restrictive practice presentation

Download free resources providing guidance on reducing restrictive practices within services.

Discover resources useful to a person with lived experience of restraint or a family carer here .

The RRN strives to provide accurate, well-researched, practical information that is of use to a wide range of stakeholders, including people that work in services and those with lived experience of restraint. Our resources and discussion documents aim to promote best practice in restraint reduction, offering new ideas, suggestions and solutions to improve practice and reduce restraint.

Please note that RRN resources are not intended to constitute legal advice. We update our work and resources as the latest understanding evolves.

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8 Types of Restraint

Consolidated six core strategies document – nasmhpd, freedom from coercion, violence and abuse – world health organization, guide to reducing restrictive practice in mental health settings – mersey care, 2017, interim report: review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability and or autism – care quality commission 2019, involve resources – nihr, legal support on behalf of relative with a learning disability, let’s talk about restraint – royal college of nursing, 2008, mental health act focus on restrictive intervention reduction 2018, minimising use of restraint in care homes – scie, national measure of environmental restraint, no safe place: restraint and seclusion in scotland’s schools – children and young people’s commissioner of scotland, 2018, positive approaches: reducing restrictive practices in social care, positive cultures of care massachusetts department of mental health, practice leadership infographic (bild), promoting less restrictive practice – local government association, 2016, reducing restrictive intervention of children and young people – cbf, reducing the need for restraint and restrictive intervention – hm government, 2019, restrain yourself toolkit – international journal of mental health nursing, restraint and seclusion in school – us department of education, 2012, restrictive interventions in inpatient intellectual disability services – royal college of psychiatrists, 2018, restrictive practices: a pathway to elimination – royal commission, australia, rights based standards for children undergoing clinical procedures edgehill university, rrn blanket restrictions resource toolkit, rrn guidance for government departments 2023: 11 key principles to inform government policy, rrn how i should be cared for in a mental health hospital resources, rrn post-incident debriefing and support toolkit, rrn power principles, rrn psychological restraint resources, rrn psychological restraint webinar july 2023, rrn psychotropic medication in children and young people’s mental health inpatient services august 2022, rrn restraint inequalities toolkit, rrn six core strategies infographic, rrn social connectivity toolkit, rrn surveillance – a rights-based approach, rrn surveillance resources, rrn towards safer services, rrn training standards certification scheme handbook, school based violence prevention – world health organization, shining a light on seclusion and restraint in schools in ireland: the experience of children with disabilities and their families – inclusion ireland, 2018, solitary confinement, stomp positioning paper – royal college of psychiatrists, 2021, supporting menstrual health, the rrn relational model of coproduction, understanding behaviour in the early years – cbf, we need to talk about restraint video, why do they hurt short film from early intervention project.

• Monitoring the Mental Health Act in 2022/23
• Foreword: Chris Dzikiti
• Workforce and staff wellbeing
• Inequalities
• Children and young people

Restrictive practices

• Closed cultures
• Our activity
• Appendix A: First tier tribunal data
• Appendix B: CQC as a part of the UK National Preventive Mechanism

Key points:

• In all services, we expect care to be person-centred where staff listen to and try to understand people, including how they communicate their needs, emotions or distress.
• Over the last year, we have seen positive examples of people being involved in their care and supported as individuals. This has helped to keep them safe and reduce unnecessary restraint.
• While we recognise that the use of restraint may be appropriate in limited, legally justified, and ethically sound circumstances, it must be remembered that it can have a significant impact on a person’s mental health, physical health, and their emotional wellbeing, and could even amount to a breach of their human rights.
• Services must work to understand the events that led up to any incidents where restrictive practice was used, report on them, learn from them, and actively work to reduce them in future.
• In August 2023, we published our cross-sector policy position on reducing restrictive practice, which clarifies our expectation of providers. We are committed to helping services promote positive cultures that support recovery, engender trust between patients and staff, and protect the rights, safety and wellbeing of all patients and people using services.

Most people know that restraint, seclusion, and segregation are the more extreme forms of restrictive practice. But there are more subtle forms of restrictive practice that easily become day-to-day normal responses to perceived risk or lack of time.

This includes, for example, not being able to make hot drinks after a specified time, or denying people access to visitors, friends, or food due to a lack of staff or time.

In all services, we expect care to be person-centred where staff listen to and try to understand people, including how people communicate their needs, emotions or distress. Providers must use this understanding to support adjustments that remove the need to consider the use of any restrictive practice.

We recognise that the use of restrictive practices may be appropriate in limited, legally justified and ethically sound circumstances in line with people’s human rights. This means that any restriction must be:

• for a legitimate aim
• the least restrictive way of meeting that aim.

However, our expectations are clear: everyone in health and care has a role to play in reducing the use of restrictive practices. In its place, we expect to see regularly reviewed, trauma informed care plans that are tailored to people’s specific needs.

In our last report, we highlighted the progress made by some services in reducing the use of restrictive practices and creating therapeutic environments for patients. While we have seen improvements in some areas, overall there is significant work still to be done. For example, we remain concerned about the disproportionate use of force against some groups of people, including:

• people from Black and minority ethnic groups
• autistic people and people with a learning disability.

Our cross-sector policy position on reducing restrictive practice , published in August 2023, clarifies our expectation of providers. Building on our work to encourage providers to reduce their use of restrictive practices and considering best practice in person-centred care, the policy is clear that we expect providers of all registered services, including mental health services to:

• promote positive cultures that support recovery
• engender trust between patients and staff
• protect the rights, safety and wellbeing of all patients and people using services.

We also ask providers in all sectors to record and analyse incidents at board level or equivalent and work to reduce them.

We are embedding our policy position on restrictive practice in our assessment framework for inspecting services. Working with British Institute of Learning Disabilities (BILD) and the Restraint Reduction Network, we have also developed training for CQC staff to improve our reporting where we identify restrictive practices during inspections.

Person-centred care

Over the last year, we have seen examples of services struggling to provide personalised care.

In one example, the family of a patient told us through our complaints service that their relative was restricted from seeing their emotional assistance dog, which was causing them unnecessary distress. We found that staff had not recorded in the patient’s treatment plan the therapeutic rationale for withholding visits from the emotional assistance dog. In addition, we found no reference to nationally recognised guidance or best practice to support the decision.

At another service, we saw how the lack of care planning could lead to patients being kept in seclusion for longer than needed:

There was no seclusion care plan for the patient and no clear steps recorded in order to bring seclusion to an end. The record of seclusion did not include the information required as set out in the Code of Practice. This included information about the person responsible for authorising the seclusion, who undertook 2-hourly nursing reviews and details of the patient’s presentation at the time, the date and time seclusion ended nor the details of the person who determined this. In the records we reviewed, the recording of seclusion reviews was inconsistent.

Psychiatric intensive care unit for men, September 2022

However, we are pleased to have also seen positive examples of people being supported as individuals, which has helped to keep them safe and reduce unnecessary restraint. For example, at one service, we observed how staff providing person-centred care to patients in long-term segregation helped them to progress:

The patients in long-term segregation had complex needs and the staff showed commitment to individualised person-centred care. While patients remained restricted, most had progressed on this ward compared to their previous places of detention. Progress for long-term segregation patients could take time and we heard about a positive example of one patient who we observed in the quiet area listening to music. He had previously been in holds throughout his time out of long-term segregation and then in a zoned area of one room. He was making progress that appeared to be small steps but, for him, were huge achievements aided by staff.

Increased support and treatment ward for men, January 2023

At another service, the care plans we read showed evidence of patients’ involvement and that people were aware of their rights under the MHA. The hospital’s booklet explained environmental blanket restrictions, contraband items, and the ward’s locked door. Staff told us that restrictions were discussed regularly. All patients could use their mobile phones on the ward. Patients who did not have a mobile phone could use the ward’s tablet to speak with their families.

Individualised restrictions were discussed with the patients during ward rounds. Blanket restrictions were reviewed by both patients and staff during weekly patients’ forum meetings.

Acute admission ward for women, November 2022

We expect services to have strong safety and learning cultures, focusing on improving expertise, listening and acting on people’s experiences to deliver person-centred care, and taking clear and proactive action when safety doesn’t improve.

Use of restrictive practices

As noted at the start of this chapter, in limited, legally justified, and ethically sound circumstances, for example where there is no other option but to restrain a person to avoid harm to themselves or others, the use of restraint may be appropriate./p>

But restraint must:

• never be used to cause pain, suffering, humiliation or as a punishment
• only be used to prevent serious harm
• be the least restrictive option, applied for the shortest possible time
• only be carried out with the correct authorisations beforehand.

We have heard of examples of restraint being used appropriately in this way. For example, during our interviews with people with lived experience, Kevin told us about seeing his daughter restrained:

Before they restrained her, they told me that it may be distressing to watch, and they offered for me to move away but I decided to stay nearby and watch it. I wanted to witness it so I could see for myself what happened. It was distressing to see it, especially as my daughter is only small and (the staff) were big. But I was really impressed with how they did it. The staff were extremely professional during the restraint. I couldn’t have asked for them to handle it any better than they did...

Interview with person with lived experience

In our interview with Andrew, he shared his experience of being restrained while detained:

I was physically restrained a few times and held down until I calmed down, but they never hurt me. I’ve never really looked into what they are allowed to do, but it felt appropriate at the time and if I was in their shoes, it’s exactly what I would do.

While these are positive examples, it must be remembered that the use of restrictive practices can have a significant impact on a person’s mental health, physical health, and their emotional wellbeing. Use of restrictive practices could even amount to a breach of their human rights. Services must work to understand the events that led up to any incidents where restrictive practice was used, report on them, learn from them, and actively work to reduce them in future.

We expect services to take a proactive and preventative approach to stop situations reaching crisis point. If aggression occurs despite this, de-escalation techniques can help staff to respond in line with the least restrictive principle. Every patient’s situation is different, and the detail of the de-escalation will depend on their needs, the environment and what has to be done to keep everyone involved safe. Person-centred planning and support can promote quicker de-escalation and reduce unnecessary restraint. Providers must have effective processes to call on and use staff with specialist skills in a timely way if a person reaches crisis.

Research published by the National Institute for Health and Care Research highlights the importance of therapeutic relationships in successful de-escalation. It states, “the fears and anxieties of both patients and staff are a key barrier to successful use of de-escalation… stronger therapeutic relationships between patients and staff could make a difference.”

The Mental Health Units Use of Force Act 2018 aims to reduce the use of force and ensure accountability and transparency about the use of force in mental health services. Services are required to have a policy, co-produced with patients, that commits to reducing the use of force. Guidance for the Act also includes requirements over training, recording and reporting the use of force, and requires services to identify a Responsible person, who is accountable for implementing the Act.

At one service, our reviewer raised concerns that some people hadn’t received any information about the Act, but other wards in the same trust have readily available information. It is essential that information for patients about the use of force is available across all wards.

Policies and governance

It is vital that staff understand policies relating to restrictive practice. Through our monitoring visits we have seen variation in how well staff knew and understood policies around restrictive practice.

Approved leave and access to fresh air are important for people’s recovery, and decisions around people’s ability to take leave should be based on risk. However, at one service we saw evidence of leave being used as a reward or punishment which, the MHA Code of Practice states as being completely unacceptable:

The way the care plan and contract were presented indicated that section 17 leave was being used as a reward or punishment.

Ward providing treatment and rehabilitation to male patients who have complex needs relating to mental illness, acquired brain injury or progressive neurological conditions, January 2023.

Another ward had applied strict blanket policies around patients’ access to fresh air and we saw evidence of staff failing to be flexible in how they applied the policy. Blanket policies are applied to everyone regardless of their individual needs and are contrary to person-centred trauma informed care. The MHA Code of Practice is clear that blanket restrictions should be avoided and should never be for the convenience of the provider. Any blanket restrictions should be:

• agreed by hospital managers
• documented with the reasons for such restrictions clearly described
• subject to the organisation’s governance procedures.

Staff applied a blanket approach to all patients who wished to access fresh air … There was a list of prescriptive times displayed in the office. We observed a patient requesting time off the ward for fresh air. Ward staff informed the patient they had missed the prescribed time for fresh air and would have to wait approximately 2 hours. The patient was becoming visibly agitated. The qualified nurse granted immediate time off the ward. We are concerned ward staff did not exercise flexibility without the nursing staff intervening.

Acute admissions ward for male patients, February 2023

Limiting fresh air time is unacceptable, and we instructed the service to ensure it was included as part of people’s individual care plans.

Mental Capacity Act and Deprivation of Liberty Safeguards

We are concerned that poor understanding of the Mental Capacity Act (MCA) and issues with the management of Deprivation of Liberty Safeguards (DoLS) are contributing to the over-use of restrictive practices.

As highlighted in our 2022/23 State of Care report, we continue to see a variable understanding of the interface between the MCA, which DoLS are part of, and the Mental Health Act (MHA). Where both frameworks could be used, it is not always clear how staff decided that using the DoLS framework would be most appropriate for a particular patient.

We have observed some providers not delivering adequate training on DoLS, resulting in a lack of understanding among staff. This could lead to them applying restrictions without considering whether less restrictive options are available in line with the MCA. We have also seen that some people are being discharged from detention under the MHA because other options such as DoLS are considered to be more appropriate. However, this leads to some people being ‘de facto detained’, as delays in DoLS assessments mean they are deprived of their liberty for longer than they need to be or without the appropriate authorisation in place. We continue to encourage the government to bring forward the much anticipated Liberty Protection Safeguards reforms.

Social and physical environment

We have seen how unsuitable physical environments increase the risk of restrictive practice. For example, on one ward we visited, access to fresh air and other therapeutic facilities were all off-ward, meaning patients could not access them unless staff were available to supervise:

Access to the 2 ward gardens was down several flights of stairs and patients could not access the gardens without staff supervision. There was no other access to fresh air on the ward. The arts and crafts room, education room in which the computers were located, occupational therapy kitchen and multi-faith room were all off-ward and patients could not access them unsupervised. These limitations amounted to blanket restrictions.

Low secure mental health service for Deaf/deaf men, January 2023

At another service, the seclusion room did not have en-suite bathroom facilities, which we were concerned could have a negative effect on people in seclusion:

The seclusion room had the toilet, shower and sink within the seclusion room and not in en-suite arrangement. This meant that young people using these facilities would have to sleep, eat and be in the same room as a toilet, which may compromise their dignity and have a negative effect on their experience of seclusion.

Acute ward for female patients of adult age, January 2023

Bathroom facilities, including those for patients in seclusion, must protect people’s human rights, especially by ensuring privacy and dignity. They must also be planned and designed with a person’s individual needs in mind. It is not acceptable to have a toilet in the main area of a seclusion room. Any requirements around maintaining safety should be assessed to ensure that they have the least impact on privacy possible and should be regularly reviewed.

We require any service in a new building to have these facilities to be able to register with us and we also expect, where possible, any refurbishment of seclusion facilities to create en-suite facilities.

It is disappointing that we continue to see the use of dormitories in mental health settings. We know that patients and carers have an overwhelmingly negative opinion of shared sleeping arrangements. As we raised in our last MHA report, on wards where dormitories are still in use, some patients have raised specific concerns with us about safety and privacy. We are clear that dormitory accommodation is unacceptable, and we welcome the government’s plans to invest over £400 million to eradicate dormitories. So far, over 600 beds have been replaced across 34 sites and we urge the government to continue to prioritise the eradication of all mental health dormitories.

We have seen how people’s experience can improve when providers adapt service environments to meet their individual needs. For example, at one service, we found the new long-term seclusion suite had its own secure garden and bathroom arrangements that were both safe and dignified:

The long-term seclusion suite...[which] had been purpose built since our last visit, was a much lighter and airier environment and was much more resilient to damage. The suite had appropriate observation arrangements for using the bathroom whilst respecting the patient’s privacy and dignity as this was done by means of an infra-red camera. The suite had separate bedroom and lounge areas. Anti-rip bedding and clothing was available where needed. The suite had its own secure garden with a bench for the patient to sit on when they wanted. We observed warm, kind and respectful interactions between staff and the patient in the long-term segregation suite.

Folkestone, Tonbridge, Poplar, Maidstone and Rochester wards (wards for autistic people and people with a learning disability), Cedar House, Coveberry Limited, December 2022

At another service, we noted a number of quiet spaces for patients to use:

Staff and patients had designed a quiet sensory space with self-soothing tools such as a blackboard wall. Patients had included inspirational recovery messages.

Bridford ward for women (acute ward), Glenbourne Unit, Livewell Southwest, August 2022

We found other positive examples, including an acute unit that had safely introduced an open-door policy. We support services in making policies as least restrictive as possible, assessing the level of risk on an individual basis, as the following shows:

Both the ward entrance door and the door of the main hospital building were kept unlocked. We were told that the open-door policy did not increase the risk of detained patients going absent without leave. At least one staff member was always present in the communal lounge area which was situated near the door. Patients were encouraged to write on a whiteboard when they were leaving the ward, including a brief note on their destination and expected time of return. Patients were supported to maintain contact with friends and relatives, and several patients had regular visitors. Patients could access their own internet enabled mobile phones on the unit. The patients’ kitchen was open 24 hours a day.

Abbey Ward (mixed gender acute admissions ward for adults of working age), Wotton Lawn Hospital, Gloucestershire Health and Care NHS Foundation Trust, December 2022

RESTRICTIVE PRACTICES

Reducing the Use of Restricted Practices

The National Institute of Intellectual Disability Studies is an Irish company, with a deep commitment and proven track record of reducing the use of restrictive practices in services for people with disabilities and schools. We are BILD certified and accredited with the Restraint Reduction Network UK. 

Governance arrangements must be in place within the centre, to monitor the use of restrictive practices and ensure that the rights of individuals using the service are always protected and promoted. The setting must promote a restraint-free environment for children and adults in their service with a specific aim to reduce or eliminate the use of restrictive practices wherever possible. The centre must ensure that the appropriate resources, such as trained workforce, are in place.

What is Restrictive Practice?

Restrictive practices in health and social care refer to the implementation of any practice or practices that restrict an individual’s movement, liberty and/or freedom to act independently without coercion or consequence (RCN, 2013).

HIQA Report ‘Restraint Procedures 2016’, defines Restrictive Practices as a restraint or practice that:

• Physical restraint, which includes Mechanical restraint.
• Environmental restraint
• Rights Restrictions which include:
• Psychosocial restraint
• Overly Risk Averse
• Rights Restrictive
• Power Control
• Consequence Control
• Blanket restrictions

For more information on Restricted Practices view our article here Download RP - niids.pdf

• Rights Restrictive 

EHUB COURSES

• Module 1 of 6 What are Restrictive Practices? https://niids.myvcampus.com/shop/what-is-restrictive-practices/  
• Module 2 of 6 Legal, Ethical and Human Rights Issues in the Use of Restrictive Practices https://niids.myvcampus.com/shop/module-2-legal-ethical-and-human-rights-issues-in-the-use-of-restrictive/
• Module 3 of 6 Alternative Strategies to the Use of Restrictive Practices - https://niids.myvcampus.com/shop/module-3-alternative-strategies-to-the-use-of-restrictive-practices/  
• Module 4 of 6 Debriefing – Effective Tool to Reduce the Use of Restrictive Practices https://niids.myvcampus.com/shop/module-4-effective-tool-to-reduce-the-use-of-restrictive-practices/
• Module 5 of 6 - Data Informed Approach to Restrictive Practices https://niids.myvcampus.com/shop/module-5-data-informed-approach-to-restrictive-practices/  
• Module 6 of 6 - Continuous Improvement Planning To Reduce the Use of Restrictive Practices https://niids.myvcampus.com/shop/module-6-continuous-improvement-planning-to-reduce-the-use-of-restrictive-practices/  

Course Bundles 

Frontline Workers - Modules 1 - 3 - https://niids.myvcampus.com/shop/resrictive-practices-1-3-modules-for-frontline-workers/

Supervisory Staff - Modules 1- 5 - https://niids.myvcampus.com/shop/restrictive-practices-1-5-modules-for-supervisory-staff/  

PICS and Registered Providers - Modules 1 - 6 - https://niids.myvcampus.com/shop/restrictive-practices-1-6-modules-for-pics-and-registered-providers/  

To view all our Restrictive Practice eHub Courses - click here 

Download our Restrictive Practice Brochure -  Download RP - niids.pdf

Recent Webinars:

This interactive workshop will allow participants to explore a case study of an individual whose behaviour is risk to life. The interactive workshop will take participants on an experiential journey to challenge them to consider approaches and practices by offering them challenging questions which will make them consider their own values, belief, and cultural responsiveness. It will engage them in critical thinking that they can use in practice to reduce the use of restrictive practice particularly in diverse client groups, such those with complex intellectual disabilities, mental health difficulties or those who have been exposed to trauma.

Watch here 

ORGANISATIONAL GOVERNANCE AND LEADERSHIP DEVELOPMENT

Toolkit: Reducing the Use of Restrictive Practices

ONLINE TOOLKIT & COURSES

This online toolkit provides your teams with the skills and knowledge to help them complete your Continuous Improvement Plan for the reduction of restrictive practices and enhancing residents' human rights

• Suitable for Frontline Staff and PPIM
• Organisational-wide Methodology
• Set against HIQA's Quality & Safety and Capacity and Capability themes
• Assists in the development of Quality Improvement Plans
• Provided through 6 online modules tailored to the learner through an award winning LMS system
• Centralised governance record of training

Available now Call Martha directly on 087 799 9739 or emailing [email protected]. Request a brochure by emailing [email protected]

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Our online EHub provides over a 1100 self-paced, multi-media bite size training programmes set against our Competency Professional Development Framework, available here at Your Fingertips.

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Understanding behaviour support and restrictive practices - for providers

Behaviour support, the role of the senior practitioner, how to contact us about behaviour support, behaviour support practitioner suitability process, which restrictive practices are regulated and what providers are required to do, surveillance technology practice guide, safe transportation practice guide, registration requirements for the use of regulated restrictive practices, compendium of resources for positive behaviour support, practices that present high risk of harm to ndis participants: position statement.

• Quality of Behaviour Support Plans (BSPs)
• Policy Guidance: Developing Behaviour Support Plans
• Policy Guidance: The safe reduction and elimination of regulated restrictive practices

Policy Guidance: Working within your knowledge, skills, and experience

Regulated restrictive practices summary and protocols, revised interim and comprehensive behaviour support plan templates v3.0, interim and comprehensive behaviour support plan checklists.

Behaviour support is about creating individualised strategies for people with disability that are responsive to the person’s needs, in a way that reduces and eliminates the need for the use of regulated restrictive practices.

Behaviour support focuses on evidence-based strategies and person-centred supports that address the needs of the person with disability and the underlying causes of behaviours of concern, while safeguarding the dignity and quality of life of people with disability who require specialist behaviour support.

Both specialist behaviour support providers (who engage NDIS behaviour support practitioners), and providers who use regulated restrictive practices (implementing providers), must meet the requirements outlined in the  National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018 .

NDIS Commission Portal for Behaviour Support

The User Guides have been updated to assist providers using the NDIS Commission Portal.

Note: A key change is the removal of instructions for using the RP Record (no BSP) function. The RP Record (no BSP) function is no longer to be used.

Please visit the below guides for step-by-step instructions on lodging a behaviour support plan, activating a plan, uploading evidence of authorisation and reporting the use of regulated restrictive practices.

The  Senior Practitioner  leads the NDIS Commission’s behaviour support function. It is the role and responsibility of the Senior Practitioner to:

• Oversee NDIS behaviour support practitioners and implementing providers who use behaviour support strategies and regulated restrictive practices
• Provide best practice advice to practitioners, providers, participants, families, and carers
• Receive and review provider monthly reports on the use of regulated restrictive practices
• Follow up on reportable incidents that suggest there are unmet behaviour support needs

Practice Quality Division – Practice Quality Reponses team – Behaviour Support (NDIS Commission) :   [email protected] NDIS Behaviour Support Practitioners:   [email protected]

The NDIS (Restrictive Practices and Behaviour Support) Rules 2018  (section 5) define an ‘NDIS behaviour support practitioner’ as ‘ a person the Commissioner considers suitable to undertake behaviour support assessments (including functional behavioural assessments) and to develop behaviour support plans that may contain the use of restrictive practices ’.

This means that behaviour support plans which may include restrictive practices can only be developed by an NDIS behaviour support practitioner considered suitable to do so. In addition, the NDIS behaviour support practitioner must be engaged by a provider who is registered by the Commissioner under section 73E of the NDIS Act (2013) to provide specialist behaviour support services.

The same applies to behaviour support (including functional behaviour ) assessments.

The practitioner suitability process involves the self-assessment of a behaviour support practitioner against the Positive Behaviour Support (PBS) Capability Framework and an application to the NDIS Commission for consideration of suitability. The self-assessment and application should be consistent with the National Disability Insurance Scheme (NDIS Behaviour Support Practitioner Application) Guidelines 2020

There are 3 steps to the practitioner suitability process:

1. Review all relevant documents to prepare for the application

2. Complete the application via the application portal

3. Access your Practitioner Suitability Outcome

The National Disability Insurance Scheme (NDIS Behaviour Support Practitioner Application) Guidelines 2020 set out how a practitioner can use the below tools to support an application to be considered an NDIS behaviour support practitioner . 

The Positive Behaviour Support Capability Framework

The Positive Behaviour Support Capability Framework focuses on the knowledge and skills that underpin contemporary evidence-based practice. It reflects the diversity and variation of the sector’s capability in delivering behaviour support and provides a pathway for recognition and professional progression for behaviour support practitioners.

The aim of the Positive Behaviour Support Capability Framework is to strengthen the safeguards for people receiving behaviour support, and to demonstrate a commitment to the reduction and elimination of restrictive practices. It establishes clear expectations for behaviour support practitioners and assists them to move towards a higher standard of practice. The framework has four practitioner levels – core, proficient, advanced and specialist.

Assessment against the Positive Behaviour Support Capability Framework forms the basis for determining suitability as an NDIS behaviour support practitioner.

Self-assessment Resource Guide for the Positive Behaviour Support Capability Framework 

This Self-assessment Resource Guide complements the  Positive Behaviour Support (PBS) Capability Framework . Its broad purpose is to provide guidance to behaviour support practitioners (whether they are registered providers or employed or otherwise engaged by registered providers) on how to assess their own capabilities against the PBS Capability Framework.

The Guide also provides a toolkit of resources that behaviour support practitioners can use to:

• self-assess their capabilities against the PBS Capability Framework
• develop a Portfolio of Evidence that may be used when applying to the NDIS Quality and Safeguards Commissioner for a determination of their suitability to undertake activities that, under the NDIS Act, can only be undertaken by an NDIS behaviour support practitioner.

This guide outlines how to use the Applications Portal to apply to be considered suitable as an NDIS behaviour support practitioner.

There are two options when completing an application for suitability:

1. Self-Assessment pathway  

Practitioners who are able to complete the self-assessment process as outlined in the Self-assessment Resource Guide for the Positive Behaviour Support Capability Framework ,

2. Alternative Assessment pathway

New entry-level behaviour support practitioners applying to be considered suitable as an NDIS behaviour support practitioner may have limited portfolio evidence. This fact sheet provides guidance on how to complete the alternative assessment process.

Please ensure all required documents and evidence are uploaded correctly, to avoid unnecessary delays in the consideration of your application.

Once an application has been submitted, the applicant may be asked for more information or work practice examples to assist in the assessment process. See Responding to a Request For Information through the Applications Portal .   A failure to respond to a request for information is likely to result in a delay in considering your application for suitability.

You will receive an email notification that an outcome has been recorded on your practitioner application. If you are considered suitable, the NDIS Commission will update your access so you can login to the NDIS Commission Portal. You will receive a second email with an activation link that you must click on to complete you practitioner profile access. This email is auto-generate and is easily picked up junk mail filters. Please check you SPAM or junk mail filters for this email if you cannot find it.  

Use the provider portal to manage your ‘Practitioner Profile’ and access your application outcome letter. If you are not considered suitable, or there is an information request on your application, you will continue to log in through the applications portal.

The NDIS Commission has developed a Quick Reference Guide to provide information to NDIS Behaviour Support Practitioners regarding the Practitioner Profile.

NDIS Behaviour Support Practitioners:   [email protected]

• Positive Behaviour Support Capability Framework (2019)
• Self-assessment Resource Guide for the PBS Capability Framework (Updated 2020)
• Self-assessment Tool for the PBS Capability Framework – Core Practitioner
• Self-assessment Tool for the PBS Capability Framework – Proficient Practitioner
• Self-assessment Tool for the PBS Capability Framework – Advanced Practitioner
• Self-assessment Tool for the PBS Capability Framework – Specialist Practitioner
• Endorsement Tool and Consent
• National Disability Insurance Scheme (NDIS behaviour support practitioner application) Guidelines 2020
• Applying to be considered suitable as an NDIS behaviour support practitioner

Fact sheet: New behaviour support practitioners: Applying for suitability

• Practitioner Profile – How to Update Practitioner Profile
• Responding to a Request For Information through the Applications Portal  

A restrictive practice means any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability. Under the  National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018  certain restrictive practices are subject to regulation. A restrictive practice is a regulated restrictive practice if it is or involves seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint. 

The  Regulated Restrictive Practices Guide  was developed for registered NDIS providers and NDIS behaviour support practitioners supporting NDIS participants. It may also be of interest to anyone who supports a person with disability. The guide supports a contemporary positive behaviour support framework.

The guide explains what a restrictive practice is, and sets out information on the five types of regulated restrictive practices. It also highlights possible impacts of, and important considerations for, the use of regulated restrictive practices. It will assist registered NDIS providers and NDIS behaviour practitioners to meet their obligations under the  NDIS Act 2013  and relevant Rules.

The  Regulated Restrictive Practices with Children and Young People with Disability: Practice Guide  focuses on the use of regulated restrictive practices with NDIS participants aged under 18 years. It aims to promote the rights of children and young people with a disability, identify special considerations and relevant safeguards, highlight the obligations of NDIS providers and provide advice consistent with contemporary evidence and a positive behaviour support framework. The guide was developed for registered NDIS providers and NDIS behaviour support practitioners. It may also be of interest to participants, their families, and others supporting children and young people with disability. 

The Surveillance Technology Practice Guide aims to clarify what is considered ‘surveillance technology’ and assist in identifying circumstances where surveillance technology could be used as part of a regulated restrictive practice. The guide highlights the ethical, human rights, privacy and practice issues with the use of surveillance technology. It outline best practice considerations and safeguards when using surveillance technology with people with disability. This guide was developed for  registered NDIS providers including specialist behaviour support providers but may also be of interest to anyone who supports a person with disability.

The purpose of the Safe Transportation Practice Guide is to:

• promote the rights and inherent dignity of people with disability,
• assist in identifying the use of regulated restrictive practice when transporting people with disability,
• highlight the special considerations and safeguards relevant to the use of transportation for people with disability,
• provide practice advice consistent with a positive behaviour support framework, contemporary evidence informed practice and the intent to reduce and eliminate the use of restrictive practices, and
• assist registered NDIS providers and NDIS behaviour support practitioners to meet their obligations under the  National Disability Insurance Scheme Act 2013  (NDIS Act 2013)  and relevant Rules.

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.

This compendium of resources provides behaviour support practitioners with a comprehensive list of assessment tools that can be used for the purposes of behaviour support assessment, planning, intervention, monitoring and review. It also includes a list of national and international Internet Resources that cover a range of areas of practice in relation to behaviour support.

The Practices that present high risk of harm to NDIS participants position statement outlines practices that place participants at high risk of harm and are associated with adverse and catastrophic outcomes for participants, such as long-term psychological or physical injury and death. The practices fall within two categories: specific forms of physical restraint and punitive approaches. NDIS providers (registered and unregistered) must not use these practices. Use of these practices must cease immediately, and should be replaced with proactive and evidence-informed alternatives based on risk assessment. Use of these practices by NDIS providers constitutes a serious breach of the NDIS Code of Conduct. The NDIS Commissioner will take strong action against any provider and individuals that engage in these practices.

Quality of Behaviour Support Plans (BSPs) – results of a national audit

The quality of comprehensive BSPs lodged over a 14 month period were audited by the NDIS Commission using the Behaviour Support Plan Quality Evaluation II Tool and the NDIS Companion Tool. The BSPs were assessed and rated across several domains. The BSP Quality paper  provides the results of this audit including the domains that were adequately and inadequately addressed and highlights the need for improvement to increase the quality of BSPs.

This Policy Guidance outlines the NDIS Commissioner’s expectations of specialist behaviour support providers and NDIS behaviour support practitioners when developing behaviour support plans that contain regulated restrictive practices.

Policy Guidance: The safe reduction and elimination of regulated restrictive practices (RRPs)

This Policy Guidance outlines the NDIS Commissioner’s expectations of NDIS providers when reducing and eliminating regulated restrictive practices to ensure this occurs in a safe and competent manner with care and skill.

• Policy Guidance: The safe reduction and elimination of RRPs

This Policy Guidance outlines the NDIS Commissioner’s expectations of NDIS providers, NDIS behaviour support practitioners and NDIS workers to work within the scope of their knowledge, skills, and experience; and to engage in continuing professional development to ensure the delivery of high quality and safe supports and services.

This template replaces the existing regulated restrictive practice protocols in the NDIS Commission’s behaviour support plan templates. It was informed by extensive consultation and represents the first step in the release of a revised suite of behaviour support plan templates. Use of this template is not mandatory, however specialist behaviour support providers are expected to ensure that they update and align their practice with this guidance to promote the reduction and elimination of regulated restrictive practices.

The revised BSP templates reflect contemporary evidence-informed practice and are approved by the NDIS Commissioner for the purposes of section 23 of the NDIS (Restrictive Practices and Behaviour Support) Rules 2018 .

• Interim Behaviour Support Plan template V3.0
• Comprehensive Behaviour Support plan template V3.0

These templates were informed by extensive consultation and thematic analysis as described in the BSP Template review: Summary of Findings.

• BSP Template Review: Summary of Findings.

The Behaviour Support Plan Checklists outline good practice and the conditions of registration that apply to specialist behaviour support providers when developing behaviour support plans. They aim to help practitioners and providers to check the quality of behaviour support plans and ensure compliance with requirements. Use of the checklists is optional. They do not need to be submitted to the NDIS Commission.

Interim Behaviour Support Plan Checklist

• Comprehensive Behaviour Support Plan Checklist

Related resources

Policy guidance: developing behaviour support plan, policy guidance the safe reduction and elimination of regulated restrictive practices, position statement - practices that present high risk of harm to ndis participants, self-assessment resource guide for the positive behaviour support capability framework.

This Self-assessment Resource Guide complements the Positive Behaviour Support (PBS) Capability Framework. Its broad purpose is to provide guidance to behaviour support practitioners (whether they are registered providers, or employed or otherwise engaged by registered providers) on how to assess their own capabilities against the PBS Capability Framework.

The Guide aims to:

• build capability in the development of behaviour support
• encourage progressively higher standards in behaviour support services provided to people with disability.

The NDIS Commission will contact behaviour support practitioners when they are required to undertake this process.

Regulated Restrictive Practices Guide

This guide explains what a restrictive practice is, and sets out information on the five types of regulated restrictive practices, being:

• chemical restraint
• environmental restraint
• mechanical restraint
• physical restraint

It assists in identifying each regulated restrictive practice and provides practice advice consistent with a positive behaviour support framework  and contemporary evidence informed practice, intended to reduce and eliminate the use of restrictive practices. It also highlights the possible impacts and important consideration with the use of regulated restrictive practices and assists registered NDIS providers and NDIS behaviour support practitioners to meet their obligations under the  National Disability Insurance Scheme Act 2013  (NDIS Act 2013) and relevant Rules.

An Easy Read version of the practice guide is also available.

Regulated restrictive practices with children and young people with disability: Practice guide

This guide and the associated decision trees focus on the use of regulated restrictive practices (RRP) with children and young people aged under 18 years who are participants of the NDIS.

The resources aim to:

• promote the rights of children and young people with a disability
• identify special considerations and relevant safeguards
• assist NDIS providers to meet their obligations under the  National Disability Insurance Scheme Act 2013  and relevant Rules
• provide practice advice consistent with contemporary evidence and a positive behaviour support framework
• address the questions most frequently asked by families and NDIS providers.

The interactive decision trees present information contained in the Regulated restrictive practices with children and young people with disability: Practice guide in an alternate format.

Behaviour support and restrictive practices

This fact sheet outlines requirements for providers who use restrictive practices and providers who write behaviour support plans.

Implementing providers: Facilitating the development of behaviour support plans that include regulated restrictive practices

This fact sheet explains how implementing providers can demonstrate they have taken reasonable steps to facilitate the development of interim and comprehensive behaviour support plans related to the use of regulated restrictive practices.

Residential aged care providers: Behaviour support and restrictive practice requirements

The arrangements outlined in this flow chart apply to residential aged care providers who transitioned to the NDIS Commission from 1 December 2020.

New entry-level behaviour support practitioners applying to be considered suitable as an NDIS behaviour support practitioner may have limited portfolio evidence. This fact sheet provides guidance on how to complete the assessment process.  Ongoing professional development is required to ensure progression towards meeting all Core practitioner level capabilities. New entry-level behaviour support practitioners will have their suitability reconsidered 12 months later. The fact sheet includes a declaration to be completed and attached in the alterative assessment evidence tab in the applications portal.

Behaviour Support Plan Quality

NDIS Commission behaviour support teams have undertaken a national project to evaluate the quality of lodged comprehensive Behaviour Support Plans (BSPs). A behaviour support plan (BSP) is a document that contains individualised, evidence-based strategies to address the needs of a person identified as having behaviours of concern. For the planned interventions to be successful, a BSP needs to be technically and clinically competent, as well as understandable to those with an interest in it.

Interim Behaviour Support Plan Template V3.0

Comprehensive behaviour support plan template v3.0.

DSDWEB: FREE STUDY GUIDES FOR CARE QUALIFICATIONS

Answers for the Care Certificate and Levels 2, 3, 4 & 5 Diploma/NVQ

Learn, Do Not Copy! ALL DSDWEB RESOURCES ARE FREE. Please do pay for anything purporting to be from DSDWEB.

• LEVEL 2 DIPLOMA IN CARE ANSWERS
• Safeguarding and Protection in Care Settings

Describe restrictive practices

This page is designed to answer the following questions:

• 10.1f Describe what constitutes restrictive practices ( Care Certificate , Standard 10: Safeguarding adults )
• 1.5 Describe restrictive practices ( Level 2 Diploma in Care , Safeguarding and protection in care settings )
• 1.5 Describe restrictive practices  ( Level 3 Diploma in Adult Care ,  Safeguarding and protection in care settings )

NOTE: This page has been quality assured for 2023 as per our Quality Assurance policy.

On this page, we will describe restrictive practices in health and social care settings.

Restrictive practice refers to a range of methods that may be used to restrain an individual. Any practice that restricts the rights or freedom of movement of an individual is considered a restrictive practice.

This can include physical restraint either by holding an individual or utilising equipment (e.g. rope, bed restraints etc.) as well as medical restraint (e.g. sedatives) or seclusion (e.g. locking an individual in a room).

Restrictive practice without legal and ethical justification is unlawful and should not be used without appropriate training, authorisation and documentation.

It should only be used as an absolute last resort to ensure the safety of the individual or others and even then, the least restrictive option should be used.

It is important to understand that some practices that were generally considered acceptable a few decades ago are considered restrictive practices today. For example:

• An individual not being able to leave their home due not to having a set of keys to the front door
• Having guard rails on a bed to protect an individual from falling out but also restricting them from getting out of bed on their own
• Covert medication administration, for example, putting medication in food without the individual’s knowledge
• Strapping an individual into a wheelchair without their consent
• Putting a seat belt on an individual in a car without their consent (although if they refused, it would be unlawful to drive them anywhere)

Before undertaking any action that may restrict an individual’s movement or liberties, even if it is for their own safety, you should ensure there is a legal and ethical justification, preferably in writing (e.g. DOLS, care plan etc.). It is also essential to protect the dignity of the individual by remaining calm and courteous and explaining what you are doing and why. Consent from the individual may also be required.

Some examples of when restrictive practices may be justified include:

• If an individual requires emergency medical treatment
• If an individual is seriously harming themselves or others

In these cases, restrictive practices may only be used by individuals with proper training and as a last resort, when all other possible options have been exhausted.

Accompanying Video

Video transcript.

My name is Daniel Dutton and I run the website dsdweb.co.uk which provides free help, guidance and support for people that are studying for care qualifications.

In this video, we will be looking at what restrictive practices are in the context of health and social care. This is an assessment criterion for the Level 2 and Level 3 Diplomas in Adult Care as well as the Care Certificate.

Before I continue, I’d be very grateful if you could click on the thumbs-up button to Like this video and subscribe to my channel. This helps the video to be more visible on Youtube so that it can be easily found by other students. So, first, let’s take a look at what restraint is. Restraint, as defined by the mental Capacity Act 2005 is:

“When someone uses force (or threatens to) to make someone do something they are resisting, and when someone’s freedom of movement is restricted, whether or not they are resisting.”

In short, anything that stops an individual from doing something or forces them to do something can be regarded as a restraint.

Sometimes restrictive practices are necessary to protect the individuals that we support. For example, we may need to use locked doors to prevent an individual with dementia from going outside on their own because there is a significant risk of them getting lost or wandering into the road and getting run over. Or, for an individual that uses a wheelchair, the lap belt must be used to prevent them from falling out.

However, restrictive practices should only be used as a last resort, be legally justified and be proportionate to the risk. In addition, the least restrictive option should always be used.

Restrictive practices should never be used as a form of punishment or to inflict suffering and should not be used for longer than is necessary. It is essential that policies and procedures are followed when planning and implementing restrictive practices.

This slide shows a list of some of the types of restrictive practices.

Physical restraint is when physical contact is used to reduce an individual’s mobility. For example, if you hold an individual that is experiencing hallucinations to stop them from running into a busy road. This is a physical restraint.

Mechanical restraints are devices that are used to restrict movement. The use of a lap belt on a wheelchair is considered a mechanical restraint.

Psychological restraints are when an individual is prevented from doing something due to threats, coercion, or even constant nagging. Preventing an individual from taking risks or making their own lifestyle choices can be a form of psychological restraint (and would also be institutional abuse).

Chemical restraints involve the use of chemicals or medications to subdue an individual. For example, an individual that is experiencing a mental health crisis may be given a sedative by a doctor if it is deemed to be in their best interests.

Environmental restraints are when an individual does not have the freedom to move around or access their environment because there are barriers or obstacles in the way. For example, food cupboards that are locked so that an individual is unable to help themselves to a snack would be an environmental restraint.

Thank you for watching and I hope you’ve found this video useful.

If you require any additional help or want to send feedback about this video, please feel free to use the comments section below or visit my website dsdweb.co.uk. More information about this assessment criterion can be found in the link in the description.

And, if you’ve not already done so, please click the Like and Subscribe buttons below.

Bye for now.

RESTRICTIVE PRACTICES

Sep 05, 2012

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Presentation Transcript

1. RESTRICTIVE PRACTICES The Fit with Behaviour Support and Crisis Intervention

2. Where do they fit?????

3. Types of Restricted Practices Exclusionary Time out Physical Restraint Psychotropic meds on PRN basis Response Cost Restricted Access Seclusion Restricted practices has become a big issue of late, i know for many setting up panels and the like it has been eth cause of sleepless nights and much confusion. Lets try to simplify it the above are considered to be restrictive. I will not g into a lot of detail as you can find it in the enthralling adhc behaviour support policy manual. As i emphasise whenever i speak about restrcitive practices it is response cost and restricted access that seems to occur the most without staff and organisations aware that they are actually restricted practice. For example locking up food items because a client has been put on a diet to reduce weight by their doctor/ dietician is a restricted practice. DR and dietician cannot authorise these type of practices any more for people with ID than they can for you and I. Restricted practices are not a swear word, you dont need to be afraid of them but you must be able to justify their use. They shoudl nt be strategies that you just simply use to manage behaviour. They need to be treated for exactly what they areRestricted practices has become a big issue of late, i know for many setting up panels and the like it has been eth cause of sleepless nights and much confusion. Lets try to simplify it the above are considered to be restrictive. I will not g into a lot of detail as you can find it in the enthralling adhc behaviour support policy manual. As i emphasise whenever i speak about restrcitive practices it is response cost and restricted access that seems to occur the most without staff and organisations aware that they are actually restricted practice. For example locking up food items because a client has been put on a diet to reduce weight by their doctor/ dietician is a restricted practice. DR and dietician cannot authorise these type of practices any more for people with ID than they can for you and I. Restricted practices are not a swear word, you dont need to be afraid of them but you must be able to justify their use. They shoudl nt be strategies that you just simply use to manage behaviour. They need to be treated for exactly what they are

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2024 NCARB Scholars in Professional Practice

By Destiny Johnson

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NCARB’s goal is to ensure that educators teaching professional practice have access to the resources they need to help students succeed. Through the annual Scholars program, NCARB will continue fostering a community of diverse professional practice educators who are propelling the future of architectural education forward. 

Congratulations to the 2024 cohort of NCARB Scholars in Professional Practice:

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• Ben Burghart, RA, LEED AP+C | Assistant Teaching Professor, Bowling Green State University
• Sandra Callies, AIA, NCARB | Architecture Instructor, South Dakota State University
• Jason R. Chandler, FAIA | Associate Professor, Florida International University
• Zhan Chen, RA | Assistant Professor, Kansas State University
• Andrea Francis Loubert | Adjunct Instructor, Boston Architectural College
• Eric Harris, Associate AIA, NOMA, SSAC | Adjunct Professor, University of the District of Columbia
• Andrew G Hawkins, AIA, NCARB, LEED AP | Assistant Professor, Texas A&M University
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