ResearchFOI 25/26-0805paper
DOCUMENT 4
Positive behaviour support
The content of this document is OFFICIAL.
Please note:
e This document is intended to assist Technical Advice and Practice Improvement Branch (TAPIB) staff with provision of technical advice or practice improvement activities. Branch Manager clearance is required before research documents are shared outside the branch.
e The TAPIB Research team take care to ensure the research presented is accurate at the time of writing. Due to the nature of our work, we are not able to ensure that all relevant research has been considered in the development of this document or that information remains accurate after publishing.
Research question:
e Is the use of behaviour support plans effective in reducing behaviours of concern or the use of restrictive practices for people with disability compared with staffing supports or environmental controls implemented without the use of positive behaviour support plans?
e What is the Positive Behaviour Support Capability Framework and how is it used to implement positive behaviour support in Australia?
e What is a containment model of care? How does it relate to seclusion as a type of restrictive practice? What are the risks of support staffing strategies becoming containment strategies?
e Where do the scopes of practice for psychologists and behaviour support practitioners overlap and differ with respect to managing and supporting people with behaviours of concern?
Date: 22/4/2026
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Summary
This paper discusses the evidence-base and regulatory framework supporting the practice of positive behaviour support in Australia.
There is evidence that positive behaviour support is effective at reducing behaviours of concern and reducing the use of restrictive practice. The quality of the literature is mixed and some studies show inconsistent results. However, there is a clinical consensus around the efficacy of a structured, multi-component human rights-based approach to managing behaviours and reducing the use of restrictive practice.
In Australia, the use of positive behaviour support, including the development of behaviour support plans, is governed by legislation and regulated by the NDIS Quality and Safeguards Commission. ‘Behaviour support practitioner’ is not a protected term, though practitioners must be deemed suitable by the NDIS Quality and Safegards Commission in order to practice positive behaviour support with NDIS participants.
Behaviour Support Practitioners
According to Behaviour Support Practitioners Australia (BSPA), a behaviour support practitioner, also called a positive behaviour support practitioner, is someone who can “assess the influences on a person’s behaviour, and design interventions to both increase a person’s quality of life and reduce challenging behaviours” (BSPA, n.d. a). This practice is known as behaviour support or positive behaviour support. According to the NDIS Quality and Safeguards Commission (2026):
Positive behaviour support is an evidence, value and rights based approach. It focuses on improving a person’s quality of life and understanding the reasons behind behaviour and ways to meet a person’s needs. This includes strategies such as teaching a person new skills, making changes to their environment and providing guidance to their support team.
A behaviour support plan provides strategies to address behaviours. It meets the individual’s needs, while respecting their dignity and working to improve their quality of life.
In Australia, ‘behaviour support practitioner’ is not a protected term, there are no specific qualifications required and the discipline is not regulated by AHPRA. Many behaviour support practitioners have a background in other allied health disciplines such as social work, psychology, or occupational therapy.Behaviour support practitioners may also be trained as Behaviour Analysts (BSPA, n.d. a-b). Refer to RES 246 ABA and positive behaviour support for further details on the differences and overlap between behaviour support practitioners and practitioners of Applied Behaviour Analysis.
3.1 Positive Behaviour Support Capability Framework
There is some overlap in the scope of practice for behaviour support practitioners and psychologists. Psychologists may conduct assessments or provide therapy to clients. They may specialise in therapeutic techniques that assist clients to identify behaviours causing them distress and aim to change a client’s behaviour (such as Cognitive Behavioural Therapy)(APS, n.d.). However, they are not for this reason qualified to provide positive behaviour support or qualified to develop behaviour support plans for NDIS participants. Psychologists and other allied health providers may assist behaviour support practitioners to implement behaviour supports outlined in a behaviour support plan(NDIA, 2025).
In order to provide behaviour support services for NDIS participants, including developing behaviour support plans, a person must be registered with the NDIS Quality and Safeguards Commission as a specialist behaviour support provider or employed by such a provider. A practitioner must be deemed suitable by the NDIS Commission(NDIS QSC, 2026; 2025; 2024). This includes a self-assessment process according to the Positive Behaviour Support Capability Framework.
The Positive Behaviour Support Capability Framework outlines the competencies necessary for a practitioner to be deemed suitable to provide positive behaviour support for NDIS participants. It defines four levels of capability: core, proficient, advanced and specialist. The capabilities for each level are described in Table 1 Levels of capabilities for behaviour support practitioners.
Further requirements of behaviour support practitioners and behaviour support plans are stated in National Disability Insurance Scheme (Restrictive Practices andBehaviour Support) Rules 2018 andNational Disability Insurance Scheme (Provider Registration and Practice Standards)Rules 2018,Schedule3-Module2-2A.
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Table 1 Levels of capabilities for behaviour support practitioners
| Level | Capabilities |
|---|---|
| Core | Recall, understand and apply concepts relating to disability and PBS in general circumstances Have a core understanding of other models of practice which are complementary to PBS (e.g., environmental enrichment, person-centred active support) Access and actively participate in supervision and supervised practice (a core practitioner works under the supervision of practitioner rated as proficient or above). |
| Proficient | Analyse and evaluate information Evaluate the quality of behaviour support plans Constructively promote PBS across the organisation Access and actively participate in supervision to build on behaviour support knowledge and skills (from an advanced or specialist practitioner) Provide and participate in peer supervision with another proficient practitioner (if relevant to their supervision schedule) Supervise a core practitioner (if the proficient practitioner has the skills and knowledge base to do so). |
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Level Capabilities
Advanced Synthesise and integrate information from a range of sources
Demonstrate high-level critical thinking and analytical skills to make effective decisions in complex situations
Demonstrate high-level knowledge of and skills in areas covered by the PBS Capability Framework and in fields that complement the PBS approach
Shape strategic thinking in PBS
Achieve results in system change that enhances the rights of persons with disability
Provide practice leadership across settings and interactions with stakeholders
Use knowledge and practical skills gained through further study and/or extensive practical experience to provide specialist behaviour support as part of an interdisciplinary team working in complex contexts
Access and participate in supervision as the supervisee (including peer supervision with another advanced practitioner)
Supervise other practitioners at all levels
Have the skills to perform in a managerial or practice leadership position.
Specialist Recognised for an area of specialisation in or relevant to PBS,
including:
- e Apractice speciality (e.g., forensic, trauma-informed practice, augmentative and alternative communication)
- e Dual diagnosis (e.g., intellectual disability and mental health)
- e Aspecific population or cultural group
- e A specific age group or transition point.
Have the skills and ability to provide supervision and support to other behaviour support practitioners in their area of expertise
Access and participate in supervision as the supervisee (including peer supervision with another specialist practitioner)
Evidence base for positive behaviour support
Two research reports from the Disability Royal Commission assessed the evidence base for positive behaviour support (Spivakovsky et al, 2023; Cortis et al, 2023).
Spivakovsky et al (2023) found some evidence for the reduction in behaviours of concern and the reduction in use of restrictive practices. In particular, training support staff in the use of PBS may improve staff understanding of behaviours as a form of communication and may reduce the likelihood that staff will rely on restrictive practices. The evidence suggests that positive outcomes for people with disability can be achieved when:
(a) staff are nonconfrontational and consistent in their communication with the person
with disability; (b) staff do not impinge on the autonomy of the person with disability; (c)
people with disability are enabled to participate in meaningful activities of their choosing;
and (d) the wishes of the person with disability are listened to and acted upon
(Spivakovsky et al, 2023, p.235).
However, the authors also note that the quality of the literature is generally low and studies show mixed results. Cortis et al (2023) note the mixed results and quality issues in the literature, while pointing out that the quality of behaviour support plans is associated with positive outcomes for people with disability, including reduction in use of restrictive practices. This is supported by Carberry et al (2024) writing in reply to Spivakovsky et al., suggesting that “when Positive Behaviour Support service provision and implementation in Australia is correctly aligned with the core components of Positive Behaviour Support, positive outcomes for people with disabilities, including a reduction in the use of restrictive practices, can be achieved.”
Previous TAPIB Research
Previous TAPIB research papers address the efficacy of different aspects and contexts of positive behaviour support.
RES 296 Home modifications and behaviours of concern discusses how environmental controls may affect behaviours of concern within a PBS framework. This paper found that while consideration of the role of environmental factors in behaviours of concern is appropriate and required by federal legislation, the evidence suggests that comprehensive strategies for managing behaviours that address multiple factors (including physical and social environment) may be more effective than just changes to physical or social environment.
RES 287 Sexual services and sexualised behaviours of concern discusses evidence that behaviour analytic techniques (including, but not limited to, PBS) may be effective in managing sexualised behaviours of concern. However, the evidence discussed is relevant to specific disability cohorts, may not be generalisable and relates to interventions that may not be socially valid.
RES 352 Home and living supports for people with dementia found that a variety of strategies employed within a PBS framework may be effective at reducing behaviours of concern for people with dementia.
These strategies include staff training in communication and behaviour support, environmental modifications promoting homelike qualities and comfort, encouragement to participate in activities of interest, and other person-centred strategies.
RES 370 Staffing strategies in positive behaviour support found that environmental and social factors such as staff numbers and training can be a contributing factor to the occurrence of behaviours of concern and also to the over-use of aversive measures or restrictive practices in managing behaviours of concern.
No evidence was found recommending specific staff ratios, though it is suggested that there needs to be sufficient staff to employ those preventive strategies identified as foundational supports or within a person’s behaviour support plan.
Containment
Containment may refer to a variety of restrictive practice. In Australia, only the Queensland state government refers to containment in their restrictive practice policies. The Queensland department of education defines containment as:
a planned restrictive practice that involves a single student being in a room or area for the purpose of engaging in learning. The room is secured by a fob, or similar system, and the student’s free exit is impeded. The student is always accompanied in the room, by at least one adult and the student is not left alone in that room or area at any time (Department of Education, n.d., p.2)
The Queensland Department of Families, Seniors, Disability Services and Child Safety (Department of Families) defines containment as:
to prevent the free exit of the adult from premises where the adult receives disability services, other than secluding the adult in response to the adult’s behaviour that causes harm to the adult or others. Containment may include securing an exit with a lock or deploying a barrier to prevent the adult from being able to freely exit the premises (Department of Families, n.d., p.1).
In contrast, the Department of Families defines seclusion as, “to physically confine the adult alone, at any time of the day or night, in a room or area from which free exit is prevented in response to the adult’s behaviour that causes harm to the adult or others” (Department of Families, n.d., p.1). In this context, seclusion and containment differ according to the presence of behaviours of concern rather than the actual intervention.
The NDIS (Restrictive Practices and Behaviour Support) Rules 2018 (s6), defines seclusion as “sole confinement of a person with disability in a room or a physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted”. The NDIS Commission’s Regulated Restrictive Practice Guide states:
Knowing when a practice is seclusion and considering the potential impact to the person
is necessary to protecting the dignity and human rights of people with disability and reducing and eliminating its use. The key defining feature of seclusion is that the freedom of movement of the person is restricted because they cannot voluntarily exit, or believe that they cannot voluntarily exit, a physical space (NDIS Commission, 2020, p.26).
Containment and seclusion do not require physical restrictions such as locked doors but could involve the implication or assertion that a person is not allowed to leave an area.
Seclusion of children under the age of 18 is a prohibited practice in New South Wales and Northern Territory (South Australian Government. 2025).
Risks of seclusion can include:
- preventable injury
- psychological trauma
- feelings of sadness, being powerless, undervalued, humiliation, unsafe, punished and emotional distress
- feelings of abandonment and rejection due to having limited or no contact with staff.
- can be triggering for a person who has experienced abandonment as a child, or trauma.
- negatively affect the relationship between the person with disability and the person who implements the seclusion.
- difficulty supervising the person, and adequately supporting them (NDIS Commission, 2020, p.27).
A 2025 discussion paper from the Queensland Public Advocate notes that containment is also used similarly to environmental restraint. This is defined by NDIS (Restrictive Practices and Behaviour Support) Rules 2018 (s6) as a practice that restricts “a person’s free access to all parts of their environment, including items or activities.” Environmental restraint can involve locking or closing doors to prevent access to an area of the house.
Spivakovsky et al (2023) note that restrictive practices may be at odds with Australia’s obligations under international treaties and conventions including:
- Convention on the Rights of Persons with Disabilities
- International Covenant on Civil and Political Rights
- Convention on the Rights of the Child
- Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
References
Australian Psychology Society. (n.d.). What does a psychologist do? https://psychology.org.au/psychology/about-psychology/what-does-a-psychologist-do
Behaviour Support Practitioners Australia. (n.d. a). What is a behaviour support practitioner? https://bspaustralia.org.au/info/what-is-a-behaviour-support-practitioner/
Behaviour Support Practitioners Australia. (n.d. b). How to become a behaviour support practitioner. https://bspaustralia.org.au/info/how-to-become-a-behaviour-support-practitioner/
Carberry, T., Wardale, S., Hutchison, S., Lackey, S., & Vassos, M. (2024). Positive Behaviour Support is effective when implemented correctly: A response to “Restrictive practice–A pathway to elimination” (Spivakovsky, Steele, & Wadiwel, 2023). Research and Practice in Intellectual and Developmental Disabilities, 11(2), 251-264. https://doi.org/10.1080/23297018.2024.2391804
Cortis, N., Smyth, C., & Katz, I. (2023). Reducing restrictive practices: A review of evidence- based alternatives. https://disability.royalcommission.gov.au/publications/reducing-restrictive-practices-review-evidence-based-alternatives
Department of Education. (n.d.). Fact sheet - Restrictive practices (seclusion containment and time out). Queensland Government. https://ppr.qed.qld.gov.au/attachment/fact-sheet-restrictive-practices-seclusion-containment-and-time-out.pdf
Department of Families, Seniors, Disability Services and Child Safety. (n.d.). Containment and Seclusion. Queensland Government. https://www.families.qld.gov.au/media/documents/disability/service-providers/centre-excellence/containment-and-seclusion.pdf
National Disability Insurance Agency. (2025). Our Guideline – Behaviour Support. https://ndis.gov.au/understanding/how-ndis-works/psychosocial-disability/psychosocial-disability-supports
NDIS Quality and Safeguards Commission. (2026).Behaviour support and restrictive practices. https://www.ndiscommission.gov.au/rules-and-standards/behaviour-support-and-restrictive-practices
NDIS Quality and Safeguards Commission. (2025). The Positive Behaviour Support Capability Framework. https://www.ndiscommission.gov.au(rules-and-standards)/behaviour- support-and-restrictive-practices/positive-behaviour-support
NDIS Quality and Safeguards Commission. (2024).The Positive Behaviour Support Capability Framework. https://www.ndiscommission.gov.au/sites/default/files/2025-04/ndis-commission-policy-positive-behaviour-support-capability-framework-v4.0-december-2024-20250402.pdf
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NDIS Quality and Safeguards Commission. (2020). Regulated restrictive practices guide.
https://www.ndiscommission.gov.au/sites/default/files/2022-02/regulated-restrictive- pactice-guide-rrp-20200 0 0.docx
Spivakovsky, C., Steele, L., & Wadiwel, D. (2023). Restrictive practices: A pathway to elimination. Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. https://disability.royalcommission.gov.au/publications/restrictive-practices-pathway-elimination
South Australian Government. (2025). Australian States and Territories Restrictive Practices Authorisation Frameworks.
https://www.sa.gov.au/data/assets/pdf file/0008/851687/Restrictive-Practices-Authorisation-Frameworks.pdf
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