What are a Support Coordinator's behaviour support responsibilities?

For those of you working in the highly valued and often complex world of Support Coordination, recent communication from the NDIS Quality and Safeguards Commission (the Commission) in NSW (and presumably to be replicated across the country) might have left you questioning whether it’s all worth it.

The letter, a “friendly reminder” about the obligations of Support Coordinators (SCs) when supporting a participant subject to the use of restrictive practices, expresses concern that “Support Coordinators in New South Wales are not doing enough to support participants to rapidly access and engage with a specialist behaviour support provider after the first use of a URP occurs with that person”.

So, what is a URP?

A URP is an unauthorised restrictive practice – that is, a practice that restricts the rights or the freedom of movement of a person with disability (for example, seclusion or a chemical or mechanical restraint) that has not been authorised for use by the relevant State or Territory authority. URPs can occur at several points during a participant’s journey (this is not an exhaustive list); however, can include the following:

A.     A participant is subject to the use of restrictive practices as a result of engaging in behaviours of concern. This is often the trigger for behaviour support dollars being included in their plan. Until a behaviour support provider is in place, and a behaviour support plan containing restrictive practices that have been authorised is developed, the use of these restrictive practices is unauthorised.

B.     A participant has a behaviour support provider, and a behaviour support plan authorising the use of restrictive practices is in place. Given that behaviour support plans must be renewed every 12 months, if this doesn’t happen on time, previously authorised restrictive practices become unauthorised.

The friendly letter goes on to say, “I also wish to advise you that in the coming months the NDIS Commission’s New South Wales office will be focused on how Support Coordinators are complying with their obligations to support participants to access behaviour support.”

We’ve said it before, and we’ll say it again …

The use of unauthorised restrictive practices is unlawful and traumatising. It is a breach of a person’s human rights, and as a sector and as individuals, we need to do our best to ensure that restrictive practices are only used where proper checks and balances are in place.

But, as we explored previously, the use of URPs is heavily tied to the supply of behaviour support providers and practitioners. Simply squeezing other players in the sector without addressing this fundamental issue is unlikely to have any significant impact on the outcomes for participants subject to URPs.

How can Support Coordinators assist?

The letter includes seven areas where the Commission believes SCs can assist participants requiring behaviour support. These include:

1.     Responding immediately to the need to support a participant to source, link and engage with a specialist behaviour support provider, after the first use of a regulated restrictive practice has occurred.

This raises two issues.

• A participant may be subject to multiple URPs prior to their engagement with an SC. The SC would be unaware of the “first use”, and if they had just commenced supporting a participant, the participant is likely to have a range of needs (not just behaviour support).

• Where a participant does have a behaviour support plan in place, it is not a requirement for the SC to be aware of the dates of the behaviour support plan; therefore, they may not be monitoring when the plan will expire.

2.     Understanding the availability of specialist behaviour support providers in the local area or those who are able and willing to travel to the area to provide supports to participants.

This is pretty much standard Support Coordination practice.

3.     Finding alternative specialist behaviour support providers for the participant to consider engaging, rather than placing participants on a waitlist which will not allow a behaviour support plan to be developed within 1 month of the first use of a URP by the participant’s implementing provider.

It is unclear what the Commission is expecting here when we know there are simply not enough behaviour support providers to go around. In most instances, SCs source multiple providers, make multiple telephone calls and place participants on multiple wait lists.

4.     Providing information to the participant and/or their representatives about what positive behaviour support services may entail.

It is likely that most SCs will have knowledge and understanding of behaviours of concern, positive behaviour support, restrictive practice definitions and the requirements for the development of interim and comprehensive behaviour support plans. Most SCs, however, are unlikely to have detailed knowledge of the elements of positive behaviour support services, including (but not limited to) assessments, functions of behaviour and strategy development.

5.     Ensuring that service agreements clearly specify and encompass the total services that are to be provided with NDIS funding (eg specifying that the specialist behaviour support provider will provide both an interim and comprehensive behaviour support plan containing all restrictive practices in use, within the agreed timeframes).

The provision of behaviour support services under the NDIS requires the registration of both the provider and the individual practitioner. Practice standards for the delivery of behaviour support services clearly specify the requirements of interim and comprehensive behaviour support plans, including timeframes. It is incumbent on those registered to provide these services to do so in accordance with the requirements and not for the Commission to use SCs to ensure compliance.

It is also unlikely that there would be enough funding available for SCs to review every service agreement the participants they support have entered into.

6.     Working with the participant’s implementing provider/s to facilitate engagement with the specialist behaviour support provider in relevant environments and with relevant people who can support the development of the behaviour support plans.

Again, the practice standards for Behaviour Support Providers and Implementing Providers (those using restrictive practices) require that they work together to develop behaviour support plans. While SCs should coordinate with the team supporting the participant, they do not have a role in “facilitating engagement” between providers.

7.     Supporting participants to seek a review of their NDIS plan where behaviour support funding may be required. This may include assisting the participant to obtain any necessary assessments or evidence from implementing providers (such as behavioural or incident reports) which assist with a request for funding.

Again, this is standard Support Coordination practice. SCs can assist participants by:

• Noticing whether behaviour support funding is missing in the first instance.

• Sourcing supporting documentation to take to a planning conversation to secure funding for behaviour support (e.g. provider reports, incident reports and police/hospital reports).

• Supporting the participant to understand review pathways.

How can Support Coordinators respond?

As an SC, receiving this letter from the Commission might have left you feeling like you have set off a shop alarm when you haven’t stolen anything! In your response (noting all the challenges listed above), some things you might also like to consider include:

• Do you know which participants need or are in receipt of behaviour support? Is there a way to flag these participants at referral or in your CRM?

• How good are your networks? Do you have a list of “go-to” behaviour support providers in your area, including those that might provide Tele-PBS?

• How good is your documentation? Do you record every telephone call/attempt to find a behaviour support provider in the participant’s file?

• What review mechanisms do you have in place? When a participant is placed on a waiting list, how often is that reviewed, and likewise, when contact is made with behaviour support providers to seek an update on the status of the referral, how often is that reviewed?
  

We’re all in this together … or are we?

Investing in both the capacity and capability of behaviour support providers and practitioners has been a priority for the Commission. This is evidenced by initiatives such as BSP Capability Building Grants, the Thin Markets project and the Building the Local Care Workforce Initiative, including the Positive Behaviour Support Capability Framework and the Self-Assessment process.

Despite this, wait times for behaviour support services in many jurisdictions are still excessively long, and participants with complex needs are subject to the use of URPs at alarming levels. There is no doubt that more needs to be done. Sometimes, this “more” will need to be done by SCs, and, as with any provider, they should be held to account when they are not doing what they are paid to do.

However, writing wholesale to all Support Coordination agencies “reminding” them of their obligations (and imposing new ones) without acknowledging the system’s constraints and challenges feels both heavy-handed and unfair.