Restrictive practices part one,
This is a post that I have been putting off writing because
of its potential content but it needs to be talked about, and discussed at length
due to it being such a grey area and it needing defining in how these practices
are used.
So what am I hammering on about well, it’s restrictive practices.
Reactive practices – I have a video on YouTube very generally
explaining what it is and how they are used So I will do a couple of posts
around this topic this post will start with what is a Restive Practice. So from my understanding, they are any form
of practice that restrict the person’s movement, environment, and the usage of
chemical restraints as well as physical restraints.
However they need to be used within the context of what is
called a positive behaviour support plan, this is a plan where a person is granted
more and more freedoms as their behaviour improves through education and
training, this is where goal setting is
really important as well, due to goals being linked back to a person plan, and
therefore their goals. Or in a long-term
case to see what diversional activities can be put into place in a disability setting.
These practices are generally used in residential, disability
settings so this could be either a sill house (supported independent living )
or an SDA home ( specialist disability accommodation) where the care is embedded
in the housing due to the setup of the housing supports. Most housing unless it
is set up as the person’s home that they own and renovated is through a disability
service provider. ( I will do a post on
a good and a bad agency and don’t judge an agency by it’s workers)
But the problem with using these practices is that a person’s
whole support network needs to be involved so both their formal and informal support
and this can create problems, such as what context is the positive behaviour
plan used, so is it just with formal support or informal support as well, does the person’s gardeners have access to
all of the information about how and why the plan and practices will be used
and under what guidelines.
So this is where things get complicated because there are
two sets of legislation in play and we see that one can be used earlier than
the other so, it depends very much on the situation at play to what piece of legalization
is used. It could be either the NDIS act [i]Or
the appropriate state legislation, the
NDIS act is federal and it is this gap that causes issues.
It all falls to what is appropriate under the state and
federal laws so the issues are freedom of movement, however, in some severe impairments,
this restriction of movement is very “reasonable and necessary,” much like
checking that passengers have seat belts on in the car, or that a young child has
adult supervision to cross the road.
However, the issues arise when it comes to abuse of power
and the lack of training in positive behaviour support, so you would need a positive
behaviours support specialist, to train the support workers to be able to work with
the client, with complex needs. As well
as working with the family to be able to see if there is a root cause of the behaviour
that can be addressed to eliminate the need for the restrictive practices.
So an easy example is a person who acts out in anger but we
discover that their home life is very unstable and in the positive behaviours practitioner
working with the family they get the family stable and the person into appropriate
care away from the family the behaviour with the appropriate counselling and
education can deescalate into a very stable person. However there needs to be the appropriate
family support in place if the person is living away from home and behaviour’s
that are tolerated in the family home aren’t tolerated in the disability setting
this is where frustrations of a support worker and other providers can be set
up to fail, so we need everyone on board.
This is where organisations like the public trustee and QCAT
( I am talking from a Queensland perspective) have their place, however they
are not without issue and there are others that are better equipped, to discuss
these issues, within these organizations.
The most controversial of the restrictive practices. Is the
usage of chemical restraints when all else fails, but this is very controversial
as this is the usage of psychotropic medications,[ii]
these are medications that modify or control a person’s behaviour, so but the problem
is that at times these can be used, inappropriately and have a long list of
side effects as well.
So in all disability settings, the medication is locked up
and there is a medication usage form filled out to ensure that the quality and appropriate
usage of medications is supported and that the participant is receiving appropriate
other strategies to support behaviour, so this is education, training, counselling
and having appropriate nutrition in their lives as well as access to meaningful
activities.
What I am meaning by meaningful activities are activities that
an appropriate to the developmental and physical age of the participant, so
things as drawing, the occasional movie, and community engagement if they can
help with cooking simple meals.
This is a shorter post today but I feel that chemical restraints
needs it’s own post to be talked about as well.
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