Public Hearing 6 of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability explored psychotropic medication, behaviour support and behaviours of concern.
Professor Leanne Dowse who is a Chair in Intellectual Disability and Behaviour Support at the University of NSW provided a statement and said that there is an important inter-relationship between the provision of positive behaviour support and the reduction or elimination of restrictive practices. The National Framework uses ‘positive behaviour support’ to describe ‘the integration of the contemporary ideology of disability service provision with the clinical framework of applied behaviour analysis’.
The National Framework focuses on identifying the underlying reasons for a person’s challenging behaviours (for example, any unmet needs), and formulating strategies to reduce their occurrence and impact, so as to ultimately ‘fade out’ the use of restrictive practices on the person.
Professor Dowse explained that positive behaviour support has been developed in Australia over the last 20 years or so and is now recognised as best practice for responding to behaviours of concern. She described positive behaviour support as ‘an evidence-based approach which focuses on understanding the purpose a behaviour serves for the person within their current environment’. According to Professor Dowse, positive behaviour support enables the individual to develop new skills and to restructure their environment.
The National Framework articulates:
Principles and strategies for maximising individualised behaviours support for people with disability, with the overall objective of reducing the occurrence and impact of challenging behaviour and the use of restrictive practices. This may include the provision of positive behaviour support and development of an individual behaviour support plan.
Public Hearing 6 also considered the definition of a Positive Behaviour Support Plan (PBSB). Ms Joyce-Lyn Smith, the Clinical Director of a business which provides support services to people with disability, offered the following general description of a PBSP:
A positive behaviour support plan is a document that is intended to identify why the person is displaying the behaviour they are displaying and what they need to do to prevent or minimise that behaviour from occurring. It is also intended to help the people around them to understand the person and why they may be displaying certain behaviours. A positive behaviour support plan should also record the plan or strategies to reduce and ultimately eliminate use of restrictive practices, including through slow and steady implementation of strategies.
Professor Dowse differentiated between ‘behaviour support practitioners’ and those who provide behaviour support to a person with disability. In her view, behaviour support practitioners should have specialised skills, prepare PBSPs and train those around the person with disability so they can understand and implement the strategies set out in the plan. She also said PBSPs should be based on ‘a thorough assessment of the person’s needs and context’. Professor Dowse recognised behaviour support plans may include the use of restrictive practices as a last resort when other behavioural support strategies have been shown to be ineffective.
Source: Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability Public Hearing Report: Public Hearing 6 (September 2021)