Residential child care practice is intellectual work. By this I don’t mean it can or should only be done by brainy people. I mean that, to do it well consistently over time, it requires us to apply our intellect.
It also requires us to engage with different forms of knowing – knowing that comes from the lived experience of being in care; knowing that comes from the lived experience of providing care, in all its myriad forms, knowing that comes from research and other forms of evidence, and knowing that comes from the road maps that have been tried and tested – theory.
And we be open and scrutinise all of these forms of knowing, being curious and tolerating the uncertainty it brings.
Our intellectual engagement, our emotional engagement, and our active, physical, tangible engagement are all necessary, but none of them are sufficient without all three being present. I would go so far to say that not incorporating any one of these on a regular basis in our practice, whether that be direct practice or indirect practice, is not acceptable. Just as it is unacceptable to be heartless in this work, or hide in the office avoiding young people day after day, it is also unacceptable to do this work without thinking deeply about what we are doing and continually building our knowledge to support that thinking.
Physical Restraints/Safe Holds
(from Holding Safely) You may have noticed already that we have avoided simply using the term restraint and instead have referred to restraining a child as just that – restraining a child. We deliberately chose to change this language to avoid losing sight of the child, who might otherwise be overlooked by the more clinical and depersonalised use of the word restraint.
Physically restraining children is something which causes many staff, as well as children, a lot of anxiety. As it should – even when done properly it can be a traumatising experience for children and staff alike. As a result, some people may not want to be explicit about restraining children, and instead emphasise only the positive experiences of children in residential care. We donʼt believe this is good enough.
Developmental trauma and effects on ability to self-regulate, form and maintain relationships, know one’s own feelings, needs and motivations, use thinking to manage experiences and emotions.
Extraordinary piece of research in relation to response rate – almost unheard of – related to the engagement of the researcher (who is also in direct practice with children and young people in relation to participation).
First study was done in large, US RCC service (360 employees. 94 responded to survey.
Second study : 250 child welfare professionals in one US state (Iowa)
Children’s rights while still needing to hold boundaries, limits within a wider context of stigma and suspicion.
Tolerance for disruption – a good shift isn’t always a settled shift – boundaries without repression
Direct focus on physical restraint versus focus on culture, wider meeting of needs.
Mention self-selecting nature of sample and how, albeit unavoidable, does skew the results.
Professionalisation we need to claim what this means -- Love
Stop catering to the lowest common denominator.
Holding the micro and macro
Tolerating what’s counterintuitive, ambiguous or uncertain.
Rigorous engagement of our heads, hearts and hands.
The Complexities of Physical Restrain in Residential Child Care: A Call to Action
The Complexities of Physical
Restraint in Residential Child Care:
A Call to Action
SIRCC Annual Conference, 4 June 2019
CELCIS/School of Social Work and Social Policy
University of Strathclyde
• To facilitate consideration of physical
restraint from multiple perspectives,
• Care experienced people, direct
practitioners, close-in managers,
external managers, care inspectors
• Ways of understanding the phenomena
and the wider context within which it
• To (further) energise efforts, turning them into a collective endeavour to:
• reduce and where possible eliminate physical restraint in residential child care
• and where physical restraints do occur, to increase the likelihood that they are (and are
experienced as) an act of care rather than brutality.
In order to provide developmental care to
children and young people whose
development has been interrupted, we
need to bring our heads, our hands and
our hearts to the endeavour.
Physical restraint is a clear example.
Knowing, Doing and Being
‘an intervention in which workers hold a
child to restrict his or her movement and
[which] should only be used to prevent
harm’ (Davidson et al., 2005. p. viii).
• Serious, imminent harm
• ‘last resort’
• Least amount of time and force
• Physical restraint, safe holds
• Pain-based behaviour
• Containment, contained.
Containment ≠ Constrainment
Term is often (mis)used disparagingly
to mean keeping a lid on or
• Involves the development of thinking to manage
experiences and emotions.
• This development can be disrupted due to
adverse early life experiences.
• Reflected in our language – e.g. ‘falling apart at the seams’, ‘trying to hold it
• Experiences of uncontainable emotions and experiences are normal; they
can be the everyday norm for some.
• Useful in thinking about adults’ and organisational processes as well.
• The experience of being contained can restore the ability to think and self-
regulate; multiple experiences can help to develop it when that
development has been disrupted (Steckley, 2010)
Containment for Containers
Necessary nesting function of containment
between staff and
When the environment, processes and relationships are robustly containing…
i.e. they absorb and make experiences and emotions more manageable, more
the need for physical restraint will be reduced or rendered unnecessary.
Physical restraint is the most extreme form of containment
• Therapeutic, developmental, restorative containment
• Crude, even brutalising containment.
• Most linkage of trauma and restraint is
around potential of restraint to traumatise
or re-traumatise (Allen, 2008; Mohr,
• In addition, what must be considered:
• Trauma history of children and young
people – developmental trauma
• Trauma history of carers
• Links between trauma, aggression and
• Vicarious trauma
Secure Care Census,
snapshot of all
children and young
people in secure
care on 1 day in
• 70% of child
reported at least
• 54% two or
more; 16% four
• 31% reported
four or more
Assessment of serious, imminent harm:
• How serious? How imminent? Whose harm?
• Under conditions of threat, adrenaline, own possible triggers.
• Authoritative vs. authoritarian
• Assessment of the young person, other young people, fellow practitioners,
• How far is too far?
• RCC last resort.
• Stigmatisation, of children and young people, of staff.
• Issues of recruitment and retention.
• History of no qualification, low qualification, wrong qualification.
• Setting-specific questions (secure, services for younger children)
Restraint and RCC as Last Resort
• Significant evidence that some (sometimes a majority of) children and
young people with experience of both, prefer residential care to
foster care (Anglin, 2002; Berridge & Brodie, 1998; Duncalf, 2010; Hill,
2009; Lawlor, 2008)
• Too many children and young people must “fail their way” into
residential care (Whittaker et al., 2015, p. 330).
• multiple placements
• broken attachments, blocked attachment
• (further) developmental trauma
Experiences and Meaning
Large-scale, in-depth qualitative study of experiences and views of
physical restraint in RCC:
• All young people spoke of negative experiences of physical restraint
• Over a third also spoke of some restraints having a positive impact on
• Distinguishing factors – good reason, whether hurt, what happened after
• Overall a theme of trust – avoidance, trying to help, feeling
(Steckley, 2010, 2012)
Touch and our Bodies
• Comparative study – Denmark, Hungary, England – Early
childhood (Jensen, 2011).
‘The body is allowed to be there’ in Danish practice, as opposed to
‘the way the body has been reduced to a head’ in English practice
• A significant minority of young people (10%) and just under a
quarter of staff spoke of restraints being used for release: to cry
and get out anger.
• Many were linked to multiple restraints; over half of the staff
also spoke of being unable to break out of cycles of repeated
restraints, and over 20% connecting this as a factor in placement
moves. (Steckley, 2012, 2018)
• Professionalism – to define in terms of what children and young
people need (and tell us they need), to demand, and to live up to
• Fortitude to hold the complexity – in all of the levels (individual,
organisational, systemic, societal)
• Tolerance for ambiguity, uncertainty, the counterintuitive
• Thinking outside the box: alternatives (e.g.sensory integration rooms)
• Rigorous engagement of our heads, hearts, hands and bodies – a
synthesis of knowing (in all its forms), doing and being.
• Allen, D. (2008). Risk and prone restraint: reviewing the evidence. In M. A.
Nunno, D. M. Day, & L. B. Bullard (Eds.), For Our Own Safety: Examining the
Safety of High-risk Interventions for Children and Young People (pp. 87-
106). Arlington, VA: Child Welfare League of America, Inc.
• Anglin, J. P. (2002). Pain, normality, and the struggle for congruence:
Reinterpreting residential child care for children and youth. New York: The
• Berridge, D., & Brodie, I. (1998). Children's homes revisited. London: Jessica
• Duncalf, Z. (2010). Listen up! Adult care leavers speak out: The views of 310
care leavers aged 17-78.Manchester: Care Leavers’ Association.
• Emond, R., Steckley, L., & Roesch-Marsh, A. (2016). A Guide to therapeutic
child care: What you need to know to create a healing home. London:
Jessica Kingsley Publishers.
• Gibson, R. (Forthcoming). Secure care census 2018. Glasgow: Centre for
Youth and Criminal Justice.
• Hill, M. (2009). Higher aspirations, brighter futures: Matching resources to
needs report. Glasgow: Scottish Institute for Residential Child Care.
• Jensen, J. J. (2011). Understandings of Danish pedagogical practice. In C.
Cameron & P. Moss (Eds.), Social pedagogy and working with children and
young people: Where care and education meet. London: Jessica Kingsley
• Lawlor, E. (2008). A false economy: How failing to invest in the care system
will cost us all. Retrieved from
• Mohr, W. K. (2008). Physical restraints: are they ever safe and how safe is
safe enough? In M. A. Nunno, D. M. Day, & L. B. Bullard (Eds.), For Our Own
Safety: Examining the Safety of High-risk Interventions for Children and
Young People. Arlington, VA: Child Welfare League of America, Inc.
• Steckley, L. (2010). Containment and holding environments: Understanding
and reducing physical restraint in residential child care. Children and Youth
Services Review, 32(1), 120-128.
• Steckley, L. (2012). Touch, physical restraint and therapeutic containment in
residential child care. British Journal of Social Work, 42, 537-555.
• Steckley, L. (2018). Catharsis, containment and physical restraint in
residential child care. British Journal of Social Work, 48(6), 1645-1663.
• Webb, R., & Johnson, D. (forthcoming). The association between traumatic
event exposure , post-traumatic stress disorder and aggression of looked-
after young people. The Scottish Journal of Residential Child Care.
• Whittaker, J. K., del Valle, J. F., & Holmes, L. (2015a). Conclusion:
Shaping the future for therapeutic residential care. In J. K. Whittaker,
J. F. del Valle, & L. Holmes (Eds.), Therapeutic residential care for
children and youth: Developing evidence-based international practice.
London: Jessica Kingsley.
Physical Restraint in Residential Child Care:
Reflections and What Next?
• Are you interested in contributing to a
collective response to what you have
• Join us in Room 506b, Level 5,
Strathclyde Business School on
Wednesday 12th June from 10.00-12.00
• Contact firstname.lastname@example.org for