Restrictive Practices Policy

Purpose
The purpose of this policy is to ensure that no restrictive practices are used in the provision of client services except in accordance with emergency procedures (see the “emergencies” section below).
This procedure is in accordance with the National Standards for Disability Services and the Disability Services Commissions’’ Code of Practice for the Elimination of Restrictive Practice which emphasises the importance of dignity and respect, freedom of expression, self-determination, choice and control, confidentiality and privacy, freedom from discrimination, exploitation, abuse, harm, neglect and violence. Next Challenge identifies that restrictive practice is considered a breach of human rights and should be eliminated wherever possible.
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Scope of Policy
This policy and accompanying procedures relate to all employees of Next Challenge, contractors and volunteers. It relates to all Next Challenge activities which form part of the Next Challenge governance framework.

Reducing and eliminating restrictive practices
Next Challenge is committed to the reduction and elimination of restrictive practices. The National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector identified the following six core strategies for reducing and eliminating restrictive practices:
1. Person-centred focus
2. Leadership towards organisational change
3. Use of data to inform practice
4. Workforce development
5. Use of restraint and seclusion reduction tools (including evidence-based assessment, prevention approaches, emergency management plans, environmental changes and meaningful activities integrated into the individual’s support plan)

Responsibilities
Employee Responsibilities:
It is the responsibility of the employee to:
  • Ensure that they remain informed regarding Next Challenge’s procedures which impact upon their duties, and to work within them;
  • Use the least restrictive practice possible as a last resort in the event of an emergency where the use of a restrictive practice is considered a reasonable community safety measure and the employee has explored and apple evidence-based, person-centred and practice strategies;
  • Advocate for the inclusion of Positive Behaviour Support in the client’s NDIS plan (see the “procedural details” section below) where appropriate;
  • Work together with the guardian and participant to trial a range of strategies to ease the participants feelings of safety, and comfort;
  • Follow appropriate documentation, recording and communication in relation to restrictive practices procedures;
  • Ensure safeguards are put in place; and
  • Seek support, advocacy or debriefing services available to them. These can be discussed with the employees manager or the Managing Director.

Manager Responsibilities:
It is the responsibility of the manager to:
  • Support all employees and ensure the restrictive practices policy is followed;
  • Provide information and direction to all employees around Next Challenge’s procedures regarding restrictive practices;
  • Provide options for support, advocacy and debriefing services to employees;
  • Ensure employees follow appropriate documentation, recording and communication in relation to restrictive practices procedures;
  • Ensure employees follow safeguards and monitor appropriately; and
  • Arrange for employee training to mitigate use of restrictive behaviours as required;

Positive Behaviour Support Therapist Responsibilities:
It is the responsibility of the external Positive Behaviour Support Therapist to:
  • Ensure collaboration & communication with the participants Next Challenge therapy team regarding relevant updates or changes to restrictive practices; and
  • Adhere to the NDIS legislation surrounding assessment, implementation and documentation of restrictive practices.

Procedural details
Considerations in defining restrictive practices
All employees of Next Challenge are educated on pathways to ascertain the existence or need for restrictive practice. They are encouraged to use NDIS decision making trees to identify and minimise restrictive practice across all service delivery contexts. Employees are also encouraged to speak with their manager/supervisor or NDIS manager should any restrictive practice be observed.
  • When restrictive practices has been observed which are not documented in the participants PBS plan:
    • Therapist responsibilities are to follow the Incident Management, Client Care and Protection policy guidelines and talk to their Manager or Director. Therapists will also contact the Positive Behaviour Support therapist to confirm if there has been any updates to the participants PBS Plan which may outline these new restrictive practices.
  • When restrictive practices has been observed and the participant does not have a PBS plan:
  • Employees can support the family to advocate for the inclusion of Positive Behaviour Support in the client’s NDIS plan by initiating a “change of circumstances” review.
  • Minimising restrictive practice use:
    • Chemical restraint:
      • The speech pathologist may engage in implementation of safe swallowing strategies to treat a diagnosis of dysphagia or additional physical impairments. It is the community speech pathologists role to diagnose and treat swallowing to support safety. This assessment is formally documented and stored in line with the Record Keeping Policy and will not be used to influence behaviour but is used to treat/enable the treatment of a diagnosed physical condition. This is not a restrictive practice.
    • Environmental restraint:
      • Next Challenge does not engage in any form of restriction beyond part of the Providers routine process/operations/house rules/community safety guidelines. When a participant presents with functional impairment impacting their ability to use cutlery, therapists provide multiple equipment options to work towards functional independence. These modifications are recorded in progress notes in line with the Record Keeping Policy and are made to reduce the risk of harm to themselves and others; as well as in line with their functional capacity.
    • Mechanical restraint:
      • Next Challenge only implement devices for therapeutic or non-behavioural purposes. These are not mechanical restraints. These are defined as devices that assist a person with everyday functional activities or help their injuries heal (Department of Health and Human Services, 2019). For example, adaptive devices, mechanical supports used to achieve proper body position, balance or alignment to allow greater freedom of mobility and reduced risk of harm. Therapeutic devices are thoroughly assessed and only used for the specific and approved purposes for which they were designed. These are recorded in progress notes and AT reports as per Next Challenge’s Record Keeping Policy.
    • Physical restraint:
      • Next Challenge do not use 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 (see Incident Management Policy), consistent with what could reasonably be considered the exercise of care towards a person.
      • When a participant does not wish to participate in intervention, the guardian and therapist will work together to trial a range of strategies to ease the participants feelings of safety, and comfort. The participant will not be provided with physical force against their will.
    • Seclusion:
      • Next Challenge does not engage in 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”.
      • Time out- Next Challenge does not deny access to reinforcement by forcibly moving a client from one setting to another (e.g. room, corridor), where they are unable to leave for a period of time. The guardian and therapist will continue to work together to trial minimally restrictive practices.

Integration with other systems and processes:
  • The initial and review Navigation process will capture if the client is engaged in Positive Behaviour Support services, ensuring that Next Challenge has a copy of the PBS plan and key contact details. The navigator will communicate to the participant/caregiver that Next Challenge do not engage in restrictive practices and that they therefore have freedom of choice to engage with another provider. The Navigator will ascertain if the PBS Practitioner is monitoring the use of restrictive practices for the safety of the participant and staff.
  • If an employee observes the use of restrictives by other stakeholders they are encouraged to consult with their manager in line with the process discussed above (see “procedural details” section above).
  • Consent will be sought from families for the therapy to use families’ property during an in-home visit and/or to generalise targets into natural settings. The home risk assessment process will capture a families consent for therapists to use their property during an in-home visit.

Emergencies:
  • If an emergency arises when a client who has never previously acted in a manner that creates an immediate risk for themselves or to staff or other clients, suddenly does, immediate action may need to be taken to reduce the risk. In these circumstances the employee must act in accordance with the Incident Management, Client Care & Protection policy Any action taken must always be the least restrictive option possible.

Continuous improvement:
All employees are encouraged to provide feedback on this policy to their supervisor, to ensure that it remains relevant and continues to reflect the actual manner in which activities are undertaken.
  • Employees will be prompted to review NC’s restrictive practice policies yearly through supervision sessions & newsletter reminders.
  • The Next Challenge NDIS coordinator will be the main point of contact to provide any clarification to employees regarding this policy.
  • Employee’s will have access to the decision making trees to inform decision making regarding restrictive practices.
  • The responsibility for providing continual improvement of this policy rests with Next Challenge Directors.

Definitions:
The definitions for the terms ‘restrictive practice’, ‘chemical restraint’, ‘mechanical restraint’, ‘physical restraint’ and ‘seclusion’ are taken from the ‘National Framework for Reducing and Eliminating the Use of Restrictive Practices’ (2014).
  • Restrictive practice- A ‘restrictive practice’ is defined as 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.
  • Chemical restraint- A ‘chemical restraint’ means the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour or movement. 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 physical condition.
  • Environmental restraint- An ‘environmental restraint’ restricts a person’s free access to all parts of their environment. Examples of environmental restraints include but are not limited to: Barriers that prevent access to a kitchen, locked refrigerators and restriction of access to personal items such as a TV in a person’s bedroom Locks that are designed and placed so a person has difficulty in accessing or operating them Restrictions to the person’s capacity to engage in social activities by not providing the necessary supports they require to do so.
  • Mechanical restraint- A ‘mechanical restraint’ means the use of a device (may include any mechanical material, appliance or equipment) 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. For example, purposes may include the use of a device to assist a person with functional activities, as part of occupational therapy, or to allow for safe transportation.
  • NDIS- The National Disability Insurance Scheme.
  • NDIS Commission- The NDIS Quality and Safeguards Commission.
  • PBS- Positive Behaviour Support.
  • Physical restraint- A ‘physical restraint’ means the sustained or prolonged 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 a person’s behaviour.
  • Seclusion- ‘Seclusion’ means the sole confinement of a person with disability in a room or physical space at any hour of the day or night where voluntary exit is prevented, implied, or not facilitated.

Resources
Date of Policy: Feb 2021
Review Date: October 2021
Due for Review: October 2022



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