As humans, we’re all familiar with the need to be held tight in times of crisis, but most of us will never have to experience a physical restraint. Restraint, and the use of it with children and young people in care settings, has been an area of research for Strathclyde Senior Lecturer Dr Laura Steckley for several years.

Physical restraint is a controversial practice, one which has attracted many negative headlines. The accepted guidelines for residential care are that it should only happen when a child’s behaviour risks serious, imminent harm and all other efforts have failed or there’s no time for an alternative. But these seemingly simple guidelines are much more complex in practice.

Restraints can cause physical and emotional damage to both the person being restrained and the people doing the restraining. Care workers are asked to support young people who are often deeply traumatised and in huge emotional pain. For some, that pain can come out in ways that cause serious harm to themselves or others. For a small number, they may be so frightened by these powerful feelings and behaviours that a physical restraint feels like the only space they can release them.

Due to the potential for serious harm, some people feel that restraining young people should never happen. Yet there continues to be situations where, despite care workers’ best efforts, other attempts to keep things safe can fail and physical restraint can be the least worst response.

Holding

The concept of “holding” is being used by Laura and her colleagues to increase the effectiveness of those other attempts. It explains that children need to be held in an environment of reparative care, predictable routines and loving relationships in order to grow and recover from what’s happened to them. When things get difficult, this “holding” environment becomes especially important - before, during and after any incidents which may occur. It acknowledges that physically holding someone with care and skill may be an important part of overall holding, and that we all need to be held during bad times.

To that end, the holding concept must be applied to staff as well. Escalating situations can raise complicated reactions in care workers, including fear, anger, guilt, and even their own trauma. These reactions can compromise their ability to respond effectively. Care workers need training and support to be aware of and manage these reactions. Services also need help in their efforts to provide holding environments for their staff. 

Supporting sector-wide change

To support sector-wide change, Laura and colleagues from Strathclyde-based CELCIS – Sara Deeley, Gemma Watson and Craig McCreadie – lead up SPRAG – the Scottish Physical Restraint Action Group – where they and over 70 residential child care services work together to “hold” differently.  SPRAG works to improve understanding and effective responses to the complexities surrounding restraint. SPRAG also co-produced a model for reflection that is being rolled out in members’ services across Scotland, and it is making a big impact.

Laura, Cecile Remy and Seamab School are taking a whole organisational approach to developing their holding environment.

The ambition of all of these projects is to support adults differently so that they, in turn, can “hold” children differently, ultimately to render physical restraint less and even unnecessary. And that can only be good for everyone involved.