4' Physical restraint

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4. Physical restraint

• Physical restraint of an adult with an
  intellectual or cognitive disability means the
  use, for the primary purpose of controlling the
  adults behaviour, of any part of another
  persons body to restrict the free movement of
  the adult.

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Discussion PointIs this an example of physical
restraint?

• David has autism spectrum disorder and an
  intellectual disability. When certain stimuli or
  events occur unexpectedly, they can promote a
  severe and intense reaction from him such as
  hitting his fist against his ear causing
  significant injury. Support staff hold his arm to
  his side when the behaviour begins until the
  unpleasant or fearful stimuli can be removed.

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Discussion PointIs this an example of physical
restraint?

• What if Davids behaviour does not result in
  harm?
• What if Davids support staff physically place
  his hands in his lap?

4
Discussion PointIs this an example of physical
restraint?

• Thelma is a 57 year-old woman who receives
  disability support. She needs assistance to
  safely make a cup of tea. Staff use physical
  prompts such as holding her wrist or elbow to aid
  her.

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Discussion PointIs this an example of physical
restraint?

• What if Thelma has a history of throwing the hot
  water and causing harm to herself or others, and
  staff hold her arms by her side and guide her out
  of the kitchen to prevent her from using the
  kettle?

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5. Mechanical restraint

• Mechanical restraint of an adult with an
  intellectual or cognitive disability means the
  use, for the primary purpose of controlling the
  adults behaviour, of a device to
• restrict the free movement of the adult, or
• prevent or reduce self injurious behaviour.

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Mechanical restraint

• However, the following are not mechanical
  restraint
• using a device to enable the safe transportation
  of the adult for example, a cover over seat belt
  buckles, or a harness or strap.
• using a device for postural support
• using a device to prevent injury from involuntary
  bodily movements such as seizures
• using a surgical or medical device for the proper
  treatment of a physical condition
• using bed rails or guards to prevent injury to
  the adult.

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Discussion PointIs this an example of mechanical
restraint?

• Rebecca is a 20 year-old woman with a profound
  intellectual disability. Rebecca has a history of
  sucking on her hands. This has led to significant
  injury to her hands. In order to prevent her from
  sucking on her hands, Rebecca wears mittens on
  her hands while she is awake.

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Discussion PointIs this an example of mechanical
restraint?

• What if Rebecca didnt cause harm to her hands?
• What if Rebecca caused harm to her mouth?

10
Discussion PointIs this an example of mechanical
restraint?

• Lily is a 50 year-old woman with an acquired
  brain injury. Since the head injury, she has
  experienced uncontrollable tonic-clonic seizures.
  During the seizure, Lily will fall to the ground
  if she is standing. This has resulted in
  significant injuries to her head. Lily now wears
  a helmet any time that she is standing.

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Discussion PointIs this an example of mechanical
restraint?

• What if Lily intentionally hits her head against
  the wall causing injury to herself?

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Discussion PointIs this an example of mechanical
restraint?

• Adrian is a young man with an intellectual
  disability and autism. When travelling in the
  car, Adrian will become agitated and physically
  aggressive towards the driver if his preferred
  route is not followed. In order to allow one
  staff member to take Adrian out, a special
  harness, which Adrian cannot unlock, has been
  purchased. This harness prevents Adrian from
  being able to reach the driver.

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6. Restricting access to objects

• Restricting access of an adult with an
  intellectual or cognitive disability means
  restricting the adults access, at a place where
  the adult receives disability services, to an
  object to prevent the adult using the object to
  cause harm to the adult or others.

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Discussion PointIs this an example of
restricting access to objects?

• Frank is a young adult who has an intellectual
  disability. Frank has a history of setting fires
  when able to access matches or lighters. Setting
  fires represents a significant risk to Frank and
  those who support him. Frank is limited in his
  free access to matches. These are stored in a
  locked cupboard that he cannot access.

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Discussion PointIs this an example of
restricting access to objects?

• Debbie is a young adult who has an intellectual
  disability. She has a history of gorging on
  food if given free access to the pantry. This
  represents a significant choking hazard. Debbie
  is limited in her free access to food by locking
  the fridge and pantry.

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Discussion PointIs this an example of
restricting access to objects?

• What if Debbie doesnt choke on the food and is
  simply overweight and her parents, who do not
  like her to overeat, have requested staff to
  limit her access to the fridge?

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PART 3 REQUIREMENTS DURING THE TRANSITIONAL
PERIOD

• Transitional policies and procedures

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Policies and procedures

• The transitional operational policy and
  procedures detail what service providers must do
  to meet the transitional requirements.
• These documents can be accessed on the DSQ
  website
• www.disability.qld.gov.au

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What is the transitional period?

• The Act includes a transitional period of 18
  months to give service providers and other
  relevant parties time to undertake preparations
  to be able to comply with the full requirements
  of the legislation.
• The transitional period means the period starting
  on 1 July 2008 and ending on 31 December 2009.
• Service providers need to ensure that, during the
  transitional period, they are working towards
  compliance with the full requirements of the
  legislation.

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When does the transitional period end?

• The transitional period ends or stops applying
  when either of the following circumstances
  occurs, whichever comes first
• at the end of 31 December 2009, or
• when the relevant decision maker under the main
  scheme (in Part 10A of the Bill) makes a decision
  about whether or not to approve the restrictive
  practice.
• Note After entering into the full scheme,
  service providers cannot return to the
  transitional period.

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What does a service provider need to do?

• The Act provides that a relevant service
  provider is not criminally or civilly liable for
  using a restrictive practice during the
  transitional period in relation to an adult with
  an intellectual or cognitive disability if the
  following six requirements are complied with
• the service provider acts honestly and without
  negligence
• use of the restrictive practice is necessary and
  the least restrictive way
• there is either consent of an authorised guardian
  or a transitional assessment has been undertaken
• monitoring occurs and a review is held every nine
  months
• notification of containment or seclusion is sent
  to DSQ on Form 16-1
• the service provider keeps and implements a
  policy.

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1. Acts honestly and without negligence

• What does it mean to act honestly and without
  negligence?
• These are complex legal concepts, but as a very
  general guide
• Honestly If service providers are using the
  restrictive practice in good faith and are
  genuinely of the view that they are acting in the
  best interests of a person they can be said to be
  acting honestly.
• Without negligence This is an objective test
  how would a reasonable service provider act in
  the situation?
• How is this demonstrated?
• As we saw in the previous slide, there are six
  requirements that must be complied with. That the
  service provider acts without negligence is
  part of one of those requirements. Probably the
  best way for a service provider to ensure that
  they are using the restrictive practice without
  negligence during the transitional period is to
  ensure that they are complying with the other
  five requirements.

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2. Necessary and least restrictive

• Use of the restrictive practice is necessary to
  prevent the adults behaviour causing harm to the
  adult or others and is the least restrictive way
  of ensuring the safety of the adult or others.
• Least restrictive means the use of the
  restrictive practice in a way that
• ensures the safety of the adult with an
  intellectual or cognitive disability or others,
  and
• having regard to paragraph (a), imposes the
  minimum limits on the freedom of the person as is
  practicable in the circumstances.
• Harm means
• physical harm to the person, or
• a serious risk of physical harm to the person, or
• damage to property involving a serious risk of
  physical harm to the person.

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Discussion PointIs this necessary and least
restrictive?

• James is 30 years old and has an intellectual
  and physical disability. He spends his waking
  hours in a wheelchair. About once a month, when
  he is upset about something, James throws himself
  out of his wheelchair. About once a year, this
  leads to injury. The manager of the service has
  directed staff to ensure, that James is strapped
  into his chair at all times.

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3. Consent of an already appointed authorised
guardian or transitional assessment

• The service provider needs to ensure that
• if there is an authorised guardian for the adult
  in relation to the restrictive practice, the
  restrictive practice must used in compliance with
  the consent of these authorised guardians where
  they exist
• otherwise, the relevant service provider must
  undertake a transitional assessment
• The service provider must also notify DSQ by
  submitting Form 16-1.

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What is an authorised guardian?

• An authorised guardian for an adult with an
  intellectual or cognitive disability in relation
  to a restrictive practice means a guardian for an
  adult
• appointed before 1 July 2008 under the
  Guardianship and Administration Act 2000, and
• who is authorised under that Act, in accordance
  with the terms of the guardians appointment, to
  make decisions about the use of the restrictive
  practice in relation to the adult.

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What is a transitional assessment?

• A transitional assessment is an assessment of the
  adult to identify
• the nature and causes of the adults behaviour
  that cause harm to the adult or others, and
• strategies for managing the adults behaviour
  that cause harm to the adult or others, and for
  meeting the adults needs.

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When does the transitional assessment need to be
undertaken?

• For containment, seclusion or restricting access
  to objects, the assessment needs to be
  undertaken within six months from the day the
  service provider first uses the restrictive
  practice in relation to the adult, on or after 1
  July 2008.
• For mechanical, physical or chemical restraint,
  the assessment needs to be undertaken within nine
  months from the day the service provider first
  uses the restrictive practice in relation to the
  adult, on or after 1 July 2008.

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4. Monitoring of practice

• The service provider must carry out monitoring
  in relation to the use of the restrictive
  practice to ensure the safety of the adult
• The service provider must ensure that the
  restrictive practice is monitored regularly, and
  reviewed at least once every nine months.
• Monitoring is generally demonstrated through
  written records which, at a minimum, show the use
  of the restrictive practice.
• Other relevant data which shows the impact of any
  behaviour strategies is also desirable.

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5. Notification

• For containment or seclusion only within 60
  days of first containing or secluding the adult
  on or after 1 July 2008, the service provider
  must give notice to DSQ in the approved form of
  the containment or seclusion
• The approved form is titled Form 16-1
  Notification of containment or seclusion of an
  adult, and is available on the web at
  www.disability.qld.gov.au/key-projects/positive-fu
  tures/publications-resources.html

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• The information provided in Form 16-1 will be
  used for the purposes of planning support to
  service providers through Specialist Response
  Service teams, coordinating assessments and the
  development of positive behaviour support plans,
  and coordinating applications to the Guardianship
  and Administration Tribunal.
• This information will assist the Specialist
  Response Service team to identify adults who
  require a multi-disciplinary assessment and
  positive behaviour support plan to adhere to the
  full requirements during the transitional period.
• This form will only apply during the transitional
  period.

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6. Keep and implement a policy

• The service provider must keep and implement a
  policy about the use of restrictive practices
  during the transitional period that is consistent
  with DSQs policy
• For containment, seclusion or restricting access
  to objects, the policy needs to be kept and
  implemented within six months from the day the
  service provider first uses the restrictive
  practice in relation to the adult, on or after 1
  July 2008.
• For mechanical, physical or chemical restraint,
  the policy needs to be kept and implemented
  within nine months from the day the service
  provider first uses the restrictive practice in
  relation to the adult, on or after 1 July 2008.

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What does keep and implement mean?

• Keep and implement a policy means

• prepare the policy and keep it up to date, and
• when providing disability services, implement and
  comply with the procedures and other matters
  stated in the policy, and
• keep a copy of the up-to-date policy at premises
  where the restrictive practice is used, and
• ensure a copy of the up-to-date policy is
  available for inspection by the following

• staff of the relevant service provider
• guardians, informal decision makers or advocates
  for adults in relation to whom the restrictive
  practices are used
• a community visitor under the Guardianship and
  Administration Act 2000.

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What needs to be in the policy?

• The policy must outline the procedures a relevant
  service provider must use including
• if the relevant service provider is required to
  undertake a transitional assessment, assess an
  adult with an intellectual or cognitive
  disability, and
• ensure an individual acting for the relevant
  service provider who uses the restrictive
  practice in relation to the adult
• has sufficient knowledge of the requirements for
  lawful use of the restrictive practice, and
• has the skills and knowledge required to use the
  restrictive practice appropriately.

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What needs to be in the policy?
The policy must also outline the procedures a
relevant service provider must use including

• monitor use of the restrictive practice to
  safeguard against abuse, neglect or exploitation,
  and
• review use of the restrictive practice at least
  once every nine months, and
• if the policy is about restricting access to
  objects, minimise the impact on other persons
  living at the premises, and
• ensure appropriate regard is had to linguistic
  and cultural diversity and Aboriginal tradition
  and Island custom.

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• DSQ has provided you with copies of the
  transitional policies and procedures in your
  resource folder and copies of all the resources
  in this folder can be found on the DSQ website as
  previously identified at
• www.disability.qld.gov.au
• Service providers may use these documents to
  adapt to their specific needs or alternatively
  adopt them and adjust according to organisational
  needs.
• Service providers need to ensure that their
  policies and procedures are consistent with DSQs
  policies and procedures.

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Special requirements for chemical restraint
(fixed dose) in respite only

• There are slightly different requirements in
  relation to the use of chemical restraint (fixed
  dose) in respite only.
• This would only apply in situations where the
  only disability service that the client was
  receiving was respite, and the only restrictive
  practice being used was chemical restraint (fixed
  dose).
• Chemical restraint (fixed dose) means chemical
  restraint using medication that is administered
  at fixed intervals and times.
• In those circumstances, only requirement 1
  (service provider required to act honestly and
  without negligence), and requirement 6 (keep and
  implement a policy) apply during the transitional
  period.

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Discussion PointIs this an example of chemical
restraint?

• John is 19 years old and has a cognitive
  disability (and impaired decision-making
  capacity). He lives with his mother. John is
  prescribed medication by his doctor to subdue his
  episodic rages. He does not have a diagnosed
  mental illness. John accesses respite each month
  where he continues to take his prescribed
  medication in accordance with his doctors
  instructions and the consent of his mother.
• Would the special requirements for chemical
  restraint (prn) in respite apply to this
  situation?

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Key steps and activities
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Step 1. Identification
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Step 2. Authorised guardian
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Step 3. Initial review
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Step 4. Conditions of use
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Step 4a. Transitional assessment
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Step 5. Monitoring and review
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PART 4 REQUIREMENTS DURING THE FULL LEGISLATIVE
SCHEME
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Restrictive Practices Requirements Glossary
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Full legislative scheme requirements post-1
January 2010
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Important messages

• The legislation reflects the requirements for
  service providers who wish to use a restrictive
  practice in supporting an adult.
• The intent of the legislation and the scheme is
  to promote good disability support and reduce the
  use of restrictive practices.

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Stay informed

• The Specialist Response Service Implementation
  Branch wants to keep people and the disability
  services sector informed of requirements under
  the new Act during the transitional period.
• The branch will be sending out regular emails
  with the latest information.
• To stay informed, subscribe to our news service
  by emailing your name, organisation and email
  address to
• positive-futures_at_disability.qld.gov.au

Note This is a subscription service. Should you
wish to unsubscribe, you can do so at any time by
emailing the above address.