Introduction to Restrictive Practices for NDIS Workers

Restrictive practices limit a person's rights or freedom of movement, so they are tightly controlled. This lesson explains why. Key points: people with disability have the same rights as everyone else, including freedom of movement and freedom from restraint; restrictive practices can cause physical and psychological harm; they must only be used as a last resort to reduce the risk of harm, in the least restrictive way and for the shortest time; and the goal of behaviour support is always to reduce and eliminate their use over time.

The NDIS (Restrictive Practices and Behaviour Support) Rules 2018 name five regulated restrictive practices. This lesson introduces them: seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint. Key points: each is defined by what it does and, for restraints, whether its primary purpose is to influence behaviour; the same object or action can be a restrictive practice in one situation and not in another; and if you are unsure whether something is a restrictive practice, ask your team leader before you use it.

Restrictive practices are usually linked to behaviours of concern, so understanding those behaviours helps us reduce restrictions. This lesson explains positive behaviour support. Key points: behaviours of concern usually serve a purpose for the person, such as escaping something difficult, getting attention or relief from pain; they are influenced by the environment, health, communication and routines; positive behaviour support focuses on quality of life and meeting needs rather than controlling behaviour; and good proactive support is the best way to reduce restrictive practices.

Seclusion is the sole confinement of a person in a room or space where voluntary exit is prevented, not facilitated, or it is implied they cannot leave. Environmental restraint restricts a person's free access to all parts of their environment, including items and activities. This lesson gives everyday examples. Key points: seclusion includes telling someone to stay in their room, not only locking a door; environmental restraints include locked fridges, cupboards, rooms or yards and removing items; restrictions on one person can affect housemates; and both need authorisation and a behaviour support plan.

Chemical restraint is the use of medication or a chemical substance for the primary purpose of influencing a person's behaviour. It does not include medication prescribed by a medical practitioner to treat a diagnosed mental disorder, physical illness or physical condition. This lesson explains the difference. Key points: medication to calm someone when they are agitated is often chemical restraint; as needed or PRN medication for behaviour is a common example; you must follow the medication chart and the behaviour support plan exactly; and never give medication to manage behaviour without authorisation.

Mechanical restraint is the use of a device to prevent, restrict or subdue a person's movement for the primary purpose of influencing behaviour. Physical restraint is the sustained or prolonged use of physical force for the same purpose. This lesson gives examples. Key points: devices used for therapeutic or safety reasons, such as postural supports, are not mechanical restraint when used for that purpose; brief physical guidance is not the same as physical restraint; some physical restraints, including any that restrict breathing, are never permitted under our policy; and all restraints carry serious risks.

The NDIS Quality and Safeguards Commission regulates restrictive practices, but it does not authorise them. Authorisation is the responsibility of the state or territory where the practice is used, and the process differs between jurisdictions. This lesson explains the basics. Key points: a regulated restrictive practice must be authorised under the relevant state or territory process, where one exists; it must also be included in a behaviour support plan; the implementing provider must be a registered NDIS provider; and without authorisation and a plan, use is unauthorised and must be reported.

A behaviour support plan is written by an NDIS behaviour support practitioner and sets out how to support a person whose behaviour may put them or others at risk. This lesson explains what plans contain. Key points: plans focus first on proactive strategies that improve quality of life, then on how to respond early, and only then on any restrictive practice; plans that include regulated restrictive practices are lodged with the NDIS Commission; an interim plan may be written first, with a comprehensive plan to follow within the required timeframe; and plans must be regularly reviewed with the aim of reducing restrictions.

Support workers are usually the people who put a behaviour support plan into practice each day. This lesson explains your role. Key points: read and understand the plan before you work with the person; ask for training in any restrictive practice you may need to use; use proactive strategies consistently; use a restrictive practice only exactly as written, only when the conditions in the plan are met, for the shortest time and in the least restrictive way; record every use accurately; and share observations that could help the practitioner reduce restrictions.

Unauthorised use of a restrictive practice happens more often than people realise, often through well meaning actions. This lesson helps you recognise it. Key points: a practice is unauthorised if there is no authorisation where required, it is not in a behaviour support plan, or it is used in a way that does not follow the plan; common examples include locking doors or food, taking away belongings, as needed medication for behaviour without a plan, and restrictions requested by families; and every unauthorised use is a reportable incident.

Unauthorised use of a restrictive practice is a reportable incident under the NDIS rules. This lesson explains the reporting pathway. Key points: tell your team leader or the on call manager straight away; complete an incident report before the end of your shift; our organisation must notify the NDIS Commission within five business days of becoming aware, or within 24 hours if the person was harmed; authorised uses are also reported to the NDIS Commission each month; and you will not be punished for reporting in good faith. Reporting is how we learn and reduce restrictions.