Reducing Restrictive Practices through Positive Behaviour Support

Richer Support is committed to reducing restrictive practices.

A restrictive pracitce means any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability. This can come in the form of;

A chemical restraint is when medications, often psychotropic drugs, are used to control a person's behaviour. It doesn't include using medication for diagnosed mental or physical conditions.
An environmental restraint involves the modification or control of a person's surroundings or living environment to manage their behaviour or reduce risk. Examples include locking the fridge door or sharps.
Mechanical restraint refers to the use of devices or physical equipment to restrict a person's movements or behaviour - this can include helmets or seat belt buckles.
Physical restraint refers to the use of action of physical force to prevent, restrict, or subdue the movement of a person in response to behaviours of concern.
It is important to note that there are certain physical restraints which can present a high risk of harm to a person with a disability (e.g., basket hold, prone restraint, supine restraint, or any restraint that inhibits a person’s respiratory or digestive functioning) - these are not to be used in any circumstance.
Seclusion involves the sole confinement of a person with a disability in a room or physical space where the voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted - examples can include ‘time out’. Seclusion is a prohibited practice for people under the age of 18 in NSW.

Q & A

Some of the conditions governing the use of regulated restrictive practices require that:
a) Make sure that the practice is clearly mentioned in the person's behavior support plan.
b) If your State or Territory has a special approval process for this practice, it needs to be authorized according to that process.
c) Only use this practice as a last resort when there's a risk of harm to the person with a disability or others. First, try strategies that are based on evidence, focus on the person's needs, and are proactive.
d) Use the least restrictive method possible to keep everyone safe.
e) The practice should aim to reduce the risk of harm to the person with a disability or others.
f) It must be proportional to the potential negative consequences or risks of harm.
g) Use the practice for the shortest time needed to keep the person with a disability or others safe.
Restrictive practices do not address the root causes of challenging behaviours. For instance, individuals with limited communication or emotional regulation skills may engage in self-harm due to underlying factors like confusion, anxiety, trauma, sensory impairments, or health issues.
Using one restrictive practice to control behaviour can lead to the emergence of other problematic behaviours.
Restrictive practices may be traumatising for individuals with a history of trauma and abuse.
These practices can result in trauma and psychological distress.
They can diminish a person's dignity and limit personal freedom, hindering their ability to participate in daily activities.
Restrictive practices can reduce meaningful interactions between individuals and their caregivers or support staff.
Prolonged use of such practices may lead to over-reliance, causing the person to seek restraint or experience anxiety without it.
Behaviour Support Practitioners play a critical role in assessing behaviours, developing strategies, and providing training to caregivers and support staff. They aim to minimise the use of restrictive practices and promote alternative, less intrusive approaches.
The NDIS Quality and Safeguards Commission holds the primary responsibility for regulating the use of restrictive practices in Australia, and each State and Territory has its own authorisation policies in place.
If a family member of a person with a disability is using a restrictive practice, (e.g., giving medication prescribed to minimise challenging behaviours), there's a process to follow. Your Behaviour Support Practitioner's main goal is to create an Interim Behaviour Support Plan with you, focusing on keeping the person with a disability and their support network safe. This needs to be done within a month of identifying the restrictive practice, as required by the NDIS Quality and Safeguards Commission.
After that, your practitioner will continue working with the person with a disability and together, you'll come up with a Comprehensive Behaviour Support Plan. This plan isn't just about safety – it's also about improving the person's overall quality of life. It figures out why the behaviour happens and offers strategies and tools to help reduce the need for using restrictive methods.
If someone can provide their own valid consent to the use of restrictive practices, then there is no need for substitute consent.
However, if substitute consent is needed, only a guardian with a restrictive practices function can provide consent.
A ‘person responsible’ cannot consent to using any restrictive practices on behalf of a person with a disability. Refer to the Guardianship Act for a definition of ‘person responsible’.
A guardianship order must be appointed by NCAT. Before appointing a guardian with restrictive practice functions, the Tribunal considers:
• The views of the person about the proposed practices
• The current behaviour support plan should include a summary of the history of the behaviour and an assessment of the function of the behaviour
• Evidence from the person’s family and friends
• Evidence from the person’s treating medical professionals, carers and disability support service providers
• Any consultation with relevant specialists
• Whether the person’s behaviours can possibly be managed without using restrictive practices
• Whether the practice has been approved by an authorisation process if required.
• If chemical restraint is proposed: o medical evidence about the person’s diagnoses, the nature of the chemical restraint proposed, how and when the medication will be used, and any possible side effects
There is a fact sheet below which runs through this in greater detail.