Behaviours' of concern and the reality of needing restrictive practices.

 

I am going to be doing a very deep dive hear but I know that people want to talk about the NDIS and what is wrong with it but we are getting side tracked by the fact that people who aren’t in disability circles or don’t know anyone who receives support, don’t know how complicated it is to get onto any type of care scheme that is offered in commonwealth countries, and even then the level of support you get can be questionable, and for me I present as very high functioning because I am until I get fatigued or tired and then I need to be able to ask for support and I have a very hard time doing this but this bring me to introducing what I am going to be talking about and it something that is very hard and complex to explain, that is restrictive  practices and in a very broad sense they can fall into two categories, Approved restrictive  practices and unapproved restrictive  practices,  these are practices that are generally outdated and as evident in the name used without approval from the NDIS quality and safeguards commission.

I will say it and I know that this is an unpopular opinion to have but I see that in some cases restrictive practices are needed and some a simply common sense, in Supported independent living and other forms of disability housing. I have lived for the past 13months next to someone with extreme behaviours of concern and her team has the approval to use restrictions on her,  but before we can discuss the types of restrictive practices we need to be clear that they need to be a last resort before all other types of support have failed, this is including positive behaviour support, redirection, education, medication ( and this has its issues with safety)  and a lack of support worker training around medication management. 

We see that people need to be very aware that if there is approval to use these practices they don’t need to be reported every time but if they are used in a way that triggers the person then another solution needs to be found,  There is generally 5 types of restrictive practices and these can be further broken down into 4 subtypes of behaviour modification, modification of the environment and the last one is the most controversial chemical restraint’s so medication that is prescribed purely for the modification of behaviour when there are other more appropriate and less harmful practices that can be used such as distraction, and positive b Behaviour support we all have seen the kids on their best behaviour during the lead up to Christmas because Santa doesn’t come to naughty children, or see the child use manners to get the extra scoop of ice cream.

We are all capable to some degree of making decisions and one alternative is supported decision making, but what we see is this informal support formalized, and we see that this is where a  person is helped with big decisions that could have a major impact on their lives so, things like big fiscal decisions, big life decisions and decisions around there support and care, so this could be things like changing care agencies or making big medical decisions as well.

I do hope that we can have an informed discussion around trauma and disability as disability can cause all sorts of little T trauma comes in two forms big T trauma and little t trauma the big T trauma is the trauma that we all know as trauma, a child going through abuse, or divorcing parents, or all forms of abuse, and for dignity sake I will just put a link to abuse and lets not go too deep into abuse in this post as that deserves a post of its own.

Child abuse - Wikipedia

But we see that little t trauma is more suitable to spot and it’s not easily treated as it’s just seen as “bad behaviour” as we don’t as a society see things like overly  harsh discipline as trauma, or overly permissive parents, parents that are friends rather than parents, or even being parentified, so taking on a parental care role, for younger siblings or being a young caregiver for parents, we also have children being bullied at school and now online and if you don’t have the support at school or a diagnose ‘s to “explain behaviour, ( you will notice I say explain but not excuse as we are all to some extent in control of our reactions and behaviour so we need to be aware of that and simply disability doesn’t equal excuse’s)

In explaining this behaviour if a child knows that a person is autistic or has trouble processing things as well, a lot of children will be very understanding as well.

But this is where we see that trauma can form and not all children with a disability or in general have the skills or support to learn how to navigate these situations, we understand that people need to be able to understand what is happening around them, so we need to be able to teach them, and we need to be able to support them.

So this then about support means that we need to be trauma-informed and that is difficult as training for trauma or how to pick up trauma is limited in training to be a support worker there are some free courses, that people can do but being trauma-informed is not an easy thing to maintain as well, so let’s see what is happening as using restrictive practices without proper training and support and care, this means that we need to be able to understand what is happening when a person is exhibiting behaviours of concern and to understand this we need to know what is a behaviours of concern.

 

This will be my next post as we keep doing a deep dive into this topic as it needs to be discussed from both sides given that its something that can cause complex PTSD in support workers and other clients and this is where I am an advocate for bringing some institutions up to the current disability thinking but we do need safe places for people who will never be able to control their behaviour’s and to be able to work with others.

This is also deeply concerning to me as I have recently moved houses and  I am currently living next door to someone with behaviours of concern, so they are very real to me and we see that people need to be very aware of them as well. I am concerned that even within disability circles that people are” reframing” it as we aren’t listening behaviours, or that we aren’t paying attention. You could be paying all the attention in the world, but we see that people need to be very aware that they exist and do need to be managed and to work with them. 

We also need to respect that people do have their own journey with disability and we need to respect that and work with this as well.