Reducing restrictive practices for people with complex disabilities

Evidence-based education programs are restoring human rights for people with complex disabilities

The need

Almost twenty years ago, Professor Keith McVilly began an analysis of data collected under the Victorian Disability Act that would change practice across the disability sector.

The analysis revealed an increasing reliance on restrictive practices to manage challenging behaviours in people living with complex disabilities. Restrictive practices include sedating, physically restraining or isolating a person if they are thought to pose a risk to the safety of either themselves or others. When used inappropriately, however, these strategies infringe people’s human rights and can cause serious psychological and physical harm – in some cases resulting in death.

Keith’s work is informed by the principle that behaviour, including challenging behaviours, are modes of communication – at times the only mode available for someone living with complex disabilities responding to their unmet needs. His research has therefore focused on creating evidence-based education to address the disconnect between training provided to professional support staff and carers of people with complex disabilities, and the standards of best practice for managing challenging behaviours.

Over the past five years, Keith’s research has been an integral part of a change in the sector through national benchmarking and the rollout of evidence-based education to support staff on the ground. This research, together with evidence-informed educational strategies Keith has delivered in collaboration with government and industry partners, pre-empted the findings of the 2023 Disability Royal Commission.

Working closely with the Department of Families, Fairness and Housing (DFFH), Keith and his colleagues identified gaps in staff knowledge and developed the Positive Behaviour Support (PBS) professional development framework. The framework educates support staff and allied health professionals about a person and their support needs using behavioural science and working with them to build systems to dramatically improve the quality of care for people with a disability.

Developing a solution

Most recently, Keith and his colleagues at Scope and Trellis Australia worked closely with the National Disability Insurance Scheme (NDIS) and DFFH to develop and roll out an eight-week training course using the Positive Behaviour Support framework to upskill more than 500 Victorian behaviour support practitioners between 2020 and 2023.

The results demonstrated a significant increase in the quality of behaviour support plans prepared for people with disabilities, from a pre-training mean of 11/24 (deemed a ‘weak plan’ and unlikely to make a difference in the life of a person with disability) to a post-training mean of 20/24 (deemed a ‘good to strong’ plan, likely to improve the person with disability’s quality of life).

This standardised best-practice care has resulted in a considerably lesser reliance on outdated behaviour management practices, improving the quality of care and quality of life for people living with complex disabilities and those who support them. It has also become the blueprint informing the development and delivery of a range of accredited training and professional development programs, including in the Vocational Education and Training (VET) and higher-education sectors, both locally and nationally.

At the University of Melbourne, Keith is currently collaborating with the Melbourne School of Professional and Continuing Education to create four Positive Behaviour Support Melbourne MicroCerts (MMCs), with the first cohort starting in March next year, and a contract to deliver the training to 585 people by June 2025. The Melbourne MicroCerts correspond directly with priority areas in the NDIS National Workforce Plan 2021-2025.

The first rollout will be voluntary and funded entirely by DFFH as the state begins to signal the move to mandatory accredited training in the coming years. Having in place mandatory tertiary training in the form of Melbourne MicroCerts is anticipated to dramatically change the landscape of care and support for people with a disability.

Due to the ongoing relationship between Keith and both state and Commonwealth governments, the research and outcomes from the project are now benchmarked against the national standards, further shaping the disability-support industry at a state and national level.

In 2020, he was invited to submit evidence from his team’s research and practice to inform the Disability Royal Commission. This evidence and practice uniquely positions Victoria to be able to respond quickly and effectively to recommendations handed down by the Disability Royal Commission in 2023, in particular the recommendation for a major uplift in the disability workforce through evidence-informed education and standards of practice – essential changes to ensure people with disability will no longer be subject to neglect, abuse and exploitation.

Keith’s research team also continues to uplift the sector by collaborating with other universities and higher education institutions to develop and roll out complimentary resources and training across the country. By creating an evidence-informed approach to policy and practice in the disability sector, this work empowers staff and families of people with disabilities with the skills they need to dramatically improve the quality of life for people living with disabilities across Australia. In turn, this empowers people with disabilities to realise their rights and live their lives free from the harms of restrictive practices.

More information

First published on 8 November 2023.

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