Recognising and Preventing High Risk Practices

A high risk practice is any action that places a participant at serious risk of physical or psychological harm, or that takes away their rights without a lawful reason. This lesson explains why these practices happen, often through habit, pressure or a wish to keep people safe, and why good intentions do not make them safe. Key points: a restrictive practice is anything that restricts a person's rights or freedom of movement, high risk practices can cause injury, trauma or death, using them can breach the NDIS Code of Conduct, and you always have the right and the duty to speak up.

The NDIS rules name five types of regulated restrictive practice: seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint. This lesson describes each one with examples from disability and aged care support. Key points: a regulated restrictive practice may only be used when it is authorised under the rules of your state or territory and included in the person's behaviour support plan, it must be the least restrictive option and used for the shortest time, and any use outside those conditions is unauthorised. If you are unsure whether something counts, stop and ask your team leader.

The NDIS Quality and Safeguards Commission has made its position clear: certain physical restraints present such a high risk of harm that they should never be used, even in an emergency and even if they appear in a plan. This lesson names these practices: prone restraint, supine restraint, pin downs, basket holds, takedowns, restraints that affect breathing or digestion, restraints that push the head forward onto the chest, and restraints that use pain, joint hyperextension or pressure on the chest or joints. Key points: these can cause injury or death, and their use is a serious breach of the Code of Conduct.

Positional asphyxia happens when a person's body position stops them breathing properly. This lesson explains how restraint and unsafe positioning can compress the chest or bend the airway, why prone restraint has been linked to sudden death, and which people are most at risk. Key points: face down positions and weight on the back or chest are dangerous, a person who is struggling may be fighting for air rather than resisting, distress signs such as noisy breathing, colour change or going quiet and limp are an emergency, and a person must never be left slumped, face down or unable to move out of a position that restricts breathing.

Dysphagia means difficulty swallowing. It is common among people with disability and older people, and it can lead to choking or to food, drink or saliva entering the lungs, which can cause aspiration pneumonia. This lesson explains the signs of swallowing difficulty, the conditions and medications linked to it, and why these risks are so serious. Key points: coughing, gurgly voice, long mealtimes, drooling and repeated chest infections can all be warning signs, and any new sign should be reported so the person can see their doctor and a speech pathologist.

A mealtime management plan is written by a speech pathologist, sometimes with a dietitian, and tells you exactly how to support a person to eat and drink safely. This lesson covers what the plan includes, how to check food and drink textures before serving, safe positioning and pace, and the unsafe shortcuts to avoid. Key points: read the plan before every mealtime support, serve only the prescribed textures and fluid thickness, keep the person upright and supervised, never rush or feed someone who is drowsy or lying back, and know how to respond to choking.

Withholding means taking away or refusing something a person needs or values in order to punish them or control their behaviour. This lesson covers withholding food and drink, activities and outings, belongings, and contact with family, friends or advocates, as well as other punitive approaches the NDIS Commission warns against. Key points: withholding can be neglect or abuse, it is never a legitimate behaviour strategy, a limit on access is only lawful when it is an authorised restrictive practice in a behaviour support plan, and we use positive behaviour support that focuses on understanding and meeting the person's needs.

When you see or suspect a high risk practice, what you do in the next few minutes matters. This lesson sets out our response: stop the practice, make the person safe, give first aid and call triple zero if needed, tell your team leader straight away, and complete an incident report the same shift. Key points: the unauthorised use of a restrictive practice is a reportable incident to the NDIS Commission, registered providers must notify within 24 hours if a person was harmed and within five business days otherwise, aged care has its own Serious Incident Response Scheme, and you can speak up without fear.

This case study follows Tomasz, a young man with autism and an intellectual disability who becomes very distressed late one evening. It shows how his support worker, Sione, uses the proactive and calming strategies in Tomasz's behaviour support plan, refuses a colleague's suggestion to hold him face down, and then reports and records what happened. Key points: never use a restraint the Commission says must not be used, follow the plan, create space and call for help early, and report every concern about a practice so the team can learn and the plan can be reviewed.

This case study follows Priya, a woman with cerebral palsy who has a mealtime management plan for minced and moist food and mildly thick drinks. At a busy community barbecue, a new worker offers her an ordinary sausage in bread. The lesson shows how her regular worker, Kofi, respects Priya's wish to join in while keeping her safe, what to do after she coughs, and how reporting leads to a medical check. Key points: the plan applies everywhere, prepare for outings, offer safe alternatives, and report new signs on the same shift.