Restrictive practices
Authorised Program Officers (APOs) review all behaviour support plans that include proposed use of regulated restrictive practice(s).
The Department of Families, Fairness and Housing defines a restrictive practice as… ‘any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with a disability’.
A regulated restrictive practice is any restrictive practice that involves seclusion, chemical restraint, mechanical restraint, physical restraint or environmental restraint.
A regulated restrictive practice must only be used in limited and specific circumstances. Its use must be justified based on evidence and/or data.
A regulated restrictive practice can only be authorised where the evidence indicates the person or others are at risk of harm.
A regulated restrictive practice cannot be included in a Behaviour Support Plan just because people think (are fearful) that something might happen.
Any authorisation of a regulated restrictive practice should be accompanied by a formal monitoring plan and a fade-out or elimination plan.
Restrictive practices must be proportionate and justified in order to protect the rights or safety of a person with disability or others.
They must only ever be used:
- as a last resort,
- as the least restrictive practice possible, and
- for the shortest period of time possible, under the circumstances.
Restrictive practices are governed under international conventions, Commonwealth legislation and NDIS policy.
State and territory requirements also apply and differ, so an APO must be familiar with these legal requirements as part of their role.
All restrictive practices must be included in a person’s behaviour support plan.
They must always be reviewed and authorised by the APO and Victorian Senior Practitioner (where required) before they can be used.
The Victorian Senior Practitioner’s Office publishes further information in its e-Learning modules, including What are restrictive practices?
The Victorian Senior Practitioner also provides information about directions and prohibitions for the state of Victoria.
Regulated restrictive practices
Legal definitions
The Disability Act 2006 definitions aligns with the NDIS (Restrictive Practices and Behaviour Support) Rules definitions for regulated restrictive practices.
Chemical restraint
Chemical restraint:
- the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour.
- does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition.
Find out more about working with chemical restraints.
Environmental restraint
Environmental restraint:
- restricting a person’s free access to all parts of their environment, including items or activities.
Find out more about environmental restraints by watching the video by the Department of Family, Fairness and Housing and reading Why is that locked? (downloads Word doc).
Mechanical restraint
Mechanical restraint:
- the use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour
- does not include the use of devices for therapeutic or non‑behavioural purposes.
Find out more about recognising and reducing mechanical restraints (downloads Word doc).
Physical restraint
Physical restraint:
- the use or action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour
- does not include the use of a hands‑on technique in a reflexive way to guide or redirect a person away from potential harm/injury, consistent with what could reasonably be considered the exercise of care towards a person.
Find out more from the Physical Restraint Direction Paper and Guidelines (downloads Word doc).
Seclusion
Seclusion:
- the sole confinement of a person with disability in a room or a physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted.
Plain(er) language definitions
In plainer language, the NDIS Commission defines types of restrictive practices.
Chemical restraint
When the person is given medicine to stop or reduce their behaviour.
Use the medication purpose form (opens PDF doc) to help clarify the purpose of the medication.
Find out more about working with chemical restraints.
Environmental restraint
When the person is stopped from having or doing certain things.
Or when the person is stopped from accessing certain places in their home or community.
Find out more about environmental restraints by watching the Department of Family, Fairness and Housing’s video.
Mechanical restraint
When a device or equipment is used to stop or reduce a person’s behaviour.
It can make it hard for them to move or access a certain part of their body.
Physical restraint
When someone holds the person or a part of their body so they cannot move freely.
They hold the person to stop or reduce their behaviour.
Seclusion
The sole confinement of a person with disability in a room or space where voluntary exit is prevented or it is implied that they cannot exit voluntary.
For example, they might be in a locked room. They might be told that they cannot leave, even if the door is open.
Find out more through the Victorian Senior Practitioner’s e-Learning module, What are restrictive practices?
Working with chemical restraint(s)
One of the challenges in working with chemical restraint(s) is determining whether the medication is a restrictive practice.
Medications can be prescribed for many different purposes. This means there is no definitive list of medicines that are chemical restraints.
A particular medication is not in itself a chemical restraint. Rather, it is the purpose the medication is used for that may or may not constitute a chemical restraint.
For one person, a particular medication might be an essential treatment for an identified medical condition. For another person, this same medication might be a chemical restraint.
Similarly, for one person a specific dose of a medication on a regular basis might be an appropriate treatment option for their identified medical condition (eg: anxiety or depression).
Meanwhile, an ‘as needed’ (also called ‘episodic’ or ‘PRN’) use – or increase in use – of this same medication for a different purpose could be considered a chemical restraint.
An example could be using the medication when needed to reduce agitation or the likelihood of a behaviour escalating in response to everyday activities, such as bathing or eating a meal.
The NDIS Commission’s medication purpose form is a useful form that can be used to seek clarification from the prescriber as to the purpose and use of a medication.
It can be included with a Behaviour Support Plan to provide the necessary information to identify if a medication is a treatment for an identified condition or if it is a chemical restraint.
The Medication Purpose Form (opens PDF doc) can help APOs clarify the intended purpose of the medication and to ensure restrictive practices are:
- identified,
- only ever used as a last resort,
- used legally,
- improve the person’s quality of life,
- authorised,
- monitored, and
- working toward being reduced and eliminated.
When working with the person’s general practitioner, psychiatrist or other prescriber, APOs are likely to find completing as many of the background details as possible on the form to support the prescriber helps them complete the required paperwork efficiently and results in a faster return process for APOs.
APOs can also refer to the Therapeutic Goods Administration (TGA) guidelines to understand whether a medication is officially classified as therapeutic treatment for managing a health condition. This website includes searchable medications and Consumer Medication Information (CMI), which lists the formal approved uses for the safe and effective use of medication in Australia.
Sometimes a medication might be prescribed as a treatment for which it is not usually prescribed. This is called prescription 'off label'. If a medication is being prescribed 'off label', the APO may need to seek further clarification from the prescriber regarding the intent of the medication. This can be done using the Medication Purpose Form (opens PDF doc). Find out more about working with medical doctors/general practitioners.
The NDIS Commission’s Regulated Restrictive Practices Guide (2020) includes a chemical restraint decision tree to support with decision-making around what constitutes a chemical restraint (see page 13).
The Department of Families, Fairness and Housing also provides information about chemical restraint for Authorised Program Officers (opens PDF doc).
Reducing restrictive practices
A key role of the APO is to help to reduce the use of restrictive practices in behaviour support.
APOs must be vigilant for red flags and support their team in reviewing the progress of behaviour support plans (see more information for Authorised Program Officers, including when working with disability service providers (downloads Word doc) and registered NDIS providers (downloads Word doc)).
APOs therefore need to understand the use of regulated restrictive practices, how to minimise them and, wherever possible, work towards stopping them altogether.
Consider whether there are alternative approaches considering this limitation. Remember you can always contact the Victorian Senior Practitioner for advice.
Fade-out strategies
Fade-out strategies are plans to appropriately reduce or eliminate the use of restrictive practices, in line with the Victorian Disability Act 2006.
A duty of the APO is to ensure a person’s behaviour support plan includes steps for fade-out strategies, including timeframes.
If fade-out strategies are not included for each proposed restrictive practice, the APO should question this and seek the inclusion of such strategies.
It is also important to monitor this action, revisiting the fade-out strategy in the person’s next plan to ensure continuity and movement toward fade out, where appropriate.
Evidence of fade-out strategies or movement toward fading out should be documented. This could include a designated fade-out plan and supporting skill-building strategies.
There should be clear documentation detailing how staff will implement, document, monitor and review the fade-out plan.
This might include documenting discussions with the person with disability and people in their support network about less restrictive alternatives, and successes and failures.
A chemical restraint medication fade-out plan template is available under the Department of Families, Fairness and Housing’s resources for Authorised Program Officers.
The APO needs to be alert to the possibility that established plans that work successfully may result in a fear of reducing restrictive practices.
Every person has the right to have the least restrictive practice possible used and have their restrictive practice(s):
- reassessed regularly, and
- used only ever as a last resort.
As such, APOs will need to work with provider staff, Behaviour Support Practitioners, families or others, to assess the situation and work to ensure the person’s rights and quality of life remains at the centre of their care.
Find out more about working with support networks, families and carers.
Remember, a regulated restrictive practice should not be included or continued in a Behaviour Support Plan simply because people think (are fearful) that something might have happened in the past or might happen in the future.
There must be clear evidence (recent data) that the identified behaviour is more than likely to occur and that less restrictive alternative strategies have been insufficient.
When reducing restrictive practice(s) may not be feasible
There may cases where reducing restrictive practices is difficult due to a person’s environment, current skill level or other factors.
In these cases the person still has the same rights as others and the restrictive practices must therefore be regularly reviewed, with the aim of trying to reduce and eliminate them where possible. Circumstances may change, so every person deserves this right of review with an open mind.
If restrictive practices are not reduced when reviewing a plan, check there is strong formally documented evidence provided as to why this decision has been made and who was consulted as part of the process.
This should always include a plan to increase quality of life and support the reduction of restrictive practice(s), even in cases where the steps may be small.
Also check that a timeframe has been set for next reviewing these restrictive practices, with the aim of identifying ways to reduce them where possible.
Prohibited restrictive practices
Prohibited practices are:
- prohibited forms of physical restraint, and
- the use of seclusion with children under the age of 18.
Refer to restrictive practice prohibitions under Section 27(5B) (opens PDF doc), published by the Department of Families, Fairness and Housing.
Also watch the prohibited physical restraint animation, published by the Department of Family, Fairness and Housing.
Any identified, alleged or suspected use of prohibited restrictive practices must be reported.
Report to the Victorian Senior Practitioner’s Office via email: RIquestions@dffh.vic.gov.au.
High-risk restrictive practices
Dangerous physical restraint
Some restrictive practices are considered high-risk and should never be used, including certain forms of physical restraint and punitive restrictive practices.
The NDIS Commission (opens PDF doc) states: ‘High-risk regulated restrictive practices are practices that place the recipient at high risk of harm and may constitute or result in abuse, unlawful physical contact or neglect of a participant.’
Table 1 on pages 2 - 4 of Practice Alert – High-risk restrictive practices includes details of high-risk restrictive practices, examples of the restrictive practices and associated risks.
The practices include:
- basket hold
- prone restraint,
- supine restraint,
- takedown techniques,
- pin downs,
- any physical restraint that inhibits breathing or digestive functioning,
- any physical restraint that pushes the person’s head forward onto their chest,
- any physical restraint that inflicts pain, including hyperextending joints or applying pressure to the chest or joints.
Punitive restrictive practices
Other high-risk practices include those that can be considered emotional, psychological and/or social abuse.
This includes using physical force or humiliation as punishment, or denying basic needs or verbally scolding a person.
Table 2 (pages 4 - 6) of the NDIS Commission’s Practice Alert – High-risk restrictive practices includes details of punitive approaches that present high risk to participant health, wellbeing and safety, including definitions, examples and risks.
These can include:
- aversive practices
- response cost
- limiting or denying access to culture
- overcorrection
- denial of key needs
- degradation, and/or
- vilification.
The NDIS Commission states that ‘any high-risk restrictive practices must be ceased immediately and replaced with proactive and evidence- informed alternatives’.
Unauthorised restrictive practices
Unauthorised restrictive practices can be:
- restrictive practices that are in use, but that have not been authorised or registered,
- restrictive practices that are prohibited and are in use, and/or
- restrictive practices that are proposed (or enforced) by an unregistered NDIS provider (for NDIS plans).
Unauthorised practices – including alleged or suspected unauthorised practices – must be reported within 5 days of becoming aware of the incident.
Find out about reporting to the NDIS on their website.
State-funded supports (through disability support providers) should be reported in State-based portal under ‘emergency reporting’.
Report concerns of neglect, harm or abuse
An APO safeguards both the person with disability, the people implementing the plan and their organisation.
Find out more about preventing and responding to abuse and neglect from the Disability Services Commissioner.
All suspected abuse or neglect should be reported to the relevant authorities.
Police:
- dial 000 immediately for emergencies
- non-urgent abuse or concerns: 131 444
- Crime Stoppers (Anonymous): 1800 333 000
NDIS Quality and Safeguards Commission (for NDIS providers or workers):
Child abuse:
- Report child abuse (Victoria Police) – always call 000 in an emergency
- Make a report to Child Protection
- Child Protection (Emergency): 13 12 78 (after hours)
Victorian Disability Services Commissioner:
- 1800 677 342
- Make a complaint (including online complaints form)
Victorian Disability Worker Commissioner:
- 1800 497 132
- Completing an online form
Disability Abuse/Neglect: 1800 880 052 (Hotline)
The Victorian Senior Practitioner provides information about directions and prohibitions for the state of Victoria.
Find out how to report unauthorised restrictive practices.
Reporting breaches to the NDIS
Reportable incidents must be reported through your organisation’s incident management system. All organisations must have an incident management system to be registered with the NDIS.
Reportable incidents relate to events that involve the:
- death of,
- serious injury to,
- abuse or neglect of,
- unlawful sexual or physical contact with – or assault of,
- sexual misconduct against (including grooming of), or
- use of unauthorised restrictive practice against a person with disability.
Notify the NDIS using the NDIS Commission Portal.
Find out more about mandatory reporting timeframes on the NDIS website.
You can email: incidentintake@ndiscommission.gov.au
You can also make a report via the National Disability Abuse and Neglect Hotline: 1800 880 052
Helpful advice can be sourced from:
- The Victorian Disability Services Commissioner
- The Victorian Disability Worker Commissioner
- The Victorian Public Advocate
Find out how to report unauthorised practices.
Report issues or complaints about NDIS providers or workers.
Reporting breaches to the Victorian Senior Practitioner 
In cases of suspected or known breaches, always ensure the person’s immediate safety as the first step.
Report breaches under the Disability Act 2006 to the Victorian Senior Practitioner’s Office via email on victorianseniorpractitioner@dffh.vic.gov.au.
Email questions about Directions and Prohibitions to victorianseniorpractitioner@dffh.vic.gov.au.
Reporting breaches to the Victorian Disability Worker Commission
Under the Disability Service Safeguards Act 2018 (Vic), disability workers and employers must notify the Commission if they form a reasonable belief that a disability worker has engaged in notifiable conduct. Follow the reporting flowchart.
NOTE: The law protects anyone who makes a notification in good faith. A person is not liable for any loss, damage or injury suffered by another person because the notification was made.
On receipt of a notification, the Commissioner will undertake an investigation.
The Victorian Disability Worker Commissioner has the power to issue prohibition orders regarding both registered and unregistered disability workers.
A prohibition order stops a person from being able to lawfully practise as a disability worker or requires that they can only work if certain conditions are met.
The Commissioner can make a prohibition order if they are satisfied that it is necessary to avoid a serious risk to the life, health, safety or welfare of a person or the health, safety or welfare of the public, and that the unregistered disability worker.
Orders may be permanent or for a limited period of up to 12 weeks (this is called an interim prohibition order).
Prohibition orders may be revoked or amended or include conditions.
Possible penalties
Professionally, people involved in unlawful restrictive practice(s) can also face criminal charges, for example assault or unlawful deprivation of liberty.
They may also face professional sanctions or lose their job.
The Victorian Disability Worker Commissioner has the authority to prohibit a person from working in the disability sector across Victoria.
They publish a publicly available list of people who have been sanctioned or banned. APOs can register to receive an update when a person’s name is added to the Prohibited Worker List.
Organisations may also face severe financial penalties and reputational risk. Depending on the type and severity of the breach, legal practices report fines of $1.8m and penalties of between 600 and 2400 units in some cases, or up to 5 years in jail.
It is therefore essential that an APO is properly trained and resourced to perform their duties properly.
If you have any doubts at all as the APO, you have the authority to send a behaviour support plan back to the Behaviour Support Practitioner to be clarified, revised and resubmitted.
More information
Find out who to contact with questions or concerns.
See more information from:
- restrictive practice information from the Department of Families, Fairness and Housing;
- the NDIS legislation, including the NDIS Act (and rules);
- NDIS Quality and Safeguard Commission’s Regulated Restrictive Practices Guide;
- National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018; and
- The Justice System and Lawful Orders: A guide for supporting people with disability