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4.7 Therapeutic Crisis Intervention and Use of Physical Restraint

Last Modified: 28-Jun-2022 Review Date: 01-Jun-2019

Purpose

​​To provide information about the use of Therapeutic Crisis Intervention (TCI) procedures and use of physical restraint in residential care group homes. 

Practice Requirements

​Therapeutic Crisis Intervention

  • ​​​All residential care workers must complete TCI training before commencing active duties in the group homes (this may differ in some country group homes). 
  • To adhere to TCI accreditation, residential care workers must undertake refresher training once every 12 months, or twice a year (once every six months for six hours within the home). All training must be with an accredited TCI trainer. 
  • All refresher training must contain physical restraint practice and theory review. 
  • Residential care workers must aim to be re-tested and re-certified at least every twelve months. 
  • If a refresher is not undertaken within 18 months, residential care workers must complete a five day workshop course. 

Physical restraint of children to protect safety and wellbeing of children and staff 

  • ​​Authorised TCI accredited staff must only use TCI procedures to physically restrain a child when the safety and wellbeing of the child, and others (including staff) is compromised. 
  • Reasonable and minimal physical force may only be used: 
    • as a last resort, and 
    • until the imminent danger has passed and the child has returned to baseline. 
  • Except in an emergency, only an authorised officer who has completed TCI training and has been assessed as competent may physically restrain a child. 
  • Physical restraint must not be used to demonstrate power or control over a child, or as a form of punishment. 
  • Following a restraint residential care workers must seek medical attention as soon as possible if there are any health concerns for the child after the incident, and forward a report on the child’s physical condition to the Assistant Director, Residential Care. 
  • When the situation has stabilised, the staff involved in (or witnessing) an incident must complete and forward copies of a signed Critical Incident Report to the 70 manager, Assistant Director and the child’s case manager, and debrief as soon as possible. 
  • After an incident involving physical restraint: 
    • staff must review the child’s safety plan, and 
    • the child must be invited to complete a Child’s View of the Incident report – the child keeps this report, and a copy is given to the home’s manager. 
  • ​Staff must attempt to hold a Life Space Interview (LSI) with the child as soon as possible after the incident to provide opportunities for growth and change. The child should be invited to participate in decisions about behaviour intervention for his or her self-care plans. 
  • Staff must record attempts to hold the LSI on the Critical Incident Report. 

Procedures

  • Therapeutic Crisis Intervention
  • Physical Restraint of a child
  • Therapeutic Crisis Intervention

    ​​Therapeutic Crisis Intervention (TCI) procedures are used to de-escalate and manage potentially violent or crisis situations and aggressive behaviour in the home. 

    Residential Care and Secure Care management are responsible for overseeing completion of TCI and refresher training. Homes managers and Learning and Development Centre staff record residential care workers’ attendance and completion of TCI training.

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    Physical Restraint of a child

    ​Whenever possible, restraint should only take place in the context of an ongoing relationship with the child involved. The message behind a restraint should be, “I care enough about you to not let you hurt yourself or others”. 

    Where possible a discussion between residential care workers should take place so that physical intervention is planned and agreed. 

    Situations may arise where use of physical restraint is ill-advised. Due to the danger presented, residential care workers are best-placed to assess whether or not a physical restraint may be attempted. Things to consider include: 

    • ​Does the child have any potentially lethal weapons? 
    • Will physical intervention compromise the safety of any person and place them at risk, for example, due to the size of the child? 
    • Does the child or worker have any medical conditions? 
    • Are there enough staff available to implement TCI safely? 

    Restraint should not occur in public areas unless the child is at imminent risk (refer to TCI Manual). 

    Any physical intervention must always be the least intrusive to protect the child and others’ safety. 

    Physically restraining a child may not be used as a regular or ongoing management technique. Where possible, safety planning should be developed to avoid using intrusive or restricted procedures. 

    To promote open communication between residential care workers and children the possibility of physical restraint, and situations that may lead to this should be discussed with the child during his or her initial Residential Care Plan (or review) meeting. Physical restraints may also be included in the child’s safety plan.

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