In April 2009 the Guardian commenced an inquiry into the use of physical restraint of children in SA residential facilities. As part of the inquiry the researchers, Associate Professor Andrew Day and Dr Michael Daffern, reviewed the written evidence and theory on the effectiveness and safety of restraint.
Restraint can take several forms. Most think of ‘hands-on’ restraint, where one or more people take hold of the person to control them.
Restraining devices to limit movement are sometimes also used, as is seclusion in a room and chemical restraint with drugs to manage extreme behaviour. This inquiry focused only on ‘hands-on’ restraint.
The use of restraint on children or young people is regulated to some extent by conventions, legislation and procedures which, if not actually contradictory, come from different perspectives. The UN Convention on the Rights of the Child, the Charter of Rights for Children and Young People in Care, regulations to the 1993 Children’s Protection Act and government and non-government procedures all have implications for practice and the legality of practice. The tension lies between the rights of a child to freedom from coercion or force and the right to safety from harm.
There is little empirical basis to determine when restraint is appropriate. There is no evidence to support the view that physical restraint assists children or young people to learn self-regulation or that it helps them to acquire useful and appropriate interpersonal skills. Physical restraint is a potentially dangerous practice and discussion on its use is highly charged. Restraint can appear to a child like abuse, frightening them and alienating them from care givers who administer it. Restraint can lead to serious injury and death, and the evidence from overseas confirms the high risk and the adverse psychological impact on staff and residents. However restraint can, and is, used to prevent immediate and significant harm.
Attitudes to the use of restraint are divided among the young people in residence. In a recent Scottish study, for example, residents agreed with staff that physical restraint would ensure young people’s safety in some circumstances. They advocated the use of non-physical alternatives to de-escalate situations and reserving the use of physical restraint to a last resort.
Some researchers have noted a major reduction in the use of restraints when the behaviour management practices of care staff are examined and modified. Training and ongoing support for workers and carers in applying behavioural techniques has been shown to produce major reductions in the need for physical intervention in several settings accommodating young people. This suggests that regular review of practice is needed to ensure that restraint is only used when all else has failed and where there is a high risk of serious harm.
The inquiry is due to conclude in early 2010 and further information will be available in future newsletters.