Behaviour support (NDIS Participants)
What is the role of the NDIS Commission’s behaviour support function?
The NDIS Commission’s behaviour support team is responsible for providing clinical leadership in behaviour support and promoting the reduction and elimination of restrictive practices.
The goal of behaviour support in the NDIS is to improve quality of life outcomes for people with disability and reduce and eliminate restrictive practices.
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, with the primary purpose of protecting the person or others from harm.
What are the regulated restrictive practices?
There are five categories of regulated restrictive practices that are monitored by the NDIS Commission. These are the following:
- Seclusion - 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.
- Chemical restraint - the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. 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 - 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.
- Physical restraint - 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 the exercise of care towards a person.
- Environmental restraint - which restrict a person’s free access to all parts of their environment, including items or activities.
What is a behaviour support plan?
A behaviour support plan is a document prepared in consultation with the person with disability, their family, carers, and other support people that addresses the needs of the person identified as having complex behaviours of concern. The behaviour support plan contains evidence-informed strategies and seeks to improve the person’s quality of life.
Who can develop a behaviour support plan?
A behaviour support plan can only be developed by practitioners who are considered suitable by the Commissioner to undertake functional behaviour assessments and develop behaviour support plans. Behaviour support practitioners (whether a sole provider or employed by a provider) must be registered with the NDIS to provide specialist behaviour support (Registration group 110).
Can a behaviour support plan recommend the use of a regulated restrictive practice?
The aim of positive behaviour support is to reduce and eliminate restrictive practices. There is a primary emphasis on upholding the rights of the person with disability by looking to support the person through evidence-informed, person-centred strategies reflected in a behaviour support plan. There may be limited circumstances in which a regulated restrictive practice is used. The NDIS (Restrictive Practices and Behaviour Support) Rules 2018 specify that any use of restrictive practices must be:
- Used only in response to a risk of harm to the person with disability or others, as a last resort.
- Authorised in accordance with any state or territory legislation and/or policy requirements
- In proportion to the risk of harm and used only for the shortest possible time.
Use of a regulated restrictive practice must be reported to the NDIS Commission.
What if a behaviour support plan does not contain a regulated restrictive practice?
Behaviour support plans that do not contain a regulated restrictive practice do not need to be lodged with the NDIS Commission.
Note: Use of restrictive practices that are not detailed in a behaviour support plan or do not have the required authorisation and consent may constitute a reportable incident under the NDIS (Incident Management and Reportable Incidents) Rules 2018.
What needs to be reported to the NDIS Commission?
Any behaviour support plan containing a regulated restrictive practice must be lodged with the NDIS Commission. NDIS service providers must regularly report the use of a regulated restrictive practice with a NDIS participant to the NDIS Commission.
In most instances reporting is done monthly, however providers in South Australia are required to report fortnightly on use of a restrictive practice under a short term approval, and reportable incident reporting requirements also apply.
Note that transitional arrangements apply for existing providers in New South Wales and South Australia.
Who needs to report the use of a regulated restrictive practice to the NDIS Commission?
NDIS service providers using a regulated restrictive practice in their service with participants must comply with the relevant reporting requirements.
Any concerned relevant person can make a complaint about the use of a restrictive practice to the NDIS commission.
What happens if there is a regulated restrictive practice used in my service that is not part of a behaviour support plan?
This is most likely to be an unauthorised use of a restrictive practice. If so, the implementing service provider needs to report this as a reportable incident to the NDIS Commission within 5 days of the service provider being made aware of this occurrence.
What about a one off use of a regulated restrictive practice to manage a crisis?
If it is likely to occur again, the use of the practice needs be incorporated within a behaviour support plan. If the restrictive practice is authorised by the state body, the service provider has one month to report this to the NDIS Commission and needs to take all reasonable steps to engage a behaviour support practitioner to develop an interim behaviour support plan (within 3 months).
How often do behaviour support plans need to be reviewed?
At a minimum, any behaviour support plan that contains a regulated restrictive practice needs to be reviewed every 12 months or earlier if the participant’s circumstances change.
What if the implementing provider already has a regulated restrictive practice in place at the time the practitioner becomes engaged?
The practitioner needs to work with the implementing provider to investigate whether a less restrictive option is feasible. If not, the practice needs to be incorporated within an interim behaviour support plan and the service provider needs to comply with any relevant state or territory legislation and/or policy requirements to gain authorisation and consent. The interim behaviour support plan and evidence of authorisation and consent needs to be lodged with the NDIS Commission.
While developing the comprehensive behaviour support plan, the practitioner needs to provide sufficient positive practices so that the restrictive practice may no longer be required. If the practice is still being implemented, the comprehensive behaviour support plan needs to include fade out strategies for the restrictive practice.
What if a family is using a regulated restrictive practice?
As part of developing and implementing a behaviour support plan the practitioner will work with the person with disability’s support network on implementing the proactive and evidence-informed strategies. Under the new arrangements, the oversight role of the NDIS Commission extends to registered NDIS providers only.
How will the NDIS Commission review plans?
The NDIS Commission will be implementing a quality assurance process that includes, in the first instance a quality audit of all behaviour supports plans received. Over time, the NDIS Commission will rely on the patterns and data trends as well as information provided by other areas of the commission (e.g complaints) to indicate which plans need to be reviewed, in addition to conducting random audits.
How do I obtain authorisation and consent?
States and territories remain responsible for the legislative and policy frameworks regarding the authorisation of regulated restrictive practices in the NDIS. Providers will need to be aware of and comply with any relevant requirements in their state or territory in relation to seeking authorisation of and consent to the use of a restrictive practice.
How will the new arrangements intersect with other services such as schools?
A person with disability’s behaviour support plan will take account of the person’s interaction with mainstream services and form part of their person-centred and holistic plan. While the NDIS Commission is only responsible for the provision of behaviour support services funded through the NDIS, it may be appropriate, if the person with disability consents, for their NDIS behaviour support plan to be shared with other parties they engage with (for example, school teachers).
A behaviour support plan that incorporates person-centred and evidence-based strategies should be able to work effectively across the various service settings the person with disability accesses.
Can participants self-manage their specialist behaviour support funding and receive services from unregistered providers?
Restrictive practices represent a serious risk to the human rights of people with disability and there is a need to ensure there will be appropriate reporting and scrutiny of the use of restrictive practices in the NDIS. For this reason, the NDIS Quality and Safeguarding Framework requires that the delivery of specialist behaviour support services and use of restrictive practices should only be undertaken by registered NDIS providers and be managed by the National Disability Insurance Agency (NDIA).
Registration of providers will give the NDIS Commission the necessary level of oversight of behaviour support and restrictive practices. The NDIS Commission conditions of registration are outlined in the NDIS (Restrictive Practices and Behaviour Support Rules) 2018.