Should breakaway, restraint, safe or therapeutic holding and physical intervention training be offered to foster carers?
Physical intervention should always be a last resort and de-escalation skills, proactive behavioural strategies and empathetic behavioural support are always preferable but there are occasions when physical skills may sometimes be necessary and appropriate. If a foster carer is grabbed and then there is a refusal to release and the person is being kicked or punched, shouldn’t they be able to escape the grab to allow them to move away?
Breakaway or disengagement techniques give foster carers the confidence and skills to defend themselves from physical aggression in a way that does not harm or hurt the child so this is an important skill to have to prevent unlawful force.
Restraint or safe holding involving children is an emotive and complicated subject with strong opinions on both side as to the ethical issues relating to the restraint or holding of any young person.
The argument against offering restraint and physical intervention training to foster carers is that children that are likely to require physical intervention should not be placed with foster carers and thus such training should not be necessary. There could even be a concern that providing such training could encourage a use of physical intervention when it is not appropriate or necessary.
The counter argument recognises that, in reality, foster carers do find themselves caring for children who present the kind of challenging behaviour to which physical intervention may be appropriate. Such training equips foster carers with the skills to respond to such a situation safely and with respect for the child should they be necessary. As with first aid training, the hope is that it will never be necessary to use it but a foster carer should be confident and capable in using restraint and physical intervention techniques when they are required as a matter of last resort.
Every person reading this has probably used a physically restricted a person at some point in their lives. For example a car seat belt is a physical intervention. It is a non-restrictive use of direct force to limit a person’s movement or behaviour which is the definition of physical intervention.
So why is this physical intervention acceptable?
This may seem obvious but it simply reduces the risk of injury in the event of a car accident.
Does it carry any risks of harm?
Yes, it can damage ribs and increase the risk of whiplash.
Is the risk proportional?
In the event of a crash, the risk of not wearing a seat belt is significantly higher than the risk of not doing so. So a seat belt is a justified means of protecting a person’s welfare, however it is not always adequate.
An infant needs a body harness rather than a seat belt but why?
Due to their physical strength and body structure, and the cognitive understanding of the risks relating to not wearing a seat belt a higher level of restriction may be necessary to maintain the same level of safety. This form of restraint is not seen as wrong or abusive as it is a proportional, necessary and reasonable use of force.
When foster carers are told that holding a child’s hand is abuse could this be dangerous? YES!!!
It all depends on why the hand is being held and the way it is held. Is it to protect them from danger? To prevent them causing harm to themselves or others? Or is it a form of control? Was there any other option? Was it done in an appropriate manner or with the aim to hurt or cause damage?
This is why training in physical intervention is vital. It is far better to have a skill and not need it than need it but not have it – and if it is needed it should be done correctly and as safely as possible.
Legal use of physical intervention in foster care
Understandably, foster carers can be reluctant to consider the use of restraint and physical intervention as, by definition, it requires some use of force and could be considered to be unlawful if incorrectly applied. However, the use of restrictive physical intervention is likely to be legally defensible when it is required to prevent:
- Injury to the self.
- Significant injury to other people
- An offence from being committed.
The use of force must be reasonable, proportionate and necessary. It should always be used only as a last resort and never as a punishment. Any training you provide should be compliant with these principles.
The context for using breakaway, restraint and physical intervention training in foster care
Because physical intervention should only be used as a last resort, the focus should be on de-escalation and reducing the risk of the need for restraint or physical intervention whilst recognising that sometimes challenging behaviour can move into an area where it becomes sufficiently aggressive that it presents a danger to the child or other individuals. In these instances, physical intervention can be the only practical response and must be deployed in a way that contains the situation effectively, respects the rights of the child, and is within the law.
Physical intervention training should be considered as part of a holistic approach to managing challenging behaviour, not taught in isolation. Because all our physical intervention trainees have already attended our Challenging Behaviour course, they are able to put the exercise of physical intervention in a context where clear communication and de-escalation techniques already play their role.
What should you look for in physical intervention training in foster care?
Currently, Ofqual offers no accredited qualifications in physical intervention training but there are standards which any such training should meet. Look out for physical intervention training that understands:
- Training, Support and Development Standards for Foster Carers issued by the Department of Education
- National Minimum Standards for Fostering Services issued by OFSTED
- Positive and Proactive Care: reducing the need for restrictive interventions issued by the Department of Health
- The Equality Act 2010
- Human Rights Act
- The European Convention on the Rights of the Child 1991
Whilst accreditation to the following standards is not obligatory, it is also desirable that training follows the standards set by:
You should also look for an approach that:
- Actively engages delegates with learning physical intervention skills and with the situations where use of such skills are appropriate.
- Increases staff confidence and ability in dealing with challenging behaviour in ways that are child-centred and promote and protect positive relationships.
- Puts physical intervention in the wider context of managing challenging behaviour through communication and de-escalation techniques.
- Is tailored to the context of foster care and understands the particular issues that foster carers can face.
- Can even be adapted to address specific challenges and instances that your foster carers deal with.