Part 2, this week, from Lee Hollins. In this blog Lee further develops the understanding of restraint, with the concept of “safe and therapeutic holding”; and explains how they can be introduced as an aid to keeping children safe. Many thanks to Lee for writing these two blogs. It’s always good to hear from someone else, bringing as it does a greater breadth to the discussion and to our knowledge and understanding.
Safe and Therapeutic Holding – Lee Hollins
Following on from the last blog which charted the evolution of ‘restraint’ and ‘physical intervention’ techniques, I pick up on a discussion that took place at the recent ‘Child to Parent Violence in adoptive and foster families’ conference.
In their guide ‘Holding Safely’, the Scottish Institute for Residential Child Care (SIRCC) acknowledged the difficulties in talking about the wider subject of child ‘restraint’. This was because for many their framing of the concept has been understandably sensitised by the coercive and dangerous practices that have prevailed in the past (see Part 1). However, because of the prevalence of serious challenging behaviour SIRCC underscored the need to be able, in extremis, to ‘hold (a child) to prevent harm’.
‘Safe holding’ is something that should take place within the context of an agreed plan, which should contain extensive safeguards. Any ‘safe hold’ must take into account the child’s health, their developing anatomy and physiology as well as their cognitive abilities and emotional needs. The plan should specify the explicit criteria for use (to prevent harm), effective communication strategies and safety guidelines as well as the aftercare required.
‘Therapeutic Holding’ is different. It is defined by the Royal College of Nursing (2010) as “a method of helping children, with their permission, to manage a painful procedure quickly or effectively”. Whilst such holds are used to facilitate medical procedures, such as drawing blood, its two core concepts are equally relevant to behavioural management: That any intervention should be understood and consented to by the child, and be provided in order to help them safely process the emotional and physical responses arising from pain or distress. Therefore ‘therapeutic holding’ within the context of physically challenging behaviour might be defined as “a method of helping children, with their permission, to manage a distressing experiences safely and supportively”.
The principles underlying such an approach draw on Winnicotts ‘holding’ and Bions ‘containing’. Steckley (2013) offers 4 core criteria for such a ‘holding environment’. It should:
- Create reliably safe boundaries
- Offer a protective space
- Enable children to experience themselves as valued and secure
- Is associated with a secure base
When building a child-centred ‘Therapeutic Holding’ plan, Securicare don’t always rely on pre-configured techniques, we often build them around naturally occurring soothing/self-soothing strategies which the child has historically initiated or demonstrated they respond positively to. The plan is typically built around a single parent/carer responding to a single child where everything is on the child’s terms. The child decides when and how to draw upon the comfort that the holding environment offers with the value of the hold being determined directly by the child. Their input is welcomed during the formulation of any plan, as well as their feedback is when evaluating the therapeutic value of any holds.
SecuriCare has delivered planning and training for over 20 years, and has been in the forefront of developing person-centred, trauma informed and sensitive behavioural management strategies. We offer a planning and training service that incorporates child-centred ‘safe holding’ and ‘therapeutic holding’ strategies.
Lee Hollins, PGCert Health Research, BSc (Hons) Physiotherapy
E: firstname.lastname@example.org M: 07760788712 W: http://www.securicare.com
Davidson, Jennifer and McCullough, Dennis and Steckley, Laura and Warren, T. (2005) Holding safely: guidance for residential child care practitioners and managers about physically restraining children and young people. Scottish Institute for Residential Child Care
Steckley, L. (2013) Therapeutic Containment and Holding Environments: Understanding and Reducing Physical Restraint in Residential Child Care. Centre for Excellence for Looked After Children in Scotland: Child & Youth Care World Conference
RCN (2010) Restrictive physical intervention and therapeutic holding for children and young people. Guidance for nursing staff. London: RCN.