We may know through working with our customers what the basis is for restrictive practice - but did you know it can even mean child locking a car door, when a support worker takes a participant on a community outing?
Ensuring safety for both your staff and customers is paramount to your business!
If you are new to the provider sector and want to know the basics, please read on.
Restrictive practice means any intervention that has the effect of restricting the rights and freedom of movement of a person living with a disability.
The NDIS Quality and Safeguards Commission provides guidelines on reducing restrictive practices and outlines what we should do. They ensure that any practice is ethical and only used as a last resort.
What are the main types of Restrictive Practice?
Seclusion
This refers to confining a person in a room or area from which they cannot freely leave. Historically, this has involved locking people in their rooms at night for their safety, for instance people who wander around at night disorientated. This has been used by providers as alternative to paying staff for an active night shift.
Chemical Restraint
Chemical restraint involves using medication to control behaviour or limit freedom of movement. In some cases, psychiatrists have prescribed medications such as antidepressants, benzodiazepines, and opioids to residents in supported living environments. These medications can induce drowsiness, reducing the likelihood of these individuals’ displaying behaviours of concern, making them calmer and easier to handle.
Mechanical Restraint
Use of devices to restrict movement. There have been reports of people being strapped down to stop them from falling out of bed. Or for a person who displays behaviours that are a detriment to themselves or others. We would think of mental health facilities, but these types of restraints have been seen in supported living and nursing homes.
Physical Restraint
The use of physical force to restrict movement can include practices intended for safety, but these also limit control. Examples include chairs that tip backwards called princess chairs, tightening bed sheets, and bedside rails. An instance you would know is in hospitals, where bedside rails are raised on the bed after a surgery to prevent patients, who are under the effects of anesthesia from falling, but are more commonly used in aged care.
Environmental Restraint
Modifying a person's environment to restrict their movement or behaviour. These could include seclusion of a person in a secured unit or garden. If you have ever visited a dementia ward, these types of environmental restraints can be seen in practice. It has also been seen when working with people living with non-verbal autism, some have had the inclination to open car doors while the car in motion, and the worker has used safety lock on the doors.
What are the considerations?
Safety and Well-being
The main consideration is the safety and well-being of the person living with a disability.
Last Resort
Restrictive practices should only be used when all other positive behaviour support strategies have been exhausted.
Proportion
Any restrictive practice must be proportionate to the potential harm it seeks to prevent.
Least Restrictive
The practice must be the least restrictive option available.
Time-limited
Restrictive practices should be applied for the shortest time possible.
How do we implement restrictive practice, if it is needed or is there an alternative?
The NDIS recognises that sometimes these practices are required and build capacity building supports into a plan, which include.
Positive Behaviour Support Plans (PBSPs): Before restrictive practice can be used, a PBSP must be developed by a qualified practitioner and approved by the NDIS Quality and Safeguards Commission. Practitioners can also spend some of their allocated funding to train and develop strategies for supports to employ.
State and Territory Requirements: The process can vary by state and territory but must align with the national standards. As we brought to you in one of our first posts: The Victorian Government has a different system and procedure than other states Restrictive Practice in Victoria
What are our obligations as providers?
Training
Staff must be adequately trained in behaviour support and the ethical use of limiting a person living with a disability.
Monitoring and Reporting
Providers must monitor the use of restrictive practices and report to the NDIS Commission.
Reduction Plans
Providers must work towards reducing and eliminating the use of restrictive practices.
Work with BSP Practitioners and Allied Health
Use the opportunity to build a solid working relationship with everyone who is involved with a participant and work towards limiting and lessen the use of restrictive practices, where possible and practical.
What are the Rights of Participants and their representatives?
Participants or their guardians must be informed and provide consent for the use of restrictive practices.
Participants have the right to appeal decisions and seek reviews of their behaviour support plans and the use of restrictive practices.
Participants can access advocacy services to support their rights and interests.
What about safety issues for your staff?
When a customers actions lead to unsafe work environment, your staff will be more inclined to want to use restrictive practice. As an employer and a provider you will consider everyone's safety and dignity. But you can make a difference for both and have a balance.
Take a proactive approach to identifying signs of emotional or mental strain in your staff, when it occurs you can offer intervention and support.
Regularly debriefing after incidents helps to address the immediate concerns, but also allows for opening up avenues for rethinking your processes.
Revise your rosters to include more allocated hours for staff numbers and cross over shifts to ensure that everyone is less stressed.
Offer training where required and collaborate with all stakeholders of your customer. Building relationships in the support of your customers wellbeing also lessens the impact for your staff.
Resources if you want to seek more information
NDIS Quality and Safeguards Commission: NDIS Commission Website
Positive Behaviour Support Plans Guide: Understanding Behaviour Support
State and Territory Guidelines: Specific guidelines can be accessed through respective state and territory disability services websites.
Contact Information
NDIS Quality and Safeguards Commission:
Phone: 1800 035 544
We wish you well, as always.
The Lama Care Team
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