[This article was first published in The Advertiser 13 January 2010.
Using force to hold, immobilise or move a child who is in danger can be a normal protective response. Pushing, pulling and lifting may be necessary to protect the child or others nearby from immediate and serious harm.
I have just completed an inquiry into the use of physical restraint of children in South Australian residential facilities. Residential facilities for children and young people in state care are run by government and non-government organisations. Children stay for periods of a few days to a month.
Included in the inquiry were the youth training centres at Magill and Cavan.
I started the inquiry because we had heard from some young residents and staff that restraint was used often and children were suffering injuries as a result of being restrained.
In other countries children and young people have died in schools and residential facilities from asphyxiation as a result of physical restraint. Some methods of restraint are very dangerous, particularly when they involve neck holds, obstruction of the nose or mouth, or holding a child face down on the ground.
Thankfully, we did not hear of any incidents of children dying recently in children’s services in Australia as a result of a physical restraint. However injuries were confirmed, reinforcing the evidence that restraining a child can be dangerous.
Restraint also has a considerable psychological effect on both the child and the staff involved.
We found that the use of restraint is decreasing and awareness of its dangers is rising.
Nevertheless restraint was not uncommon and was sometimes used inappropriately, such as when a young person refused repeatedly to comply with an instruction and emotion was high.
Restraint is more common in the facilities which accommodate higher numbers of children; not because the staff are any less skilled than others but because it is so difficult to keep everyone safe in a home with ten young people compared to four. Some young people were restrained often and undoubtedly had extremely challenging behaviour.
Fortunately, the background research and findings make us confident that we can make all children’s residences safer.
First, we would have no more than four young people in any one house, maybe up to six in some circumstances. Second, we would have a consistent positive approach to bad behaviour, and restraint would never be sanctioned for non-compliance or punishment.
Third, care staff would be well-trained and well-supported to act professionally, warmly and calmly.
Fourth, specialist advice would be provided for the care of children with extremely challenging behaviour and a review of all incidents would be done routinely. And fifth, there would be rigorous external monitoring of use of restraint so that patterns could be picked up early.
The inquiry found that there are inconsistent procedures and practice in children’s residential facilities and a number of situations in which it was unclear how staff should manage difficult behaviour. For example, plucking children from harm’s way is easy to defend as necessary but is it right to haul a 14 year old boy out of bed on a third attempt to get him to school? And is it right to immobilise with an arm hold a distressed 13 year old girl who is lashing out at anyone who comes near her?
It is these types of difficult situations that residential care workers routinely face, and they have to decide whether or not and when restraint is required.
Residential staff want the best for children in their care. They need our support and government’s commitment to achieve this.
Within the next few years I hope to see the larger residential facilities replaced with home-like residences, specialist advice for children with high need and consistent guidance to staff on dealing positively with problem behaviour.
Numbers add up to cause concern
- On an average day in SA there are 345 children and young people in some form of residential care, including those in secure custody.
- Over a 27 month period (Jan 2007 – March 2009) there were 19 confirmed cases of injury of children in residential care as a result of physical restraint.
- Most of those restrained are male.
- Many residents will never experience a restraint but some are repeatedly restrained, usually over a short period of time.
- Residential facilities for children and young people in state care are run by government and non-government organisations and children stay for periods of a few days to a few years.
- In the past decade in Australia there have been incidents of serious injury of children in formal settings which have triggered inquiries, such as a 2006 WA Ombudsman’s investigation, a 2007 review by the WA Inspector of Custodial Services and a 2001 NSW Community Services Commission review.