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Reducing the Need for Restraint and Restrictive Intervention

The Government has today published the long-awaited guidance on reducing restrictive intervention of children ‘Reducing the Need for Restraint and Restrictive Intervention’. Families, the CBF and others have been calling for this delayed guidance since 2014 when the adult equivalent was published.

 

We welcome the fact that the guidance is now available and clearly states that “Every child and young person has a right to be treated with respect and dignity, and deserves to have their needs recognised and be given the right support” (page 5). We are also pleased that the guidance points to Positive Behaviour Support (PBS) as the best evidenced approach for supporting children with learning disabilities whose behaviours challenge and contains further advice to schools about best practice in recording and learning from incidents involving restrictive intervention and working in partnership with families.

 However,

·         this guidance is non-statutory and therefore merely sets out a set of expectations rather than governing how schools and other settings must behave towards disabled children.

·         it only covers special schools, meaning it does not apply to children with learning disabilities or autism in mainstream schools, even those in Special Educational Units attached to mainstream schools.  This is a huge omission and means that the same child can be treated differently depending on the setting they are in. 

·         the risks and significant harm associated with prone restraint are not covered in this guidance. Equivalent adult guidance (Positive and Proactive care, 2014) states clearly that ‘There must be no planned or intentional restraint of a person in a prone/face down position on any surface, not just the floor’.  This omission leaves children at greater risk.

·         there is no requirement to notify families about the use of restraint, or to record or report it, which perpetuates the current situation whereby the use and scale of restraint is unknown.

·         there is no implementation plan to deliver the change required

 

Vivien Cooper, Chief Executive of the Challenging Behaviour Foundation said “All children have the right to access education, be protected from harm, be well cared for and be free from cruel or inhuman treatment, whichever type of school they attend.  This guidance is a long overdue small first step but needs to be followed by a significant programme of work by the Government to reduce restraint, seclusion and other restrictive interventions.  We will be asking the Government how they will know if this guidance makes a difference, and what they will put in place to support implementation. There is no commitment or resource to explain how they will train school leaders and staff in early intervention and Positive Behaviour Support; how they will improve the safeguarding and accountability systems to protect disabled children from harm when they are at school, or how they will record and monitor the use of restrictive practices. We will continue to campaign for consistency across all settings.”

 

A report published by the Challenging Behaviour Foundation and Positive and Active Behaviour Support Scotland (PABSS) in January 2019  found significant negative physical and emotional impacts of restrictive intervention on both children and their families. 58% of families whose child experienced restraint said that it led to injury. 

Unexplained bruises, what looked like carpet burns to knees and ankles, unexplained broken wrist”

and 91% of CBF survey respondents reported an emotional impact on their child. 

“Incontinence, meltdowns, shutdowns, unable to communicate as overloaded with emotions and information

·         Families stated that recording and reporting of restrictive intervention and associated injuries is very rare.  From the 566 case studies collected, only 19% of families reported that injuries were recorded and only 17% reported that the restrictive intervention was recorded.  

·         More restrictive interventions were recorded where staff had received training. 

·         61% of survey respondents felt that Headteachers were using restrictive intervention as their main method of addressing behaviours that challenge among disabled children and 42% felt that staff were trying to punish their child.

 

The new guidance does not address these issues. There is no mention of informing families about the use of restraint, no requirement to record or report it and it states that using restrictive practices such as seclusion rooms can be used “as a disciplinary penalty” (page 10).  This is not acceptable.

Almost all the families who responded to our survey (91%) called for better training for teachers and school staff in learning disability, autism, challenging behaviour and Positive Behaviour Support (PBS).

Our findings raise major concerns about the use of restrictive intervention with disabled children in the UK and cast doubt on the assumption that it is being used only as a last resort.  The new guidance is not clear on what constitutes a last resort.

The evidence families have presented to us suggests that restrictive interventions are being used too readily and are happening at a frequency that reflects a lack of planning or a focus on children’s rights. The Government is unable to provide any evidence to counter that view.

There is an urgent need for a programme of action.  As Norman Lamb MP stated in a parliamentary debate on this issue:If it is possible to avoid it, to use it is an abuse of that child’s human rights….There can be no compromise on this. We have to end it, and that is why it is so important that the Department for Education takes notice. (Hansard 25th April 2019)

The CBF and PABSS have established a group to work with us on a strategy to reduce restrictive intervention and safeguard children and young people (Rrisc) across the UK and we call on the Department for Education to work in partnership with Rrisc to keep our children safe from harm.

 

'Reducing the Need for Restraint and Restrictive Intervention' can be read here.

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