Restrictive practice’ means any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability, with the primary purpose of protecting the person or others from harm.
What are the regulated restrictive practices?
There are five categories of regulated restrictive practices that are monitored by the NDIS Commission. These are:
- Seclusion – the sole confinement of a person with disability in a room or a 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.
- Chemical restraint – 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.
- 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 but does not include the use of devices for therapeutic or non-behavioural purposes.
- Physical restraint – the use or action of 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. Physical restraint does not include the use of a hands-on technique in a reflexive way to guide or redirect a person away from potential harm/injury, consistent with what could reasonably be considered the exercise of care towards a person.
- Environmental restraint – which restrict a person’s free access to all parts of their environment, including items or activities.
The Regulated Restrictive Practices Guide outlines NDIS providers’ obligations when implementing regulated restrictive practices.
Can a behaviour support plan recommend the use of a regulated restrictive practice?
The aim of positive behaviour support is to reduce and eliminate restrictive practices. There is a primary emphasis on upholding the rights of the person with disability by looking to support the person through evidence-informed, person-centred strategies reflected in a behaviour support plan. There may be limited circumstances in which a regulated restrictive practice is used. The NDIS (Restrictive Practices and Behaviour Support) Rules 2018 specify that any use of restrictive practices must be:
- Used only in response to a risk of harm to the person with disability or others, as a last resort.
- Authorised in accordance with any state or territory legislation and/or policy requirements
- In proportion to the risk of harm and used only for the shortest possible time.
Use of a regulated restrictive practice must be reported to the NDIS Commission.
What if a behaviour support plan does not contain a regulated restrictive practice?
Behaviour support plans that do not contain a regulated restrictive practice do not need to be lodged with the NDIS Commission.
Note: Use of restrictive practices that are not detailed in a behaviour support plan or do not have the required authorisation and consent may constitute a reportable incident under the NDIS (Incident Management and Reportable Incidents) Rules 2018.
Who needs to report the use of a regulated restrictive practice to the NDIS Commission?
NDIS service providers using a regulated restrictive practice in their service with participants must comply with the relevant reporting requirements.
Any concerned relevant person can make a complaint about the use of a restrictive practice to the NDIS Commission.
What happens if there is a regulated restrictive practice used in my service that is not part of a behaviour support plan?
If a restrictive practice is not included in a participant’s behaviour support plan the implementing provider needs to report this as a reportable incident to the NDIS Commission within 5 days of the provider being made aware of this occurrence.
What about a one off use of a regulated restrictive practice to manage a crisis?
If it is likely to occur again, implementing providers must take all reasonable steps to engage a behaviour support practitioner to develop an interim behaviour support plan within 1 month. The behaviour support plan must include information about the restrictive practice and how it is used.
Implementing providers must also obtain authorisation for the restrictive practice in accordance with any state or territory requirements.
What if the implementing provider already has a regulated restrictive practice in place at the time the practitioner becomes engaged?
The practitioner needs to work with the implementing provider to investigate whether a less restrictive option is feasible. If not, the practice needs to be incorporated within an interim behaviour support plan and the service provider needs to comply with any relevant state or territory legislation and/or policy requirements to gain authorisation and consent. The interim behaviour support plan and evidence of authorisation and consent needs to be lodged with the NDIS Commission.
While developing the comprehensive behaviour support plan, the practitioner needs to provide sufficient positive practices so that the restrictive practice may no longer be required. If the practice is still being implemented, the comprehensive behaviour support plan needs to include fade out strategies for the restrictive practice.
What are the registration requirements for the use of regulated restrictive practices?
The Registration requirements for the use of regulated restrictive practices guide is a flow chart that assists participants and their families to identify the types of supports that only a registered NDIS provider can deliver. It also identifies the options available when an unregistered provider is currently involved and using a regulated restrictive practice. An accessible version of the flow chart is included in the appendix.
What if a family is using a regulated restrictive practice?
As part of developing and implementing a behaviour support plan the practitioner will work with the person with disability’s support network on implementing the proactive and evidence-informed strategies. Under the new arrangements, the oversight role of the NDIS Commission extends to registered NDIS providers only.
