Children as young as five still restrained in care homes despite ‘promise’ to stop

SCOTTISH local authorities are continuing to use “traumatising and humiliating” restraint methods on children as young as five in residential care, almost two years after signing up to keep “The Promise” – an agreement published following the care review – to abolish it.

The “worrying lack of progress” in ending the practice is revealed by figures obtained by freedom of information requests to every local authority in Scotland and passed to The Ferret.

In February 2020, Scotland’s Independent Care Review found that the use of restraint on young people in care had “no place in Scotland” and should end. However, figures reveal some local authorities have actually increased the practice in recent years.

Though there is no official definition, restraint is agreed to be an intervention in which staff hold a child to restrict his or her movement so they will not cause harm to themselves or others. At its most extreme it can involve four adults pulling a young person to the ground and holding them there.

Concerns that this practice is not always used as a last resort have been long-standing and documented harms as a result of restraint include carpet burns, broken bones and psychological trauma such as flashbacks to previous abuse.

Campaigners said they were particularly concerned about its increased use during the pandemic and lockdowns when children and young people were likely to be isolated and distressed.

Highland Council was among those whose use of restraint has increased. In 2018 it used restraint 15 times, and the youngest child affected was 12. This year it has used restraint 40 times and the youngest child was just eight years old.

Stirling Council used the practice in children’s homes fewer than 10 times in 2018 but this had increased to 32 times this year. It did not provide ages.

The figures were highest by a significant amount in Glasgow City Council, which used restraint 514 times in 2018 including on children as young as five. This had reduced to 229 times in 2020 but increased to 286 this year.

Ten local authorities did not use restraint, according to the figures. They included East Lothian and the Scottish Borders, which have phased out its use in recent years. In both North Ayrshire and Perth incidences have reduced to fewer than five.

While five was the youngest, one local authority also used restraint twice on seven-year-olds this year and several reported its use on eight-year-olds.

However, some local authorities did not supply data or said they did not keep records.

Jamie Kinlochan, an independent campaigner who obtained the figures, said: “The Promise told care providers in February 2020 that they must strive to end restraint. Some have responded with record numbers of the practice, with children as young as five being pinned down by the adults looking after them.

“It is not tenable for local authorities and charities to continue to take taxpayers’ money and tell us that they are ‘keeping The Promise’, while they promote practices that cause distress and humiliation.

“It’s time for young people to see the return on the investment that we have all made to reform care. We can, and should, do better than this.”

RACHEL, now 22, left residential care provided by Highland Council when she was 16 and said she was left traumatised by the experience of being repeatedly restrained.

“I was taken into care so I would be safe from abuse,” she said. “I ended up in care and lost the shred of dignity I had left because of multiple staff members restraining me to the floor, especially in front of other vulnerable children.

“This suggested to me and the other children that it was normal for staff members to grab children which could leave physical injuries and cause emotionally traumatised children to repeat the actions they have seen from their carers.

“I felt attacked, humiliated, impaired and neglected because no one asked me, ‘what is bothering you today? Let’s talk about it.’ Instead, I would be thrown into my room and told to stay there. I felt so isolated because I wasn’t receiving the therapeutic care I needed to survive my trauma.”

Another young woman, who did not want to be named, told The Ferret that she was also heavily restrained by multiple members of staff when she went into residential care at 14. It happened, she said, when she “misbehaved” due to emotional distress.

She claimed this sometimes led to bruising. “I would feel mortified as other young people would see what was happening to me,” she said. “Then I would see other young people being restrained which again would lead to me feeling angry, upset and vulnerable.

“This impacted on the trust I had between staff and myself which turned into negative and damaging relationships. I believe that if staff had taken more time to interact with me about my thoughts and feelings my time in the care system would have been a more of a positive experience.”

Fiona Duncan, of The Promise Scotland, said the figures showed that while there was improvement in some areas, there was also “a very worrying lack of progress overall” with the aim to end the use of restraint.

Fiona Duncan said the lack of progress was ‘worrying

In late 2020, more than 100 organisations agreed implementation plans to ensure the care review’s findings were fully implemented by 2030. One of the 25 actions is that all care- experienced children will be protected from violence.

The increase of restraint of children during the pandemic in some areas was “deeply concerning”, said Duncan.

“This was happening at the time when the same children and young people were facing greater restrictions on their connections with the outside world than their peers. This will have resulted in a huge amount of worry about the impact of Covid on their loved ones health and well-being, and therefore may have led to greater displays of distress.”

There should now be “a national effort” by all care providers “to support the workforce to respond to behaviour in a trauma-informed way and make sure staff build strong relationships with the children in their care and develop a deep understanding of their needs”, she continued.

“Children and staff have worked together to effectively ban physical intervention in some residential homes. If this can happen in some, there must be learning for all.”

Bruce Adamson, children and young people’s commissioner for Scotland, said children had the right under international human rights law to safety, dignity and protection from cruel, inhuman or degrading treatment, which meant that restraint must only be used as a last resort to prevent harm.

HE continued: “It is disturbing to see the numbers of children being restrained, particularly those as young as five. It is also concerning that some local authorities have not been able to say how many children have experienced restraint. Recording and monitoring of incidents is crucial to ensuring that practice is rights-compliant and that the use of restraint is kept to an absolute minimum.

“It is important to recognise that any use of physical restraint is traumatic and creates a risk of harm for the child and the staff member involved. The question we need to ask is, what is the child trying to tell us? Very often behaviour that is interpreted as challenging by adults is actually the child communicating distress, anxiety or fear.”

He called for local authorities and the Scottish Government to take seriously the call for further training and support of the residential care workforce to ensure alternatives were employed wherever possible.

But John Ryan, assistant director of children’s charity Aberlour, said his organisation’s work showed that another way was possible.

The charity, which runs residential children’s homes, started to look at how to change its restraint policy in 2017. In consultation with children and young people in its residential homes and the adults working with them, it has developed alternatives and has drastically reduced its use.

In 2018 it used restraint 68 times in its residential homes for children from eight to 18, which increased to 85 by 2019. But the following year it used restraint just seven times and this year only two restraints have been carried out in its homes.

“We had conversations with children who said they didn’t like being restrained and the adults didn’t like restraining them,” he said.

“We introduced a clinical psychologist – this was about helping our workforce understand the children’s rights and needs and understand what a relationship approach could look like. The key ingredient here is the culture. Our leadership team believes there is a different way to look after children.

“The children are noticing that when they are distressed the adults will be patient and they will understand how to help them. We can’t change the past but we can create better ways of doing things.”

Working in partnership with Kibble, which provides both residential and secure care, Aberlour has also put in place a review process for each restraint to learn lessons about why it took place. It has now got funding from the Corra Foundation to work with two partners, including Glasgow City Council, to help them phase out the use of restraint.

Local authorities claimed they were committed to keeping The Promise but some still defended the practice of restraint.

A Highland Council spokesperson said: “There is no doubt Covid-19 has impacted on young people’s behaviours with increasing frustrations, particularly during lockdowns.

“This has resulted in the use of restraint to help keep young persons safe, however clear thresholds are adhered to. We are continuing to up-skill staff in de-escalation techniques and other therapeutic options to help reduce the need to use restraint.”

FIFE Council’s head of education and children’s services Kathy Henwood added: “When a child or young person is distraught, and their behaviours present a risk to themselves or others, staff are prepared to intervene effectively and safely and are trained in the best way of doing this.

“We are committed to the principles outlined following last year’s Independent Care Review and prioritising the quality of relationships that children experience in residential settings. We actively review our processes and are working hard with young people in our care to get it right.”

A Stirling Council spokesperson said its plan “incorporates our commitment to a sustained reduction of the use of restraint, recognising that understanding of trauma and associated reparative approaches has to be at the heart of our practice”.

They said “even minimal intervention is recorded with the expectation that workers and young people, where appropriate, are able to reflect upon and debrief following an incident” and said “staff are provided with supervision and training to ensure they are able to offer nurturing and usually pre-emptive behaviour support”.

Glasgow City Council, which cares for 146 children and young people across 19 homes, said it had taken significant steps to reduce restraint in the last nine months including setting up a Promise implementation team and an advisory group co-designed by children and young people. It is due to start work with Aberlour and Kibble next year.

A Cosla spokesperson claimed local government was “fully committed” to “keeping The Promise”, adding that there would be “many individual circumstances” associated with the figures. “ A Scottish Government spokesperson said it aimed to ensure “more children will only know love and compassion and not a care ‘system’”.

They added: “We are working with key partners to reduce and where possible eliminate the use of restraint on children and young people in care. This includes working closely with the Scottish Physical Restraint Action Group which is exploring definitions of restraint, the data that is held and the training and support available for residential care staff.”