OPERATIONAL PROCEDURE Title: Short term approval for the use of restrictive practices in disability services (full legislative

scheme) How to read this document This procedure must be read in conjunction with the following: Operational policy statement - Short term approval for the use of restrictive practices for disability services (full legislative scheme) Operational policy - Restrictive practices (full legislative scheme) Operational procedure: Restrictive practices for general disability services (full legislative scheme) Operational procedure - Restrictive practices for respite or community access services only (full legislative scheme). Purpose These procedures will direct action regarding the application of the short term approval provisions of the Disability Services Act 2006 (the Act) and the Guardianship and Administration Act 2000 (the GAA). The provisions apply to the use of a restrictive practice under the full legislative scheme by staff of Department of Communities (Disability Services) provided or funded service providers to an adult with an intellectual or cognitive disability accessing accommodation support, community support, respite and/or community access services. In particular, this procedure outlines operational processes relating to sections 123O, 123ZK, 123ZL, 123ZM and 123ZN of the Act and Chapter 5B, Part 4 of the GAA. The short term approval provisions provide a process for approving the short term use of a restrictive practice only where the use of the restrictive practice is the least restrictive way to protect the adult and others from harm. The provisions provide for a time limited approval (for a maximum of six months) in some circumstances. While the short term approval is in place, appropriate steps can be taken in line with the requirements of the Act, to undertake assessment, develop a plan for the adult and, if required, seek full approval or consent for the use of a restrictive practice. This procedure assists a relevant service provider (RSP) to meet the legislative requirement to keep and implement a policy and procedure in relation to the short term approval requirements in the Act. Transitional period arrangements If, in the period up to 30 September 2010, an RSP considers it necessary to use a restrictive practice before they have obtained approval or consent under the full legislative scheme, they must comply with the transitional

requirements in the Act as detailed in the transitional policy (and procedures) of the Department of Communities (Disability Services). Note: During the transitional period, unless there are exceptional circumstances, a short term approval may not be sought where the need for a restrictive practice has been identified prior to 30 June 2010. Instead, the RSP should undertake the required activities under the Act and apply to the appropriate authority for a full scheme approval or consent. 4 March to 30 June 2010 During this period a short term approval will be available for containment or seclusion in a limited circumstance only. Most RSPs will not need to access a short term approval because transitional period provisions will continue to provide the authority to use a restrictive practice. For further information see the information sheet Short term approvals in the transitional period to 30 September 2010. 1 July to 30 September 2010 During this period short term approvals will be available for containment, seclusion, physical restraint, chemical restraint, mechanical restraint and restricting access to objects where the need for a restrictive practice first emerges after 1 July 2010. This will assist services where there is insufficient time to meet the full legislative requirements before the end of the transitional period on 30 September 2010. From 1 October 2010 Transitional provisions will no longer apply. Full implementation of short term approvals will commence from this date. General requirements When a short term approval is appropriate The short term approval provisions apply only to adults: with an intellectual or cognitive disability who have impaired decision making capacity about the use of restrictive practices who exhibit behaviour that causes harm who are receiving disability services from an RSP. Situations in which a short term approval may be used include where: an adult enters a disability service and displays the behaviour that causes harm for the first time, including following a transfer from another service provider previous behaviour that causes harm re-emerges previously unharmful behaviour escalates to harmful levels an existing adult client begins behaving in an uncharacteristic manner an adults behaviour is no longer manageable through the use of currently approved/consented restrictive practices. A short term approval may be appropriately sought while awaiting a QCAT approval for containment/seclusion or while awaiting a QCAT appointment of a guardian for a restrictive practice matter.

When a short term approval is NOT appropriate A short term approval is not appropriate if: there is a QCAT approval and a positive behaviour support plan in place for the use of a restrictive practice for physical restraint, chemical restraint, mechanical restraint and restricting access to objects in general disability services: there is a guardian for a restrictive practice (general) matter already appointed for containment or seclusion in respite/community access services: there is a guardian for a restrictive practice (respite) matter already appointed and the adult is receiving respite or community access services only for physical restraint, chemical restraint (fixed dose in respite), mechanical restraint and restricting access to objects in respite/community access services: there is an informal decision maker identified or a guardian for a restrictive practice (respite) matter already appointed. for chemical restraint (PRN in respite) or chemical restraint (fixed dose and PRN in community access): there is a guardian for a restrictive practice (respite) matter already appointed. In these circumstances the RSP needs to obtain QCAT approval or guardian consent consistent with the requirements of the Act for developing or changing a positive behaviour support plan. The exception is where a guardian for a restrictive practice (general) matter is appointed and the short term approval relates to containment/seclusion in which case the provisions by which the Adult Guardian may provide short term approval prevail. Short term approval decision makers A short term approval can only be made by either: the Adult Guardian for containment and/or seclusion the Chief Executive delegate for physical restraint, chemical restraint, mechanical restraint or restricting access to objects. The Chief Executive delegate is the Specialist Response Service (SRS) positions of Individual Response Leader or Principal Clinician. The decision maker for a short term approval for a given restrictive practice depends on: the type of restrictive practice what if any, guardian appointments, restrictive practice approval or consent is already in place whether the adult is receiving general disability services or respite or community access services. (see Table 1 over page). Table 1 Short term approval pathways (post 1 July 2010) General disability services Current situation Relevant decision maker Containment/seclusion Physical restraint/chemical restraint/mechanical restraint/restricting access to objects

QCAT containment or seclusion approval in place No short term approval QCAT - Change of plan No short term approval QCAT - Change of plan Guardian for a restrictive practice (general) matter appointed Adult Guardian - Short term approval No short term approval Guardian for a restrictive practice (general) matter - Consent or change of plan No QCAT approval No guardian for a restrictive practice (general) matter appointed Adult Guardian - Short term approval Individual Response Leader or Principal Clinician - Short term approval Respite or community access services Current situation Relevant decision maker Containment/seclusion Chemical restraint PRN in respite Chemical Restraint (fixed dose and PRN) in CAS Physical restraint Chemical restraint fixed dose in respite Mechanical restraint Restricting access to objects Guardian for a restrictive practice (respite) matter appointed No short term approval Guardian for a restrictive practice (respite) matter -Consent or change of plan No short term approval Guardian for a restrictive practice (respite) matter -Consent or change of plan No short term approval Guardian for a restrictive practice (respite) matter -Consent or change of plan Informal decision maker in place No guardian for a restrictive practice (respite) matter appointed Adult Guardian - Short term approval Individual Response Leader or Principal Clinician - Short term approval No short term approval Informal decision maker - Consent No informal decision maker in place No guardian for a restrictive practice (respite) matter appointed Adult Guardian -Short term approval Individual Response Leader or Principal Clinician - Short term approval Individual Response Leader or Principal Clinician - Short term approval

Critical incident reporting requirements In some cases a short term approval will be sought in response to unforeseen or reasonably unforeseeable events that have caused or have the potential to cause harm to the adult or others. In these circumstances, even if a short term approval is sought, critical incident reporting requirements must also be followed. Process The process for a short term approval is described in steps 1 4 (See Figure 1 on page 8)

1. 2. 3. 4.

Short term approval request and decision Short term approval decision notice Short term plan submission Short term plan decision notice

Background A request for a short term approval is only appropriate if it can be established that it is probable that a restrictive practice will be required in a planned or ongoing way due to circumstances including: a series of critical incidents where an unapproved restrictive practice is used a new adult enters the disability service with a known history of behaviour that causes harm approval/consent is in place to use physical restraint, chemical restraint, mechanical restraint or restricting access to objects but, due to a change of circumstance, containment or seclusion is required to prevent harm. Where there has been a series of critical or potentially harmful incidents the relevant service manager is responsible for conducting a timely incident review to determine the least restrictive, effective approach for preventing future harm. Relevant interested parties for the adult should be involved in the review process. Wherever possible, alternative methods will be tried that do not require the use of a restrictive practice. A short term approval should not be sought unless probable ongoing need can be established. Where ongoing probable need is difficult to determine a short term approval should be sought and the situation monitored to avoid unnecessary use of a restrictive practice. Note for transfers of service provider: If there is a QCAT approval already in place or a guardian appointed, the receiving service provider will work with the referring service provider to seek an appropriate approval in the course of developing a transition plan for the adult. Step 1: Short term approval request and decision The relevant service manager will make direct telephone contact with the appropriate short term approval decision maker during normal business hours (9am to 5pm, Monday to Friday). The relevant service manager is responsible for ensuring the safe and responsible use of any restrictive practices in the short term until a decision maker can be contacted. This may include a consideration of recent life events and medical, psychiatric, environmental and human resource issues. The relevant service manager will ensure they have the necessary information available and, where appropriate, supporting information (e.g. behaviour records, critical incident reports) to respond to questions from the decision maker.

The decision maker will need to establish the following, at a minimum, in order to make a short term approval decision: the adult is not subject to a containment or seclusion approval from QCAT there is no guardian for a restrictive practice matter appointed the adults behaviour has previously resulted in harm to the adult or others there is immediate and serious risk that if the approval is not given, the adults behaviour will cause harm to the adult or others the use of the restrictive practice is the least restrictive way of ensuring the safety of the adult or others if the restrictive practice is chemical restraint, the adults treating doctor has been consulted if the adult is subject to a forensic order or involuntary treatment order under the Mental Health Act 2000, the authorised psychiatrist has been consulted. The short term approval decision maker will consult with and consider the views of relevant stakeholders, at a minimum: the adult or a guardian or an informal decision maker for the adult if the restrictive practice is chemical restraint, the decision maker must be satisfied that the RSP has consulted with and considered the views of the adults treating doctor if the decision maker is aware of a forensic order or involuntary treatment order under the Mental Health Act 2000, the authorised psychiatrist responsible for the treatment of the adult under this Act. There is no legal obligation for the decision maker to consult with any party where it is not practical in the circumstances; however, every reasonable effort will be taken to make contact. Wherever possible, consultation will include the adult and significant others for the adult, (including family members). The decision maker will also seek input from workplace health and safety personnel as appropriate. Assuming the necessary information is available, the decision maker will wherever possible provide a decision (to approve or not approve the use of the restrictive practice under a short term approval) the same day. The decision may be subject to conditions including the condition that subsequent consultation confirms the appropriateness of the approval. As an interim measure prior to issuing a decision notice, the decision maker may advise the service manager of the decision by fax or email including any conditions relating to the decision. The service manager may provide written confirmation by fax or email. Step 2: Short term approval decision notice As soon as practicable, but within seven days, the decision maker will provide a short term approval decision notice notifying all relevant parties of the decision to approve or not approve the use of the restrictive practice. The decision notice will be provided to parties as outlined in Attachment 1.

Where a short term approval has been granted for containment or seclusion, the relevant service manager will alert the local SRS that a referral may be made, pending the approval of the short term plan (see step 4). The relevant service manager is responsible for ensuring all reasonable efforts are made to explain the decision to the adult. Step 3: Short term plan submission Within 14 days of receiving the short term approval decision notice, the relevant service manager will develop and submit a Short term plan to the original decision maker. If the short term plan is not received within this time the short term approval ceases. The short term plan must include, at a minimum, those items outlined in Attachment 1. The decision maker will approve the short term plan where: the information in the plan is consistent with the information considered by the decision maker in deciding whether to give the short term approval there is an immediate and serious risk that, if the short term approval does not continue in effect, the adults behaviour will cause harm to themself or others use of the restrictive practice is in compliance with the short term approval the plan is the least restrictive way of ensuring the safety of the adult or others. This stage is an opportunity for the decision maker to review and reflect on all information that has been provided and to ensure that the risk of harm is serious enough to warrant the use of the restrictive practice as the least restrictive option. Step 4: Short term plan decision notice As soon as practicable after deciding to approve or not approve a short term plan, the decision maker will provide a short term plan decision notice to all relevant parties (see Attachment 1). On receipt of the decision notice the relevant service manager will ensure that an application for a full approval or consent is initiated as soon as possible. For containment and seclusion this involves a formal referral to, and a joint application to QCAT with, the SRS. If the behaviour that causes harm is due to an identifiable transient event (e.g. a medication reduction or personal loss) the decision maker may consider delaying the initiation of a full approval/consent. This may allow the adults behaviour to settle without resorting to the approval of ongoing use of a restrictive practice. The relevant service manager will discuss this possible course of action with the decision maker and where followed, maintain ongoing contact to ensure appropriate action is taken regarding a full approval/consent.

Skills and monitoring The relevant service manager is responsible for ensuring that: any person acting for the service provider who uses a restrictive practice under a short term approval has sufficient knowledge of the requirements for the lawful use of the practice and has the skills and knowledge to use the restrictive practice appropriately the use of the restrictive practice is monitored to safeguard against abuse, neglect and exploitation. Short term approval cessation If a short term approval is in place and one of the following situations occurs, the short term approval ceases. 1. where a QCAT containment or seclusion order is made, including where an application is dismissed (i.e. the practice is not approved) 2. where a guardian for a restrictive practice (general or respite) matter is appointed for an adult 3. where an RSP identifies that a restrictive practice is no longer necessary 4. where the term of the short term approval expires 5. where a short term plan is not provided within 14 days of the receipt of the short term approval decision notice 6. where a short term plan is not approved by the decision maker 7. where a subsequent decision is taken to not proceed to a full approval/consent such as the decision not to proceed to a multidisciplinary assessment or a positive behaviour support plan under the full scheme. In the above circumstances: in situations 1 to 4 above the relevant service manager will inform and/or discuss with the short term approval decision maker and the SRS (if required) as soon as possible in situation 5 the short term approval decision maker will make contact and discuss with the relevant service manager where no formal decision notice is provided (situations 1 to 5 above) the short term approval decision maker will provide to the relevant service manager written confirmation of the outcome of the discussion including the date on which the approval ceases the RSP will cease using the practices outlined in the short term approval. A short term approval will also cease if the conditions of the approval are not being complied with. If the short term approval decision maker becomes aware of claims that the conditions of an approval are not being followed, the decision maker will discuss the matter with the relevant service manager as soon as possible with a view to determining whether a short term approval will cease or continue, either unchanged or changed. The short term approval decision maker will provide written confirmation of the outcome of the discussion.

Changes to a short term approval A relevant service manager can request a change to a short term approval by discussing the matter with the decision maker. The decision maker can only change or extend a short term approval in exceptional circumstances. Where a change to a short term approval is granted, the decision maker will provide an amended short term approval decision notice. All subsequent steps in the approval process must then be followed including the 14-day timeframe for the development and submission of a short term plan. During the life of a short term approval if a new RSP commences supporting the adult, a new short term approval is required. Short term approval and Short term plan review of decision The RSP or a person consulted as part of the short term approval process may apply to QCAT for a review of the decision when: a short term approval decision maker gives or refuses to give a short term approval a short term plan is not approved. The QCAT may make any order it considers appropriate. Sharing information and confidentiality The Act facilitates the disclosure of information to the Adult Guardian by any person who has control of the information. The Adult Guardian has the right to all information that: the adult would have been entitled to if the adult had capacity is necessary for the Adult Guardian to make an informed decision. The person, or service, controlling the information must give the information to the Adult Guardian. If this is refused the Adult Guardian can apply to QCAT to order the person to provide the information. Where QCAT orders a person to provide the information, the person must comply with the order unless they have a reasonable excuse. The Act facilitates the disclosure of information by health care professionals for the purpose of assessments and the development of plans. Note: The Act requires that confidentiality of information must be maintained. It is an offence under the Act to disclose the information to anyone other than as allowed under the Act. Records Under the Act, the RSP must: keep at the premises where disability services are provided to the adult a copy of any short term approval and short term plan for the adult keep at the premises where the restrictive practice is being used an up-todate policy and procedure on short term approval and ensure the policy and procedure is available for inspection by: o staff of the RSP o a guardian, informal decision maker or advocate for the adult o a community visitor under the GAA.

Further information For further information about the restrictive practice provisions of the Act, including the short term approval provisions, legislation (including access to forms, templates and information sheets), see www.disability.qld.gov.au/positive-futures Note: If there is any inconsistency between this procedure (and related policy) and the Disability Services Act 2006, the provision in the Disability Services Act 2006 applies to the extent of the inconsistency Records File No.: <If applicable> Date of approval: 21 June 2010 Date of operation: 1 July 2010 Date to be reviewed: 31 December 2010 Office: Deputy Director-General, Disability and Community Care Services and Multicultural Affairs Queensland Help Contact: Specialist Response Service Implementation Branch Links Policy Operational Policy Statement - Short term approval for the use of restrictive practices in disability services (full legislative scheme) Operational policy - Restrictive Practices (full legislative scheme) Operational policy statement: - Locking of gates, doors and windows as the least restrictive way of supporting an adult with an intellectual or cognitive disability safely Critical incident reporting policy (Disability Services Queensland provided services) 2008 Preventing and responding to the abuse, neglect and exploitation of people with a disability policy Reviews and appeals policy Related policies and procedures Operational procedure - Restrictive practices for general disability services (full legislative scheme) Operational procedure - Restrictive practices for Respite and/or community access services only (full legislative scheme) Operational procedure - Locking of gates, doors and windows as the least restrictive way of supporting an adult with an intellectual or cognitive disability safely Critical incident reporting procedures (Disability Services Queensland provided services) Accommodation support and respite services 2008 Preventing and responding to abuse, assault and neglect of people with disability procedure Reviews and appeals procedure Strategic context Disability Services Queensland Strategic Plan 20092013 Related legislation or standard Disability Services Act 2006 Guardianship and Administration Act 2000

Linda A Apelt Director-General ATTACHMENT 1 Decision notices (short term approval decision notice and short term plan decision notice) Where the Adult Guardian is the decision maker (i.e. for containment or seclusion) the decision notice will be provided to: the RSP the adult the tribunal (QCAT) the chief executive (disability services) the guardian for a restrictive practice (general) matter for the adult any other person consulted by the Adult Guardian. Where the Chief Executive delegate is the decision maker (i.e. for physical restraint, chemical restraint, mechanical restraint or restricting access to objects) the decision notice will be provided to: the Adult Guardian any person consulted by the chief executive delegate including the adult or the guardian or the informal decision maker. The decision notice must include the following at a minimum: the adults name the name of the RSP the decision (to approve or not approve) reasons for the decision if approved, the period of the approval (up to a maximum of six months) any terms and conditions. Contents of a short term plan The short term plan must include, at a minimum: the adults name the service provider details (including the service outlet location) a description of the behaviour that causes physical harm and the consequences of the behaviour including details that describe why there is an immediate and serious risk of harm a description of the restrictive practices used with the adult, in particular the restrictive practices for which there is a short term approval the reason/s for using the restrictive practices the reasons why the restrictive practice is the least restrictive way of ensuring the safety of the adult and others date of the short term approval decision notice name and position of the short term approval decision maker name, position and signature of the applicant and date.