The debate has been dominated by inquiries into, and concerns about, the dangers of abusive practice by staff within children’s homes. Following the Pindown Inquiry (Levy and Kahan 1991) there was an understandable preoccupation with proscribing dangerous or abusive measures. Inquiries were undertaken by Utting (1991) and Warner (1992) and, in Scotland, by Skinner (1992) to examine practice within residential homes, all of which highlighted restraint as a significant issue for all concerned. However this seemed to some staff to lead to a situation in which they were far clearer about what they could not do than about what they could:
… there is an understandable feeling that, while antiquated and inappropriate methods of physical control have quite properly been forbidden, staff have very little help, advice or training in better methods to replace them (Utting 1991, p.43). Recommendation 76 of Warner’s Report was that the Government issue full guidance for staff on issues of control, restraint and physical contact with children in residential care and that this be kept up to date and supported by the provision of training materials which helped the staff apply guidance in real situations. Similar recommendations were made by Utting and Skinner but it is arguable whether this ‘full’ guidance has ever been achieved.
The Children Act 1989 Guidance and Regulations. Volume 4: Residential Care (Sections 1.82 to 1.91) set out official guidance on behaviour management and restraint in children’s homes whilst making it clear that care and control are linked. It specifies prohibited disciplinary measures, such as corporal punishment, and makes the important point that ‘a major determinant of good behaviour and positive ethos of the home is the quality of the relationships between the staff and the children’. This guidance has been further developed through more detailed subsequent Government directives and by the Care Standards Act 2000.

When can restraint be used?

The criteria within the original Children Act guidance for the use of physical restraint are as follows:
Physical restraint should be used rarely and only to prevent a child harming himself or others or from damaging property.

Force should not be used for any other purpose, nor simply to secure compliance with staff instructions (DH 1991, p.15).

In 1993 it was felt necessary to issue more specific guidance on exactly when physical restraint might be applied: Guidance on Permissible Forms of Control in Children’s Residential Care (DH 1993a). This sets out seven guiding principles relating to the use of physical restraint:
• Staff have good grounds for believing immediate action is necessary to prevent significant injury to the child or others or serious damage to property.
• Staff should take pre-emptive steps to avoid the need for restraint (dialogue and diversion).
• Only the minimum force necessary to be effective should be used.
• Every effort should be made to secure the presence of other staff before applying restraint –as assistants or witnesses.
• As soon as it is safe restraint should be relaxed to allow child to regain control.
• Restraint should be an act of care and control, not punishment.
• Restraint should not be used purely to force compliance with staff instruction when there is no immediate risk to people or property.
This guidance seems to raise the threshold: injury must be significant, the damage to property must be serious and the risk must be immediate to justify restraint.
Yet more ‘clarification’ was issued in 1997 in the form of a Chief Inspector’s letter, The Control of Children in the Public Care: Interpretation of the Children Act 1989, in response to criticism that the guidance was too vague and that staff were not intervening in risky situations because of a concern that they would be criticised for infringing children’s rights. This was particularly the case where young people wanted to leave the premises without permission.
Children must be listened to and their wishes and feelings taken into consideration. But this does not mean that local authorities, social workers or carers are constrained to abide by the wishes of the child. The wishes and feelings of children can, and indeed should, be overridden in decisions that affect them if this is necessary to safeguard and promote their welfare and protect others …(DH 1997, p.3).
The letter emphasised that staff have the duty to intervene immediately to prevent children putting themselves or others at risk or seriously damaging
property, and it was the action that needed to be immediate – not the risk:
… .if necessary staff have the authority to take immediate action to prevent harm occurring even if the harm is expected to happen some time in the predictable future (DH 1997, p.4).

This is in direct contradiction to the above 1993 guidance. Moreover, staff:
… have the responsibility and the authority to interpret ‘harm’ widely and to anticipate when it is clearly likely to happen. Although introduced as a ‘clarification’ some saw the letter as a confusing shift of emphasis to a more assertive and proactive use of physical interventions:
In all the previous guidance staff had been told to ‘back off’ immediately if young persons resisted attempts by staff to exert control over them. It seemed that, outside secure accommodation, almost any attempt to stop young people from doing what they wanted should be avoided. Staff who attempted to enforce the
agreed rules would either be accused of assault or unlawful restriction of liberty (Allen 1998, p.184).
Now the emphasis seemed to have shifted from avoiding the risks and consequences of taking action, to avoiding the risks and consequences of inaction. The Children’s Homes: National Minimum Standards (DH 2002a) have not brought about significant change. The matter of restraint falls within Standard 22 which defines the desired outcome of a home’s approach to behaviour management:

Children assisted to develop socially acceptable behaviour through encouragement of acceptable behaviour and constructive staff response to inappropriate behaviour.
Each establishment is expected to have a behaviour management policy which is clear to staff, parents and the children themselves. Measures to manage behaviour must be:
• appropriate to age and individual need;
• not excessive or unreasonable;
• only used to prevent injury to child concerned or others or to prevent serious damage to property. It is not used as punishment or to enforce compliance with instructions;
• consistent with any relevant government guidance on approved methods.

Methods of restraint

In fact, none of the Government guidance actually specifies such ‘approved methods’. The statements which do touch on methods of restraint are contained not in guidance but in a training pack issued by the Department of Health in 1996. Their status is therefore somewhat unclear:

Physical restraint techniques which are suitable for children and young people observe certain principles. These include:
• the techniques should only be used in children’s homes where there is an ethos of anticipating and defusing children whenever possible;
• they take account of the young person’s age, gender and stage of development;
• they do not rely on threatening or inflicting pain;
• holds do not apply pressure that works against the joints;
• they do not rely on routinely taking a young person to the floor but preferably to a seated position;
• they minimise movement, particularly the risk of toppling over;
• you can continue talking to the young person as you restrain them;
• you approach the young person from the side, not face to face;
• techniques allow you to phase down the hold or restraint as the young person regains control;
• you can break away at any time – so that staff are not tempted to escalate the restraint using desperate and inappropriate techniques (DH 1996, pp.33-34).
The extent to which these principles have been adopted in practice is unclear. Certainly the Department of Health has not, and does not intend to, endorse specific  echniques. This has left the providers of children’s residential care to search for their own solutions from amongst the large number of systems and approaches on offer from commercial organisations. There is nothing to stop establishments from modifying the technique they have selected or even inventing their own methods provided they ostensibly comply with the principles of minimal force and are said to be ‘non-harmful’. There is currently no system of mandatory quality control for assessing whether methods are safe, effective or ethical.
Department of Health guidance asserts that any in-service training in the use of restraint must only be given as part an overall programme of care and control which includes the creation of a positive ethos and the involvement of young people. It states that such training is essential for workers in secure units but ‘a matter of judgement’ for workers in open accommodation. Noting that there are several forms of restraint training being offered it states that:
Above all, managers should satisfy themselves that any training sought is relevant to a Social Services setting and appropriate for use with children and young people (DH 1993a, p.19). In the absence of firm evidence or specific guidance, it is difficult to see how managers can make these judgements.

Recording and monitoring

It is important that incidents of restraint are taken seriously. Department of Health guidance (1993a) states the following:
i. The circumstances and justification for using physical restraint must be recorded immediately.
ii. Afterwards, the child should be counselled on why it was necessary to restrain him. He should also be given the opportunity to put his side of the story.
iii. The care worker’s line manager should discuss the incident with him within 24 hours.
iv. A full report of every incident should be prepared within 48 hours and submitted by the head of home to his line manager/ supervising officer.
v. Senior managers are required to monitor every such incident and take any action indicated. They should be prepared to investigate homes where, for example, there is a pattern of children absconding or where there is frequent use of physical restraint by staff.
vi. Arising from (v) senior managers must ensure that arrangements exist for children who run away to be interviewed about the reasons and circumstances by someone who is not connected with the home in question; for example, the field social worker.
vii. Where it is clear that the care worker concerned needs further advice/support/training the line manager should take prompt action to ensure that it is provided.
viii. Staff meetings should provide the opportunity for a ‘post mortem’ of the incident. Such discussion is essential to prevent the development of a culture where a physical
response becomes routine.
The Minimum Standards have specified in more detail the nature of the recording which should take place, in a ‘separate dedicated bound and numbered book’. This book should then be regularly monitored by the registered person (i.e. person responsible for the home) to ensure compliance with policy and identify any patterns which require intervention – either amongst specific staff or children or practice in general. The registered person must record their comments about the appropriateness of each restraint and any subsequent actions and sign the record to indicate that the monitoring is taking place. Children should be given the opportunity to discuss incidents, either individually or as a group. They should also be actively encouraged to write down their own views following an incident or to have someone else record their views for them and to sign this.