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Positive behaviour support and restrictive practices

Suitsme does not support the implementation or continuation of restrictive practices. Suitsme promotes positive behaviour support as an alternative to restrictive practices.

Suitsme values the uniqueness of each individual and while Suitsme staff support clients to make positive change, we do not seek to impose change on clients. Suitsme staff are employed to work with clients towards the goals they identify, not to work on them. Suitsme staff will never attempt to coerce clients to change their behaviour through restrictive practices or otherwise.

What are restrictive practices?

In all NDIS funded services, the following practices are considered restrictive:

Seclusion

Seclusion is 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

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;

Mechanical restraint

Mechanical restraint is 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

Physical restraint is 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 as the exercise of care towards a person.

Environmental restraint

Environmental restraint restricts a person’s free access to all parts of their environment, including items or activities.

What is Positive Behaviour Support?

Positive Behaviour Support is an evidence-based approach with the primary goal of increasing a person’s quality of life and a secondary goal of decreasing the frequency and severity of their “challenging behaviours”.

At Suitsme, we deliver positive behaviour support by maximising choice and control for clients. This means ensuring that clients have full control over who supports them, what they get support for and (perhaps most importantly) how they are supported.

What are “challenging behaviours”?

First up, Suitsme doesn’t really like this term, but it’s what is used in the literature so we’re going with it for now.

Challenging behaviours are behaviours that someone else finds challenging to deal with. Some examples are aggression, shouting and ignoring.

Suitsme views challenging behaviour as a reasonable response to an unreasonable situation. They are a way that someone can tell those around them that something is not working for them.

To use an everyday example:

I get a bill from my phone company for services I never used. I call them to resolve the issue and after keeping me on hold for an hour, they transfer me between four different people, and I need to keep retelling my story. By the time I’m transferred to the fourth person I exhibit a “challenging behaviour” and yell at them. I didn’t intend to yell at them, I don’t want to be yelling, but this situation isn’t working for me and I don’t feel heard.

Have you ever exhibited challenging behaviours?

What do positive behaviour support, restrictive practices and challenging behaviours have to do with each other?

To put it simply, when someone’s behaviour is challenging there are two options. Either restrict the person so they can’t behave that way or support them in a positive way to change the behaviour.

Let’s use the phone company example again:

I’ve yelled at this person, so now they have two options:

  1. Put a restrictive practice in place – tell me that I’m being difficult and hang up on me. I call back again and they tell me if I don’t pay my bill, they will send debt collectors. I continue to yell, and they block my number.
  2. Work with me in a positive way – speak to me calmly and tell me they are sorry that I’m having to tell my story again, but that they will listen and then resolve it, they won’t transfer me again but they need me to stop yelling. Although I’m still frustrated, I stop yelling and tell them my story. The person repeats back the story and they get it! They tell me what they will do to fix it. They ask my permission before putting me on hold and then 10 minutes later the same person picks up and tells me the issue has been resolved.

Which option would you prefer?

How does positive behaviour support work at Suitsme?

There are two broad ways Suitsme does this:

The first is in our day to day practice of providing choice and control. Clients and staff both have profiles on the app; this means each can make a choice about who they work with. We provide some hints on building your profile on the profile questions’ page. Suitsme also encourages clients to give guidance and feedback to workers and Suitsme.

If a worker finds client behaviour challenging, the worker should have an open and honest conversation with the client. This conversation should be framed as “this doesn’t seem to be working for you, what can I do differently?” The worker must be prepared to either change the way they support the client, or to stop working with them.

If a client is not happy with how a worker is supporting them, they should let the staff member or Suitsme know. If the staff member doesn’t change, the client may choose to stop working with them.

Suitsme management are able to assist clients and workers with these conversations.

The second is a more formal approach. Some clients will have funding in their NDIS plan specifically for positive behaviour support. In this situation a psychologist (or some other expert) will work with the client to create a positive support plan. If you are a client and you have a positive behaviour support plan, it would be very helpful for you to share it with Suitsme. We will ensure staff who support you have a copy and understand how best to work with you.

How do restrictive practices work at Suitsme?

We don’t support restrictive practices.

Where a client is not able to be supported without the use of ongoing of restrictive practices, Suitsme management will discuss this with the client and their family and support them to transition to an alternative organisation.

Restrictive practices and duty of care

If a staff member acts to uphold their duty of care, this is not considered a restrictive practice. Here are a couple of examples:

Incidents

Sometimes a restrictive practice might be necessary in an emergency. An emergency means trying to save a person’s life, trying to stop a person from being injured or trying to stop other people being injured. This is considered an unplanned restrictive practice and it must be reported as a serious incident.

All incidents, including near misses and restrictive practices, must be reported as per the Incident management document.

Involuntary Admission

If a client poses a serious risk to themselves or others, then Suitsme workers or management may initiate a process which results in a client being involuntarily admitted to hospital. In these cases, it is medical professionals who decide if an involuntary admission is appropriate. Suitsme hands duty of care to the medical system, which has its own process to reduce restrictive practices.

If a client is admitted to hospital, then an incident report must be submitted as soon as it is safe to do so.

Staff Responsibilities

All staff recruited by Suitsme have completed the NDIS Orientation Module, which includes a unit on restrictive practices. Suitsme provides staff with refresher information at the time of recruitment and ongoing to reinforce their awareness of restrictive practices and positive behaviour support.

All staff are expected to be able to identify restrictive practices. All staff are responsible for the continued identification and reporting of restrictive practices. All staff are required to support the elimination of restrictive practices and implement positive behaviour support.

Suitsme monitors practice for effectiveness and this includes ensuring staff have adequate skills, knowledge and ability to meet the requirements of their position. Suitsme management is responsible for scheduling roll outs of development resources via the app and social media. This includes maintaining a register of development resources rolled out related to restrictive practices.

Reporting

If a support worker identifies any restrictive practice is must be reported immediately via the app.

Suitsme management is responsible for following up any reported restrictive practice within 24 hours.

More information

If you’ve found this interesting and want to know more, here are some resources we used when developing this document:

Regulated Restrictive Practices

Behaviour Support

Positive Behaviour Framework – Effective Service Design