In the context of providing care under the National Disability Insurance Scheme (NDIS), balancing participant needs, ensuring compliance with Workplace Health and Safety (WHS) guidelines, and meeting the NDIS Quality and Safeguards Commission’s standards can often create grey areas for providers. One of these areas is the use of restrictive practices, which arise when a participant’s environment or movements are limited in some way.
A case in point is the installation of Crimsafe doors, which allow support workers to view the participant while providing emotional regulation support, and the restriction of their movement, which may be viewed as a restrictive practice by the NDIS Quality and Safeguards Commission. However, such measures can also align with WHS requirements to protect staff in high-risk situations.
This blog will discuss the NDIS Quality and Safeguards Commission’s position on restrictive practices, the conflict that can arise with WHS compliance, and how providers can navigate these competing interests.
Understanding Restrictive Practices under the NDIS
A restrictive practice refers to any action that limits the rights or freedom of a person with a disability. According to the NDIS (Restrictive Practices and Behaviour Support) Rules 2018, these practices are only permitted under certain conditions and with proper authorisation, as they are considered a last resort. There are five recognised types of restrictive practices under the NDIS:
- Seclusion – isolating a participant from others.
- Chemical Restraint – using medication to manage behaviour.
- Mechanical Restraint – using devices that restrict movement.
- Physical Restraint – using physical force to restrict movement.
- Environmental Restraint – restricting access to certain environments.
In this context, the situation falls under environmental restraint. When participants are prevented from seeing or accessing their support worker, even through the installation of solid doors, it can be interpreted as restricting their access to emotional regulation support, which they may need in that moment.
For instance, if a participant is distressed and seeks visual reassurance from a support worker, a solid door that prevents visual contact could worsen their emotional state. The NDIS Commission considers this a form of environmental restraint because it denies the participant access to their regular support.
However, the Commission advises alternatives such as Crimsafe doors. These provide a physical barrier while allowing visual access, which helps the participant maintain some level of interaction with the support worker, thus reducing the severity of the restrictive practice.
WHS Obligations for NDIS Providers
On the other hand, providers must also adhere to Workplace Health and Safety (WHS) guidelines, which are designed to ensure the safety and well-being of workers, including support workers. Under the Work Health and Safety Act 2011 (Cth), employers have a duty to provide a safe work environment, free from risks to health and safety.
In high-risk environments where participants may exhibit behaviours that could harm themselves or others, such as aggression or unpredictable outbursts, physical barriers like solid doors are often used to protect staff. The installation of such doors ensures that support workers have a level of physical protection, allowing them to manage risks from a safe distance without putting themselves in harm’s way.
However, using such barriers can result in the restriction of access for participants, as they lose the ability to see and communicate with their support worker. This presents a clear conflict between WHS regulations, which prioritise worker safety, and the NDIS Commission’s standards, which prioritise the rights and freedoms of participants.
NDIS Commission’s Viewpoint vs WHS Requirements
As highlighted in the case described, the NDIS Commission’s stance on restrictive practices differs significantly from the approach suggested by WHS protocols. While the NDIS Commission acknowledges that measures like Crimsafe doors allow for both safety and visual communication, WHS requirements may favour more robust barriers, such as solid doors, to provide maximum protection for workers in high-risk situations.
The NDIS Commission’s guidance in such cases is focused on the least restrictive practice principle. This principle demands that providers take every reasonable step to minimise restrictions on a participant’s freedom, even when safety risks are present. According to the NDIS (Restrictive Practices and Behaviour Support) Rules 2018, restrictive practices must be authorised by relevant authorities and must also be part of a participant’s Behaviour Support Plan (BSP), which outlines how and when such practices may be used.
In contrast, WHS legislation emphasises the protection of employees and managing risks, which can sometimes lead to more restrictive measures being used in the interest of safety. In extreme cases, WHS guidelines could support the use of solid barriers that ensure the support worker is physically protected, even if it limits the participant’s access to their environment or support person.
Navigating the Conflict
For NDIS providers, balancing the needs of participants with the safety requirements of staff can be challenging. The key is to develop solutions that are compliant with both NDIS and WHS standards, while also protecting both participants and workers.
- Risk Assessments: A comprehensive risk assessment should be conducted for every participant, particularly those who may exhibit challenging behaviours. This will help identify potential risks to both participants and staff and determine what safety measures need to be in place.
- Behaviour Support Plans (BSPs): For participants who may require restrictive practices, ensure that the BSP is developed in collaboration with a Specialist Behaviour Support Practitioner and includes clear guidelines for the use of environmental restraints. The BSP must be reviewed regularly to ensure it remains appropriate for the participant’s needs.
- Consultation with WHS and Behaviour Specialists: Consulting both WHS professionals and behaviour support practitioners will ensure that any measures implemented are aligned with both sets of requirements. This includes selecting appropriate physical barriers, like Crimsafe doors, that provide visibility while ensuring safety.
- Staff Training: Support workers must be properly trained on how to manage situations where restrictive practices are used. They should be equipped to de-escalate situations and understand how to apply restrictions in a way that prioritises the participant’s well-being, while also ensuring their own safety.
- Review and Monitoring: Constantly reviewing and monitoring both participant behaviour and the effectiveness of the implemented measures is crucial. This allows providers to make adjustments when needed and ensure that both participant rights and worker safety are maintained.
Conclusion
The tension between NDIS guidelines on restrictive practices and WHS requirements for staff safety is not easily resolved, but it is not impossible to navigate. The NDIS Commission advocates for the least restrictive option, such as Crimsafe doors, which maintain participant access to support while ensuring worker safety. In contrast, WHS guidelines may support more robust measures in high-risk environments, sometimes at the expense of participant access.
Providers must tread carefully, ensuring that restrictive practices are used only when absolutely necessary, and that they comply with NDIS rules. At the same time, they must ensure that workers are protected under WHS regulations. By working closely with both WHS specialists and behaviour support practitioners, NDIS providers can develop solutions that strike a balance between participant rights and workplace safety.
This dual compliance requires careful planning, constant review, and a willingness to adapt as new challenges emerge in providing care.
