February 11, 2025 • 36 mins
A restrictive Intervention is any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability.
The Research Report Restrictive Practices: A Pathway to Elimination, which is available on the Disability Royal Commission website states: "Restrictive practices are at odds with the human rights of people with disability and represent a significant form of violence and coercion".
What are the obligations of NDIS providers and practitioners and the path to elimination?
Our guest is Maddy Bilal, who is a Behaviour Support Practitioner/Senior Clinician at ermha365.
ermha365 provides client-centred, evidence-based specialist behaviour support for people who experience a range of complex and high-risk presentations as a result of their disability and/or mental health condition.
INFO:
Regulated Restrictive Practices Guide (NDIS Commission)
Behaviour Support and Restrictive Practices
Recognising Restrictive Practices: Guide (National Disability Service)
ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.
Helplines (Australia):
Lifeline 13 11 14
QLIFE 1800 184 527
13 YARN 13 92 76
Suicide Callback Service 1300 659 467
ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.
We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Get Real is recorded on the unceded lands of the Boon
, Wurrung and Wurundjeri peoplesof the Kulin Nation.
We acknowledge and pay ourrespects to their elders, past
and present.
We also acknowledge that theFirst Peoples of Australia are
the first storytellers, thefirst artists and the first
creators of culture and wecelebrate their enduring
(00:21):
connections to country knowledgeand stories.
Celebrate their enduringconnections to country knowledge
and stories.
Speaker 2 (00:28):
Welcome to Get Real talking.
Mental health and disabilitybrought to you by the team at
Burma 365.
Speaker 1 (00:34):
Join our hosts, Emily Webb and Carenza Louis-Smith,
as we have frank and fearlessconversations with special
guests about all things mentalhealth and complexity with
special guests about all thingsmental health and complexity.
Speaker 3 (00:52):
We recognise people with lived experience of mental
ill health and disability, aswell as their families and
carers.
We recognise their strength,courage and unique perspective
as a vital contribution to thispodcast so we can learn, grow
and achieve better outcomestogether.
Speaker 4 (01:13):
Welcome to Get Real talking mental health and
disability.
I'm Emily Webb, erma 365 CEO.
Corenza-louis-smith is here,too, and we're going to talk
about restrictive practices.
Corenza-louis Smith is here,too, and we're going to talk
about restrictive practices,also known as restrictive
interventions, in the context ofthe mental health and
(01:33):
disability services sector andthe pathway to reduce and
ultimately eliminate their use.
A restrictive intervention isany practice or intervention
that has the effect ofrestricting the rights or
freedom of movement of a personwith disability.
In Australia, we followlegislation that promotes and
protects the rights of peoplewith a disability, the
(01:54):
overarching being the Conventionof the Right of People with
Disabilities.
The National DisabilityInsurance Scheme Act 2013
outlines how NDIS providers likeOMER 365 and behaviour support
practitioners meet theirobligations under this Act.
Before we introduce our guest,carenza, this is not my area of
(02:17):
expertise, so can you explainwhy we're talking about this
really important topic?
Because you suggested it and Ithink we're going to need a few
episodes to cover all the issues.
Speaker 5 (02:28):
Oh, my word, that is such a huge question.
Emily, it's great to be back onthe podcast and I think talking
about specialist behavioursupport is really important, not
least in light of what'shappening at the moment in the
NDIS.
Specialist behaviour support isreally here to help guide
disability support workers.
If we talk about the disabilitysetting to understand a person's
(02:49):
challenging behaviours and howto support them to live I guess
you know their best lives.
It's a really critical rolethat is played by practitioners
and in fact, you know, emily,that when we talk about
practitioners, when we thinkabout behaviour support
practitioners and occupationaltherapists, they are two of the
five hardest jobs to recruit forright now in Australia, which
(03:09):
is terrible when you think abouthow do disability services
support people with complex andchallenging behaviours when you
can't get the staff who can comein and actually prepare really
specialised and nuancedstrategies that disability
support workers can deliverquality services that help keep
participants safe and keepworkforce safe, keep the
(03:31):
community safe, but also giveparticipants the things that
they need to really thrive.
So I think this is a reallyinteresting conversation.
I'm really keen to, like yousaid, this could definitely be a
series, but to be talking aboutthis.
It's such a topical issue atthe moment.
It's something that we shouldbe really all across.
Speaker 4 (03:48):
Our guest is Maddy Bilal and we are very grateful
to have her here.
Maddy is a behaviour supportpractitioner, senior clinician
with Therma 365, and she is veryexpert in this area and Carenza
.
You suggested Maddy as beingthe guest for us, so welcome
Maddy.
Thanks so much for your time.
Speaker 6 (04:08):
What a passionate start.
Karenza and Emily.
I absolutely share hersentiments.
I would start with that I'vebeen working as a behaviour
support practitioner typicallysince 2021, but prior to working
specifically in this role, I'vehad extensive experience in
working in fields of disabilitycase management, youth and
family services, refugeesettlement and training.
(04:30):
Now, all these experience thatexpands over the course of 20
years has given me a very uniqueinsight towards the importance
of fostering inclusion andindependence in our communities.
Communities, specifically atIRMA 365,.
I am providing clinicalsupervision and ad hoc advices
to clinicians to ensure thedelivery of high quality of
positive behaviour supportacross the board, including all
(04:53):
the stakeholders that areworking with the participant.
I'm also overlookingparticipants with complex needs
myself.
In addition to that, my rolealso entails clinical review of
behaviour support plans, all thefunctional behaviour analysis
reports, support letters and anyother documentation to ensure
clinical excellence andcontinued improvement.
Speaker 4 (05:14):
There's always a lot of frameworks, isn't there?
I know, right, that's what Ithink.
When I see the stuff that we do, I'm like, wow, there are a lot
of frameworks to comply with.
And yeah, I am really, reallyinterested in hearing about this
topic because, as I shared, youknow, when we first met to talk
about this, I'm not adisability or mental health
(05:34):
practitioner.
I work in communications andadvocacy and, honestly, the
first thing that came to my mindwhen restrictive practices is
mentioned is, oh, actualphysical restraints.
And then, thinking more aboutit, you know, it's good, I think
, for everyone to get anunderstanding.
So, maddie, what are defined asrestrictive practices?
(05:55):
Because I think it's importantto define these.
As I said before, I had a verylimited view of it.
I've not had experiencepersonally of having a family
member or loved one who has hadrestrictive practices done to
them or done to myself.
So what are we talking about?
Speaker 6 (06:14):
Very good point that you've raised, emily.
I think this is a very commontheme of understanding of
restrictive practices in thesector, especially when we're
going out to a participant'sfamily or meeting their care
teams.
We have to like redefine whatrestrictive practices actually
entail and I would say that,although there is a lot more
understanding around therestrictive practices which I
(06:35):
might be referring to as RPs Now, when I started working as a
PBS practitioner four years ago,I believe that there is a huge
shift in the understanding.
People are more aware of it.
I would say actually moretalking about it a bit more than
actual awareness.
In terms of the definition,ndis has given a very specific
(06:57):
definition that a restrictivepractices basically mean that
any practices or interventionsthat has the effect of
restricting the rights offreedom of movement of a person
with disability.
It is a very broad definition,but it is the true definition.
So restrictive practices aretypically categorized into two
broad categories at this stagein the sector.
(07:19):
So any restrictive practicesthat are regulated are called
regulated restrictive practices.
And then we have prohibitedrestrictive practices as well,
and that happened in December2019 because the Disability
Reform Council endorsedprohibiting certain practices.
I'm not going to go into detailof those but, just for the sake
(07:40):
of example, practices likepinning down, practices like
basket hold, takedown techniques, so any physical restraint that
has a purpose or effect ofrestraining or inhibiting a
person's respiratory ordigestive functioning all those
restrictive practices weredeemed as prohibited.
There is a long list.
(08:00):
There's a disclaimer here and Iwill definitely be leaving
links for Emily to share, butrestrictive practices like that
were prohibited in 2019.
And you'll be surprised, emily,that how many times we actually
go out there and we take a lookat the way people are being
handled and the responses to thebehavior those restrictive
practices are prohibited,illegal to use, and we go out
(08:23):
there and try to educate andgive some sort of capacity
building around that for theteams who are implementing it or
the family or carers.
The second part of therestrictive practices that we
say they are regulated are therestrictive practices that are
used in the sector.
There are five kinds ofrestrictive practices.
It's not just physicalrestraint, as a lot of people
(08:44):
assume.
There are five and if you want,I'm happy to give a brief
definition and example.
Yes, please, fantastic.
So I think the most common onethat we use in the sector which
is not deemed as a restrictivepractice by a lot of people is
seclusion.
Now this is a sole confinementof a person with disability in a
(09:05):
room or a physical space at anyhour of the day or night, where
voluntary exit is prevented ornot facilitated.
Now any example that you knowhow common it is to give people
time out as a response of theirbehavior.
When their access is actuallylimited, they can't go out of
the room or there's an illusionthat is created for them that
(09:28):
unless you calm down, you arenot going to be allowed to get
out of that room.
Now that is seclusion and it isa restrictive practice.
The second most common thing,that restrictive practice type
that we see, which is not deemeda restrictive practice, are the
prescribed medication.
Now those are called chemicalrestraint.
(09:51):
Now, use of medication or anychemical substance for the
primary purpose of influencing aperson's behavior is an actual
definition of a chemicalrestraint.
It comes as a lot of surprisewhen we tell parents or the
carers that the two milligrammelatonin that you're giving to
little Johnny is actually arestrictive practice.
Speaker 4 (10:08):
Wow, I'm sorry this is making my brain burst a bit
hearing this.
Speaker 6 (10:13):
Yes, so you need to have an identified diagnosis to
be able to administer melatoninas well, like sleeping disorder,
but a lot of time.
This medication and that's justan example this medication is
being given just to make surethat you are a little bit more
calm.
People take some rest as well,so that it is modifying their
behavior, so it is definitelydeemed as restrictive practice
(10:37):
in certain circumstances.
However, it is also importantto understand with chemical
restraint that there aremedications that are given for
different purposes.
If a medication is given as aresult or as a consequence of a
prescription to treat a disorder, then it is not deemed as a
chemical restraint.
But if the same medication isused to modify a behavior which
(11:01):
is not related to thatparticular diagnosis, it is a
chemical restraint.
And, as I said before, we willbe leaving some links for the
listeners.
The third kind of restraint thatwe talk about is a mechanical
restraint.
Now again, we haven't touchedthe physical restraint that you
spoke about, emily.
We haven't even gone there yet.
Now, mechanical restraints arealso quite interesting
(11:23):
restraints that we see in thissector.
Basically, it is defined as theuse of a device to prevent,
restrict or subdue a person'smovement for the primary purpose
of influencing a person'sbehavior, but that does not
include the use of devices fortherapeutic purposes, the use of
splints or gloves or helmets toprevent a person from
(11:46):
self-harming like headbanging orscratching themselves.
These are all actuallymechanical restraint, and this
is also sometimes when we go toa person's house and the parents
tell us are we be using thisglove from last 20 years?
And now you're telling us it'sa restraint and we go yes,
because have we tried strategiesfrom the last 20 years to
(12:06):
prevent him from using it.
Then the fourth kind ofrestraint, which is also very,
very interesting and I would sayprobably the most misunderstood
kind of restraint, is anenvironmental restraint.
Still not talking aboutphysical restraints here.
Now, the environmentalrestraints are the restrictive
practices defined as restraints.
(12:26):
That restricts a person's freeaccess to all parts of the
environment, not some, all partsof the environment, including
items or activities.
Speaker 4 (12:38):
Okay.
So we're talking aboutenvironment, as in everything
like a house, public access anditems Okay.
Speaker 6 (12:47):
Absolutely so.
If, for example, little Billyis showing a lot of behaviours
in a play centre and we say, youknow what, we're not going to
take Little Billy to a playcentre, that is an environmental
restraint.
Okay.
If Johnny is going to abscondin shopping centres, you know
what, we're going to takeshopping centres out of his
(13:08):
environment of access.
That is an environmentalrestraint, okay.
Speaker 5 (13:13):
Wow, I imagine, maddy , you know if you're a parent
and you're listening to thislike, these are the things like
if you're a parent of a childwith a disability like your, you
know your primary concern is Idon't want to take Johnny to the
shopping centre because whenthat happens, want to do what's
best for my child and keep themsafe and look after them.
So it's a really hard thing,isn't it, I think, for families
(13:45):
at times to navigate andunderstand and think about.
Speaker 6 (13:49):
Absolutely, and this is why the behaviour support
practitioner will go out thereand try to give them, like, some
sort of modifications.
Let's keep the access to allthe environments, whether it is
certain power area within theirenvironment, even like access
control to the kitchen, that isalso an environmental restraint.
So, talking to them about howcan we enrich the environment
(14:11):
and how can we address thefunctions or the factors that
are causing the behavior, ratherthan restricting their access
to certain places.
And then, last but not theleast, the most used concept of
restrictive practice thephysical restraint.
Now, physical restraint orrestrictive practice is the use
or action of physical force toprevent, restrict or subdue
(14:34):
movement of a person's body orpart of their body for the
primary purpose of influencingtheir behavior.
Again, it is very important tonote that physical restraint
does not include the use ofhands-on-hand technique, so a
lot of these techniques are usedby OTs or physiotherapists,
anything like that.
This is not a restrictivepractice.
(14:56):
It's basically could be holdinga person's hand down to prevent
them from hitting themselves orgrabbing someone, so that you
know if they're moving towardsongoing traffic and you're
grabbing their arm to pull themtowards you or keep them in a
safe way.
That's a restrictive practice,so this is like the perception,
(15:16):
but the reality is that thereare way more than one kind of
restrictive practices out there.
Speaker 5 (15:22):
Maddy, I think that's such an interesting thing,
isn't it?
Because I want to quote theresearch report Restrictive
Practices a Pathway toElimination, which is available
on the Disability RoyalCommission's website Now.
The authors state thatrestrictive practices are at
odds with the human rights ofpeople with a disability and
represent a significant form ofviolence and coercion.
And yet, listening to thethings that you're talking about
(15:44):
, I would imagine there would bea bunch of listeners listening
here that would actually notagree with that.
I think this is a reallyinteresting part of the
conversation I'd love to havetoday.
Can you talk a bit more in thecontext of the obligation, in
particular about NDIS providersnow and practitioners and the
path to actually having theleast possible amount of
(16:05):
restrictive practices to supporta person, because the
Disability Royal Commission hasheard so many instances whether
it's statements and submissionsabout the use of restrictive
practices on people with adisability that are just way too
many, not appropriate, used tocontrol, you know.
So there's this big dilemma.
I kind of sort of see thesescales, you know, in my hand.
(16:27):
On one hand, you know, here'sthe human rights and dignity of
people, and then, on the otherhand, here's the restrictive
practices part of this debate.
How do you strike this balanceand get this right so that you
have the least restrictivepractices possible?
Because obviously you don'twant you know, karenza to step
into the traffic and be hit by acar.
Right, you're not going tostand back and say, oh sorry,
(16:47):
karenza, I'm going to let youchoose to do that.
It's the balancing of thesethings, and how do NDIS
providers, registered andunregistered, I guess, really
understand this and balance thatto get that balance right?
Speaker 6 (17:01):
That's an extremely important question that you've
asked, karenza, because this isa question that is out there in
the sector, especially when wego out there and we are telling
the parents and the carers andthe whole team that what you're
doing is a restrictive practice,whether it's a prohibited
restrictive practice or it's arestrictive practice that needs
the regulation.
My answer to this is we need toget the sector more educated
(17:26):
and trained around that.
Restrictive practices areregulated because we need to
protect the rights of people.
Restrictive practices areregulated also because we
understand that in the sector,there are times that we will
need those restrictive practicesto keep the person with the
disability safe and keep thecommunity safe.
(17:48):
So, yes, understanding this isreally really important.
I think I can commend NDISaround the fact that there are
some very regulated and verywell-documented guidelines that
are being given.
For example, there are somevery key legislative guidelines
that need to be followed byeveryone who is involved in all
(18:10):
the aspects of implementingrestrictive practices, right
from the one who are using therestrictive practice on the
people with disability, thepeople who need to report the
restrictive practices to thecommission and the people who
are there to fade out thoserestrictive practices, and we
don't have enough time to goaround all of that but just for
the sake of the work that we doat Irma we have got excellent
(18:33):
support workers working with alot of clients with complex
needs and we've got PBS, and PBSare here in positive behavior
support PBS clinicians workingon ground with those support
workers to guide the use ofrestrictive practices as well.
Now there are certain reportingobligations and authorization
requirements by the NDIS, whichmeans that all registered NDIS
(18:56):
providers and NDIS PBSpractitioners need to be aware
of the reporting obligations.
They need to follow their ownstate and territory
authorization, consent andreporting requirements which are
consistent with relevantlegislation.
And here we are following theVictorian guidelines.
So a lot of times we haveprobably heard the portal called
(19:20):
PRODA.
That's where any behavioursupport plan with the
restrictive practices, whetherit's implemented by registered
or unregistered service provideror by family all those plans
need to be uploaded.
If the restrictive practicesare implemented by a registered
service provider, they need toget the authorization letter to
(19:42):
get those restrictive practicesimplemented by their staff.
And I'm making it sound very,very simple.
It's not that simple.
There is a lot of paperworkthat goes into it.
All the behavior supportpractitioners need to report a
restrictive practice within 30days of engagement when they
identify a restrictive practice,and they need to develop an
interim behavior support plan.
(20:02):
And then there is another part,another layer to it, which is
like within six months we needto develop a functional behavior
analysis to identify thefunctions of the behavior and
then say what kind ofrestrictive practices do we
recommend or we can endorse asPBS practitioner, what kind of
restrictive practices do werecommend or we can endorse as
PBS practitioner?
And then the cycle of gettingthose approved and getting those
reported begins again.
(20:23):
Look, I must say that we stillhave a long way to go, like we
still have a long way to go tounderstand and eliminate and
probably to fade out all therestrictive practices, but we're
getting there.
Personally, I do like the ideaof reporting and continuous
monitoring of the userrestrictive practices and that's
(20:43):
what we are implementing in thesector and I can say for sure
that at Irma we are doing it.
Speaker 5 (20:49):
So I'm going to be a bit controversial.
I think there are situationsand circumstances that people
find themselves in where arestrictive practice is crucial,
and it might be that they'redoing things that put their life
at risk, for example, and sothose restrictive practices are
in place.
It might be someone who has abehavior where they set fire to
their home or burn things down.
You know so you have thosepractices.
(21:11):
So there's a place forrestrictive practices.
I don't know if there's anargument about that.
Do you think that there are?
And again I'm being slightlycontroversial do you think that
restrictive practices over timecan decrease, or does it depend
on the person, or is it part ofa bigger picture, in a way that
you look at things?
Speaker 6 (21:28):
Absolutely.
Again, a very good question,karenza, and I would say it's
not as controversial as we thinkit is.
It is like literally givingpeople their right of choice and
right of movement back, andthat's what we call, in
technical term, a fade-out plan.
So every behavior support planwith a restrictive practice
should come with a fade-out planthat very clearly defines the
(21:50):
time duration and all theaspects that goes into
implementation, including therationale, timeframe and bits
and bobs that go intoidentifying what the restrictive
practice is.
What other strategies can beused prior to implementing.
A restrictive practice is whatcould be a capacity building or
skill building that could gotowards the team, towards the
(22:11):
staff, towards a person with adisability, to eventually reduce
and, if safe sorry, it's veryimportant to note in regards to
your question if it is safe toremove a restrictive practice,
then yes, we will remove it.
I also like to make a veryclear point here that, being a
PBS practitioner, we always aimto reduce and eliminate.
(22:33):
We come from a belief thatrestrictive practices can be
avoided, if I must say it, butobviously this is not the
reality of sector.
Just to remind you here thatprohibited restrictive practices
were identified in 2019.
So we are pretty fresh inidentifying the restrictive
practices as prohibited andillegal to now, moving towards
(22:58):
reducing and eliminating, so weare pretty new to it.
Speaker 5 (23:01):
I would say and Maddy , that seems so recent, like
2019.
I mean, like seriously, I justkind of put my hands in my head
and just go.
Are you kidding me?
It's taken us that long to saywhat we're actually going to say
is prohibited.
Speaker 6 (23:16):
Absolutely, Absolutely.
It is mind baffling, I must say.
But it's also the moreawareness we're getting out in
the sector, the more we aregetting educated ourselves and
the more we're getting trainedaround, that I think the
awareness is definitelyincreasing, but we have a long
way to go.
Speaker 4 (23:35):
When I hear the reference to registered NDIS
providers have this rigorousreporting schedule around the
use, it actually makes me reallyconcerned about unregistered
providers and the big questionabout how do you monitor and
(23:59):
know what everyone's doing.
You know, at the time ofrecording yesterday, I watched
the National Press Club addressand Bill Shorten was doing it
and he had some really starkpoints about the NDIS in terms
of some of the failings that hadhappened with the previous
government.
This isn't a politicalstatement, this is just what he
(24:24):
said.
But you know, the fact is thatall the criticism that the NDIS
comes in for now the generalpublic, like it's a rort, it's a
money, you know, grabbingexercise, and the fact that he
quoted that 90% of NDISproviders are unregistered, like
I didn't even understand, likehow that could be possible.
So I guess my question isthere's obviously a lot of scope
(24:46):
for still the misuse of this,and Corenza is going to cover
this a bit more in her question,but I just wondered your
thoughts about that.
Sure.
Speaker 6 (24:56):
Emily, I think you've asked a very, very important
and relevant question.
I have a very and I must sayit's not as controversial as it
could be, but I believe that, aswe were talking about
involvement of the whole sector,you know NDIS in itself is
pretty new as opposed to theprevious form of disability
(25:16):
insurance.
We have to understand thatthere are people with
disabilities who have beenworking with unregistered
providers for a very, very longtime and there's a lot of trust
and work that families have putin to find those people who are
kind of like in a very greatkind of trustworthy connection
with people of disabilities.
Personally, I would like allthe disability service providers
(25:39):
to be registered and there is areason, there is a very solid
reason behind that.
I would believe that theregistration process lot of
disability service providers whoare independent and working
(26:02):
privately or working with aservice who has been in the
sector from the good odd 20years but is just not educated
or not well aware or, to befrank with you, are not
advocating for use of anyrestrictive practice whatsoever,
so they are refusing to getregistered.
So there's so many layers to it, it's not as simple.
(26:23):
So I would believe that NDISneeds to, just like in any other
way.
They need to sit down with thepeople who are actually
providing those services andunderstanding their viewpoint
and then including them in thedecision-making so that we can
address this very importantissue in the sector.
Take a look at the stats.
(26:44):
If it is actually 90% of thedisability service workers out
there who are unregistered, weare talking about a very big
workforce.
Here we are talking aboutexceptional workers who have got
exceptional bond with theirpeople with disabilities.
We have to listen to theirvoice, invite them on the table
(27:04):
of discussion and then make apolicy.
I was talking to a disabilityservice provider and I was
capacity building them aroundthat how they need to get
registered to be able to workwith this particular family, and
they said that they have putthe application out from the
last nine months without anyonegetting back to them.
We are talking about ninemonths that person with a
(27:25):
disability without any supportfrom a person that that person
with disability can trust.
They're working with registeredproviders, great providers, but
not the people that they cantrust.
So I would like us to thinkabout how it is impacting the
quality of life of that personwith disability.
Speaker 4 (27:45):
Corinne.
So when we talk aboutregistered NDIS providers and
unregistered, what does thatmean?
Because I guess if you're notworking in the space or you're
using the service, to me itsounds like, oh well, it's not
as good.
That's just thinking generally.
So what is the actual, themeaning?
Speaker 5 (28:03):
of it.
Well, it's really interesting.
Em I think you know I mean Emis a registered provider and as
I can certainly talk about ourexperience as a registered
provider, so we have to beaccredited, we have to be
audited.
We have auditors that come inand will spend up to a week.
They will talk to the peoplethat we support.
They will look at our systems,our policies, how well we
quality and safeguard people.
(28:24):
We have to report, as Maddy hassaid, all restrictive practices,
including any unauthorisedrestrictive practices that might
occur, and be accountable forthose.
And I think that certainlythere are a lot of, you know,
emphasis and onus on that withregistered providers, but also
we're a larger organisation.
So we have some of theresources that support that.
And I think Maddy's touched ona really important point how
(28:46):
does the scheme create a betterservice, I think broadly, for
people with disabilities?
And you know I think themonitoring around restrictive
practices is such an importantissue.
It should occur whether you'reregistered or unregistered,
which kind of leads me to mynext question.
So obviously, behaviour supportand specialist behaviour
(29:09):
support, which is what we do atIrma, is a significant part of
our work and we've certainlyheard from the Disability Royal
Commission and the RoyalCommission into Victoria's
mental health as well thatsystemic restrictive practices
have been misused, abused andused as punitive measures in
many areas of society and manyand you know.
The fact that, maddy, you'resaying that there was only a
(29:30):
list of bad restrictivepractices, things that you can't
do anymore that list only cameinto effect in 2019 just still
blows my mind.
How can we ensure that trainingand support for workers
registered unregistered if we'retalking specifically about the
NDIS protects the human rightsof people with a disability who
(29:52):
display complex, at timeschallenging behaviours?
You know families as well.
You know how can we build and Ithink you're right build that
narrative, build thatunderstanding and build the
awareness.
I think, emily, just listening,you're as a lay person, you're
going.
Wow, I would never haveconsidered some of those things
of restrictive practice If I waskeeping my child safe by not
going to the shopping centre.
I would do that.
(30:13):
So how do we start to have somemore of that dialogue?
Speaker 6 (30:18):
I would say whenever someone asks this question, my
brain just goes into two things.
One is more of a emotional sideof the brain and the other one
is more rational.
The emotional side of the brainwill say we need to have
cultural change, we need to havethese conversations, we need to
challenge the status quo, weneed to prioritise the dignity,
(30:39):
autonomy and respect of theperson with a disability.
That's the foremost thing.
And this can involvechallenging the norms, practices
that we think are going to keepus safe, but are they really
keeping us safe or they'reactually inhibiting the rights
of the person with a disability?
Once the culture change ishappening within the
(31:02):
organization, or you know thesector in a broader way, then
the organization need to embracea philosophy which is a bit
more person-centered and support, and we do it perfectly at Irma
Like.
We're constantly having thoseconversations, we're constantly
getting challenged within ourpolicies and procedures and we
constantly keep them updated.
(31:22):
Our staff is currently goingthrough trainings as well.
Our previous practitioners doreceive some regular clinical
supervision to make sure that weare completely working within
this framework of changing theculture.
The second thing I think thatis very important, it is
training and education.
I think comprehensive trainingfor the staff, comprehensive
(31:45):
training aimed towards thesupport staff in training them
in alternative approaches,rather than restrictive
practices, to manage challengingbehaviours.
It is very, very vital that wego through the pathway of
training Now that can includethe response strategies and that
can also include thepreventative strategies.
(32:05):
That needs to be trained inorder to prevent a behaviour of
concern from happening, becauseall restrictive practices are
typically just to address abehaviour of concern.
So I think these two things arereally, really critical to be
implemented.
Speaker 4 (32:23):
You know this conversation is really opening
my mind and thoughts to the factthat we are talking about
restrictive practices in thecontext of the NDIS and
disability support.
But you know I'm reflectingback as a parent.
My children don't access theNDIS.
(32:44):
They both have ADHD, though,which was diagnosed later.
But you know, just thinkingabout everyday life, there's a
lot of stuff we do that arerestrictive practices.
So I think this is really goingto make people think.
Speaker 6 (32:57):
I would say behaviour support practice is definitely
not everyone's gig.
You have to have your heart init.
You have to believe in therights of people, you have to
believe that behaviours have gotreasons.
There are functions of thebehaviours.
Every behaviour iscommunicating something.
(33:18):
I would say that you know 20years of my career.
This is the most rewarding jobthat I'm in at the moment.
Once you understand that everybehavior serves a purpose and
you are there for the rightreason and you are there not
just to give response strategiesor the behavior support plans
to the teams.
You're there to make adifference and you're there to
enhance the quality of thatperson's life.
(33:40):
I would, however, say that forthe new workforce that is
planning to become a behavioursupport practitioner, do your
research.
Make sure that you are actuallyjoining a company where there
is excellent clinicalsupervision available, where
there is support available.
Yes, we are definitely the one,but I would definitely
(34:02):
encourage the people to considerthese as a great rewarding
addition to their work.
Speaker 4 (34:07):
This is specialist work, working with people with
complex mental health anddisability.
It's not for everyone right,and the people who do it the
people I've seen at Irma who doit are really passionate and
they're very skilled and theyknow the people they're working
with and that makes the peoplethey're working with feel safe.
(34:28):
And the little wins like theprogress is, you know, to many
people we think, well, that'snot much, it's huge.
It's like a reduce in theamount of incidents reported to
RiskMan.
It means that someone isn'tgoing to hurt themselves.
They've found a way to expressthemselves.
And this has been such a greatconversation and there's going
(34:50):
to be more to talk about,because I think we've just
scratched the surface.
And, maddy and Corenza, it's areal privilege to hear you both
talking about this and to havethis podcast be available for
people to listen to.
So, maddy, have we got anyfinal thoughts before we wrap up
and we will be speaking to youagain.
Speaker 6 (35:10):
Absolutely, Emily.
I think the conversation isongoing.
The conversation is not goingto stop.
We will keep advocating for therights of the people with
disabilities.
That primary goal of behavioursupport is to improve the for
the rights of the people withdisabilities.
That primary goal of behavioursupport is to improve the
quality of life of the personwith disabilities.
Reduction of the behaviours ofconcern is always a secondary
goal.
Speaker 4 (35:30):
Thank you so much, maddy and Karenza, and we're
going to put in some informationin the show notes.
So, listeners, if you want tohear more and I'll certainly be
deep diving more There'll belinks to some of the information
referenced in this episode, aswell as other resources that
Maddie will provide.
And please do share thisepisode because it's really
important.
(35:50):
There's the advocacy part andalso it's really interesting
information.
So, thank you for listening andplease share this episode with
your friends and family,co-workers, and also rate and
review, because it actuallyhelps more people find us.
So, thanks, corenza, thanksMaddie.
Speaker 2 (36:09):
You've been listening to Get Real talking mental
health and disability, broughtto you by the team at Irma365.
Get Real is produced andpresented by Emily Webb, with
Corenza Louis-Smith and specialguests.
Thanks for listening and we'llsee you next time.
Get Real is recorded on the unceded lands of the Boon
, Wurrung and Wurundjeri peoplesof the Kulin Nation.
We acknowledge and pay ourrespects to their elders, past
and present.
We also acknowledge that theFirst Peoples of Australia are
the first storytellers, thefirst artists and the first
creators of culture and wecelebrate their enduring
(00:21):
connections to country knowledgeand stories.
Celebrate their enduringconnections to country knowledge
and stories.
Speaker 2 (00:28):
Welcome to Get Real talking.
Mental health and disabilitybrought to you by the team at
Burma 365.
Speaker 1 (00:34):
Join our hosts, Emily Webb and Carenza Louis-Smith,
as we have frank and fearlessconversations with special
guests about all things mentalhealth and complexity with
special guests about all thingsmental health and complexity.
Speaker 3 (00:52):
We recognise people with lived experience of mental
ill health and disability, aswell as their families and
carers.
We recognise their strength,courage and unique perspective
as a vital contribution to thispodcast so we can learn, grow
and achieve better outcomestogether.
Speaker 4 (01:13):
Welcome to Get Real talking mental health and
disability.
I'm Emily Webb, erma 365 CEO.
Corenza-louis-smith is here,too, and we're going to talk
about restrictive practices.
Corenza-louis Smith is here,too, and we're going to talk
about restrictive practices,also known as restrictive
interventions, in the context ofthe mental health and
(01:33):
disability services sector andthe pathway to reduce and
ultimately eliminate their use.
A restrictive intervention isany practice or intervention
that has the effect ofrestricting the rights or
freedom of movement of a personwith disability.
In Australia, we followlegislation that promotes and
protects the rights of peoplewith a disability, the
(01:54):
overarching being the Conventionof the Right of People with
Disabilities.
The National DisabilityInsurance Scheme Act 2013
outlines how NDIS providers likeOMER 365 and behaviour support
practitioners meet theirobligations under this Act.
Before we introduce our guest,carenza, this is not my area of
(02:17):
expertise, so can you explainwhy we're talking about this
really important topic?
Because you suggested it and Ithink we're going to need a few
episodes to cover all the issues.
Speaker 5 (02:28):
Oh, my word, that is such a huge question.
Emily, it's great to be back onthe podcast and I think talking
about specialist behavioursupport is really important, not
least in light of what'shappening at the moment in the
NDIS.
Specialist behaviour support isreally here to help guide
disability support workers.
If we talk about the disabilitysetting to understand a person's
(02:49):
challenging behaviours and howto support them to live I guess
you know their best lives.
It's a really critical rolethat is played by practitioners
and in fact, you know, emily,that when we talk about
practitioners, when we thinkabout behaviour support
practitioners and occupationaltherapists, they are two of the
five hardest jobs to recruit forright now in Australia, which
(03:09):
is terrible when you think abouthow do disability services
support people with complex andchallenging behaviours when you
can't get the staff who can comein and actually prepare really
specialised and nuancedstrategies that disability
support workers can deliverquality services that help keep
participants safe and keepworkforce safe, keep the
(03:31):
community safe, but also giveparticipants the things that
they need to really thrive.
So I think this is a reallyinteresting conversation.
I'm really keen to, like yousaid, this could definitely be a
series, but to be talking aboutthis.
It's such a topical issue atthe moment.
It's something that we shouldbe really all across.
Speaker 4 (03:48):
Our guest is Maddy Bilal and we are very grateful
to have her here.
Maddy is a behaviour supportpractitioner, senior clinician
with Therma 365, and she is veryexpert in this area and Carenza
.
You suggested Maddy as beingthe guest for us, so welcome
Maddy.
Thanks so much for your time.
Speaker 6 (04:08):
What a passionate start.
Karenza and Emily.
I absolutely share hersentiments.
I would start with that I'vebeen working as a behaviour
support practitioner typicallysince 2021, but prior to working
specifically in this role, I'vehad extensive experience in
working in fields of disabilitycase management, youth and
family services, refugeesettlement and training.
(04:30):
Now, all these experience thatexpands over the course of 20
years has given me a very uniqueinsight towards the importance
of fostering inclusion andindependence in our communities.
Communities, specifically atIRMA 365,.
I am providing clinicalsupervision and ad hoc advices
to clinicians to ensure thedelivery of high quality of
positive behaviour supportacross the board, including all
(04:53):
the stakeholders that areworking with the participant.
I'm also overlookingparticipants with complex needs
myself.
In addition to that, my rolealso entails clinical review of
behaviour support plans, all thefunctional behaviour analysis
reports, support letters and anyother documentation to ensure
clinical excellence andcontinued improvement.
Speaker 4 (05:14):
There's always a lot of frameworks, isn't there?
I know, right, that's what Ithink.
When I see the stuff that we do, I'm like, wow, there are a lot
of frameworks to comply with.
And yeah, I am really, reallyinterested in hearing about this
topic because, as I shared, youknow, when we first met to talk
about this, I'm not adisability or mental health
(05:34):
practitioner.
I work in communications andadvocacy and, honestly, the
first thing that came to my mindwhen restrictive practices is
mentioned is, oh, actualphysical restraints.
And then, thinking more aboutit, you know, it's good, I think
, for everyone to get anunderstanding.
So, maddie, what are defined asrestrictive practices?
(05:55):
Because I think it's importantto define these.
As I said before, I had a verylimited view of it.
I've not had experiencepersonally of having a family
member or loved one who has hadrestrictive practices done to
them or done to myself.
So what are we talking about?
Speaker 6 (06:14):
Very good point that you've raised, emily.
I think this is a very commontheme of understanding of
restrictive practices in thesector, especially when we're
going out to a participant'sfamily or meeting their care
teams.
We have to like redefine whatrestrictive practices actually
entail and I would say that,although there is a lot more
understanding around therestrictive practices which I
(06:35):
might be referring to as RPs Now, when I started working as a
PBS practitioner four years ago,I believe that there is a huge
shift in the understanding.
People are more aware of it.
I would say actually moretalking about it a bit more than
actual awareness.
In terms of the definition,ndis has given a very specific
(06:57):
definition that a restrictivepractices basically mean that
any practices or interventionsthat has the effect of
restricting the rights offreedom of movement of a person
with disability.
It is a very broad definition,but it is the true definition.
So restrictive practices aretypically categorized into two
broad categories at this stagein the sector.
(07:19):
So any restrictive practicesthat are regulated are called
regulated restrictive practices.
And then we have prohibitedrestrictive practices as well,
and that happened in December2019 because the Disability
Reform Council endorsedprohibiting certain practices.
I'm not going to go into detailof those but, just for the sake
(07:40):
of example, practices likepinning down, practices like
basket hold, takedown techniques, so any physical restraint that
has a purpose or effect ofrestraining or inhibiting a
person's respiratory ordigestive functioning all those
restrictive practices weredeemed as prohibited.
There is a long list.
(08:00):
There's a disclaimer here and Iwill definitely be leaving
links for Emily to share, butrestrictive practices like that
were prohibited in 2019.
And you'll be surprised, emily,that how many times we actually
go out there and we take a lookat the way people are being
handled and the responses to thebehavior those restrictive
practices are prohibited,illegal to use, and we go out
(08:23):
there and try to educate andgive some sort of capacity
building around that for theteams who are implementing it or
the family or carers.
The second part of therestrictive practices that we
say they are regulated are therestrictive practices that are
used in the sector.
There are five kinds ofrestrictive practices.
It's not just physicalrestraint, as a lot of people
(08:44):
assume.
There are five and if you want,I'm happy to give a brief
definition and example.
Yes, please, fantastic.
So I think the most common onethat we use in the sector which
is not deemed as a restrictivepractice by a lot of people is
seclusion.
Now this is a sole confinementof a person with disability in a
(09:05):
room or a physical space at anyhour of the day or night, where
voluntary exit is prevented ornot facilitated.
Now any example that you knowhow common it is to give people
time out as a response of theirbehavior.
When their access is actuallylimited, they can't go out of
the room or there's an illusionthat is created for them that
(09:28):
unless you calm down, you arenot going to be allowed to get
out of that room.
Now that is seclusion and it isa restrictive practice.
The second most common thing,that restrictive practice type
that we see, which is not deemeda restrictive practice, are the
prescribed medication.
Now those are called chemicalrestraint.
(09:51):
Now, use of medication or anychemical substance for the
primary purpose of influencing aperson's behavior is an actual
definition of a chemicalrestraint.
It comes as a lot of surprisewhen we tell parents or the
carers that the two milligrammelatonin that you're giving to
little Johnny is actually arestrictive practice.
Speaker 4 (10:08):
Wow, I'm sorry this is making my brain burst a bit
hearing this.
Speaker 6 (10:13):
Yes, so you need to have an identified diagnosis to
be able to administer melatoninas well, like sleeping disorder,
but a lot of time.
This medication and that's justan example this medication is
being given just to make surethat you are a little bit more
calm.
People take some rest as well,so that it is modifying their
behavior, so it is definitelydeemed as restrictive practice
(10:37):
in certain circumstances.
However, it is also importantto understand with chemical
restraint that there aremedications that are given for
different purposes.
If a medication is given as aresult or as a consequence of a
prescription to treat a disorder, then it is not deemed as a
chemical restraint.
But if the same medication isused to modify a behavior which
(11:01):
is not related to thatparticular diagnosis, it is a
chemical restraint.
And, as I said before, we willbe leaving some links for the
listeners.
The third kind of restraint thatwe talk about is a mechanical
restraint.
Now again, we haven't touchedthe physical restraint that you
spoke about, emily.
We haven't even gone there yet.
Now, mechanical restraints arealso quite interesting
(11:23):
restraints that we see in thissector.
Basically, it is defined as theuse of a device to prevent,
restrict or subdue a person'smovement for the primary purpose
of influencing a person'sbehavior, but that does not
include the use of devices fortherapeutic purposes, the use of
splints or gloves or helmets toprevent a person from
(11:46):
self-harming like headbanging orscratching themselves.
These are all actuallymechanical restraint, and this
is also sometimes when we go toa person's house and the parents
tell us are we be using thisglove from last 20 years?
And now you're telling us it'sa restraint and we go yes,
because have we tried strategiesfrom the last 20 years to
(12:06):
prevent him from using it.
Then the fourth kind ofrestraint, which is also very,
very interesting and I would sayprobably the most misunderstood
kind of restraint, is anenvironmental restraint.
Still not talking aboutphysical restraints here.
Now, the environmentalrestraints are the restrictive
practices defined as restraints.
(12:26):
That restricts a person's freeaccess to all parts of the
environment, not some, all partsof the environment, including
items or activities.
Speaker 4 (12:38):
Okay.
So we're talking aboutenvironment, as in everything
like a house, public access anditems Okay.
Speaker 6 (12:47):
Absolutely so.
If, for example, little Billyis showing a lot of behaviours
in a play centre and we say, youknow what, we're not going to
take Little Billy to a playcentre, that is an environmental
restraint.
Okay.
If Johnny is going to abscondin shopping centres, you know
what, we're going to takeshopping centres out of his
(13:08):
environment of access.
That is an environmentalrestraint, okay.
Speaker 5 (13:13):
Wow, I imagine, maddy , you know if you're a parent
and you're listening to thislike, these are the things like
if you're a parent of a childwith a disability like your, you
know your primary concern is Idon't want to take Johnny to the
shopping centre because whenthat happens, want to do what's
best for my child and keep themsafe and look after them.
So it's a really hard thing,isn't it, I think, for families
(13:45):
at times to navigate andunderstand and think about.
Speaker 6 (13:49):
Absolutely, and this is why the behaviour support
practitioner will go out thereand try to give them, like, some
sort of modifications.
Let's keep the access to allthe environments, whether it is
certain power area within theirenvironment, even like access
control to the kitchen, that isalso an environmental restraint.
So, talking to them about howcan we enrich the environment
(14:11):
and how can we address thefunctions or the factors that
are causing the behavior, ratherthan restricting their access
to certain places.
And then, last but not theleast, the most used concept of
restrictive practice thephysical restraint.
Now, physical restraint orrestrictive practice is the use
or action of physical force toprevent, restrict or subdue
(14:34):
movement of a person's body orpart of their body for the
primary purpose of influencingtheir behavior.
Again, it is very important tonote that physical restraint
does not include the use ofhands-on-hand technique, so a
lot of these techniques are usedby OTs or physiotherapists,
anything like that.
This is not a restrictivepractice.
(14:56):
It's basically could be holdinga person's hand down to prevent
them from hitting themselves orgrabbing someone, so that you
know if they're moving towardsongoing traffic and you're
grabbing their arm to pull themtowards you or keep them in a
safe way.
That's a restrictive practice,so this is like the perception,
(15:16):
but the reality is that thereare way more than one kind of
restrictive practices out there.
Speaker 5 (15:22):
Maddy, I think that's such an interesting thing,
isn't it?
Because I want to quote theresearch report Restrictive
Practices a Pathway toElimination, which is available
on the Disability RoyalCommission's website Now.
The authors state thatrestrictive practices are at
odds with the human rights ofpeople with a disability and
represent a significant form ofviolence and coercion.
And yet, listening to thethings that you're talking about
(15:44):
, I would imagine there would bea bunch of listeners listening
here that would actually notagree with that.
I think this is a reallyinteresting part of the
conversation I'd love to havetoday.
Can you talk a bit more in thecontext of the obligation, in
particular about NDIS providersnow and practitioners and the
path to actually having theleast possible amount of
(16:05):
restrictive practices to supporta person, because the
Disability Royal Commission hasheard so many instances whether
it's statements and submissionsabout the use of restrictive
practices on people with adisability that are just way too
many, not appropriate, used tocontrol, you know.
So there's this big dilemma.
I kind of sort of see thesescales, you know, in my hand.
(16:27):
On one hand, you know, here'sthe human rights and dignity of
people, and then, on the otherhand, here's the restrictive
practices part of this debate.
How do you strike this balanceand get this right so that you
have the least restrictivepractices possible?
Because obviously you don'twant you know, karenza to step
into the traffic and be hit by acar.
Right, you're not going tostand back and say, oh sorry,
(16:47):
karenza, I'm going to let youchoose to do that.
It's the balancing of thesethings, and how do NDIS
providers, registered andunregistered, I guess, really
understand this and balance thatto get that balance right?
Speaker 6 (17:01):
That's an extremely important question that you've
asked, karenza, because this isa question that is out there in
the sector, especially when wego out there and we are telling
the parents and the carers andthe whole team that what you're
doing is a restrictive practice,whether it's a prohibited
restrictive practice or it's arestrictive practice that needs
the regulation.
My answer to this is we need toget the sector more educated
(17:26):
and trained around that.
Restrictive practices areregulated because we need to
protect the rights of people.
Restrictive practices areregulated also because we
understand that in the sector,there are times that we will
need those restrictive practicesto keep the person with the
disability safe and keep thecommunity safe.
(17:48):
So, yes, understanding this isreally really important.
I think I can commend NDISaround the fact that there are
some very regulated and verywell-documented guidelines that
are being given.
For example, there are somevery key legislative guidelines
that need to be followed byeveryone who is involved in all
(18:10):
the aspects of implementingrestrictive practices, right
from the one who are using therestrictive practice on the
people with disability, thepeople who need to report the
restrictive practices to thecommission and the people who
are there to fade out thoserestrictive practices, and we
don't have enough time to goaround all of that but just for
the sake of the work that we doat Irma we have got excellent
(18:33):
support workers working with alot of clients with complex
needs and we've got PBS, and PBSare here in positive behavior
support PBS clinicians workingon ground with those support
workers to guide the use ofrestrictive practices as well.
Now there are certain reportingobligations and authorization
requirements by the NDIS, whichmeans that all registered NDIS
(18:56):
providers and NDIS PBSpractitioners need to be aware
of the reporting obligations.
They need to follow their ownstate and territory
authorization, consent andreporting requirements which are
consistent with relevantlegislation.
And here we are following theVictorian guidelines.
So a lot of times we haveprobably heard the portal called
(19:20):
PRODA.
That's where any behavioursupport plan with the
restrictive practices, whetherit's implemented by registered
or unregistered service provideror by family all those plans
need to be uploaded.
If the restrictive practicesare implemented by a registered
service provider, they need toget the authorization letter to
(19:42):
get those restrictive practicesimplemented by their staff.
And I'm making it sound very,very simple.
It's not that simple.
There is a lot of paperworkthat goes into it.
All the behavior supportpractitioners need to report a
restrictive practice within 30days of engagement when they
identify a restrictive practice,and they need to develop an
interim behavior support plan.
(20:02):
And then there is another part,another layer to it, which is
like within six months we needto develop a functional behavior
analysis to identify thefunctions of the behavior and
then say what kind ofrestrictive practices do we
recommend or we can endorse asPBS practitioner, what kind of
restrictive practices do werecommend or we can endorse as
PBS practitioner?
And then the cycle of gettingthose approved and getting those
reported begins again.
(20:23):
Look, I must say that we stillhave a long way to go, like we
still have a long way to go tounderstand and eliminate and
probably to fade out all therestrictive practices, but we're
getting there.
Personally, I do like the ideaof reporting and continuous
monitoring of the userrestrictive practices and that's
(20:43):
what we are implementing in thesector and I can say for sure
that at Irma we are doing it.
Speaker 5 (20:49):
So I'm going to be a bit controversial.
I think there are situationsand circumstances that people
find themselves in where arestrictive practice is crucial,
and it might be that they'redoing things that put their life
at risk, for example, and sothose restrictive practices are
in place.
It might be someone who has abehavior where they set fire to
their home or burn things down.
You know so you have thosepractices.
(21:11):
So there's a place forrestrictive practices.
I don't know if there's anargument about that.
Do you think that there are?
And again I'm being slightlycontroversial do you think that
restrictive practices over timecan decrease, or does it depend
on the person, or is it part ofa bigger picture, in a way that
you look at things?
Speaker 6 (21:28):
Absolutely.
Again, a very good question,karenza, and I would say it's
not as controversial as we thinkit is.
It is like literally givingpeople their right of choice and
right of movement back, andthat's what we call, in
technical term, a fade-out plan.
So every behavior support planwith a restrictive practice
should come with a fade-out planthat very clearly defines the
(21:50):
time duration and all theaspects that goes into
implementation, including therationale, timeframe and bits
and bobs that go intoidentifying what the restrictive
practice is.
What other strategies can beused prior to implementing.
A restrictive practice is whatcould be a capacity building or
skill building that could gotowards the team, towards the
(22:11):
staff, towards a person with adisability, to eventually reduce
and, if safe sorry, it's veryimportant to note in regards to
your question if it is safe toremove a restrictive practice,
then yes, we will remove it.
I also like to make a veryclear point here that, being a
PBS practitioner, we always aimto reduce and eliminate.
(22:33):
We come from a belief thatrestrictive practices can be
avoided, if I must say it, butobviously this is not the
reality of sector.
Just to remind you here thatprohibited restrictive practices
were identified in 2019.
So we are pretty fresh inidentifying the restrictive
practices as prohibited andillegal to now, moving towards
(22:58):
reducing and eliminating, so weare pretty new to it.
Speaker 5 (23:01):
I would say and Maddy , that seems so recent, like
2019.
I mean, like seriously, I justkind of put my hands in my head
and just go.
Are you kidding me?
It's taken us that long to saywhat we're actually going to say
is prohibited.
Speaker 6 (23:16):
Absolutely, Absolutely.
It is mind baffling, I must say.
But it's also the moreawareness we're getting out in
the sector, the more we aregetting educated ourselves and
the more we're getting trainedaround, that I think the
awareness is definitelyincreasing, but we have a long
way to go.
Speaker 4 (23:35):
When I hear the reference to registered NDIS
providers have this rigorousreporting schedule around the
use, it actually makes me reallyconcerned about unregistered
providers and the big questionabout how do you monitor and
(23:59):
know what everyone's doing.
You know, at the time ofrecording yesterday, I watched
the National Press Club addressand Bill Shorten was doing it
and he had some really starkpoints about the NDIS in terms
of some of the failings that hadhappened with the previous
government.
This isn't a politicalstatement, this is just what he
(24:24):
said.
But you know, the fact is thatall the criticism that the NDIS
comes in for now the generalpublic, like it's a rort, it's a
money, you know, grabbingexercise, and the fact that he
quoted that 90% of NDISproviders are unregistered, like
I didn't even understand, likehow that could be possible.
So I guess my question isthere's obviously a lot of scope
(24:46):
for still the misuse of this,and Corenza is going to cover
this a bit more in her question,but I just wondered your
thoughts about that.
Sure.
Speaker 6 (24:56):
Emily, I think you've asked a very, very important
and relevant question.
I have a very and I must sayit's not as controversial as it
could be, but I believe that, aswe were talking about
involvement of the whole sector,you know NDIS in itself is
pretty new as opposed to theprevious form of disability
(25:16):
insurance.
We have to understand thatthere are people with
disabilities who have beenworking with unregistered
providers for a very, very longtime and there's a lot of trust
and work that families have putin to find those people who are
kind of like in a very greatkind of trustworthy connection
with people of disabilities.
Personally, I would like allthe disability service providers
(25:39):
to be registered and there is areason, there is a very solid
reason behind that.
I would believe that theregistration process lot of
disability service providers whoare independent and working
(26:02):
privately or working with aservice who has been in the
sector from the good odd 20years but is just not educated
or not well aware or, to befrank with you, are not
advocating for use of anyrestrictive practice whatsoever,
so they are refusing to getregistered.
So there's so many layers to it, it's not as simple.
(26:23):
So I would believe that NDISneeds to, just like in any other
way.
They need to sit down with thepeople who are actually
providing those services andunderstanding their viewpoint
and then including them in thedecision-making so that we can
address this very importantissue in the sector.
Take a look at the stats.
(26:44):
If it is actually 90% of thedisability service workers out
there who are unregistered, weare talking about a very big
workforce.
Here we are talking aboutexceptional workers who have got
exceptional bond with theirpeople with disabilities.
We have to listen to theirvoice, invite them on the table
(27:04):
of discussion and then make apolicy.
I was talking to a disabilityservice provider and I was
capacity building them aroundthat how they need to get
registered to be able to workwith this particular family, and
they said that they have putthe application out from the
last nine months without anyonegetting back to them.
We are talking about ninemonths that person with a
(27:25):
disability without any supportfrom a person that that person
with disability can trust.
They're working with registeredproviders, great providers, but
not the people that they cantrust.
So I would like us to thinkabout how it is impacting the
quality of life of that personwith disability.
Speaker 4 (27:45):
Corinne.
So when we talk aboutregistered NDIS providers and
unregistered, what does thatmean?
Because I guess if you're notworking in the space or you're
using the service, to me itsounds like, oh well, it's not
as good.
That's just thinking generally.
So what is the actual, themeaning?
Speaker 5 (28:03):
of it.
Well, it's really interesting.
Em I think you know I mean Emis a registered provider and as
I can certainly talk about ourexperience as a registered
provider, so we have to beaccredited, we have to be
audited.
We have auditors that come inand will spend up to a week.
They will talk to the peoplethat we support.
They will look at our systems,our policies, how well we
quality and safeguard people.
(28:24):
We have to report, as Maddy hassaid, all restrictive practices,
including any unauthorisedrestrictive practices that might
occur, and be accountable forthose.
And I think that certainlythere are a lot of, you know,
emphasis and onus on that withregistered providers, but also
we're a larger organisation.
So we have some of theresources that support that.
And I think Maddy's touched ona really important point how
(28:46):
does the scheme create a betterservice, I think broadly, for
people with disabilities?
And you know I think themonitoring around restrictive
practices is such an importantissue.
It should occur whether you'reregistered or unregistered,
which kind of leads me to mynext question.
So obviously, behaviour supportand specialist behaviour
(29:09):
support, which is what we do atIrma, is a significant part of
our work and we've certainlyheard from the Disability Royal
Commission and the RoyalCommission into Victoria's
mental health as well thatsystemic restrictive practices
have been misused, abused andused as punitive measures in
many areas of society and manyand you know.
The fact that, maddy, you'resaying that there was only a
(29:30):
list of bad restrictivepractices, things that you can't
do anymore that list only cameinto effect in 2019 just still
blows my mind.
How can we ensure that trainingand support for workers
registered unregistered if we'retalking specifically about the
NDIS protects the human rightsof people with a disability who
(29:52):
display complex, at timeschallenging behaviours?
You know families as well.
You know how can we build and Ithink you're right build that
narrative, build thatunderstanding and build the
awareness.
I think, emily, just listening,you're as a lay person, you're
going.
Wow, I would never haveconsidered some of those things
of restrictive practice If I waskeeping my child safe by not
going to the shopping centre.
I would do that.
(30:13):
So how do we start to have somemore of that dialogue?
Speaker 6 (30:18):
I would say whenever someone asks this question, my
brain just goes into two things.
One is more of a emotional sideof the brain and the other one
is more rational.
The emotional side of the brainwill say we need to have
cultural change, we need to havethese conversations, we need to
challenge the status quo, weneed to prioritise the dignity,
(30:39):
autonomy and respect of theperson with a disability.
That's the foremost thing.
And this can involvechallenging the norms, practices
that we think are going to keepus safe, but are they really
keeping us safe or they'reactually inhibiting the rights
of the person with a disability?
Once the culture change ishappening within the
(31:02):
organization, or you know thesector in a broader way, then
the organization need to embracea philosophy which is a bit
more person-centered and support, and we do it perfectly at Irma
Like.
We're constantly having thoseconversations, we're constantly
getting challenged within ourpolicies and procedures and we
constantly keep them updated.
(31:22):
Our staff is currently goingthrough trainings as well.
Our previous practitioners doreceive some regular clinical
supervision to make sure that weare completely working within
this framework of changing theculture.
The second thing I think thatis very important, it is
training and education.
I think comprehensive trainingfor the staff, comprehensive
(31:45):
training aimed towards thesupport staff in training them
in alternative approaches,rather than restrictive
practices, to manage challengingbehaviours.
It is very, very vital that wego through the pathway of
training Now that can includethe response strategies and that
can also include thepreventative strategies.
(32:05):
That needs to be trained inorder to prevent a behaviour of
concern from happening, becauseall restrictive practices are
typically just to address abehaviour of concern.
So I think these two things arereally, really critical to be
implemented.
Speaker 4 (32:23):
You know this conversation is really opening
my mind and thoughts to the factthat we are talking about
restrictive practices in thecontext of the NDIS and
disability support.
But you know I'm reflectingback as a parent.
My children don't access theNDIS.
(32:44):
They both have ADHD, though,which was diagnosed later.
But you know, just thinkingabout everyday life, there's a
lot of stuff we do that arerestrictive practices.
So I think this is really goingto make people think.
Speaker 6 (32:57):
I would say behaviour support practice is definitely
not everyone's gig.
You have to have your heart init.
You have to believe in therights of people, you have to
believe that behaviours have gotreasons.
There are functions of thebehaviours.
Every behaviour iscommunicating something.
(33:18):
I would say that you know 20years of my career.
This is the most rewarding jobthat I'm in at the moment.
Once you understand that everybehavior serves a purpose and
you are there for the rightreason and you are there not
just to give response strategiesor the behavior support plans
to the teams.
You're there to make adifference and you're there to
enhance the quality of thatperson's life.
(33:40):
I would, however, say that forthe new workforce that is
planning to become a behavioursupport practitioner, do your
research.
Make sure that you are actuallyjoining a company where there
is excellent clinicalsupervision available, where
there is support available.
Yes, we are definitely the one,but I would definitely
(34:02):
encourage the people to considerthese as a great rewarding
addition to their work.
Speaker 4 (34:07):
This is specialist work, working with people with
complex mental health anddisability.
It's not for everyone right,and the people who do it the
people I've seen at Irma who doit are really passionate and
they're very skilled and theyknow the people they're working
with and that makes the peoplethey're working with feel safe.
(34:28):
And the little wins like theprogress is, you know, to many
people we think, well, that'snot much, it's huge.
It's like a reduce in theamount of incidents reported to
RiskMan.
It means that someone isn'tgoing to hurt themselves.
They've found a way to expressthemselves.
And this has been such a greatconversation and there's going
(34:50):
to be more to talk about,because I think we've just
scratched the surface.
And, maddy and Corenza, it's areal privilege to hear you both
talking about this and to havethis podcast be available for
people to listen to.
So, maddy, have we got anyfinal thoughts before we wrap up
and we will be speaking to youagain.
Speaker 6 (35:10):
Absolutely, Emily.
I think the conversation isongoing.
The conversation is not goingto stop.
We will keep advocating for therights of the people with
disabilities.
That primary goal of behavioursupport is to improve the for
the rights of the people withdisabilities.
That primary goal of behavioursupport is to improve the
quality of life of the personwith disabilities.
Reduction of the behaviours ofconcern is always a secondary
goal.
Speaker 4 (35:30):
Thank you so much, maddy and Karenza, and we're
going to put in some informationin the show notes.
So, listeners, if you want tohear more and I'll certainly be
deep diving more There'll belinks to some of the information
referenced in this episode, aswell as other resources that
Maddie will provide.
And please do share thisepisode because it's really
important.
(35:50):
There's the advocacy part andalso it's really interesting
information.
So, thank you for listening andplease share this episode with
your friends and family,co-workers, and also rate and
review, because it actuallyhelps more people find us.
So, thanks, corenza, thanksMaddie.
Speaker 2 (36:09):
You've been listening to Get Real talking mental
health and disability, broughtto you by the team at Irma365.
Get Real is produced andpresented by Emily Webb, with
Corenza Louis-Smith and specialguests.
Thanks for listening and we'llsee you next time.
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