The Lowdown On Restrictive Practices

Here at DSC we have had a few questions about the new NDIS rules – specifically, in relation to restrictive practices. We will be delving in to these more in our upcoming Quality & Safeguarding workshops but there are two common, tricky questions we want to address in the meantime:

 

If a participant has a behaviour support plan that includes the use of restrictive practices, must they use registered providers for all supports?

It depends and it’s complex. The NDIS (Provider Registration and Practice Standards) Rules 2018 tell us that providers that implement behaviour support plans that may involve the use of restrictive practices must be registered.

A person must be registered…to provide a class of supports to a participant if, during the provision of the supports, there is, or is likely to be, an interim or ongoing need to use a regulated restrictive practice in relation to the participant.

They also tell us that the specialist behaviour support services who develop the plan must be registered.

A person must be registered…to provide specialist behaviour support services to a participant if the person will, as part of the provision of the services:

  • undertake a behaviour support assessment (including a functional behavioural assessment) of the participant; or

  • develop a behaviour support plan for the participant.

The NDIA requires that the delivery of specialist behaviour support services and use of restrictive practices must only be undertaken by registered NDIS providers and specialist behaviour support funding must be managed by the NDIA. As we know, the NDIA, will only purchase supports from registered providers. So, what about other supports? Is it possible to self-manage part of the funding?

In regard to self-management and restrictive practices the NDIS Quality and Safeguarding Framework states that:

Where the supports are not related to the behaviour supports (e.g. transport), or are regulated by other means (e.g. registered allied health professionals), it will remain the decision of the participant, their family and the NDIA about whether to self-manage those supports or if additional supports may be needed for a participant to safely engage with a range of providers (registered and unregistered) and implement their plan (for example, decision-making supports). 

Therefore, in determining need for registration, we need to consider who is involved in developing and implementing the behaviour support plan. 

Say, for example a participant has a behaviour support plan (that includes the use of restrictive practices) and they wish to use an unregistered cleaning service that is not going to be involved in implementing the plan, there is nothing in the rules that prohibits this.

However, if the provider was engaged to work with the participant to develop their domestic skills, they might be more involved in implementing the behaviour strategies contained in the plan. In this case, the provider would need to be appropriately trained, registered, sign off on the plan, be assessed against the relevant supplementary module and only implement the regulated restrictive practice in accordance with the plan.

 

I am providing services to a person that takes a medication listed as chemical restraint, so do they require a chemical restraint authorisation and positive behaviour support plan? 

It depends. The NDIS (Restrictive Practices and Behaviour Support) Rules 2018 state that a chemical restraint is the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. Here are some examples:

If Mary has been prescribed Ativan by her doctor for her diagnosed generalised anxiety disorder then it is not being used for behaviour control, it is being used to treat her diagnosed mental illness.

If Mark has been prescribed Androcur to treat his prostate cancer, that is to treat a physical illness. However, if he were prescribed it to reduce his sexualised behaviours then it would be chemical restraint and the restrictive practices rules apply.

If Tom takes Epilim to treat his diagnosed epilepsy, then it is being used to treat a physical condition. If Tom is taking Epilim and he doesn’t have epilepsy, we should be asking what the purpose of the medication is – if it is to manage behaviour, it is chemical restraint.  

Ann and I are really excited to trek around Australia in November to unpack all things Quality and behaviour support. If you are thinking about attending one of our workshops and have some burning questions, we’d love you to hear from you prior so we can be best prepared to workshop these really important issues. Click here to submit those questions.