For Providers: Behaviour Support in the NDIS Commission - video transcript

My name is Tracy Harkness. I'm the Director of the National Behaviour Support team at the NDIS Quality and Safeguards Commission. This video will give you an overview of the requirements of the implementing providers for behaviour support in the NDIS Quality and Safeguards Commission.

Implementing providers are registered providers who implement any restrictive practice in the person's plan. The NDIS Quality and Safeguards Commission, through the senior practitioner, has a role in providing clinical leadership in the area of positive behaviour support and reducing and eliminating the use of restrictive practices for participants in the NDIS. So eliminating and reducing the use of restrictive practices is really in line with Australia's commitment to the UN Convention on the Rights of Persons with Disability, and is also outlined in the National Quality and Safeguarding Framework which really outlines the responsibilities of the Commission in its work.

The National approach is really important because for the first time ever we will have a national picture on the prevalence and the use of restrictive practices and this really gives us a great view about how many practices for participants and people with disability generally but also that means that we can provide clinical leadership and improve the clinical practice. This approach will raise the bar of clinical practice because we need to ensure that people are focusing quality of life outcomes for people, providing more choice and control in people's plans to ensure that we don't actually need to use restrictive practices and work to eliminate and fade out those practices over time.

The definition of a restrictive practice is any practice or intervention that restricts the person's freedom of movement or access to particular preferred activities. Things that aren't covered under restrictive practices are things such as gentle encouragement or guiding for a person that's not restricting their freedom of movement or not restricting their access to activities. So, for example, something like gently guiding a person to be where they need to be at a particular time of day, helping them remain safe and providing a high quality service to them at the same time are not restrictive practices.

The NDIS Commission has five regulated restricted practices that we monitor and have oversight over. These are in the categories of seclusion, which is the confinement of someone in an area where they are unable to leave, or at least even implied that they are unable to leave. Chemical restraint, and this covers any psychotropic medications. That's any medication that has an effect on the brain, that has the primary purpose of influencing or suppressing your behaviour. This can be either routine medication as well as "as needed" medication, also known as PRN medication. The next category is mechanical restraint, and that's using a device to suppress or manage a behaviour. There's physical restraint which is using part of your body to manage or suppress a behaviour. And the last category is environmental restraint, which is the broadest category of restrictive practices, but mostly includes things such as restricted access. So, restricted access to sharps, restricted access to the community.

Over time we'll be working with the states and territories to reform national definitions so that we'll have the same definitions across all the different jurisdictions.

Sometimes, it's important to use restrictive practices because it's the only way to keep the participant and others safe. Restrictive practices can be used if they: reduce the risk of harm to the self or others; are clearly identified in a behaviour support plan; are authorised from the state or territory; are used as a last resort; are the least restrictive response available; are proportionate to the potential harm to self or others; are used for the shortest possible time, and; are implemented only by registered NDIS providers.

So a behaviour support plan is a plan that is written for a participant by a registered behaviour support practitioner. If you're going to use restrictive practices for a person in their environment you need to make sure it's clearly outlined in the positive behaviour support plan for the person and ensure there's positive practices in the plan as well as protocols that's able to show you how to implement the restrictive practices as well.

The person that's responsible for developing the behaviour support plan needs to be a registered behaviour support practitioner with the NDIS Commission. They also need to be considered suitable by the senior practitioner and to be able to be develop positive behaviour support plans as well.

Specialist behavioural support practitioners often have a wide range of qualifications because there is not one particular qualification that you need to have to provide positive behaviour support. They may be registered psychologists or registered other allied health disciplines. They could have a special education teaching background, habilitation, developmental educators, and any other qualification or experience that's relevant. They have to be registered under registration group 110 which is specialist behaviour support.

Any behaviour support plan that contains restrictive practices must be lodged with the NDIS Commission. That is the responsibility of the behaviour support practitioner, in line with working with the implementing provider as well. Any plan that doesn't include restrictive practices does need need to be lodged with the Commission. If you wish to use restrictive practices and you're implementing a behaviour support plan you need to obtain authorization from the state or territory jurisdiction, however that's described. And they also have to ensure that their staff have appropriate supervision and training to provide support to the participant.

Any implementing provider that is implementing restrictive practices needs to be a registered provider with the Commission. This does not need that you need to be registered as a specialist behaviour support provider. You only need to be registered for the supports that you're providing.

Restrictive practices need to be reported monthly to the NDIS Commission. The NDIS Commission has a monthly reporting form that can be used to record the instances. If there are no use of the restrictive practices during that month, there also needs to be a NIL report provided to the Commission.

So any restrictive practices that are not covered in a behaviour support plan and do not have the current authorization from the state or territory are considered an unauthorised restrictive practice and need to be reported to the reportable incidents team in the NDIS Commission in a five-day notification.

In order to help illustrate the requirements of implementing providers, here is a case of an NDIS participant, Ella.

Ella is 20 years old. She has a mild intellectual disability and a trauma background in her early childhood. She's reported to have emotional outbursts and is quite violent towards staff and other participants. Ella has two providers that provide support to her. The first one is a specialist disability accommodation where she lives with three other people. And the second one is her day programme that she attends five days a week. So Ella has funding in her NDIS plan to provide behaviour support. Given that there's funding in the NDIS plan for behaviour support a specialist behaviour support provider will then work with Ella and any other stakeholders in Ella's life to deliver the plan.

The specialist behaviour support practitioner will work with the implementing provider to ensure that strategies that you have tried previously are included in the behaviour support plan. Ella's plan includes changes to the physical environment, and it also includes teaching her new skills to be able to not need to use her behaviours of concern. Ella's plan also includes restrictive practices. There is seclusion where she's directed back to her room to calm down when needed. She also has restricted access to sharps in the kitchen. And she has daily medication to help manage her behaviour.

The specialist disability accommodation and the day programme are both listed on the behaviour support plan as implementing providers. They both have restricted access to sharps and seclusion in place, and the specialist disability accommodation also has daily medication to help manage Ella's behaviour. Both providers have obtained authorisation from the relevant state body. Over the course of months both providers used varying levels of restrictive practices in their care and support of Ella. In the group home they utilised daily medication to help manage her behaviour. They also had restricted access to sharps and they had one incident of seclusion after an emotional outburst. For the day programme they had restricted access to sharps and they also had seclusion but they didn't use it during that month. Both providers kept records on each of the incidents and use of restrictive practices for Ella. And at the end of the month they provided those reports to the NDIS Quality and Safeguards Commission.

In Ella's case, both providers had to report to the commission on used restrictive practices. In the case where you just used a practice every now and then and didn't use it all the time and you might have no use for the month you still need to provide a NIL report to the Commission.

The positive behaviour support plan needs to be reviewed every twelve months or sooner if the circumstances of the person's life changes. This will be done by the behaviour support practitioner in consultation with any stakeholders and the implementing providers. The goal of the review of the behaviour support plan within that year is to make sure any new information that needs to be included in the plan, any new strategies that need to be tried are also included as well as moving towards reducing and fading out the restrictive practices over time.

In Ella's case, the positive behaviour support plan review indicated that a number of positive behaviour support strategies been used to respond to her verbal outbursts which meant overtime her medication could be reduced.

The behaviour support team is here to assist implementing providers in meeting the obligations under the Commission. For implementing providers I think its really important that we help improve the capacity of you to be able to provide more complex support to people and also to people who have behaviours of concern. It's also a way that you can advertise your service as a point of difference from another service by it being a quality service. We understand that every case and organisation is quite different and unique and we're here to help you work through the requirements for your specific situation.

You can contact the behaviour support team via phone through the contact centre or via our email inbox. We can help you understand whether something is considered a restrictive practices or not or help you with the specific nuances of a case that you have.

The NDIS Commission's behaviour support team are committed to providing better outcomes for participants under the NDIS scheme through the reduction and elimination of restrictive practices. Working in partnership with implementing providers we can ensure that all NDIS services are of a high quality while safeguarding the rights of people with a disability.