In our last article we put a spotlight on positive behaviour support (PBS) and how this can work to help individuals with an intellectual or cognitive disability who experience challenging behaviours.
One of the goals of positive behaviour support is to eliminate the use of restrictive practices.
What are challenging behaviours?
Sometimes people behave in ways that might cause them to hurt themselves, hurt other people or break things. These ways of behaving are commonly called “challenging behaviours”.
What is a restrictive practice?
Restrictive practice means any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability.
Under the National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018 certain restrictive practices are subject to regulation. These include seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint.
Where an NDIS participant’s behaviours of concern place themselves or others at risk of harm and a regulated restrictive practice is required, a behaviour support plan must be developed by a Behaviour Support Practitioner and lodged with the NDIS Commission. There are principals about how this happens, including ensuring that it is the least restrictive option and that there is a plan to reduce or eliminate the restricted practice.
Only an approved registered provider (known as an implementing provider) can follow an approved behaviour support plan which incorporates the use of restrictive practices.
What are the types of restrictive practice?
Seclusion
Seclusion is the sole confinement of a person with disability in a room or a physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted.
This could be when a person is put in a room or place and the person cannot leave when they want to. This can occur at any time of the day. It may also include a staff member moving away and leaving the person who may not be independently mobile.
Chemical restraint
Chemical restraint is the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. The medicine might make the person calmer or sleepy. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition.
Mechanical restraint
Mechanical restraint is the use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour but does not include the use of devices for therapeutic or non-behavioural purposes.
This is when something is put on a person to stop or make it harder for the person to move or to control their behaviour. The person with disability also needs to say it is OK. Physical restrain may refer to when people use their hands or body to stop or lessen the person’s ability to move when they are upset or when a challenging behaviour is happening.
Sometimes a device is put on a person to help them to move or to stay healthy. This is called a ‘Therapeutic Device’. This type of device is OK as it can help reduce pain, improve health or help the person do an activity. It is OK to use a therapeutic device when a health professional like a doctor or occupational therapist has approved it.
Physical restraint
Physical restraint is the use or action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour. Physical restraint does not include the use of a hands-on technique in a reflexive way to guide or redirect a person away from potential harm/injury, consistent with what could reasonably be considered as the exercise of care towards a person.
Environmental restraint
Environmental restraint restricts a person’s free access to parts of their environment, including items or activities. This is when a person’s daily life is restricted so they cannot get what they want, when they want it. This sometimes includes locking cupboards and fridges, taking away things people like and/or stopping the person from going to places they enjoy.
What are the rights of people with disability?
People with disability have the same rights as all people and to be free from discrimination this means that:
What are the rules for restrictive practices?
Restrictive practices can only be used where an NDIS participant’s behaviours of concern place themselves or others at risk of harm, and subsequently a regulated restrictive practice is required, a behaviour support plan must be developed and lodged with the NDIS Commission.
An implementing provider who uses regulated restrictive practices needs to provide monthly reports to the NDIS Commission.
The Rules outline the requirements for developing behaviour support plans containing regulated restrictive practices.
What are some other ways to provide support?
Other ways to help a person who is experiencing challenging behaviours can include:
Why do we have legislation?
The purpose of the legislation is to strengthen safeguards to uphold the human rights of people with an intellectual or cognitive disability who exhibit challenging behaviours. In addition, the legislation regulates the use of restrictive practices and provides a positive behaviour support system to improve quality of life.
The legislation ensures that any use of restrictive practices (for example, containment or seclusion) by a service provider has regard for human rights and is the least restrictive way of safeguarding a person and others from harm. In addition, the legislation aims to reduce or eliminate the need for the use of restrictive practices across the disability services sector and helps ensure transparency and accountability.
Further information and reading
Webinar: Unauthorised restrictive practices (16 July 2020)
This webinar provides information relating to a notice (as a condition of registration under S 73F(2)(i) of the NDIS Act 2013) that was issued on 6 July 2020 by the NDIS Quality and Safeguards Commissioner to registered providers in New South Wales and South Australia.
NDIS Website
NDIS Participant Fact Sheets for Behaviour Support
A “Physio” works with people with disabilities to help them increase their mobility, reduce pain, and improve their physical function. A Physio will assess your needs, strengths and challenges and develop an individualised plan to support you in achieving your goals.
Olivia is 15 years old and lives in Brisbane with mum, dad and two sisters. Olivia has global developmental delay and receives funding through the NDIS to help her overcome challenges that she faces with mobility, social skills, speech and communication.
Speech Therapy (also known as Speech Pathology) is a type of therapy that supports people who experience challenges with communication and/or swallowing difficulties. Speech Therapy is provided by a qualified Speech Pathologist, a Speech Language Pathologist (SLP) or a “Speechie”.
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