6.1.13 Managing Behaviour within Foster Homes
- Behaviour Management
- Safer Caring
- Permitted Sanctions
- Non Permitted Sanctions
- Restrictive and Non-Restrictive Physical Interventions
- Resources and Training Available to Foster Carers
- The Planning Framework
- Essential Required Good Practice Relating to Physical Intervention
Foster care can be a complex, difficult, stressful, yet rewarding task. Wakefield Council recognises that carers need relevant information, support and training to assist them in offering good quality care to children and young people that are looked after. As a Corporate Parent, Wakefield Council also recognises that children and young people that are looked after require foster carers who have the skills, knowledge, and abilities to manage their behaviours appropriately if they are to be able to take advantage of the 'life chances' which they are afforded.
Support given to a child or young person that is fostered must ensure that the child is safeguarded and protected and that the welfare of the child is paramount. Children who are looked after are all subject to individual circumstances, which can result in feelings of hurt, fear and sadness.
Such feelings together with previous experiences can at times be expressed in behavioural terms. At the same time, children and young people will grow up into a world where people will not always take account of their difficult past experiences. They need to be able to act with consideration for others and themselves.
Behaviour management, like all aspects of foster care is a team effort. Foster carers should never feel isolated in managing behaviour. If you have doubts or concerns please ask someone.
The aim of the policy and associated procedures and training is to equip carers with the knowledge and skills to be able to manage children's behaviour with confidence.
Underlying this are certain principles which seek to guide carers in managing behaviour effectively. They are:
- Seeking to reward good behaviour;
- Adopting a non confrontational approach;
- Establishing a good relationship/rapport with children and young people based on mutual respect;
- Establishing house rules which are consistent, explicit and applicable to all children and young people in within the household;
- Acknowledging and appreciating the past life experiences which the children and young people bring;
- The use of age/developmental stage appropriate sanctions but only when necessary, not as routine;
- Receiving training "TCIF" which covers both the origin of behaviours and standard techniques/strategies;
- Having access to resources, including the Foster Carer Manual;
- Working within a multi-agency context;
- Working in partnership with children, young people, carers, parents, professionals and voluntary agencies.
There is a safer caring policy that should be referred to in order to understand the principles and more significantly meet the child or young person's specific needs. Having access to this, the foster carer, child and professionals should ensure that the Placement Agreement is completed and the foster carers have been advised of any possible behaviour issues that can be expected from the child or young person. This information should also include how all those issues are dealt with on a practical level. Such practical arrangements should be in line with this policy.
The techniques that are deployed will be largely dependant upon the child or young person's individual circumstances and needs and should also be relevant to their age and developmental stage. The aim is always to reduce and/or eradicate behaviours in a positive and consistent manner.
Occasionally, though, foster carers will need to exercise sanctions for unacceptable behaviours in the home and the following sanctions are permitted.
The curtailment of leisure activities, additional house chores, loss of privileges, use of increased supervision.
The appropriation of pocket money or savings to repair damage or for the replacement of loss. Restitution maybe in full, in part or merely token but the children and young people must not be deprived of more than 2/3rds of their total spending money for the week.
The confiscation, temporarily, or permanently, of any article or substance belonging to a child if that same article, material or substance be considered potentially dangerous or injurious to property or persons such as for example, knifes, gas canisters, needles etc. Caution has to be taken when having any consideration of confiscation as this could trigger negative behaviours.
Other sanctions are not permitted and foster carers cannot:
- Use any element of force as punishment including slapping, pinching, squeezing, shaking, throwing missiles, rough handling, punching or pushing in the heat of the moment and/or in response to violence from young people;
- Punish or treat in any way that is humiliating, including requiring a child to wear distinctive or inappropriate clothing;
- Refuse meals or deprive of food or drinks, deny access to amounts and range of foods and drinks normally available to children and young people being cared for (unless this is on medical advice);
- Use or withhold medication, medical or dental treatment;
- Use accommodation to physically restrict the liberty of any child e.g. locking or otherwise blocking doors;
- Restrict contact to and from family and friends. This will include, independent visitors, advocate, any officer appointed by CAFCASS, solicitor, social worker, independent person regarding complaints and any person representing Ofsted;
- Intentionally deprive a child of sleep;
- Impose fines, except for reparation and restitution (see paragraph above);
- Conduct intimate physical searches. If it is suspected that a child has secreted drugs/weapons on his/her person, then consideration should be given to notifying the police, following consultation with child/young persons social worker or the carers supervising social worker;
- Allow participation in the consideration of, or the administration of any form of punishment by a child or young person on any other child or young person;
- Any threat to use any of the above.
The emphasis is on individual children and behaviour management which is tailored to each child's needs. Some of the behaviours that foster carers may find difficult could include persistent lying, persistent stealing, sexually harmful behaviours, self harming, aggression, repeated destruction of properties and going missing from home.
Wherever possible, rewarding acceptable behaviour should be the preferred and usual method of reinforcing and encouraging acceptable conduct and behaviour.
Foster carers will be encouraged to seek help and advice where appropriate and are to be provided with in-depth information about the child and their family, such as Placement Plan, care plans, risk assessments etc that can help the carer in fully understanding the needs of children or young people placed and any current behaviours or potential future difficulties.
Foster Carers will be supported in obtaining knowledge of external specialist services to assist in the management of particularly difficult or extreme behaviours for example CAMHS/drug and alcohol services.
Physical intervention refers to direct contact between one person and another or to physical contact related to the use of an aid, such as a protective helmet.
- Non-Restrictive Physical intervention covers areas such as touching and managing the environment;
- Restrictive Physical intervention involves the use of force to restrict movement or mobility or the use of force to disengage from dangerous or harmful physical contact initiated by young people.
Managing the Environment:
Foster carers will, based on the knowledge and the needs of the young person, display an ability to alter the surrounding to prevent situations occurring or escalating; e.g. discreetly moving objects that may be used as weapons or asking other children to leave the vicinity (redirecting).
Normal physical contact (as would be expected between good parents and their children) is expected between the foster carers and the children they look after. Although physical contact may on occasions be used to assert authority over a child or young person it is more often an important element of care and parenting.A young person or child may be successfully engaged by using a 'caring gesture' e.g. placing a hand gently on the young person to encourage compliance and emphasise concern felt for them but clearly it would be essential that the carer has a good trusting and ongoing relationship with the child or young person. It is therefore important that foster carers exercise extreme caution when touching an angry or agitated young person as this could escalate a situation.
Non-restrictive physical interventions should not be used as a matter of routine but only if absolutely necessary to the situation, in order to safe guard the child or another person.
Children who are looked after have various needs which the adults caring for them should respond to and those needs will include the need for guidance, personal example, influence, sensitivity, and in some circumstances control.
Foster carers have broadly, similar rights and responsibilities that a parent would to promote a child's welfare, safeguard a child from negative influences and protect others from harm. In such circumstances non-restrictive interventions may be necessary.
Any physical intervention must be justifiable and appropriate to the child or young person's circumstances and must enhance safety. Any physical intervention should take account of the physical, emotional and medical needs of the individual young person as set out in the Individual Crisis Management Plan (ICMP). Physical intervention should not be in any way used as a substitute for any other type of intervention.
Placement Agreements, Risk Assessments, ICMP and behaviour management training and policy will inform any physical intervention and will indicate the necessity for the use of any physical intervention. Where this is indicated, foster carers will receive relevant training and information about the management of behaviour, which will emphasise positive approaches and alternatives to the use of physical intervention where possible.
Foster carers should be made aware of their responsibilities in recording accurate, up to date information regarding any child placed with them (daily log sheets) and particularly following any incidents of behaviours whether positive or negative, as this can inform about the current needs of the children and young people placed with them.
Where physical intervention has been necessary the child's social worker and supervising social worker should be informed immediately so that the child can be seen. Children, young people and foster carers will receive additional support when required (Post Crisis Response).
Restrictive Physical Intervention (Restraint)
In a nutshell, Wakefield's approach is that our carers or our staff do not use restrictive physical intervention other than as an absolute last resort (see the Protocol on National Restrictive Physical Intervention which Wakefield staff helped to devise and to which Wakefield MDC wholeheartedly subscribes).
Most foster carers will go through their careers without having to employ restrictive intervention. However, we recognise that there are a very small number of young people whose behaviour is such that restrictive physical intervention may be required as part of a comprehensive and agreed behaviour management plan. Similarly, there are very rare occasions when some form of intervention will be required to prevent harm to people.
However, so serious is the issue that comprehensive guidance is given on the matter below. This should be seen as militating against restrictive physical intervention not as endorsing it in anything other than a last resort. Similarly, we provide training to foster carers on behaviour management, which includes physical intervention, so that they can appreciate and can manage the risks safely not so that they have a 'license' to intervene physically in any way.
Put simply, it is almost always easier to remove yourself from a situation or to allow the young person to remove themselves from a situation than to physically intervene in that situation. The outcomes for all parties are almost always better.
Physical restraint is the use of trained carers to hold a young person in order to contain acute physical behaviour which is defined as "behaviour likely to result in physical injury the young person, other young people/children, carers or others at imminent risk of physical harm". The goal of physical intervention is safety.
- Physical interventions to contain and/or control the behaviour of children and young people in care should only be used to ensure safety and protection. Except where otherwise specified as part of an approved Individual Crisis Management Plan, physical interventions should only be employed as a safety response to acute physical behaviour and their use is restricted to the following circumstance: The child/young person, other Children and Young people, Foster carers or others are at imminent risk of physical harm;
- As any physical intervention involves some risk of injury to the young person or foster carers, foster carers must assess this risk against the risks involved in failing to physically intervene when it may be warranted. Physical intervention should never increase (or create more) risk then the behaviour it is trying to contain;
- Physical interventions must never be used as (1) punishments, (2) consequences, or (3) for "demonstrating who is in charge". Unless approved by the relevant statutory authorities and specified in an Individual Crisis Management Plan, physical interventions must never be used for programme maintenance (such as enforcing compliance with directions or rules or for preventing the young person from leaving the premises). Physical restraint should never be used for therapeutic purposes (such as forming attachment as promoted by "holding" therapy advocates or inducing regressive states);
- Physical interventions should only be employed after other less intrusive approaches (such as behaviour support techniques or verbal interventions) have been attempted unsuccessfully, or where there is no time to try such alternatives;
- Physical interventions must only be employed for the minimum time necessary. They must cease when the child/young person is judged to be safe and no longer at rick of self-injury or harming other;
- Physical interventions may only be undertaken by Foster carers who have successfully completed a comprehensive Therapeutic Crisis Management course that covers: (1) crisis definition and theory; (2) the use of de-escalation techniques; (3) crisis communication; (4) anger management; (5) physical intervention techniques; (6) the legal, ethical, and policy aspects of their use; (7) decision-making related to physical interventions; (8) debriefing strategies; (9) signs of distress and effect on the child/young person, and (10) the needs and behaviours of the population served. They must also have demonstrated competency in performing and/or state regulatory guidelines;
- All Foster carers involved in an incident of physical intervention must have successfully completed the same training program which has been fully endorsed and implemented, been assessed as competent in the use of physical interventions, and have successfully completed a skills review within the previous six months;
- Only physical intervention skills and decision-making processes that are taught in the Therapeutic Crisis Management course and approved Wakefield Family Services and any relevant statutory or accrediting body may be used. All techniques (including decision-making processes) must be applied according to the guidelines provided in the training and in this policy;
- Where possible, foster carers must consult with peers and supervisors prior to initiating any physical intervention;
- Two or more foster carers should be involved in any physical intervention to help ensure safety and accountability;
- Children and young people may not be permitted to restrain or to assist in the restraint of other Children and Young people;
- Following any incident involving physical restraint, Family Services will ensure that there is post incident medical and follow-up evaluation, debriefing and support is offered to the child or young person, the foster carers and any other people involved in or witnesses to the episode. Foster carers should provide the child or young person with an explanation for the intervention and offer an opportunity to express his/her views on what transpired;
- Wakefield has a formal complaints procedure in place for the children/young people in its care (or their advocates), that is easy to understand, assures confidentiality, and is readily accessible. This is available to children and young people in relation to anything they feel dissatisfied about, including behaviour management programmes or techniques;
- Any initial use of physical restraint and any injuries sustained by any party will be reported to Ofsted and an agreed Individual Crisis Management Plan will be developed and implemented by all parties, including the child and involved family members. The plan should cover the use of positive and less intrusive intervention techniques and specify the circumstances under which physical intervention may or may not be an appropriate response in the future;
- All incidents of physical intervention must be recorded on incident report forms and include (at least) details of the incident, the people involved, the preventive strategies that were employed, actual techniques used, any injuries sustained by children or young people, or foster carers and debriefing that was provided for the child or young person. All such reports will be reviewed by Family services Critical Incident Monitoring Group and appropriate action will be taken (for example, counselling for the client and/or foster carers, incident review, skills update, notification to external authorities, notification of the family);
- A formal review of the incident and the individual crisis management plan should be implemented.
Training underpins the development of understanding and insight for carers seeking to establish behaviour management strategies for individual children.
Foster carers receive information regarding behaviour management in a variety of ways and formats.
- The Skills to Foster preparation course is underpinned by the Training, Support and Development Standards for Foster Carers and links to the Fostering Services National Minimum Standards and Regulations 2011;
- The Skills to Foster preparation course covers areas of child development and children who may have needs beyond what would normally be expected for their age and developmental status. Separation and loss are discussed and all strategies and interventions are based on the needs of the individual child. Case studies are used to create discussion which incorporates house/home rules and safer caring. These discussions are then related to applicants' feelings about the kind of children they would like to foster and potential behaviour issues which may arise. Each discussion is based upon the circumstances of the individual family. There is also a focus on the needs to understand the Looked After Children's backgrounds in order to understand the behaviour;
- Those foster carers who undertake National Vocational Qualification training Level 3 'Caring for Children and Young People' (or its successor, the Diploma in Child Care) receive input which addresses the issues of management and aggression;
- Foster Carers will be given access to a comprehensive Therapeutic Crisis Management course, Therapeutic Crisis Intervention for Family Care Providers (TCIF). This covers crisis definition and theory, the use of de-escalation techniques, crisis communication, anger management, physical intervention techniques, the legal, ethical, and policy aspects of their use, decision making related to physical interventions, debriefing strategies and signs of distress and effect on the child and young person. They must also have demonstrated competency in performing the intervention techniques. Regular refreshers have to be attended;
- Foster carers also have the opportunities within their contact with both supervising social workers and social workers for the children they care for, to discuss issues of behaviour management both generally and specifically and if necessary there is access to external specialist agencies e.g. Children and Adolescents Mental Health Services (CAMHS).
At the matching stage any known difficult behaviour should be considered together with any risk posed to the child/young person/or foster carers. Placement Plan, Chronology, Care Plan, Single Assessment/risk assessment and Individual Crisis Management Plan (ICMP) if available.
It is essential that foster carers receive the relevant background written information on the child (LAC documentation), Placement Plan and care plan. A safeguarding statement should be completed with confirmation that the foster carers have been advised of any possible behaviour issues expected from a child and how those issues will be dealt with on a practical basis. Such practical arrangements should be in line with this policy.Foster carers will be informed of the out of hours support arrangements. If a planned admission then foster carers should attend any relevant meetings applicable to the child/young person that is pending admission to their care.
Despite the emergency nature of unplanned admissions it is essential that they should be an element of matching, discussion and risk assessment. In line with current child care procedures, the placement agreement meeting should be held within 5 days of placement and the relevant background information provided to foster carers. Where appropriate an ICMP should be completed.
Individual Crisis Management Plan
An ICMP is a functional analysis of current crisis behaviour describing the behaviours at each phase of the stress model of crisis and appropriate strategies for managing behaviour. It also states any medical conditions/medication being taken. If physical intervention is an option it identifies the appropriate technique to be used. ICMPs should be regularly reviewed and amended as required.
The permissible types of non-restrictive physical intervention which entail the physical involvement of foster carers are described during training. They are not intended to be progressive and failure of one method should not necessarily automatically lead to the next.
The type of physical intervention used will always depend upon and need to be in keeping with the circumstances including the age, competence and nature of the child and the potential risks involved. Wherever possible, physical intervention should be guided by a risk assessment and ICMP
Any intervention should always be preceded by clear and verbal instructions and warnings of the consequences of ignoring them and then accompanied throughout by attempts to "talk down" and calm the incident until any risk has passed.
Physical intervention should only be used when required by the particular circumstances prevailing and never as part of a general regime. Consideration must be given to the health and cultural background of each individual child/young person before intervening.
Carers should be able to express "parental affection" towards children and young people in their care and to provide comfort to ease distress. This may include a hug or friendly arm on the shoulder etc. Carers need to be mindful that a high proportion of children and young people who are looked after have experienced sexual and physical abuse. Therefore carers need always to be cautious and ensure that any physical contact is not misinterpreted.
The family "safe caring" policy should give parameters of acceptable behaviour within the foster home. Reference should be made to the "safe caring statement" and any relevant background information about the child. Carers also need to be aware of issues of age and gender and to be clear on when it is not appropriate to touch a child or young person.
Carers should ensure that care is taken not to touch a child or young person in any way they are uncomfortable with as certain physical contact may be open to misinterpretation.
Where a carer is concerned that behaviour may have been inappropriate, they should discuss their concerns with their supervising social worker.
Children and young people who have been sexually abused may exhibit sexualised or inviting behaviour. Carers need to remain aware of their role and acknowledge any issues such as behaviour that arises for them, seeking advice and guidance from their supervising social worker.