Regulated restrictive practices

Which restrictive practices are regulated and what providers are required to do

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.

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;

Chemical restraint

Chemical restraint is 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

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;

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 all parts of their environment, including items or activities.

In the past, restrictive practices were often a first response to behaviours that caused significant harm to the person or others. It is now recognised that restrictive practices can present serious human rights infringements.

In 2014, state and territory governments responded to this by endorsing the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector.

Under the NDIS Commission, registered providers who develop behaviour support plans or use restrictive practices (implementing providers) are required to comply with the NDIS Quality and Safeguarding Framework, which is underpinned by the same high-level guiding principles, including human rights and a person-centred approach as the national framework.

What if an NDIS participant needs a restrictive practice to keep themselves and/or others safe?

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.

Provider obligations

Specialist behaviour support providers have certain obligations to deliver behaviour support under the NDIS Commission. These apply regardless of whether regulated restrictive practices are included in a behaviour support plan.

Implementing providers who use regulated restrictive practices also have additional obligations which are detailed below.

What is specialist behaviour support?

Specialist behaviour support is:

  1. 1. Undertaking a functional behaviour assessment and;
  2. 2. Developing a behaviour support plan for the participant.

Specialist behaviour support providers are required to:

  • Be registered for behaviour support (registration group 110) with the NDIS Commission
  • Engage behaviour support practitioners considered suitable by the NDIS Commission
  • Work with the implementing provider to ensure that regulated restrictive practices in the final behaviour support plan are authorised where required
  • Specify in the behaviour support plan that person-centred strategies must be applied first, with restrictive practices used as a last resort in response to a risk of harm to the person or others
  • Develop behaviour support plans containing regulated restrictive practices in accordance with any state or territory authorisation and consent requirements
  • Lodge behaviour support plans containing regulated restrictive practices with the NDIS Commission
  • Help NDIS participants, their families, and other decision-makers to understand the NDIS Commission’s behaviour support function

What is an implementing provider?

An implementing provider is any NDIS service provider that uses a regulated restrictive practice in the course of delivering NDIS supports to a participant. For example, support workers restricting a participant’s free access to the community due to behaviours of concern are implementing a regulated restrictive practice.

Implementing providers are required to:

  • Be registered with the NDIS Commission for the type of support they are providing. They do not need to be registered specifically for behaviour support registration group 110
  • Submit monthly reports to the NDIS Commission on the use of restrictive practices
  • Ensure staff are appropriately trained to implement positive behaviour strategies or use restrictive practices
  • Notify the NDIS Commission in the event of any unplanned or unapproved use of a restrictive practice through the reportable incident process
  • Help your staff, NDIS participants, their families, and other decision-makers to understand the NDIS Commission’s behaviour support function

Behaviour support plans

An NDIS behaviour support plan is a document developed for a person with disability by an NDIS behaviour support practitioner. It is developed in consultation with the participant, their family, carers, guardian, and other relevant people, as well as the service providers who will be implementing the plan.

A behaviour support plan specifies a range of evidence-based, person-centred and proactive strategies that focus on the individual needs of the participant. This includes positive behaviour support to:

  1. build on the person’s strengths
  2. increase their opportunities to participate in community activities
  3. increase their life skills

What are the requirements for an interim behaviour support plan?

An interim plan is a brief plan that provides protocols for the safe use of the regulated restrictive practice, as well as general preventative and response strategies. The focus is keeping people safe while the practitioner undertakes functional behaviour assessment and develops a comprehensive behaviour support plan.

Using restrictive practices as part of a behaviour support plan

For plans that contain a regulated restrictive practice, the use of that practice must meet NDIS Commission conditions and may also require authorisation or consent under the relevant state or territory legislative and policy frameworks.

As a registered specialist behaviour support provider, you must ensure that:

  • For a comprehensive plan, a behaviour support practitioner completes a functional behaviour assessment and develops the behaviour support plan in consultation with the participant, their family, carers, guardian, and other relevant people, as well as the service providers who will be implementing the plan.
  • A statement of intent to include a restrictive practice in the behaviour support plan is given to the participant and their family, carers, guardian, and other relevant people in an accessible format
  • The behaviour support plan contains:
    • Strategies that are outcomes-focused, person-centred and proactive
    • Strategies that address the participant’s individual needs and the functions of the behaviour of concern
    • Strategies to reduce or eliminate the use of restrictive practices over time
  • The behaviour support plan is lodged with the NDIS Commission to enable monitoring of regulated restrictive practices

All providers using regulated restrictive practices when delivering NDIS supports are required to meet conditions of registration. The conditions include:

  • A restrictive practice can only be used when it is part of a behaviour support plan developed by an NDIS behaviour support practitioner
  • If a restrictive practice is used it must:
    • Be the least restrictive response possible in the circumstances
    • Reduce the risk of harm to the person or others
    • Be used for the shortest possible time to ensure the safety of the person or others
  • Where required, the implementing provider must obtain authorisation for the use of a restrictive practice from the state or territory
  • The implementing provider must comply with monthly reporting requirements

What are the authorisation arrangements for restrictive practices under the NDIS?

  • States and territories remain responsible for the authorisation of restrictive practices
  • Practitioners should assist implementing providers to understand the relevant state and territory legislative and/or policy requirements
  • Unauthorised use of a restrictive practice by an implementing provider constitutes a reportable incident. The provider must notify the NDIS Commission within 5 business days of becoming aware of the use

For Practitioners: Behaviour Support in the NDIS Commission

 

For Providers: Behaviour Support in the NDIS Commission