RESTRICTED PRACTICE AUTHORISATON

1. RESTRICTED PRACTICE AUTHORISATON Restrictive practices are sometimes included as a reactive or management strategy when a client�s behaviour is posing immediate risks. They are part of a wider plan. Restrictive practices should never been used as the only strategy. In accordance with the �Behaviour Intervention Practices� in the Department Policy Manual for Working with People with Disabilities, all restricted practices require Restricted Practices Authorisation approval. Restrictive practices involve some intrusion on the client�s freedom in an attempt to achieve the decrease in a particular way of behaving. Restrictive practices (eg withdrawing of privileges) usually involve some cost to the client for behaving in a particular way, feedback on the inappropriateness of their actions, and alteration of the circumstances maintaining the undesirable behaviour. Restricted practices are non-exclusionary time out, containment, response cost, extinction, over correction, physical restrain, restricted access, seclusion and exclusionary time out. Any practice that necessitates physical contact with a client where the client indicates objection to the practice, eg, physically escorting a client back to a house where the consumer indicates by word or action that they do not wish to return. Restrictive practices are sometimes included as a reactive or management strategy when a client�s behaviour is posing immediate risks. They are part of a wider plan. Restrictive practices should never been used as the only strategy. In accordance with the �Behaviour Intervention Practices� in the Department Policy Manual for Working with People with Disabilities, all restricted practices require Restricted Practices Authorisation approval. Restrictive practices involve some intrusion on the client�s freedom in an attempt to achieve the decrease in a particular way of behaving. Restrictive practices (eg withdrawing of privileges) usually involve some cost to the client for behaving in a particular way, feedback on the inappropriateness of their actions, and alteration of the circumstances maintaining the undesirable behaviour. Restricted practices are non-exclusionary time out, containment, response cost, extinction, over correction, physical restrain, restricted access, seclusion and exclusionary time out. Any practice that necessitates physical contact with a client where the client indicates objection to the practice, eg, physically escorting a client back to a house where the consumer indicates by word or action that they do not wish to return.

2. Overview What is a restricted practice? Brief overview of why problem behaviours can occur Objectives of Restricted Practice Authorisation Restricted Practices Prohibited Practices Current DADHC process of Restricted Practice Authorisation. Guardianship and RPA Documentation required to support applications Special requirements for ETO and Seclusion Group activity

3. What are Restricted Practices? Restricted practices refer to the use of any technique or method to direct, manage or change a person�s behaviour They stop the person from doing what they want to do Example When someone behaves in a way that hurts others or destroys property, they might need to be stopped quickly before they do too much damage. A restricted practice might have to be used for a short while, until people work out what is making them act in this way Restricted practices are those practices where the intervention involves some intrusion on the client�s freedom in an attempt to achieve the curtailment of, or a decrease in a particular way of behaving. Restricted practices are those practices where the intervention involves some intrusion on the client�s freedom in an attempt to achieve the curtailment of, or a decrease in a particular way of behaving.

4. Restricted Practice Authorisation The RPA is an organizational monitoring and authorisation process for restricted practices, it includes: Reviewing the use of restricted practices at an individual level; Authorising the practice, providing interim authorisation, or not authorising practices. The RPA panel has a role in the monitoring of such practices to ensure that they meet good clinical and ethical standards. The RPA panel has a role in the monitoring of such plans to ensure that they meet good clinical and ethical practicesThe RPA panel has a role in the monitoring of such plans to ensure that they meet good clinical and ethical practices

5. Behaviour is Communication! Challenging behaviour by a person generally indicates that some element of their life is not working. Such behaviour may be a way of communicating a message. It is our responsibility to try and understand the message and respond in the most appropriate way Ageing and Disability Department, 1997,The positive approach to challenging behaviour

6. Behaviour Management & Ethics things to consider� Is the behaviour inhibiting the person from enjoying life as an active community member? Is the decision to intervene justified? Will the intervention improve the person�s quality of life? What is the least restrictive or least intrusive option available? Has the program been discussed with the person or their advocate? Has consent been obtained? Are there sound reasons to believe the program will work? How and when will the program be reviewed? Does the program respect the rights and dignity of the individual?

7. Challenging behaviours - Can occur for a variety of reasons, such as:-  Fear � A perceived need (sometimes irrational) to escape, defend against, or eliminate a perceived threat of personal injury or emotional well-being Frustration � Attempting to gain control by physically attacking the source of frustration or someone or something else Manipulation � Attempting to obtain or avoid something eg, temper tantrum, playing the numbers, promoting confusion Intimidation � a calculated and deliberate attempt to get something in exchange for physical safety or freedom from threat, �don�t make me hurt you� (often used by people diagnosed with an anti-social personality disorder) Smith, Paul A, 2004, predict, assess and respond to challenging behaviour. Fear � A perceived need (sometimes irrational) to escape, defend against, or eliminate a perceived threat of personal injury or emotional well-beingFear � A perceived need (sometimes irrational) to escape, defend against, or eliminate a perceived threat of personal injury or emotional well-being

8. Some strategies and expected outcomes for dealing with challenging behaviour Motivation Intervention Outcome FEAR Threat Reduction Perceived Safety FRUSTRATION Assisting with Control Self-control MANIPULATION Detach and Redirect Positive Re-engagement INTIMIDATION Identify and Safe / Better choices Communicate Consequences

9. Restricted Practices Restricted Access Physical Restraint Exclusionary Time out Seclusion Response Cost PRN medication PRN medicationPRN medication

10. Restricted Access Restricting a person�s independent access to items, activities or experiences through physical barriers or staff intervention. Physical restraint or unwanted physical contact The use of any device or strategy that restricts the person�s movement in response to challenging behaviour. Physical restraint or unwanted physical contact The use of any device or strategy that restricts the person�s movement in response to challenging behaviourPhysical restraint or unwanted physical contact The use of any device or strategy that restricts the person�s movement in response to challenging behaviour

11. Special Approval Requirements for Physical Restraint Physical Restraint has special requirements for implementation. only to be used if necessary and where less intrusive alternatives have been demonstrated to be ineffective, and the person or others are likely to be harmed without restraint; and staff implementing restraint are trained and competent to do so. Physical restraint does not include physical assistance for involuntary movement in instruction, function support devices / aids, safety devices to prevent injury of devices commonly used for specific medical, dental or surgical procedures. Physical restraint does not include physical assistance for involuntary movement in instruction, function support devices / aids, safety devices to prevent injury of devise commonly used for specific medical, dental or surgical procedures. Physical restraint does not include physical assistance for involuntary movement in instruction, function support devices / aids, safety devices to prevent injury of devise commonly used for specific medical, dental or surgical procedures.

12. Response cost Requires the person to lose or forego valued items or activities as a result their behaviour. The �cost� is not to be excessive or interfere with any medication regime. Predetermined items or activities that are not to be included in response cost procedures include access to basic needs and possessions and access to support persons. Proactive programs (eg, reward programs) are often a better option RC programs require the person to have the capacity to understand the �cost�. RC programs require the person to have the capacity to understand the �cost�.RC programs require the person to have the capacity to understand the �cost�.

13. Exclusionary time out Following the occurrence of a particular behaviour, the person is removed from a setting for a period to withdraw their access to the thing that is causing their behaviour. This needs to be a planned response to the behaviour. The ability to leave this setting is prevented. Seclusion Where a person is confined in a setting on his or her own in response to a crisis, and the person�s capacity to leave is denied. This is only used until the crisis is over. Seclusion differs from ETO in that it may be an immediate response to a crisis � as opposed to the last option available - and duration may not be able to be specified as it is dependent on the duration of the crisis. Exclusionary time out Where the client is removed, following the occurrence of a specified behaviour, from a setting for a period to withdraw their access to reinforcement, which is part of a planned response to the behaviour. The ability to leave is prevented. Exclusionary time out Where the client is removed, following the occurrence of a specified behaviour, from a setting for a period to withdraw their access to reinforcement, which is part of a planned response to the behaviour. The ability to leave is prevented.

14. Special Requirements Seclusion and Exclusionary Time Out Physical requirements: adequate light, comfortable temperature, adequate ventilation, means of easy observation, fixed furnishings and appropriate flooring to avoid potential for harm. Seclusion and Exclusionary Time Out Physical requirements: adequate light, comfortable temperature, adequate ventilation, means of easy observation, fixed furnishings and appropriate flooring to avoid potential for harmSeclusion and Exclusionary Time Out Physical requirements: adequate light, comfortable temperature, adequate ventilation, means of easy observation, fixed furnishings and appropriate flooring to avoid potential for harm

15. Special Requirements In addition: seclusion does not necessarily require restricted access to all possessions, accesses to toilet to be provided as necessary. Continual observation is a mandatory requirement. Duration: must not exceed 15 minutes unless imminent danger remains. Unit manager needs to be notified if duration needs to exceed 15 minutes. Data must be recorded for each time it is used Each use of seclusion or exclusionary time out must be reviewed within 24 to 72 hours by unit manager, behaviour practitioner, and support staff representative. Each use of seclusion or exclusionary time out must be reviewed within 24 to 72 hours by line manager, unit manager, programmer, and representative of staff on duty. Each use of seclusion or exclusionary time out must be reviewed within 24 to 72 hours by line manager, unit manager, programmer, and representative of staff on duty.

16. PRN Psychotropic medication Pro re nata is a Latin phrase that literally means "for the thing born". It is commonly used in medicine to mean "as needed" or "as the situation arises�. The administering of PRN psychotropic medication in response to challenging behaviour PRN is not considered appropriate as the sole strategy or treatment and need to be detailed in a support plan after that incorporates and emphasises less intrusive methods. Needs to be prescribed and reviewed by a psychiatrist or other relevant physician.

17. Some Key Rules about Restricted Practices They should be used when everything else has been tried/explored They must be used together with �positive programming� There must be someone senior in charge responsible for Monitoring and reviewing the use of restricted practices at an individual level; Authorising the practice, providing interim authorisation, or not authorising the practice. They are a requirement of current policies and legislation. They are a requirement of current policies and legislation.

18. Restricted Practice Authorisation Without organizational authorisation, staff implementing restricted practices are operating outside of policy and, some of the above practices without formal consent from a legal guardian may constitute punitive practices, wrongful imprisonment or assault. If this occurs internal disciplinary action may be taken and/or criminal charges may be pursued. For this reason, the above practices are subject to the departmental procedures and approvals, namely the Behaviour Intervention Policy and the Restricted Practice Authorisation process.For this reason, the above practices are subject to the departmental procedures and approvals, namely the Behaviour Intervention Policy and the Restricted Practice Authorisation process.

19. Prohibited practices Practices implemented by staff that are abusive and constitute assault or wrongful imprisonment are unlawful. These practices may constitute:- Corporal punishment or physical abuse such as hitting, hair pulling or slapping Over correction where the person has to repair more damage than caused Exclusionary time-out without proper approval and consent. Administering medication without authority or an overall plan. Prohibited Practices can also include: Restricted practices without authorisation and consent. Restricted practices without planned positive programming. Wrongful imprisonment Wrongful imprisonment

20. Assault Any reckless and intentional act that is harmful, offensive, unwanted and unlawful. An act intended to arouse fear such as shouting and making threats. Accidental touching is not an assault. Wrongful imprisonment The unauthorised, deliberate confining of a person in a setting where the person�s capacity to leave is denied. Eg. seclusion and exclusionary time out without valid consent, or if the particular procedure or conditions of the consent are not adhered to, or if unreasonable force is used. Assault Is any touching of another person which is harmful or offensive or unwanted. Any non trivial touching would probably be regarded as harmful or offensive by the courts. An act intended to arouse fear of such a touching like shouting and threatening is also an assault. Accidental touching is not an assault. Examples of assaults are restraining someone by holding them, putting on a splint or spraying someone in the face with water. Assault Is any touching of another person which is harmful or offensive or unwanted. Any non trivial touching would probably be regarded as harmful or offensive by the courts. An act intended to arouse fear of such a touching like shouting and threatening is also an assault. Accidental touching is not an assault. Examples of assaults are restraining someone by holding them, putting on a splint or spraying someone in the face with water.

21. Prohibited Practices cont� Aversive Practices Is the application of painful or noxious conditions (eg. unwanted cold bath, unwanted application of chilli powder on food, unwanted squirting of liquid into person�s face) Any planned behaviour intervention that produces pain or serious discomfort (including significant distress). Any planned behaviour intervention that produces pain or serious discomfort (including significant distress).Any planned behaviour intervention that produces pain or serious discomfort (including significant distress).

22. Consent and Guardianship Free Consent Restricted Practices Authorization and Consent The Guardianship Tribunal

23. Free Consent The person who is the subject of intrusive or restrictive procedures may provide a valid consent if they have a general understanding of what is consented to. Consent can be withdrawn at any time; If a person has previously consented to a behaviour management procedure and now physically resists it, this can be a withdrawal of consent. Deciding whether a person with an intellectual disability has given a free and valid consent to an intrusive or restrictive behaviour management procedure is difficult to judge. If doubtful cases, an application should be made to the Guardianship Tribunal. Of the person who is the subject of intrusive or restrictive procedures if they have a general understanding of what is consented to. Consent can be withdrawn at any time. If a person has previously consented to a behaviour management procedure and now physically resists it, this can be a withdrawal of consent. Deciding whether a person with an intellectual disability has given a free and valid consent to an intrusive or restrictive behaviour management procedure is difficult to judge. If doubtful cases, an application should be made to the Guardianship Tribunal.Of the person who is the subject of intrusive or restrictive procedures if they have a general understanding of what is consented to. Consent can be withdrawn at any time. If a person has previously consented to a behaviour management procedure and now physically resists it, this can be a withdrawal of consent. Deciding whether a person with an intellectual disability has given a free and valid consent to an intrusive or restrictive behaviour management procedure is difficult to judge. If doubtful cases, an application should be made to the Guardianship Tribunal.

24. RPA and Guardianship Guardianship Tribunal is a legal tribunal. It has the power to appoint legal guardians and/or financial managers for people with disabilities over 16 years of age who are not able to make decisions for themselves. The Tribunal can also consent to certain medical and dental treatments. The restricted practices, that require a legally appointed Guardian with authority to consent, are: Physical restraint and unwanted physical contact; Exclusionary time out Seclusion There is a lack of clarity from ADHC if the range of restricted practices requiring consent has been expanded to include most practices. Some cases may be referred to the Supreme Court eg, when invasive medical procedures are involved The behaviour intervention practices, which require a legally appointed Guardian to consent, are: physical restraint and unwanted physical contact; and exclusionary time out. The behaviour intervention practices, which require a legally appointed Guardian to consent, are: physical restraint and unwanted physical contact; and exclusionary time out.

25. RPA and Guardianship (cont.) When a restricted practice does not by law require an appointed Guardian�s approval, the service user or �person responsible� needs to be consulted and provide agreement to the use of the practice. RPA is designed to supplement and enhance the process of seeking consent from the Guardianship Tribunal, Guardian or responsible person. Whilst the Guardian can consent to the use of a practice, DADHC staff require RPA before they can implement a restricted practice so that they are operating within DADHC policy. RPA cannot override a Guardians objection to a restricted practice RPA cannot override a Guardians objection to a restricted practiceRPA cannot override a Guardians objection to a restricted practice

26. What happens before the RPA meeting� New behaviour of concern requiring staff to use a restricted practice Every occurrence of the relevant challenging behaviour must be recorded, eg data sheets (ABC), incident reports These reports should identify if a RP has been used or may be required to manage the behaviour Initial meeting for developing interim or planned RPA submissions The Service Supervisor should arrange an initial meeting as soon as practical and involve: The service user (when appropriate);�service supervisor or delegate; BIS practitioner;�direct support staff who know the person; the guardian or person responsible. Initial meeting for developing interim or planned submissions The unit manager or delegate will arrange an initial meeting as a soon as practical which would be attended by those involved including: The client (where applicable);�psychologist or BIS clinician;�unit manager or delegate; at least one person who has managed the behaviour; an invitation to the person responsible or guardian if appropriate; and�an advocate (where appropriate).�Initial meeting for developing interim or planned submissions The unit manager or delegate will arrange an initial meeting as a soon as practical which would be attended by those involved including: The client (where applicable);�psychologist or BIS clinician;�unit manager or delegate; at least one person who has managed the behaviour; an invitation to the person responsible or guardian if appropriate; and�an advocate (where appropriate).�

27. RPA Process (cont.) The meeting is to complete the following: Operationally define the behaviours of concern and behaviour cycle�(topography)� what when where how� Develop an interim incident response plan�� Develop / revise data collection formats Allocate tasks and time frames to complete work required for RPA (eg, LER, Behaviour assessment etc see workplan in RPA procedures). Review and update the Client Risk Management Profile, assess the risk and update the risk management plan ;and Minute the meeting, set time frames and allocate responsibilities for further assessment. Minute the meeting, set time frames and allocate responsibilities for further assessment.Minute the meeting, set time frames and allocate responsibilities for further assessment.

28. RPA Process Interim Authorisation There may be an urgent need to implement a restricted practice as identified in the above meeting. If this is the case, the service supervisor or delegate should seek interim permission from the Client Services Manager For interim permission to be granted consent from the appropriate Guardian must also be obtained eg Public Guardian. Interim Authorisation There may be an urgent need to implement a restricted practice as identified in the above meeting. If this is the case, the clinician/network manager should seek interim permission from the Manager, Behaviour Support. For interim permission to be granted consent from the appropriate guardian must also be gained. In the event that there is a public guardian appointed to the client concerned they will need to be contacted to gain interim consent.  Interim Authorisation There may be an urgent need to implement a restricted practice as identified in the above meeting. If this is the case, the clinician/network manager should seek interim permission from the Manager, Behaviour Support. For interim permission to be granted consent from the appropriate guardian must also be gained. In the event that there is a public guardian appointed to the client concerned they will need to be contacted to gain interim consent.

29. RPA Process The meeting recommends a restricted practice as part of PLANNED intervention. further documentation will be required to support this including: current Lifestyle and Environment requirements or Lifestyle Management Plan; Behavioural assessment report; Any relevant reports from other professionals eg, psychiatrists. Evidence of skill development programs; Incident Prevention and Response Plan; Evidence of staff training and an ongoing coaching strategy; and Monitoring and review procedures. � current Lifestyle and Environment requirements or Lifestyle Management Plan; behavioural assessment report; Any relevant reports from other professionals eg, psychiatrists. skill development programs; incident prevention and response plan; evidence of training and an ongoing coaching strategy; and monitoring and review procedurescurrent Lifestyle and Environment requirements or Lifestyle Management Plan; behavioural assessment report; Any relevant reports from other professionals eg, psychiatrists. skill development programs; incident prevention and response plan; evidence of training and an ongoing coaching strategy; and monitoring and review procedures

30. RPA Process � Panel Composition (proposed) A Behaviour Support Practitioner � Not the person making the submission (chairperson) A Client Services Manager or Director An independent person (independent to the process or agency). In the absence of an independent a CSM, BSP or AC can sit in their stead. The RPA panel consists of: A clinical consultant � usually a senior member A service manager A person independent � to the process or agencyThe RPA panel consists of: A clinical consultant � usually a senior member A service manager A person independent � to the process or agency

31. The RPA Panel Hearing (The �Approval Checklist�) Panel members will have read the information prior to coming to the panel meeting. The panel may ask for A brief picture of the situation; the person, the practice and why this practice is being used. Questions will generally be around the following: Quality of the Lifestyle and Environment Review and Behaviour assessment (if there is one);� the appropriateness of the restricted practice;�� staff implementation training;��� progress on recommendations made in reports;�� plans for implementation requirements - who will be responsible and when things will be completed;�� data collection formats and analysis;� guardianship and consent status; evidence that Individual Plans have been implemented. Quality of the Lifestyle and Environment Review and Behaviour assessment (if there is one);� the appropriateness of the restricted practice;�� staff training;��� progress on recommendations made in reports;�� plans for implementation requirements - who will be responsible and when things will be completed;�� data collection formats and analysis;� guardianship and consent status; evidence that Individual Plans have been implemented. Quality of the Lifestyle and Environment Review and Behaviour assessment (if there is one);� the appropriateness of the restricted practice;�� staff training;��� progress on recommendations made in reports;�� plans for implementation requirements - who will be responsible and when things will be completed;�� data collection formats and analysis;� guardianship and consent status; evidence that Individual Plans have been implemented.

32. RPA Panel Hearing cont. The panel will then make the decision about whether or not they will approve the practice/s. Practices will either be given approval for up to 12 months, not given approval, or given conditional/limited approval (usually be for periods less than 3 months) A number of recommendations will often be made at the RPA panel meetings with respect to what needs to be completed between the authorisation period; these will often need to be completed before further authorisation will be considered. The BSP sends the Service Supervisor and Area Coordinator a copy of the signed approval. BSP updates the RPA database The panel will set a date at each meeting for the next review of the plan if it is to continue.The panel will set a date at each meeting for the next review of the plan if it is to continue.

33. Documentation Required for Application Lifestyle and Environment Review / Plan Data collection documentation and summary. Behaviour intervention Plan, including Skill development plans, Reactive Strategy, etc. Evidence of staff training and support strategies. Current IP, and information on progress & goals Documented consent. Rationale for the practice Prior Improvement Plan (for reviews) Any other Relevant report, eg. psychiatrist report Various documentation is required to Support RP submissions, these are:- Lifestyle and Environment Review / Plan Data collection documentation and summary. Behaviour intervention Plan, including Skill development plans, Reactive Strategy, etc. Evidence of staff training and support strategies. Current IP, and information on progress & goals Documented consent. Prior Improvement Plan (for reviews) Any other Relevant report, eg. psychiatrist reportVarious documentation is required to Support RP submissions, these are:- Lifestyle and Environment Review / Plan Data collection documentation and summary. Behaviour intervention Plan, including Skill development plans, Reactive Strategy, etc. Evidence of staff training and support strategies. Current IP, and information on progress & goals Documented consent. Prior Improvement Plan (for reviews) Any other Relevant report, eg. psychiatrist report

34. Restricted Practices as part of a risk Management Plan Under our Duty of Care we put safeguards in place for many of our clients who may not have sufficient safety skills that can be viewed as restrictive We record and monitor these practices but may not need the level of documentation and level of scrutiny that some restricted practices may require, eg full BIS plan Still need a current Lifestyle and Environment Review, Client Risk Profile, and positive programs The Behaviour Support Policy (2009) makes no distinction between �safety skill deficit� restricted practices and other restricted practices

35. Lifestyle and Environment Review The Lifestyle and Environment Review is a process of reviewing a person�s current lifestyle and environment requirements. This review is to identify what actions might need to occur to improve the current lifestyle and address the behaviours of concern. � For the purposes of RPA, evidence of a current Lifestyle and Environment Review is required for all submissions as well as the implementation of the Panel�s recommendations for improvement. For the purposes of RPA, evidence of a Lifestyle and Environment Review is required for all submissions as well as the implementation of recommendations for improvement. For the purposes of RPA, evidence of a Lifestyle and Environment Review is required for all submissions as well as the implementation of recommendations for improvement.

36. Lifestyle Management Plan The recommendations from the Lifestyle and Environment Review should be acted upon, and written into the person�s updated Lifestyle Management Plan as part of their Individual Plan. It is to inform all support people of the person�s support needs in all aspects of daily living and any plans in place that need to be followed in order to meet the client�s needs effectively. Lifestyle and Environment Requirements or Lifestyle Management plan The recommendations from the Lifestyle Review should be written into the person�s updated Lifestyle and Environment requirements or Lifestyle Management Plan as part of their Individual Plan. It is to inform all carers of support needs in all aspects of daily living and plans in place that need to be adhered to in order to meet the client�s needs effectively. The Lifestyle Management plan prevents inconsistent or inappropriate support to the individual, which can trigger challenging behaviour Lifestyle and Environment Requirements or Lifestyle Management plan The recommendations from the Lifestyle Review should be written into the person�s updated Lifestyle and Environment requirements or Lifestyle Management Plan as part of their Individual Plan. It is to inform all carers of support needs in all aspects of daily living and plans in place that need to be adhered to in order to meet the client�s needs effectively. The Lifestyle Management plan prevents inconsistent or inappropriate support to the individual, which can trigger challenging behaviour

37. Behaviour Assessment Report*By Behaviour Support Practitioner Behavioural assessment involves the systematic collection of information about the person, the behaviour and their environment. A detailed functional analysis of the behaviours occurs A hypotheses or statement as to why the person engages in the behaviour of concern is generated Recommendations are then made for the environmental, skill building and reactive strategies � The complexity of the assessment will vary depending on the complexity of the client and their problem behaviours. � For the purposes of RPA, all submissions will require a behavioural assessment report with recommendations. The complexity of the assessment will vary depending on the complexity of the client�s needs. For the purposes of RPA, all submissions will require a behavioural assessment report with recommendations. The complexity of the assessment will vary depending on the complexity of the client�s needs.

38. Behaviour Management Plans Behaviour Support PlanBIS Plans   There are three main components of a behavioural Support Plan: The Lifestyle Management component Skill Development component Reactive Strategies/Incident Prevention Response Plan Skill Development component (functionally equivalent skill) Skill Development component (functionally equivalent skill)

39. Skill Development Plans (positive programming) Skill development, in behaviour intervention, are plans to teach the person skills to provide them with more efficient ways of having their needs met instead of using challenging behaviour. Skills taught may include coping skills, communication skills, social skills, anger management skills, or skills to enhance his or her independence and self esteem in doing things around the home, work, recreation, and community. The behavioural assessment informs what skills are required. Skill development programs need to be embedded in the Individual Plan for monitoring and timely review. Skill development programs need to be embedded in the Individual Plan for monitoring and timely review. However, function of behaviour needs to be considered so as not to inadvertently reinforce challenging behaviour.eg, an IPRP may suggest taking the client home when the behaviour occurs but if the client is using the behaviour to escape a situation or environment, this strategy will only reinforce the challenging behaviour. In this situation, a communication skill to indicate they wish to leave the environment would be an example of functional skill development. Again an assessment of the function of the behaviour in different contexts will inform as to the best way to respond so as not to reinforce challenging behaviourSkill development programs need to be embedded in the Individual Plan for monitoring and timely review. However, function of behaviour needs to be considered so as not to inadvertently reinforce challenging behaviour.eg, an IPRP may suggest taking the client home when the behaviour occurs but if the client is using the behaviour to escape a situation or environment, this strategy will only reinforce the challenging behaviour. In this situation, a communication skill to indicate they wish to leave the environment would be an example of functional skill development. Again an assessment of the function of the behaviour in different contexts will inform as to the best way to respond so as not to reinforce challenging behaviour

40. Examples of Skill Development Plans: A communication program that teaches a client how to say, �I don�t want to do that� instead of using assaultive behaviour to communicate the same message. A relaxation procedure that helps a person to manage their stress; A timetable that shows an anxious person what activity they�ll be doing next; An exercise class that gives an active person the opportunity to burn off some excess energy; A social skills group that shows a person how to appropriately interact with others Examples of Proactive Strategies:- A communication program that teaches a client how to say, �I don�t want to do that� instead of using assault behaviour to communicate the same message. A relaxation procedure that helps a client to manage their anger; A timetable that shows an anxious client what activity they�ll be doing next; An exercise class that gives an active client the opportunity to burn off some excess energy; A social skills group that shows a client how to appropriately interact with others Examples of Proactive Strategies:- A communication program that teaches a client how to say, �I don�t want to do that� instead of using assault behaviour to communicate the same message. A relaxation procedure that helps a client to manage their anger; A timetable that shows an anxious client what activity they�ll be doing next; An exercise class that gives an active client the opportunity to burn off some excess energy; A social skills group that shows a client how to appropriately interact with others

41. Incident Prevention & Response Plans Plans to prepare staff in advance on how to prevent, manage or end a challenging incident safely and effectively. Aim to provide a means of consistency in support. Should still have a focus on prevention of behaviours, not just response strategies. All people who know the client well should be encouraged to participate in the development and review of these plans.  Plans need to have endorsement from the person responsible and the unit manager. Not designed to teach the person anything, just aimed at safety and containment of the behaviourNot designed to teach the person anything, just aimed at safety and containment of the behaviour

42. Further reading DADHC resources available on the Intranet Behaviour Support: Policy and Practice manual (2009) Restricted Practice Authorisation (RPA) Mechanism: Operational Guide (June 2010) DADHC RPA procedures and templates (2006) DADHC Behaviour Intervention Policy (2003) Consent for Specific Behaviour Intervention Practices, Exchange of Consumer Information and for Medical and Dental Treatment Positive Approach to Challenging Behaviour, 1997 Guardianship act (1987) Guardianship act Guardianship act