25/7/19 Slides are not for sharing/distribution without written permission of authors. 1 Restrictive Practices 101 for Therapists Ellie Koski (Speech Pathologist/BSP) and Stuart Koski (Psychologist) Slides are not for sharing/distribution without written permission of authors. Brief Overview of Topics What are Restrictive Practices? Restrictive Practices and NDIS Why are Restrictive Practices important? Critical Incidents Regulated Restricted Practices RPA Processes Case Example Useful Links/Resources Questions
Transcript
25/7/19
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Restrictive Practices 101 for Therapists
Ellie Koski (Speech Pathologist/BSP) and Stuart Koski (Psychologist)
Slides are not for sharing/distribution without written permission of authors.
Brief Overview of Topics
� What are Restrictive Practices? � Restrictive Practices and NDIS � Why are Restrictive Practices important?� Critical Incidents� Regulated Restricted Practices � RPA Processes� Case Example� Useful Links/Resources� Questions
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What are Restrictive Practices?
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Restrictive Practices - support strategies/practices that impose restrictions on a service users rights or freedom.
Restricted Practices - a distinct number of Restrictive Practices that have additional safeguards placed upon their use by Policy.
Prohibited Practices� Are practices which are abusive and constitute
assault or wrongful imprisonment.
� Include practices which may not be unlawful, but are unethical:
◦ Involve denial of access to basic needs or supports.
◦ Cause physical pain, serious discomfort or emotional distress.
◦ Degrade or demean the person with a disability.
◦ Are practices which are restrictive and used without lawful consent and/or authorisation.
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Restrictive Practices and the NDIS
� NDIS Quality and Safeguarding Framework (the Framework) was agreed by all States at the Council of Australian Governments (COAG) in December 2016.
� NDIS (Restrictive Practices and Behaviour Support) Rules 2018 introduced by the NDIS Quality and Safeguards Commission on1 July 2018.
� NDIS Quality and Safeguards Behaviour Support Capability Framework produced by NDIS Commission in June 2019 with Positive Behaviour Support Principles at the core of practice.
� Restrictive Practices Authorisation Policy v2 – June 2019, NSW policy document developed by FACS
� Restrictive Practices Authorisation Procedural Guide v2 – June 2019 guidance document developed by FACS
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Why are Restrictive Practices Important for us?
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Source: ABC – 7.30 Report (17 Aug 2016, 12:10am) by Louise MilliganLink: https://www.abc.net.au/news/2016-08-16/school-investigated-after-claims-boy-with-autism-locked-in-cage/7747494
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Responding to a Critical Incident � Crisis response refers to the actions taken by care givers in response to an
unpredictable crisis situation/critical incident.
� A Crisis Response may require the use of a Restricted Practice in order to prevent serious self-injury or harm to another person.
� The Crisis Response should involve the minimum amount of restriction or force necessary, the least intrusion, and be applied only for as long as is necessary to manage the risk.
� If the incident has the potential to be repeated and a restricted practice may again be used, planning in the form of a written interim strategy is required and a submission for interim RPA approval will need to be made.
� Crisis management cannot justify continued use of restricted procedures and is prohibited by policy.
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Specific Exceptions relating to Restricted Practice Authorisation
Specific exceptions where authorisation is not required when the practices are related to:
� therapeutic or safety measures ◦ Chemical Restraint for treatment of a diagnosed mental
disorder, physical illness or physical condition◦ Mechanical Restraint does not include devices for therapy
or non-behavioural purposes◦ Physical Restraint does not include hands-on techniques to
guide or re-direct a person away from potential harm/injury
� the management of unintentional risks
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Categories of Regulated Restricted Practices
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Regulated Restricted Practices
� Always developed in the context of Positive Behaviour Support Principles.
� The least restrictive alternative is always recommended.
� Use of a restricted practice may only be considered after a range of less restrictive options have been trialled and evaluated.
� The Restricted Practice Authorisation (RPA) Panel needs to approve the restricted practice and sets proper processes to review and monitor the restricted practices.
� Consent is essential – there is a guide in the policy for consent requirements that need to be considered depending on the person’s age, capacity to consent and the category of practice being implemented.
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Seclusion
The sole confinement of a person with disability in a room or physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted.
Physical Restraint
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The use of action or physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour.
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Mechanical Restraint
The use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour.
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Chemical Restraint
The use of medication or chemical substance for the primary purpose of influencing a person’s behaviour.
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Environmental Restraint
Restricting a person’s free access to all parts of their environment, including items and activities.
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Obtaining Authorisation for use of a Regulated Restricted Practice in NSW
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Behavioural Incident Occurs requiring Restricted Practice
Provider takes all reasonable steps to engage a behaviour support practitioner
Develop interim BSP (within 1 month) and lodge with NDIS
Commission
Develop comprehensive BSP (within 6 months) and lodge with NDIS
Commission (BSP) and FACS (Service Provider)
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Restricted Practice Authorisation
� Once submitted, a Restricted Practice Authorisation Panel must occur to approve the use of the practice.
� In NSW, RPA Panels are organised through FACS by the Provider recommending and/or implementing the practice.
� RPA Panel can give approval to a practice for up to 12 months, at which time BIS plan would need to be reviewed by a Behaviour Support Practitioner.
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Minimum Standards for Documentation � A description of the use of the regulated restrictive
practice� A description of the behaviour that led to use of the
practice � Times, dates and places for use of the practice (start
and end dates)� Names and contact details of those involved in use of
the practice� Actions taken in response to use of the practice� Other less restrictive options considered� Strategies used to prevent the need for use of the
practice
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Case Example - Jane
Jane has an intellectual disability. Her accommodation support provider has placed locks on the cupboards and fridges around her house to limit her access to food. This practice has occurred for years without review, with a high turnover of support workers. As a result of the recurring restriction, Jane begins to shoplift food to meet her needs. Jane’s sister, Barbara, discovers that Jane has been shoplifting and gets involved, soon discovering the locks placed around Jane’s house.
What happens next for Jane? � Barbara discusses her concerns with Jane’s Behaviour
Support Provider. � A routine review of Jane’s behaviour support plan notes that
this restrictive practice is not part of her plan. � When the NDIS Commission undertakes further queries, the
NDIS accommodation provider says the restrictive practice was done ‘for Jane’s own good’ because of her weight gain.
� The NDIS Commission works with Jane’s Behaviour Support Practitioner to review the situation.
� The Practitioner requests a medical review, finding that the drugs Jane is required to take are causing her weight gain, so there is no behavioural concern that would require locks on the cupboards.
� The Practitioner works with Jane’s support workers to educate them on Jane’s condition and refine Jane’s behaviour support plan.
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Useful Online Links/Resources� An Introduction to PBS video -
https://youtu.be/epjud2Of610� NDS Recognising Restrictive Practices: a
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