2. The Positive Programme System: a framework for positive behaviour support

3. Context of Project Stephan Van Vlijmen, Director of Accommodation, Nulsen  Background to project  Collaboration within sector  Support of DSC

4. Purpose of Project  Aim to build capacity within the direct support staff and front line managers in PBS  Staff are supported by the framework to achieve the outcomes to improve the quality of life for people with disabilities.

5. Restricted Practice  Currently no specific legislation in WA  Recognition that Restricted Practices were being used without approval  Desire for cultural change and a self regulation model for Restricted Practice authorisation

6. What are Restricted Practices?  Practices which reduce or restrict the rights or freedom of a person with a disability. These would not be acceptable to a non-disabled person in the community.  Illegal in some cases, and breaches the human rights of people in all cases.

7. What are Restricted Practices? Seclusion Chemical Restraint Mechanical Restraint Physical Restraint Restricted access Punishment Withdrawal of privileges

8. What are Restricted Practices? The INTENT of the practice: To punish? To teach a lesson? To teach a skill? To manage risk?

9. Restricted Practice Audit Amnesty period Consciousness raising Education Cultural Shift

10. Restricted Practice Audit Outcomes

11. Restricted Practice Committee Practice use Review Assessments Completed Documentation in place Check Staff training planned Plan to fade practice planned and review date Consider Approve with Review date Interim Approval No Approval granted Decide Informed consent sought Consent

12. Restricted Practice Committee Aim is to eliminate all restricted practices over time, AFTER ensuring that effective alternatives have been put in place.

13. Restricted Practice Approvals

14. Question is: What do we replace these practices with? Answer: Positive Behaviour Support Framework

15. A Framework for Systemic Positive Behaviour Support ProcessContentMaterials Systemic Support Plan Change Overtime PPR Client Design and Evaluation Procedural Reliability Critical Change Restricted Practice Audit PPR Frontline Managers Support Staff Specialized staff Support Staff Families Frontline Managers Specialised staff Clients Frontline Managers Support Staff Specialised Staff Families General Training Specific Training Compliance Continuum of Supervision Reduction in unapproved Restricted Practice Reduction in Severity and Frequency of Challenging Behaviour Minimized Client Risk Behaviour Increased application and Quality of Positive Programming Increased individual Multielement support elements clients Increased Procedural Reliability support staff Assessment Systemic Support Plan Mediation Dependent Variables Independent Variables

16. Positive Programme Review – Initial Outcomes  Based on Periodic Service Review – LaVigna, Willis et al (1994)  Group homes – 52 Standards  Alternatives to Employment – 52 Standards  Respite Centre Based – 48 Standards  Respite In home – 33 Standards

17. PPR Scores per Unit

18. Decreased Challenging Behaviour Upon starting the project limited data collection existed, mainly in the form of incident reports Graphing of frequency data was introduced Programme managers can see data in real time using Nulsen document management system Data is sent to treating doctors, families and others as appropriate

19. Frequency Chart - Behaviour

20. Risk Management – Group Home

21. Risk Management - ATE

22. Procedural Reliability Also known as Specific Training Addresses the issue of procedural slippage Quality and quantity reviewed through Positive Programme Review Verbal, simulated and in situ reliability monitored for procedures across the organisation

23. Overall Reliability

24. Reliability Cross Check Five standards on the PPR provide a cross check of Procedural Reliability Verbal reliability – reactive strategy Independent procedural reliability check Reviewer observes skill training session Check of notes to match reactive strategy use to last incident Reviewer records any incidents occurring at home and cross checks with staff recording

25. Awareness Training Online – easy access Lower cost – administration and replacement costs Units recycle for ongoing accreditation Can be customised for individual services

26. Staff Coping and Resilience Measure the job related stress of staff twice yearly Identify staff groupings who may be experiencing stress or burnout related to work Provide support or respite for these staff

27. Emotional Exhaustion

28. Model Strengths Advantages of a Multi-Element, Non Linear model – All of the framework elements provide cross checking Eg. Risk is captured in the audit, examined in restricted practice approvals, risk management is checked in Positive Programme Reviews Implementation of elements for each person’s support plan is encouraged in each of the activities required for the framework implementation

29. Barriers Stephan Van Vlijmen, Nulsen Length of Project timeline – 1 year Service design not always conducive to the framework Cultural issues Organisational structures Skilled staff availability

30. Future Directions 7 months of project time left Contributing to the development of WA policy for restricted practice Some small side line research projects happening Ongoing take up of the framework within the sector in WA

32. Contacts Stephan Van Vlijmen Director, Accommodation S_VanVlijmen@nulsen.com.au Cindy Wieman Manager, Positive Behaviour Support C_Wieman@nulsen.com.au