Restrictive practice (also referred to as restrictive intervention) is defined by the Victorian Disability Act 2006 as “any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability”.

The TAC has aligned with the five types of regulated restrictive practice used by the National Disability Insurance Scheme (NDIS) and adopted by the Disability Act, being:

• Seclusion - the sole confinement in a room or a physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted.
• Chemical restraint - the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition.
• Mechanical restraint - the use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour but does not include the use of devices for therapeutic or non-behavioural purposes.
• Physical restraint- the use or action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour. Physical restraint does not include the use of a hands-on technique in a reflexive way to guide or redirect a person away from potential harm/injury, consistent with what could reasonably be considered the exercise of care towards a person.
• Environmental restraint – the use of restraints which restrict a person’s free access to all parts of their environment, including items or activities.

Authorisation – a process for authorising the proper use of restrictive practice in accordance with the Disability Act.

Victorian Senior Practitioner (VSP) - responsible under the Disability Act for ensuring that the rights of persons who are subject to restrictive practices are protected and that appropriate standards are complied with. This includes working with all stakeholders in the sector to reduce restrictive practices where possible, and where restrictive practices are necessary, to ensure that the benefit continues to outweigh the potential harm. The functions of the VSP are specified in section 24 of the Disability Act.

Authorised Program Officer (APO) – a person appointed as an APO by the attendant care provider and whose appointment is approved by the VSP. The roles and responsibilities of the APO are defined on the VSP website.

Independent Person – someone who has a connection with the client and is able to explain to them the proposed use of the regulated restrictive practice in their behaviour support plan and their right to have a decision to use restrictive practice reviewed. An IP is someone independent of the attendant care provider; that is someone who has no connection to the provider and is not a paid support. Details of what an independent person must not be, are stipulated in Guidelines for authorising regulated restrictive practices in Victoria (Word).

Prohibited practice – forms of physical restraint and use of seclusion for a person under the age of 18 years as specified in the Restrictive practice prohibitions under section 27 (PDF). Under the Disability Act, engaging in prohibited restraint is a criminal offence.

For the purposes of this policy, the following definitions are used:

Attendant care provider – a TAC or WorkSafe Victoria (WSV) funded attendant care provider.

Behaviours of Concern – ‘any behaviour that is a barrier to a person participating in and contributing to their community (including both active and passive behaviours) that undermines, directly or indirectly, a person’s rights, dignity or quality of life, and poses a risk to the health and safety of a person and those with whom they live or work’¹. (McVilly, 2002)

Client – a TAC client or WSV injured worker with disability (as defined under the Disability Act).

Emergency – an imminent risk of the client causing serious physical harm to themselves or another person.

• The TAC is committed to the delivery of safe and high-quality services to get a client's life back on track after a transport accident.
• We actively promote the rights and safety of our clients through a zero-tolerance approach to the abuse, neglect and exploitation, and application of the Victorian Charter of Human Rights and Responsibilities.
• There are some circumstances when restrictive practice is necessary as a last resort to protect a person with disability and/or others from physical harm. For example, in relation to behaviours of concern. The least restrictive option possible must be used to reduce the risk of harm.
• Restrictive practice can present serious human rights breaches. A decision to use a restrictive practice needs careful clinical and ethical consideration, considering a person's human rights and the right to self-determination.
• The aim is the reduction and elimination of use of regulated restrictive practices where possible.

Key purpose of the policy:

The TAC has engaged with the Victorian state government to implement restrictive practice safeguard protections that are legislated under the Disability Act.

• The directions and prohibitions issued by the Victorian Senior Practitioner (VSP) under the Disability Act must also be met.
• These protections apply to clients receiving a service in Victoria.
• The TAC expects attendant care providers to carefully consider the use of restrictive practice prior to its use.

The definitions of regulated restrictive practice have been adopted from the NDIS (Restrictive Practices and Behaviour Support) Rules 2018.

This policy aligns with the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector, which is underpinned by the United Nations Convention on Rights of Persons with Disabilities.

The following should be read in conjunction with this policy:

• Working with the TAC
• Attendant Care policy
• Mental health and wellbeing services
• TAC Clinical Framework
• VSP website.

This policy applies to:

• Clients receiving a service in Victoria who sustain injuries from a transport accident before the age of 65 years (if over 65 years, clients will be considered on a case-by-case basis).
• Attendant care providers:
  • funded by the TAC or WSV, and
  • authorised to deliver Disability Services under section 23 of the Transport Accident Act 1986, and
  • registered with the Social Services Regulator, and
  • that deliver individual support to a client in their home, in a supported accommodation setting and in the community.

Under Phase 1, this policy only applies to the attendant care providers outlined on this list.

The TAC can pay for the development of a behaviour support plan (BSP) to identify strategies to improve a client's quality of life and reduce behaviours of concern. The proposed use of restrictive practice must be documented in a BSP, if required.

All Providers (including clinicians/treaters)

All providers working with clients who recommend or oversee a recommendation of restrictive practice use, must:

• Have tried all least restrictive options.
• Work collaboratively with the treating team to ensure restrictive practice is used and implemented in accordance with the directions of a BSP, and
• Plan for the reduction and elimination of restrictive practice use where possible.

Attendant care providers

Attendant care providers are responsible for applying the restrictive practice policy and the definitions of regulated restrictive practice.

Conditions for use

If a provider intends to use restrictive practice, the following conditions must be met:

• It is used to prevent risk of physical harm to self or others and is proportionate to risk of harm;
• It is used as the last resort and is the least restrictive option in the circumstances;
• It is not applied for longer than necessary;
• The use is clearly identified in a BSP and is used in accordance with that plan;
• There is a plan to reduce its use.

Prior authorisation

Restrictive practice use on a client by an attendant care provider is not permitted without prior authorisation and additional approval by the VSP (if required).

An attendant care provider is responsible for determining that restrictive practice can be implemented safely by their staff.

The authorisation process for an attendant care provider intending to use restrictive practice includes:

1. Submitting a SIR to the TAC.
2. An Authorised Program Officer (APO) is appointed by the attendant care provider and approved by the VSP. The APO is responsible for authorising the use of restrictive practice in line with requirements under the Disability Act.
3. Use of restrictive practice is to be included in a current BSP that has a maximum duration of 12 months and be authorised. The attendant care provider is to discuss the need for a new/reviewed BSP with the client’s TAC claims manager who will consider and action.
4. The intended use of restrictive practice and process for review being explained to the client by an Independent Person and provided in an accessible format.

An APO must not authorise the use of a regulated restrictive practice on a client unless satisfied:

• The proposed use of regulated restrictive practice is necessary to prevent the client from causing physical harm to themselves or another person.
• The use and form of the proposed regulated restrictive practice is the option which is the least restrictive to the client as is possible in the circumstances.
• The regulated restrictive practice is included in and used in accordance with the client’s BSP and is not applied for longer than necessary to prevent the client from causing physical harm to themselves or another person.
• If seclusion is used, the client is provided with bedding and clothing, food and drink at appropriate times, adequate toilet arrangements and access to heating and cooling as are appropriate in the circumstances.
• An independent person is available to explain the proposed use of the regulated restrictive practice to the client, and
• Any other requirements imposed by the VSP have been followed, including any directions and prohibitions issued by the VSP.

Attendant care providers are required to file correspondence from the VSP confirming the outcome of authorisation/approval/refusal. The client’s TAC claims manager and neuropsychologist must be informed of the outcome in writing.

Monitoring requirements

Once restrictive practice use is authorised/approved, it is the role of the attendant care provider to collate and use data to monitor the effectiveness of behaviour support strategies. They are also required to enable appropriate and timely BSP reviews and promote reduction and/or elimination of restrictive practice use where possible.

Attendant care providers are required to meet the VSP’s monthly reporting requirements.

A range of resources are available on the VSP’s website to provide support and guidance to an attendant care provider and APO. This includes a step-by-step guide on the restrictive practice authorisation process and reporting requirements.

If advice is required on a specific client matter, the VSP can be contacted at RIquestions@dffh.vic.gov.au.

Emergency Use

An attendant care provider can use regulated restrictive practices on a client in an emergency to prevent risk on condition that:

• the client:

1. does not have a BSP which provides for the use of regulated restrictive practices, or
2. has a BSP which provides for the use of regulated restrictive practices and the APO has not authorised that use

• the proposed use and form is the least restrictive as possible in the circumstances
• a SIR is subsequently submitted, and
• the APO (if appointed or Senior Manager) determines if the restrictive practice will be required again and if so, commence the RP authorisation procedure.

Neuropsychologists

Health professionals are expected to provide treatment to clients in accordance with the TAC’s Clinical Framework.

The TAC requires a neuropsychologist to develop a BSP for the purpose of restrictive practice authorisation, in accordance with the requirements of the VSP and this policy.

A BSP is to be prepared in consultation with the client, their family, the implementing attendant care provider/s and treating team.

Conditions for use

The following conditions have been set by the VSP on the content of a BSP developed for the purpose of restrictive practice authorisation:

• Either the NDIS or the VSP template are to be used.
• The BSP is to be reviewed every 12 months (unless there is a significant change in the client’s circumstance and the plan is reviewed earlier).
• The neuropsychologist must:
  • Reflect client needs, includes strategies to improve quality of life
  • Take into account any previous behaviour support assessments and other assessments
  • Monitor implementation of behaviour support strategies by the attendant care provider
  • Deliver staff training.
• The behaviour support plan must:
  • Provide a clear description of the behaviour causing physical harm to the client or others, including baseline data about the frequency, duration, severity and outcome of the behaviour of concern.
  • Demonstrate the use of regulated restrictive practices is the option which is the least restrictive of the client as is possible in the circumstances.
  • Provide a detailed description of proactive and non-restrictive strategies to lessen the need for the behaviour of concern.
  • Include changes to be made to the environment to reduce or eliminate the need for the regulated restrictive practice.
  • State the necessary de-escalation (reactive) strategies that will be used to re-engage, re-direct or calm the client when they start displaying behaviours of concern.
  • Provide clear information regarding the use and form of any proposed restrictive practice, including pro re nata (PRN) or non-scheduled medication protocols, if required.
  • Include strategies to reduce and eliminate the use of the restrictive practices, and
  • Satisfy Disability Act requirements.

The neuropsychologist will provide to the attendant care provider’s APO a copy of the final BSP. The APO will authorise the restrictive practice and submit the BSP to the VSP for additional approval and/or noting.

As the TAC funds the BSP, the neuropsychologist will provide a copy of the BSP to the TAC.

Monitoring requirements

It is a requirement of the TAC that the neuropsychologist and attendant care provider jointly determine what monitoring of client behaviour will be undertaken. Data provided by the attendant care provider is to be assessed and the behaviour support strategies adjusted where required.

Reporting

For attendant care providers, the VSP will monitor whether the use of regulated restrictive practice is in accordance with the Disability Act. The VSP will advise the APO as to the intervals, not exceeding 12 months, within which the APO is to provide a report via the Restrictive Intervention Data System (RIDS) on the implementation of a client’s BSP.

A RIDS report must be provided to the VSP within 7 days after the end of each month. The report must contain information which specifies:

• the form of the regulated restrictive practice used and, if seclusion was used, the period of time during which it was used;
• the reasons why the regulated restrictive practice was used;
• the effect on the client’s behaviour;
• the name of the person who approved the use of the regulated restrictive practice;
• the name of the person who applied the use of the regulated restrictive practice, and if seclusion was used, kept the client in seclusion.

The VSP is responsible for providing RIDS reporting data to the TAC for oversight purposes.

Reporting emergency use of regulated restrictive practices

If the attendant care provider intends to continue to use a regulated restrictive practice on the client, a BSP must be developed as soon as possible.

The APO must within seven days after the end of each month prepare and send to the VSP a report in respect of the use of regulated restrictive practices in an emergency.

Emergency use of restrictive practice is to be reported to the TAC in accordance with the Serious incident reporting (SIR) guidelines. The frequency of reporting emergency use in a SIR may be negotiated with the TAC to minimise potential administrative burden.

An attendant care provider’s APO (if appointed or Senior Manager) must oversee a response to emergency use of restrictive practice on behalf of the organisation.

Safeguarding

If a TAC client or their family member becomes aware of the inappropriate or emergency use of restrictive practice, the attendant care provider and/or allocated TAC claims manager should be notified.

Complaints and enquiries about providers registered under theSSR Act can also be directed to the Social Services Regulator (SSR).

Restrictive practice use on TAC and WSV clients may fall under the responsibility of other jurisdictions (aged care, health, mental health and education), states and territories, and disability funding bodies (NDIS). They may have their own legislation or policies that apply to the regulation.

Restrictive practice use in a different jurisdiction (such as hospitals and aged care where the TAC is not funding the attendant care) is not included in this policy. The TAC’s Safer Services Support can advise of the appropriate authority to raise a concern or complaint if required.

Compliance

An attendant care provider cannot implement use of restrictive practice unless authorised in accordance with the Disability Act, and conditions of use are clearly identified in a BSP.

If it is determined an attendant care provider has not complied with these requirements, the VSP and the TAC will provide education and support to upskill the provider. A serious compliance breach may be raised with the SSR. If the SSR determines that the attendant care provider’s registration is to be revoked, the TAC will terminate services.

State government resources are available at VSP resources including Guidelines for authorising regulated restrictive practices in Victoria (Word).