1. What does the term “restrictive practices” refer to?
The term ‘restrictive practices’ refers to any practice, device or action that removes or restricts another person's freedom, movement or ability to make a decision. Some examples of restrictive practices include:
- mechanical, such as devices that limit a person’s movements (and this includes the removal and/ or disengagement of mechanical supports that assist the person’s movements)
- seclusion, such as the sole confinement of a person at any time in any room where the doors and windows cannot be opened by that person
- environmental, such as preventing free access to all parts of a person’s environment or house (for example locking the refrigerators)
- social, such as the imposition of sanctions that restrict the person’s access to relationships/opportunities they value
- chemical, such as medications that blunt the person’s emotions, cognition, and motor activity
- physical, such as holding or ‘pinning down’ by another person
- psycho-social restraints, such as power control strategies which might include threats, intimidation, fear, coercion, discipline, or retaliation
- organisational, such as excluding the person from activities, and restrictions to the person's choice
- communication restraint, such as switching off someone’s communication device
- decision making restraint, such as failing to provide options for supported decision making
2. Who is likely to be exposed to restrictive practices?
Some groups in the ACT community, including people with disability, older people, people living with mental illness, children and young people, and people intersecting with the justice system are more likely to be subjected to restrictive practices to manage behaviours that are perceived as challenging. It is often assumed that people with a disability are restrained as a result of them exhibiting so-called ‘challenging’ behaviour(s), whereas in fact these people might well behave in this manner as a result of having restrictions imposed upon them.
3. Why are some individuals likely to be exposed to restrictive practices?
Some research has suggested that often, such behaviours are functional and adaptive, due to the fact that people with a disability have led atypical lives. For instance, where they:
- May react to circumstances in which they are forced to do what they do not want to do.
- Cannot communicate their needs and wants effectively.
- Feel they are not listened to or heard.
- Have communication impairments, don’t negotiate well and are much more likely to react in a problematic way.
- Exhibit behaviours which are caused by pain or other physiological conditions.
- Have experienced abuse – physical, emotional, sexual.
- Have been placed in a group where all, or most of the role models, exhibit inappropriate responses (school, institution, group homes).
- Have certain syndromes which lead them to self–injure.
- Are unable to ‘read’ (interpret) or make sense of their environment, or the mood, feelings of others, or who respond in stereotypical ways eg people with autism.
4. What are the consequences of being exposed to restrictive practices?
While taking action to avert a clear and present risk of harm is understandable, there are a number of problems with the imposition of restrictive practices. These include (but are not necessarily limited to):
- the negative consequences the restrictive practice by its nature can have on the person’s progress towards good life chances, their general well-being, physically and psychologically including the impact on self-esteem
- restrictive practices that are focused on behaviour suppression as opposed to supporting genuine positive behaviour change
- restrictive practices that are focused on a negative reinforcement paradigm (the use of punishment to extinguish an unwanted behaviour, as opposed to positive reinforcement paradigms that focus on rewarding the emergence of behaviour choices that can advance the person’s life chances)
- restrictive practice that are inadequate in terms of their conceptualisation and implementation
- restrictive practices that are inadequate in terms of a clearly defined timeframe and process for review
- restrictive practices that constitute an assault on the person’s human rights
- restrictive practices that are crafted and/or executed by staff with inadequate skills and perspective
5. What are the alternative avenues or other options to using restrictive practices?
The use of restrictive practices has often come about in response to challenging behaviours from an individual. There are many strategies aimed at the prevention or decrease of challenging behaviour in the first instance.
Research supports the use of alternative strategies that are tailored to the needs of the consumer and the setting, for example the differing approaches for acute adolescent services compared with aged care. Training and education is a key element of practice change, and enables workers to predict, prepare for and respond appropriately to challenging behaviours and resistance to care, and thereby avoid using restrictive practices.
Some examples of positive strategies to minimize the use of restrictive behaviours include:
- Involving people who use services, families and carers in planning, reviewing and evaluating all aspects of care and support.
- Engaging early with consumers and carers so that where possible as much information is exchanged and known to service providers who will be involved in ongoing care for the individual. This is especially important for individuals known to have been restrained or secluded in the past.
- Assessing, treating and managing the individual’s physical and mental health condition(s) and associated symptoms, using evidence-based guidelines and appropriate interventions.
- Providing the most appropriate physical, social and emotional environment that seeks to avoid triggers and support prevention, care and recovery.
- Recognising the development of challenging behaviour - this includes assessing the individual’s behaviours, understanding their triggers or contributing factors, recognizing their level of distress and risk of challenging behaviours. It is important that appropriate screening and assessment tools are used.
6. What is the role and responsibility of an Office of the Senior Practitioner?
This can vary. In some jurisdictions, the Office of the Senior Practitioner does not have strong formal powers, and is there to raise awareness about the issues of restrictive practices, and to work with government and service providers to explore alternatives. In other jurisdictions, the Office of the Senior Practitioner has formal powers, usually created by legislation, to oversee if and how restrictive practices are used, and to ensure that a person's rights are protected.
7.What does this series of consultations hope to achieve?
The aim following these consultations is to provide feedback to the ACT government on people's views about the best approach to establishing an Office of the Senior Practitioner in the ACT. JFA Purple Orange will collate and analyse the opinions, views and advice provided throughout these consultations and will then report to the ACT government. In undertaking this work, JFA Purple Orange is working with local peak bodies in the ACT, to help ensure the consultation and the resulting report properly reflect the local situation. This is being done using a process called co-design.