Tag Archives: safe holding

Safe and Therapeutic holding

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

Director, SecuriCare

E: lee.hollins@securicare.com M: 07760788712 W: http://www.securicare.com

 

REFERENCES

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.

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We need to talk about restraint

In November I was privileged to chair a conference in London about child to parent violence in adoptive and foster families. The day had been crafted to follow a narrative as we explored the effects of trauma for the child and then for the whole family; different insights into law and practice; and finally a session on how to respond when things really kick off. This came in part as a response to discussions I and others had been having about the training available for families in how to keep children safe. I know that some people had found this difficult or impossible to access, and so we were pleased to be joined by Lee Hollins of Securicare and Amanda Boorman of the Open Nest, who, between them, have done much to open up this topic and provide some answers. Following on from the conference, Lee has written 2 guest blogs for us, the first here and the second to follow in a week or so. 

We Need To Talk About Restraint – Lee Hollins

Restraint. It’s word that conjures up many images in the minds of many people. Mostly bad, and often in the minds of practitioners working in the field of fostering and adoption. That’s why we need to talk about it. The recent ‘Child to Parent Violence in adoptive and foster families’ conference chaired by Helen was just such an opportunity.

As a guest speaker I started by offering a definition. The Mental Capacity Act 2005 defines ‘restraint’ as when someone “uses, or threatens to use force to secure the doing of an act which the person resists, or restricts a person’s liberty whether or not they are resisting”. To me this speaks of control and coercion; of overriding people’s minds and overwhelming their bodies.

Sadly the use of restraint to control and coerce is nothing new. It was a central feature of the Asylum movement in the 1800’s, with psychiatric patients being subject to the use of force by often very physical male attendants. A former ‘inmate’ at Stafford Asylum described the regime there, “No thought can conceive, no tongue can tell, no pen can describe the manifold horrors, the atrocious cruelty, the fraud, the guile, the imposture that pervaded every part of that lauded asylum. . . .” (Smith, 1988)

For many in the modern era the embodiment of Physical Restraint was the ‘Control and Restraint’ system that operated across the prison service estate in the 1980’s (Wright 1999). It was derived from various Martial Arts including Aikido and Jiu-Jitsu (Tarbuck, 1992). It included many powerful techniques, such as pain compliance, takedowns and holding individuals face down on the floor (the forced prone restraint position). Restraint was often implemented by 5-person teams specifically trained to dominate unruly prisoners. In time the overuse, misuse and abuse of these techniques led to injuries and deaths, and scandals that revealed the punitive use of techniques (Amnesty International, 2001). Things needed to change.

In the early 1990’s the community care reforms led to markets opening up which supported the provision of therapeutic health and social care environments. It proved to be the perfect time to redefine and rebrand ‘restraint’. The term that came into common usage was ‘physical interventions‘. This referred to “any method of responding to challenging behaviour which involves some degree of direct physical force to limit or restrict movement or mobility” (Harris et al, 2008). Key to meeting the needs of the market, and in particular serving the best interests of service users, was the jettisoning of the coercive and harmful elements of the earlier C&R system. No more five person teams, no more takedowns, no more pain compliance and no more prone restraint.

SecuriCare has operated in the health and social care sector for over 20 years, and has been in the vanguard of developing person-centred, trauma informed and sensitive behavioural management strategies. The good news is that the evolution of holding strategies has continued apace. In my next blog we will examine the most up-to-date ‘safe holding’ and ‘therapeutic holding’ practices.

Lee Hollins, PGCert Health Research, BSc (Hons) Physiotherapy

Director, SecuriCare

E: lee.hollins@securicare.com M: 07760788712 W: http://www.securicare.com

 

REFERENCES

Amnesty International (2001) Public statement on Wormwood Scrubs. https://www.amnesty.org.uk/press-releases/united-kingdom-public-statement-wormwood-scrubs.

Department of Health (2015) Mental Health Act 1983: Code of Practice. London: The Stationary Office.

Duxbury, J. and Paterson, B. (2005) The Use of Physical Restraint in Mental Health Nursing: An examination of principles, practice and implications for training, Journal of Adult Protection, 7 (4) pp. 13-24.

Harris, J., Cornick, M., Jefferson, A. and Mills, R. (2008) Physical Interventions. A Policy Framework. Revised Edition. Kidderminster: BILD/ NAS.

Smith, L.D. (1988) Behind Closed Doors; Lunatic Asylum Keepers, 1800–60, Social History of Medicine, 1 (3) 1: pp. 301–327.

Tarbuck P. (1992) Use and abuse of control and restraint. Nursing Standard, 6, pp.30–32.

Tucker, R. (2003) Good practice in the management of violence, Paper presented at the Therapeutic Management of Aggression and Violence Conference, Royal Scottish National Hospital, Larbert.

Wright, S. (1999) Physical restraint in the management of violence and aggression in inpatient settings: a review of issues, Journal of Mental Health, 8 (5) pp.459-472.

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“Not a solution, but a system”: Adoption and Fostering Podcast interview with Delyth Evans

Another cracking podcast from the Adoption and Fostering Podcast team!

 

 

 

 

 

 

 

 

Episode 26 features an interview with Delyth Evans, Service Manager at the Centre for Adoption and Support. Delyth and Al Coates talk about the experience of child to parent violence within adoptive families. I have been asked a lot recently about safety plans and so of particular interest to me were discussions about family safety planning and safe holding, and all within a context of safeguarding the whole family.

The Centre for Adoption Support offer a three stage support programme for families,

  • A 1 day workshop on child to parent violence
  • An introduction to the principles of NVR
  • A workshop on how to manage challenging behaviour at a practical level

and family safety plans are described as fundamental to the whole offer. The emphasis is very much on understanding the violence in context, rather than as a specific incident; and in supporting parents to find strategies to manage their child’s behaviour while keeping the whole family safe.

Well worth a listen!

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