picture of young person in isolationTime-out, isolation and seclusion are used as a response to challenging behaviour, and children are particularly likely to be subjected to it.  However, there is a world of difference between a two minute slow-down in a child’s bedroom and an hour’s detention in a bare room.  As more has become known about the detrimental effects of isolating people and depriving them of social contact, the use of seclusion as punishment or control has been discouraged in many institutional settings.  However, more can be done to minimise its use.

Seclusion is the involuntary placement of a person in a room, exit from which is not permitted (Ferleger 2008).  Physical and mechanical restraint often precedes or accompanies seclusion.  Isolation in prisons and other detention facilities ranges from solitary confinement away from any human contact except for staff, to prohibition on joining others in scheduled activities including the sharing of meals.

Regulations for the provision of residential care for children in South Australia include instruction about the use of force and isolation.  Detention in a room is prohibited in residential care but not in training centres.  Training centre residents aged under 12 must not be detained in a detention room and there are time limits for others.

The Office of the Guardian monitors its use at the sites the advocates visit though there have been difficulties in getting accurate information about the use of seclusion.  In the one residential facility where it had been used, the practice was discontinued as a result of the visit.  In the training centre, where its use is more common, the Office has agreement with the Department on what is expected and how this will be measured.  Most detention periods are now under one hour which is a huge change from when monitoring commenced in 2006 when long periods of detention were common.

There is no evidence to suggest that restraint or seclusion effectively reduces either the frequency or the intensity of challenging behaviours, though restraint may temporarily protect the child or others from immediate and serious harm. Contemporary guidelines and policies on managing behaviour in service settings say that restrictive practices should only be used as part of a treatment plan and that its use must be reduced by positive behaviour supports, appropriate physical environments and individualised planning (Australian Psychological Society 2011; Office of the Public Advocate of SA 2012).

A treatment-based approach recognises that the causes of challenging behaviour have to be addressed and new ways of behaving introduced and learned.  It is not simple but it is effective.  It requires expertise from those working with the young people and energy and enthusiasm in its application.  Those who work with children need support and supervision but most importantly training to give them a range of responses to challenging behaviours, and a common language and understanding with the therapists providing the advice.

References

Australian Psychological Society 2011 Evidence-based guidelines to reduce the need for restrictive practices in the disability sector.  http://www.psychology.org.au/practitioner/resources/restrictive/

Ferleger D 2008 ‘Human Services Restraint: Its Past and Future’ Intellectual and Developmental Disabilities Vol 46 No 2

Office of the Public Advocate of South Australia (2012) Guardian Consent for Restrictive Practices in Disability Settings http://www.opa.sa.gov.au/resources/restrictive_practices

Reducing the use of restraint or seclusion requires:

  •  Leaders who set an organisational culture change agenda;
  •  Systematic collection of seclusion and restraint data;
  • Use of data to inform staff and evaluate incidents;
  • Improvement in environmental conditions;
  • Individualised treatment and responsiveness to clients;
  • De-escalation tools;
  • Debriefing to both analyse seclusion events and to mitigate their adverse effects; and
  •  Staff training.

(Ferleger 2008)

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Child and Youth Worker Matt Smith says it's great to see young people actually thinking and talking about their rights and starting to become their own advocates.

Child and Youth Worker Matt Smith says it’s great to see young people actually thinking and talking about their rights and starting to become their own advocates.

Residential care worker Matt Smith has been having regular house meetings with the young people in his care for many years but only in the last year or so has he been making formal use of the Charter of Rights.

‘We have house meetings every month and after going through the minutes of the last meeting, the Charter of Rights is the first item.

‘Each meeting we take different group of rights, say the right to feel good about yourself, and we discuss it. Then I ask them to read out the rights and say if it true in their case. If it isn’t, then we try to work out why and put some actions in the minutes to try to get it put right.

‘It’s easy for some young people to get overlooked in the day-to-day running of the house, where perhaps one resident is demanding a lot of attention. In these meetings, everyone gets a turn and important issues get a chance to come up.

‘Some of what is discussed is house matters like the dinner menu, a change in bedtime or a request for more one-on-one time with a worker. But recently we had an example where a request in a meeting led to a young person being able to spend time with their mother over Christmas and the new year.

‘Every young person gets a chance to chair house meetings which gives them practice but can also get them respect in a house if they are younger or quieter than the others.

‘The meetings work well because we have a fairly stable group of young people and we have built up familiarity and trust with each other over a long period.

‘And we make sure that we follow up on all of our actions and report back at the next meeting.

‘Regularity and reliability is so important. We have meetings every month, we have the same agenda and we make sure the young people are reminded when a meeting is coming up and given a chance to add to the agenda.

‘I’ve found it’s essential to have the support of my supervisor. It makes the practical arrangements easier, the young people take it more seriously and so do the other staff when they see it has official support.

‘Using the Charter like this has been a real benefit. We find out and address some things that really matter to the young people. It’s great to see them actually thinking and talking about their rights and starting to become their own advocates.

‘And sure, some of them try the rights thing on – it’s my right to have a lolly machine in my room – but they are smiling while they say it and when it comes down to it  they have a pretty good idea of what is fair and reasonable.’

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Of the 2,657 children and young people in out of home care in South Australia at 30 June 2013, 268 lived in in residential care and another 62 in emergency accommodation with rotating carers.

In 2012 the Office focused it’s monitoring on a selection of facilities.  This involved an online survey completed by almost all facilities, the selection of a small number of facilities to monitor, a review of their safety records and a visit to the residents.

The results this year are presented in separate reports, 2012-13 Monitoring of larger residential care facilities of eight to twelve residents and 2012-13 Monitoring of smaller residential care facilities of up to four residents.

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Guardian Pam Simmons and CLASS General Manager Graeme Kirkin sign the Charter of Rights certificate at CLASS's 30th birthday celebration  on March 12.

Guardian Pam Simmons and CLASS General Manager Graeme Kirkin sign the Charter of Rights certificate at CLASS’s 30th birthday celebration on March 12.

Guardian Pam Simmons and Charter Coordinator Yvette Roberts joined staff and clients from CLASS and Kim McHugh the Mayor of Alexandrina Council to celebrate CLASS’s 30th birthday.

CLASS supports people with disabilities, the frail aged and socially isolated to become more involved in their community predominantly in rural South Australia, including the Adelaide Hills, Fleurieu Peninsula, the Riverland, Kangaroo Island, the South East and Southern Metropolitan areas.

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Guardian Pam Simmons is pictured with Sue Horsnell and the Community Lifestyles team at the presentation of their certificate of endorsement of the Charter of Rights in their Murray Bridge headquarter on March 4th.

Guardian Pam Simmons is pictured with Sue Horsnell and the Community Lifestyles team at the presentation of their certificate of endorsement of the Charter of Rights at their Murray Bridge headquarters on March 4th. Community Lifestyles is a not-for-profit, community-based organisation that supports people with developmental delay, autism and acquired brain injury and those with intellectual, neurological, physical and other specific learning disabilities.