Positive Behaviour Support and Restrictive Practices: What Families Should Know

Of everything covered in this series, this is the area where the gap between good and poor practice does the most damage — and where families are least equipped to tell the difference.

Done well, positive behaviour support changes lives. It identifies why something is happening, addresses the cause, teaches alternatives, and systematically removes the restrictions that accumulated while nobody understood what was going on. People who were described as having severe behaviours of concern end up living ordinary lives, and the plan quietly becomes unnecessary.

Done badly, it is a document in a folder justifying restrictions that nobody intends to remove, written by someone who met the person twice, implemented inconsistently by staff who weren’t trained, and reviewed annually by changing the date.

This guide is about recognising the difference. It covers what a behaviour support plan should contain, what the five regulated restrictive practices are, the authorisation and reporting requirements, and what genuine reduction planning looks like.

It is written for participants and families. It is not clinical guidance — behaviour support plans must be developed by appropriately qualified practitioners.

What “behaviours of concern” actually means

The language has shifted, and the shift matters.

Older terminology — “challenging behaviour”, “problem behaviour” — located the problem in the person. Current practice treats behaviour as communication and as a response to environment. The question is not “what’s wrong with this person” but “what is this behaviour achieving, and what need is it meeting that nothing else currently meets?”

That reframing is the entire foundation of positive behaviour support, and it has practical consequences. Behaviour that looks inexplicable usually isn’t, once you know enough. Common drivers include:

• Pain or physical discomfort — the most under-recognised driver by a wide margin, particularly for people who can’t easily report it. Toothache, constipation, a urinary tract infection, an ill-fitting wheelchair cushion, reflux
• Communication difficulty — not being understood, or having no reliable way to say no, ask for something, or object
• Sensory factors — noise, lighting, crowding, temperature, texture
• Environment — a chaotic house, a lack of privacy, an incompatible housemate
• Unpredictability — not knowing what’s happening next, or having no control over it
• Trauma — a substantial and frequently unrecognised factor
• Unmet needs — boredom, loneliness, having nothing meaningful to do
• Staff practice — being rushed, spoken over, handled without warning, or supported by people who keep changing

A good functional behaviour assessment investigates all of these before concluding anything. An assessment that goes straight to a restriction has skipped the actual work.

What a behaviour support plan should contain

Under the NDIS framework, behaviour support plans are developed by NDIS behaviour support practitioners — people considered suitable by the NDIS Quality and Safeguards Commission. Specialist behaviour support providers are registered and subject to conditions.

A plan should include:

A functional behaviour assessment. The investigation of why. This should draw on interviews with the person and the people who know them, direct observation across settings and times, record review, and consideration of medical and environmental factors. A plan written without one is not a behaviour support plan; it’s a restriction with a cover sheet.

The person’s voice. What they want, what they find difficult, what helps. Including for people who don’t use speech — there are established methods for capturing this.

Proactive strategies. The bulk of a good plan. Environmental changes, routine changes, communication supports, meaningful activity, skill teaching, staff practice changes. These are what actually reduce behaviours of concern over time.

Early intervention strategies. What to do when early signs appear, before escalation.

Reactive strategies. What to do during an incident, focused on safety, including de-escalation.

Any regulated restrictive practices, each with a full protocol.

A reduction and elimination plan for every restrictive practice, with responsibilities and timeframes.

Monitoring and review arrangements.

A useful test: what proportion of the plan is proactive? A plan that is mostly reactive strategies and restrictions has identified what to do when things go wrong without addressing why they go wrong. That is not behaviour support.

The five regulated restrictive practices

Under the NDIS framework there are five regulated restrictive practices (RRPs):

Chemical restraint — medication or a chemical substance used to influence behaviour, other than medication prescribed to treat a diagnosed physical or mental health condition.

Environmental restraint — restricting a person’s free access to their environment, including parts of their home or to items within it.

Mechanical restraint — a device used to prevent, restrict or subdue movement for the primary purpose of influencing behaviour. This excludes devices used for therapeutic or non-behavioural purposes, such as postural support or safe transport.

Physical restraint — the use of physical force to prevent, restrict or subdue movement of a person’s body, or part of it, for the primary purpose of influencing behaviour.

Seclusion — the sole confinement of a person in a room or physical space, at any hour, where voluntary exit is prevented or they believe exit is prevented.

Two things families frequently don’t realise.

The list is broader than it sounds. A locked cupboard restricting access to food is environmental restraint. A seatbelt-style device used to stop someone standing up is mechanical restraint. Medication given to settle someone rather than to treat a diagnosed condition is chemical restraint, regardless of what it’s called. Practices have frequently been in place for years without ever having been identified as restrictive practices at all.

Unauthorised use is a reportable incident. Where an RRP is used without authorisation, or not in accordance with a behaviour support plan, registered providers must report it to the NDIS Commission.

Authorisation and reporting

The requirements are specific, and families are entitled to see the evidence.

Authorisation is a state and territory matter. A behaviour support plan containing an RRP must be developed and authorised under the authorisation and consent requirements of the relevant state or territory — and those arrangements differ meaningfully between jurisdictions.

The plan and evidence of authorisation must be lodged with the NDIS Commission, consistent with the Rules.

Chemical restraint requires specific reporting. Details are entered into the Commission’s portal, including total daily dose. Medication must be administered in accordance with the prescriber’s instructions.

Each RRP must have its own protocol, covering:

• A description and rationale, including why it is the least restrictive option and a last resort
• Whether it is routine or used as required, and in what circumstances
• Strategies to be tried first
• The procedure itself, including debriefing afterwards
• Impacts and safeguards
• Training, monitoring and review
• A plan to reduce and eliminate the practice, with named responsibilities and timeframes

Consultation must be documented — who was consulted, when, and how, in an accessible format.

For chemical restraint, additionally: medication name, route, dosage, frequency, prescriber, dates prescribed or last reviewed, next review date, and the purpose.

If a provider cannot produce authorisation evidence for a practice in use, that is a serious finding and grounds for asking harder questions.

Reduction and elimination: the part that gets skipped

Every regulated restrictive practice must have a plan to reduce and eliminate it. This is a requirement, not an aspiration.

It is also the single most commonly neglected part of the framework. Restrictions get authorised, the paperwork is compliant, and then nothing changes for years. The annual review updates the date.

What genuine reduction planning looks like:

Specific targets with dates. Not “will be reviewed” but “will reduce from daily use to three times weekly by March, through the following strategies.”

Named strategies that address the cause. If the restriction exists because of unmanaged pain, the reduction plan involves pain management. If it exists because of communication frustration, the reduction plan involves communication support.

Data showing whether it’s working. Frequency of use, tracked over time. A restriction used less often this year than last is evidence of progress; the same figure three years running is evidence of nothing happening.

A clear endpoint. What would need to be true for this practice to stop entirely?

Questions worth asking at every review: has the frequency reduced since last time? What specifically are we doing to reduce it further? What would need to change for this to end? If nobody can answer, the reduction plan exists on paper only.

What good behaviour support looks like day to day

The plan is a document. Practice is what happens.

Every worker knows the plan and can describe it. Not locate it — describe it. Including agency staff, before they work alone.

It’s implemented consistently. Inconsistent implementation is worse than no plan, because unpredictability is itself a driver of distress. If half the team uses the strategies and half improvise, the person experiences chaos.

Proactive strategies actually happen. The communication support, the routine, the meaningful activity. These are frequently the first things dropped when a shift is busy, and they’re the things that make the difference.

Data is collected properly. Incident frequency, antecedents, what worked. This is what allows the practitioner to refine the plan.

Debriefing happens after incidents — for the person and for staff.

The practitioner is actually involved. Not a plan written once and never revisited. A behaviour support practitioner should be observing, consulting staff, reviewing data and updating the plan.

Medical causes have been excluded and are re-checked. When behaviour changes suddenly, the first question should be clinical. Pain, infection, medication side effects, constipation, dental problems. This gets missed constantly, particularly for people who communicate differently.

Trauma, and why it changes the approach

A significant proportion of people receiving behaviour support have experienced trauma — including abuse, neglect, institutional care, repeated loss of relationships, medical trauma, and the cumulative effect of having very little control over their own lives.

This matters practically, not just compassionately.

Behaviour that looks irrational often makes sense in light of history. A person who becomes distressed during personal care may have a history that makes being touched by strangers frightening. Someone who reacts strongly to a raised voice may be responding to something that happened decades ago. Without that context, the behaviour appears to come from nowhere.

Restrictive practices can re-traumatise. Physical restraint, seclusion and environmental restriction can replicate aspects of earlier experiences in ways that escalate rather than settle a situation. This is one of the strongest arguments for genuine last-resort use.

Predictability and control are protective. Knowing what is happening next, having choices that are actually honoured, and having consistent people are among the most effective interventions available — and they’re interventions about how support is delivered rather than about the person.

Staff turnover is a trauma issue. For someone whose history involves repeated loss of important people, a rotating cast of workers is not a neutral staffing arrangement.

A trauma-informed approach doesn’t require knowing someone’s history in detail. It requires assuming that history may exist and designing support accordingly: predictable, respectful, choice-rich, and consistent.

When something goes wrong

Incidents happen, including in well-run services. What matters is what follows.

Immediate safety, then debriefing — for the person, and separately for staff. Both are frequently skipped and both matter. A person who has experienced a distressing incident needs support afterwards, not just containment during.

Accurate recording. What happened, what preceded it, what was done, what the outcome was. This feeds the behaviour support practitioner’s work and it protects everyone.

Reportable incident obligations. Registered providers must report certain incidents to the NDIS Commission, including unauthorised use of restrictive practices, and serious incidents involving harm. Families are entitled to know when a report has been made.

Review of the plan. A pattern of incidents means the plan isn’t working — the functional assessment may have missed something, the strategies may not be right, or implementation may be inconsistent. The response to repeated incidents should be a plan review, not an additional restriction.

Looking at the environment and the practice, not only the person. A house where incidents cluster at particular times, with particular staff, or around particular activities is telling you something about the environment rather than about the resident.

Raising a concern

If you believe a restrictive practice is being used without authorisation, that a plan isn’t being followed, or that someone is being treated badly:

Raise it with the provider first, in writing, and ask for a written response. Registered providers must have complaints processes.

Contact the NDIS Quality and Safeguards Commission on 1800 035 544. You don’t need the person’s permission to raise a concern about a provider, and you don’t need to be certain.

Contact an independent advocate. Free disability advocacy services operate in every state and territory, and restrictive practices are core business for them.

In an emergency, call 000.

Communication, and why so much of this is really about it

If there is a single thread running through behaviour support, it is communication.

A very large proportion of what gets recorded as behaviour of concern turns out, on investigation, to be someone attempting to communicate something with no reliable means of doing it. Pain they cannot report. A preference nobody asks about. A refusal that isn’t accepted when expressed politely. Fear of something that happens every Tuesday.

This has practical consequences for what a behaviour support plan should contain and what families should expect.

A communication assessment should be part of the picture. Where a person has limited or no speech, a speech pathologist’s involvement is frequently more useful than any behavioural intervention, because giving someone a reliable way to say “no”, “stop”, “I’m in pain” or “I want that” removes the need for the behaviour.

Augmentative and alternative communication (AAC) covers a wide range — picture systems, communication books, switches, speech-generating devices, sign and gesture systems. Provision is only half of it: AAC only works where the people around the person are trained to use it and it is consistently available. A device in a cupboard, or one left in the other room, is not communication support.

Receptive communication matters as much as expressive. Many people understand far more than they can express, and much distress comes from not knowing what is about to happen. Visual schedules, consistent routines, and simply telling someone what you are about to do before you do it are interventions in their own right.

Honouring communication is the part that gets skipped. Giving someone a way to say no, and then overriding it, teaches that the new method doesn’t work and the old behaviour did. If a person’s communication is only accepted when it says yes, it isn’t communication support.

The pace of interaction. Some people need considerably longer to process and respond than a busy worker naturally allows. Waiting — genuinely waiting, in silence, for ten or fifteen seconds — changes outcomes more than most formal strategies.

Housing, housemates and the environment

A substantial amount of what is managed as individual behaviour is produced by a living situation.

Housemate compatibility. People in shared supported accommodation are frequently placed together on the basis of a vacancy rather than compatibility. Someone who needs quiet living with someone who is noisy, or two people whose support needs conflict, will generate incidents — and those incidents get attributed to the individuals rather than to the placement. Where a pattern of incidents involves the same two people, the question is about the placement.

Privacy and space. Having nowhere to be alone is a significant stressor, and many group settings offer very little genuine privacy. Access to one’s own room, and respect for a closed door, is both a dignity issue and a behaviour support intervention.

Sensory environment. Noise, fluorescent lighting, television permanently on, crowding, temperature. These are easy to change and are rarely examined.

Predictability. Knowing what is happening today, who is working, and what happens next. Visual schedules, consistent rosters, and advance notice of changes.

Staff consistency. A rotating cast of unfamiliar workers is one of the most reliable drivers of distress in supported accommodation, and one of the least often named in behaviour support plans. Where a provider’s answer to escalating incidents is a new strategy rather than a stable team, the diagnosis is probably wrong.

Meaningful activity. Boredom is a cause, not a background condition. A person with nothing to do, no work, no regular outings and no role will generate behaviour, and the intervention is a life rather than a plan.

Our guides on supported independent living and home and living options cover how placement and housemate matching should work.

Questions for providers

• Is there a current behaviour support plan, who wrote it, and when was it last updated?
• Are there any regulated restrictive practices in use? Which ones?
• Can I see the authorisation evidence for each?
• What is the reduction plan for each, and has frequency actually reduced?
• How are workers trained in this plan, and is that before they work alone?
• How consistently is it implemented — what happens with agency staff?
• Who is the behaviour support practitioner and how often are they involved?
• How do you check for medical causes when behaviour changes?
• What happened at the last review, and what changed as a result?

A provider who answers “none” to the restrictive practices question is giving a perfectly good answer. Vagueness is the warning sign.

For families

Three things worth saying.

You’re entitled to see everything. The plan, the authorisation, the data, the reduction targets. These are documents about your family member.

Restrictions that have been in place for years deserve fresh scrutiny. Circumstances change, people change, and practices frequently persist out of habit rather than necessity. “We’ve always done that” is not a rationale.

Behaviour that appears suddenly is usually medical until proven otherwise. If someone who was settled becomes distressed, the first call is a GP, not a behaviour support referral. Pain is the most under-recognised driver of behaviours of concern in people who cannot easily report it.

And a point that applies throughout this series: a person who communicates differently is not a person with nothing to say. A great deal of what gets labelled behaviour is someone making themselves understood in the only way available to them. The most effective behaviour support often turns out to be giving someone a better way to say what they mean.

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We support participants with behaviour support needs across NSW as part of our high intensity supports, in supported independent living homes, respite and people’s own homes, working with registered behaviour support practitioners. Our related guides cover high intensity daily personal activities and epilepsy and seizure support. Call 1300 271 824.

General information only. This guide explains how behaviour support and restrictive practices are governed under the NDIS. It is not clinical guidance. Behaviour support plans must be developed by appropriately qualified NDIS behaviour support practitioners, and regulated restrictive practices must be authorised under the requirements of the relevant state or territory. To report a concern about a provider, contact the NDIS Quality and Safeguards Commission on 1800 035 544. Requirements are published by the Commission and revised periodically; confirm current detail at ndiscommission.gov.au. In an emergency, call 000.