Physical intervention in vehicles: keeping journeys safe in children's homes

A fourteen-year-old in the back seat has unclipped his seat belt and is kicking the driver's headrest. The motorway is busy, the next junction is four miles away, and the member of staff beside him is wondering whether to hold his arms. Ask any residential team about the incidents that frighten them most, and journeys come near the top of the list.

At ProActive Approaches we approach this through #AimingForZero, the position our founder Simon Gower has held since 2016. A reduction target implies there is a number of restraints that is acceptable. Zero removes that permission, and it changes what a team asks after an incident. In a vehicle that question is sharper than anywhere else, because a car is one of the worst places to physically intervene with anyone. The aim is not to get better at holding children in cars. It is to plan journeys so that a hold is never the only option left.

Regulation 20 of the Children's Homes (England) Regulations 2015 applies in a vehicle exactly as it does in the home: restraint is only permitted to prevent injury or serious damage to property, and it must be necessary and proportionate. That is the legal floor. This guide is about the work that sits above it.

Why vehicles are such a high-risk place

Every physical intervention carries risk. In a vehicle, almost every risk factor is multiplied at once.

• There is no space. Staff cannot step back, give distance or change position. Holds have to be attempted while seated, twisted and off balance, which is exactly when injuries happen.
• Breathing is easily compromised. A child pressed against a seat, folded forward or held across a lap can quickly have their breathing restricted. Government guidance on reducing the need for restraint and restrictive intervention warns staff to avoid any hold that affects a child's airway, breathing or circulation, including pressure on the neck or abdomen. In the cramped space of a back seat, that is very hard to guarantee.
• The driver is a casualty risk. A struggle in the back of a moving car can distract or injure the driver, and a crash endangers everyone in the vehicle and on the road.
• Help is far away. At home, colleagues can arrive in seconds. On a motorway there may be no one else for miles.
• Seat belts become part of the problem. UK law makes the driver responsible for making sure children in the vehicle are properly restrained. A child who unclips their belt creates an immediate legal and safety issue, and staff may feel pushed to hold them in place to put it right.

Our guidance on positional asphyxia risk explains why seated and folded positions are so dangerous. A car makes all of those positions more likely.

Prevention: planning journeys well

Most incidents in vehicles do not come out of nowhere. They follow patterns that a team can see if it looks: the drive back from contact, the journey to a new school, the trip after a difficult phone call, the long drive to a medical appointment. Good planning turns those patterns into decisions made calmly in advance, not under pressure on the hard shoulder.

Ask whether the journey needs to happen now

The first question is not how to manage the journey but whether it should happen at all, at this time, in this way. Could the appointment be moved? Could the child walk, take a train with staff, or travel later when they are calmer? If a journey is known to be hard, building in choice and flexibility is often the single most effective step.

Build travel into the child's plan

For children who find journeys difficult, their behaviour support plan and risk assessment should say so plainly. Our guide to physical intervention risk assessment in children's homes covers how to do this well. A useful travel section might cover:

• Known triggers, such as particular destinations, times of day, music, noise or who else is travelling.
• Early signs of distress the child shows, and what helps them stay settled.
• Who travels, how many staff, and which staff member the child trusts most.
• Where the child sits. Usually this means the back seat, behind the front passenger rather than the driver, with a member of staff alongside if needed.
• What the child can bring: headphones, a game, a snack, a familiar object.
• The agreed plan if the child becomes distressed, including where staff will stop and who they will call.

Involve the child

Ask the child, at a calm time, what makes journeys hard and what would make them easier. Agree a signal they can use if they need to stop. Children who helped design the plan are more likely to use it, and more likely to tell staff early when they are struggling.

Prepare the vehicle and the staff

Make sure the car is clean, comfortable and suitable for the child's size and needs, with the right car seat or booster where the law requires one. Drivers should know the route, the safe places to stop and the plan if things go wrong. Staff travelling with the child should have the child's plan, a charged phone and the number of the person on call.

Plan longer journeys with care

Long journeys, such as moves between placements, visits to distant family or trips to specialist appointments, need extra thought. Plan regular breaks at places where the child can get out, stretch and have something to eat. Avoid travelling when the child is tired or hungry. Tell the receiving setting when you expect to arrive and who to call if you are delayed. For a placement move in particular, the journey is often the moment a child's worry about the change is at its highest, so the people they trust most should travel with them wherever possible.

In the moment: when a journey goes wrong

When a child becomes distressed in a moving vehicle, staff need a simple rule they have rehearsed: stop first.

1. Stay calm and use your voice. Lower your tone, slow down and use the strategies in the child's plan. Offer the agreed signal, music or distraction. Acknowledge how they feel.
2. Find a safe place to stop. Pull over as soon as it is safe and legal to do so. On a motorway, that may mean the next services or junction. Do not try to manage serious distress while the car is moving.
3. Create space once stopped. If it is safe, staff can step out of the vehicle to give the child room, while keeping them in sight and staying with them. Space is usually more calming than closeness.
4. Call for support. Contact the on-call manager or home. In an emergency, call the police or ambulance service.
5. Only then consider physical intervention. If there is an immediate risk of serious injury, and nothing less restrictive will prevent it, staff may need to physically intervene, using only techniques they are trained in, for the shortest time possible, and never in a way that restricts breathing.

Do not continue a journey with a child who has refused to wear their seat belt. Stop, keep everyone safe and agree the next step with the on-call manager.

Restricting movement in vehicles

Teams sometimes use vehicle features to manage risk: child locks, central locking, or keeping a child in a parked car until they settle. Child locks used while a car is moving are a reasonable safety measure for many children. But using locks or a stationary car to keep a child somewhere they want to leave is a restriction of their liberty of movement, which the Regulations treat as restraint. It must meet the same test of necessity and proportionality, be recorded within 24 hours, and be reviewed by the registered person. A car must never be used as a place to contain or isolate a child.

After an incident on a journey

When everyone is safe, the child's wellbeing comes first. Check for injuries, make sure they are warm and comfortable, and offer reassurance. Get them home or to their destination as gently as possible. Give the child the chance to talk about what happened when they are ready, and listen to their account.

Any physical intervention or restriction must be recorded and reviewed in the usual way. For journeys, the review should ask some specific questions:

• Did this journey need to happen at that time and in that way?
• Were there early signs that were missed, or a plan that was not followed?
• Was the seating, staffing and vehicle right for this child?
• How quickly did staff stop, and was there a safe place to do so?
• What will change before the next journey?

Look at journeys across the home as well as individually. If most incidents happen on the way back from contact, or with one driver, or on one route, the pattern is the most useful information the team has.

Training that prepares staff for journeys

Staff who transport children need more than general physical intervention skills. They need the confidence to say "not now" to a journey, the skills to calm a distressed child in a small space, and a clear understanding of why stopping comes before holding. Training certified against the Restraint Reduction Network Training Standards must be based on a training needs analysis, so if journeys are a risk in your home, they should be part of the training.

Our physical intervention training for children's homes treats physical skills as the smallest part of a much larger approach, and our physical intervention training can include realistic scenarios for vehicles and transport where a home needs them. For our full range of support, see training for children's homes.

FAQ

Can staff restrain a child in a moving car?

Only where there is an immediate risk of serious injury and nothing less restrictive will prevent it. In practice, the safest response to distress in a moving vehicle is almost always to stop the car safely first. Holding a child in a moving car is extremely risky for the child, the staff and the driver.

What should staff do if a child takes off their seat belt?

Stop the vehicle as soon as it is safe and legal to do so. Do not continue the journey until the child is wearing their seat belt or another safe plan is agreed with the on-call manager.

Is using child locks a form of restraint?

Child locks used to stop a door opening while the car is moving are a normal safety measure. Using locks or a parked vehicle to keep a child somewhere they want to leave is a restriction of liberty and must be justified, recorded and reviewed.

Should journeys be included in a child's behaviour support plan?

Yes, for any child who finds travel difficult. The plan should cover triggers, seating, staffing, what helps and what staff will do if the child becomes distressed.