Yesterday (27/06/19), the Government published the long awaited ‘Reducing the Need for Restraint and Restrictive Intervention’ which covers children and young people with learning disabilities, autistic spectrum conditions and mental health difficulties in health and social care services and special education settings.
The guidance follows on from the Positive and Proactive guidance published by the Department of Health in 2014. It states: “Restrictive intervention should only be used when absolutely necessary, in accordance with the law and clear ethical values and principles which respect the rights and dignity of children and young people, and in proportion to the risks involved. It can never be a long-term solution, and we are particularly concerned about long-term or institutionalised uses of restrictive interventions” (p.5)
This guidance is non-statutory and advisory, but applies to the following settings and services:
- Local authorities;
- Clinical Commissioning Groups;
- Maintained and non-maintained special schools, special academies and special free schools;
- Independent educational institutions which have applied to the secretary of state for education for approval under section 41 of the children and families act 2014;
- Special post-16 institutions;
- Children’s homes (including secure children’s homes);
- Residential holiday schemes for disabled children;
- Local authority and independent fostering service providers; and
- NHS commissioned health services (p.10-11)
It advises that all those involved in the care or support of children and young persons should organise any responses to behaviours that are deemed to be challenging by asking and answering the following question: “What is in the best interests of the child and/or those around them in view of the risks presented?” (p.6)
It states: “A positive and proactive approach is vital to anticipate potential triggers for behaviour that challenges, and minimise the likelihood of, or avoid the need to use, restraint.”
In respect of physical restraint, it states: “The unnecessary or inappropriate use of force may constitute an assault and may also infringe the rights of a child or young person under the Human Rights Act 1998” (p.12).
It sates restraint may be necessary to safeguard the individual and/or others from serious injury or harm, and sometimes it will be the only realistic option, for example to prevent a child from running into a busy road.
The following key principles are offered to guide settings and services in developing their policies and practice in the context of the particular legal requirements that apply to them:
- Promote a positive and proactive approach to behaviour, including de-escalation techniques appropriate to the child or young person, to minimise the likelihood of or avoid the need to use restraint;
- Use of restraint is based on assessment of risk and to safeguard the individual or others;
- Restraint should only be used where it is necessary to prevent risk of serious harm, including injury to the child or young person, other children or young people, to staff, the public or others, if no intervention or a less restrictive intervention were undertaken;
- An intervention is in the best interests of the child or young person balanced against respecting the safety and dignity of all concerned, including other children, young people or adults present;
- Restraint is not used to punish or with the intention of inflicting pain, suffering or humiliation;
- Techniques used to restrain or restrict liberty of movement are reasonable and proportionate to the circumstances, risk and seriousness of harm; and are applied with the minimum force necessary, for no longer than necessary, by appropriately trained staff;
- Use of restraint, reasons for it and consequences of its use, are documented, monitored, open and transparent; and
- When planning support and reviewing any type of plan which references restraint (such as a behaviour support plan), children and young people, and parents, and where appropriate (for example, where the child or parent/carer wants it), advocates should be involved (p.18-19).
The guidance says the new RRN Training Standards “offer a benchmark for training which includes restrictive intervention in health settings and are mandatory in NHS commissioned services. Although primarily designed for health, the standards reference education and social care settings” (p.30).
It concludes “When commissioning training, settings and services are advised to consider UKAS accredited training as UKAS is the government recognised national accreditation service” (p.30).
The BILD-ACT certification scheme which certifies training against the RRN standards is working toward UKAS accreditation and this will be in place by the Autumn.
You can read the full published report here
Lee Hollins (BILD/ RRN), 2019