Practice Guide – Positive Behaviour Support and Behaviours of Concern | FOI document library

Practice Guide – Positive

Behaviour Support and Behaviours of Concern

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Purpose ………………………………………………………………………………………………………. 3
To be used by ………………………………………………………………………………………………. 3
Scope ………………………………………………………………………………………………………….. 3
Legislative and Policy Context ………………………………………………………………………… 3 4.1 Behaviours of Concern ……………………………………………………………………………….. 4 4.2 Impacts of Behaviours of Concern (BoC) ………………………………………………………. 5 4.3 Positive behaviour support ………………………………………………………………………….. 6 4.4 Restrictive practices ……………………………………………………………………………………. 8 4.5 Restrictive practice guidelines ……………………………………………………………………… 9 4.6 Point of crisis …………………………………………………………………………………………… 10 4.7 Incident management ……………………………………………………………………………….. 11
Pre-planning……………………………………………………………………………………………….. 12 5.1 Streaming ……………………………………………………………………………………………….. 12 5.2 Plan duration …………………………………………………………………………………………… 13 5.3 Arranging the planning meeting ………………………………………………………………….. 13 5.4 Planning conversation ………………………………………………………………………………. 15
Planning …………………………………………………………………………………………………….. 16 6.1 Core supports ………………………………………………………………………………………….. 17 6.2 Capacity Building supports ………………………………………………………………………… 18 6.3 Plan comments ………………………………………………………………………………………… 23 6.4 Plan management ……………………………………………………………………………………. 24
Plan implementation and monitoring ………………………………………………………………. 25
Scheduled plan reviews ……………………………………………………………………………….. 25
Appendices ………………………………………………………………………………………………… 25 9.1 State and territory restrictive practice legislation …………………………………………… 25
Supporting material ……………………………………………………………………………………… 28
Feedback …………………………………………………………………………………………………… 29
Version change control ………………………………………………………………………………… 29

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1. Purpose

The purpose of this Practice Guide is to guide you through the considerations, roles and responsibilities when planning for a participant who displays Behaviours of Concern (BoC).

2. To be used by

Plan Developers – Planners and Local Area Co-ordinators [LACs]
NDIA Plan Delegates.

3. Scope

This Practice Guide provides information to support plan developers to understand when and how positive behaviour support may be a reasonable and necessary support where the participant displays BoC. This includes the respective roles and responsibilities of the National Disability Insurance Scheme (NDIS), NDIS Quality and Safeguards Commission (NDIS Commission) and states and territories.

Behaviour supports are to be provided in accordance with the NDIS Commission’s requirements for positive behaviour support. The NDIS funds reasonable and necessary supports designed to identify and reduce BoC, to improve the participant’s quality of life, uphold their dignity and safeguard their rights.

The NDIS Commission is operating in all states and territories except for Western Australia. Current state requirements for quality and safeguards continue to apply in Western Australia until the NDIS Commission commences operating from 1 July 2020. Behavioural supports are provided in accordance with the NDIS Commission’s requirements for positive behaviour support. The Positive Behaviour Support Capability Framework includes guiding principles to assist in delivering positive behaviour support.

The NDIS Commission and states and territories have oversight of behaviour support and restrictive practices. They are committed to a regulatory framework for behaviour support that is founded on contemporary evidence-based practice and aligned with the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Services Sector (external).

4. Legislative and Policy Context

The NDIS Commission is responsible for best practice guidance, monitoring and oversight of behaviour support service provision and the use of restrictive practices. State and territory governments remain responsible for specific legislation, policy and procedures related to the authorisation of restrictive practices. These are separate but related processes and requirements.

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The NDIS Commission assesses behaviour support practitioners and providers using a Positive Behaviour Support Capability Framework. This provides guiding principles to assist in delivering specialist positive behaviour support as an NDIS behaviour support practitioner. In all states and territories (excluding Western Australia), providers who use or are likely to use restrictive practices, or who develop behaviour support plans (BSPs) must be registered with the NDIS Commission and meet the supplementary requirements of the NDIS Practice Standards (external).

To support safeguarding for people subject to restrictive practices, any use of restrictive practice must comply with the NDIS (Restrictive Practices and Behaviour Support) Rules 2018. These safeguards include but are not limited to:

behaviour support practitioners, and providers who use regulated restrictive practices (also known as implementing providers) must meet the requirements outlined
state and territory governments remain responsible for the authorisation of BSPs, which include the use of a regulated restrictive practice. Providers must comply with requirements of their state or territory
restrictive practices are clearly identified in a BSP.

The Western Australian government remains responsible for the legislative and policy frameworks regarding the authorisation of regulated restrictive practices and behaviour supports in the NDIS.

Refer to Appendix 1 for state and territory restrictive practice legislation.

The NDIA is not obligated to fund supports which have been imposed by state and territory bodies, which involve the use of restrictive practices, for example where a supervision order has been imposed by a civil or criminal court. However, where a restrictive practice has been authorised, recommended, or implemented by another body, this is a relevant consideration when determining if the support is reasonable and necessary.

4.1 Behaviours of Concern

Behaviours of Concern, also known as challenging behaviours, refer to a wide range of behaviours of an intensity, frequency or persistence that threatens the quality of life, physical safety of the individual and/or others and generally results in limiting access to the community.

Behaviours of Concern can be any behaviour that results in an adverse impact on the person’s quality of life. This may include:

physical or verbal aggression
property damage
inappropriate sexual behaviour
disinhibited and impulsive behaviour

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• self-injurious behaviour also referred to as self-harm. It differs with each person and can include head banging, picking and hitting. This behaviour may not be an attempt to cause harm.

Please note the term self-harm when used in mental health settings typically refers to inintentional harm without suicidal intent such as neglect, cutting, ingesting objects and self- poisoning. Mental health professionals must be consulted by the participant’s supports as this is typically an indication of serious distress.

In order to provide successful interventions, it is necessary to understand the function of that behaviour for the person and the context it occurs. There may be a range of underlying factors influencing BoC including:

• underlying physical, neurological, mental or emotional health issues • biological/physical due to experiencing pain or discomfort • acting out a repetitive behaviour or routine • frustration in not being able to do something • communication/social needs due to difficulties in communication, seeking social interaction or attention • demonstrating a learned behaviour • the physiological effects of substances including alcohol, illegal drugs or medications • difficulty with service systems or support networks • attempting to avoid a situation • interpersonal environment such as quality of social interactions • change in routine or structure • inflexible thinking • attempting to manage sensory overload • having a high pain threshold and the behaviour is intended to provide sensory stimulus • support staff skills and turnover, perceptions and level of resources available.

4.2 Impacts of Behaviours of Concern (BoC)

Behaviours of Concern affect the quality of life of the individual. Factors such as the intensity, frequency or persistence of the behaviours may limit a participant in their opportunities to pursue social, educational, economic and/or recreational activities. Often this is due to the need to maintain the physical safety of an individual or other people (such as family, support workers or the community) and reduce the risk of unsafe social participation (such as inappropriate and/or unsafe sexual behaviours).

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Where the participant exhibits BoC, they may require supports in several areas of their life. Informal supports can have difficulty in sustaining relationships and caring responsibilities due to the potential risk of harm to the participant, other people in the home or themselves. NDIS funded supports can be used to support informal and formal supports in their roles and build their capacity to effectively address the BoC with the participant. These supports may help sustain the participant’s current living and/or support arrangements and encourage the participant to positively engage with others. Where the participant has complex and longstanding BoC there may be further difficulties in engaging and sustaining funded supports. The participants with complex BoC may be at risk of breakdown of their living arrangements such as being temporarily removed from shared living arrangements to individualised accommodation support settings, or family supports no longer being able to sustain the person living in the family home. There is also the risk of increased support staff turnover that in turn can lead to further escalation in behaviours due to constant changes in their environments, formal and informal supports, and the impact of fractured relationships. In some cases, when informal supports are unable to continue to care for the participant who displays complex BoC, an alternative accommodation arrangement may be required for short or long term periods. Where there has been an escalation of behaviours and this requires a change of circumstances refer to the Practice Guide - Unscheduled Plan Review, Practice Guide – Supported Independent Living (SIL) and the Practice Guide – Medium Term Accommodation. In the case of a person under the age of 18, refer to the Practice Guide – Children and Young People with Disability Living in a Voluntary Agreement Outside the Family Home.

4.3 Positive behaviour support

Positive behaviour support is an effective approach for BoC as it focuses on addressing a person’s needs, their home environment and overall quality of life through assessment, planning and intervention. The positive behaviour support process typically follows similar steps.

Brief functional behaviour assessment - focussed on identifying requirements for incident prevention and response.
Interim plan - may also be referred to as a safety interim plan, incident prevention and response plan, reactive strategy response plan or reactive strategy. Interim BSPs include the provision for the use of a regulated restrictive practice developed within one month of engagement by a behaviour support practitioner while a comprehensive BSP is being developed.
Comprehensive functional behaviour assessment - the process for determining and understanding the function or purpose behind a person’s behaviour, and may involve the collection of data, observations, and information to develop an

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Training and implementation support implementation support - this usually targets informal supports and direct support workers and may also include reports and liaison with other stakeholders, reports for the psychiatrist; reports to restrictive practice authorisation mechanisms.
Monitoring - data collection, analysis and reporting.
Review - ongoing review of effectiveness of the BSP; revisit functional behaviour assessment at least annually.

The plan developer includes the appropriate capacity building support in the participant’s plan for the provision of these supports.

4.3.1 Behaviour Support Plan (BSP)

A BSP specifies a range of evidence-based, person-centred and proactive strategies which focus on the individual needs of the person. It is developed with the aim of addressing the underlying functions of BoC taking place or increasing. The plan will outline specifically designed positive behaviour support strategies for the participant, their informal and funded supports to assist in reducing BoC and supporting their quality of life and goal attainment.

There are rules regarding practitioners and BSPs that are relevant to the staff member or coordinator of supports who is assisting the participant to implement their NDIS plan. A registered specialist behaviour support practitioner must develop all functional behaviour assessments and BSPs, as positive behaviour support practice requires a specific skillset and appropriate safeguards. The Positive Behaviour Capability Framework (external) is used to determine suitability of the behaviour support practitioner required.

Behaviour support practitioners must lodge BSPs containing restrictive practices with the NDIS Commission.

If the BSP does not include restrictive practices, it does not need to be lodged with the NDIS Commission. However, the practitioner developing the positive BSP must still be registered as a specialist behaviour support practitioner and the provider implementing restrictive practices must also be a registered NDIS provider.

4.3.2 Assessment, development and review

To develop a positive BSP, a functional behaviour assessment must be completed where practitioners consult with the participant, their family, guardian and other relevant people including the service provider/s who will be implementing the plan. This is to gather historic and current information which identifies settings, triggers, actions and results according to the behaviours displayed.

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The BSP is designed to address the factors identified in the assessment. It will include a range of strategies used to support the person, including proactive skill development to build on the participant’s strengths and response strategies to use when the behaviour presents. Behaviour support plans are formally reviewed annually or earlier if the participant’s circumstances change. At the time of review, the effectiveness of all aspects of the plan including the preventative/environment, skill building/teaching and reinforcement strategies are measured along with step-down strategies when there is the use of restrictive practice. Importantly the progress towards the person’s goals and identified quality of life measures is considered. Assessment information can be used by the plan developer to consider effectiveness and outcomes of funded supports and determine the level and type of capacity building support for inclusion in the NDIS plan. Refer to the Compendium of Resources for Positive Behaviour Support (external) for further information about the range of positive support assessment tools that can be used by practitioners for assessment, planning, implementation, monitoring and review.

4.3.3 Younger People in Residential Aged Care (YPIRAC)

Residential aged care providers have the same responsibilities towards NDIS participants as they do to other residents who receive services and supports under the Aged Care Act 1997. Currently, services are regulated by the Aged Care Quality and Safety Commission. From 30 June 2020 all providers applying the use of restrictive practices with young people in residential aged care will be regulated by the NDIS Quality and Safeguards Commission. Refer to the Practice Guide – Younger People in Residential Aged Care for further information.

4.4 Restrictive practices

A restrictive practice is any practice or intervention which has the effect of restricting the rights or freedom of movement of a person with a disability. All states and territories endorsed the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Services Sector which was reaffirmed in the NDIS Quality and Safeguarding Framework. If there is the use of restrictive practices or request for restrictive practices, the plan developer must make a referral for advice to the Technical Advisory Team (TAT). Refer to the TAT mandatory referrals page for more information. Restrictive practices must be authorised through a formal process which is the responsibility of each state or territory and varies across jurisdictions. Restrictive practices can be considered only if they are the least restrictive alternative, and in the context of positive behaviour support strategies.

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When a person is exhibiting BoC, those around them may try to stop or modify their behaviours in a number of ways with the intention of keeping them or others safe. They may intervene physically, try to control where they go, what they do or administer mood altering medications. Where a practice is age-appropriate to keep a child safe, for example holding a child’s hand while crossing the road, this would not be considered a restrictive practice.

The use of restrictive practices are a risk to the human rights of people with disability and there is a need to ensure there is appropriate reporting and scrutiny when used. The NDIS Commission has identified five forms of regulated restrictive practice:

Seclusion: The sole confinement of a person with disability in a room or a physical space where voluntary exit is prevented, not facilitated or it is implied that exit is not allowed. This may include when a person is put in a room or placed on their own and the person cannot leave when they want to as the door has been locked.
Chemical restraint: The use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. The medication or chemical substance provided is not treating a diagnosed illness or condition and is intended to make them calm or sleepy. This is often psychotropic medication, which affects mood and is generally prescribed by a psychiatrist.
Mechanical restraint: The use of a device to prevent, restrict or subdue a person’s movement for the primary purpose of influencing a person’s behaviour. This includes but is not limited to putting gloves on a person that they cannot remove independently so they are unable to scratch themselves or others, or restraining someone in a wheelchair using a harness that they are unable to undo independently for the purpose of keeping them in the wheelchair. Note: this does not include the use of devices for therapeutic or non-behavioural purposes.
Physical restraint: The 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 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.
Environmental restraint: Restricting a person’s free access to all parts of their environment, including items or activities such as locking cupboards or fridges.

4.5 Restrictive practice guidelines

The NDIS Commission is taking the lead role in reducing and eliminating the use of restrictive practices and holds responsibility for monitoring the use of all restrictive practices recommended and implemented by NDIS providers in Australia. The NDIA is not responsible for making decisions about the use of restrictive practices.

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the relevant State or Territory and where it is part of a BSP that has been developed by a registered behaviour support specialist. The registered behaviour support practitioner is responsible for:

submitting written applications to restrictive practice authorising panels or bodies seeking authorisation
submitting regular progress reports, data summaries, and other documents to restrictive practice authorising panels or bodies
attending restrictive practice panel meetings or other contact with the authorising body.

4.5.1 Participant with immediate needs

Where there is no current interim or comprehensive BSP in place and the participant has an immediate need for a restrictive practice due to a new or previously unexperienced degree of severity in the escalation of behaviour, the NDIS Commission outlines that:

an interim BSP must be completed within a month of engagement by the behaviour support practitioner, and
a comprehensive BSP must be developed within six months of the interim plan being completed by the behaviour support practitioner.

4.5.2 Implementing providers

The NDIS Commission refers to service providers who use a regulated restrictive practice as implementing providers. Implementing providers are expected to understand the context of the person’s behaviour and follow the authorised BSP to make sure the use of any restrictive practice is a last resort intervention and in proportion to the risks posed by the behaviours. Implementing providers will report monthly to the NDIS Commission regarding all restrictive practices used, monitor, and collect data as outlined in the BSP. This forms part of the ongoing focus on reducing or eliminating restrictive practices and addressing BoC. Service providers must aim to reduce the use of restrictive practices by working with the participant and their supports to obtain a greater understanding of the function of the behaviour as well as triggers, and provide preventative strategies and techniques to develop more appropriate ways to support the participant. The behaviour support practitioner will support the implementing provider where required to understand the relevant state or territory legislative and/or policy requirements.

4.6 Point of crisis

A point of crisis is a period of intense difficulty and distress experienced by a participant that disrupts and makes their usual day-to-day life hard to cope with. Participants may experience points of crisis for various reasons, such as escalation of mental health issues or the unexpected loss of formal and/or informal supports. Emergency support may also be

Incident management

4.7.1 Registered providers

Registered service providers must have effective incident management systems and are responsible for recording and managing all incidents that happen in the delivery of NDIS supports and services, and notifying the NDIS Commission of any reportable incidents (including allegations) that occur with the provision of supports and services to an NDIS participant. Reportable incidents include:

serious injury or death of an NDIS participant
abuse or neglect of an NDIS participant
unlawful sexual or physical contact with, or assault of an NDIS participant
sexual misconduct committed against, or in the presence of, an NDIS participant, including the grooming of the NDIS participant for sexual activity

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• the unauthorised use of restrictive practice. Refer to the NDIS Commission’s Reportable Incidents for further information.

4.7.2 Unregistered providers

Unregistered providers must follow their internal provider reporting channels. All providers (registered and unregistered) who are providing NDIS funded supports must follow the NDIS Code of Conduct.

4.7.3 National Disability Insurance Agency (NDIA)

NDIA staff and Partners in the Community may be advised or learn of allegations of serious harm occurring to a participant from a participant, their carer, nominee or other relevant party. This is known as a participant critical incident. If information is provided to you which suggests or alleges a participant critical incident has occurred, refer to the Participant Critical Incident Framework. You must notify the Participant Critical Incidents team where appropriate, refer to Participant Critical Incidents page.

As noted above, any unauthorised use of restrictive practice is a participant critical incident. This incident may be a trigger for a section 48 plan review. The participant and/or their authorised representative can request a review or the NDIA may choose to initiate based on the information provided around the critical incident. Participant critical incidents highlight that the participant’s supports may require adjustment or further changes are needed. It is the responsibility of the NDIS to make sure that a participant has appropriate funding for their support needs, including behaviour support.

5. Pre-planning

5.1 Streaming

Plan developers need to ensure the correct streaming decision has been recorded in the System for the participant to receive the appropriate level of support to implement their plan. Factors to change the streaming decision are dependent on the complexities presenting in the participants current life situation or environment which may be identified during your conversation.

Where a participant has complex support needs requiring a different approach, a referral to the Complex Support Needs Pathway may be appropriate.

Refer to Standard Operating Procedure – Update Participant Streaming and Standard Operating Procedure – Referral for Complex Support Needs for further information.

Note: The term streaming is for internal use only.

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5.2 Plan duration

The plan duration ready reckoner guide recommends plans are developed for up to 12 months when a participant is requiring behaviour support and/or is streamed as super intensive. However, the participant’s individual circumstances should be considered and a shorter plan duration may be required if, for example, the BSP is being assessed, accommodation needs/options are being assessed or close monitoring is required. Where the participant’s situation is stable a longer plan duration may be also be appropriate. Refer to Standard Operating Procedure – Complete the Risk Assessment and Practice Guide - Pre-Planning for further information.

5.3 Arranging the planning meeting

Contact the participant and/or their authorised representatives (nominee/s, child representatives, and court or tribunal appointed decision makers) through their chosen method of communication and confirm/obtain consent for information sharing and exchange. A participant or their authorised representative may choose to invite other family members, friends or NDIS funded support providers to the NDIS planning meeting.

It is important to confirm all meeting attendees. This will allow for appropriate consideration of location, meeting room, time allocated and whether additional or senior staff are required to attend.

In limited circumstances, it may be necessary to appoint a plan nominee to act on behalf of, or make decisions on behalf of a participant. Refer to the Standard Operating Procedures – Appoint, Decline, Suspend or Cancel a Nominee.

Where possible and appropriate, the participant should be in attendance during the planning conversation. The participant’s wellbeing is the priority and discretion is required at times to determine whether it is suitable for their attendance, such as if there is significant unrest and/or concerns about safety due to events such as accommodation or relationship breakdown as a result of significantly challenging behaviours.

In these instances, efforts should be made to include the participant, and consider a shorter meeting to confirm key details or having them contribute in another way such as completing the relevant NDIS booklet prior to the meeting.

When confirming a meeting location and time, it is important to check the System for alerts and confirm the following with the participant or their authorised representative:

Consider the participant’s routine. For example, if the participant has difficulty sleeping at night they may not function well in the mornings and prefer an afternoon meeting.
If known, consider the sensory needs of the participant and confirm an appropriate location. For example, if BoC are triggered by sensory overload, suggest a quiet office to conduct the meeting.

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• Understand any specific environmental factors that may present a risk to the participant or to other members of the meeting including the NDIS staff member. • Understand and respect any cultural sensitivities or barriers to communicate effectively for example, they may prefer to meet with someone of the same gender. • Explore options to book a meeting for an extended period of time to allow breaks, or hold the planning meeting over multiple sessions or arrange for the participant to attend for shorter periods. • Be aware of any behaviour response strategies that may need to be implemented during the meeting and what the role of the NDIS staff member will be, noting the service providers and informal supports who know the person well should lead the response directly with the person to de-escalate the situation or conclude the meeting.

5.3.1 Gathering documentation

Arranging the planning meeting provides an opportunity to follow-up on relevant supporting documentation that has not been provided yet. The participant, authorised representative or their support coordinator may provide this information to the NDIA. In some circumstances, the NDIA may need to follow-up directly once appropriate consent has been obtained.

Behaviour support documentation may include: • the most recent BSP • behaviour protocols or strategies (where not collated in an interim or comprehensive plan as per the NDIS Commission) • behaviour support recommendations report outlining next steps in behaviour support and estimated hours required • incident reports, preferably incident summary reports • data summary reports • Restrictive Practice Authorisation documentation (if relevant) • support model assessment reports including identifying housing options • other assessment reports and support plans, such as speech pathologist, occupational therapist, psychologist, psychiatrist, paediatrician or other medical practitioner • other relevant reports from service providers or mainstream agencies such as court reports.

All new or updated legal/court orders and other documents provided to the NDIS must be uploaded to inbound documents in the System.

5.3.2 External meetings

If a meeting is taking place at a location external to an NDIS office, follow the usual appointment booking process and ensure the following:

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complete and attach a copy of the home visit risk screen document and journey plan to the participant’s record in the System
review other information available in the System including, but not limited to previously completed planner risk assessment, guided planning questions, planning conversation tool and inbound documents. This information will assist in ascertaining if there are any likely risks or concerns, such as other people being in the premises and the general safety of surrounds
discuss any identified risks and take any appropriate action as determined with your team leader
familiarise yourself with the journey management procedure and out of office best practice guide.

NDIA staff are supported to make decisions at all times to protect their personal safety. These decisions may include:

deciding that a visit requires a second employee to be present
arriving at a location and deciding to cancel a visit due to safety concerns
terminating a visit part way through due to safety concerns.

Refer to the Work Health and Safety page for further information.

For circumstances where the health, safety and/or security of NDIA staff or others is put at risk due to the behaviour of a participant or other third party, NDIA staff should refer to the Work Health and Safety page and NDIA Managing Unreasonable Behaviour Framework, Policy and Guideline for information, advice, reporting and escalation protocols.

5.4 Planning conversation

The participant is at the centre of the planning process and their goals and needs are explored by discussing their strengths and what they would like to achieve. The planning conversation should identify goals, capacity, risks and safeguards and provide an opportunity to discuss any assessments and reports.

Information provided in the planning meeting about the participant’s BoC must be detailed in the guided planning questions free text box and in the planning conversation tool.

The following points can support you to have a high quality conversation:

Be mindful of the person’s communication needs and preferences including whether an interpreter is required.
Make decisions about what will be appropriate to ask the person directly and what may be triggering or distressing that can be gathered in another way.
Read previous planning information (if applicable), interactions and inbound documents.

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Review the support coordination progress reports. These should detail information including the participant’s circumstances, identified risks, strategies and outcomes for the participant’s goal progression.
Review the behaviour specialist reports and any other assessments that identify outcomes achieved, key barriers and recommendations for the new plan.
Follow up any requested reports and/or assessments not yet provided, to assist informing the planning process.
Use visual tools to assist in communicating. For example, if asking a participant about their schedule, use the weekly supports table in the NDIS planning booklet (external) to help break down the questions, or other format as determined appropriate to their communication needs.
Encourage the participant to talk about/communicate their interests, what daily life is like, what challenges they face and allow time as needed for them to explain this to you.
Discuss the previous plan (if applicable), what they found worked well and what did not. For example, they may have strong informal supports or may be at risk of losing their housing or in temporary accommodation placing them at risk of homelessness.
Be conscious to not ask leading questions as people are likely to give the answer they think you want to hear.
If the participant is appearing anxious or not engaging, consider asking them what would make them feel more comfortable such as having a break.
Depending on the participant’s situation, there may be multiple stakeholders with differing input present in the planning process. In these circumstances, make sure the participant and their authorised representative are the focus of your attention. Make sure they understand that they can request other people leave the room at any time.
In some circumstances, due to the complexity of the participant’s BoC further discussion may need to take place with the participant’s informal supports and positive BSP practitioner to discuss current and proposed support needs, or there may need to be a second meeting.
Where appropriate, seek consent to follow-up with specific individuals or providers. Refer to the Standard Operating Procedure – Consent and Authority for further information.

6. Planning

The Agency must be satisfied that the funded supports in the participant’s NDIS plan meet each of the criteria outlined in section 34(1)(a)-(f) of the National Disability Insurance Scheme Act 2013 (NDIS Act) and the NDIS (Supports for Participants Rules) 2013.

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When planning for the participant with BoC

When planning for the participant with BoC, it is important to be aware of any recent or upcoming changes in their life. Behaviours of concern may take place more frequently or at a greater severity during transitional periods for example during adolescence, leaving school or changes in living arrangements. It is important to also be mindful that effective positive behaviour support:

is not a linear process. For example, the practitioner may be conducting an assessment while revising the plan and training
is highly individualised
is holistic and integrated
utilises a systems approach
includes crisis response and BSP revision as required
includes multi-disciplinary input in all elements including assessment, design, implementation and review
varies in intensity and time required depending on the complexity of the person’s situation and support needs
cannot always be delivered in monthly amounts across the year. For example, there may be a high utilisation initially for providers to complete the initial assessment, interim planning, comprehensive assessment and comprehensive BSP development.

Refer to Practice Guide - Determine Reasonable and Necessary Supports for further information.

6.1 Core supports

Core supports are intended to assist with or supervise personal tasks of daily life to enable the participant to live as independently as possible. The BSP is expected to be used by all formal supports to build on the participant’s strengths, increase their opportunities to participate in community activities and increase their life skills. Where possible, the funds can be used to strengthen the capability and capacity of the participant and their informal supports (if applicable) by reinforcing strategies and encouraging independence towards goal attainment. Providers for participants with complex BoC may request higher support costs, for example 2:1 or 1:1 for the participant to continue to attend a day program. This level of support can be considered an environmental constraint where it is as a response to behaviour concerns and not related to other support needs such as health. The delegate may need to consider that the sudden removal of funded Core supports for participants with high level staff ratios and/or restrictive practices may put the participant’s living arrangement, their staff, or others at risk.

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It is therefore important to consider a transitional or gradual step down model to effectively reduce supports in line with the BSP. This is likely to take place over the course of multiple NDIS plans and should be guided by the registered specialist behaviour support practitioner. The TAT may be consulted as needed via TAPS and advice should be sought from TAT for all plans that contain restrictive practices. For more information refer to mandatory referral. If the participant requires a higher intensity level of support, refer to the Standard Operating Procedure – Self-Care and Community Access Supports for further information.

6.1.1 Behaviours support provision in supported independent living (SIL)

Behaviour supports need to take a whole of house approach when a participant is living in a supported independent living (SIL) arrangement with other people with disabilities. Behaviour support may be recommended where there are high-level staffing ratios such as 2:1 or 1:1 support for individual residents and/or active overnight support are in place to manage risk to staff and residents, or there are frequent incidents such as assaults, self-harm and/ or property damage.

A whole of house approach for behaviour support involves considering reasonable and necessary funded supports allocated for each participant can be utilised in a coordinated way to meet the needs and increase the quality of life of all residents.

Behaviour supports for a whole of house approach may include:

shared living environmental assessment, also known as ecological assessment
behaviour support systems review
program development
staff training.

Some of these supports may be shared in a whole of house approach, for example, there would be one shared living environmental assessment completed by the one provider to assess the overall household situation. The cost of the environment assessment would then be broken down and shared amongst all those living in home. Refer to the Practice Guide – Supported Independent Living (SIL).

6.2 Capacity Building supports

Before including funding for behaviour supports, consider the Capacity Building funding generated by the TSP and whether these funds are sufficient to provide some or all of the required behaviour support. To do this you will need to understand what other Capacity Building supports are required by the participant and work out whether the total Capacity Building funding needs to be increased to support the participant with their BoC. For instance, a child or younger person may require a higher level of funding so their informal supports are appropriately trained to implement the BSP.

There is a guided planning question related to BoC which must have the correct responses recorded. Responses to this question are for data capturing only and do not generate any

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funding in the TSP. The TSP is a guide and decisions on reasonable and necessary supports should be made in accordance with S34 of the NDIS Act.

6.2.1 CB Daily Activity

Best practice in behaviour support involves a multidisciplinary approach tailored to the needs of the person. It is therefore important to ensure the relevant therapeutic assessments and services are included in CB Daily Activity area of the plan. NDIS reasonable and necessary improved daily living supports may include:

assessments including psychological, communication and sensory
individual skills development and training
training for carers or parents.

As noted previously, a functional behaviour assessment can only be completed by a registered specialist behaviour support practitioner or provider.

6.2.2 CB Relationships

Behaviour supports within the category of CB Relationships may include:

specialist behavioural intervention support for assessment and development of BSP
behaviour management plan and training in behaviour management strategies
individual social skills development.

Dependent on the participant’s circumstances, NDIS funded support workers may require individualised training specific to the participant to maintain consistency and positive behaviour supports. Practitioners may provide training plans for the support worker or therapy assistant in the development of social skills identified as required due to BoC.

When determining reasonable and necessary funding, the specialist behaviour support practitioner would be expected to monitor the BSP implementation and review accordingly. Regular review allows opportunity for changes and updates to the BSP if the progress differs from expectations.

Questions which may help in determining the amount of funding include:

Which stage of behaviour support currently applies? Are they at the brief assessment and safety planning stage (Refer to 5.2) or are they stable and in the monitoring stage? This indicates how many hours are still required for assessments and reporting.
Does the participant already have a current comprehensive behaviour assessment?
- If so, the next assessment will usually require less time.
Does the participant already have a current comprehensive BSP?
- If so, the next BSP update will usually require less time.

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• How many BoC does the person engage in?

Usually the more behaviours, the more time required for all stages of the behaviour support process. • What is the intensity and severity of the behaviour/s of concern? More intense and high-risk behaviour is likely to require more time in assessment, design, protocol revision and implementation support. • How many informal and formal support providers are involved? This will impact on the amount of observations, interviews, file review required; the amount of tailored strategies required for various environments and roles; and the amount of training and implementation support required. • How many regulated restrictive practices are proposed or in place? The more practices, the more time required for assessment, design, implementation, and reporting. • How many informal or funded supports require training and implementation support? Can this be done in one session or do multiple repeat sessions need to be factored in? • What other reporting requirements does the specialist behaviour support practitioner have? This may include data summaries and consultation with a psychiatrist to inform medication review. • How will the multidisciplinary team collaborate? How often will they need to meet or have other contact? • How many other stakeholders does the specialist behaviour support practitioner need to engage with? • How much direct contact will the specialist behaviour support practitioner have with the person for skill development? Is this sessional, what is the frequency? • What other pieces of work are required? Are there specific assessments that can inform the behaviour assessment behaviour assessment report (such as Assessment of Sexual Knowledge); Support Model Assessment report; transition plan development and implementation (such as from one placement to another). • Where there are regulated restrictive practices required, you should also include funding for the specialist behaviour support practitioner to meet their obligations under the NDIS Commission specific to this participant and the state or territory authorisation process.

6.2.3 Levels of behaviour intervention support

You will need to ensure the participant receives the appropriate support required to implement their plan and to address any behavioural complexities in their current life situation. There are two levels of behaviour intervention support provided as a guide however the participant’s individual circumstances and supporting information must be considered in every plan to determine appropriate funding and supports required.

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The levels of support include a behaviour management plan and training in the management of strategies to form a package of support to address a participant’s immediate need for behavioural intervention. You will need to make a reasonable and necessary decision to determine the appropriate level of support included in the participant’s plan. The guidance in hours has been suggested for a plan of 12 months in duration. Use your easonable and necessary decision making for plans with durations less or more than 12 months. If a participant has significant behaviours of concern it is highly unlikely that there will be a plan over 12 months due to the need to monitor and review outcomes and circumstances. Consult with your team leader and refer to the participant’s individual supporting documents, Practice Guide - Determine Reasonable and Necessary Supports and the Standard Operating Procedure – Include Behavioural Intervention Support in a Plan for further guidance.

6.2.3.1 Level 1

Level 1 funding could be considered appropriate for participants who require intervention due to significant behavioural complexities that are impacting on the ability of the participants informal supports to sustain care at home and assist the participant to safely engage in activities. Level 1 criteria includes: • behaviours of concern that could require single or minimum interventions • lack of services willing to engage with the participant due to presenting behaviours and risk to staff/participants/community • change of participant circumstances that will result in withdrawal of service support and need for immediate intervention. Use reasonable and necessary decision making to include specialist behavioural intervention support. Most level 1 plans should not exceed 45 hours (approx. 3-4 hours per month) which will enable the participant to receive support from a psychologist or appropriate therapist to develop a BSP, implement strategies and review interventions over a period of time. To support carers and any other significant informal supports in the participant’s life to implement the behavioural support plan and behavioural strategies, include training in behaviour management. Most level 1 plans should not exceed 20 hours (1-2 hours per month) which will ensure the behavioural intervention support plan is applied consistently in all necessary environments to best support the participant. Participant’s that may have significant 1:1 support in the community (equal to 30% of the day) or at home due to their harmful or persisting behaviours that may present risk to themselves or others. V2.0 2020-02-26 Positive Behaviour Support and Behaviours of Concern Page 21 of 29 This document is uncontrolled when printed. Page 50 of 388

6.2.3.2 Level 2

Level 2 funding could be considered appropriate for participants that require immediate intensive behavioural intervention support and are streamed Super Intensive. In the majority of circumstances, level 2 funding is not appropriate for children aged 7 and under.

Level 2 criteria includes:

multiple complexities that may require multiple interventions
extreme behaviours of concern that could require restrictive intervention
lack of services willing to engage with the participant due to presenting behaviours and risk to staff/participants/community
significant change of participant circumstances that will result in withdrawal of service support and need for immediate intervention
behaviours of concern involving various stakeholders (multiple issues for intensive intervention requiring comprehensive assessment, planning, support and training for the participant and carers)
participants who may have significant 1:1 support in the community, 1:2 support in the community (greater than 30% of the day ) or exceptional circumstance supports at home due to their harmful or persisting behaviours that may present risk to themselves or others
participants who require additional support to implement newly developed strategies in the community or within newly engaged activities/services.

Use reasonable and necessary decision making to determine how many hours of specialist behavioural intervention support to include in the plan. Most level 2 plans should not exceed 90 hours (7-8 hours per month) for specialist behavioural intervention support which will support participants with significantly harmful or persistent behaviours of concern.

This package of support would be considered in the following circumstances:

when a participant has extreme behaviours that could require restrictive intervention
where there is significant change of circumstances that will result in a withdrawal of service support
where there is significant risk to support staff, other participants or the community
to support carers and other significant informal supports in the participant’s life to apply the developed BSP and behavioural strategies, include training in behaviour management. Most level 2 plans should not exceed 30 hours (2-3 hours per month) which will ensure the behavioural support plan is applied consistently in all necessary environments to best support the participant
for participants that require additional support to implement newly developed strategies in the community or within newly engaged activities/services, include

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6.2.4 Support coordination

Support coordination is intended to strengthen the participant and/or their authorised representative’s abilities to coordinate and implement supports in the plans to participate more fully in the community, and to build and maintain a resilient network of formal and informal supports. This includes addressing barriers to implementation and regular monitoring. A participant who displays BoC may require support coordination or specialist support coordination to assist where required.

You will need to consider the level of support the participant and/or their authorised representative will require to build their capacity to connect with supports and services, ensure they understand their NDIS plan and how to implement their funded supports, and strengthen their ability to self-direct services and achieve their goals.

It is also part of the support coordinator’s role to build capacity of the participant and/or authorised representatives to gather supporting documents including assessments and reports and ensure these are provided to the NDIS.

Where the participant experiences a crisis, the support coordinator will assist them as required, to manage and link into appropriate supports. This information should form part of their next progress report to the NDIS where any known causes of the crisis, how it was managed, the outcome and proposed strategies to reduce the likelihood of a reoccurrence are detailed.

The reporting and monitoring requirements must be clearly outlined in the Request for Service and discussed at plan handover. Refer to Standard Operating Procedure – Include Support Coordination in a Plan.

6.3 Plan comments

Make sure your plan comments recorded in Determine Funded Supports task include a description of the behaviour supports included within each budget.

Example (Core) – only relevant where there is a regulated restrictive practice in the participant’s BSP: I can use my core support funding flexibly to help with my daily activities. Assistance with self-care activities and accessing the community to be provided by a registered implementing provider.

Example (Capacity Building): Funding for XX hours of specialist behaviour intervention support, XX hours of behaviour management plan and training in behaviour management strategies. A report detailing outcomes achieved is to be provided to the NDIA by the registered specialist behaviour support practitioner before this plan is due for review.

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6.4 Plan management

It is important to understand the distinction between choice and control in regards to plan management and the legislative requirements to use a registered provider.

The NDIS (Provider Registration and Practice Standards) Rules 2018 specifies that to maintain safeguards and minimise risk to the participant, NDIS providers must be registered for:

functional behaviour assessments
developing BSPs, and
regulated restrictive practices.

Behaviour support practitioners (whether a sole provider or employed by a provider) must be registered with the NDIS to provide specialist behaviour support (registration group 110).

The NDIS recommends that CB Relationships is Agency managed to ensure the use of NDIS registered providers; however, participants and/or their authorised representatives may choose to have their supports plan or self-managed. It is important for participants and/or their authorised representatives to understand the distinction between choice and control in regards to plan management and the legislative requirements to use a registered provider for specific behaviour supports (functional behaviour assessments, BSPs, and regulated restrictive practices).

NDIS legislation is based on the presumed capacity to self-manage. Therefore, a request by the participant to manage their funding should be considered positively by the delegate unless there is evidence of a significant risk to the participant.

The NDIS supports the participant to maximise their choice and control where there is not unreasonable risk or other factors impacting the participant’s and/or their authorised representative’s ability to manage NDIS funding. The determination of unreasonable risk is assessed with every plan review, having regard to the participant’s individual circumstances and considerations.

6.4.1 Restrictive practice

Where the BSP includes regulated restrictive practice, the participant and/or their authorised representatives should be aware that the implementing service provider for the behaviour support must also be registered with the NDIS Quality and Safeguards Commission.

Where supports are self or plan–managed, a thorough conversation with the details recorded in the appropriate pre-planning tasks and clear NDIS plan comment (see 6.3) should follow. This is to make sure that the participant and/or their authorised representatives understand while the funding management allows for the use of unregistered service

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providers, there is a legislative requirement that registered providers must be used for BSPs and regulated restrictive practices. Refer to Planning Operational Guideline – Managing the funding for supports under a participant’s plan (the plan management decision) for further information.

7. Plan implementation and monitoring

There should be ongoing monitoring during the plan period to measure whether the participant is meeting their desired outcomes and goals. This can take place through a variety of means including support coordination reports, regular updates and Panda Live data.

It is important to check the plan utilisation to make sure that the plan is being implemented as expected and provide opportunity for earlier follow-up if there appears to be an over or under utilisation. Due to the nature of this support, there is likely to periods of intensive support and high budget utilisation, therefore the utilisation should be considered over time. Refer to PANDA, Practice Guide – Plan Implementation and Practice Guide – Monitoring for further information.

8. Scheduled plan reviews

Make sure you have received the progress report from the support coordinator or specialist support coordinator and reviewed it to understand key issues and outcomes from the plan period.

It is expected the NDIA will be provided with supporting information demonstrating outcomes, barriers and where appropriate, recommendations for the next NDIS plan. For example where there has been successful implementation of capacity building supports, it may lead to a reduction of supports based on the behaviour support practitioner recommendations. Fade-out or step down approaches will be clearly documented based on supporting information. These approaches form a key part of reasonable and necessary decision making when a participant’s BSP includes restrictive practices. For further information refer to Practice Guidance - Scheduled Plan Reviews and Standard Operating Procedure – Complete a Plan Review (full).

9. Appendices

9.1 State and territory restrictive practice legislation

The state and territory governments remain responsible for specific legislation, policy and procedures related to the authorisation of restrictive practices. This is complementary to the NDIS Commission who is responsible for best practice guidance, monitoring and oversight of behaviour support service provision and the use of restrictive practices in all states and territories (excluding Western Australia).

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Behaviour Support Practitioners and Restrictive Practices

Behaviour support practitioners must adhere to the requirements of the NDIS Commission and the state or territory in which they operate. Plan developers can refer practitioners, providers and plan implementers (support coordinator or LAC) to the relevant source of information. If there are concerns, discuss with your supervisor, request TAT Advice or escalate feedback that may need to be considered for report to the NDIS Commission.

9.1.1 New South Wales

While there is no specific legislation regarding restrictive practices in New South Wales, there is the Guardianship Act (1987).
New South Wales also have the restrictive practice authorisation policy and procedural guide outlining requirements. Approval is provided through the restrictive practices authorisation (RPA) panels.
Service providers must comply with the New South Wales restrictive practices authorisation policy and procedural guide.
There is expected to be an updated New South Wales policy concerning restrictive practices authorisation mechanism, which providers will also need to comply with.

9.1.2 Victoria

The Victorian government remains responsible for the legislative and policy frameworks regarding the authorisation of regulated restrictive practices and behaviour support in the NDIS.
The Victorian Senior Practitioner has the power to issue prohibitions and directions related to restrictive practices, compulsory treatment and supervised treatment orders under the Disability Act 2006.

9.1.3 Queensland

The Queensland government remains responsible for the legislative and policy frameworks regarding the authorisation of regulated restrictive practices in the NDIS through the Disability Services Act (2006) for those over 18 years.
The Disability Services Act (2006) helps safeguard people with an intellectual or cognitive disability and their rights against the inappropriate use of restrictive practices and provides an accountability framework that allows for transparency in the decision-making process to authorise the use of a restrictive practice by a relevant service provider with an adult with an intellectual or cognitive disability.
The Disability Services Act (2006) sets out a number of requirements that the relevant disability service provider must follow to legally use a restrictive practice.

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Western Australia

• The Western Australian government remains responsible for the legislative and policy frameworks regarding the authorisation of regulated restrictive practices and behaviour supports in the NDIS. • Providers are encouraged to follow the Code of Practice: A Guide for the Elimination of Restrictive Practices (external).

South Australia

• The South Australian government has policy and procedures outlining state requirements regarding restrictive practice authorisation. • The Disability Services Act 1993 requires disability service providers to have restrictive practices policy and procedures in place. Seclusion of an adult with disability must only be used if specifically authorised by the South Australian Civil and Administrative Tribunal (SACAT) under Section 32 of the Guardianship and Administration Act 1993.

Tasmania

• The Tasmanian government remains responsible for the legislative and policy frameworks through the Disability Services Act 2011 regarding the authorisation of regulated restrictive practices, which are approved by Tasmanian Senior Practitioner. • Chemical restraint does not have authorisation requirements in Tasmania.

Australian Capital Territory

• The Senior Practitioner Act (2018) remains responsible for the approval of behaviour support plans, which include the use of a regulated restrictive practice. • The Senior Practitioner Act (2018) provides the powers and functions of the Senior Practitioner and regulates the use of restrictive practices by persons or other entities who provide any of the following services to another person: − education, including education and care − disability − care and protection of children.

Northern Territory

• The Northern Territory government will be responsible for the legislative and policy frameworks regarding the authorisation of regulated restrictive practices in the NDIS through the NDIS (Authorisations) Act 2019.

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10. Supporting material

• NDIS Act 2013 • NDIS (Quality and Safeguards Commission and Other Measures) Transitional Rules 2018 • NDIS (Restrictive Practices and Behaviour Support) Rules 2018 • NDIS (Code of Conduct) 2018 • NDIS (Incident Management and Reportable Incidents) Rules 2018 • NDIS (Provider Registration and Practice Standards) Rules 2018 • NDIS (Plan Management) Rules 2013 • Overview of the NDIS Operational Guideline – Quality and Safeguards • NDIS Quality and Safeguards Commission • NDIS Quality and Safeguarding Framework • Convention on the Rights of Persons with Disabilities (external) • National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector (external)

10.1.1 New South Wales

• Guardianship Act 1987 • Restrictive Practice Authorisation Policy (June 2019) • Restrictive Practice Authorisation Procedural Guide (June 2019)

10.1.2 Victoria

• Disability Act 2006: Supervised Treatment Orders, Restrictive Practices, Compulsory Treatment

10.1.3 Queensland

• Disability Services Act 2006

10.1.4 Western Australia

• Code of Practice: A Guide for the Elimination of Restrictive Practices

10.1.5 South Australia

• Safeguarding People With Disability Restrictive Practice Policy (2017) • Restrictive Practice Reference Guide for the South Australian Disability Service Sector (2017)

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10.1.6 Australian Capital Territory

e Senior Practitioner Act 2018

10.1.7 Northern Territory

e NDIS (Authorisations) Act 2019

10.1.8 Tasmania

e Disability Services Act 2011

11. Feedback

If you have any feedback about this Practice Guide please email Planning Support. In your email, remember to include the title of the resource you are referring to and to describe your suggestion or issue concisely.

12. Version change control

Version No	Amended by	Brief Description of Change	Status
1.0	ZWECKM P19702	Guidance to support staff when APPROVED	2020-01-20
planning for participants who
display behaviours of concern.
Behavioural supports are to be
provided in accordance with the
NDIS Quality and Safeguard
Commission’s requirements for
positive behaviour support.

Behaviour intervention levels moved to PG from SOP — Behaviour intervention supports. Class 3 approval | | 2.0 | KNO014 | Replacing National Critical Incident APPROVED | 2020-02-26 Response with Participant Critical Incidents Framework Class one approval |

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Practice Guide – Positive Behaviour Support and Behaviours of Concern