Family & Community Services RESTRICTIVE PRACTICE . AUTHORISATION (RPA) IN NSW NDS FORUMS April/May 2019 1
Recap 2
States and Territories, including NSW, are responsible for managing the authorisation of regulated restrictive practices. NSW has an interim policy for authorising Restrictive regulated restrictive practices. It started on 1 July 2018 with the full-scheme NDIS. The interim policy Practice will end on 30 June 2020. NSW Government will design how NSW will authorise regulated restrictive practices from Authorisation 1 July 2020. in NSW 3
In NSW, there are three requirements for the use of a regulated restrictive practice: 1. A Behaviour support plan is developed, and 2. Informed consent is obtained by the participant or their guardian, and 3. Authorisation is approved by a restrictive practice authorisation panel Regulated (RPA Panel) managed through internal policy and procedures of the registered NDIS provider. Restrictive Restrictive Practices should be: Practices Person centred Least restrictive response Used for the shortest possible time Focused on the reduction & elimination of the practice Monitored Reviewed regularly. 4
Restrictive Practice Authorisation (RPA) serves to: appraise the need, risk, applicability and outcome of a regulated restrictive practice for a person with disability with reference to the person’s needs, quality of life and living context enable the use of regulated restrictive practices as a component of a Restrictive documented behaviour support plan ensure that people who receive a behaviour support service are protected Practice from exploitation, abuse, neglect, and unlawful and degrading treatment ensure that consent is in place for any recommendation for the use of a regulated restrictive practice Authorisation consider the appropriateness of a documented support plan or strategy ensure the appropriate documentation is available and contains information that is sufficiently evidence based to justify the strategies being requested, and ensure the timely reduction and cessation of regulated restrictive practices. 5
Requests for RPA must be submitted via the NSW (FACS) RPA System by the NDIS Provider or Behaviour Support Practitioner All registered NDIS Providers must have an RPA mechanism that comprises a properly constituted RPA Panel which meets membership requirements Membership will comprise as a minimum, a senior manager of the NDIS Provider and a specialist who is independent of the service provider and the person . Additional panel members may be included according to an individual provider’s preference The senior manager of the NDIS Provider is to be the chair of the RPA Panel. No member of the RPA Panel can also bring forward an application for the RPA Panel’s consideration Authorisation The NSW government has established a pool of Restrictive Practices Authorisation Independent Specialists to ensure that registered NDIS Providers have access to requirements appropriately qualified behaviour support practitioners to support the operation of provider RPA Panels The RPA Panel considers the appropriateness of a documented behaviour support plan and evaluates the recommendations in the context of the NDIS Provider’s operations, as well as the appropriateness of the strategy to achieve the intended therapeutic outcomes The RPA Panel’s decision to authorise a regulated restrictive practice is to be unanimous . On making its determination the RPA Panel specifies the length of time for which the authorisation applies, not exceeding 12 months Decisions of the RPA Panel are recorded in a formal Outcomes Summary in the NSW (FACS) RPA System. 6
engagement is increasing The good news 7
Rich data - distribution of regulated restrictive practices 8
About – Planned vs Interim 9
Regional Metro All Panel meetings 401 431 Panel meeting with FACS IS 129 128 RPA Panel Meetings Metro, 128 Independent Regional, 129 Specialists 401 431 All panel meetings Panel meeting with FACS IS 10
Main Themes: Main Themes: • • Definitions and policy are clear Limited funding in NDIS plans to create and update BSP’s, and to • RPA system and dashboard participate in the RPA process Sentiment • • Self assessment tool and Thin behaviour support market guidance documents • analysis Chemical restraint, specifically • Support from the Central PRN and its use for behaviours Restrictive Practices Team of concern/mental health • • Access to Independent Support planners stating that Specialists funds can not be allocated for restrictive practice related needs • ‘Amazing panels’, ‘great behaviour support practitioners ’ • High volume of unauthorised restrictive practices • Well managed Panels 11
13.6% Chemical Restraint 6.5% System themes – questions 5.8% Policy 5.2% Non purposeful risk 4.5% Scope of requirements 4.2% Transition timeframes 3.9% Consent 3.2% Definitions - clarity in practice 2.6% Reporting requirements 1.9% Definitions 1.9% Policy - clarity in practice 1.6% Chemical restraint - clarity in practice 1.6% Environmental Restraint 1.6% Mechanical Restraint 1.3% Independent Specialists 1.3% Interim practices 1.3% Panel 1.3% Reportable Incidents 1.3% Resources 12
Enabling access to the RPA System 13
Why is 1 3 4 2 engagement Manage information Comply with Decisions are important? Submit requests NSW on RPA in one single recorded and for authorisation Government accessible location. reduction and through the elimination can be policy and RPA FACS RPA requirements. evidenced. System. 14
Work with the Q&S Commission on known issues What Refine the FACS RPA System based on user FACS is feedback doing to Develop key resources to support policy and improve practice support the sector Assess risks and work collaboratively with providers to address the issue/s Communicate in an open, engaging way and be responsive to questions and concerns 15
Clarification Points 16
• A review of an RPA is required when a RPA Panel decides to monitor the progress of the implementation and/or the enacting of their recommendations. The review of a submission can occur at any time within the authorisation period, once or according to a schedule of multiple reviews. While often requested by an RPA Panel, it can also be requested by those implementing the practice. What is a • The review process ensures that the recommendations made by RPA Panels are being progressed by NDIS Providers as a part of their commitment to the reduction and elimination of regulated restrictive review of a practices. It also provides the opportunity for NDIS Providers to provide feedback to the RPA Panel in regards to any constraints they are facing or RPA any improvements gained by enacting these recommendations. • It is important to remember that a review is not a re-authorisation, or renewal of authorisation which is about to expire. As such, the date of review and the date of expiry should not be the same. These dates should also not occur within a short time frame of each other. When setting a review date, consideration to the expiry of the authorisation should be given to allow time for NDIS Providers to action recommendations and collect data, and to avoid the duplication of information when submitting for re-authorisation. 17
• Re-authorisation is required where the person has an existing regulated restrictive practice in place which is authorised, however it is due to expire or has expired. • When seeking a re-authorisation for an existing regulated restrictive practice within the NSW (FACS) RPA System, a new RPA Submission must be created. This ensures that information and documents supporting submissions for re-authorisation are updated on at least an annual basis. What is Re- This is in line with the NDIS Restrictive Practices and Behaviour Support Rules 2018 requirement of behaviour support plans being reviewed every 12 months. authorisation • When a new RPA submission is created, the form will pre-populate with all historical submissions that have been completed within the NSW (FACS) RPA System. NDIS Providers and the RPA Panel can refer to this when completing new submissions. • If a regulated restrictive practice is being implemented where the authorisation has expired, it is considered to be a reportable incident and providers are obliged to notify the NDIS Commission’s Reportable Incident Team. 18
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