Physical restraint in residential care

In April 2009 the Guardian initiated an inquiry into the use of restraint in residential care facilities following reports from some youth workers and residents that physical restraint was used too often and young people were suffering injuries.  The inquiry was conducted by Associate Professor Andrew Day and Dr Michael Daffern and the inquiry report, Policy and Practice in the Use of Physical Restraint in SA Residential Facilities for Children and Young People, was released on 13 January 2010.  The full report is available for download and a summary.

Use-of-Restraint-Report-2010

Use-of-Restraint-Report-summary-2010

The inquiry found that the use of physical restraint has been falling since 2007 but that it could be reduced still further.  Restraint should only ever be used where the young person is at risk of immediate and serious harm to themselves or to another person nearby.  It is a ‘last resort’ intervention.  It should not be used because a young person is cheeky, refuses instructions, is shouting or throwing things around.  It should only ever be used by people trained to restrain safely.

The vast majority of residential staff are extraordinary people and are doing a great job under very difficult circumstances.  The failures identified in the inquiry report are systemic failures and should not reflect on the many dedicated workers and managers, nor on the young people who act out their distress. The failures were with inconsistent policies and practices, too many residents housed together, not enough on-the-job training and reflection on incidents, and not enough specialist support for young people with high needs.

There were different rates of use of restraint in different places and generally there was lower use in non-government houses.  This was a function of the size and design of the facility and higher investment in training and support. We could not answer the question about whether South Australia had higher rates of use than elsewhere because the data is too inconsistent to make any comparisons meaningful.  Instead the researchers could say that the rate of use could be reduced further.

To minimise the need to use physical force five recommendations were made.  In summary these were to replace the large residential units with smaller home-like houses of three or four young people, provide more on-the-job training and support for staff, change the regulations in the Family and Community Services Act 1972 so that restraint is never sanctioned for non-compliance, have specialist advice more readily available for children with the highest needs and have more rigorous external monitoring so that patterns are picked up early.

So much goes well in our residential care sector and we learn as much from what works well – see our report What works best in residential care – as what doesn’t. We do though tend to review things that we are concerned about and that we want to do better at.  As one young interviewee said, ‘I know it takes a lot out of them emotionally,’ referring to youth workers.  Compassion and understanding is a great place to start.

Report on the physical restraint of children in South Australian residential facilities

[This article was first published in The Advertiser 13 January 2010.

The Use-of-Restraint-Report-2010 on which it is based and the Use-of-Restraint-Report-summary are both available in PDF.

Using force to hold, immobilise or move a child who is in danger can be a normal protective response.  Pushing, pulling and lifting may be necessary to protect the child or others nearby from immediate and serious harm.

I have just completed an inquiry into the use of physical restraint of children in South Australian residential facilities.  Residential facilities for children and young people in state care are run by government and non-government organisations.  Children stay for periods of a few days to a month.

Included in the inquiry were the youth training centres at Magill and Cavan.

I started the inquiry because we had heard from some young residents and staff that restraint was used often and children were suffering injuries as a result of being restrained.

In other countries children and young people have died in schools and residential facilities from asphyxiation as a result of physical restraint. Some methods of restraint are very dangerous, particularly when they involve neck holds, obstruction of the nose or mouth, or holding a child face down on the ground.

Thankfully, we did not hear of any incidents of children dying recently in children’s services in Australia as a result of a physical restraint. However injuries were confirmed, reinforcing the evidence that restraining a child can be dangerous.

Restraint also has a considerable psychological effect on both the child and the staff involved.

We found that the use of restraint is decreasing and awareness of its dangers is rising.

Nevertheless restraint was not uncommon and was sometimes used inappropriately, such as when a young person refused repeatedly to comply with an instruction and emotion was high.

Restraint is more common in the facilities which accommodate higher numbers of children; not because the staff are any less skilled than others but because it is so difficult to keep everyone safe in a home with ten young people compared to four. Some young people were restrained often and undoubtedly had extremely challenging behaviour.

Fortunately, the background research and findings make us confident that we can make all children’s residences safer.

First, we would have no more than four young people in any one house, maybe up to six in some circumstances.  Second, we would have a consistent positive approach to bad behaviour, and restraint would never be sanctioned for non-compliance or punishment.

Third, care staff would be well-trained and well-supported to act professionally, warmly and calmly.

Fourth, specialist advice would be provided for the care of children with extremely challenging behaviour and a review of all incidents would be done routinely.  And fifth, there would be rigorous external monitoring of use of restraint so that patterns could be picked up early.

The inquiry found that there are inconsistent procedures and practice in children’s residential facilities and a number of situations in which it was unclear how staff should manage difficult behaviour.   For example, plucking children from harm’s way is easy to defend as necessary but is it right to haul  a 14 year old boy out of bed on a third attempt to get him to school?  And is it right to immobilise with an arm hold a distressed 13 year old girl who is lashing out at anyone who comes near her?

It is these types of difficult situations that residential care workers routinely face, and they have to decide whether or not and when restraint is required.

Residential staff want the best for children in their care.  They need our support and government’s commitment to achieve this.

Within the next few years I hope to see the larger residential facilities replaced with home-like residences, specialist advice for children with high need and consistent guidance to staff on dealing positively with problem behaviour.

Numbers add up to cause concern

  • On an average day in SA there are 345 children and young people in some form of residential care, including those in secure custody.
  • Over a 27 month period (Jan 2007 – March 2009) there were 19 confirmed cases of injury of children in residential care as a result of physical restraint.
  • Most of those restrained are male.
  • Many residents will never experience a restraint but some are repeatedly restrained, usually over a short period of time.
  • Residential facilities for children and young people in state care are run by government and non-government organisations and children stay for periods of a few days to a few years.
  • In the past decade in Australia there have been incidents of serious injury of children in formal settings which have triggered inquiries, such as a 2006 WA Ombudsman’s investigation, a 2007 review by the WA Inspector of Custodial Services and a 2001 NSW Community Services Commission review.

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Magill photo expo

This photo is just one of the dozens of remarkable images created by the residents of Magill Youth Training Centre in September.

Photographer and tutor Jeremy Watson said the images, produced after only a few hours of tuition and practice, were as good as those produced by some of his other students over many days and weeks.

‘We started out by getting the young people to pick out a couple of photos from a collection I brought and asking them to say why they had picked them and how they made them feel.

‘From the start the interest and enthusiasm were great.’

Very soon the discussion progressed to the genres of portraiture, landscape and close- up and then onto mastering the controls of the digital cameras newly purchased for the project.

‘After shooting we brought all the kids back and they had the chance to look at and evaluate their work on the monitor.’

In the words of some of the young people involved:

Taking pictures, it was fun.

I learnt how to hold steady the camera and how to use macro.

It’s not always about a front on photo, you can take them in all different ways.

It felt like we had freedom and fun with the photos.

I learnt how you can find good photos anywhere.

Program Coordinator at Magill, Julie Wright, said that it was great to be able to introduce a new activity for the residents and one which was so interesting and accessible to all of them.

‘Everything went off without a hitch, and since we bought the cameras staff are finding other ways to use them as part of unit activity and to document events.’

At the end of Child Protection Week, a photo exhibition of prints of selected pictures was staged for all residents, some staff and guests from the Office of the Guardian.

Viewers were very impressed by the originality and technical quality of the images produced by the young photographers while the residents were enthusiastic.

‘Now that it has gone so well’, says Julie, ‘we’ll be trying to organise more photography activities in the future and we are already looking for opportunities for some residents who’ve shown a real interest to continue their photography when they leave juvenile detention..’

View the Magill residents pictures collage in PDF.

 

Magill Youth Training Centre

The axing of a new youth detention facility in the State Budget had condemned hundreds of young South Australians each year, some as young as 10, to spend their days in the grim decrepit confines of Magill Youth Training Centre.

Many will spend their nights on a mattress on a single wooden bunk in a 2m x 3m cell off a narrow corridor, unrelieved by a picture on the wall or a desk or a chair.

The toilets are down another corridor. Taps leak, tiles are broken and the cut-off doors afford no privacy. The windows are rendered opaque by grime, thick bars and wire mesh.

This tired and threadbare institution sabotages the efforts of staff to provide a safe and positive environment. It sends the clear message to staff and young residents alike that they are worthy of nothing better, seriously undermining the work of rehabilitation.

This decision is poor economics. For each of these young people we allow to graduate into a life of crime the cost to policing, the justice system and prisons is many times over the cost of rehabilitation.

It leaves South Australians in breach of international rules to provide ‘facilities and services that meet all the requirements of health and human dignity’ for juvenile offenders.

But most of all it is profoundly unkind and uncaring to some of our most vulnerable young people. I challenge any Minister responsible for this budget to spend an hour or two with the children in Magill and not feel deeply ashamed.

Pam Simmons

Guardian

Published in The Advertiser 8 June 2009.

Let’s exhaust alternatives to jail for young people

 

pam

Pam Simmons Guardian

With news reports of youth gangs and Operation Mandrake you could be forgiven for thinking that youth crime is on the increase. It is not. The trend is downwards. Over a ten year period to 2005 the fall in police apprehensions was 39 per cent. You could be forgiven for believing that young people who commit offences will do so again. Most do not.The implications are clear. Instead of addressing the problems some groups of young people face we would be adding to them by bringing them into the youth justice system for first and minor offences.

 

Most young people in South Australia are never in trouble with the police. In 2005, only 0.5 per cent of young people aged 10 to 17 years were apprehended by police. More than half of these did not warrant a court appearance.

For the most part, we have long accepted that we would treat young people as a special category when it comes to criminal justice in recognition of their underdeveloped moral reasoning.

Indeed it was South Australia that led the way in this country with the Children’s Act aged 10 to 13 are presumed to not be fully capable of understanding their actions unless a court can prove otherwise.

There is growing evidence that delays in moral reasoning will continue in to your early 20s and some jurisdictions have extended the principle of different treatment accordingly.

In SA there is a separate Court. The steadily falling youth crime rate is testament to a mostly good youth justice system.

That is why the recent proposals to change legislation so that young offenders are treated more harshly, including defining the offences when juveniles will face the adult court system, are so worrying. They are abrupt reactions to problems that have been with us for a long time and which, largely, we have handled sensibly.

We do well at steering first time offenders away from their second or third offence with crime prevention strategies, and cautions or family conferences following police apprehension. What we don’t want to do now is to counteract this success by widening the channel into the criminal justice system. Introducing anti-social behaviour orders, public shaming and mandatory sentencing could do just that.

Give someone a label, especially a young person, and they will live up to it. Becoming known in the neighbourhood as an “offender” or a “hoon” sticks hard and fast.

In the UK having an “Asbo” or anti-social behaviour order has become something of a badge of honour. Almost half the Asbos in the UK are breached at least once. A highly disproportionate number are imposed on black or Asian young people and the BritishInstitute for Brain Injured Children reported that 35 per cent of the orders were imposed on young people with a disability such as Tourette syndrome, autism or Aspergers syndrome.

The more vexing problem is how to stop that small minority, around 8 per cent, who persist in offending. Out of anger, it is tempting to punish and punish again. If your goal is to stop further crime however then brutalising young offenders, or any offenders, will defeat this.

Most repeat offenders are familiar with brutal environments and have experienced rejection, isolation, failure and cruelty most of their lives. Imprisonment can be a badge of honour, too, among some groups.

As many as 60 per cent of incarcerated young people are reported to be at risk of significant mental health problems.

There is little sympathy for young people who commit crime but it is not sympathy they need. We could instead offer, as other states and countries do, medium or low security facilities that focus on re-integration to the community rather than punishment.

We could ensure that our programs in detention centres deal with substance use, mental illness, post-abuse trauma and learning difficulties. We could introduce sentencing conferences that bring the young person’s family and community into the decisions about consequences and addressing causes of re-offending.

There are many effective alternatives to ongoing imprisonment. If we had tried these first, the call for longer imprisonment may be acceptable.

We have not and it is not.

Pam Simmons

Guardian

(First published in The Advertiser 23 March 2007.)

Review of programs in youth training centres

In July 2007 the South Australian Guardian for Children and Young People commissioned the Centre for Applied Psychological Research, University of South Australia to conduct a review of programs available to young people in secure custody. The report was completed in January 2008. There had been no independent review of programs in secure custody, although the need to develop youth justice programs was identified by the Families SA Youth Justice Directorate in their 2007 Training Centre Action Plan, the SA Social Inclusion Commissioner, and the SA Parliamentary Select Committee on the Youth Justice System which reported in 2005.

The report is in two sections. Part 1 is a review of the scientific literature on theories and practice in youth justice. Part 2 reports the findings from interviews with a range of stakeholders and focus groups with young residents. Part 2 also contains the recommendations.

Download the literature review

Download the report

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Serious repeat young offenders

Among other statutory functions the Guardian for Children and Young People acts as an advocate for the interests of children under the guardianship, or in the custody, of the Minister for Families and Communities.  This includes young people in the secure care centres.  It is in this capacity that the following submission is made.

This submission is prepared on the basis of the Office’s experience in investigating individual matters, talking with experts in the area of youth justice, and our knowledge of policies and practice in Families SA.

You can download a PDF file of Serious Repeat Young Offenders .