Bringing life to the client voice in decisions regarding restrictive - - PowerPoint PPT Presentation

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

• ur 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

• r service providers.

Organisational framework

• Public Guardian

Child Corporate

Adult Adult community visitors Guardianship/Statutory Health Attorney Investigating abuse and neglect Protecting client’s legal rights Approve use of restrictive practices Child community visitors Child advocacy

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”.

• Public Guardian Act 2014
• Guardianship and Administration Act 2000
• Disability Services Act 2006
• Powers of Attorney Act 1998

Restrictive Practices Framework

• 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.

Restrictive Practices Legislation applies to:

• 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

Purpose of the Restrictive Practices Framework

• 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 definitions

• 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

• r 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

• r 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.

Restrictive Practices

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

• f non-spoken languages

Article 3 - General principles (a) Respect for inherent dignity, individual autonomy including the freedom to make one's own choices, and independence of persons; Article 21 - Freedom of expression and opinion, and access to information …. shall take all appropriate measures to ensure that persons with disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek, receive and impart information and ideas on an equal basis with others and through all forms of communication of their choice…

Function of challenging behaviour = communicate needs 1) Communication 2) Acquire/Obtain 3) Escape/Avoid 4) Increase/Decrease Sensory Stimulation 5) Manage Negative Emotions 6) Social Interaction 7) Neurological/Psychiatric (Lavigna, Willis, Marshall, IABA 2009)

Finding a voice through Positive Behaviour Support

• Visual schedule
• Communication dictionary
• Augmented/assisted communication
• Being offered choice
• Behaviour – e.g. putting shoes on (indicating going out)

gestural – turning keys in ignition facial – smile, nod, eye movement, laughter, excitement

• Patterns of behaviour – need to be directly observed over time

family members and long term support workers are a valuable asset to indicating what patterns of behaviour mean

The Adults’ world in the RP context

Service Providers Family Friends Administrators

Health Providers

Interests

THE ADULT MHRT QCAT Lawyers Housing Co-tenants

Guardian

Mental Health QLD Health Disability Services Advocates Legal Advocates QPS Clinicians NDIS

Neighbours

• ‘Jill ‘ is 35 years old
• Lives in Brisbane region
• Came to the attention of OPG through an application for a

Short Term Approval

• Some evidence of behaviours of harm in the community
• Mother appointed as guardian for general matters
• Relationship described as close
• Advocate involved
• Everything looked good ‘on paper

Restrictive Practices – Case Study #1

What the Guardian found:

• Jill is a very intelligent lady, and very articulate
• Jill is very controlled at her home environment, service user is

using compliance directions

• Community access is very little/ad hoc
• Jill would escalate because her voice was not listened to / her

wishes not met

• Antecedents, triggers not being recognised, escalations

justifying the need for restrictive practices

• Mother agreeing on some things with Jill but not others
• Jill very capable of using a mobile phone and managing the

cost, but does not have one, it is not ‘approved’

What the Guardian did:

• Frequent visits, observing, listening to Jill, and Jill’s views
• Talking to support staff and clinicians and promoting Jill’s views
• Talking with her mother and her advocate
• Advocating at QCAT for the use of containment and seclusion to

be least restrictive, ensure that the PBSP is scrutinised and altered, Jill’s views and concerns be heard

• Environment is not suitable; choice and control be recognised

and given to Jill

• Returning to a subsequent QCAT hearing and requesting that Jill

actually be present at her own hearing and give her own views to QCAT

• Jill very anxious and heightened at hearing due to so many people

and having to leave the room and return on several occasions

Jill today:

• Moved to her own accommodation with 1:1 support
• Jill is given more choice and control
• Antecedents and triggers from the staff environment recognised

and reduced

• Reduced containment approval (only when escalated)
• Jill is booked in to see a Psychiatrist
• Jill has a mobile phone – choice of contact with others
• Jill now plans what activities she would like to access in the

community

• Parents have a better understanding of the RP regime and

navigating the system

• Support staff are more positively focussed in supporting Jill

• ‘Sam’ is 26 years old
• Lives in regional Qld, reduced access to services
• At the time of appointment of the Guardian
• Sam had sustained an ABI 2 years prior in a work-related

accident

• Had experienced a relationship breakdown following the

accident

• Had a young child
• Had family – parents, siblings
• Friendships had fallen away
• Was non-verbal with no alternative communication method

being used

• Had 5:1 staffing – frequent restraint being utilised

Restrictive Practices – Case Study #2

• Sam had NO VOICE – NO CHOICES
• Service Provider
• Wanted to implement restrictive practices, without

demonstrated evidence, without assessment, without consultation with Sam

• Guardian
• Visited and Consulted Sam, family, staff, service management
• Made a referral for communication assessment
• Involved an independent advocate
• Made a referral for a medical review (including medication

review)

• Removed triggers
• Oversaw implementation for communication and consultation

recommendations

Restrictive Practices – Case Study #2

• Sam today:
• Communication device
• Consulted for everything
• Regular access to independent advocate
• Change of service provider
• 1:1 staffing
• Social life
• Regular contact with family, child, networks
• Access to transport
• Purchased his own home – suitable to his needs, his choice

Restrictive Practices – Case Study #2

• Navigating the sector
• Finding the adult’s voice
• Advocating for the adult’s voice
• Video evidence
• NDIS

Challenges

Questions?

Contact us

For information, general advice, forms, to make a referral or talk to a guardian or investigator

• Postal:

PO Box 13554, Brisbane George St, QLD 4003

• Phone:

1300 653 187 or 07 3234 0870

• Email:

adult@publicguardian.qld.gov.au

• Website:

www.publicguardian.qld.gov.au