Guidance on Methods of Care and Control

Each child and young person is entitled to an individual care plan, which respects difference; addresses equality issues and encompasses their and their family’s feelings and wishes. We will consider each aspect of the child’s or young persons care by providing a range of services that meet and promote their development, such as personal care, health care, education attainments, as well as preparing young people for independence – all in a framework which safeguards and promotes their safety and well-being.

For children to develop healthily, certain needs must be met. Basic needs that are common to all children include:

• Appropriate physical, medical care and protection from harm;
• Positive role modelling from adults who are supporting them;
• Positive regard to nourish, promote self-esteem and healthy emotional development;
• Full access to educational opportunities;
• Age appropriate stimulation and opportunities to develop knowledge and skills;
• Clear consistent boundaries appropriate to age; level of understanding;
• Respect for gender, race and ethnicity, religion, culture, level of functioning;
• Language and methods of communication;
• Consideration of the child/young person’s individual views, wishes and feelings.
• To feel valued and cared for.

Challenging behaviour refers to ‘behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour that is likely to seriously limit the use of, result in the person being denied access to ordinary community facilities’.

_{(Emerson et al 1995) Positive Behaviour support policy-safe management of challenging behaviour in children and young people with learning disabilities and autism. Challenging Behaviour Strategy Group Salford Aug 2011}

Violence that is directed toward other people and violence that is less clearly targeted and arises from distress, confusion or panic are often managed with a restrictive physical intervention.

_{Positive Behaviour support policy-safe management of challenging behaviour in children and young people with learning disabilities and autism. Challenging Behaviour Strategy Group Salford pg 18 Aug 2011}

Self-directed violence or self injury is another relatively common form of challenging behaviour associated with the use of restrictive physical interventions. Examples include hitting the head with a clenched fist, banging the head against hard objects, skin picking ad eye gouging.

_{Positive Behaviour support policy-safe management of challenging behaviour in children and young people with learning disabilities and autism.
Challenging Behaviour Strategy Group Salford pg 18 Aug 2011}

A person behaving with a reckless disregard for their own safety or for the safety of others (e.g.) by wandering across a busy road or persistently setting fires) may result in people being subjected to a restrictive physical intervention.

Disruptive or socially unacceptable behaviours are those which are likely to seriously limit an individual’s access to ordinary community facilities or lead to significant avoidance by members of the public such as that the individual is not able to have a meaningful presence in their community.

Staff are expected to work with the child or young person by setting and implementing, agreed and consistent boundaries. Staff should help and support children and young people to follow socially expected norms, which are individually identified based upon the child or young person, e.g. age, culture, etc. Children and Young people should be encouraged and supported to participate in age appropriate daily routines, in order to promote problem solving and negotiation skills, and develop their ability to live within a group, and learn independence skills.

Staff should promote acceptable behaviour through their own conduct and their interaction with children and young people. Staff should also always endeavour to reward acceptable and wanted behaviours that a child or young person demonstrates, that in consistent with the care planning.

Staff within supervision and incident de briefings should feel able to explore and express the feelings that come up when managing children and young people that challenge. Staff are reminded that they also can access the Boroughs free Staff Counselling Service.

Behaviour that challenges may require a sanction to be put in place. Sanctions are at times necessary forms of discipline and will vary depending upon the young person, their understanding and sanctions that are appropriate to them individually.

Factors that need to be taken into account include:

• The usual forms of control and discipline that is permissible in children's Short breaks Units and staff experience of what works well with the individual child;
• The age, ability and health needs of the child;
• The child's history, including any experience of abuse/trauma;
• Any needs of the child arising from a disability;
• A Child's religious or cultural needs.

If Sanctions are imposed, staff should apply the following principles:

• Sanctions should be the exception, not the rule. A last resort;
• Sanctions must not be imposed as acts of revenge or retaliation;
• Think before imposing the sanctions-don’t apply it in the heat of the moment;
• Sanctions may only be imposed upon children for persistent or serious misbehaviour; where reminders and reprimands have already failed or are likely to fail;
• Sanctions should only be used if there is a reasonable chance they will have the desired effect of making the point and in reducing or preventing further unacceptable behaviour;
• Before applying any sanction, make sure the child is aware that his/her behaviour is unacceptable and, if possible, warn him/her that sanctions will be applied if the unacceptable behaviour continues;
• It is the certainty not the severity of sanctions that is important;
• Sanctions should only last as long as they need to, allowing the child the opportunity to make a fresh start as quickly as possible.

The following provides guidance on the sanctions that are generally acceptable in Children's homes. The list is not meant to be exhaustive, nor is it meant to imply that all these methods are appropriate and acceptable in all circumstances. Staff must use their judgement before employing any of these methods and if necessary liaise with colleagues or seek further advice from the Manager.

• Delay of pocket money. Where the child's behaviour is very challenging pocket money may be delayed (up to a maximum of 48 hours) or need to be spent under supervision;
• Withdrawal of Privileges. These may be withdrawn for unacceptable behaviour. This may include denial of recreational facilities and bus fares, but should not normally include denial of attendance at a regular out of school activity such as swimming lessons, children's clubs or brownies. Looked after children are often less skilled than their peers or socially isolated and the use of such a sanction may further disadvantage the child;
• Early bedtime. An early bedtime can be used positively in order for the child to reflect upon their behaviour. This should be no more than one hour before their regular bedtime;
• Time out. This should be used to affect positive change. It should be used as an opportunity to restore order in the child and home and to enable the child to reflect upon their behaviour. It should be for limited timescales only and appropriate to the age of the child. Time out involves physically removing a child from a situation that is dangerous and/or a situation where the child is exhibiting behaviour that is not acceptable. The purpose of time out is to allow the child to re-establish self-control, to end unacceptable behaviour, and to provide an opportunity to think about behaviour and its impact.
  
  Time out is not punishment. It is simply providing the child an opportunity to regain control of his or her behaviour. You are helping in that process by removing the child from the situation or the stimulation that brought about the loss of control. If you are angry or yelling, it is doubtful that the time out will be effective. Some basic guidelines for using time out include:
  • Take time to gain your composure and self-control;
  • Give the child an opportunity to change the behaviour;
  • If this effort fails, tell the child where to go for a time out;
  • Select a quiet and safe time out area away from other stimuli;
  • Tell the child how long the time out will be, but explain that you will only begin timing when the child becomes quiet;
  • Ignore the child's behaviour while in time out;
  • Focus the child on a positive activity after the time out. (Child Welfare League of America).
• Restriction of access to personal belongings. Children have a right to their own clothes, toiletries and other possessions. However, personal belongings may be removed temporarily if they are being misused and /or are likely to be damaged. They should only be removed permanently where it is agreed they are harmful to the child.
  
  Access may be restricted in the use of personal possessions, for example a play station or personal stereo, as a sanction for a specified period.
  
  Comfort items should never be removed from a child as a sanction;
• Staff when setting sanctions should endeavour to ensure that any sanction:
  • Follows the Sanction policy;
  • Is as far as possible implemented within the shift;
  • Is age/developmentally appropriate;
  • As far as possible is negotiated with the child or young person.

• Sanctions need to be recorded in the Units Behaviour and Consequences Book;
• When recording the use of sanction these should be recorded in full detail within 24 hrs;
• Staff should leave a message for the Manager when a sanction has been entered into this book;
• The child/ young person should record their perception of the sanction and where necessary be supported by an advocate to be able to do this.

_{(CA 1989 Guidance and Regulations Children’s Homes Vol 5 2:91)}

Staff should endeavour to think about:

• Antecedents, what triggered the behaviour, could it have been avoided?
• Behaviour, what exactly was the unwanted behaviour, could it have been ignored?
• Consequences, these can be both positive and negative, and negative interaction can be viewed positively by the child/young person. Did the sanction work? Was it appropriate?

The Department of Health, Education and skills on seclusion reads as follows:

3.11 ‘To the extent that seclusion (where an adult or child is forced to spend time alone against their will) involves restricting a person’s freedom of movement, it should also be considered a form of physical intervention. The use of seclusion for people detained under The Mental Health Act (1983 under review) is set out in the code of Practice published 1999’.

3.12 ‘The right to liberty and personal freedom is enshrined in Article 5 of the Human rights Act 1998 and is protected by the criminal and civil law. For these reasons the use of seclusion outside the Mental Health Act should only be considered in exceptional circumstances and should always be proportional to the risk presented by the child or service user’.

3.13 Under The Children's Act 1989 any practice or measure such as 'time out' or seclusion which prevents a child from leaving a room or building of his own free will, may be deemed a 'restriction of liberty'. Under this Act restriction of liberty of children being looked after by the Local Authority or accommodated by the NHS establishments is only permissible in very specific circumstances. For example when a child is placed in secure accommodation approved by the Secretary of State or when a court order is in operation.

3.14 In care settings, if seclusion is required other than in an emergency (For periods of longer than a few minutes or more frequently than once a week) then staff should seek advice regarding the use of statutory powers under the mental health or childcare legislation. (3:14)

_{Guidance for Restrictive physical interventions. How to provide safe services for people with Learning Disabilities and Autistic Spectrum Disorder DoH / DfES 3.11, 3.12, 3.13, 3.14 2002.}

Time Out involves restricting the service user's access to all positive reinforcements as part of a behavioural programme.

Withdrawal which involves the removing of the person from a situation which causes anxiety or distress to a location where they can be continuously observed and supported until they are ready to resume their usual activities.

The Registered Manager will familiarise themselves with behaviours that are being presented via consideration of Incident Reports and the Sanctions Book. The incident reports are also discussed as part of the Units weekly staff meeting to ensure all staff are familiar with behaviours that have been presented and explore any necessary strategies to include in the Care plan and Behaviour Management Plan. The Units records on sanctions are collated monthly to produce a report which is sent to OFSTED every 6 months. 
_{(Regulation 34 Schedule 6)}

The management and staff will review behaviour and respond promptly where any worrying issues or trends emerge. and enable changes to behaviour management practice to be made so that this continues to be effective and sensitive to the needs of all the children/ young people in the Unit.

This information can be used as part of discussions with the social worker and the child/young persons (Care plan /Behaviour Management plan) may need to be changed. Changes should be based on through systematic appraisal of the evidence about what interventions have been effective in the past in changing and improving the child’s behaviour and Include details of de-escalation and diversion tactics that should be followed to minimise the possibility of the child needing to be restrained.

_{CA 1989 Guidance and Regulations Children’s Homes Vol 5}

Sanctions that are not to be used as disciplinary measures prohibited as detailed in the Children’s Homes Regulations 2001 Reg 17 are as follows:

No measure of control or discipline which is excessive or unreasonable.

1. Any form of corporal punishment. any intentional application of force as punishment for example smacking, slapping, shaking, punching, rough handling or throwing missiles;
2. Any sanction relating to the consumption or deprivation of food or drink;
3. Any restriction other than one imposed by a Court or in accordance with regulation 15 on:
   1. A child’s contact with parents, relatives or friends;
   2. Visits to the child by the child’s parents relatives or friends;
   3. A Child's communications with any of the persons listed in regulation (15)2; or
   4. A Child's access to any telephone help line providing counselling for children.
4. Any requirement that a child wear distinctive clothing;
5. The use of withholding medication or medical or dental treatment;
6. The intentional deprivation of sleep;
7. The imposition of any financial penalty, other than a requirement for the payment of a reasonable sum which may be by instalments by way of reparation;
8. Any intimate physical examination of the child;
9. The withholding of any aids or equipment needed by a disabled child;
10. Any measure which involves:
    1. Any child in the imposition of any measure against any other child;
    2. The punishment of a group of children for the behaviour of an individual child.

It is essential for staff to be aware of identified patterns of behaviour and any antecedents (triggers) which might provoke particular behaviours so that they can plan and prepare accordingly to reduce the risk of an incident occurring and the need for sanctions or a physical intervention.

On occasion’s children and young people can demonstrate behaviour that endangers either the safety or well-being of themselves or that of others. The policy ‘Restraint of Children using Physical Interventions’ provides guidance on the management of these behaviours.

Where unacceptable behaviour is of a serious nature or is demonstrated frequently, then staff should discuss this within either supervision, a team meeting or directly with a Manager of the Unit. In these instances, a risk assessment should be undertaken, which may identify strategies to deal with unwanted behaviours.

A Behaviour Management Plan specifies the graded response needed to safeguard children and young people who challenge services through their behaviour.

The Behaviour Management Plan is a document that staff will follow to provide individual support strategies aimed at reducing the incidence of challenging behaviour.

The Behaviour Management Plan will describe the behaviour/s and individual primary and secondary prevention strategies and the safe and effective use of restrictive physical interventions and will describe the complex support needs of children and young people with learning disabilities and autism that will look to prevent challenging behaviour.

A Behaviour Management Plan will be based on assessment of evidence such as Incident Reports, ABC charts and should be developed in agreement with parents/carers.

Where a Behaviour Management Plan indicates a restrictive Physical intervention may need to be implemented for children/young people with disabilities a Health Assessment Form will need to be completed and advice sought from a suitably qualified medical practitioner before a Restrictive Physical intervention can be used. (Unless unplanned in an emergency). This is because the incidence of other health related conditions is more prevalent in children and young people with disabilities who have a higher vulnerability to physical injury or psychological distress than the general population.

The Behaviour Management Plan by describing the secondary prevention strategies will look at strategies that will distract or de-escalate the situation at an early stage to avoid the behaviour escalating into an episode of increased challenging behaviour. The Behaviour Management plan will also detail the specific Restrictive Physical interventions to be used and in what circumstances in order to safeguard the individual child/young person engaging in challenging behaviour.

If the challenging behaviour is complex, if it happens in more than one environment or initial attempts at management have proved unsuccessful, it is necessary in the best interests of the child/young person to co-ordinate the actions of agencies/practitioners who can offer additional skills, experience and guidance.

A more comprehensive assessment will be necessary if a new pattern of challenging behaviour is emerging or the existing behaviour management strategy is proving ineffective in reducing the incidence of challenging behaviour and the necessity to use a Restrictive Physical Intervention is likely or likely to continue.

The management will monitor the use and frequency of Restrictive physical interventions and compile a monthly report to wards schedule 34 reporting which is sent to Ofsted.

When reviewing the Physical Intervention book and incident forms these will show the effectiveness of the strategies used from the Behaviour Management Plan.

If the behaviour has not reduced or has increased then this should trigger a re- assessment of the child/young person’s needs as a priority through a CIN meeting which should include actions involving specialist support from other agencies. These can include CYPMHS, The Challenging Behaviour Team (CBT), Speech and Language Therapists, Education staff or Health Services.

The monitoring of Restrictive Physical Interventions is necessary to identify any concerns patterns or trends and address any issues that may have arisen from such monitoring. These are compiled into a monthly report Regulation 34 Schedule 6 and are forwarded as required to Ofsted on a 6 monthly basis.

Standard 3:22 NMS requires that children’s homes develop constructive relationships with the police in their area. Homes should agree with the local police force procedures and guidance on police involvement in with the home in order to reduce unnecessary police involvement in managing behaviour. Children/young people should not be charged with offences resulting from behaviour which would not lead to police involvement if it occurred in a family home.

The Unit staff will endeavour to manage any challenging behaviour using their knowledge of the child/young person, behaviour detailed in their care plan /Behaviour Management Plan and use strategies and guidance to support the child / young person to regain control of their behaviour. Police should only need to be involved when behaviour escalates to the point whereby there is a strong indication of a significant risk to the child; another or significant damage to property exists. In these instances a Restrictive Physical Intervention may need to be used as a last resort. Where a Restrictive Physical Intervention has been implemented and the situation cannot be contained whereby methods of physical intervention have failed to bring the situation to safety then staff in these instances will seek advice from the Management and in such instances it may be necessary to call the police.

“Rights" are things every child should have or be able to do. All children have the same rights. These rights are listed in the UN Convention on the Rights of the Child.

Almost every country has agreed to these rights. All the rights are connected to each other, and all are equally important. Sometimes, we have to think about rights in terms of what the best is for children in a situation, and what is critical to life and protection from harm.

As you grow, you have more responsibility to make choices and exercise your rights.

Article 1 everyone under 18 has these rights.

Article 2 all children have these rights, no matter who they are, where they live, what their parents do, what language they speak, what their religion is, whether they are a boy or girl, what their culture is, whether they have a disability, whether they are rich or poor. No child should be treated unfairly on any basis.

Article 3 All adults should do what is best for you. When adults make decisions, they should think about how their decisions will affect children.

Article 4 The government has a responsibility to make sure your rights are protected. They must help your family to protect your rights and create an environment where you can grow and reach your potential.

Article 5 Your family has the responsibility to help you learn to exercise your rights, and to ensure that your rights are protected.

Article 6 You have the right to be alive.

Article 7 You have the right to a name, and this should be officially recognized by the government. You have the right to a nationality (to belong to a country).

Article 8 You have the right to an identity - an official record of who you are. No one should take this away from you.

Article 9 You have the right to live with your parent(s), unless it is bad for you. You have the right to live with a family who cares for you.

Article 10 If you live in a different country than your parents do, you have the right to be together in the same place.

Article 11 You have the right to be protected from kidnapping.

Article 12 You have the right to give your opinion, and for adults to listen and take it seriously.

Article 13 You have the right to find out things and share what you think with others, by talking, drawing, writing or in any other way unless it harms or offends other people.

Article 14 You have the right to choose your own religion and beliefs. Your parents should help you decide what is right and wrong, and what is best for you.

Article 15 You have the right to choose your own friends and join or set up groups, as long as it isn't harmful to others.

Article 16 You have the right to privacy.

Article 17 You have the right to get information that is important to your well-being, from radio, news-paper, books, computers and other sources. Adults should make sure that the information you are getting is not harmful, and help you find and understand the information you need.

Article 18 You have the right to be raised by your parent(s) if possible.

Article 19 You have the right to be protected from being hurt and mistreated, in body or mind.

Article 20 You have the right to special care and help if you cannot live with your parents.

Article 21 You have the right to care and protection if you are adopted or in foster care.

Article 22 You have the right to special protection and help if you are a refugee (if you have been forced to leave your home and live in another country), as well as all the rights in this Convention.

Article 23 You have the right to special education and care if you have a disability, as well as all the rights in this Convention, so that you can live a full life.

Article 24 You have the right to the best health care possible, safe water to drink, nutritious food, a clean and safe environment, and information to help you stay well.

Article 25 If you live in care or in other situations away from home, you have the right to have these living arrangements looked at regularly to see if they are the most appropriate.

Article 26 You have the right to help from the government if you are poor or in need.

Article 27 You have the right to food, clothing, a safe place to live and to have your basic needs met. You should not be disadvantaged so that you can’t do many of the things other kids can do.

Article 28 You have the right to a good quality education. You should be encouraged to go to school to the highest level you can.

Article 29 Your education should help you use and develop your talents and abilities. It should also help you learn to live peacefully, protect the environment and respect other people.

Article 30 You have the right to practice your own culture, language and religion - or any you choose. Minority and indigenous groups need special protection of this right.

Article 31 You have the right to play and rest.

Article 32 You have the right to protection from work that harms you, and is bad for your health and education. If you work, you have the right to be safe and paid fairly.

Article 33 You have the right to protection from harmful drugs and from the drug trade.

Article 34 You have the right to be free from sexual abuse.

Article 35 No one is allowed to kidnap or sell you.

Article 36 You have the right to protection from any kind of exploitation (being taken advantage of).

Article 37 No one is allowed to punish you in a cruel or harmful way.

Article 38 You have the right to protection and freedom from war. Children under 15 cannot be forced to go into the army or take part in war.

Article 39 You have the right to help if you've been hurt, neglected or badly treated.

Article 40 You have the right to legal help and fair treatment in the justice system that respects your rights.

Article 41 If the laws of your country provide better protection of your rights than the articles in this Convention, those laws should apply.

Article 42 You have the right to know your rights! Adults should know about these rights and help you learn about them, too.

Articles 43 to 54 These articles explain how governments and international organizations like UNICEF will work to ensure children are protected with their rights.