Core skills training: RCO

Student name:

Service centre:

Core skills training: RCO

Follow established person-centred

behaviour supports learning resource

(CHCDIS002)

Version 2.4– October 2021

© Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships Version 2.4 – October 2021 Follow established person-centred behaviour support learning resource 2 of 57

Learning resource: Person-centred behaviour

supports

Resource Development and Maintenance: Workforce Capability.

Feedback can be provide to the Curriculum development team via email to

[email protected]

© 2021, Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships.

Copyright protects this publication. Except for the purposes permitted by the Copyright Act, reproduction

by any means (photocopying, electronic, mechanical, recording or otherwise) is prohibited without the prior

written permission of the Department of Seniors, Disability Services and Aboriginal and Torres Strait

Islander Partnerships. Inquiries should be addressed to the Workforce Capability, PO Box 15397, City East,

Queensland 4002 Australia

mailto:[email protected]


Contents

Introduction ........................................................................................................................ 5

Understanding behaviour ................................................................................................. 6

Time intensity model ........................................................................................................ 7

Routines and why they are important ............................................................................... 9

Positive behaviour support ............................................................................................. 10

Positive behaviour support and the use of restrictive practices ................................. 11

Introduction .................................................................................................................... 11

The Disability Services Act 2006 .................................................................................... 11

2014 Amendments to the Disability Services Act 2006 .................................................. 12

Forensic Disability Act 2011 (QLD) ................................................................................ 12

Restrictive practices ........................................................................................................ 13

Containment ................................................................................................................... 14

Seclusion ........................................................................................................................ 14

Chemical restraint .......................................................................................................... 14

Mechanical restraint ....................................................................................................... 15

Physical restraint ............................................................................................................ 16

Restricting access to objects .......................................................................................... 16

How will an adult with a disability be assessed? ............................................................ 16

Positive behaviour support plan ..................................................................................... 17

Reporting unauthorised restrictive practices .................................................................. 18

Positive behaviour support versus restrictive and aversive behaviour support ....... 19

Responding positively to communication and behaviour ........................................... 20

Factors to consider when providing support ................................................................... 21

Specialist Services .......................................................................................................... 24

Coordinating services ..................................................................................................... 24

Incidents and reporting ................................................................................................... 28

What is incident management and why is it so important? ............................................. 28

When, and how, does a work-related incident need to be reported?.............................. 29

What is required after a work-related incident has been reported? ................................ 29

Critical incident reporting ............................................................................................... 31

Manual Form .................................................................................................................... 41

Duty of care ...................................................................................................................... 53


Dignity of risk ................................................................................................................... 54

Social model of disability ................................................................................................ 54

References ....................................................................................................................... 56


Introduction

As a Residential Care Officer (RCO) you are often required to provide person centred behaviour

supports. The Program 3: Follow established person-centred behaviour supports learning

resource contains some of the underpinning knowledge towards the unit CHCDIS002 - Follow

established person-centred behaviour supports which contributes towards the Certificate IV in

Disability qualification.

It is recommended that you read the learning resource to assist you completing the Follow

established person-centred behaviour support workbook. This learning resource aims to guide

you through how to follow established person-centred behaviour supports and how to support the

implementation of a Positive Behaviour Support Plan (PBSP). You will also find this resource an

invaluable tool to refer to throughout your training.

The information contained within this learning resource is designed to assist you in answering the

questions in your Follow established person-centred behaviour support workbook.

In this learning resource we will cover the following key areas:

• positive behaviour support and the use of restrictive practices

• coordination of specialist services relating to behaviour support

• what is an incident, including critical incidents and reporting requirements

• duty of care and dignity of risks implications.

https://training.gov.au/Training/Details/CHCDIS002

https://training.gov.au/Training/Details/CHCDIS002


Understanding behaviour

There are many reasons why people with disability demonstrate what we call ‘challenging behaviour’.

The most common reason is that people use behaviour as their way to communicate their feelings

and needs.

People often think that ‘challenging behaviours’ describe serious problems that a person has. But

the ‘challenges’ are actually challenges to us as support workers to find better ways of supporting

the person to cope more successfully with daily living activities.

In your role you will have observed that each person communicates in varied ways, to express

themselves. Each person can also communicate in different ways to gain your attention that may

have included: Yelling, banging items to gain your attention, pushing items away, standing at the

kitchen.

If the person is non-verbal, they may find it difficult to communicate using their preferred

communication mode when they are experiencing pain, distress, fear or anger. In some situations,

the person may use physical aggression towards themselves or others. Supporting someone who

expresses their behaviour through physical aggression requires a planned response to ensure

supporting the person is the least restrictive method and reduce the need for these expressions of

behaviour.

The underpinning framework of positive behaviour support is to respond to the function of the

behaviour and provide the person the necessary skills, abilities and opportunities to learn new ways

of communicating their feelings in a more appropriate way. Accommodation Support and Respite

Services (AS&RS) works from a positive behaviour support framework.

Challenging behaviour

Behaviour may be described as ‘challenging’ if:

• Other people find it difficult to manage

• It presents a risk of harm to the person or others

• It is not appropriate for the environment in which it is being used

• The behaviour is deemed inappropriate for the person’s age or abilities.

(Paley, 2012)

Defining challenging behaviour

“behaviour of such intensity, frequency or duration that the physical safety of the person and

or others is likely to be placed in serious jeopardy or behaviour which is likely to seriously limit

access to and use of ordinary community facilities.”

(Emerson, 1995)


Time intensity model

The Time intensity model assists us in understanding the cycle of challenging behaviour that a

person exhibits by illustrating the sequence of events that lead to and follow on from challenging

incidents. The Time intensity model is not just a model that explains the challenging behaviour of

people with disability, but the behaviour of all people who engage in some form of challenging

behaviour.

The most fundamental level all behaviour can be understood is as serving the need of accessing or

avoiding certain events or states. As an RCO you will often be involved in collecting a range of

information about the people you support. Behaviours that follows an ABC frame of analysis,

identifying antecedent behaviours (what happened immediately before the behaviour), describing

the specific behaviour with clarity and objectivity and understanding the possible consequence

(meaning or outcome of the behaviour).

Note that Consequence as labelled in the ABC chain above is not describing an aversive action or

punishment of the person’s behaviour, it is purely a technical behavioural term that describes the

outcome of the challenging behaviour/s engaged in by a person who presents with challenging

behaviours. A consequence is another technical behavioural term that is equivalent to function of

behaviour.

What happened IMMEDIATELY

BEFORE the behaviour?

Why was this behaviour used?

[FUNCTION]

ACCESS

or

AVOID

Background Factors

Triggers (cues of distress)

Escalation (signs of

escalation)

Challenging Incident /Crisis

Recovery

Sadness /

Remorse


Example of a behaviour recording form;


Routines and why they are important

‘Routines’ are what we do to get us through our daily activities. They are the regular and recurring

habits we have learnt that assists to make our lives easier. We don’t have to think about our routines,

and this frees up our brains so we can solve the everyday problems that happen. Refer to the

example below.

Predictability and consistency provide security and a feeling of comfort. The person being supported

needs predictability and consistency especially if the person has a mental health condition or a

cognitive disability that requires the person to be dependent on others to support their daily activities.

The person will often have several different support workers providing support to them. Often the

support workers do have an established routine that they follow however, sometimes each support

worker can slightly change the routine.

This can affect the person in a number of ways. The person may:

• not learn or maintain self-care skills because each support worker has a different way of

doing or teaching things

• become upset and distressed because things are done in a different way by each support

worker

• give up trying to do anything for themselves because they can’t work out what’s expected of

them

• become aggressive because they can’t depend on activities happening either in the right

order or at the right time – or at all.

Think about your early morning ‘routine’ and what you do in getting ready for work. Also consider

how much you depend on electricity to get you through the routine, so you’ll be on time for work.

Some electric items we might use include alarm clock, hot water system, toaster, kettle, shaver,

lights, heating – and so on. Now, how would your routine be affected if there was a power failure?


Positive behaviour support

The primary goal of Positive behaviour support is to increase a person’s quality of life with a

secondary goal of decreasing challenging behaviours. It is a comprehensive approach to

assessment, planning and intervention that focuses on addressing the person’s needs and their

living environment. Positive behaviour support is about working with all stakeholders to develop a

shared understanding about the function of the behaviour.

“Positive behavioural support is a multicomponent framework for:

a) Developing an understanding of the challenging behaviour displayed by an individual,

based on an assessment of the social and physical environment and broader context

within which it occurs

b) With the inclusion of stakeholder perspectives and involvement

c) Using this understanding to develop, implement and evaluate the effectiveness of a

personalised and enduring system of support; and

d) That enhances quality of life outcomes for the focal person and other stakeholders.”

Gore et al, 2013

© Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships Version 2.3 – March 2021 Person-centred behaviour support learning resource 11 of 57

Positive behaviour support and the use of restrictive practices

Introduction

In 2008 the Queensland Government made amendments to the Disability Services Act 2006 (Qld)

to introduce a framework regulating the use of restrictive practices. This may affect an adult with an

intellectual or cognitive disability who displays challenging behaviour. The purpose of the legislation

was to reduce or eliminate the need to use restrictive practices in disability services by using positive

behaviour support.

In 2014, further amendments were made to the Act which strengthened the

recognition of the human rights of adults with disability by further improving

the regulations and safeguards around the use of restrictive practices. As

a support worker you play a vital supporting role. We understand that any

changes to the persons care takes teamwork from families, friends,

support workers and disability services.

Note: When this guide refers to ‘family’, it means family, friends, and any other

members of an adult’s personal support network.

The Disability Services Act 2006

The Honourable W. J. Carter QC wrote a report in 2006 called Challenging Behaviour and Disability

— A Targeted Response recommending that the Disability Services Act 2006 be changed to:

• protect the rights of people with an intellectual or cognitive disability who have challenging

behaviour by only allowing the use of restrictive practices by disability service providers

where the practices are shown to be necessary, the least restrictive alternative and are

authorised by the right decision maker; and

• establish a stronger system of positive behaviour support that would lead to a better

quality of life.

Changes to the Disability Services Act 2006 and the Guardianship and Administration Act 2000

commenced on 1 July 2008. These changes aimed to reduce or eliminate the need for use of

restrictive practices in the disability services sector. Under the Act, before a restrictive practice can

be used, a service provider must meet several requirements and go through an approval process.

For some types of restrictive practices, the Queensland Civil and Administrative Tribunal (QCAT)

will approve and review the restrictive practices and appoint guardians for restrictive practice

matters. Some types of restrictive practices require approval from other decision makers.

All types of restrictive practices require a positive behaviour support plan to be developed.

https://www.legislation.qld.gov.au/view/html/inforce/current/act-2006-012



https://www.qcat.qld.gov.au/matter-types/guardianship-for-adults-matters


2014 Amendments to the Disability Services Act 2006

In March 2014, the Queensland Government approved further changes to these two acts. These

changes were made after a review of the existing restrictive practices framework. The changes were

made to make it simpler and provide protection of people’s human rights. The government worked

closely with people from the disability sector to ensure that the changes were necessary, appropriate

and could be implemented.

When did the amendments take effect?

The amendments to the Disability Services Act 2006 and the Guardianship and Administration

Act 2000 took effect on the 1st July 2014.

Who does the legislation apply to?

The legislation will apply to an adult person with disability aged 18 years or over and has an

intellectual or cognitive disability (this can include adults with an acquired brain injury) and:

• behaves in a way that either causes harm, or represents a serious risk of harm, to themselves

or others (sometimes referred to as challenging behaviour)

• has impaired decision-making capacity about restrictive practices, and

• is receiving disability services provided by:

o AS&RS or

o A service provider that provides disability services prescribed by regulation and

funded under a National Disability Insurance Scheme (NDIS) participant plan.

It is important to understand that the legislation applies only to the use of restrictive practices by staff

of services provided by AS&RS, or services prescribed by regulation and funded under a NDIS

participant plan.

Forensic Disability Act 2011 (QLD)

Introduction to Act and application

This Act provides the guidelines for the involuntary detention, care, support and protection of people

who have a disability, yet have committed a crime. These types of clients are termed as ‘forensic

disability’. The Act has a strong

focus on balancing the rights and

freedoms of individuals, with the

rights and freedoms of other people,

as well as ensuring the

enhancement of an individual’s

quality of life and the maximisation of successful reintegration into the community. The Act provides

the Mental Health Court with a more appropriate option to secure care for individuals with an

intellectual disability.


ttps://www.legislation.qld.gov.au/view/html/inforce/current/act-2000-008

ttps://www.legislation.qld.gov.au/view/html/inforce/current/act-2000-008


Forensic Disability Service

The Act came out of the 2006 Justice Carter - Challenging Behaviour and Disability – A Targeted

Response (The Carter report). The report had 24 recommendations with recommendation 22 leading

to the development of the Forensic Disability Service.

That consideration be given to the amendment of the Mental Health Act 2000 in relation to the Mental

Health Court’s power in making a forensic order in respect of a person with intellectual disability to order

that the person be detained other than in a mental health service.

The FDS Unit is a purpose-built, medium secure, highly structured and supervised residential

treatment and rehabilitation facility in Wacol, Brisbane, with the current capacity to accommodate

and provide care for up to ten individuals. As a medium secure facility there are security features in

place, including fully fenced outdoor areas, locked doors, provision for search and seizure of items

from residents and the requirement that all visitors be admitted through central security.

The service aims to provide evidence-based programs and person-centred support to

facilitate positive changes for people with an intellectual disability subject to a Forensic

Order to:

• reduce their risk of re-engaging in offending behaviour

• increase their social, coping and independent living skills

• maximise their quality of life; and

• increase their opportunities for community reintegration.

The Forensic Disability Service is for people with an intellectual or cognitive disability defined within the

Forensic Disability Act, who have been found to not have capacity to plead, and for whom a secure

setting is judged by the Mental Health Court, at the time, to be the most appropriate setting. The Mental

Health Court places the person on a Forensic Order (Disability).

Forensic Order is an order made by the Mental Health Court if the court decides a person was of

unsound mind at the time of the offence, or that the person is permanently unfit for trial. This order

authorises a person's detention in an authorised mental health service for involuntary treatment and

care.

Restrictive practices

Restrictive practice is any of the following practices which restricts an adult with an intellectual or

cognitive disability’s free access to all parts of their environment, including items or activities when

used in response to the behaviour of a person with disability that causes harm to the adult or others:

• containing or secluding the person

• using chemical, mechanical or physical restraint of the person

• restricting the person’s access to objects.

Harm to a person means:


• physical harm to the person

• a serious risk of physical harm to the person

• damage to property involving serious risk of physical harm to the person.

Least restrictive, in relation to an adult with an intellectual or cognitive disability means use of the

restrictive practice that:

• ensures the safety of the adult or others; and

• having regard to the previous point, imposes the minimum limits on the freedom of the adult

as is practicable in the circumstances.

Now let us explore the different types of restrictive practices in more detail.

Containment

If the person, in response to a behaviour that causes harm, is being physically prevented from freely

exiting the premises where he or she receives disability services, other than by being secluded (see

Seclusion below), this may mean he or she is being contained.

An example of containment

Ken is a 35-year-old man with an intellectual disability who lives in his home with support staff. Ken

has been known to leave his home without support staff and will try to take soft drinks from the local

shop. When the shopkeeper tries to stop Ken he gets upset and hits the shopkeeper, Support staff

have been keeping the front door to his home locked to stop Ken from freely leaving his home without

support staff and preventing Ken from going to the shop.

Seclusion

If the person, in response to a behaviour that causes harm, is being physically confined alone, at

any time of the day or night, in a room or area from which he or she cannot freely exit, this may mean

he or she is being secluded.

An example of seclusion

Kathy receives 24-hour accommodation support. She lives with three other women. When she and

her flatmates are leaving for work in the morning, she can become upset when she feels rushed and

unable to take her time to get ready and hurts other people. When his happens, Kathy’s support

worker locks Kathy in her bedroom until she calms down. This action is a restrictive practice as Kathy

is being secluded.

Chemical restraint

Chemical restraint is the use of medication for the primary purpose of controlling the adult’s

behaviour in response to behaviour that causes harm to the adult or others. It is important to note,

however, that using medication for the proper treatment of a diagnosed mental illness or physical


condition is not chemical restraint. For the purpose of this definition, an intellectual or cognitive

disability is not a physical condition. Diagnosed means a doctor has confirmed the adult has the

mental illness or physical condition. Mental illness is defined in Section 12 of the Mental Health Act

2000.

If a person is being given medication for the primary purpose of controlling his or her behaviour, this

may mean he or she is being chemically restrained.

Using medication in the following situations are not considered chemical restraint:

• for the treatment of a diagnosed mental illness or physical condition

• using medication e.g. a sedative, prescribed by a medical practitioner to enable the adult to

receive a single instance of health care under the Guardianship and Administration Act

2000.

An example of chemical restraint

Stacey is a 55-year-old woman who lives in shared accommodation with two other women. Support

workers visit Stacey and her housemates to support them to do their shopping or visit doctors.

Sometimes, when her housemates are running late, Stacey gets angry and hits them. If the women

are running late, and the support workers see Stacey getting angry, they give Stacey her medicine.

This medicine has been prescribed by Stacey’s doctor to calm her down and stop her from hurting

others.

Mechanical restraint

Mechanical restraint is the use, for the primary purpose of controlling the adult’s behaviour, of a

device in response to the adult’s behaviour that causes harm to the adult or others:

• to restrict the free movement of the adult; or

• to prevent or reduce self-injurious behaviour.

However, the following are not mechanical restraint:

• using a device to enable the safe transportation of the adult — for example, a harness or a

seat belt cover

• using a device for postural support

• using a device to prevent injury from involuntary bodily movements, such as seizures

• using a surgical or medical device for the proper treatment of a physical condition; or

• using bed rails or guards to prevent injury while the adult is asleep.

An example of mechanical restraint

Rebecca is a 20-year-old woman with a profound intellectual disability. Rebecca has a history of

sucking on her hands. This has led to significant injury to her hands. In order to prevent her from

sucking on her hands, Rebecca wears gloves on her hands while she is awake.




Physical restraint

Physical restraint is the use, for the primary purpose of controlling the adult’s behaviour, of any

part of another person’s body to restrict the free movement of the adult in response to the adult’s

behaviour that causes harm to the adult or others.

An example of physical restraint

David is a young man with autism and an intellectual disability who lives in supported

accommodation. David has a set plan of things to do each day. Sometimes when these plans change

David can get upset and begins to hit his ear with his fist. When support staff see David hitting himself

they hold his arms down to stop him from hurting himself. When David relaxes and feels comfortable

again the support staff let go of David’s arms.

Restricting access to objects

Restricting access is restricting the adult’s access, at a place where the adult receives disability

services, to an object in response to the adult’s behaviour that causes harm to the adult or others to

prevent the adult using the object to cause harm to the adult or others.

An example of restricting access to objects

Ivy is a young woman who has an intellectual disability. Ivy has been known to set fires around the

house when she finds matches or lighters. To keep Ivy and other people safe in the house, the

matches and lighters are kept locked away in the cupboard, which Ivy is unable to access.

How will an adult with a disability be assessed?

If a restrictive practice is being used or considered as the least restrictive way of ensuring the safety

of your family member or others an assessment must be done to:

• work out the nature of the behaviour

• what contributes to the behaviour occurring; and

• recommend strategies to reduce the behaviour and improve quality of life.

For containment and seclusion an assessment must be completed by at least two people

appropriately qualified or experienced in different fields. For physical, mechanical or chemical

restraint, the person must be assessed by at least one appropriately qualified or experienced person.

If the person is only using community access or respite, the service provider is not required to have

them assessed by an appropriately qualified person but must still complete a risk assessment.

Once an assessment is completed the person’s service provider will talk to the guardian about how

they will develop a positive behaviour support plan. They will need to see approval or consent if they

still propose to use a restrictive practice when supporting the person.


Positive behaviour support plan

Service providers must develop a positive behaviour support plan following the assessment of an

adult with disability.

A positive behaviour support plan must include:

• the strategies that will be used to:

o meet the adult’s needs

o support the development of skills

o maximise opportunities through which the adult can improve their quality of life.

• a detailed description of the behaviour including triggers

• the positive strategies that must be tried before using a restrictive practice

• a description of how the restrictive practice is the least restrictive option to keep your family

member and others safe

• how to use the restrictive practice, including how it will be monitored to make sure it is safe

• when the restrictive practice will be reviewed (must be at least once a year).

Some restrictive practices will have extra requirements - for example, if a service provider is

containing or secluding a person, the plan has to include suitability of the environment and the

maximum amount of time the person can be contained or secluded. Chemical restraint, details of

the medication, how it is to be taken and the name of the prescribing doctor must be included.

Who can approve restrictive practice?

The table below provides a guide of the level of approval required for each type of restrictive practice,

although this may vary in certain circumstances, for example, if the person is only using community

access or respite services.

Restrictive Practice Who can approve?

Containment or seclusion Queensland Civil and Administrative Tribunal (QCAT)

Chemical restraint The guardian for restrictive practice matters who is

appointed by the Queensland Civil and Administrative

Tribunal (for example, a family member, friend, adult

guardian or other public official)

Note: Any decisions made by the guardian will be reviewed

by the Queensland Civil and Administrative Tribunal (QCAT)

Mechanical restraint

Physical restraint

Restricted access to objects A relevant decision maker if there is no guardian for

restrictive practice matters


Reporting unauthorised restrictive practices

The department requires any unauthorised use of restrictive practice within the services operated

by Accommodation Support and Respite Services (AS&RS) to be formally reported to Ethical

Standards unit within the department

Unauthorised restrictive practice is a restrictive practice that is used and

• which is not approved or consented to

• is not included in an approved Positive Behaviour Support Plan

• while a Positive Behaviour Support Plan is in place the restrictive practice used is outside of

approvals and consent periods

• is not an unforeseeable one-off unplanned restrictive practice in order to keep a client and/or

others safe from harm.

Reporting the unauthorised use of a restrictive practice is a requirement of the Disability Services

Act 2006 and the Disability Services Regulation 2017 and demonstrates transparency and

accountability in facilitating the appropriate investigative and clinical assessment processes.

Steps in reporting the unauthorised use of restrictive practices:

1. Unauthorised use of a restrictive practice must be verbally

reported to the immediate line manager (Direct Services

Team Leader (DSTL) / Team Leader (TL) / AS&RS

Manager) prior to the end of the shift.

2. The Unauthorised Use of Restrictive Practices form is to be

completed and provided to the relevant immediate line

manager (as above) prior to the end of the shift.

3. Where an injury has occurred staff must complete a

Workplace Injury Illness and Incident Report Form (WIRF).

4. The unauthorised use of any restrictive practice must be reported by the AS&RS Manager

via email and verbal notification to the Director AS&RS, Principal Clinician (Quality &

Safeguards Behaviour Support during NDIS transition phase) in the region.

5. The AS&RS Manager or Team Leader, in conjunction with the Principal Clinician (Quality &

Safeguards Behaviour Support during NDIS transition phase) and in consultation with

decision maker or interested party, as advised, will determine whether the continued use of

the restrictive practice is necessary, or that the practice be ceased immediately and, if

necessary, identify other strategies that could be implemented. A multidisciplinary

assessment of the unauthorised use of any restrictive practice is recommended as part of

the process of determining that the continued use of the restrictive practice is warranted.

https://dccsds.cls.janisoncloud.com/pages/atlas-training-programs-core-skills-rco




Should a Short-Term Approval for consent to use the restrictive practice be required an

application for approval should be commenced (see below).

6. The Manager AS&RS will report the unauthorised use of a restrictive practice to Ethical

Standards DCDSS via email [email protected] and attach the

completed Unauthorised Use of Restrictive Practices form. This referral will enable Ethical

Standards to determine whether a potential criminal offence has occurred.

7. After assessing the details of the situation, Ethical Standards will provide advice to the region

/ appropriate manager on required actions, which may include:

• take no action (for example, if the situation has already been adequately addressed

locally)

• recommend additional local AS&RS management action

• undertake preliminary inquiries, or

• Ethical Standards to retain the matter and conduct a formal investigation.

Positive behaviour support versus restrictive and aversive behaviour support

As previously covered positive behaviour support is a way of responding to the behaviour of others

using positive strategies. These strategies are designed to find out why a person is demonstrating

the behaviour and provide them opportunities for learning and development to find other ways to

have their needs met and to learn alternative communication strategies to enable them to seek help

without the need to demonstrate behaviours of concern.

As previously discussed restrictive practices are practices which restrict a person’s free access to

all parts of their environment, including items or activities when used in response to the behaviour of

someone with an intellectual or cognitive disability that causes harm to the adult or others.

Aversive practices or punishments are not legal and breaches the person’s human rights. These

practices are breaking the law and inhumane, i.e washing a person’s mouth out with soap when the

person swears.

In the past, aversive practices have been used in attempts to modify the behaviour of concern of

some people with a disability particularly where the behaviour posed a threat to the safety of the

person with a disability and/or others. The very nature of this type of intervention is contentious.

More importantly, researchers and practitioners in the mid-to-late 1980’s demonstrated quite

conclusively that punishment (aversive practices) does not create lasting changes in behaviour.

Aversive practices are usually only effective in the short term, whereas long term sustainable change


in behaviour is achieved through positive, individualised environmental adaptations and the provision

of skill development opportunities.

Aversive practice imposes limitations on the ability of an individual to exercise freedom of movement,

are potentially abusive and a denial of human rights and therefore breaches the department’s code

of conduct, the Disability Services Act and ethical and legal questions as to their validity.

Responding positively to communication and behaviour

The key role of a support worker is to work with a person

in such a way that it leads to the person needing them

less. This means that support workers need to empower,

encourage and develop, educate, enable, inspire and

motivate. One of the key areas that any person, especially

someone with a disability, struggles with is

communication and coping strategies necessary to

manage daily life. Some support workers make the

mistake of waiting until a person shows signs of needing them before they provide support or

intervention. In your role, it’s essential that you try to anticipate needs and provide support prior to

the person having to demonstrate behaviour (which is essentially just communication) to acquire it.

Providing reinforcement regularly is one of the first, most positive steps in achieving this.

Reinforcement could be defined as anything that is positive to the person being reinforced.

Reinforcement is not just giving someone something or providing a reward. Reinforcement can

include spending time with someone or having some one-on-one discussion with someone and

making them the focus and center of the conversation. For people with disability who have minimal

social networks, or live with other people with disability and thus have to share the time with their

support workers with many others, one of the most reinforcing things can be providing them focused,

uninterrupted one-on-one time to read a book, look at a magazine, chat about their day, or do some

cooking. Providing this time is an excellent way of developing rapport, supporting strong relationship

building and encouraging positive responses from the person.

In behaviour worlds, when you reinforce someone without them having to do something to get the

reinforcement, it’s called non-contingent reinforcement. Non-contingent reinforcement is a powerful

strategy within the field of applied behaviour analysis and a key component of the positive behaviour

support realm. Essentially if you provide someone with reinforcement which is not contingent on their

behaviour, then you are increasing the quality of their life in that moment and not leading them to

have to seek out the reinforcement using whichever method of communication or behaviour they

may need to. Their needs are met, and they are likely to feel supported and valued.


The central component to the positive behaviour support and person-centred framework is to provide

education, reinforcement, coping strategies and life strategies that lead the person to have their

needs met, increase the general and overall quality of their life, manage difficult situations and not

need to communicate in such a way that it’s considered problematic by those around them. In order

to do this, there are a few things that support workers need to be able to do.1

Factors to consider when providing support

Below are some factors that can contribute to a person demonstrating a behaviour of concern and

support strategies to assist in reducing them?

Type of factor Contributing factors Support strategies

Medication Side effects of medication can cause

the person to become sick, weak,

withdrawn, unable to communicate

effectively, excited, or other adverse

reactions.

Regular medical check-ups with

their health professional.

Understanding the side effects of

medication and how it interacts

with other medications.

Physical or

health

Health can contribute to a person’s

behaviour as, if the person is unwell,

then they are less likely to want to

participate and less tolerant of others.

If the person is in pain, then in some

cases, the only way to show this is

through aggression.

Regular medical check-ups with

their health professional.

Fulfilling the client’s health needs

i.e. adequate nutrition, hydration,

exercise, relaxation, medication if

required, and sufficient sleep

Emotional or

psychological

If a person is down, or worried, or

upset about something, then naturally

this will affect their behaviour. Many

people with a disability who struggle

to communicate with people in a way

that others can understand, often

endure significant emotional ups and

downs with little or no support from

others. Furthermore, the presence of

Regular reviews of the Positive

Behaviour Support plan with the

clinical physiologist can ensure

that the effective support

strategies are in place for the

person.

Mental well-being may be

enhanced by social and family

1 Information taken from TAFE Queensland CHCDIS002 Follow established person-centred behaviour supports learner guide


Type of factor Contributing factors Support strategies

mental health issues can often be

masked by intellectual impairment

and people and medical

professionals can miss vital and key

information which was veiled by

behaviour determined to be ‘due to

their impairment’ or ‘because they are

difficult to provide support to’.

contacts, activities of interest, a

clean comfortable environment

etc.

Providing a safe environment

Provide encouragement regularly

and be the source of inspiration if

you see signs that they are feeling

down or losing interest.

Encourage the person to try new

things and be excited with their

life and choices.

Environmental These are broad and extensive and

relate in so many ways to behaviour

and coping mechanisms. Some

people with an intellectual

impairment, which affects their

sensory pathway (such as people

with autism), often struggle with

different environments, noise, sudden

changes or different staff. Changes to

routine, layout of the home/bedroom

and various other situational changes

to the way furniture is placed, can

pose difficulties for people who rely

on things to remain the same. Other

environmental factors can include

general presence of noise or stimulus

or, even quietness.

Regular reviews of the Positive

Behaviour Support plan with the

clinical physiologist can ensure

that the effective support

strategies are in place for the

person.

Reviews of the communication

strategies that the person uses.

Unmet needs are needs that a person have not manage to satisfy yet.

Just like there are physical needs such as the need to eat or the need to sleep

there are psychological needs that people must satisfy in order to feel good.

Indicators of unmet needs are:

• person shows signs of agitation or frustration

• changes in behaviours – especially behaviours of concern

• reluctance to undertake preferred routines and activities


• changes in physical health and wellbeing such as unexplained weight loss, avoidance of

social contacts, or sleep patterns disturbed.

Factors which can lead a person with a disability to feeling depressed, isolated, and

anxious or devalued include:

• rejection

• poor transport access

• isolation and segregation

• insufficient service provision

• health and nutrition issues

• insufficient resources (money)

• aversive or restrictive responses to

their behaviour

• lack of access to communication

devices, specialists or medical

professionals

• not being acknowledged

• lack of respect for their culture.

background

• staff who cannot

communicate with them

• food/drink they don’t

enjoy or doesn’t suit

them

• not having their needs met

• lack of access to meet their spirituality

and/or religious preferences

• inability to access their friends and/or

family

• lack of access to partners and/or

sexuality/relationships.

You can minimise the impact by utilising the below support practices:

• helping the person to be included socially

• encouraging the person to stay positive and

providing inspiration and motivation to keep trying,

despite adversity

• ensuring that planning is done appropriately and

that the person is an integral part of their planning

process

• helping the person navigate through service

provision, resource, financial and issues pertaining to

inequity

• providing support that is positive, strengths-based and centred around the person’s needs,

wants, goals and individual preferences

• providing a predictable and consistent routine and environment

• planning a schedule of interesting and enjoyable activities to keep the person occupied both

at home and in the community

• identifying and teaching the person the skills needed to help with activities at home and in

the community

• making sure the person is ‘praised’ using positive reinforcement for good behaviour

• working out the best ways to teach the person and praise using positive reinforcement


• supporting the person to keep regular friends and family contact, and to make new social

contacts

• making sure the person’s health and any medical conditions are reviewed when necessary

• learning to recognise the signs that the person is becoming unhappy or upset

• learning what calms the person down quickly so that the challenging behaviour doesn’t

happen

• having a good understanding of the person’s Positive Behaviour Support Plan so that you

understand what action to take when a challenging behaviour occurs

• having a good team approach with other work colleagues in the RCO Team.

Specialist Services

There will be times where the person you are supporting needs change. This may require a specialist

referral.

The below are some examples of specialist services you can refer the person you are supporting to:

1. Speech Pathologist to help with speech/developing or reviewing communication aids or

reviewing mealtime management plans.

2. Occupational Therapist to assist with lifestyle modification equipment or assistive technology.

3. Psychologist or Behaviour Analyst to develop and review positive behaviour support plans,

help manage trauma, develop coping strategies or talk through difficult decisions or

situations.

4. Medical practitioners such as Doctors, Neurologists, Gastroenterologists and Dentists can

also be necessary points of referral, depending on the nature of the person and what support

they require.

The department’s referral process:

1. identify what type of referral is needed

2. speak to the DSTL/ TL about the need

3. DSTL or TL will process the referral request

Speak to an experienced Residential Care Officer (RCO) or the (DSTL) or (TL) if you need assistance

with organising the referral.

Coordinating services

National Disability Insurance Scheme (NDIS) and Disability Support of Older Australians (DSOA)

fund a range of supports and services which may include education, employment, social

participation, independence, living arrangements and health and wellbeing. These services can be

accessed to improve a person’s quality of life. How these services are coordinated depends on how

the person is funded.


NDIS participants

Most NDIS participants over seven years of age will have a Local Area Coordinator

(LAC) to help them understand and implement their plan. This includes showing

participants and their decision maker how to use the myplace portal and connecting them with funded

supports. LACs support participants throughout their plans to monitor how the plan is going, and

they can check progress regularly.

LACs come from organisations in the person’s local community, which work with the National

Disability Insurance Agency (NDIA) to deliver the NDIS. The NDIA is an independent statutory

agency whose role is to implement the National Disability Insurance Scheme (NDIS).

If LAC Partners are not available in the local area, or the person needs more help coordinating

their supports and services, the NDIA may fund a Support Coordinator in their NDIS plan. A

Support Coordinator will support the person and their decision maker to understand and implement

the funded supports in their plan and link them to community, mainstream and other government

services. A Support Coordinator will focus on supporting the person to build skills and direct their

life as well as connect them to providers.

The Support Coordinator will assist the person to negotiate with providers about what they will offer

the person and how much it will cost out of their plan. Support coordinators will ensure service

agreements and service bookings are completed. They will help the person build their ability to

exercise choice and control, to coordinate supports and access their local community.

They can also assist the person in planning ahead to prepare for their plan review.

Support coordinators will assist the person to 'optimise' their plan ensuring that they are getting the

most out of their funded supports.

If the person is unhappy with supports, they are receiving from their service provider, provide

feedback on the concerns to the Team Leader who will contact the LAC or Support Coordinator to

follow up on any issues.

https://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwi8tMG2z5ngAhVKfSsKHZIQByMQjRx6BAgBEAU&url=https://geelongindy.com.au/news/21-09-2018/trips-waste-vital-disability-money/&psig=AOvVaw1OgKSuAsjJmHmjnMCiq3qY&ust=1549079077654360


DSOA individuals

The Individual Support Package agreement is to be completed every 2 years and the action plan to

be reviewed annually.

The review is conducted every 12 months and is to

include:

• what is working or not working

• any changes in abilities of the client and the

impact these changes have

• changes to the types of clinical supports

• changes to the abilities of the individual in

accessing their home environment or the

community.

DSOA service coordinators prepare ‘Plan Review

Reports’ for DSOA clients. These reports cover areas

such as: current plan, daily life, goal review and new

plan goals. Service coordinators will contact AS&RS for

their feedback in this report.

The review can be completed by the TL in a Team Meeting once they have received feedback from

the individual’s relevant stakeholders.

Support team responsibilities

Each member of the support team has responsibilities when dealing with the person’s individual

planning requirements.

The supports coordinator/service coordinator is an external party to the department and has the

following responsibilities:

• develop an Individual Support Plan (ISP) with the client and their relevant others

• deliver disability services directly to the client and/or subcontract other disability service

providers to deliver services under the client’s ISP

• review the services provided to the client annually (or more often if required) to ensure they

are meeting the client's needs

• organise change of needs applications, including confirmation of appointment for

independent assessments, where appropriate

• manage the administration of grant funding (including reporting)

• ensure the quality and safeguard requirements of the NDIS/DSOA Program are met


• notifying the service provider representative i.e. DSTL/TL of emerging issues during the

development, implementation and monitoring or review of each client’s files

• DSOA program funding is provided via a grant funding arrangement and payments will be

quarterly in advance.

Coordinating Officer (CO) responsibilities include:

• coordinating the annual reviews

• coordinating the completion of the Resource – Individual Planning Booklet

• coordinating the writing of plans and other required accompanying documentation

• notifying the DSTL of emerging issues during the development, implementation and

monitoring or review of each client’s files.

Residential Care Officer (RCO) responsibilities include:

• contribution to the development, implementation, and review of support plans

• follow the individual support needs process including the completion of the required

documentation using approved documents

• Maintain daily recordings into the client’s file and health file.

Direct Services Team Leader (DSTL) responsibilities include:

• supervising the development, implementation, monitoring and review of all individual

support plans for clients

• ensuring that supporting the individual needs of the person takes a developmental model

approach and balances the least restrictive alternatives with duty of care obligations

• ensuring the approval process for the individual support plan has been completed

• ensuring any additional training is completed, and that any additional resources have been

approved before relevant plans are implemented

• complete and maintain a schedule for all clients they are responsible for, and when reviews

have last occurred, and when reviews are to occur again

• notifying the Team Leader if a client requires an additional review because of significant

changes to the client’s life circumstances, and

• notifying the Team Leader of emerging issues during the development, implementation,

monitoring or review of each client’s individual support plans.

Team Leader (TL) responsibilities include:

• developing Service Agreements for all clients

• working with the Coordinating Officer (CO) for each client

• overseeing the development, implementation, monitoring and review of individual support

plans and notifying the Service Centre manager of any issues.

• ensuring that supporting the individual needs process takes a developmental model


approach and balances the least restrictive alternatives with duty of care obligations,

• ensuring any additional training is completed, and that any additional resources have been

approved before relevant plans are implemented

• acquiring knowledge and understanding of AS&RS registration groups as a registered

provider under NDIS Services and sharing this knowledge with all support staff.

Incidents and reporting

An incident is an unplanned or unwelcome occurrence, which doesn’t result in property damage,

minor injury, severe injury or death. An accident is an unplanned or unwelcome occurrence, which

results in property damage, minor injury, severe injury or death.

Work related incidents are events in the workplace that include:

• a near miss incident where a person was not injured but there was potential for serious

injury or illness e.g. a person slips on a wet floor but does not sustain an injury

• a person suffering a work injury or work caused illness e.g. a person slips on a wet floor

and strains their lower back

• a notifiable incident defined under the Work Health and Safety Act 2011 with specific

reporting requirements to Workplace Health and Safety Queensland (WHSQ) and means a

death of a person; or a serious injury or illness of a person; or a dangerous incident.

Incidents and /or accidents are usually caused by a combination of factors and rarely have a single

cause. These factors can lead to unsafe acts and conditions known as contributing factors.

Contributing factors can include:

• Workplace and task design

• Management of work

• Tools and equipment; and

• Worker skills, experience, capability, motivation, and behaviour.

What is incident management and why is it so

important?

Workplace health and safety incident management is the response strategy to those unplanned

events that occur within the work environment that may, or may not, cause injury or illness to

employees. It is the process of ensuring that once those unplanned events occur, action is taken to

minimise any recurrence thereby greatly minimising the risk of further injury to others.

Incident management is an essential process for the effective prevention, treatment and

management of hazards and risks in the workplace. The process includes:

• the recording, reporting, investigation of work-related incidents and


• early intervention activities for employees experiencing symptoms of injury or illness that

could increase the risk of a work-related incident e.g. a person experiencing headaches

possibly due to inadequate/inappropriate lighting for computer-based tasks.

• What is incident management and why is it so important?

When, and how, does a work-related incident need to be

reported?

All employees are required to report work related incidents using a Workplace Injury, Illness and

Incident Report Form (WIRF). For a client a Client Report Form (CRF) is required to be completed.

Any identified workplace hazards that require management action should be reported. Using a

system of Health and Safety Hazard Report forms.

A CRF and WIRF hard copy versions are available in all work areas.

An employee who experiences a work-related incident is required to:

• where possible, make immediate verbal notification to their Team Leader (or on call

arrangements for employees after core business hours) shortly after the occurrence –

seeking first aid or medical treatment is a first priority if injured

• complete a WIRF and submit to their Team Leader on the same day

• when unable to submit a WIRF on the day of the occurrence, a WIRF must be completed

and submitted within two days

• provide additional information about the work-related injury, illness or incident as requested

by their manager to assist the incident investigation and requirement for corrective actions.

Where an employee is unable to complete the WIRF within two days due to injury or illness (e.g.

employee is unable to write due to a hand injury and is not expected to return to the workplace in

the immediate future), the Team Leader must liaise with the employee and complete the form on

the employee’s behalf.

What is required after a work-related incident has been

reported?

Team Leaders need to:

1. Contact the employee in response to a work-related incident as soon as practicable and

• check on their wellbeing, discuss injury management processes and refer them to EAS,

as required

• gather further information on the actual incident so action can be taken to minimise

reoccurrence; and

• follow up on any incomplete or incorrect information provided on the WIRF.

https://cdssintranet.root.internal/resources/dcdssintranet/forms-templates/human-resources/health-safety/workplace-injury-report.pdf

https://cdssintranet.root.internal/resources/dcdssintranet/forms-templates/human-resources/health-safety/workplace-injury-report.pdf


2. Confirm if any other employees/clients have been impacted by the incident. If yes, consider

what interventions are required to support these others.

3. Confirm that the environment has been made safe for others.

4. In consultation with Safety, Wellbeing and Injury Management (SWIM) Regional / Human

Resources and Ethical Standards (HRES), the Team Leader will need to determine whether

the work related incident is deemed a notifiable incident under the Work Health and Safety

Act 2011 and follow the reporting requirements for notifiable incidents.

5. Complete an incident analysis of the work-related incident in Part B of the WIRF.

The completed WIRF should be forwarded (within two days) to the SWIM Advisor who will:

• contact with the employee if they are absent from the workplace as a result of the incident to

offer assistance with return to work

• complete Part C of the WIRF after reviewing the information provided by the employee and

the incident analysis.

The SWIM Advisor will make recommendations, including further investigation as necessary, based

on the information provided and actions to date, seriousness of the incident and health and safety

risk to others.

6. Once the WIRF is completed, you should ensure feedback is provided to the employee on

what actions have been taken to resolve any identified health and safety issues and prevent

a recurrence in the workplace.

© Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships Version 2.3 – March 2021 Person-centred behaviour support learning resource 31 of 57

Critical incident reporting

A critical incident can be defined as any event that has a stressful impact sufficient to overwhelm the

usually effective coping skills of an individual.

Critical incidents are abrupt, powerful events that fall outside the range of ordinary human experiences.

The department has a Critical Incident Reporting (CIR) Policy and Procedure which has two Critical

Incident types

These procedures aim to ensure all critical incidents are reported to the appropriate management level

in a timely manner and dealt with appropriately by all staff involved.

Definitions of critical incidents are described in two levels - critical incidents and major incidents.

Reporting requirements

Who is responsible for reporting a critical incident?

• Any staff member who is involved in, witnesses, or has a critical incident brought to their

attention must promptly report the critical incident to their supervisor and complete the

appropriate documentation.

• Critical Incident Reports are completed online in the Critical Incident Reporting Management

System (CIRMS) by the following staff:

o Team Leader

o Direct Support Team Leader

o Direct Service Support Officer (DSSO) or On-Call (after hours).


Who should the critical incident be reported to and by

when?

Completing a Critical Incident Report Form

All staff with intranet access can submit a Critical Incident Report (CIR) on the Critical Incident Reporting

Management System (CIRMS).

Details of the incident should be succinct, but should have sufficient detail and contextual information

to enable the report to be understood as a stand-alone record

Details of each client/subject associated with the incident must be included in the CIR individually (e.g.

subject child, service user, support worker, parent and departmental officer). Ensure to list the service

centre with the case responsibility.

Complete this process within 31 hours, otherwise applications saved as pending will be deleted and all

data input will be lost. An automated email alert will be sent to the submitter after 12 hours if a report

hasn’t been finalised.

Follow up actions, updating and closing a critical

incident report

Following submission of the CIR form, the Regional Executive Director or Regional Director may provide

direction in relation to the need for any follow up actions. Alternatively, departmental staff may need to

initiate follow-up activities and provide updated information.


A critical incident will be moved to ‘closed’ status by the Governance team only when there is sufficient

information in the report to indicate the critical incident event has been/is being appropriately managed

or resolution has been reached.

Online System Failure

Although unlikely, there may be times when access to the online Critical Incident Reporting

Management System (CIRMS) is not available due to system failure. In those instances, the following

process should be followed.

• instigate the verbal notification process as per Section 3

• complete a manual critical incident form

• fax or email the completed form to relevant officers including the Governance team

([email protected])

• complete the online CIRMS form once access is restored.

Example of Critical Incident Reporting

Scenario

On Monday 28/10/19 Jenny Smith is on shift (7am to 7pm) supporting two (2) clients Peter Jones

(26/08/72), Helen Rymer (16/11/64).

Address: 15 Coffee Street, Crestmead. 4123 Phone number: 3805 0000

Team Leader: Sally Fields Manager: Bob Hope

At 12:30pm while assisting Helen and Peter to prepare their lunch, Jenny receives a phone call

from Peter’s day placement informing her that his outing has been cancelled. Jenny informs Peter

that his outing has been cancelled, Peter shouts “No! No!” and proceeds to grab the saucepan of

hot soup of the stove and flings it across the room. The hot soup splashes all over Helens legs and

she screams in pain. Jenny uses the strategies outlined in Peter’s PBSP and redirects Peter to his

room.

Jenny applies first aid to Helens burns but come to realise they are too severe for just first aid and

that she needs to call an ambulance. At 12:38pm she contacts Sally her Team Leader and informs

her of the critical incident and that Helens burns are severe, and she needs to go to hospital for

treatment. Sally agrees and asks you to call an ambulance and keep applying first aid until they

arrive. Sally informs Jenny that she will arrange for staff support at the hospital. She will also

contact the Service Centre Manager Bob and inform him of the incident.

Jenny spends some time chatting with Peter and assists him to calm himself as he is very

distressed that he hurt Helen and is very worried that she had to gone to hospital.

Later that afternoon Sally calls Jenny to offer support and completes a debrief conversation with

her in regard to the incident. She asks her to ensure all the relevant documentation is completed

mailto:[email protected]


and indicate they will commence a review of Peters PBSP. Sally supplies Jenny with the contact

details for EAS for her to access counselling service if required.

Over the following pages you will find examples of the completed forms.

Client Report Form

This form is to be completed by an AS&RS Officer using respectful language. The details of the incident must be clear, factual and legible and contain what you observed and/or heard and/or have been told. This form must be submitted to the Team Leader as soon as possible after the incident occurs. Additional pages can be used if required. Please contact your team leader if you require assistance when recording the information in this form.

Part A - Details of the incident Name and date of birth of Client Helen Rymer, 16/11/64 Address of Client 15 Coffee Street, Crestmead. 4123

Date of Incident 28/10/19 Time of Incident 12:30pm

Location of Incident Kitchen

Name of AS&RS Officer Jenny Smith Signature J Smith

Shift time of AS&RS officer 7x7pm Work Location 15 Coffee Street

Reported To: Sally Fields Time and Date 28/10/19 12:38pm

Include the following information in your report 1. Background Information – What happened leading up to the incident 2. What is the incident – describe what occurred 3. People involved – Name the clients and/or staff and/or any other people involved

in the incident 4. Names and times of anyone contacted 5. Instructions provided – Describe instructions provided, including times 6. Outline any actions taken and by whom:

At 12:30 pm when making lunch with Peter and Helen I received a phone call from Peters

day placement cancelling his outing.

I told Peter his outing was cancelled to which he replied “No! No!” and grab the hot

saucepan filled with soup of the stove and threw it across the room. Hot soup splashed

over both of Helens legs and she cried out in pain.

I took Helen to the bathroom and applied first aid to her legs by running cool water on the

burns. Due to the size and severity of the burns I called an ambulance. At 12:38pm I called

Sally Fields my team leader to inform her of the incident and the severity of Helens burns,

she agreed with my assessment of the burns and that an ambulance was needed.

Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships


Sally informed me she would organise support for Helen for when she arrived at the

hospital and she would contacted Bob Hope the Service Centre Manger to inform him of

the incident.

Helen was transported to hospital where she had a burn assessed and treated.

Privacy Notice The Department of Communities, Disability Services and Seniors collects personal information for the provision of disability support services. Your personal information (which may include that of a representative or guardian acting on your behalf), held by the Department of Communities, Disability Services and Seniors may be used or disclosed to non-government disability service providers, health service providers or to Commonwealth, Queensland or other State government departments and agencies for the provision of disability services. Your personal information will be managed in accordance with the Information Privacy Act 2009.



Checklist of information included in this CRF. Have you YES NO NA

1. Completed Part A - Details of the Incident?

2. Described what occurred?

3. Named the clients and/or staff and/or any other people involved in the incident?

4. Named anyone you contacted and the time you contacted them?

5. Described any instructions you provided and the time you provided them?

6. Outlined any actions taken by you or anyone else involved?

7. Reported the incident to a Team Leader?

8. If the incident occurred outside of business hours, was the incident reported to after-hours staff?

Comments:

The original CRF is to be filed in the Client file held at the house.

The CRF with the Team Leader’s response to be filed in the Team Leader Client File and if appropriate copy to be sent to the client.


Additional Information: Please provide any additional information relevant to the incident



Team Leader Use Only

Part B – Response to the incident by Team Leader AS&RS Team Leader responding to the report

Signature

Date

Response: Briefly describe the response to this incident

Action: Briefly outline (a) any actions taken in response to this incident, (b) who is responsible for taking the action and (c)

timeframe for the action to be finalised

Follow Up: Identify if any further action is required.

Team Leader name and signature:

Date






Client Report Form

This form is to be completed by an AS&RS Officer using respectful language. The details of the incident must be clear, factual and legible and contain what you observed and/or heard and/or have been told. This form must be submitted to the Team Leader as soon as possible after the incident occurs. Additional pages can be used if required. Please contact your team leader if you require assistance when recording the information in this form.

Part A - Details of the incident Name and date of birth of Client Peter Jones, 26/08/72 Address of Client 15 Coffee Street, Crestmead. 4123

Date of Incident 28/10/19 Time of Incident 12:30pm

Location of Incident Kitchen

Name of AS&RS Officer Jenny Smith Signature J Smith

Shift time of AS&RS officer 7x7pm Work Location 15 Coffee Street

Reported To: Sally Fields Time and Date 28/10/19 12:38pm

Include the following information in your report 7. Background Information – What happened leading up to the incident 8. What is the incident – describe what occurred 9. People involved – Name the clients and/or staff and/or any other people involved

in the incident 10. Names and times of anyone contacted 11. Instructions provided – Describe instructions provided, including times 12. Outline any actions taken and by whom:

At 12:30 pm when making lunch with Peter and Helen I received a phone call from Peters

day placement cancelling his outing.

I told Peter his outing was cancelled to which he replied “No! No!” and grab the hot

saucepan filled with soup and threw it across the room. Hot soup splashed over both of

Helens legs.

I used the strategies outlined in Peter’s PBSP and redirected Peter to his room to either watch

Television or engage in an activity on his IPAD so I could attend to Helen.

I called Sally Field my Team Leader at 12:38pm to inform her of the incident. Sally asked

me to monitor Peter as the incident would be distressing for him and that she would

organise a review of Peters PBSP. Sally also informed me she would contact Bob Hope

the Service Centre Manger to inform him of the incident.



Checklist of information included in this CRF. Have you YES NO NA

13. Completed Part A - Details of the Incident?

14. Described what occurred?

15. Named the clients and/or staff and/or any other people involved in the incident?

16. Named anyone you contacted and the time you contacted them?

17. Described any instructions you provided and the time you provided them?

18. Outlined any actions taken by you or anyone else involved?

19. Reported the incident to a Team Leader?

20. If the incident occurred outside of business hours, was the incident reported to after-hours staff?

Comments:




Additional Information: Please provide any additional information relevant to the incident



Team Leader Use Only

Part B – Response to the incident by Team Leader AS&RS Team Leader responding to the report

Signature

Date

Response: Briefly describe the response to this incident

Action: Briefly outline (a) any actions taken in response to this incident, (b) who is responsible for taking the action and (c)

timeframe for the action to be finalised

Follow Up: Identify if any further action is required.

Team Leader name and signature:

Date





Critical Incident Reporting

Manual Form

Critical Incident Summary

To which area of the department does this incident, situation or event apply?

☐ Communities

☒ AS&RS

☐ FDS

☐ Qld Community Support Scheme

☐ Continuity of Support

☐ Seniors

Was verbal notification of the incident, situation or event immediately provided to Director?

☐ Yes

☒ No

Name of Director who was verbally advised 2 Time:

Referred to QPS? ☐ Yes

☒ No

Death referred to Coroner? ☐ Yes

☒ No

Name of person and/or organisation who notified the Police or Coroner (if applicable)

NA

Name of person completing critical incident form Jenny Smith

Position/role of person completing critical incident form Residential Care Officer

Are you completing the critical incident form on behalf of another departmental officer?

☒ No

☐ Yes

Date of Incident 28/10/19 Time of Incident 12:30 pm

Location of incident, situation or event

Address 15 Coffee Street,

Suburb/Town Crestmead. Post Code 4132

Category Level 1: Critical Incidents

Immediate verbal notification to the Director (or similar level officer) followed by critical incident report form to be submitted within four business hours of the staff member becoming aware of the incident.

Category Level 2: Major Incidents

Immediate verbal notification to the Manager (or similar level officer) followed by critical incident report form to be submitted by 5pm next business day of the staff member becoming aware of the incident.


Category Level 1: Critical Incidents

1.1 Death of a person

☐ Death of a person who is a client, carer or staff member

☐ Death of a person where another person subject to departmental

intervention, client, carer or staff member is allegedly involved in the death

☐ Death of a person while attending or using departmentally provided or

funded, services, facilities or activities

1.2 Life threatening or serious injury to a person

☐ Life threatening

Serious injury to a person where another client, carer or staff member is allegedly involved in the injury

☐ Life threatening

Serious injury to a person while attending or using a departmentally provided or funded services, facilities or activities

1.4 Abduction

☐ kidnapping of a person who is a client, carer or staff member

☐ kidnapping by a person who is a client, carer or staff member

1.5 Major security incident

☐ Major security incident or event involving an emergency response to a

hostage situation, fire, natural disaster, power failure, bomb threat or discovery of a bomb

1.6 Alleged rape, sexual assault or serious assault

☐ of a carer or client while attending or using departmentally provided or

funded services

☐ of a staff member while at work

☐ by a carer or client while attending or using departmentally provided or

funded services

☐ by a staff member while at work

1.7 Attempted suicide

☐ of a person who is a client of accommodation or respite provided or

funded by the department

☐ of, or by a person while attending or using departmentally provided or

funded services, facilities

1.8 Missing person ☐ a person is missing from their place of residence or respite which is

provided or funded by the department

1.9

Alleged abuse, neglect or exploitation of a person with a disability

☐ Alleged abuse, neglect or exploitation of a person with disability where

another client, staff member or direct carer is allegedly involved

☐ Alleged abuse, neglect or exploitation of a person with disability who is a

client of accommodation support provided by the department


Description of the incident, situation or event

Details of critical incident including agencies, services providers, organisations involved and taken action

When making lunch with Peter and Helen, I received a phone call from Peter’s day placement

cancelling his outing. When I informed Peter of the cancelation he proceeded to yell ‘No! No!”

and grabbed a saucepan of hot soup off the stove top and threw it across the room.

The soup splashed on to Helens legs and burnt her. I redirected Peter to his room as I applied

first aid to Helens legs. I rang Sally Fields to inform her of the incident and that I felt Helens

burns required hospital attention as they were severe, she agreed with my assessment and an

Ambulance was called to transport Helen to hospital for treatment.

Details of future actions proposed

Team Leader will commence a review of the Peters PBSP

Safety of other persons (including siblings, other clients) where relevant to critical incident

Helens legs were burnt when hot soups was splashed on to them. First aid was applied. An

Ambulance was called due to the size and severity of the burns and she was transported to

hospital for treatment.

Details of counselling services and/or supports in place where relevant to critical incident

Not required

Details of support and/or debriefing for departmental staff where relevant to critical incident

Sally Fields called and offered support and debriefed the incident. EAS service were offered.


Incident Management and Notification

Date of initial contact 28/10/19 Time of initial contact 12:30 pm

Reporting person (1) who notified the department

First name Jenny Last name Smith

Work phone 3805 0000 Mobile phone

Email

Reporting person (2) who notified the department

First name NA Last name NA

Work phone Mobile phone

Email

Has the incident been reported to the Queensland Police Service?

☒ No

☐ Yes

What is the QPS reference/referral number? NA

Emergency Services involved in the incident

☒ Ambulance

☐ Fire Services

☒ Hospital

☐ SES

☐ Other


Subject Details (person 1)

Subject Type Client

How was the Subject involved in the Critical Incident?

Helen receive burns to her legs when hot soup was splashed on to them. First aid was applied

by running cool water on the burns. To the size and severity of the burns Helen was required to

be transported to hospital for treatment.

Subject’s First Name Helen

Subject’s Middle Name NA

Subject’s Last Name Rymer

Alias (if known) NA

Subject’s Date of Birth 16/11/64

Subject’s Gender

☐ Male

☒ Female

Is this the Primary Subject?

☒ Yes

☐ No

ICMS Reference Number (if applicable) NA

Cultural Identity NA

Other Language NA

Subject’s primary place of residence


Suburb/Town Crestmead. Suburb/Town 4132

Service Area Responsibility

☒ Disability Services

☐ Community Services

☐ Seniors



Subject Type Client


Peter threw a saucepan full of hot soup across the room which went on to Helens legs.

Subject’s First Name Peter

Subject’s Middle Name NA

Subject’s Last Name Jones

Alias (if known) NA


Subject’s Gender

☒ Male

☐ Female


☐ Yes

☒ No



Other Language NA



Suburb/Town Crestmead. Suburb/Town 4132




☐ Seniors



Subject Type Departmental staff


I witnessed the incident, redirected Peter to his room and applied first aid to Helen. Contacted

Team Leader and advised of the incident and that I had called an ambulance.

Subject’s First Name Jenny

Subject’s Middle Name

Subject’s Last Name Smith

Alias (if known) NA


Subject’s Gender

☐ Male

☒ Female


☐ Yes

☒ No



Other Language NA


Address 19 Rainbow way

Suburb/Town Logan Reserve Post Code 4133




☐ Seniors



Subject Type


Subject’s First Name

Subject’s Middle Name

Subject’s Last Name

Alias (if known)

Subject’s Date of Birth

Subject’s Gender

☐ Male

☐ Female


☐ Yes

☐ No

ICMS Reference Number (if applicable)

Cultural Identity

Other Language


Address

Suburb/Town Post Code


☐ Disability Services


☐ Seniors


Example of Positive Behaviour Support Plan Summary

Below you will find what is known as the Positive Behaviour Support Plan Summary or “Traffic Light”.

This is simply a concise version of the person’s Positive Behaviour Support Plan. The information in

the positive strategies section (green) is just how the person should be supported. This gives you an

idea of what the person is like, how they communicate and what things they enjoy doing.

The early intervention strategies section (amber) describes how you need to respond if the person

begins to show signs of agitation, upset or aggression.

The final reactive strategies or crisis intervention section (red) has a list of strategies that are to be

used in the case of the person seriously losing control and exhibiting obvious Behaviours of concern”

Peter’s Positive Behaviour Support Plan Summary

Positive Strategies/Behaviour Support Things that are important to me (Peter):

• I have been diagnosed with Autistic Spectrum Disorder (ASD) and Epilepsy;

• I have limited verbal language skills. There is a COMMUNICATION DICTIONARY in my File –

please use this to assist in communication. I also use my iPad for communication;

• Maintaining a structured daily routine;

• A consistent routine in the morning when I am going on an outing;

• Visual prompt of activity for the day through the use of my iPad (i.e. picture of trains, eating, park,

toilet);

• Increased accessing of alternate activities, such as the park, swimming, sand play;

• Designated time when I can engage in a preferred individual activity (e.g. watching a DVD, jigsaws,

iPad);

• It is vital that I am told of changes to my normal routine immediately, as this will minimize the risk

of me engaging in self-injurious activities or acting out at others;

• Minimise impact of crowded/noisy environments;

• If the area to visit is normally busy, aim to choose times of the day when there is likely to be fewer

members of the public (e.g. visiting the shopping centre in the early morning as opposed to lunch

time);

• Choose public areas that have less competing stimulation if I am presenting with early warning

signs of becoming agitated (e.g. a quieter area of the park, with few other people nearby);

• Provide positive reinforcement for use of appropriate communication and social skills: e.g. if I sit

patiently waiting for staff to attend to my needs (even for a few seconds), it is important to

acknowledge my initial calmness with a thumbs up gesture or a pat on the back, prior to me

demonstrating frustration and agitation. This will reinforce my coping behaviours;

Early Intervention Strategies

When I begin to show signs of agitation/distress; which could include the following body cues:

• Screaming or loud vocalisations;

• Pushing people away;

• Straightening my arms (with tension) with forced vocalisations;

• Lunging towards others with fingers outstretched;

• Knocking things over; and

• Abruptly walking towards a person, with arms outstretched.

These body cues suggest that I may be feeling anxious, frustrated, upset or angry and I may escalate into

an episode of challenging behaviour.

At the first Signs of Agitation (as evidenced by behaviours above):


• Communicate with me to identify and acknowledge my need prior to me becoming further

distressed (i.e. ripping my shirt);

• If the source of my distress is not immediately obvious, use communication strategies (e.g.

communication book, emotions cards) to check what I am trying to communicate, and then

attempt to meet this need / want if possible;

• If I do not engage in staff attempts to communicate what I may need or want, it is

recommended that you attempt to determine my need or want via redirecting me to try

different activities;

• Engage in a joke with me as a form of distraction; and

• Have me move to a different section of the house to engage in an active behaviour as a

form of distraction (e.g.., use my iPad outside).

Then you should (if you feel that my behaviours are escalating) call my mum and dad (Karen and Brian)

and let me speak to them on the phone. They may be able to reason with me.

This is a list of things that may trigger my challenging behaviour:

• Interacting with unfamiliar people or environments;

• Unfamiliar people who are in close proximity to me;

• Being hungry;

• My feeling uncomfortable or embarrassed after soiling my incontinence aid;

• People failing to follow through with planned activities;

• People speaking immaturely or disrespectfully to me;

• My feeling frustrated or anxious;

• A lack of sleep/feeling tired; and

• People failing to inform me about upcoming activities or my schedule for the day.

Reactive Strategies/Crisis Intervention

If none of the above strategies have been successful and I begin to engage in physically aggressive

behaviours, the following responses should be implemented (these must be attempted prior to physical

restraint or seclusion):

• If I attempt to hit or kick anyone, staff should attempt to move themselves away from within my

reach;

• If staff are unable to move themselves out of the way, they should deflect my hand motion where

possible;

• Verbally prompt me to cease attempts to engage in the behaviours by telling me firmly and clearly

to stop (e.g. Peter “Stop hitting” or “Hands to yourself”) and provide praise if I cease the behaviour;

and

• If I continue to display the behaviours, where possible, guide me to a safe setting where the risk of

harm to others is minimised or remove other clients or dangerous items (e.g. things I could throw

at others) from within my vicinity. I should not be secluded in this safe setting.

Techniques

One Handed Grab to One Arm Release:

When I do not respond to a verbal command to stop and verbal negotiation, respite workers use their hands

or arms to remove my arms or hands from their person. Refer to the release description in the attachments.

Two Handed Grab to Two Arms Release:

Refer to the release description and photographs in the attachments.

If none of the above strategies have been effective and there is a risk of physical harm to others, then

SECLUSION can be used as a last resort.


Seclusion Protocol:

Staff should remove themselves and others to the kitchen or office area;

I must be visible through the glass and staff should monitor me for signs that I have calmed (e.g. if I sit on

the armchair or tap on the window for staff). I can only be secluded for 10 MINUTES IN A 24hr PERIOD.

When I have calmed I should then be fully supported to carry on with my day. It is important to fill out my

BEHAVIOUR RECORDING SHEETS as this informs people about the frequency and intensity of my

behaviours of concern. On-Call must be notified of any incidences of seclusion.

Seclusion Protocol

Emergency plan in response to physically aggressive

behaviours. (These must be attempted prior to

seclusion):

The following responses should be implemented when Peter has attempted to engage in physically

aggressive behaviour:

1. If Peter is observed to attempt to engage in any harmful behaviours (e.g. physical aggression,

property damage), firstly talk to him calmly and instruct him to put his hand down/stop biting his

shirt/stop spitting and walk away (to other area of the house.) in order to provide Peter the

opportunity to cease the behaviour independently;

2. If Peter attempts to hit or kick a respite worker, staff should attempt to move themselves away

from within reach of Peter;

3. If staff are unable to move themselves out of the way, they should deflect his hand motion where

possible; using a safer approach

4. Verbally prompt Peter to cease attempts to engage in the behaviours by telling him firmly and

clearly to stop (e.g. Peter “Stop hitting” or “Hands to yourself”). Redirect Peter to an activity e.g.

go for a walk in the garden or offer to watch his train DVD with him and provide praise if he does

cease the behaviour;

5. If Peter continues to display the behaviours, where possible, guide him to a safe area of the

home. where the risk of harm to himself and others is minimised or remove other clients or

dangerous items (e.g. things he could throw at others) from within his vicinity; and

6. If the above strategies have been implemented without success and Peter appears to be highly

agitated (as evidenced by loud vocalisations, physical agitation etc.) staff will remove themselves

and other service users into the kitchen or office area of the home for up to but not exceeding 10

minutes. Staff will continue to monitor Peter though glass windows while using Seclusion. Staff

will observe Peter for signs that he has calmed (e.g. sitting on armchair, tapping on window for

staff) at this stage staff would re-enter the common area and engage Peter with full support.

Once staff have ensured Peter is no longer agitated or elevated the other service users are

reengaged and encouraged to move back into the other areas of the house.


PLEASE NOTE: Seclusion must be used as a last resort and Peter can only be secluded for a

maximum of 10 minutes per 24-hour period.


Duty of care

Duty of care is a legal concept. A duty of care is a duty to take reasonable care to avoid causing

harm to another person (e.g. a person that you are supporting). A duty of care also exists when it

could reasonably be expected that a person's actions or failure to act might cause harm to another

person.

You have a general legal duty to take reasonable care to avoid causing harm to another person. As

a direct support worker within the human services sector supporting vulnerable or dependent people

you must exercise a higher level or care, diligence, and professional competence.

Sometimes issues may arise that challenge your duty of care to the person you assist, and their

dignity of risk. Work together with other staff, your line manager and significant others, as

appropriate, to develop strategies and identify solutions.

During the course of your work you will be required to make decisions based on the duty of care you

have to people with disability that you are responsible to support in your role. Here are some

examples:

• A person you are supporting falls and sustains a deep cut above his eye. You have a duty

of care to seek medical assistance for him and to follow the advice from the doctor e.g.

observe him, dress the cut, etc.

• You are halfway through a morning shift. One person you are supporting has been

intimidating another person during this period and is threatening to hurt him. You had planned

to go out with another person you support and leave the others unsupervised in their home.

However, on reading the individual’s PBSP this outlines that your role is to follow the plan

and support individuals. Duty of care to the other person is to contact and arrange for another

team member to go out with the other person. Because there’s someone at risk of being hurt,

you decide to stay.

Remember to follow departmental policy, practice and procedures for addressing specific incidents,

or issues that relate to duty of care. You must ensure incidents and decisions are documented and

appropriate people are informed or consulted in a timely manner. During handover ensure all vital

information is given to oncoming staff and ensure a note is written in the Report book directing

oncoming staff to read the person’s daily notes or the incident report. Do not hesitate to contact your

Team Leader if you are at all unsure or require assistance.


Dignity of risk

Dignity of risk refers to the right of all people to undertake some tasks that have a level of risk, the

idea that self-determination and the right to take reasonable risks are essential for dignity and self-

esteem and so should not be impeded by excessively-cautious caregivers, concerned about their

duty of care.

Allowing people under care to take risks is often perceived to be in conflict with the peoples’ duty of

care. Finding a balance between these competing considerations can be difficult when formulating

policies and guidelines for supporting people with disability.

Overprotection of people with disability causes low self-esteem and underachievement because of

lowered expectations that come with it. Internalisation of low expectations causes the person to

believe that they are less capable than others in similar situations.

The first of eight ‘guiding principles’ of the United Nations' Convention on the Rights of Persons with

Disabilities states:

"Respect for inherent dignity, individual autonomy including the freedom to make one’s own choices,

and independence of persons."

Social model of disability

According to the social model of disability, ‘disability’ is socially constructed.

The social model sees ‘disability’ is the result of the interaction between people living with

impairments and an environment filled with physical, attitudinal, communication and social barriers.

It therefore carries the implication that the physical, attitudinal, communication and social

environment must change to enable people living with impairments to participate in society on an

equal basis with others.

A social model perspective does not deny the reality of impairment nor its impact on the individual.

However, it does challenge the physical, attitudinal, communication and social environment to

accommodate impairment as an expected incident of human diversity.

The social model seeks to change society in order to accommodate people living with impairment; it

does not seek to change persons with impairment to accommodate society. It supports the view that

people with disability have a right to be fully participating citizens on an equal basis with others.

The social model of disability is now the internationally recognised way to view and address

‘disability’. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) marks

the official paradigm shift in attitudes towards people with disability and approaches to disability

concerns.


People with disability are not “objects” of charity, medical treatment and social protection but

“subjects” with rights, capable of claiming those rights, able to make decisions for their own lives

based on their free and informed consent and be active members of society.

What did this mean to us?

• places some responsibility for dealing with the impact

of disability back onto the community, rather than

solely with the person or their families

• places some responsibility onto the community for

supporting people with disabilities rather than solely

on the family

• emphasises the person’s right to participate in the

community

• recognises that attitudes and environments could inhibit community participation of people

with disability.

If a community is actively supporting the social model of disability, its members are looking for ways

of enabling independence and equity of community members including:

• good design of buildings for access to the front door, not making do with access

• information in a range of formats including Braille, audio, and plain English

• direct supports for everyday living; and

• education, awareness, and legislation to prevent unjust discrimination.

o Human Rights Act 2019 (Qld)

o Disability Services Act 2006 (Qld)

o Anti-Discrimination Act 1991 (Qld)

o Disability Discrimination Act 1992 (Cth)


References

Commonwealth Continuity of Support Programme. (2019, July). Retrieved from Department of

Health- Aging and Aged Care: https://agedcare.health.gov.au/programs-

services/commonwealth-continuity-of-support-programme

Complex communication needs booklet. (2018, September). Retrieved from Queensland

government: Better communication:

https://www.qld.gov.au/disability/community/communicating

Customer service compliments and complaints. (2018, November). Retrieved from Department of

Communities, Disability Services and Seniors: https://www.communities.qld.gov.au/about-

us/customer-service-compliments-complaints

Disability Services Act 2006 Qld. (2019, July). Retrieved from Queensland legislation:


Disability Services Regulation 2017. (2019, July). Retrieved from Queensland Legislation:

https://www.legislation.qld.gov.au/view/html/inforce/current/sl-2017-0099

Guardian for restrictive practices. (2018, March). Retrieved from Queensland Civil and

Administrative Tribunal (QCAT): https://www.qcat.qld.gov.au/matter-types/guardianship-for-

adults-matters/guardian-for-restrictive-practices

Guardianship and Administration Act 2000 . (2019, July). Retrieved from Queensland legislation:


Guide for families - Positive behaviour support and the use of restrictive practices. (2019, July).

Retrieved from Department of Communities, Disability Services and Seniors:

https://www.communities.qld.gov.au/resources/dcdss/disability/service-providers/centre-

excellence/a-guide-for-families-positive-behaviour-support.pdf

Information privacy guide. (2019, March). Retrieved from Department of Communities, Disability

Services and Seniors: https://www.communities.qld.gov.au/resources/dcdss/about-us/right-

to-information/privacy-guide.pdf

National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018.

(2018, May). Retrieved from Federal register of legislation:

https://www.legislation.gov.au/Details/F2018L00632/

Practice - Reporting unauthorised use of Restrictive Practices. (2019, August). Retrieved from

iLearn - ATLaS - AS&RS practices: https://dccsds.cls.janisoncloud.com/pages/atlas-

resources-as-rs


Procedure: Use of restrictive practices in general disability services . (2019, July). Retrieved from

Positive Behaviour Support/Department of Communities, Disability Services and Seniors:

https://www.communities.qld.gov.au/resources/dcdss/disability/disability-services-

act/procedure-restrictive-practices-general-disability-services.pdf

Restrictive practices: Publications and resources. (2019, July). Retrieved from Department of

Communities, Disability Services and Seniors:

https://www.communities.qld.gov.au/disability-connect-queensland/national-disability-

insurance-scheme/ndis-quality-safeguard-requirements-providers/restrictive-

practices/publications-resources

Social model of disability. (2019, September). Retrieved from People with disability Australia:

https://pwd.org.au/resources/disability-info/social-model-of-disability/

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