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Department of Communities TasmaniaHOUSING, DISABILITY AND COMMUNITY SERVICES - DISABILITY AND COMMUNITY SERVICES

OFFICE OF THE SENIOR PRACTITIONER

File No.:

Disability and Community ServicesSenior Practitioner - Annual Report1/7/18-30/6/19

August 2019

Table of Contents

1 Executive summary..............................................................................3

2 Processing of Applications...................................................................42.1 Background..................................................................................................42.2 Secretary Approvals for Restrictive Interventions........................................42.3 Guardianship and Administration Board Approvals......................................62.4 Unauthorised Restrictive Interventions........................................................72.5 Consultations................................................................................................8

3 Key issues...........................................................................................93.1 RISET-Tas.....................................................................................................93.2 Unauthorised use of a restrictive intervention...........................................103.3 Roadmap to rights......................................................................................113.4 Positive behaviour support workshops......................................................113.5 Dual Disability Roundtable.........................................................................123.6 Amendments to the Act..............................................................................133.7 Transition to National Disability Insurance Scheme....................................133.8 Information and education.........................................................................143.9 Fact/information sheets..............................................................................14

4 Priorities for 2019/2020.....................................................................154.1 Dual Disability Roundtable.........................................................................154.2 Roadmap to rights......................................................................................164.3 Trauma informed PBS.................................................................................16

5. References.......................................................................................16

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1 Executive summary

As outlined in the Disability Services Act 2011 (Tas), (the Act) the Senior Practitioner must provide to the Secretary by 1 September each year a report consisting of:

(a) information on the performance of the functions, and the exercise of the powers, of the Senior Practitioner during the previous financial year; and

(b) data relating to the use of restrictive interventions during the previous financial year.

It is also a requirement of the Act that a report provided to the Secretary under Section 31 must not enable a person with disability to be identified.

Finally the Secretary must ensure that a copy of the report provided to the Secretary under Section 31 is available to the public at an electronic website of the Department for at least twelve months after it is so provided. The Senior Practitioner’s reports are available at :

http://www.dhhs.tas.gov.au/disability/senior_practitioner

This report details the data relating to the use of restrictive interventions from 1 July 2018 to 30 June 2019.

The data indicates some trends that require further examination and the development of guidelines and standards in accordance with best practice in the disability sector as related to the incidence of use of restrictive interventions.

The report also outlines the activities conducted by the Senior Practitioner in order to make recommendations about the provision of specialist disability services as well as in the regulation of use of restrictive interventions. The report concludes with some areas identified as priorities to assist the sector to provide improved services for those living with disability during the next reporting period

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http://www.dhhs.tas.gov.au/disability/senior_practitioner

2 Processing of Applications

2.1 BackgroundA disability services provider or a funded private person must not carry out, in relation to a person with disability who is under their care or control, a restrictive intervention unless there is in force an approval under section 38 or section 42 of the Act.

Section 4 of the Act provides a definition of restrictive intervention as follows:

restrictive intervention means any action that is taken to restrict the rights or freedom of movement of a person with disability for the primary purpose of the behavioural control of the person but does not include such an action that is –

(a) taken for therapeutic purposes; or

(b) taken to enable the safe transportation of the person; or

(c) authorised under any enactment relating to the provision of mental health services or to guardianship;

Part 6 of the Act provides for the regulation and monitoring of restrictive interventions. The Act separates ‘restrictive interventions’ into two categories – ‘environmental restrictions’ and ‘personal restrictions’.

Personal restrictions can only be approved by the Guardianship and Administration Board under section 42 of the Act.

The Secretary of the Department of Communities Tasmania can approve environmental restrictions under section 38 of the Act.

Under Section 36 of the Act a restrictive intervention that has not been authorised is only allowed to be used if: a) the action is used to protect a person from harm; b) the action used is the least intrusive type of restriction; c) the Senior Practitioner is notified as soon as practicable after use of the action and; d) the action isn’t used again for 72 hours.

2.2 Secretary Approvals for Restrictive InterventionsA disability services provider or funded private person may apply to the Secretary for approval to carry out, in relation to a person with disability, a type of restrictive intervention that is an environmental restriction.

The Secretary can only approve an application if the Secretary is satisfied that consultation has occurred with the person with disability or a person nominated by

Office of the Senior Practitioner Annual Report – August 2019 of 16

the person, any persons who have expertise in the carrying out of the proposed intervention and with the Senior Practitioner.

Before granting an approval the Secretary must be satisfied that the restrictive intervention will be carried out only to ensure the safety, health or wellbeing of the person or other persons and that the restriction is the least restrictive alternative available in the circumstances.

In reaching a decision whether to grant an approval the Secretary must have regard to a number of issues (detailed under section 38) including the best interests of the person with disability, any alternative methods reasonably suitable to address the situation and the nature and degree of risk to the person with disability.

Table 1. Applications approved by the Secretary (environmental restrictions)

Location Setting

Description of restriction Date

Further Approvals

Approvals Prior Applicant

Southaccommodation

No access to computers 7/8/18 none 5 CSO manager

Northaccommodation

Access to TV 9/10/18

22/1/1916/5/19 7

CSO based clinician

There were approvals relating to two individuals this financial year which is significantly less than the last reporting period (six). Part of this reduction (2) is due to the Senior Practitioner, in conjunction with Disability Assessment and Advisory Team (DAAT) clinicians, working with the organisations to eliminate the need for restricting access to rooms and pantries.Restrictions on two other individuals no longer needed approval in the current reporting period because they were transferred to a Supervision Order under the Criminal Justice (Mental Impairment) Act (1999) and to guardianship under the Guardianship and Administration Act (1995). The Senior Practitioner therefore ceased to have a role in the regulation of these restrictive interventions under section 4 of the Act.During the current reporting period a psychologist was appointed to provide behaviour support services to the individual who was restricted from using his computer at all. Based on the psychologist’s assessment and after consulting with the individual’s psychiatrist, the Senior Practitioner was able to conclude that, due to the nature of the person’s psychiatric condition the total restriction of access to the computer was for therapeutic purposes.


2013 2014 2015 2016 2017 2018 20190

20

40

60

80

100

120

multiplelockingaccesstapsphone/IT/TV

Year of reporting period

perc

enta

ge o

f ann

ual a

ppro

vals

Figure1: breakdown of category of environmental restriction (percentage of total annual approvals) across reporting periods

As noted above the annual number of people subjected to the use of an environmental restriction over time continues to fall and is currently only one at the time of writing. The graph above shows the continuing trend, first noted in the 2016/2017 reporting period, in the proportionate rise of approvals to restrict access to phone/IT/TV.2.3 Guardianship and Administration Board ApprovalsA disability services provider or funded private person may apply to the Guardianship and Administration Board (the Board) for approval to carry out, in relation to a person with disability, a type of restrictive intervention that is either a personal restriction or an environmental restriction. The application must contain a statement from the Senior Practitioner as to why he or she is of the opinion the Board ought to grant the approval sought.

An approval can only be granted if the Board has consulted with the person with disability or a person nominated by the person and any persons who have expertise in the carrying out of the proposed intervention. The Board also needs to be satisfied that the type of restriction being considered is for the safety, health or wellbeing of the person and is the least restrictive on the person’s freedom of decision as practicable.

Table 2 (next page) shows that seven applications were forwarded to the Board with recommendations for approval.


Table 2. Applications forwarded to Guardianship and Administration Board

Location Setting Description Hearing Date/s

Outcome

North West accommodation Use of harness 11/10/1818/4/19

Approved for 6 months (x2)

South accommodation Use of body suit 20/11/1816/7/19


South accommodation Use of body suit 13/12/187/6/19


South accommodation Use of body suit 18/4/19 Withdrawn - therapeutic purposes

South accommodation Line of sight & access to mobile phone

6/9/185/4/19


North Community access

Use of physical restraint

15/3/19 Approved for 6 months

North accommodation Use of physical restraint

21/12/1814/6/19


The table above shows that of the seven individuals who were subject to applications to the Board this reporting period, four of them had applications approved in the previous reporting period. A further two individuals had applications approved for the first time in this reporting period. One application for the use of a body suit was deemed by the Board to be for therapeutic purposes. Continuing a trend seen in the previous financial year, the Board has approved more applications to use body suits as a personal restriction in this reporting period than those determined as being used for ‘therapeutic purposes’. 2.4 Unauthorised Restrictive InterventionsUnder certain conditions it may be a defence to a charge of an offence of the use of unauthorised restrictive interventions, if certain conditions are met. Included in those conditions are the need for the Senior Practitioner to be notified by the


disability services provider or funded private person as soon as practicable after a restrictive intervention is carried out. Table 3 shows those unauthorised interventions notified during the reporting period.

Table 3. Reports of unauthorised use of restrictive interventions (previous year’s data in brackets)

Restrictive Intervention Type Total Accommodation Community Access

Personal 92 (87) 82 (15) 10 (72)Environmental 23 (0) 23 (0) 0 (0)Overall Total 115

(87) 105 (15) 10 (72)

The total of 115 reports for 2018/2019 represents a thirty three percent (33%) increase in reporting when compared to the previous reporting period. However this increase is due almost entirely to the reporting of use of an environmental restriction on one individual because of a delay in approval of the practice.

The data also shows that reporting from community access organisations has decreased dramatically compared to the last reporting period whereas those from accommodation services have increased by about the same amount. The last reporting period’s data was found to be inaccurate when an audit of reporting of unauthorised use of restrictive interventions was carried out early in this reporting period. It was discovered that the 2017/2018 data was an artefact of ‘whole of life’ accommodation services being erroneously counted as community access services. An analysis of the notifications provided to the Senior Practitioner revealed a similar pattern of ‘no reports’ from some large organisations over the whole reporting period as was found during the three month audit period (see section 3.2 for more detail about the audit).

2.5 ConsultationsThe Senior Practitioner responded to and gave advice in relation to one hundred and ninety-two (192) enquires relating to the potential use of restrictive interventions in the current reporting period. The table below shows the number of consultations in each category of restrictive intervention.

Table 5. Breakdown of category of consultations (previous year’s data in brackets)

Type of consultationNumber of consultations


Personal 86 (72)Environmental 74 (39)Use of Medication 8 (0)Policy 27 (0)Overall Total 192 (111)

Both categories show a nearly seventy-five per cent (75%) increase in enquires when compared to the previous reporting period. This may be due not only to an increase in awareness of the role of the Senior Practitioner brought about by providing information and education sessions to the sector but also an awareness from providers of the imminent arrival of the NDIS Quality and Safeguards Commission (the Commission) in Tasmania on I July 2019. This view is supported by two new categories of consultation appearing in a Senior Practitioner annual report for the first time, namely queries about the use of medication and general policy questions during this reporting period.

A trend first seen in the previous reporting period has continued into this current report is noted that enquires from clinicians working in private practice and coordinators of support working with NDIS participants have now grown to twenty-three percent (23%) of all consultations. This may in part be due to information sessions conducted by the Senior Practitioner to NDIS coordinators of support and local area coordinators and the contact made to registered behaviour support practitioners in the previous reporting period.

The main topics that enquirers required advice about relating to personal restrictions included, restraint during transportation (fifteen per cent), the use of belts (seven per cent), physical intervention (seven per cent), locking doors or gates (five per cent), medical procedures (three per cent) and bed rails (three per cent). For environmental restrictions the main topics included, locking cupboards (nine per cent), restricting foods or personal items (fourteen per cent), access to rooms (four per cent), surveillance (four per cent) and restricting the use of phones, TV or computers (four per cent).

When compared to the previous reporting period, large falls in proportion of total consultations were seen in this reporting period for queries about locked gates and doors, use of belts, use of onesies, locking cupboards, restricting food/items, access to rooms, restricting phones, TV or computers and surveillance.


Many of these topics were included the on-line educational tool (RISET-Tas) that was developed during the last reporting period and these reductions are evidence that the tool is being used effectively by the sector.

3 Key issues3.1 RISET-Tas

The Restrictive Intervention Self Evaluation Tool (RISET) is an on-line tool developed by the Office of the Senior Practitioner (Vic) to help service providers decide whether or not a restrictive intervention has occurred. During the previous reporting period the Senior Practitioner (Tas) worked with a Senior Project Officer from the Office of the Senior Practitioner (Vic) to modify the RISET to match Tasmanian legislation and service delivery context. A working group made up of interested service providers also provided input into the content and layout of the RISET-Tas.

The RISET-Tas was launched in August 2018 and the Senior Practitioner spent the subsequent 4 months working with service providers to help their support teams to become familiar with using the tool.

A graph of cumulative usage can be seen below.

Figure 2: Cumulative usage of RISET-Tas per month

A breakdown of the access data shows that although the tool has predominately been accessed by Tasmanian providers across the state (58%), there has also been interest shown by Victorian based groups (30%), NSW (9%) other parts of Australia and even New Zealand and Ireland.


On the basis of discussions with the Senior Practitioner during this reporting period, the Department of Family and Community Services (NSW) will be developing a similar tool in their jurisdiction.

The RISET-Tas can be accessed via the link below using any ‘smart’ device and there is no password required.

Access practice resources and restrictive intervention information via RISET-TAS online: RISET-Tas Link

3.2 Unauthorised use of a restrictive interventionAs a result of notification data received in the 2017/2018 year the Senior Practitioner contacted disability service providers in August 2018 and asked them to conduct an audit of incident reports from the previous 3 months (June-August) to check that the required Senior Practitioner form had been completed where staff had needed to use some form of physical intervention to prevent harm.

The purpose of the audit was twofold namely:

to investigate a feature noted in the last Annual Report where rates of notifications from accommodation services hadn’t changed between 2016/2017 and 2017/2018 and

to change reporting behaviour of service providers, particularly those who support a large number of people and who were not notifiers to the Senior Practitioner.

The results of the audit showed that:

A significant majority of service providers reported that they do not need to use unauthorised restrictive interventions on the people they support.

There was an immediate effect of the audit request which resulted in an increasing rate of notifications however these notifications were from service providers who were already in the habit of reporting to the Senior Practitioner.

The audit process only led to one additional service provider starting to provide notifications and the rate of receipt of notifications after the audit process (in late 2018) hasn’t changed significantly from the rate seen in late 2017.

There were significantly more notifications from services providing both accommodation and community access compared to those services solely providing community access


http://www.surveygizmo.com/s3/4271753/98578e0c4f52

Based on the findings of the audit the Senior Practitioner will, in the next reporting period, prioritise training efforts towards large organisations that have not made a notification and have not received any information and education about the use of restrictive interventions. In addition to these efforts the OSP will continue to promote the fact sheet on ‘Unauthorised use of Restrictive Interventions’, the use of RISET-Tas online educational tool and provide on-going information and education sessions to the sector.

3.3 Roadmap to rightsDuring 2018/2019 the Senior Practitioner organised a workshop with Professor Ramcharan (RMIT University) to build on work commenced in the previous reporting period which showcased his program ‘The Roadmap to Dignity without Restraint’. The program aims to foster principled thinking about everyday support work which in turn will maximise rights and minimise controls and restraints. The program also focusses on organisational change to transform practice and culture to improve the lives of people with disabilities (Ramcharan, Robertson, Strong & Nankervis, 2009). The workshop included:

A refresher introduction to the Roadmap The six key areas required to implement a reduction in the use of restrictive

practices. Complementarity of preventative and human-rights approaches and positive

behaviour support The essential need for high level organisational communication channels and

what that requires.

The workshop was well attended by all the major service providers in the State (via video conference) and although there was strong interest from the sector in being involved in a potential pilot program, this was not progressed in the current reporting period due to the competing commitments of Prof Ramcharan. Renewed efforts to progress this project will be made in the next reporting period.

3.4 Positive behaviour support workshops

Disability and Community Services (DCS) provided funding and the Senior Practitioner facilitated the development of two series of positive behaviour support (PBS) workshops during this reporting period. The first series was conducted in February and March 2019 by Autism Tasmania and was titled ‘Positive Behaviour Support: A course for parents of teenagers and young adults on the autism spectrum with co-occurring anxiety. The second was conducted in April 2019 by SAL Consulting and was titled ‘A neuro-developmental, attachment and trauma-


informed (NATI) approach to PBS’. This second series of workshops had a broader focus than autism and was aimed at enhancing support to young people/adults with disability who exhibit significant hyperarousal and associated high levels of behaviours of concern.

Both series of workshops ran sessions for families (Hobart, Launceston and Ulverstone) and the NATI workshop also included separate sessions for service providers and clinicians (Hobart and Launceston).

Feedback from the Autism Tasmania workshops was that all participants thought: the material relevant to their family’s situation; the instructors’ knowledge of the material as excellent; successful in increasing their understanding of why their child may exhibit challenging behaviours; that as a result of the course they were very or extremely likely to use PBS in their home.

Feedback from the NATI workshops (both family and service provider) was strongly positive in terms of participant overall satisfaction, the training meeting learning needs, improving work practice or ability to handle difficult situations, and participants learning new information. An additional common theme in both sets of workshops was the desire to have further workshops spread over two days featuring case studies to illustrate the main components of the model. Preliminary discussions with SAL consulting were held towards the end of this reporting period by the Senior Practitioner with a view to continuing collaboration into the next reporting period.3.5 Dual Disability Roundtable

During 2018/2019 the Senior Practitioner approached the Chief Psychiatrist (Mental Health, Alcohol and Drug Directorate) to discuss how mental health services for people with disability might be improved. The context of this activity was that people with intellectual disability (ID) experience very high rates of mental ill-health and multiple barriers to effective mental health care. In March 2018 the University of NSW convened the Second National Roundtable on the Mental Health of people with an Intellectual Disability. This forum allowed national leaders in the two sectors to meet and devise a set of recommendations aimed at improving the mental health system for people with intellectual disability and so realise their right to receive the highest attainable standard of mental health.

The outcome of these discussions was that a Roundtable was held in October 2018 where senior clinicians and managers from Disability & Community Services, Primary Health, Mental Health, Victorian Dual Disability Services, National Disability


Services and Royal Australian College of General Practitioners met to discuss how to implement some of the low resource intensive recommendations of the Second National Roundtable in Tasmania.

The Roundtable discussed a number of options, including a number of ways to provide support and training to existing Community Mental Health teams, capacity building of existing services and setting up the right care pathways, using flexible teams across the state at different tiers and providing general ID awareness raising training across the health sector. The group agreed to hold another meeting at the first quarter of 2019 but this has been postponed until July 2019 at time of writing.3.6 Amendments to the Act Towards the end of this reporting period a number of amendments to the Act were proclaimed as result of a review that was conducted in the previous reporting period. Amendments that have direct relevance to the work of the Senior Practitioner are:

A definition of ‘therapeutic purposes’ – “treating (by diagnosing, curing or relieving) a disease, disorder, ailment, defect or injury and facilitating such treatment, but does not include preventing or reducing the risk of ailment or injury.” (Section 4 of the Act);

The Board may now grant provisional approval to use a restrictive intervention once an application has been received by the Board (Section 41A);

Lengthening the period for which a Guardianship and Administration Board approval of a restrictive intervention may apply to up to 2 years (Section 44(3)).

In the next reporting period the Senior Practitioner will review past cases and amend relevant fact sheets to ensure that practices previously assessed as being for ‘therapeutic purposes’ still fall within the new definition. 3.7 Transition to National Disability Insurance Scheme

Meetings and information sessions

During this reporting period the Senior Practitioner participated in meetings to support the commencement of the Commission in Tasmania on 1 July 2019.

National Disability Services facilitated a number of Disability Sector Roundtables throughout the reporting period where, the Senior Practitioner was a key speaker alongside other DCS and Justice representatives and some National Directors from the Commission.


The Senior Practitioner also disseminated information about restrictive interventions and their role in relation to regulation to NDIS key players in this reporting period including NDIS Local Area Coordinators (LACs) and Coordinators of Support (CoS).

Since the commencement of the Commission in NSW and SA on 1 July 2018 and the appointment of a National Senior Practitioner (NSP), the Tasmanian Senior Practitioner has attended quarterly Practice Leadership Group meetings chaired by the NSP.

The aim of the group is to be a practice-focussed collective developing contemporary evidence-based practice leadership, aligned with the Convention on the Rights of People with Disability, with regard to behaviour support and the reduction and elimination of restrictive practices in the NDIS. Discussions within the group will help frame policy and practice direction which in turn will assist in developing a nationally consistent approach defining and authorising restrictive practices.

The Senior Practitioner has also worked with the Commonwealth Department of Social Services and other jurisdictions to progress work in achieving consistency both in the definitions of the categories of restrictive practices and in authorisation processes across Australia.

Practice Consultants

As a result of the restructure of DCS in preparation for the commencement of the Commission on 1 July, the Office of the Senior Practitioner (OSP) gained 3 Practice Consultant positions during the last quarter of this reporting period. A work plan has been developed for the new team and next reporting period the OSP will be able to work more locally with service providers, who will be able to access their own designated Practice Consultant.

3.8 Information and education2018/2019 saw the Senior Practitioner present information sessions to 17 groups and organisations including the Guardianship and Administration Board, Allied Health Professionals, CoS, LACs and TAFE as well as disability service providers across the state. As well as covering restrictive practices and their impact on the rights of people with disability these sessions included information about the changes that will occur once the NDIS Q&S Commission begins operating in


Tasmania from 1 July 2019. Some of the sessions also included additional topics such as ‘Positive Behaviour Support’ and the ‘Principles of working with someone with behaviours of concern’. The Senior Practitioner also worked with Association for Children with Disability and TasCare to provide information to families about the RISET-Tas.

In June 2019 the Senior Practitioner presented sessions on Chemical Restraint to service providers in conjunction with the Commission’s National Director for Behaviour Support.3.9 Fact/information sheetsDuring this reporting period the Senior Practitioner has released the following new fact sheets:

Unauthorised use of Restrictive Interventions; Surveillance and Monitoring of People with Disability. Chemical Restraint FAQs Is This Chemical Restraint ? Purpose of Medication Form

Updates have been done to the existing fact sheets: The Role of the Senior Practitioner; Personal Restrictions;

During the next reporting period the Senior Practitioner will be releasing the following new fact sheets based on issues raised during 2018/2019. These are:

Seclusion Children and the Disability Services Act Preparing for a visit to the GP

The following existing fact sheets will be updated based on changes due to the commencement of the Commission and on amendments to the Act (see section 3.6):

Restrictive interventions not requiring authorisation Safe transportation Locking of fridges and pantries Use of restrictive interventions and defining therapeutic purposes

4 Priorities for 2019/2020The main priorities for the Senior Practitioner in the next reporting period will be the following activities:


OSP to provide special assessment and other assistance where there is risk of harm or use of a restrictive intervention;

Facilitate growing the behaviour support capability of the sector in conjunction with other relevant stakeholders;

Updating content of RISET Tas;

Developing an education package based on the Individual Plans Policy Framework;

Provide on-going monitoring and review of actions deemed for ‘therapeutic purposes’ or ‘safe transportation’.

4.1 Dual Disability RoundtableThe Senior Practitioner will work with the Chief Psychiatrist to progress further work that aims to improve mental health services for people with disability. Further Roundtables will be planned for the next reporting period.

4.2 Roadmap to rights

During the next reporting period the Senior Practitioner will continue efforts to work with Professor Ramcharan to develop a pilot program and associated research project in conjunction with participating service providers. The program will focus on collecting individual case studies that illustrate the implementation of the ‘Roadmap to Rights’ model and shows changes in everyday support work that maximises rights and minimises controls and restraints.

4.3 Trauma informed PBSThe Senior Practitioner will continue to collaborate with SAL consulting in the next reporting period to develop a sustainable ‘train the trainer’ model of delivering training in the neuro-developmental, attachment and trauma-informed (NATI) approach to PBS to local clinicians. This will have great benefit for those clinicians working with adolescents and young adults who exhibit significant hyperarousal and associated high levels of behaviours of concern and where current service models do not adequately meet their needs.

5. References


Ramcharan, P., Robertson, J., Strong, R. and Nankervis, K. (2009). Restrictive practices in the lives of people with disabilities. Melbourne: RMIT.


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