Restrictive practices

Restrictive practice means any of the following practices used to respond to the behaviour of an adult with an intellectual or cognitive disability (‘the Adult’) that causes harm to the Adult or others –

• Containment means physically preventing 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. It is not regarded as containment if the Adult has a skills deficit (e.g. lack of road safety skills) and the Adult’s free exit from the premises is prevented by the locking of gates, doors or windows to prevent the Adult from being subject to harm.
• Seclusion means to 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.
• 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 use of medication for the proper treatment of a diagnosed mental illness or physical condition is not chemical restraint. An intellectual or cognitive disability is not a physical condition.
• 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 that restricts the free movement of the Adult or prevents or reduces self-injurious behaviour.
• Physical restraint means the use, for the primary purpose of controlling the Adult’s behaviour, of 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.
• Restricting access means restricting the Adult’s access, at a place where the Adult 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.

An order about restrictive practices can only be made for an Adult who receives services from a relevant service provider.  The use of restrictive practices in response to challenging behaviours can only occur when it can be demonstrated that other less restrictive practices are not sufficient to protect the person and/or others from harm.

Generally, only QCAT can approve the use of containment and seclusion. However, if a guardian for restrictive practices (respite) has been appointed, they can approve the use of containment and seclusion but only for the period of time the adult is receiving respite and/or community access services.

Only the Department of Child Safety, Seniors and Disability Services can make an application for containment and seclusion for an adult in an accommodation setting. However, if a non-government service provider is involved, the application must be made jointly by the Department of Child Safety, Seniors and Disability Services and the service provider.

The following approvals are required (except when the adult is only receiving respite care and/or community access):

Restrictive practice	Approval required from
Containment or seclusion	QCAT
Mechanical, physical or chemical restraint	Guardian for restrictive practice (general) appointed by QCAT
Restricting access to an object	Guardian for restrictive practice (general) appointed by QCAT or an informal decision maker (see section 144 of the Disability Services Act 2006)
Any form of restrictive practice plus containment and seclusion	QCAT

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The following approvals are required when the adult only receives respite and/or community access services:

Restrictive practices	Approval required from
Containment or seclusion	Guardian for restrictive practice (respite) appointed by QCAT
Restricting access to an object	Guardian for restrictive practice (respite) appointed by QCAT or if no guardian appointed, an informal decision maker
Mechanical or physical restraint	Guardian for restrictive practice (respite) appointed by QCAT or if no guardian appointed, an informal decision maker
Chemical restraint - (as and when needed) for an adult in respite	Guardian for restrictive practice (respite) appointed by QCAT
Chemical restraint - (as and when needed) for an adult with community access	Guardian for restrictive practice (respite) appointed by QCAT
Chemical restraint - fixed doses for an adult in respite	Informal decision maker or guardian for restrictive practices (respite) appointed by QCAT
Chemical restraint - fixed doses for an adult with community access	Guardian for restrictive practice (respite) appointed by QCAT

The use of restrictive practices must be accompanied by a positive behaviour support plan that emphasises the development of positive, socially valued skills as well as strategies for reducing challenging behaviour. The objective of this plan is to eliminate as much as possible the need for the restrictive practice.