Session-3

[Start of recorded material at 00:00:00]

Paul Miller: Good afternoon everybody, we might get started. I think we’ve just about got the last few people signed up and finding a seat. Welcome to this session on behaviour support in the NDIS. This afternoon’s session focuses on implementing providers. So we had a session this morning focusing on behaviour support providers and practitioners, this is about implementing providers.

For those of you who came this morning, there’s a fair degree of overlap between what we’re going to present now and what you heard this morning. In particular the second half of our presentation, the New South Wales session, will be the same, so unless you just want to make sure you heard everything right, you probably don’t need to stay around for that. In terms of our session around the Commission and the new requirements, there’ll be some overlap with this morning, but the focus will very much be on what the requirements are of implementing providers rather than behaviour support providers, so that content will be a little bit different, so you might get a different angle on that, hopefully.

So like this morning’s session, this session will be divided into two parts, the first part being the future requirements, the new quality and safeguarding arrangements and the new Commission, and what the requirements will be on providers as of 1 July. And then we’ll have questions relating to that. Then we’ll have afternoon tea. And then the second half of this afternoon’s session will be about the New South Wales authorisation and consent requirements.

My name’s Paul Miller, for those of you who weren’t here this morning, and I’m from the Department of Social Services. And my reason for being here I guess is because I’ve been largely responsible for a whole lot of the policy and legislation around the Quality and Safeguarding Framework first of all, then establishing the Commission, and now getting the Commission set up and going. And one of the areas that’s my key responsibility has been the development of the behaviour support policy side of things, so thus my presence here today.

Tracey Harkness will be joining me in the presentation I’m about to give. Tracey has been appointed fairly recently as the Director in charge of behaviour support in the new Commission. So as of 1 July, gradually we will be handing over more and more to Tracey and the senior practitioner team to take over.

Before I start my presentation I’d like to acknowledge the traditional owners of this land and pay my respects to Elders past and present.

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So just by way of background, in December 2016 COAG signed up to the National Quality and Safeguarding Framework, a key element of which was behaviour support, both promoting best practice and behaviour support, but also regulating, reducing and eliminating restrictive practices over time. That of course is consistent with Australia’s international obligations around the reduction and elimination of restricted practices in human rights for people with disability in general, and also is in line with the national policy on reducing and eliminating the use of restricted practices in the disability sector.

The behaviour support function a little bit differently to some of the other functions of the Commission like complaints and reportable incidents which have kind of been taken over in a sense from the states as far as the NDIS is concerned at the Commonwealth level. So complaints about things that happen in the NDIS around providers and the services that are provided will now be undertaken as a national function at the Commission level, same with reportable incidents, registration functions, a couple of those other functions.

Behaviour support though, and workers’ screening, are two functions that remain Commonwealth state responsibilities. The Commonwealth has responsibility in behaviour support for leadership in behaviour support, and monitoring of restricted practices, and the states though retain responsibility for the authorisation and consent arrangements around restricted practices. So that will be an ongoing and continuous division, which means that the Commonwealth and the state will have to work fairly closely together in this area, and as everyone’s jointly committed to I guess the goals of reducing and eliminating restricted practices, hopefully that will work quite well, although as I’ll talk about a bit later, there is variation across states and territories in how they approach this issue, so that will be something that we’ll have to work through.

The Commonwealth’s leadership role will sit with the new Quality and Safeguards Commission that starts in New South Wales and South Australia from 1 July 2018. It will start in the other jurisdictions from 1 July 2019, except for WA alone, which it will start in 2024.

So in the legislation, the new Commission has a role in providing leadership in relation to behaviour support and in the reduction of the use of restricted practices by NDIS providers. That ‘by NDIS providers’ is a fairly important limitation, and it’s actually a limitation that broadly goes to the whole Quality and Safeguarding Framework. What we’re really talking about here is a regulatory function that looks after services and supports delivered under the NDIS. And no doubt this will come up in questions. Obviously there’s kind of an overlap where people might be in the education system or health system and restricted practices and things might be being used. And while the Commission broadly has a role in promoting best practice, even outside of the

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NDIS, as far as the regulatory functions of the Commission go, it only relates to NDIS supports and services.

So that’s the broad function. Within that broad function there are if you like several sub-functions or elements to the way that the Commission will carry out those functions. The first three on the slide there you’ll see are very much concerned with best practice, developing the sector, both behaviour support practitioners and implementing providers, educating, and broadly I guess working through that educational and best practice role to lift the bar around knowledge and approaches to behaviour support and the elimination of restrictive practices.

The Commission though also has quite an important monitoring role in regard to restrictive practices. And we’ll say more about this later, but all implementing providers will have to report on the use of restrictive practices. And this means for the first time in Australia at least there will actually be a national picture of what’s going on with restrictive practices. At the moment only Queensland and Victoria have regular reporting on restrictive practices, and as a part of the NDIS Quality and Safeguarding Framework, that’s been picked up as a national function. So that will be, importantly for implementing providers in New South Wales, that will be a new function or a new requirement that you’ll have to meet, and we’ll say more about that a little bit later.

And the final dot point there, and this came in fairly late into the piece into the legislation, is that the Commission will play a role in assisting states and territories in achieving nationally consistent minimum standards around authorisation and consent, and also the definitions of restrictive practices. So as many of you probably know, the states and territories differ greatly in both areas, so there are inconsistent definitions of restrictive practice, and that means that something that’s a restrictive practice in one state might not be considered a restrictive practice in another as far as their legislation policy is concerned. And also authorisation consent arrangements are different. So here you have kind of a panel-based system at the moment. In other jurisdictions a senior practitioner actually approves a lot of restrictive practices, particularly those that are higher risk, and it varies very much from state to state.

So there was a recognition when we were setting up the Commission from the states and territories and the Commission and the Commonwealth generally that it would be good if we achieved greater consistency in those areas. So that’s an ongoing project that we’ll be working towards. I think that’s probably a medium term project, I don’t expect us to in the next month suddenly land common definitions or anything around these things. If any of you have worked with states and territories and across the Commonwealth in that space, you’ll know it’s quite hard to get consistency in some of these

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areas. But it’s certainly a goal everyone’s committed to.

So in delivering those functions, this is the broad structure that the Commission has to deliver the functions. As a senior practitioner coming in, we have Dr Jeffrey Chan, he starts on 9 July, and he works directly to the Commissioner, so there are three major function alarms within the Commission. There’s a registration function and a registrar sits under the Commissioner. There’s a complaints function, and a complaints person sits under the Commissioner. And then the other major function is the behaviour support function, and Dr Jeffrey Chan, as the senior practitioner, will sit under the Commissioner for this function.

Working for Jeffrey we’ve got four broad groups of staff. We’ve got a national group of clinicians, who will be responsible for I guess the broad overall national policy and the design of the system, education and support materials that might be nationally developed, and also responsible for plan audits. So one of the requirements under the new arrangements will be that behaviour support practitioners have to put plans onto the Commission system, implementing providers will need to link to those plans, and those plans will be audited, not necessarily every single plan, but certainly some kind of random selection of plans, or plans that have been identified because of a particular priority area that they might have, and perhaps it’s something like a plan that might have more than two or three providers involved in the use of restrictive practices, or it might be a particular restrictive practices like seclusion or something like that that we’re looking at. So whatever those priorities are, they’ll be determined a bit later by the Commission staff, but a combination of priorities and randomly looking at plans will give us a good sense of the high quality or the quality of plans that we can hope to improve if they do need improving.

As well as that national group of clinicians, there will also be a regional group of clinicians. In New South Wales it will be a group that are covering New South Wales and ACT. And that regional group of clinicians will be the ones who will be working most closely probably with you people around the room. So they’ll be the people that you go to if you need any help with interpreting anything in terms of the Commission’s requirements, they’ll also be the people who will offer you more day to day advice around the implementation of behaviour support strategies, and/or any support you need in terms of restrictive practices. And so they’ll support both implementing providers and behaviour support practitioners. They’ll also be responsible largely for the interface with jurisdictions. So as I mentioned each jurisdiction has their own authorisation and consent arrangements, and those regional clinicians will work pretty closely with the relevant jurisdictional authorities to make sure that the Commission’s systems and approaches align with the authorisation arrangement, and it works well together, that relationship. And obviously they’ll also be involved in potentially plan audits as well.

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There’s a third group of researchers, they’re only a fairly small group, there’s only three of them, so they’re not going to be racing around doing a whole lot of their own primary research. But what they will be doing is keeping across what the evidence base tells us, both the evidence base in Australia and also the international evidence base, and they’ll be making sure that any findings, the most recent kind of evidence-based practices are promoted and used in educational materials and supporting the clinicians to work with implementing providers and behaviour support practitioners around Australia.

And then finally we’ve got a group there of behaviour support analysts, and that group will be concerned with looking at the whole lot of data that we’re going to get in around behaviour support plans, strategies, and also of course restrictive practices and the reporting on those, to actually start identifying issues, priorities that the clinicians and the senior practitioner need to pay attention to.

So the functions and the structure are all aimed very much at raising the bar in this area. I had the privilege to meet Dr Chan at an advocacy forum a couple of weeks ago, and at that advocacy forum he outlined what his vision was in this area, and it was very much about improving the way things were done, raising the bar, making sure behaviour support practitioners were absolutely up to date with current evidence and making sure they were implementing the best strategies they could, and making sure both behaviour support practitioners and implementing providers were seriously taking steps to reduce and eliminate restrictive practices. He certainly thought this was an area that we could definitely improve in, with the goal to working towards eliminating restrictive practices. So it’s not a set and forget as far as he’s concerned, we’re really looking for behaviour support plans to lead to reductions, and that to be seen and monitored over time.

A very key theme for him was safeguarding the dignity of people with disability, and improving their quality of life, which of course is the whole basis for which we’re trying to reduce and eliminate restrictive practices and skill people up so that the behaviours of concern don’t occur. Very strong on contemporary evidence-based practice, and making sure that what we did actually had a solid basis in research and evidence in terms of our plans, and that was what we were implementing. And of course all of that leading to the constructive reduction of behaviours that may lead to harm of self and others, and ultimately reducing and eliminating restrictive practices.

So that’s very much the kind of overall purpose and goal here, is to implement best practice and eliminate restrictive practices and raise the bar in those areas, do a lot better than we’ve been currently doing.

This slide is meant to depict a bit of an overview of how we see behaviour

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support and the function working in the NDIS. Different people start at different points, so this is taken from the point of view of a person who doesn’t have a plan in place at the moment, so they’re going along to the NDIS for their first plan. And the idea is that as a part of the development of that plan, their behaviour support needs would be identified, so either themselves, their family members, perhaps a provider they’re already working with will recognise this person has behaviours of concern or behaviour support needs. There’ll be a complexity level assessment done by the planners. Now I should say at the moment they don’t actually have any particular tools to do this, but it’s something that we’re looking to develop with the NDIA. And basically they would use that tool to give a broad assessment of the complexity level of the behaviour support needs of an individual. And then there would be a funding package allocated and approved for behaviour support. So specifically for behaviour support.

Now, I’m aware that that doesn’t happen perfectly as I’ve kind of described it there, that’s a bit of an ideal. But it is an ideal we’re actually striving to make real progress towards. There’s been a working group going on for some time now that involves all the senior practitioners around Australia, and they’ve been working very closely with the NDIA to address what they all recognise is a problem in this area, which is that there’s insufficient resources going into behaviour support plans, and going towards behaviour support practitioners to develop plans, or at the very least it’s not consistent across the individuals. And so we’ve been working with the NDIA to come up with a better way of coming up with a reasonable level of funding.

And that’s involved looking at that complexity level that I mentioned, and then looking at the various elements that a behaviour support practitioner will need to do to properly implement a plan from assessing the need through to developing a plan, through to supporting the provider in terms of training staff, and implementing the plan, through to evaluating the plan. So we’ve been working through with them a more sensible assessment of what the hours might be involved for the different complexity levels, and hopefully where that lands us in the longer run is that there will be a sufficient package put in up front into somebody’s plan, and that there’ll be some flexibility around that package for behaviour support practitioners working with implementing providers to work around and meet behaviour support needs. So I realise we’re still a fair way away from that ideal, but that’s certainly what we’re working towards. The NDIA I think in our last chats with them were looking at potentially implementing a pilot around the new levels of funding that I was just talking about. So it’s the first step, still a little way off, but that’s sort of where we’re heading in this direction.

Once the funding is in the plan, (I have some accompanying music….thats great! They’ll ring back is the problem ), once there is funding in the plan we’ve then got the development of the plan, the individual would engage a

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behaviour support practitioner, they would then potentially create an interim plan, if there was a need for restrictive practices or behaviour support in the very short term, then they’d do the full functional analysis and consult with families, carers, implementing providers to make sure that the plan was workable for everyone, and then create a comprehensive plan for the individual. Importantly then implementing providers, so this is another requirement for implementing providers, would need to get state and territory authorisation and consent for the implementation of any restrictive practices that they were involved in as an implementing provider. So it’s not the behaviour support practitioner’s role to get that authorisation, it’s the implementing provider’s role. That authorisation applies to an individual in an implementing provider in the context that they’re delivering those services, so it’s very specific, and generally not transferable across providers or across circumstances. But the New South Wales people will tell us more about that when they get up here.

So then the plan is developed, then obviously there’s implementing the plan, education and guidance initially up front to make sure everyone knows how it’s going to work and has the skills and knowledge to implement it properly. Promote positive strategies to (reduce) restrictive practices. As I said before, Jeffrey Chan’s going to be very focused on this, making sure that there are positive strategies and they’re all attempted before there’s any use of restrictive practices. And with the idea that ultimately you wouldn’t be using those restrictive practices over time in most cases. So restrictive practices in this context would only be used as the last resort to address behaviours that may cause harm to self and others. And obviously as the plan’s implemented there may be need to adjust the plan along the way, in which case the behaviour support practitioner would need to get involved again with the implementing provider.

In terms of monitoring and reporting, implementing providers will required to report monthly on the use of any restrictive practices. We’ll talk more about that a bit later, but hopefully we’ve tried to make that as streamlined as possible, particularly for routine matters of restrictive practices, but there will be a requirement for monthly reporting. And if there’s a use of restrictive practice that doesn’t have authorisation or a plan in place, then it will need to be reported by an implementing provider as a reportable incidence, such as for example in the emergency use of restrictive practices, somebody’s about to run on the road, you have to grab them and stop them in that case, it’s a restrictive practice so it has to be reported as a reportable incident, but it might be a one-off case that you don’t need a behaviour support plan in place for, so that might be the end of it. On the other hand, if you’re constantly stopping the person from running on the road, then you need some other strategies in place, and you need to get a behaviour support plan in place.

And then finally, as I said, a very clear emphasis on trying to improve the

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situation. So there’s as a minimum an annual review of plans. So the minimum is a year’s space, but a behaviour support practitioner or the implementing provider or somebody else might want to review the plan before then if there’s been a change of circumstance, or if they just want to see how the strategy’s going. But at least once a year. And as I said, an emphasis on evaluating the plan’s effectiveness to see that it’s working, and if it’s not working it needs to change.

Okay. That’s the broad framework. Now specifically around what the requirement on implementing providers is. The first thing, and one of the most important things to recognise is that providers implementing behaviour support plans that involve the use of restrictive practices must be registered providers. So it’s only those behaviour support plans that involve the use of restrictive practices. So you can implement behaviour support plans in generally as an unregistered provider, but as soon as a restrictive practice comes into play, you’ve got to be a registered provider. Unregistered providers can’t deliver services that contain restrictive practices under the new arrangements, that’s the first and important point.

Secondly, if a restrictive practice is used, it must be implemented in accordance with the behaviour support plan, and authorised or consented in line with state and territory requirements, however they may exist in the different states and territories. In some states and territories there are things called short term approvals. I don’t think you have to worry about that in New South Wales. But that’s a particular type of approval. So that’s the second thing. If you’re going to use a restrictive practice as an implementing provider, got to have a plan, got to have authorisation where required.

A third point, there’s going to be a requirement to keep records on the use of restrictive practices, and again we’ll go into this in more detail about what records, but essentially all the records that need to be kept will help inform your reporting, your monthly reporting that is now the requirement. So that’s the next point there, monthly, regular reporting, monthly reported with the use of restrictive practices in accordance with the plan, and also comply with the reportable incident requirements which I have already mentioned, if you’re using a restrictive practice without authorisation or a plan.

The next point there is take all steps to facilitate the engagement of a behaviour support practitioner if a behaviour of concern arises, or if a behaviour support plan needs to be reviewed. So clearly it’s not within the power of the implementing provider to actually engage a behaviour support practitioner necessarily, or develop a behaviour support plan off their own bat. So the requirement on implementing providers is not to make sure that plan’s in place, but it’s to do everything they can to make sure the plan’s in place, and that you’ve engaged a behaviour support practitioner. So obviously the individual might have to go away and get an NDIS plan review, or there might

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be a whole range of reasons why a plan mightn’t be able to put in place quickly.

But the implementing provider has to facilitate that as best they can, and they need to be able to demonstrate that. So the Commission might come to you as an implementing provider say, if you haven’t got a plan in place within three months, and say “Well, what have you done to facilitate the plan?” And you’ll need to be able to demonstrate that you’ve done stuff. Now, if you’ve done everything you can, and the reason it hasn’t been in place for three months is because the NDIA still hasn’t actually manage to approve a plan review, or there’s no behaviour support practitioners in your area, or whatever the case may be, then obviously you can’t be held responsible for that. But what the Commission will hold you responsible for is making sure that you’ve done everything you can to let the individual know there’s a need to change their NDIA plan, talk to the NDIA, contact the Commission and say to the Commission “This person needs a plan, we need to facilitate this and make this happen”, whatever it is that’s reasonable for you to do to facilitate the engagement of a behaviour support practitioner.

Obviously you’re responsible for making sure that any staff implementing a behaviour support plan and any restrictive practice are appropriately trained. So it’s kind of a standard requirement for anything I guess you get a staff member to do, they’ve got to be able to do it and have the skills and knowledge to do it. No different for a behaviour support plan or implementing a restrictive practice, you’ve got to make sure your staff are up to the task.

And lastly there is working with behaviour support practitioner to monitor the outcomes for the person and the progress of the plan. So obviously because you’re the implementing provider implementing the plan, you’re in the best position to keep records, keep track of how well it’s going, what’s working, what’s not working et cetera on a day to day basis. So when the behaviour support practitioner comes back to talk to you about how the plan’s going, you’re in the best position to at least have the evidence to give to the behaviour support practitioner so they can do a thorough review of the plan and make any necessary adjustments.

So that’s broadly the requirements, and in a minute Tracey will go through them in a bit more detail. But before we get on to that, all of those requirements, not all of those will necessarily be in place for you for every person from day one. So clearly we’ll need to put in place some transition requirements so that these things are gradually brought in. We’re not going to have time, or the resources, and neither are you, to get everybody, every existing person with a behaviour of concern and restrictive practice, you’re not going to be able to get everybody’s plan on the system on day one for example. So we’ve got to have transition arrangements.

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Broadly the principle that underpins these transition arrangements is we’re trying to target those individuals that are highest risk to come into line with the new requirements as quickly as possible. So what that means in practice is that if you have an individual, so this is an existing provider with existing people with plans in place, let’s stress that first off. If that person has a plan in place and it has authorisation for any uses of restrictive practices, then the requirement is to notify the Commission that such a person exists. And you’ve got to do that within three months. But you don’t actually have to start reporting on that person or get that plan on the system for up to 12 months. So the next time their plan comes up for review, that’s when you put them on the system and start your monthly reporting. But otherwise you’ve got up to 12 months before they actually have to go on the system. Assuming they have a behaviour support plan, and authorisation. I should stress there a behaviour support plan, what we’re talking about there is a proper behaviour support plan, not just a bit of paper with ‘behaviour support’ written at the top, it’s actually got to be a plan with positive behaviour support strategies, phase out arrangements for restrictive practices, something that the Commission will consider a bona fide behaviour support plan.

And the Commissioner can deem otherwise. So if for example for some reason is considered high risk because of the types of restrictive practices that are being used or a complaint comes up or something like that, the Commissioner can ask you to put it on earlier. But otherwise up to 12 months or the next plan review, whichever is sooner.

If there’s a person who has authorisation but no behaviour support plan, then you’ve got to facilitate the development of a plan within six months basically, or the Commissioner again can deem otherwise. And if there’s no authorisation or behaviour support plan, then you’ve got to notify the Commission within a month that such a person exists, and you’ve got to develop an interim plan within three months. So if you go by that principle that I said before about who’s most at risk, we’re thinking if someone’s got a plan in place and it’s authorised and it’s a decent plan, then they’re probably the least risky, so that’s given you the longest period to transition for them. Whereas if they’ve got no authorisation or behaviour support plan and they’re subject to a restrictive practice, we figure they’re the people who are most at risk, and that’s why there’s the shortest time period for them. Any new providers, so this is all for existing providers and existing people with restricted practices in place, all new providers or all new participants will have to adhere to the requirements as set out in the rules.

So that’s it for me for the moment. I’ll hand over to Tracey who’s going to go through in more detail each of those requirements that we just went through, and then we’ll open it up to questions after that.

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Tracey Harkness: Hi. Just for some clarity around what we’re actually talking about when we’re talking about regular restrictive practices. Restrictive practices as many of you would already know means any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with a disability. And the regulated restrictive practices, the ones the Commission is looking at regulating and monitoring, are practices of seclusion, which is preventing someone from being in the bedroom, preventing them from leaving. And in New South Wales that would have been covered as seclusion and exclusionary time out, or fit under seclusion.

Chemical restraint, and we’re talking about routine chemical restraint, so any chemical, any medication that’s used to influence a person’s behaviour or suppress a behaviour. We’re talking about routine everyday medication for that, as well as PRN medication, and previously New South Wales PRN medication was the main restrictive practice that we monitored as well. I must stress though the chemical restraint delineates that those medications that are used to address a diagnosed mental illness for example that’s existing within the person rather than just suppressing behaviour, it may be treating a medical condition or a diagnosed mental illness, obviously there’s a lot of grey areas around that, and we’re going to be working with New South Wales government just to be a bit more clear in terms of having a consistent line in that grey area what that includes.

Mechanical restraint is obviously the use of a device such as a splint or something to restrain someone. Physical restraint is using a part of your body to restrain someone. And environmental restraint are things that would have been included before in New South Wales such as restricted access, so locked kitchens, locked fridges, and also response cost procedures in New South Wales, if you used a response cost procedure that’s now covered under your environmental restraint.

So just as a reminder, regulated restrictive practices can only be used in the context of reducing the risk of harm to the person or other people. It has to be clearly be identified in a behaviour support plan. The authorisation has to be by the New South Wales state government, where it’s required. It only can be used as a last resort, and needs to be the least restrictive response available to the person. It also needs to be used for the shortest period of time, and be proportionate to the potential harm that that person can pose to themselves or others. And the NDIS participant has to be given the opportunity to develop new skills that have the potential to avoid the need for a restrictive practice.

So the person needs to be, as part of their comprehensive behaviour support plan, as service providers you need to be able to see or make sure that there’s positive practices in that plan that you receive from the behaviour support practitioner. We need to make sure that we’re not just going straight to restrictive practices. I should also let people know that these slides will be

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available on the website, and this whole presentation will be available on the website as well.

Okay, so as Paul’s mentioned already, behaviour support practitioners will be able to use the NDIS Commission’s portal, and we’re in the middle of looking at whether or not we keep the name of CBAS or change it, so watch this space, but it’s going to be the Commission’s portal either way. So one of the things that people will be able to do is behaviour support practitioners will be able to attach behaviour assessments and other relevant assessment reports that they’ve used to develop their functional behaviour assessment. People will be able to enter behaviour support plans directly onto the system, so behaviour support practitioners can actually enter the portal itself, and I’ll show you a couple of screenshots soon, and you can actually put the details in yourself and then print out a report at the end that has all the fields already there.

Manage and update the current behaviour support plans that they’ve got in place. Upload assessments including the functional behaviour assessment. So we want to make sure that everybody’s plan is developed on a functional behaviour assessment, and making sure that it’s approved, has a biopsychosocial focus for the functional behaviour assessment as well, so we want to have evidence of that being uploaded onto the system. And any associated and implementing service providers to plan. So what will happen is that a behaviour support practitioner will write the plan on the system eventually, when it’s up and running and fully functional. Once they submit the plan it goes across to the associated, whoever’s the associated service provider to approve the plan. So as a service provider you’ll be able to log onto the system and have a slightly different view, where you’ll be able to see any plans that are waiting for your approval. So the behaviour support practitioner will need to put your details of being the service provider into the portal itself, so it goes to the right place.

Okay, so this is just a very quick overview of what it looks like in the first instance when you go into the system. So here if I’ve logged in as myself, this will be the plans that I’ve got already in place. The plan identification number you can see on the left hand side of this box down here, that’s a number that’s been given, that gets automatically generated and given by the system to each plan that I upload. It’s got a plan created date, start date, review date, and the plan type. So the plan type is just whether it’s an interim or a comprehensive plan, and then also the status of the plan as well, an active plan, like the first one is, is one that’s already been approved by the service provider and in place. A pending plan might be one, it might be a draft plan that I’m in the middle of writing, or it might be one that’s pending approval. And then you can view those each. So you come up with a summary list first of all of all the different plans that are written by you.

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And this is an overview screen which is the first thing you see when you go into a plan itself. So once you open one of the plans that were in your list, you’ll have the person’s name up the top left hand corner, you’ll have comprehensive, the status of the plan, and also the behaviour support practitioner’s name as well. Now the overview just gives more and more details the more details you go in. So you can see down the left hand side here of the screen, you’ve got person details, key contacts, plan details, assessment, and the assessment tab is where as a behaviour support practitioner you can upload your functional behaviour assessment, you can just upload it into there. Proactive strategies, the providers that are associated with the implementation, the behaviours of concern and the schedule for a restrictive practice. So once you go into these details and fill out more, you’ll get a little bit more detail in the behaviour support plan overview. But at the moment we’ve only got the basic information in there.

So at this point in time it talks about there’s more than three providers, yes, there’s no more than three restraints, it’s got the plan identification number, again the created date, the practitioner and whether it’s authorised. And you can see in the box down the bottom it’s got the provider list. So at this point in time we’ve got, for this particular person we’ve got two implementing providers. So behaviour support practitioners can actually go into each of these tabs, into proactive strategies and be able to fill in their own proactive strategies in place for the person, the environmental considerations on each of those things, and again like I said they can print out a report at the end of that.

Obviously the other thing just to mention is that as of the 2nd of July you cannot use the system straight away on the 2nd of July to input your plans. There’ll be a manual workaround of those situations. As you can imagine it’s been really quick to get all this happening in the last six months or whatever, to have the portal up and running and all sorted, so we’ve got a manual workaround for the first few weeks at least, so that we’ve got templates at the moment that will be available on the website, and we’re in the process of getting them to be fillable pdf templates, so that you an fill out those templates and then send them back to us as is, and we’ll upload them onto the system when we can.

Audience: Tracey, I’m sorry, is it providers that do that, or behaviour support practitioners?

Tracey Harkness: Behaviour support practitioner, yep. Okay, so uploading behaviour support plans, this is again one of the steps that people need to make sure that they do, which is practitioners making sure that when they have a plan they’ve assessed someone as being the primary provider in the system. And that way when they submit the plan it will come to you to approve.

Okay, so in terms of record keeping, and this is around your reporting form,

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monthly reporting of restrictive practices. Some of the things that you need to keep in mind or think about when you’re reporting these restrictive practices is the impact to the person with the disability or another person, any injury the person has sustained, whether the restrictive practice was a reportable incident. So you’ll remember any unauthorised use of a restrictive practice in a behaviour support plan is a reportable incident, and you have five days to report that incident to the Reportable Incidents Team. The behaviour of concern that the restrictive practice was trying to address, or is aimed at addressing. The reason for the use of restrictive practices, the time, date and place of the restrictive practice, name and contact details of those involved, including any witnesses, actions taken in response to the restrictive practice, any less restrictive options that you considered in responding to the behaviour of concern, and actions and strategies used leading up to the use of the restrictive practice. So that’s again similar to the less restrictive options that you’ve considered as well.

Audience: Is that for the monthly reporting, or just for reporting for our own purposes?

Tracey Harkness: That’s partly for the monthly reporting. We will have time for questions and things after I complete the slides if we could hold it till then too, just so that we could have more formal discussion about it would be good too. Implementing providers will use the CBAS portal, so you’ll use that to report the monthly use of any regulated restrictive practice that is described in the behaviour support plan. So any plan that you’ve got. So the behaviour support practitioner will already develop, back on the other screen they’ll develop a schedule with the restrictive practice, so it might be a protocol, to administer PRN medication, or it might be a protocol to intervene with a physical restraint, and that will be the manner in which you implement the restrictive practice, and then you’ll be reporting on that. So if it’s a routine situation, you just need to say if it’s a routine chemical restraint, the person gets medication every day. You’ll just be able to say “For the month of May, John received his medication every day”, you don’t have to report every single time it happened.

So the role of the authorising reporting officer. Now this is a role that needs to be identified within your own organisation as making the most sense, so whether it’s a senior manager, or whether it’s a quality compliance person, or whether it’s a clinical governance person in your organisation, whoever it is needs to be just the identified authorised reporting officer for reporting the incidents to us. Is responsible for reviewing and submitting the monthly reports on the use of restrictive practices, and the fields included a restrictive practice type and sub-type. Now, I should have mentioned before, the restrictive practice type in New South Wales will continue to be the regulated restrictive practice, because New South Wales is going to be aligning their definitions with us, so there will be no sub-type of restrictive practices. So in other states where they’re not necessarily aligned, there could be sub-types

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that fit under those general categories, but you don’t need to worry about that in New South Wales.

Duration, so for how long it was used, where it was used, behaviour of concern it was trying to address and also the free text comment section. So the monthly reports are to be submitted to the Commission on the first day of the new month, and are due five business days after the end of the month.

So this is what it looks like in terms of the CBAS system at the moment. You’ve got the schedule of restrictive practices, so remember I said the behaviour support practitioner puts in the schedule of the restrictive practice and what you need to report on, as agreed in the behaviour support plan. And again if state authorisation is required it must be obtained before any practices are used. So report usage, the schedule of report usage is actually what the behaviour support practitioner has designed that and said “Well, this is the routine chemical restraint” in this particular practice, and the reported usage at the bottom is where the service providers put in their report. And you’ll see there’s a little tab down in the bottom right hand side that says ‘export’, and you can export that data for your own system as well.

So as I said, there’s what we call PRN reporting, and that doesn’t bear any relationship to medication, it’s just an as-needed reporting. So if you’ve got a restrictive practice that’s not always in place but it’s used sometimes, but not all the time, this would be the kind of reporting you would do and the information you’d need to keep. So again don’t worry about the sub-type, because you’d talk about the restrictive practice. You’d talk about the date, how long it went for, the use, whether it was as per the behaviour support plan or was a variation of that, behaviour of concern that it was trying to address, the start date and end date, and where was the restraint used. So that’s for any as-needed things that might happen once a month, could happen three times a month, four times a month.

For routine reporting, and that’s for any routine physical restraint, chemical restraint or anything else that happens every day at the same time for example, you can report against an agreed routine schedule. So if the person’s getting chemical restraint every day to manage their behaviour, rather than reporting “On May 1 they got their medication, May 2, they got their medication” et cetera and reporting each individual thing, you could say “For the month of May the person got their medication every day in accordance with the behaviour support plan”. So the fields included otherwise are just the report usage, start, end date and behaviour of concern that it was addressing as well. So we have tried to make it a slightly more streamlined approach for routine reporting, because there’s no point you reporting every incident if it’s exactly the same as described in the behaviour support plan.

Okay, just for your information I guess around what behaviour support

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practitioners need to do. So a person the Commissioner considers is suitable, or is deemed suitable to undertake behaviour support assessments including functional behaviour assessments, and to develop behaviour support plans that may contain the use of a restrictive practice. So behaviour support practitioners during the transition nominated by the transitioning providers, so we wrote out to all behaviour support providers in New South Wales and South Australia, because they’re starting on 1 July this year, we wrote out to all the providers and said “Who are the people that are providing behaviour support in your organisation, please provide the names and the qualifications of those people”, so that at the moment those people are nominated – all you had to do is nominate the providers and they’re deemed suitable for the short term process. To make sure that we didn’t get to the 2nd of July or the 10th of July and have three providers in New South Wales that could provide behaviour support because we had to have a complex assessment process.

So in the longer term though, potential NDIS behaviour support practitioners will be formally assessed, including against a national competency framework. So we’re yet to develop this competency framework. That will be our priority to develop that framework in the next couple of months, and we’ll be trying to progress that as quickly as possible. So in the longer term that’s what people will be assessed by. So all providers and practitioners across New South Wales and South Australia will be assessed against the competency framework.

And these are just again for your information that is helpful to understand about what some of the requirements for the specialist behaviour support providers are. You need to make sure that you use behaviour support practitioners that are deemed suitable by the Commission to deliver these services. The general timeframes that people have in place, this is now different, this is the general timeframes that are in place, irrespective of the transition arrangements. Once the person is engaged, the behaviour support practitioner is engaged, they have one month to develop an interim plan, and they have six months to develop a comprehensive plan, and they need to review the plan at least every 12 months, if not beforehand, if you decide the plan needs adjustment as providers, and you realise it’s not working anymore or it’s not working as well, or the behaviour support practitioner wants to review the plan or the family or someone else prompts a review, but at least every 12 months.

They need to develop plans that meet the Commission requirements, so they need to be developed in consultation with a person with a disability, their support network and implementing provider. Obviously implementing providers need to be consulted when practitioners are developing any plans, because you guys are the ones that need to implement the plan and make sure it’s doable and workable in your environment. It needs to be aimed at reducing and eliminating restrictive practices. It needs to be developed in a

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form approved by the Commissioner and lodged with the Commission. Now, ‘approved in a form by the Commissioner’ will be if the behaviour support practitioner is entering the plan onto the CBAS system, into that portal, that will be the form approved, and if you’re filling out all the different requirements. So if you’ve already got a plan that you’re working and it’s in a Word document or whatever, you can cut and paste into the portal itself, that will work as well.

So end of our formal presentation, happy to take questions. We’ve got a couple of roving mics. Just because we’re recording this session, if you could just talk into the microphone when you ask your question, and we will endeavour to answer all questions as much as we can, but for things we don’t know yet we’ll take them on notice as well.

Audience: Thank you. At what point is the person and/or their family consulted for consent to be part of this system, and who is responsible for doing that?

Paul Miller: Sorry, which part of the system did you mean? Actually having a plan developed, or going on to the …

Audience: [Unintelligible 00:51:32] to the system.

Paul Miller: Yeah, so they’ll be consulted as a part of the development of the plan. So when the practitioner develops the plan with them, they’ll inform them that the plan will go up on the system, and that will be their chance – so it’s by exception I guess that they don’t go up on the system. So they would have to say “No way, I don’t want my plan to go up on this system”. The other thing that will be by exception in terms of that kind of thing you’re talking about, in general implementing providers will have access to the plan, the full plan. But again, that’s another thing that if the individual says “No, no, no I don’t want this implementing provider knowing what this implementing provider’s doing”, then they’re not allowed access. But the default is that they are allowed access, it would go on the system. But there’s provision for the person to say “No, I don’t want that to happen”, in which case it won’t happen, because they haven’t given their consent.

Audience: Is there formats or forms for that?

Paul Miller: You mean like a form or something?

Audience: Yeah, like how we formally gain consent from the person for this process.

Paul Miller: Yes, I’m trying to think, I think it’s a tick box in the section.

Tracey Harkness: I think it’s a tick box and then you have to identify. I think it’s a tick box saying yes or no you’ve got consent, and then there’s a drop down box of who

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you’ve got consent from, depending on whether it’s the person responsible or the local guardian or the family member or whoever is providing that consent. In fact in the key contact screen for the behaviour support plan, that’s where you would put that information in terms of who provides consent for this person, whether it’s the participant themselves, whether it’s a substitute decision maker as well. So that’s where you’d put all that information that would link automatically, prepopulate the bit where you’re talking about consent, it would drag it across. The system will note that you’re putting in the key contacts as the consent provider, and that will then populate it back there as well, when you’re asking about consent.

Audience: And will multiple versions of the plans be available under that person’s record? Say for example if you’re a new provider, can you see the plans from previous providers?

Paul Miller: That’s a good question. I think in general the answer’s yes, but there are limits on that just because of the system limits. So I think the way it works, and we’re still developing, finalising what the system will be like, so with that caveat, you can make changes as you go to the plan, and some of those changes will overwrite the previous changes. But if it’s a new plan, so that would be like a formal review point, then the old version is saved, and the new plan goes on the system. So not every change to the plan is recorded, but at snapshots at points in time. But I’m not sure who actually, I’ll have to go back and check who actually has access to the previous records. Because the way it works is it’s the behaviour support practitioner who puts them on the system, so the behaviour support practitioner has access to all the ones they’ve created, but obviously behaviour support practitioners change, and so I’ll have to check as to who has historical access to the system. It may be the Commission only has historical access to the system. But I’ll take that on notice and check it out for you.

Audience: I’ve got a question. I’ve got three doctors that signed off on – I’m in a debate at the moment, and I’ve got three, it’s a medical decision, three doctors, a professor, a neurologist and a GP have signed off on a normal person’s fluid intake. Two litres a day. It’s not a restriction, it is a normal person’s fluid intake. What it is is not allowing the person to kill himself with 14 litres of fluid. I’ve got another service provider saying it’s a restriction, and I’ve got three medical people saying it is a not a restriction, it is a normal person’s fluid intake. If he drinks 14 litres he’s going to die of over-hydration. Where does medical versus panel come in, and as one doctor said, is this behaviour practitioner going to sign his death certificate? No, he’s going to get out of bed and sign the death certificate, not the behaviour practitioner. So I’ve got three doctors telling me that your behaviour practitioners are Mickey Mouse, like at the end of the day, “I’m a neurologist”, “I’m a psychiatrist” and “I’m a GP”, they’re fighting to save this man’s life, but it’s normal restrictions. You drink two litres.

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Paul Miller: Well, I think there’s a couple of things here that I’d say to that. The first thing is there’s …

Audience: It’s very complicated.

Paul Miller: It’s not – well, I think it’s, so there’s a normal intake of as you said of what you need a day, and you’ve got somebody who would keep drinking until they die, basically.

Audience: Non-stop, until they die, yes.

Paul Miller: So clearly in that case there, potentially putting themselves at risk, at harm, so where the restrictive practice comes in though is well, how do you stop the person doing that drinking?

Audience: One on one him.

Paul Miller: And it may be one on one, it may be locking the fridge, it may be restricting their access to the tap or whatever it might be. So they are restrictive practices. But I guess too while we’re looking to reduce and eliminate restrictive practices, the priority here too is the safety of the person and the people around them. And there are times when restrictive practices are necessary. That may be one of those times. A little child’s about to run on the road, I’m going to grab the kid. It’s a restrictive practice by definition, but in terms of protecting the child, it’s probably a reasonable use of a restrictive practice in that case. So it’s not that restrictive practices can’t be used in any circumstances, they can provided it’s to protect the person or others around them, then you can use a restrictive practice. So in a sense both of your people are right, going to your question. The behaviour support practitioner is right to say if you’re stopping that person getting access to water or whatever it is they’re drinking, then yes, that is a restrictive practice. But that doesn’t mean it wouldn’t necessarily be approved when it gets to the New South Wales government. They might go “It’s perfectly reasonable”.

Audience: It will be forever though, it won’t ever be cured, it’s a chromosome.

Tracey Harkness: Well, I guess that’s the thing. You have to do what you can over time, and hopefully …

Audience: It’s very hard.

Tracey Harkness: Yeah, of course. But over time, if you were able in theory to teach this person a different way of managing that, then you would do that. If you’ve tried all these things before, remember, if you’ve tried to do lesser restrictive things, and it’s the last resort, and you’ve tried all these other education programs and

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skill building and all those sorts of things, and this is the least restrictive thing you can do, then that’s kind of following the …

Audience: You cannot turn off taps.

Tracey Harkness: That’s what I’m saying, but that’s following a process of being the last resort, and that’s how you get there, because you’ve tried all these other things, and they haven’t worked, and you’ve worked out this is the only thing to make sure he doesn’t die.

Audience: And I’ve got medical versus …

Tracey Harkness: Well, it’s not necessarily one or the other I don’t think, this is what we’re saying. You’ve got to balance those things out each time, about the dignity of the person versus what’s going to keep them safe as well. So it’s balancing those things out, and obviously it’s a bit complicated when you’ve got one person saying this and they’re at odds. But they really shouldn’t be, because they’re actually trying to do the same thing in terms of protecting the person and keeping them safe, I would imagine.

Audience: Well, they are.

Tracey Harkness: And the only thing generally I would say is that this whole monitoring and safeguarding we’re trying to do is just to protect participants where restrictions are used when they don’t need to be.

Audience: Yeah, I understand.

Tracey Harkness: Like when they’re overly restrictive environments. Everyone knows probably situations where there’s really, really overly restrictive environments that are not necessary at all.

Audience: I do understand, but I’m in a complicated situation where this man’s going to die if I don’t …

Paul Miller: But I mean the answer to your question is the behaviour support practitioner is right to ask the question, or to identify this as a restrictive practice. Is there a better positive behaviour support strategy we can use? If the answer to that is no, then the answer to that is no, but that question has to be asked, and that’s what the behaviour support practitioner would do. But the issue of it being two litres a day or whatever I’m not sure of the exact science around it, but whatever the doctors are saying is the norm is obviously a correct kind of norm, there’s no debate about that, that’s not what the behaviour support practitioners are I guess questioning.

Audience: At the end of the day, that’s what the doctors are saying. Who is this

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behaviour support practitioner to be questioning three doctors, who do they think they are?

Tracey Harkness: I think it’s still okay to question doctors occasionally, but anyway, that’s another whole …

Paul Miller: Yeah, it is. But I don’t think they’re questioning the two litres a day, all they’re questioning is what are the strategies in place to stop that person doing …

Tracey Harkness: Maybe they’re asking the wrong question.

Paul Miller: So maybe the behaviour support practitioner isn’t asking in the right way, but they’re not challenging the doctor, they’re just saying “What practices can we put in place to best stop that person?”. And there might be alternatives, there may not be, you might have tried them, to, I don’t know, locking them in their room so they can’t access water or whatever, I don’t know what it is.

Tracey Harkness: We’ll move on to the next question just because we’re, thank you.

Audience: Actually sorry, I just had one small point I wanted to make in relation to that. So Angela Koelink, I’m with Family and Community Services and can talk to that point in the context of authorisation. I think your point about the practitioner and where their advice and their consideration of the practice fits in relation to the medical recommendation. They’re not diametrically opposed. So if we think of the context of chemical restraint, it’s a prescription, it’s a health and medical – so where a prescribing physician writes a prescription or makes a clear recommendation for a particular practice, that’s absolutely their professional decision to do so. Where authorisation comes in, it’s about making sure that those implementing the practice do it the right way under the right circumstances, and support the person as best as that person can be supported in the context of that recommendation. So they’re not questioning the doctors’ decision, but they’re putting the right safeguards in place to make sure it gets done properly.

Audience: A very basic question. We talked a little bit about, and it’s the first time, as I was here this morning as well, the context of families and consent has really come up. My question is who actually has to seek consent of the family and/or the guardians? Is it the practitioner or the implementer, the provider or the practitioner?

Tracey Harkness: Well, the practitioner, as we said before, the practitioner would need to seek consent when they’re writing the plan anyway from whoever they need to get consent from.

Audience: So it’s their responsibility to sign off and to get the consent from those

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families?

Paul Miller: So it’s their responsibility to get general consent around the plan. But if it involves a restrictive practice, then when it requires a formal authorisation or consent, then it goes to the …

[Unclear talking from audience]

Paul Miller: Yep, absolutely. So one of the key requirements of a behaviour support practitioner is then working with the person with the disability, and ideally obtaining any consent for anything they do from them. And then obviously if there’s a guardian or someone because that person can’t give that kind of consent, then it goes to other people. But yes, you’re absolutely right.

Audience: Hello. I’m just wondering about the definition of ‘implementing provider’. If you’re let’s say a provider of three hours of supports on a Saturday morning, and that’s all the contact that you have with the person in their week, are you considered to be an implementing provider if there’s a chance that you might have to use a restrictive practice in that three hours? And then do you have any suggestions about how a provider in that context would balance the administrative burden of this process with the very small number of hours of support that they’re providing and associated funding that goes with that?

Paul Miller: So the answer’s yes, if you’re receiving funding under the NDIS for that three hours, then you have to meet the registration requirements which are the types of things we’ve been talking about there. In terms of reporting, as I think Tracey said, we tried to streamline it as much as possible. So it depends obviously on the type of restrictive practice that might be being used during those three hours. But ideally if it’s a PRN one, then you would only have to report if you use that during that three hours, during that month, otherwise it’s kind of a nil response, effectively. If it’s a routine one, it will hopefully be a matter of going on to the system, say it was giving someone, you gave them one dose of their medication or whatever during that time. It would be a case of going on – your part of the plan would have “You have to give them one dose every day or every week” or whatever it is, and you just go on the plan and tick off “Done as required”. It would only be if there’s a variation from that. So hopefully the reporting burden will be as minimal as we can make it from that side of things. But just as general comment on funding and resourcing for any of these arrangements, there isn’t any additional money for implementing providers. It’s expected that this would be picked up as a normal part of business. It already is in Queensland and Victoria, and this is just making it nationally.

Now, I don’t want to get into a debate around whether the NDIA level of funding is sufficient, because that’s way out of our – we’re not involved in actually setting dollars, the NDIA is. But there isn’t actually any additional

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money for implementing providers. We are looking as I said at behaviour support practitioners and the number of hours to try and get that right. But the implementing providers, the reporting requirements and things like that are expected to be a normal part of business. I am aware that the NDIA as a result, they’re looking at costing and pricing and so forth, is looking at a complexity loading, so instead of just having a flat hourly rate regardless of the complexity of the client, they are looking at whether there should be higher hourly rates for complex clients. Again, don’t know where that’s up to, but I am aware they’re actually looking at that and that seems reasonably sensible. I think that was a part of the recommendation of the recent pricing review that went through. So yeah, hopefully that tells you a little bit. But unfortunately we can’t do anything about the adequacy of funding, I know that’s probably an issue for many of you, but it’s beyond our mandate, I’m afraid.

Audience: Hi. Just a quick question about the actual portal, and it’s probably for FACS as well, I know not everyone’s been here this morning, but is access, like the company has one access and then they give access to their employees, or is it like NDIS where each employee has to go on and gain access from the company’s registration?

Paul Miller: The registered provider will identify individuals who have the role of behaviour support practitioners, so they’ll then be able to go on and enter plans. In terms of reporting, a similar thing, the, what do we call it, an authorising …

Tracey Harkness: A reporting officer.

Paul Miller: A reporting officer, again, the organisation will identify “These five people are reporting officers and here’s their details”, and then they’ll have the reporting officer access. So effectively on the CBAS system in general, the registered provider or the provider says “These are the people I want identified for these functions”, and then they’ll get the relevant access to the system.

Audience: But each individual will register, then the company authorises it, like you do with NDIS? Or does the company actually set up the people themselves?

Paul Miller: No, the company sets it up. So the company registers, and then as a part of the registration they’re asked “Who do you want in these roles?”, and you just say who they are and then they go onto the system.

Audience: Okay. And then if they change they’ll just go in and change it?

Paul Miller: Yep.

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Audience: And will that be similar for – I know you’ll get to that, but yep.

Paul Miller: Yep.

Audience: Hi, this is a question about SDAs. Historically we’ve had whole of service for restrictive practices for SDAs, i.e. locked kitchens, sharps, that kind of thing. What is I suppose the Commission’s stance on that currently? Do we now need to go and get a restrictive practice for each person that comes into the service? And with the way the SDAs are currently running, sometimes we don’t know who’s coming in, so I suppose how do we manage that? Because people may ring us up on a Wednesday looking to come in Friday, and we don’t know, we might get another call Friday afternoon for somebody to come in Friday night if we’ve got space. So have you had any thoughts about how that can possibly be managed?

Paul Miller: Yeah, so I guess it’s a difficult one, because particularly in supported accommodation where there might be several people in a house, so a restrictive practice on one person is a restrictive practice on a number of people. So I might not have an issue with access to sharps, but somebody else might, and so then the drawer’s locked and I can’t get access as well. So I think there are a whole lot of complex areas that will need to be worked through with Tracey and the Commission staff. But the general approach here that we’re talking about is that it’s an individual-based system, so the people would need to have behaviour support plans in place, ideally in advance, and then any restrictive practice like locking drawers or whatever would need to be justified for particular individuals, and I would suggest that other alternatives would need to be considered first, like we were talking about before. If at the end of the day locking the drawer is the best strategy, and it is a restrictive practice, then so be it. But you would want to see that other options are being considered first, I guess would be what I would say.

Tracey Harkness: Can I just say also, whenever you’ve got a shared care situation where other people are living with some people with restrictions, it’s obviously going to effect them and their behaviour, absolutely. However, I would expect if you were in that situation you have some like one page kind of thing, or half a page about how the person who doesn’t need the restrictions is going to get access to that, and making sure they have opportunities to do that, so it doesn’t actually effect them. Yes, so you’d do that anyway.

[Unclear talking from audience]

Tracey Harkness: Yes. So the short timeframe of when you know you’re going to have someone and all those sorts of things, and I think …

[Unclear talking from audience]

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Tracey Harkness: I think in a short term, not knowing when someone’s coming in, just for the purpose of the recording, not knowing who you’re going to have on a particular weekend or whatever, I think there’d be situations where you would already have to have a certain level of information I suppose prior to accepting a new person.

[Unclear talking from audience]

Tracey Harkness: You need to have the microphone sorry, no one else can hear.

Audience: Sometimes not, so sometimes we just get a call at nine o’clock on a Friday night, or Friday morning to say can we take so and so, they want to come in for a short term stay. And if they haven’t been with us before we would go through some information on the phone with them, do a quick risk assessment. But it’s crisis, so you’re going on the fly. And more often than not it happens on a Friday night.

Tracey Harkness: Yeah, of course it does. Yeah, I guess it comes back to the interim approval for things, that as you’re going along the system in terms of getting interim authorisation and interim approval. And I guess one of the questions that might be in your risk assessment, I would imagine would already be in your risk assessment, is does the person already have a restrictive practice in place or something. So then you could identify through the system who you might need to get interim authorisation for it, or interim approval for it as well. We can talk more in the break if need be.

Paul Miller: Yeah, can I just say there’s probably a lot of individual circumstances that are going to inform practice as things go along, because of the whole range of different service delivery models that are out there, including the type of one you’re describing. So while we’ve described a system, how it works, there’ll obviously, we might need to work through issues and see if there’s streamlined ways around things as we go on to make it work. Because clearly in that situation you’re not going to have time to get all these authorisations and things in place, but there might be other alternatives, as Tracey said, if the person already has a plan in place, then it’s a case of you just implementing something that’s already been identified in a plan, I don’t know. So I think it will be a case of the New South Wales authorising people working with the Commission to work out what a sensible thing is going to be.

Audience: As you may be aware, sometimes you are not always given permission as a registered disability service provider, to see full elements of the person’s particular plan. So what can we do as providers, if we come in, and we might see something where there’s cases of restrictive practice and we’ve got no idea if there’s authorisation or not?

Paul Miller: Where would you be going in …

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Audience: Say it’s a community, going into someone’s home to help them undertake community participation, and you’re instructed by the carer to undertake something that you think might be restrictive practice.

Paul Miller: Oh right, yep. So two things. Remember earlier I said we’re only regulating the service providers? So while one level, at a macro level it’s a bit of a gap in the system I guess, but carers and family members and things doing restrictive practices is kind of out of our mandate. However, two things I’d say. If they’re asking you to do the restrictive practice, then it is something you’re doing in delivery of your service, and you’re well within your rights to say either no, or “I need to get a behaviour support practitioner in to have a look at this, because that’s what I’m required to do”.

The other thing is under the code of conduct generally, so it’s outside of behaviour support specifically, there’s a requirement on all implementing providers to ensure that people with disability are free of abuse, neglect and those kind of things. So if it was serious enough, it might also be something that an implementing provider might want to report, if they considered it, that the family member or the person was being subject to those kind of things as well.

Audience: Just a question regarding the portal, when you were discussing about how the provider might have to approve the behaviour support plan, can you expand a little bit on what you mean by that?

Paul Miller: Yeah. It’s probably not approving the behaviour support plan as the whole behaviour support plan. What it’s doing is going in and saying for that element of the plan that I’m required to do, so the behaviour support plan has this is what I have to do as an implementing provider, I can sign up to that, I’m comfortable that what you’ve said that I need to do as a part of that behaviour support plan is something that I as the implementing provider are willing to sign up for. So it’s not quite approval of the whole plan, it’s signing up to your bit of the plan.

Tracey Harkness: And I mean it could be approval to the whole plan, but if I was the behaviour support practitioner, you were the provider, I’ve talked to you about the plan, I’ve run a draft by you, all those sorts of things, and as good practice I would get you to sign off, after my plan’s finished, to sign off to say “I’m going to implement this”, in a sense.

Audience: It’s in agreeance to, basically.

Tracey Harkness: It’s an agreement, yeah, that’s right, to say that you’re going to implement it, and I’m going to provide this training, and you’re going to provide this support to staff or whatever. So it’s really essentially that part, it’s the

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agreement that you’re going to do what’s written in the plan, and you’re okay with it, and it’s realistic and all those other things.

Audience: This is just a follow up to that question. Say for example in a therapy setting, where there is a client with say severe behavioural issues. Is that organisation then required, if they agree to that behaviour support plan and implementation, are they then required to make a reporting on that if any part of that behaviour support plan was used with regards to restrictive practices? Within a therapy setting, so one hour contact, and someone with say severe self-injurious behaviour.

Tracey Harkness: If you’re – surely, yes.

Audience: Because that happens quite a lot within a therapy setting.

Tracey Harkness: If the person’s already got an approved plan and a restrictive practice in place?

Audience: Yeah, and say the actual organisation agrees to follow that, are they then required to report on that?

Tracey Harkness: If they implement the restrictive practice, then yes, they do need to report it.

Paul Miller: So I think there’s two kind of cases where that might happen. If they’re an implementing provider and they know they’re going to implement that practice, then the answer would be yes, they have to report it, sort of the way we’ve been talking about. If it’s say the person just goes for a one-off therapy session to a therapist, and during that session the therapist has to use some kind of restrictive practice, but the therapist isn’t actually in the behaviour support plan, they still have to report it, but it’s a reportable incident. That’s something that’s happened on their watch that they’ve had to use a restrictive practice that they weren’t authorised for, that wasn’t in the plan, so they would then just have to report it as a reportable incident. Now, again as I said earlier, if it’s a one-off, you’re only going to see that person for that hour and that was that one-off thing, then at that reportable incident level, that’s probably all you’d need to do in terms of reporting. On the other hand, if you’re going to see that person regularly, and you thought you might have to use that intervention again, then you would have to make sure you were included as a part of their behaviour support plan and talk to a behaviour support practitioner.

Audience: For reporting, if there’s practices on the way to your venue, for example like a seatbelt cover or something, would you include that in your reporting of them coming to you with the restrictive practices? Do you know what I mean?

Paul Miller: Yep. Are you the ones who are transporting?

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Audience: We’re not transporting, they’re just being unloaded.

Paul Miller: No, so whoever the provider is who’s transporting would have to do any reporting, because it’s on their watch, not on your watch.

Audience: But then if at the end of the day when they’re going home, and we put them into a car …

Paul Miller: Oh, if you’re the ones who are putting on the seatbelt, then you’d have to report that, yeah.

Audience: And then if we’re unloading we don’t need to report that?

Paul Miller: No, whoever puts them on, if it’s their parents obviously they don’t have to report, but if it’s the provider themselves that are actually clipping them in, then yeah, they would theoretically have to report that one.

Audience: And similar with taking meds, if there’s behavioural chemical restrictions, if they’re having them at home, and then sometimes you might need to provide them, but it’s not in the report, do you still report on that?

Paul Miller: Yeah, so again, if anything happens on your watch that’s a restrictive practice you’ve got to report on. Obviously if they’re having it at home, then you don’t report on that, because it’s their parents or carer or whoever who’s actually doing that, yeah.

Audience: I just wanted some clarity on something that we discussed in the morning session about a reportable incident with relation to medication. So if the medication is a psychotropic medication and it’s a restrictive practice, and it’s in a behaviour support plan and it’s got authorisation et cetera, and the medication is missed, is that a reportable incident?

Paul Miller: It would depend on the circumstances, but potentially yes. So say they were meant to have a – it’s the same as an overdose.

Tracey Harkness: It depends on the effect.

Paul Miller: Yeah, it depends on the effect, the same as an overdose. For example say you accidentally gave them twice the dosage that they were meant to get, then potentially that would also be a reportable incident. But you’d need to look at the reportable incident guidelines to see whether it actually met the threshold, because I think in the reportable incident guidelines, and I suggest you go on and read them because I’m not an expert on it, but it’s actually got a meter threshold of it actually causing a serious injury et cetera. So just missing a dose or double dosing someone may not actually lead to anything as far as

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harm is concerned, so you might not have to report it.

Tracey Harkness: Since we’re doing reportable incidents at the moment, our team’s going across it, it depends on the effect that it has on the person. So it has to meet a threshold absolutely, but it’s more about did you need to seek medical attention, whatever. If you just rang the poisons line and they said “Oh, look, no dramas, what’s the usual dose?”, “Oh, I gave them twice as much”, well, they’ll be able to give you expert advice about what’s that going to mean. But if they just said “That will be okay, just monitor the person for the next few hours, they might just be a bit unwell” or whatever, if you didn’t need to seek medical attention, you didn’t need to go to hospital and that sort of thing, it probably wouldn’t meet the threshold, just one-off. But it depends on the effect it has on the person.

Paul Miller: What it would probably do though is go in your organisation’s incident management system. So if it was something that goes in your incident management system, and then it would have to meet a certain threshold before it reached the reportable incident to the Commission.

Audience: Thank you very much. I’m interested in the grey zone of this space, and an example that I’m thinking of is one of our participants almost in jest and in a cheeky mood trying to touch someone in a – thought it was hilarious, having a support worker just gently guiding the hand back. My question is will there be clear definitions of restrictive practice, will there be someone to ask, is guiding a hand in that context a restrictive practice, how will we know, and then is it the responsibility of the people developing the plan to tell us “These are the restrictive practices to look out for”, and other things in the grey zone, do we report to the practitioner, do we report to you guys, like how do we deal with the grey zone?

Tracey Harkness: The practitioner should be able to delineate which restrictive practices are in the report and which aren’t. Gently guiding someone is not considered a restrictive practice, it’s not a physical restraint, you’re not restraining them. I guess as a general rule. However the behaviour support practitioner should be able to tell you these things and be clear about which ones are restrictions as well, and so can help you work out whether you need authorisation for them or not. And in terms of someone to ask, the state will put up a slide in terms of how to contact them, if you’ve got any questions about that at the end of their presentation. So you could ask the state in terms of authorisation, they’ve got an e-mail inbox and a website.

And we’ve got our own e-mail inboxes because we’re brave at the moment, and our direct phone lines, anyway. Because we’re in the middle of setting up, there’s an e-mail inbox that’s set up in theory, but we just can’t access it yet, so I didn’t want to put that out there. But it is behavioursupport@ndiscommission.gov.au. You can either ask the state or

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you can ask the Commission. And there will be a state-based Commission team based in New South Wales, covering New South Wales and ACT coming on hopefully soon, we’re expecting two Assistant Directors to start very soon. And they will have a few more resources than the national team has, so they will have a Director, Behaviour Support, at least two Assistant Directors, Behaviour Support, and then a small team of clinicians, about four or five. So they will be probably your people to ask these sort of locally-based questions, certainly in the first instance.

Paul Miller: It’s 2:30, we’ll make this the last question.

Audience: Just one more. Drop-in support, into a person’s own home where we don’t do medication, and we notice that medication hasn’t been taken. Reportable or not reportable?

Tracey Harkness: Well, again it depends on the effect on the person.

Audience: It depends what it is?

Tracey Harkness: It depends on the effect on the person, and I guess in the first instance I would follow my own organisation’s incident management strategy and what I would normally do when there’s a missed medication.

Audience: Yep, incident report.

Paul Miller: Okay, well, look, thanks very much for that. Hopefully that session’s given you a bit more idea of what the requirements are likely to be. As Tracey said you can contact us if you’ve got any further questions. In the longer run it will be your people on the ground, behaviour support questions. We’ll have about a 15 minute break if we could, and get back together about 2:45 for our New South Wales session. Thanks very much.

[End of recorded material at 01:26:30]

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