Bringing life to the client voice in decisions regarding restrictive practices 24 March 2017
Introductions 1. Fiona Phipps Regional Manager, Statewide Services, Office of the Public Guardian 2. Darren Harris A/Team Leader, Positive Behaviour Support Team, Statewide Services, Office of the Public Guardian
Today’s presentation 1. About the Public Guardian 2. Restrictive Practices Framework 3. The Adult (client) 4. Complexity of the Adult’s world 5. Case Studies 6. Challenges 7. Questions
About us • Established on 1 July 2014 as a result of the Carmody Inquiry and the Public Guardian Act 2014 . • The OPG has all the functions and powers of the former Adult Guardian, the visiting functions of the former Commission for Children, Young People and Child Guardian (CCYPCG), and a new legal advocacy function. • Independent statutory officer – current Public Guardian is Natalie Siegel-Brown. • Not under control or direction of the Minister.
The purpose of OPG is to advocate for the human rights of our clients. • For our adult clients , this means advocating for their rights, access to services, independence and choice as part of a supported decision-making model. • For our children and young people clients , this means advocating for their rights, access to services and where appropriate, their independence and choice. • Advocacy means understanding the lives and views of our clients with the aim of promoting and protecting their human rights. Advocacy can mean working to prevent or address discrimination, abuse or neglect. Advocacy does not mean taking over a client's life or problems. Advocacy does not mean taking over the roles and responsibilities of other government agencies or service providers.
Organisational framework Public Guardian • Corporate Child Adult Adult community visitors Child community Guardianship/Statutory Health Attorney visitors Investigating abuse and neglect Child advocacy Protecting client’s legal rights Approve use of restrictive practices
OPG Guardianship function The Public Guardian can be appointed to make personal and health decisions, including legal decisions (not relating to property or finance); ‒ as Guardian appointed by Queensland Civil and Administrative Tribunal (QCAT) ‒ as Attorney when nominated under an Enduring Power of Attorney or an Advance Health Directive; ‒ as Statutory Health Attorney of the last resort
OPG Guardianship function The sorts of decisions that the Public Guardian can make include: • Accommodation • Health care (except special health care) • Service provision • Contact • Legal decisions (not relating to property or finance) • Restrictive practices • Other personal decisions
Community Visitor Program - adults • Community Visitors (CVs) protect the rights and interests of adults with intellectual, psychiatric or cognitive disability. • CVs regularly visit authorised Mental Health services, Level 3 supported accommodation and Disability Service funded accommodation sites. • CVs make inquiries and report on the services and standards maintained at the facilities in order to promote the rights and interests of the adults who live there or go there for periods of time for treatment. • They refer complaints that remained “unresolved”.
Restrictive Practices Framework • Public Guardian Act 2014 • Guardianship and Administration Act 2000 • Disability Services Act 2006 • Powers of Attorney Act 1998
Restrictive Practices Legislation applies to: • Adults (over 18) • GAA – s13A – Advance appointment • Who have an intellectual or cognitive disability, and • Who are receiving a disability services from a funded service provider, and • Whose behaviour represents a risk of harm to themselves or others.
Purpose of the Restrictive Practices Framework • Protect the rights of adults with an intellectual or cognitive disability by: a) Stating principles to be taken into account by funded service providers in providing disability services to those adults with behaviour that causes harm to themselves or others, and b) Regulating the use of restrictive practices by funded service provides in relation to those adults in a way that: i) Has regard to the human rights of those adults, and ii) Safeguards them and others from harm; and iii) Maximises the opportunity for positive outcomes and aims to reduce or eliminate the need for use of the restrictive practice, and iv) Ensures transparency and accountability in the use of the restrictive practices
Restrictive Practices definitions • Restrictive Practice – means any of the following practices used to respond to the behaviour of an adult with an intellectual or cognitive disability that causes harm to the adult or others – a) Containing or secluding the adult b) Using chemical , mechanical or physical restraint on the adult c) Restricting access of the adult • Harm to a person means – a) Physical harm to the person, or b) A serious risk of physical harm to the person, or c) Damage to property involving a serious risk of physical harm to the person
Restrictive Practices • Containment • Seclusion • Chemical Restraint • Physical Restraint • Mechanical Restraint • Restricted Access to Objects
Restrictive Practices • Contain an adult with an intellectual or cognitive disability means physically prevent the free exit of the adult from premises where the adult receives disability services, other than by secluding the adult, in response to the adult’s behaviour that causes harm to the adult or others • However, the adult is not contained if – a) the adult is an adult with a skills deficit under part 8, division 2, and b) the adult’s free exit from the premises is prevented by the locking of gates, doors or windows under that part
Restrictive Practices • Seclude an adult with an intellectual or cognitive disability means physically confine the adult alone, at any time of the day or night, in a room or area from which free exit is prevented in response to the adult’s behaviour that causes harm to the adult or others
Restrictive Practices • Chemical Restraint means the use of medication for the primary purpose of controlling the adult’s behaviour in response to the adult’s behaviour that causes harm to the adult or others. • However, the following are not chemical restraint: • using medication for the proper treatment of a diagnosed mental illness or physical condition; • using medication, for example a sedative, prescribed by a medical practitioner to facilitate or enable the adult to receive a single instance of health care under the GAA 2000 • To remove any doubt, it is declared that an intellectual or cognitive disability is not a physical condition.
Restrictive Practices • Physical restraint means the use, for the primary purpose of controlling the adult’s behaviour, or any part of another person’s body to restrict the free movement of the adult in response to the adult’s behaviour that causes harm to the adult or others. • Physical restraint can include: • blocks, holds, deflects, redirection, hair-pull releases, etc.
Restrictive Practices • Mechanical Restraint means the use, for the primary purpose of controlling the adult’s behaviour, of a device in response to the adult’s behaviour that causes harm to the adult or others to: • a) restrict the free movement of the adult, or • b) prevent or reduce self injurious behaviour. • The following are NOT mechanical restraint: • a) Using a device to enable safe transportation • b) Using a device for postural support • c) Using a device to prevent injury from involuntary movement (e.g. seizure) • d) Using a surgical or medical device for the proper treatment of a physical condition • e) Using bedrails or guards to prevent injury while asleep
Restrictive Practices • Restricting the adult’s access , at a place where the adult usually receives disability services, to an object in response to the adult’s behaviour that causes harm to the adult or others to prevent the adult using the object to cause harm to the adult or others • Can include: • sharps / forks / glass / china • shampoo / soap / toothpaste / toiletries / toilet paper • laundry items • DVDs / TV remotes / CDs / books / tablets / phones and other technology • pantry / fridge / freezer • electrical items, or • rooms of the house.
Voice and The Adult Office of the High Commissioner, Human Rights, United Nations http://www.ohchr.org Article 2 - Definitions "Communication" includes languages, display of text, Braille, tactile communication, large print, accessible multimedia as well as written, audio, plain-language, human-reader and augmentative and alternative modes, means and formats of communication, including accessible information and communication technology; "Language" includes spoken and signed languages and other forms of non-spoken languages
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