TCI Restraint Information

• Physical interventions to contain and/or control the behaviour of children and young people should only be used to ensure safety and protection. Except where otherwise specified as part of an approved Individual Crisis Support Plan or emergency intervention plan, physical restraints should only be employed as a safety response to acute physical behaviour and their use is restricted to the following circumstance: The child/young person, other children, staff members or others are at imminent risk of physical harm.
• As any physical intervention involves some risk of injury to the child, young person or staff, staff must weigh this risk against the risks involved in failing to physically intervene when it may be warranted. Physical intervention should never increase (or create more) risk than the behaviour it is trying to contain.
• An informed consent process for the family or guardian of the child should be in place prior to the use of any physical intervention with a child or young person.
• Physical interventions must never be used as (1) punishments, (2) consequences, or (3) for “demonstrating who is in charge.” Unless approved by the relevant statutory authorities and specified on the Individual Crisis Support Plan, physical interventions must never be used for programme maintenance (such as enforcing compliance with directions or rules or for preventing the child from leaving the premises). Physical restraints must not be used for the convenience of staff, as a substitute for an engaging and developmentally appropriate programme, as a substitute for less restrictive alternatives, or as a substitute for adequate staffing patterns. Physical restraint should never be used for therapeutic purposes (such as forming attachments as promoted by “holding” therapy advocates).
• Physical interventions should only be employed after other less intrusive approaches (such as behaviour support techniques or verbal interventions) have been attempted unsuccessfully, or where there is no time to try such alternatives.
• Physical interventions must only be employed for the minimum time necessary to reduce the risk. They must cease when the child/young person is judged to be safe and no longer at risk of self-injury or harming others.
• Physical restraints may only be undertaken by staff who have successfully completed a comprehensive crisis management course that covers: (1) crisis definition and theory; (2) the use of de-escalation techniques; (3) crisis communication; (4) emotional regulation; (5) physical intervention techniques; (6) the legal, ethical, and policy aspects of their use; (7) decision-making related to physical restraints; (8) debriefing strategies; (9) signs of distress and effect on the child/young person and how to monitor, (10) identification of events and environmental factors that may trigger emergency safety situation, (11) the needs and behaviours of the population served , and (12) the effects of trauma and adversity on children’s development. They must also have demonstrated competency in performing the intervention techniques, which is measured and documented according to relevant professional and/or regulatory guidelines.
• All staff involved in an incident of physical restraint must have successfully completed the same training programme which has been fully endorsed and implemented in the Agency, been assessed as competent in the use of physical restraints, and have successfully completed a skills review within the previous six months. Although all staff will not be trained in physical restraints, all staff should be trained in safety concerns and documentation during an orientation training. The Agency policy on physical restraint should be reviewed with all staff and immediately with any newly hired staff. Untrained staff, or staff not current in their training and certification, may not restrain young people.
• Only physical restraint skills and decision-making processes that are taught in the comprehensive crisis management course and approved by the Agency (and any relevant statutory authority) may be used. All techniques (including decision-making processes) must be applied according to the guidelines provided in the training and in this policy.
• Where possible, staff members must consult with peers and supervisors prior to initiating any physical restraints.
• Two or more trained staff members should be involved in any physical restraint to help ensure safety and accountability and a nurse or medically trained person should be in attendance during any physical restraint to observe and monitor the young person and staff for physical indicators of distress.
• Young people may not be permitted to restrain or to assist in the restraint of other young people.
• Following any incident involving physical restraint, the Agency must ensure that there is post incident medical and follow-up evaluation, debriefing and support is offered to the young person, the staff members, and any other people involved in or witnesses of the episode. Staff members should provide the young person with an explanation for the intervention and offer the young person an opportunity to express their views on what transpired. The family of the young person should be notified following any use of restraint.
• The Agency must have a formal grievance procedure in place for the young people (and their families or advocates), that is easy to understand, assures confidentiality, and is readily accessible. The grievance procedure should include how to contact senior Agency management and relevant external authorities.
• The initial use of physical restraint should be reported to the appropriate statutory authority and an Individual Crisis Support Plan or emergency intervention plan should be developed and implemented by the Agency, including making an informed decision with families and/or guardian. Use of restraint should be discussed with the young person and family. The discussion should include under what circumstances restraint would be used and what type of restraint. The plan should cover the use of positive and less intrusive intervention techniques and specify the circumstances under which physical restraint may or may not be an appropriate response in the future.
• All incidents of physical intervention must be recorded on incident report forms which reflect the stated policy and include (at least) details of the incident, the people involved, the preventive strategies that were employed, actual techniques used, any injuries sustained by the young person or staff, and debriefing that was provided for the young person. All such reports should be reviewed by senior Agency personnel and appropriate action should be taken (for example, counseling for the young person and/or staff members, incident review, skills update, notification to external authorities, notification of the family). The data collected should be used for a data-informed decision-making process that concentrates on adjusting the system to support the young person and ultimately reduce the use of restraints across the Agency.

If any injuries to young people result from the use of physical restraints, the details must be reported to the appropriate statutory authority. A formal review of the incident and the Individual Crisis Support Plan or emergency intervention plan should be implemented and/or adjusted.