • o Wrapping their arms across the front of their body (basket holds)
  • o Holds around the neck;
  • o Holds that involve the use of pain;
  • o Hyper extending (i.e, locking out) and/or putting pressure on joints;
  • o Applying pressure to the torso, chest, neck, abdomen or groin areas; and
  • o Hyper flexing the person (bending them forward at the torso).
• All steps should be taken by those applying the physical restraint, and any witness monitoring, to minimise the risk of injury during the physical restraint. This includes only using the minimum number of people for the type of restraint, the minimum necessary force and ending the restraint at the earliest opportunity possible.
• Where it is possible and is safe to do so, no other children and young people should be present when the physical restraint is occurring. For example, where the situation allows, other children and young people may require to be moved to another area where they will be supervised.

Mechanical restraint

65. Definition of mechanical restraint:

“The use of equipment to restrict freedom of movement.”

Recognising mechanical restraint

66. Many children and young people use equipment provided by health and social care services to support their daily healthcare needs. 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 such equipment in schools involves an element of restriction of movement, for example a wheelchair strap, its use could be considered a mechanical restraint. All efforts must be taken to avoid the misuse of any equipment that could restrict movement. 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.

67. The use of seatbelts during motorised transport is a precondition of safe travel. Used appropriately for their intended purpose during transport, they would not be considered a mechanical restraint within the terms of this guidance.

Safeguards for using mechanical restraints

68. 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. This would usually be in collaboration with allied health professionals or other specialists;
• only be used in accordance with its agreed use in a child or young person’s support plan, in the safest least restrictive manner and for the shortest time necessary;
• only be used by staff who have been appropriately trained in its 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;
• be reported, recorded and monitored if its use was unplanned or if it was used for a longer period of time or more frequently than anticipated.

Seclusion

69. 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 in which they are prevented from leaving.”

Recognising seclusion

70. The following are key features of any seclusion.

• Where a child or young person has been moved to a space or room against their will (possibly involving a physical restraint).
• The child or young person cannot leave the space in which they have been secluded. This may be because staff are blocking an open door, or are in any other way preventing the child or young person from leaving a room or space in which they have been moved to.

Everyday restrictions of movement within a school

71. When considering practice, it should be acknowledged that in a 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. Other restrictions include the use of high handles on doors or fobs that only staff can open. These types of restrictions are sometimes known as blanket restrictions. They apply equally to all children and young people and should be reviewed and risk assessed on a regular basis to ensure they are only used when necessary. Such restrictions of movement do not amount to seclusion.

Implications of using seclusion

72. Seclusion, similar to other types of restraint, places an additional level of temporary restriction on an individual child or young person’s freedom of movement. While much will depend on the circumstances of each individual case, the use of seclusion also carries the risk of overstepping the line and 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 an act which goes beyond a restriction of movement and deprives a child or young person of their liberty would, in that context, not be prescribed by law, and the education provider may be acting unlawfully. 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, and education providers' policies and practices should be informed by appropriate legal advice. 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, used frequently.

The use of seclusion in schools

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

74. Seclusion should only ever be used in an emergency to avert an immediate risk of injury to a child or young person, or others, where no less restrictive option is viable (i.e. as a last resort). It should end as soon as the immediate risk of injury is reduced. Where seclusion is used in an emergency, the safeguards outlined below must be in place.

Safeguards for using seclusion

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

• Seclusion must only ever be used for the shortest possible time and in the least restrictive manner possible.
• Seclusion should not form part of any child or young person’s support plan. Education providers should review current plans and update where necessary to reflect this position.
• Any room or area that might be used should be subject to an immediate 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 seclusion.
• Every effort should be taken to protect the dignity of the child or young person being secluded.
• As soon as possible, a senior member of staff should also attend to undertake an additional risk assessment of the incident and the appropriateness of the response.
• If seclusion involves a physical restraint, the safeguards outlined for physical restraint should also be followed.
• 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 to bring the period of seclusion to an end.
• As soon as the immediate risk of injury has passed, the child or young person should be free to leave the space they were secluded in and offered support to return to an appropriate space.