Physical restraint in residential care

In April 2009 the Guardian initiated an inquiry into the use of restraint in residential care facilities following reports from some youth workers and residents that physical restraint was used too often and young people were suffering injuries.  The inquiry was conducted by Associate Professor Andrew Day and Dr Michael Daffern and the inquiry report, Policy and Practice in the Use of Physical Restraint in SA Residential Facilities for Children and Young People, was released on 13 January 2010.  The full report is available for download and a summary.



The inquiry found that the use of physical restraint has been falling since 2007 but that it could be reduced still further.  Restraint should only ever be used where the young person is at risk of immediate and serious harm to themselves or to another person nearby.  It is a ‘last resort’ intervention.  It should not be used because a young person is cheeky, refuses instructions, is shouting or throwing things around.  It should only ever be used by people trained to restrain safely.

The vast majority of residential staff are extraordinary people and are doing a great job under very difficult circumstances.  The failures identified in the inquiry report are systemic failures and should not reflect on the many dedicated workers and managers, nor on the young people who act out their distress. The failures were with inconsistent policies and practices, too many residents housed together, not enough on-the-job training and reflection on incidents, and not enough specialist support for young people with high needs.

There were different rates of use of restraint in different places and generally there was lower use in non-government houses.  This was a function of the size and design of the facility and higher investment in training and support. We could not answer the question about whether South Australia had higher rates of use than elsewhere because the data is too inconsistent to make any comparisons meaningful.  Instead the researchers could say that the rate of use could be reduced further.

To minimise the need to use physical force five recommendations were made.  In summary these were to replace the large residential units with smaller home-like houses of three or four young people, provide more on-the-job training and support for staff, change the regulations in the Family and Community Services Act 1972 so that restraint is never sanctioned for non-compliance, have specialist advice more readily available for children with the highest needs and have more rigorous external monitoring so that patterns are picked up early.

So much goes well in our residential care sector and we learn as much from what works well – see our report What works best in residential care – as what doesn’t. We do though tend to review things that we are concerned about and that we want to do better at.  As one young interviewee said, ‘I know it takes a lot out of them emotionally,’ referring to youth workers.  Compassion and understanding is a great place to start.

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