On the journey to reduce restrictive practices

By Maxine Subramany and Kate Reid, 17 October 2019 , Comments

The NSW Government is working on a new restrictive practice authorisation (RPA) model that better protects the rights of people with disability and seeks to reduce the use of restrictive practices.

We caught up with Northcott’s RPA Practice Manager Maxine Subramany to learn more about Northcott’s views on restrictive practice.

For those who don’t know, what is a restrictive practice?

A restrictive practice is any practice that restricts or inhibits a person’s human rights, or freedom of movement.

When are restrictive practices used?

Regulated restrictive practices are used together with positive behaviour support strategies to manage behaviours of concern, and keep people safe.

Prohibited restrictive practices are not allowed to be used at any time. They are against the law and cannot be authorised.

What was the former restrictive practice authorisation model?

Until July 2018, restrictive practice authorisation was managed internally by service providers, with minimal external oversight of the processes used.

In NSW, there were six categories of restrictive practice:

  • Seclusion
  • Exclusionary Time Out
  • Physical Intervention/Restraint
  • Chemical Restraint
  • Restricted Access
  • Response Cost

Why has the model been updated?

The Restrictive Practice Authorisation model has been updated in response to the NDIS Quality and Safeguarding Framework agreed on by the Council of Australian Governments (COAG) in December 2016.

In the current model, there is national oversight of the use of restrictive practices, with the provision of best practice advice, and reviewing and reporting requirements. The authorisation of restrictive practice continues to be managed at state level.

There are now five categories of restrictive practice:

  • Environmental
  • Physical
  • Chemical
  • Mechanical
  • Seclusion

The aim is to have a sustainable and consistent model of restrictive practice authorisation that protects the rights of people with disability and reduces and/or eliminates the use of restrictive practices.

What process has been undertaken to update the model?

Family and Community Services (FACS) NSW launched the interim authorisation process in July 2018, with providers required to:

  • Convene a properly constituted panel including an independent specialist and a senior manager, as well as other panel members as required.
  • All submissions must be entered into the FACS RPA portal
  • All submissions must have:
    • A current Behaviour Support Plan outlining all restrictive practices recommended by a Behaviour Support Practitioner
    • Legal consent for the use of the proposed restrictive practices
  • All Behaviour Support Practitioners must be registered with the NDIS Quality and Safeguarding Commission

The model allows for Interim Authorisation (up to 6 months) in response to a reportable incident, as well as Planned Authorisation (up to 12 months).

What’s Northcott’s view on restrictive practice?

Northcott actively supports the consistent use of positive behaviour support strategies to manage behaviours of concern.

Regulated restrictive practices should only be used:

  • As a last resort
  • With the least restrictive options possible
  • As part of a structured behaviour support protocol
  • Including fade-out strategies.

Here at Northcott we have a strong commitment to reducing and ultimately eliminating the use of restrictive practices. The Restrictive Practices Authorisation Panel has successfully used the conditional authorisation mechanism to work with frontline staff and specialists, challenging established protocols with person-centred positive behaviour support alternatives, to drive change and reduce restrictive practice.

What is Northcott hoping to see in this new model?

Ideally, the new model supports a person-centred authorisation process, including consultation with key support staff, customers and frontline specialists collaborating to reduce and eliminate the use of restrictive practices.

We are also advocating for changes that will result in the current administrative burden associated with online submissions (using the FACS portal) being streamlined.

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