031 Positive Behaviour Support Policy

1. Purpose  

At Proactive Support, we advocate for the implementation of positive behaviour support to effectively collaborate with individuals with disabilities exhibiting behaviours of concern. We recognise the need for diverse service types and approaches tailored to each person, ensuring equal opportunities for all. Positive behaviour support involves working closely with families and caregivers to establish a shared understanding of the function of behaviours of concern.

At Proactive Support, we understand that the development of positive behaviour support is most effective through collaboration with participants, their families, friends, caregivers, advocates, nominees and other stakeholders. We acknowledge their expertise as the primary authorities in their lives, best positioned to convey their choices and decisions. Our expectation is that our staff prioritises the utilisation of positive behavioural strategies to address minor behaviours of concern, even when formal documentation in a behaviour support plan may not be necessary.

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2. Scope  

This policy applies to:  

• All staff of Proactive Support  

• All situations where staff may be required to provide positive behaviour support for a participant.  

• All situations where a participant’s dignity could be compromised.  

3. Definitions  

In the policy:  

Staff means any person employed by Proactive Support, including managers and workers, regardless of pay, status or working hours.  

Participant means a client or potential client who is receiving supports or services from Proactive Support  

Informed consent is where the participant, carer or nominee is informed in what circumstances their information could be disclosed, and consent is given by the participant, carer or nominee for this to occur.  

Positive Behaviour Support is a comprehensive approach to assessment, planning, and intervention which focuses on addressing the person’s needs, their environment and overall quality of life. It is an evidence-based approach to supporting people with disabilities who use behaviours of concern. It seeks to both improve the quality of life of the person with a disability and to reduce the impact of the person’s behaviours of concern.

Regulated Restricted Practice is as any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability.

Positive Practice Framework is a model of positive behaviour support. It acknowledges the idea that difficult behaviour is a language used by people who have no other way to relay their message.  

A Positive Behaviour Support Plan (PBSP) specifies a range of person-centred, proactive strategies that focus on the individual needs of a person, in order to build on their strengths; increase their opportunities to participate in community activities; and increase their life skills. It may include restrictive practices. It is developed by a behaviour support practitioner in consultation with the participant, their family and other relevant people, as well as the provider implementing the plan.

Behaviours of Concern are when participants behave in ways that might hurt themselves, hurt other people, or break things, or put themselves or others at risk of harm

4. Rights and Responsibilities  

Management 

• Will ensure staff working with participants who have a PBSP are trained in implementing the Plan relevant to their role and skills.

• Uphold the rights of people with disability and take all reasonable steps to reduce and eliminate the need for, and use of regulated restrictive practices.  

• Comply with the NDIS Code of Conduct when providing supports or services to NDIS participants with Positive Behaviour Support needs.

• Measure, monitor and evaluate outcomes, including improvements in quality of life, behaviour change and steps to reduce and eliminate restrictive practice.

• Comply with reporting as required by the Positive Behaviour Specialist and the NDIA

Specific Staff  

• Attend training as required in the participant’s PBSP.  

• Support the effective and consistent implementation of behaviour support plans to meet the needs of the person with disability.

• Support staff have the right to advocate for the well-being and best interests of the participant, ensuring that PBSP aligns with their goals, preferences, and dignity.

• Regularly monitor the effectiveness of the PBSP and provide feedback for adjustments, as needed.

• Maintain accurate and detailed records related to the implementation of PBSP, including observations, interventions, and outcomes.

• Effectively communicate with the participant, their family, carers and nominees, and other team members to ensure a collaborative approach. This involves sharing insights, progress, and any challenges encountered.

• Uphold the dignity and rights of the participant at all times, ensuring that the strategies used are respectful, person-centered, and aligned with their values and preferences.

• Take proactive measures to prevent crises by implementing strategies identified in the PBSP and seeking support from supervisors or other professionals when needed.

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5. Positive Behaviour Support

Positive behaviour support is a ‘multi-component framework’ for:

• developing an understanding of the behaviour of concern displayed by a person based on assessing the social and physical environment and broader context within which it occurs

• including stakeholder perspectives and involvement

• using this understanding to develop, implement and evaluate the effectiveness of a personalised and enduring system of support

• enhancing quality of life for the person through changing the person’s environment and teaching them skills they can use instead of their behaviours of concern.

To be effective, positive behaviour support strategies need to focus on:

• Changing the environmental/background factors that lead to behaviours of concern (what changes could be made in the person’s environment that would lessen the likelihood that the person will be triggered to use their behaviour of concern?  And think about how to help the person understand changes in their routine or environment)

• Teaching the person new skills to use to replace their behaviour of concern (what functionally equivalent replacement behaviour/s (FERB/s) could the person learn to use to get their needs met and replace their need to use their behaviours of concern?)

• Teaching the person other skills to make them more independent and improve their quality of life (What other general skills would the person like to learn that would improve their quality of life?)

6. Principles of Positive Behaviour Support

Positive Behaviour Support (PBS) supports people of all ages in all settings in reducing behaviours of concern (or challenging behaviours). It is the key strategy identified in the Act (Section 6) to maximise opportunities for achieving positive outcomes and reducing or eliminating the need for restrictive practice. PBS is:

• Person-centred: ensuring the person’s (or child’s) life goals are at the centre of the process.

• A Partnership: collaborating with the person and all key stakeholders shapes the process of change.

• Planned: creating a clear document to ensure shared understandings and accountability.

• Positive: focusing on preventative, rather than reactive, strategies.

• Proactive: placing the responsibility for changing behaviour on both the person and their supporters.

• Purposeful: using a functional behavioural assessment approach to identify the reason for the behaviour.

• Process driven: cycling iteratively through a process of identifying, assessing, planning, implementing, monitoring, and evaluating data.

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7. Positive Behaviour Support Plans

A PBSP will be based on the results of a “Functional Assessment”, carried out by a Clinical Psychologist or Behavioural Specialist. All PBSP should include:

1. Strategies to build on the person’s strengths

• Overview of person’s biopsychosocial strengths and needs (such as health, routine, relevant history)

• Replacement behaviour and skills to be taught

• Environmental supports

• Staff supports

• Communication /sensory/ learning supports

2. Strategies to reduce the behaviour of concern

• Description of behaviour of concern including frequency, intensity, and duration

• Background to behaviour of concern including early warning signs and triggers

• Identified consequences of behaviour of concern

3. Positive strategies to be used prior to using restrictive practice

4. Identification of regulated Restrictive Practices included in PBS Plan

5. Detailed summary/ protocol for each proposed restricted practice

• Rationale for the use of the restrictive practice

• Circumstances in which the restrictive practice is to be used

• Procedure for using the restrictive practice including observations and monitoring

• Implementation instructions for staff

• Schedule of review of the restrictive practice

• Fade out / reduction of restrictive practice strategies

• De-escalation and debriefing strategies

6. Evidence of the consultation process with others (Including a person with knowledge of PBS) during the plan development  

7. Strategies for monitoring and team responsibilities

• Considerations of the safety of all people and duty of care obligations under the Work Health Safety Act 2011 and the Human Rights Act 2019.

NOTE: While positive behaviour support is appropriate for supporting all people with behaviours of concern, only PBS Plans that include restrictive practices need to be submitted to the Department of Child Safety, Seniors, and Disability Services (DCSSDS) and the Queensland Civil and Administrative Tribunal (QCAT). Under the Act, a registered PBSP expires 12 months after the day the plan is registered.

8. Regulated Restrictive Practice

Regulated restrictive practice is defined in the amended Act as any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability. A restrictive practice is a regulated restrictive practice if it is, or it involves, chemical restraint, mechanical restraint, seclusion, physical restraint, or environmental restraint.

Restrictive practices can only be used to prevent physical harm to self or others.

Regulated restrictive practice must be included in the PBSP and approved before use.

Questions to consider about restrictive practices that must be answered in a PBSP:

• Is it necessary to prevent the person from causing physical harm to themselves or others?

• Is it the least restrictive option under the circumstances?

• Is there a plan to decrease the use of this restrictive practice in the BSP?

• Is the use and form of the proposed regulated restrictive practice included in the BSP?

• Is the proposed application of the regulated restrictive practice for no longer than necessary to prevent the person from causing physical harm to themselves or others?

• In relation to seclusion, is the person provided with appropriate bedding, clothing, food, drink  

• and toilet arrangements?

• In relation to physical restraint, is it to be used as PRN? Are any of the prohibited physical restraints  

• being proposed?

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9. Types of Regulated Restrictive Practice

9.1 Chemical Restraint

Definition:

Section 6(b) of the NDIS (Restrictive Practices and Behaviour Support) Rules 2018 defines chemicalrestraint as: ‘the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness, or a physical condition’.

Guidelines:

If PRN restrictive practice has been prescribed, the de-escalation section needs to state what the  person’s presentation looks like in order to use that restrictive practice. That is, at what point do you implement the restriction as well as the way (how) the restrictive practice will be implemented.

- PRN (as required) chemical name (drug)  

• Dose (must be a measure, not drops)  

• Route (oral or injection)  

• How often it can be given (frequency of doses)  

• If more than one dose, how long you must wait between doses?  

• Maximum amount you can give in 24 hours  

• Maximum and minimum doses. What level of use is allowed within this plan?  

• Any change in medication will require a review of the BSP.  

• An increase in medication does not require review. Report the increase via the NDIS portal.  

• Why the medication is prescribed – what is it targeting?  

• How do you know if it has been effective?  

• Why the dosage would change  

• Prescriber’s name and job title

- Routine chemical name(s) drug  

• Dose (must be a measure)  

• Frequency (mane, midi, nocte, TDS, BD)  

• Prescriber’s name and job title

9.2 Mechanical Restraint

Definition:

The use of a device to prevent, restrict or subdue a person’s movement for the primary purpose of influencing a person’s behaviour but does not include the use of devices for therapeutic or non-behavioural purposes.

Mechanical restraint can include, but is not limited to:  

• belts/straps  

• helmets  

• protective head gear  

• harnesses  

• bedrails  

• splints  

• cuffs  

• gloves  

• wheelchairs  

• tables/furniture  

• restrictive clothing (bodysuits, wheelchair belt or tray).  

Consider:  

• What is being used?

• Why is this restriction being applied?

• How is this restriction applied?

• When and for how long will the restriction be applied? How long will each episode of restraint last? (frequency, duration, maximum time)

• How often will the person be checked?

• In what ways is this restriction the least restrictive option under the circumstances?

• How will the regulated restrictive practice be reduced over time?

The maximum time and frequency of mechanical restraint needs to be reasonably based on evidence.

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9.3 Seclusion

Definition:

The sole confinement of a person with a disability in a room or a physical space at any hour of the day or night where the voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted. Seclusion can include, but is not limited to, exclusionary time out in a car/vehicle, the person’s own room, in other room or outside.

Guidelines:

Seclusion can only be used on a person to:

1. prevent the person from causing physical harm to themselves or any other person; or  

2. prevent the person from destroying property where to do so could involve the risk of harm to themselves or any other person.

A PBSP must also state why the use of seclusion is the least restrictive as is possible in the circumstances. The least amount of time possible and 15-minute visual observations should be maintained. If this is not possible a verbal response should be obtained, particularly if PRN medication has been administered.

Consider:  

• Where will seclusion occur?

• What is the person prevented from accessing?

• How is the restriction applied? Is the person provided with the necessary food, water, toilet, etc.?  

• When and for how long will the restriction be applied? (frequency and duration)  

• How is this the least restrictive option under the circumstances?  

• How will the regulated restrictive practice be reduced over time?

9.4 Environmental Restraint

Definition:

Other restrictive practices that restrict a person’s free access to all parts of their environment, including items or activities.

Environmental restraint can include, but is not limited to:  

• electronic monitoring devices  

• CCTV cameras  

• tracking devices  

• door/window buzzers  

• locked doors/cupboards/fridge/gates  

• time out directed to remain in a particular place or position  

• consequence-driven strategies (withdrawing activities or other items, e.g. phone, preferred activities  until the person ‘behaves’).

Consider:  

• What is the person prevented from accessing? (What activity, item or objects?)  

• Why is the restriction applied? (What behaviours of concern does it stop?)  

• How the restriction applied? (Lock, alarm, etc.)

• What is the impact of the restraint? (Who else does this affect?)  

• When and for how long will the restriction be applied? (frequency and duration)

• How will the regulated restrictive practice be reduced over time?

9.5 Physical Restraint

Definition:

Section 6(d) of the NDIS (Restrictive Practices and Behaviour Support) Rules 2018 defines physical restraint as: “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, consistent with what could reasonably be considered the exercise of care towards a person”

Consider:  

• Why is this restriction applied?  

• How is this restriction applied?

• When and for how long will the restriction be applied? (frequency and duration)

• In what ways is this the least restrictive option under the circumstances?

• How will the regulated restrictive practice be reduced over time?

Prohibited Forms of Physical Restraint:  

All states and territories have either prohibited or agreed to prohibit the following forms of physical restraint in relation to NDIS participants, as they are associated with high risk of injury and death:

• prone restraint (subduing a person by forcing them into a face-down position)

• supine restraint (subduing a person by forcing them into a face-up position)

• pin downs (subduing a person by holding down their limbs or any part of the body, such as their arms or legs)

• basket holds (subduing a person by wrapping your arm/s around their upper and or lower body)

• takedown techniques (subduing a person by forcing them to free-fall to the floor or by forcing them to fall to the floor with support)

• any physical restraint that has the purpose or effect of restraining or inhibiting a person’s respiratory or digestive functioning

• any physical restraint that pushes a person’s head forward onto their chest

• any physical restraint that compels a person’s compliance by inflicting pain, hyperextending joints, or applying pressure to the chest or joints (Department of Health and Human Services, 2011).

10. Maybo Training at Proactive Support

Proactive Support is currently licensed to provide Maybo training to its staff (only) until January 2027 when it will require renewal (subject to annual fees to maintain licensing).

The approved trainer is the Community Access Co-ordinator, Geoffrey Airs.

Maybo training for staff is offered during the year as full courses (2 days training) and refreshers.

Maybo techniques will only be used by staff who have completed their training, and where it is authorised in the participant’s PBSP.

11. Restrictive Practice Protocol – Detailing it in the PBSP

All regulated restrictive practices must be thoroughly detailed in the behaviour support plan in accordance with Part 3 of the NDIS (Restrictive Practice and Behaviour Support) Rules 2018.

A restrictive practice protocol is a good way to detail regulated restrictive practices in the behaviour support plan. It helps guide registered NDIS providers on how to use the regulated restrictive practice consistently and safely.

The following headings and points are helpful to consider in detailing a regulated restrictive practice in a behaviour support plan.

• Description of the restrictive practice: What is it?

• Rationale: Why is it being used? Explain why positive strategies alone were not effective. For example, what strategies were tried before the restrictive practice was considered?

• Frequency? PRN (on an ‘as needed' basis) or routine (i.e. at a set time in the day).

• Procedure: Include detailed instructions of how, where, when the restrictive practice will be used, and for how long.

• Reviews: How will the use of the restrictive practice be monitored, and how often will it be reviewed?

• Data recording and monitoring: How will incidents be recorded and reviewed? How will you monitor the effectiveness of the positive behaviour support strategies in reducing the restrictive practice? How will you monitor side effects of the restrictive practice?

• The plan to reduce and eliminate the restrictive practice: What strategies are in place to reduce the restrictive practice? Details can be included in the protocol or other sections of the behaviour support plan (i.e. under preventative or skill building strategies that target the function of the behaviour). How will you measure the fade out of a restrictive practice?

• Training: How will training occur? For example, a ‘train the trainer’ approach might be used, staff may be trained at the registered NDIS provider’s team meeting, or a video training resource is developed

12. Incident Management

Proactive Support has developed Policies and Procedures which detail the management and reporting of an incident. When an incident occurs for a participant on a PBSP it is important to be aware of their post-incident behaviour and take special note of the time it takes them to return to baseline.

• How do you know the person is calming down?  (body language, facial expression, language / tone of voice, behaviours)

• What should you do at this time?  (support the participant, support staff, determine who should be informed, complete records e.g. Behaviour Recording Sheet)

• Reflection -What would help in the future?  What were the triggers?  How could they have been prevented?  What did the person respond well to?  What didn’t work?

13. Positive Practice Framework

The positive practice framework is a model of positive behaviour support. It acknowledges the idea that difficult behaviour is a language used by people who have no other way to relay their message.  

It is based on a two-part assessment that involves getting to know the person and getting to understand their behaviour. The two-part assessment forms the foundation that focuses on not only reducing the behaviour but also on improving the person’s quality of life by supporting the person the learn skills to create a better match between the environment they are in and one they prefer. ABC and STAR charts can be used help understand when the person uses a behaviour of concern and what might lead to the behaviour. Functional behaviour assessments can be used to think about possible reasons why the person uses the behaviour of concern.  

The other important aspect of positive behaviour support is finding ways to support the person get their needs met. Deciding what skill/s the person needs to learn that could replace their need to use their behaviours of concern. Often these are communication skills that provide a way to communicate their needs.  

The Positive Practice Framework also recognises that to support an individual effectively, their family and circles of support need to be consulted in order to work constructively, creatively, and responsively together. It uses skills teaching as a central intervention because a lack of critical skills is often a key contributing factor to developing and maintaining behaviours of concern.

14. Personal Dignity 

Proactive Support staff will ensure participants’ personal dignity is maintained by respecting their personal boundaries by only using restrictive practices where necessary to protect the participant and/or the staff member.

15. Informed Consent  

The support worker’s priority is securing informed consent from participants, carers and/or nominees, making sure they understand care procedures and treatments before proceeding. They are to actively involve participants, carers and/or nominees in discussions, respecting their autonomy, and only proceed with care interventions upon obtaining explicit agreement. 

16. Related Documentation  

Proactive Support  

001 Participant’s Rights Policy

003 Participant’s Privacy, Dignity and Confidentiality Policy 

004 Risk Management Framework

005 Risk Management Policy

006 Work Health and Safety Policy

008 Incident Management Policy

012 Participant’s Supports Management Policy

015 Managing an Incident Procedure

016 Reporting an Incident Procedure

018 Risk Management Procedure

External  

NDIS Regulated Restrictive Practices Guide, Version 1.1 October 2020

NDIS Policy Guidance: Developing Behaviour Support Plans, October 2023

Work Healthy Safety Act 2011

Disability Services Act 2006

Department of Child Safety, Seniors and Disability Services: FAQ Fact Sheet, November 2022

NDIS Practice Standards and Quality Indicators, Version 4 November 2021

National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018

NDIS Positive Behaviour Support Capability Framework

National Disability Insurance Scheme (Incident Management and Reportable Incidents) Rules 2018

NDIS Code of Conduct 2019  

Commonwealth Privacy Act 1988 

Human Rights Act 2019

Restrictive Practice Requirements, Flowchart and Decision-Making Tool (filed in PS Library of Resources >Positive Behaviour Support)

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