What do you think about the proposed amendments?

Now Closed

This online engagement was hosted on YourSAy from 15 December 2020 to 29 January 2021. Find out more about the consultation process. Below is a record of the engagement.

 

We want to introduce amendments to the Disability Inclusion Act 2018 (Act) to provide clarity for participants in the National Disability Insurance Scheme (NDIS) and the sector about restrictive practices. 

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Consider the discussion questions and give feedback by commenting below.

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Louise Butler

29 Jan 2021

Disability Inclusion (Restrictive Practices – NDIS) Amendment Bill 2020. South Australia
Thank you for the opportunity to provide feedback and pose questions regarding the first draft of the Amendment Bill to the Disability Inclusion Act 2018.
I currently work as a Teaching Specialist Clinical Practitioner in the School of Social Work at Flinders University. I also work with Clinicians and service providers in Positive Behaviour Support and Restrictive Practices. I have a background in Positive Behaviour Support and Restrictive Practices including most recently the first Director, Behaviour Support for the NDIS Quality and Safeguards Commission.
Firstly, I would like to commend the Government of South Australia, Department of Human Services for embarking on the important work involved in working toward the significant and much needed changes in the Restrictive Practices Authorisation process for South Australia. It is important to recognise that the people who are the subject of Restrictive Practices, their families and the services that implement the practices have been looking forward to a significant review of the Authorisation Process for some time. I would also like to acknowledge that the practices and processes outlined in this Bill represent significant limitations and restrictions on peoples lives which also contribute to trauma and distress for people. In providing the following feedback I am drawing on my experience working with people with lived experience of Restrictive Practices.
1. Please provide greater clarity regarding who the Authorisation of Restrictive Practices Amendment Bill relates to. Will people who are subject to the Authorisation of Restrictive Practices, as outlined, be subject to a capacity assessment as it is currently the case for people who are subject to SACAT orders? The term Disability and NDIS participant is very broad and it is important to specify if the intention is to approve the same restrictions for people who have for example full cognitive capacity and a physical disability, partial or fluctuating cognitive capacity to make decisions or is the Bill applicable to all people with any type of disability in South Australia who receives NDIS supports regardless of cognitive capacity?

2. It appears the newly proposed process of authorisation only relate to people who receive supports from prescribed NDIS providers. What plans do the state government have for overseeing the safe use of restrictive practices for people who are supported by family, are self-funded, children in schools or supported through the Lifetime Support Authority?

3. Please provide more detail about what mechanisms will be in place to ensure that the Authorised Program Officer will be independence in decision making whilst maintaining their accountability to the Provider who is their employer.

4. In section 23B (a) the Amendment Bill refers to a Behaviour Support Plan as being ‘in force’, it is more appropriate to refer to a plan as being ‘current’.

5. Please provide detail of what level 1 or level 2 restrictive practices refer to. No hierarchy of restrictive practice or the rationale for the rating system has been provided. I was not able to determine if a level 1 restrictive practice is considered more restrictive than a level 2 practice or if the opposite is correct. It is impossible to determine if the proposals are reasonable without this detail. Restrictive Practices are very personal, it is important to remember what one person perceives to be restrictive can be very different to another person’s experience.
6. In section 23C the meaning of detention is not detailed enough, it does not specifically refer to seclusion which is a much more restrictive and potentially traumatic form of detention.

7. In section 23G, as well as other parts of the Bill it is important to emphasise that Restrictive Practices should only ever be used as a last resort and evidence of least restrictive means of supporting the person should be provided for all Authorisation purposes. Does 23G (vi) suggest that this Authorisation process is only relevant when there is current behaviour Support Plan in place? Is this referring only to a Behaviour Support Plan that has been written by an independent and suitably qualified Registered Practitioner or does it also refer to ‘behaviour support plans’ written by support staff in an organisation?

8. Regarding 23H, when will the guidelines be published? Will the guidelines be written by people with experience in Restrictive Practices and Behaviour Support? Will there be a consultation process regarding the guidelines?

9. Regarding Division 2, 23I It is the strong preference of the sector to have a role with the title of Senior Practitioner, as in the case in most other states and territories in South Australia. It would be helpful to understand the experience that would be required for this professional. It is not enough for a person to have clinical experience in Positive Behaviour Support, they would also need specific experience in exercising powers that limit a person’s liberty and understanding the impact that this can have on the person.

10. 23J(e) suggests that the role of Senior Authorising Officer (SAO) will have a role in supporting the sector to develop and grow in it’s ability to support people with complex needs in a way that reduces the need for Restrictive Practices. This more developmental and proactive support sits more comfortably with a role that has the title of Senior Practitioner rather than Senior Authorising Officer, which suggests the role is only to authorise rather than the developmental role that is being suggested.

11. Under 23J it is vitally important for South Australia to have a person in the role who has the responsibility to consult and collaborate with Senior Practitioners and equivalents from other states and territories as well as the Commonwealth to progress the important work in striving for National Consistency in authorisation of Restrictive Practices.

12. Does section 23K suggest that the SAO would have a team to support the work of the role or is it envisaged that the SAO would delegate powers to others?

13. Regarding 23L (2) (d) Authorisation does not cease to have effect, authorisation is revoked. People with disability have a right to very clearly specified dates regarding the authorisation of Restrictive Practices, which often represent significant power to overrides these citizens’ rights. Rather than a system of loose plans which can continue or cease to have effect, people have the right to review dates and evidence that the practices are considered to continue to be needed or not. I acknowledge that the term revoke was used in 23L (3), it is important that this term is consistently applied.

14. Regarding 23M (2) it is important that the Implementing g Provider is required to provide evidence of the least restrictive methods that have been trialled. 23M (3) Please provide parameters about who the Implementing Provider would be able to co-opt to assist. Would, for example, the provider be able to call upon other participants to assist? 23M (4), it would be helpful to provide a provider with a timeframe for the use of the practice. 23M (5) (b) Best Practice is to work with a person and their substitute decision maker in advance, if possible, to seek consent for practices when behaviours occur. This is different to expecting a person to consent to Restrictive Practices whilst in the middle of an incident. Does this part refer to all environments? Would it, for example be applicable in a Day Program?

15. 23N (a) please specify the level of risk that would need to be in place for the Restrictive Practice to be used? Whose perception of risk would be considered? 23N (c & d) Again, please specify the type of Behaviour Support Plan.

16. 23O (5) (a, b & c) The authorisation to enter a person’s home, search their person and remove their belongings are usually powers that are only available to police officers, they should never sit with the person or group who will be taking those actions, in this case an NDIS Provider. I would argue it would be impossible for staff to enter a person’s home, search them and remove their property without causing humiliation, offence, and distress. In fact, it is likely to exacerbate the behaviour.
Providers of Disability Services are not one homogeneous group who share the same expertise, values, and policies regarding their use of Restrictive Practices. It is important to remember that there are a range of Providers in the sector, some with established skills, some are new and are learning about supporting people who use behaviours to communicate their deep distress and some who we may have cause to question, such as the provider who supported Anne Marie Smith.
Providers often use Restrictive Practices as they can be seen to be cost effective, expedient and require limited skill. In the interests of upholding citizen’s human rights, it would only be acceptable for an Independent Person with expertise in this area to authorise these actions. If the state approves this section, they will be moving in the opposite direction to every other state and territory in Australia and by so doing making the notion of National Consistency regarding Authorisation much more difficult to achieve.
It is also of great concern that the Bill does not encourage or require a Provider to seek consent or consultation from family or substitute decision makers. The proposals would cause people with disability to have more of their rights eroded with less independent oversight and scrutiny.

Again, thank you for the opportunity to provide feedback, I look forward to seeing the revised Bill.

Louise Butler

Dianna Smith-McCue

28 Jan 2021

I totally support that Positive Behaviour Support is essential as the basis for all support plans.

However, training in the context of how to reduce the intensity and duration of incidences is also essential. Management of Actual and Potential Aggression (MAPA) provides the training that staff need to provide the care, welfare, saftey and security for this vulnerable population group. I encourage connection is made to the Crisis Prevention Institute in looking at how to operationalise these important amendments.

Brodie Parmiter

20 Jan 2021

Restrictive practice is an extremely generic term to try and place everyone into a nice tidy pigeon hole that simply does not work and never has. Everyone MUST have boundaries and guidelines and everyone has always had them.

1. If I run out of cash, I simply cannot go to a Bank and take money as this is against the law. This also makes it a restrictive practice!

2. I cannot just speed down the highway without getting a fine, once again a restrictive practice.

3. If I want one more drink at the Hotel and I have clearly had too much and the Bar Tender says “NO” we cannot serve you any more Alcohol because you have had too much – is a Restrictive practice.

4. Some libraries only allow you to borrow X number of books per month - is a Restrictive practice.

5. During crisis times and stock shortages a Supermarket may limit the number of rolls of Toilet Paper I can purchase. - is a Restrictive practice.

6. Enforcing Social Distancing and Covid-19 related restrictions - is a Restrictive practice.

This list is enormous. In fact restrictive practice is part of the very fabric of Society. To not have and enforce restrictive practice would result in total chaos. We have these laws and boundaries to protect us and others from HARM.

Disabled persons are NOT precluded from the rules of Society and in fact are encouraged to engage in Society.

Then there is the issue of actual individual safety. If an individual with “Limited understanding and capacity” is to live in a safe and sustainable manner there MUST be Restrictive Practices in place to prevent them from harm. Just imagine a temporary carer saying to a Client with severe dementure, “yes its ok to go for a stroll on your own if you wish”’ then 5 days later they still have not returned because they don’t remember where they live!

To have everyone under a blanket of Least Restrictive Practice is extremely dangerous. No insurance company would insure a motor vehicle and call them all the same just because they have 4 wheels, - never going to happen because it would not work. Nor does a blanket policy of Least Restrictive Practice work just because you are in some form of Care!

Using a Politically Correct Jargon based term that is just a Policy, to make it sound as though we are treating a client with respect and dignity is not the solution.

Brodie Parmiter

Christine Sydenham

14 Jan 2021

I am writing as a parent of a NDIS client.
My concern over current Restrictive Practices is that are used or interpreted across a wide range of disabled people regardless of their individual needs or safety concerns. This makes it extremely difficult for support workers to safely care for some clients who have no awareness of their own safety or present dangers. Our Autistic daughter who is also severely intellectually disabled and also has drop seizures and toe walks which makes her very liable to fall. Because staff have been trained in Restrictive practices not to hold her or restrain her they are constantly trying to round her up to guide her during her daily care and activities. Hence she is much more likely to fall . Also due to this situation she has learnt not to co operate with staff and is in more danger of having accidents. Surely Duty of Care and common sense is needed when caring for a huge variety of Special Needs Clients. Restrictive Practices need to be adapted to the clients needs. We have been waiting for months to have our daughter assessed by a Specialist Practitioner for a PBSB Plan but it seems there very few available only adding to the problem.

Louise Davoren

04 Jan 2021

Still reading through the documentation. An area that seems to be very ‘grey’, including under NDIS is the use of physical barriers to protect both the pwd, and their carer. Cases in point
1. Non verbal level 3 ASD young male who absconds to access activities he enjoys - parents are regularly providing these opportunities. Child absconds when parents are asleep, despite all commonly used methods of securing the home. Child is found in locations of great risk. Parents had to fight to be permitted to add additional security measures to their home to ensure child’s safety.
2. ASD teen, Level 3, some communication. Sits in rear seat of family vehicle. Has tried to get out of moving vehicle if passing a place they want to visit right then and there - parents had to fight to be allowed to install more secure seatbelts in rear of vehicle.
Same child, about a year later having managed to find ways out of various additional seatbelts starts to reach over and grab steering wheel if wanting to go a different direction. Multiple near misses accident wise. Parents had to ‘fight’ for almost a year to enable a Perspex screen to be installed to minimise the risk.
3. ASD Level 3 non verbal teen showing episodes of extreme physical aggression towards familiar persons. Teen has undergone medical examinations to rule out any organic reasons, is working with an OT, and a BT. Is on medication prescribed by paediatrician. Mother (sole parent, and physically smaller than son) enquired as to the possibility of installing a security door on HER bedroom door whereby she could remain safe, yet still be able to communicate with her child, help him de-escalate, keep a visual on him. The door would only be used in extreme situations. Mother was told that this would not be permitted as son should be allowed access to all areas of the home.
I am the mother in case number 3. How am I to be assistance for my son, or care for him if I have been physically injured by him?
I am well aware of the overuse of restrictive practices, particularly within school settings, and have been actively involved in making changes to this over the years.

Mandy Coote

29 Dec 2020

I can think of occasions just before NDIS was introduced when people in government supported accommodation had to wait about 7 weeks to have a holiday approved which necessitated carer support. This made it very difficult for them to take advantage of discounted travel offers. I'm not sure if the same situation prevails, and it isn't technically a restrictive practice, but it nevertheless places restrictions on people in that situation.

Geoffrey Bloor

23 Dec 2020

The legislation is unclear as to the qualifications required for the Senior authorisation officer and any authorisation officers. It is also not clear whether the authorisation officers are public servants or NDIS providers.. Either way, all should be appropriately registered professionals. All concerned parties, family members, carers, the NDISprovider(s) and the person concerned should be involved in discussions about appropriate restrictions. Restrictions should be a last resort to prevent self-harm, accidental harm or harm to others. They should never be a form of punishment.

Lynda Loades

18 Dec 2020

As a former carer , companys can restrict people from for eg To visit a friend, go on a holiday with a friend, symply by not helping them to go Evan though the friend is very trustworthy, companys if they dont approve of the friend dont say , No you cant go" ,they just dont help with arrangements to go, or give them money to go, They use the excuse "they use comments like oh well you and your friend have to make arrangements between you" hiding the fact, they have control of the money say for bus tickets ect, and the friend cant give them money for lunches ect.