Earlier this year, a report from Positive & Active Behaviour Support Scotland and the Challenging Behaviour Foundation showed that, of the 566 families of children with learning disabilities and challenging behaviour surveyed, 88% said their child had experienced restraint and 58% said their children had suffered injuries as a result.
The report examined all restrictive interventions with disabled children, including mechanical restraint (such as being strapped into a chair), chemical restraint (medication) and seclusion (being isolated in a room that the child is prevented from leaving), concluding that all were overused. Some 60% of those surveyed believed that restrictive interventions were used by schools as their main method of tackling challenging behaviour, rather than as a last resort to prevent injury.
Following consultation in 2018, the Department for Education and the Department of Health and Social Care published its long-awaited guidance on Reducing the Need for Restraint and Restrictive Intervention at the end of June. It outlines how to support children and young people with learning disabilities, autistic spectrum conditions and mental health issues who are at risk of restrictive intervention.
It is designed to support education, health and care settings to understand the needs of children and young people, including the underlying causes of, and triggers for, their behaviour; develop strategies and plans to meet and regularly review those needs; adapt the environments in which children and young people are taught and cared for; and provide appropriate support for children and young people whose behaviour challenges, without the use of restraint or restrictive intervention.
The guidance sets out relevant law and guidance and provides a framework of core principles, including:
- Promoting a positive and proactive approach to behaviour, including de-escalation techniques to minimise the likelihood of, or avoid the need to use, restraint;
- Ensuring the use of restraint is based on assessment of risk and to safeguard the individual or others;
- Restraint not being used to punish or with the intention of inflicting pain, suffering or humiliation;
- Using restraint techniques that are reasonable and proportionate to the circumstances and are applied with the minimum force necessary, for no longer than necessary, by appropriately trained staff; and
- Ensuring the use of restraint, reasons for it and consequences of its use, are documented, monitored, open and transparent.
Necessary and appropriate use of restraint
The guidance 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" and that "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".
The "unnecessary or inappropriate" use of physical restraint "may constitute an assault and may also infringe the rights of a child or young person under the Human Rights Act 1998".
The Positive Behavioural Support framework is highlighted as an effective approach, and described in the guidance, and there is further advice about best practice in recording and learning from incidents involving restrictive intervention and working in partnership with families.
However, the guidance has received criticism. It 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 also does not cover mainstream schools and defends the use of restrictive practices such as seclusion rooms as "a disciplinary penalty". Unlike the equivalent adult guidance, it fails to prohibit the use of prone restraint, which is known to pose significant risks.
For more information, contact the Child Law Advice Service at www.childlawadvice.org.uk