Practice Guide – Positive Behaviour Support and Behaviours of Concern

Contents

Practice Guide – Positive Behaviour Support and Behaviours of Concern ………………………… 1

• 1. Purpose ………………………………………………………………………………………………………. 4
• 2. To be used by ………………………………………………………………………………………………. 4
• 3. Scope ………………………………………………………………………………………………………….. 4
• 4. Legislative and Policy Context ………………………………………………………………………… 4
• 5. Behaviours of Concern ………………………………………………………………………………….. 5
  • 5.1 Impacts of Behaviours of Concern (BoC) ………………………………………………………. 6
  • 5.2 Positive behaviour support ………………………………………………………………………….. 7
  • 5.3 Restrictive practices ……………………………………………………………………………………. 9
  • 5.4 Restrictive practice guidelines ……………………………………………………………………. 11
  • 5.5 Point of crisis …………………………………………………………………………………………… 13
  • 5.6 Incident management ……………………………………………………………………………….. 13
• 6. Pre-planning……………………………………………………………………………………………….. 14
  • 6.1 Streaming ……………………………………………………………………………………………….. 14
  • 6.2 Plan duration …………………………………………………………………………………………… 15
  • 6.3 Arranging the planning meeting ………………………………………………………………….. 15
  • 6.4 Planning conversation ………………………………………………………………………………. 17
• 7. Planning …………………………………………………………………………………………………….. 20
  • 7.1 Core supports ………………………………………………………………………………………….. 20
  • 7.2 Capacity Building supports ………………………………………………………………………… 21
  • 7.3 Plan comments ………………………………………………………………………………………… 27
  • 7.4 Plan management ……………………………………………………………………………………. 27
• 8. Plan implementation and monitoring ………………………………………………………………. 28
• 9. Scheduled plan reviews ……………………………………………………………………………….. 28
• 10. Case examples …………………………………………………………………………………………… 29
  • 10.1 Example 1 - Kim ……………………………………………………………………………………. 29
  • 10.2 Example 2 – Joe ……………………………………………………………………………………. 30
  • 10.3 Example 3 – Hassan ……………………………………………………………………………… 31
  • 10.4 Example 4 – Daniel ……………………………………………………………………………….. 33
• 11. Appendices ………………………………………………………………………………………………… 34
  • 11.1 State and territory restrictive practice legislation ………………………………………… 34

• 12. Supporting material ……………………………………………………………………………………… 37
  • 12.1 New South Wales ………………………………………………………………………………….. 37
  • 12.2 Victoria ………………………………………………………………………………………………… 37
  • 12.3 Queensland ………………………………………………………………………………………….. 37
  • 12.4 Western Australia ………………………………………………………………………………….. 37
  • 12.5 South Australia ……………………………………………………………………………………… 38
  • 12.6 Australian Capital Territory ……………………………………………………………………… 38
  • 12.7 Northern Territory ………………………………………………………………………………….. 38
  • 12.8 Tasmania ……………………………………………………………………………………………… 38
• 13. Feedback …………………………………………………………………………………………………… 38
• 14. Version change control ………………………………………………………………………………… 38

1. Purpose

The content of this document is OFFICIAL. 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 Coordinators [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). The NDIS Commission starts operating from 1 December 2020 in Western Australia. Until this time, the current state requirements for quality and safeguards continue to apply.

The NDIS Commission, states and territories governments 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.

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 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 regulated restrictive practice/s in an individual’s BSPs. Providers must comply with requirements of their state or territory
• restrictive practices are clearly identified in a BSP.

Refer to section 11.1 for information on state and territory restrictive practice legislation.

The National Disability Insurance Agency (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 NDIS funded behaviour support is reasonable and necessary. If unsure, discuss with your team leader.

In response to the concerns raised by the NDIS Quality and Safeguards Commission, the NDIA has committed to reviewing all requests for supports that include Regulated Restrictive Practices.

Where the use of regulated restrictive practice is proposed, or in use, a Technical Advisory Branch (TAB) advice request must be prior to plan approval. For information on how to request advice, refer to the mandatory advice section of the TAB Requesting Advice intranet page.

5. 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
• 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 intentional 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
• response to difficulties encountered with service systems or support networks
• attempting to avoid a situation
• interpersonal environment such as quality of social interactions
• change or lack of 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.

5.1 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).

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.

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 Reviews, Operational Guideline – Supported Independent Living (SIL) and the Medium Term Accommodation Operational Guideline.

In the case of a person under the age of 18, refer to the [Practice Guide – Children Living in a Formal Voluntary Arrangement Outside their Family Home](https://example.com), [Practice Guide – Children at Risk of Requiring Accommodation Outside the Family Home](https://example.com) and [Practice Guide – Children Living in Statutory Out of Home Care](https://example.com).

5.2 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.

1. Brief functional behaviour assessment - focussed on identifying requirements for incident prevention and response.
2. 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.

3. 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 understanding of the relationship of events and circumstances that trigger and maintain the behaviour.

4. Comprehensive positive behaviour support plan (see 5.2.1)

5. Training and 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.

6. Monitoring - data collection, analysis and reporting.

7. 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.

5.2.1 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.

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) provides information about knowledge and skills required by the specialist behaviour support practitioners. The framework allows self-assessment to determine their suitability to provide the behaviour support practitioner requires.

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 BSP must still be registered as a specialist behaviour support practitioner as noted above.

5.2.2 Assessment, development and review

A functional behaviour assessment must be completed when practitioners are developing a BSP. The practitioners will consult with the participant, their family, guardian, service

providers and others who will be implementing the plan. By doing this the practitioners are able to gather historic and current information about behaviours displayed to identify settings, triggers, actions and results.

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 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. Importantly the progress towards the person’s goals and identified quality of life measures is considered.

Plan developers can use assessment information 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.

5.2.3 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 1 December 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 Our Guidelines - Younger People in Residential Aged Care for further information.

5.3 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 supports will include the use of restrictive practices the plan developer must make a referral for advice to the TAB. The referral must take place prior to including or excluding the supports in the participant’s NDIS plan. Refer to the mandatory advice section of the TAB Requesting Advice intranet 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.

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.

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:

1. 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.

2. 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.

3. 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.

4. 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.

5. Environmental restraint: Restricting a person’s free access to all parts of their environment including items or activities such as locking cupboards, fridges or the use of an enclosed bed.

Note: All supports that include the use of a regulated restrictive practice must be referred to the TAB for advice. Refer to the mandatory advice section of the TAB Requesting Advice intranet page.

5.3.1 Children and Restrictive Practice

For children, restrictive practices will need to be considered on a case-by-case basis, taking into account their developmental age and cultural context and information detailed in the National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018,

Child-safe practices age, such as the use of a car seat restraint for a child under seven would be considered age appropriate. However, the use of a car seat restraint for a 12-year old child to stop them from kicking others in the car may be considered a restrictive practice.

Similarly, using child gates to prevent a toddler or child from falling down the stairs would not be a restrictive practice, however using a child gate to prevent a young person accessing the kitchen at all times would be considered a restrictive practice.

It is mandatory to seek advice for the use of assistive technology related to behaviours of concern or regulated practice eg stroller or prams for children older than 7 years, restrains, harnesses excluding standard mandatory vehicle restraints/seat belts

Refer to the mandatory referral advice section of the to the TAB Requesting Advice intranet page.

5.4 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.

Under the NDIS (Restrictive Practices and Behaviour Support) Rules 2018, restrictive practices are subject to regulation. Restrictive practices can only be used based on an assessment of behaviour with the appropriate authorisation from 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:

• undertaking a functional behaviour assessment
• developing a BSP for the participant
• submitting written applications seeking authorisation to restrictive practice authorising panels or bodies
• 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.

5.4.1 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.

The use of regulated restrictive practice that has not been authorised in accordance with any state or territory legislation or policy requirements represents a reportable incident that must be reported to the NDIS Commission. The provider must notify the NDIS Commission within five business days of becoming aware of the use of the restricted practice.

NDIS Staff and Partners in the Community should report any suspected use of unauthorised restrictive practice to the [Participant Critical Incident Team](https://example.com).

Advice can by sought via the Participant Critical Incident Team or the TAB if clarification is needed about whether an event/practice represents the unauthorised use of restrictive practice, or the use of prohibited practice.

5.4.2 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.

The implementing provider is responsible for:

• being registered with the NDIS Commission for the type of support they are providing
• report regularly as per agreed schedule to the NDIS Commission
• ensure staff are appropriately trained to implement positive behaviour strategies or use restrictive practices
• notifying the NDIS Commission in the event of any unplanned or unapproved use of a restrictive practice as per the NDIS Commission reportable incident process.

Implementing provider reporting will include any use of unrestrictive practices and other reportable incidents, monitoring, and collected 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 policy requirements.

5.5 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 provided by other government services such as child protection, homelessness services, hospitals, ambulance, police and mental health assessment teams.

A crisis may often result in the escalation of BoC and may temporarily require more intensive support. While the NDIS is not responsible for the delivery of emergency support, when the participant or their informal support contacts the NDIS during times of crisis, we need to be responsive to their concerns.

This may involve supporting the participant to access other government services as required, and explaining how the funding in their plan can be used flexibly to meet their needs during a crisis. The participant may have interacted with the After Hours Crisis service as part of the Exceptionally Complex Support Needs Program.

In some instances, reconsideration of the participant’s streaming may be required to ensure they are appropriately supported through this period. Refer to section 6.1 for further information.

You will need to ensure the support coordinator (if relevant) is aware of the situation and is responding to and supporting the participant in a timely and effective manner. The role of the support coordinator and the level of support coordination may need to be considered. For example, a specialist support coordinator to manage multiple mainstream interfaces, organise and prepare reports may be required.

In some cases, the behaviour support practitioner may be able to identify the circumstances that could lead to periods of crisis for the participant. In these cases, the BSP and other supports should be proactively designed to respond to these situations. This may impact on the way the supports are funded in the NDIS Plan.

Where additional supports beyond the flexibility of the existing plan is required, it may be appropriate to consider whether an unscheduled plan review is required. Refer to Practice Guide – Unscheduled Plan Reviews.

Interactions detailing the crisis circumstances and actions taken must be recorded in the NDIS Business System (System) and an alert added if required.

5.6 Incident management

5.6.1 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. They are also responsible for 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
• the unauthorised use of restrictive practice.

Refer to the NDIS Commission’s Reportable Incidents (external) for further information.

5.6.2 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 (external).

5.6.3 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](https://example.com). 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 reason for a section 48 plan review. The participant 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.

6. Pre-planning

6.1 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](https://example.com) for further information.

Note: The term streaming is for internal use only.

6.2 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 task and Our Guideline – Creating Your Plan for further information.

6.3 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.

You should confirm all meeting attendees to 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 Procedure – Appoint 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, you should 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.
• 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.

6.3.1 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.

6.3.2 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:

• 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 help you identify 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.

6.4 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.
• 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.
• If there are known restrictive practices in use, ask if the BSP has been lodged with NDIS Commission and the relevant state or territory has authorised the use.
• Follow up any requested reports and/or assessments not yet provided, to assist in 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:

  • Standard Operating Procedure – Check third party consent or authority
  • Standard Operating Procedure – Record third party consent

  for further information.

7. 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.

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 Our Guideline – Reasonable and Necessary Supports for further information.

7.1 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 may request higher support costs for participants with complex BoC. Consider the participant’s individual circumstances and needs using the information available to understand the purpose of the support. For example in some circumstances, the proposal

may be considered a restrictive practice or it may be required as the participant has health or physical support needs.

If a regulated restrictive practice is used, review the participant’s BSP which will record whether the relevant state or territory body has authorised the use.

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.

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.

A mandatory referral to the TAB is required for all NDIS funded supports that may result in the use of regulated restrictive practices.

If the participant requires a higher intensity level of support, refer to the Standard Operating Procedure – Determine Self-Care and Community Access Supports for further information.

7.1.1 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 frequent incidents such as assaults, self-harm, property damage or high-level staffing ratios to manage risk to staff and residents.

There may also be use the use of restrictive practices which are not targeted towards all the residents such as a locked fridge or the removal of people to a safe area during an incident.

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 Operational Guideline – Supported Independent Living (SIL).

7.2 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 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.

7.2.1 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.

Where an ecological assessment is required, a total of 10 hours per household should be funded. Where multiple participants in the same household require a BSP, if appropriate their plans should be developed at the same time and the hours divided amongst plans.

7.2.2 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 6.2) 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.
• 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.

7.2.3 Behaviour intervention support levels

You will need to make sure 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.

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 reasonable 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, Our Guideline – Reasonable and Necessary Supports and the Standard Operating Procedure – Behaviour Intervention Supports for further guidance.

7.2.3.1 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 fund the following supports:

• 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.

• Training in behaviour management strategies - 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.

7.2.3.2 Level 2

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

Level 2 criteria includes:

• multiple complexities that may require multiple interventions
• extreme behaviours of concern where there is the use of regulated restrictive practice
• 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
• participants who are anticipated to experience a significant transition during the plan period such as moving into SIL or from school to day program.

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.

Use reasonable and necessary decision making to fund the following supports:

• Specialist behavioural intervention support – 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.
• Training in behaviour management strategies – 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.
• Individual social skills development – For participants that require additional support to implement newly developed strategies in the community or within newly engaged activities/services, include individual social skill development. Most level 2 plans should not exceed 40 hours (3-4 hours per month) which will complement the recommendations in the BSP.

7.2.4 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 discussed at the plan handover and clearly outlined in the Request for Service. Refer to Standard Operating Procedure – Include Support Coordination in a Plan.

7.3 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.

7.4 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 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 NDIS (Provider Registration and Practice Standards) Rules 2018 (Part 2, section 7) 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.

7.4.1 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 7.3) 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 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.

8. 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.

You should check the plan utilisation to make sure 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 and Our Guideline – Your Plan for further information.

9. 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).

10. Case examples

10.1 Example 1 - Kim

Kim is a 20-year-old woman and lives at home with her parents and two younger siblings. She has a primary disability of autism spectrum disorder and a secondary disability of mild intellectual disability.

10.1.1 Planning meeting

At Kim’s planning meeting, her parents discuss how they are struggling to maintain support and are concerned about the impact Kim’s behaviours of concern are having on her and her younger siblings. When asked further about her behaviours, they explain that Kim bites and hits out at people around her at home and at her day program. When upset, she will also hit her head against walls and run away from those she is with.

Kim enjoyed attending a specialist school and after completing year 12, she started at a day program. The identified behaviours escalated when she left school. Kim has not settled at the day program. She is reluctant to leave home to attend and while at the day program, Kim displays increased levels of BoC.

Kim’s parents and the day program provider have tried several different strategies to support her, however the BoC have not reduced. She has not been provided with any behaviour support previously.

10.1.2 Outcome

Kim is considered to meet the criteria for level one behaviour intervention support for the following reasons:

• Kim has informal supports who are engaged and available.
• Kim is still attending a regular day program and the provider is willing to work with her and her family to implement the BSP.
• the BoC have not been longstanding having escalated only since Kim left school.

Kim’s 12-month plan provides funding for the following reasonable and necessary supports:

• Social community and civic participation for continued day program attendance allowing for higher-intensity supports while Kim is connected with a specialist behaviour support practitioner. The NDIS is awaiting further recommendations in the report by the specialist behaviour support practitioner for the associated training hours required in the BSP.

• Functional capacity assessment (10 hours).
• Specialist behavioural intervention support for functional behaviour assessment, development of a BSP, implementation, monitoring and review of behavioural support interventions in her home and day program (45 hours).
• Behavioural management plan including training in behaviour management strategies to provide training to informal/formal supports to understand and implement Kim’s BSP consistently in all environments (20 hours).
• Coordination of Supports (72 hours).

10.2 Example 2 – Joe

In the following two case examples, Joe and Hassan, two NDIS participants are living in a SIL arrangement and sharing supports. At the scheduled plan reviews, the SIL provider has provided information detailing an increase in BoC for both Joe and Hassan. After trying a number of different strategies to resolve conflict and reduce the BoC, the provider has requested an increase in both SIL and Capacity Building funding to better support them.

Joe is a 30-year-old man and lives in a SIL arrangement with two others. His primary disability is a moderate intellectual disability. Joe works at an Australian Disability Enterprise (ADE) four days per week. Joe is well supported by his parents and family and spends every Sunday with them. His family use supported decision making to make sure he is active in his life decisions.

10.2.1 Planning meeting

All the participants in the home are undertaking a scheduled plan review. Prior to Joe’s NDIS meeting, the completed provider SIL pack and quoting tool along with supporting information including his BSP are provided to the NDIS. Joe’s BSP notes his behaviour will escalate quickly if there is any unexpected change or interruption to his routine or life and he generally begins to shout, punch walls and becomes agitated. Some of Joe’s triggers include:

• Reminders of the recent death of a close friend.
• When his housemate Hassan is displaying BoC.
• Returning to his home after a family visit on Sundays.
• Varying triggers at his ADE including when there is unexpected change and loud noises, approximately twice per week.

10.2.2 Outcome

Joe is considered to meet the criteria for level one behaviour support for the following reasons:

• Joe has informal supports who are engaged and available.
• Joe works at an ADE four days per week and goes to regular activities in the community on the other weekday. The ADE provider is willing to work with Joe, his family and support workers to implement his BSP.
• The BoC have not been longstanding having escalated since Joe’s friend passed away.

Joe’s 12-month plan provides funding for the following reasonable and necessary supports:

• Supported independent living included as per SIL pack and quoting tool. The NDIS is awaiting further recommendations in the report by the specialist behaviour support practitioner for the associated training hours required in the BSP.

• Support for his continued employment at the ADE.

• Shared living environmental assessment (ecological assessment) (5 hours).

  Although Joe has been assessed as meeting the criteria for a level 1 behaviour support plan, he lives in a shared environment, and it has been identified that triggers for BoC are occurring within the home. Funding has been added to enable an ecological assessment to be undertaken to better understand contributors from within Joe’s living arrangement.

• Specialist behavioural intervention support for functional behaviour assessment, development of a BSP, implementation, monitoring and review of behavioural support interventions in his SIL home, family home and ADE (45 hours).

• Behavioural management plan including training in behaviour management strategies to provide training to informal and formal supports to understand and implement Joe’s BSP consistently in all environments (20 hours).

• Coordination of Supports (72 hours).

10.3 Example 3 – Hassan

Hassan is a 45-year-old man and lives in a SIL arrangement with Joe and one other. His primary disability is autism spectrum disorder and his secondary disability is schizophrenia. During the week, he attends a day program for two days where he consistently exhibits BoC. He does not currently have family support, usually seeing his sister on his birthday. Hassan gets distressed by many triggers that substantially increase his anxiety levels and tends to result in him scratching his own skin or hitting or kicking property or anyone who tries to intervene. He is prescribed risperidone to manage these BoC. Staff also administer a muscle

relaxant medication when becomes agitated to help calm Hassan. Some of the known triggers are as follows:

• Exposure to sensory stimulation especially loud noises, music and bright lights.
• When his housemate Joe becomes agitated and yells.
• When his formal supports prompt him with daily activities.

As the direct result of an assault on a house staff member, there is an active Mental Health Community Treatment Order in place that states Hassan must attend and receive treatment weekly.

10.3.1 Planning Meeting

All the participants in the home are undertaking a scheduled plan review. Prior to Hassan’s NDIS meeting, the completed provider SIL pack and quoting tool along with supporting information including his BSP are provided to the NDIS. The day program provider is considering withdrawing services due to the risks involved.

Hassan’s parents have both passed away. He has a sister who lives interstate and is not involved in his daily life. Hassan has the public guardian in place as his decision maker and the Public/State Trustee manages his finances.

10.3.2 Outcome

Hassan is considered to meet the criteria for level two behaviour support for the following reasons:

• Hassan is experiencing problems maintaining service providers.
• Hassan’s only informal support is his sister and he sees her once a year on his birthday.
• He is subject to restrictive practice (chemical restraint) to address BoC.

Hassan’s 12-month plan provides funding for the following reasonable and necessary supports:

• Supported independent living included as per SIL pack and quoting tool. The NDIS is awaiting further recommendations in the report by the specialist behaviour support practitioner for the associated training hours required in the BSP.

• Support for his continued attendance at his day program.

• Shared living environmental assessment (ecological assessment) (5 hours).

  It has been identified that Hassan will have his BSP reviewed at the same as Joe. As a result, the 10 hours to develop the ecological assessment has been shared between Joe and Hassan’s plan.

• Specialist behavioural intervention support for functional behaviour assessment, development of a BSP, implementation, monitoring and review of behavioural support interventions in his SIL home and day program (90 hours).
• Behavioural management plan including training in behaviour management strategies to provide training to informal/formal supports to understand and implement Hassan’s BSP consistently in all environments (30 hours).
• Coordination of Supports (108 hours).

10.4 Example 4 – Daniel

Daniel is a 12-year-old boy. He lives with his mother and younger siblings. He attends his local primary school. His primary disability is autism spectrum disorder and secondary disability is intellectual disability. It has been identified that Daniel has sensory aversion to loud noises and to sensations such as silky or synthetic fabrics. He has difficulty communicating his needs to others, and seems to have difficulties following instructions, leading to frustration and BoC.

10.4.1 Planning Meeting

During the planning meeting, Daniel’s mother said he was attending school three days per week. He would like to establish friendships with his peers and increase his social participation however experiences heightened anxiety due to bullying at school including verbal threats, teasing and pushing.

Daniel’s mother and school have identified that his BoC are high in intensity. They include self-harm (suicide attempts, absconding) and harm towards others (physical aggression and assault). At home, cutlery needs to be stored safely. Daniel’s mother has identified that she has locked away to maintain his safety due to self-harming behaviours. Usually, the cutlery would be in an unlocked drawer, as a child of Daniel’s age would generally be expected to safely use cutlery to eat or prepare food. He does not have a behaviour support plan.

His attendance at school, the bullying and identified BoC make it challenging for Daniel to form and maintain relationships and participate in social activities. His mother spoke about finding it increasingly difficult to care for Daniel. The school have funded an additional staff member to increase his attendance at school.

Daniel’s mother is requesting Core supports to support her in the home, and support for Daniel while at school and participating in his learning activities and increase his social participation. The planner provides further details of NDIS and education responsibilities, noting that service systems obligations must be met before any funding by the NDIS could be considered to meet the disability support needs that are deemed beyond ‘reasonable adjustment’.

10.4.2 Outcome

Daniel is considered to meet the criteria for level two behaviour support for the following reasons:

• Daniel is experiencing issues with school attendance.
• Daniel’s only informal support is his mother and she has expressed carer fatigue.
• Daniel’s BoC have been identified as high in intensity, particularly given his age.
• Daniel is experiencing challenges with social participation.

Daniel’s 12-month plan provides funding for the following reasonable and necessary supports:

• CB Daily Activity as it has been identified that Daniel has sensory difficulties and communication difficulties. Funds within this category will be utilised for an occupational therapist to undertake a sensory assessment and a speech pathologist to undertake a communication assessment and collaborate with the behaviour support practitioner to enable strategies to address these needs to be included within the Positive BSP.
• Specialist behavioural intervention support for a functional behaviour assessment, development of a BSP, implementation, monitoring and review of behavioural support interventions in all environments (home, education setting, any other identified setting) (84 hours).
• Behavioural management plan including training in behaviour management strategies to provide training to informal and formal supports to understand and implement Daniel’s BSP consistently in all environments (30 hours).
• Coordination of Supports (60 hours)

As discussed in the planning meeting, it was not determined to be reasonable and necessary for the NDIS to fund Core supports for Daniel in his educational environment to assist with her learning support needs and school attendance supports.

11. Appendices

11.1 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). It is important to note that BSPs containing regulated restrictive practices must be lodged with the NDIS Commission, even if authorisation of the use of the restrictive practice is not a requirement of that state or territory.

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 TAB advice or escalate feedback that may need to be considered for report to the NDIS Commission.

11.1.1 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.

11.1.2 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.

11.1.3 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 and for any use of containment/seclusion to be approved by the Queensland Civil and Administrative Tribunal.

11.1.4 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).

11.1.5 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.

11.1.6 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.

11.1.7 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.

11.1.8 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.

12. 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)
• Operational Protocols between the NDIA and the NDIS Commission intranet page

12.1 New South Wales

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

12.2 Victoria

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

12.3 Queensland

• Disability Services Act 2006

12.4 Western Australia

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

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