Positive Behaviour Support Plan · Web view2020/06/11 · I declare that: I am duly authorised by...

POSITIVE BEHAVIOUR SUPPORT PLAN INSTRUCTIONS

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How to fill in this PBSP

Fill in all sections that are coloured in blue Remove the information in orange When writing Proactive and Reactive Strategies, if you need to expand n

something you can say “see Appendix C” or you can add in a * and detail underneath that section in more dept

For the Recommendations, try to keep them thematically related (e.g. medical needs could be one single recommendation, and then split into a) ophthalmology, b) dietitian, etc.

Fill in the Disability table with NDIS-recognised categories (google if the condition is accepted under the NDIS!)

Case coordinators are responsible for first filling in the background information (with details obtained via initial interview) and then must make a time to chat with the person writing the report

Asterisks next to headings indicate that this is only required for a COMPREHENSIVE PBSP – delete if is any other type

POSITIVE BEHAVIOUR SUPPORT PLANfor

PARTICIPANT’s NAME(DATE)

2Wonderland Community Services Pty Ltd trading as Wonderland/Pirates Professionals (TAS/QLD)

A: 16 Clovis Court St Leonards TAS 7250 P: 0411 394 662 E: [email protected] Version: 24.10.2020NDIS Reg: 4050042146 ABN: 69627362912

mailto:[email protected]

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Positive Behaviour Support Plan – General/Interim/Comprehensive/Review (please delete types not required)

Plan detailsBehaviour support practitioner: CORE Practitioner ID:

Behaviour support practitioner: PROFICIENT

Practitioner ID:

Behaviour support practitioner: ADVANCED/SPECIALIST

Toni Mehigan Practitioner ID: A4241

Specialist behaviour support provider: Pirates/Wonderland Professionals (Wonderland Community Services)

Start date: Click or tap to enter a date.

End date: Click or tap to enter a date.

Review date:

Click or tap to enter a date.

State/Territory: Choose an item. Is a short-term approval in place? (SA and QLD only)

Choose an item.

Person details NDIS Participant number: Title:

First name: Middle name: Last name:

Gender: Date of birth: Country of birth:

Choose an item. Click or tap to enter a date.

Preferred method of contact: Phone number: Email address:

How does the person communicate?

Is the person of Aboriginal or Torres Strait Islander origin?

Does the person receive informal decision-making support from family/friends/advocate?

Choose an item. Choose an item.

Does the person need a translator? Which language? Does the person identify as being from a CALD background?

Guardian appointed by a Tribunal? Guardian functions:

Choose an item.

Type of residence: Length of time residing at this address:




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Disability details Disability type: (add more rows below if needed DO NOT INCLUDE MEDICAL CONDITIONS e.g. epilepsy)

Choose an item.

Choose an item.

Medical details Diagnosed conditions: (delete if not required or add more)

Current medicationsMedications and prescriptions: (delete if not required or add more)

Participant’s current addressStart date at address:


Key contacts (including those consulted as part of developing this plan)

Title: First name: Last name:

Person type: Person consulted, if other: Consulted date:


Email: Phone number:









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(If additional key contacts are involved, copy and paste another table)

Implementing providers (These are the providers that will be implementing the regulated restrictive practices/strategies in this plan. Their details are entered under the “Providers” tab in the portal) These are all NDIS Providers.

Provider name: ABN (or registration ID): Service location/outlet name:

Authorised reporting officer name: Phone: Email:

Provider name: ABN (or registration ID) Service location/outlet name:

Authorised reporting officer name: Phone: Email:

(If additional implementing providers are involved, copy and paste another table)




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Table of contentsPositive Behaviour Support Plan – General/Interim/Comprehensive/Review (please delete types not required)......................................................................

Plan details.............................................................................................................................................

Person details.........................................................................................................................................

Background............................................................................................................................................

Disability details.....................................................................................................................................

Medical details.......................................................................................................................................

Current medications...............................................................................................................................

Participant’s current address.................................................................................................................

Key contacts...........................................................................................................................................

Implementing providers.........................................................................................................................

Purpose of report...................................................................................................................................

The key aims for the PBSP are:...............................................................................................................

Assessments...........................................................................................................................................

* Tools used............................................................................................................................................

Behaviours of concern............................................................................................................................

Risk factors.............................................................................................................................................

Discussion...............................................................................................................................................

* Restrictive practices schedule.............................................................................................................

* Chemical restraint.............................................................................................................................

* Environmental, Mechanical, Physical or Seclusion.............................................................................

Fade out plan.......................................................................................................................................

Prevention and response strategies.....................................................................................................

Behaviour of concern 1.........................................................................................................................

Behaviour of concern 2.........................................................................................................................

Barriers to success................................................................................................................................

* Plan implementation and system supports.......................................................................................

Summary..............................................................................................................................................

Recommendations...............................................................................................................................

* Declaration by participant/authorised representative & stakeholders.............................................

Declaration by behaviour support practitioner....................................................................................

Appendices...........................................................................................................................................

Appendix A – Compilation of Earlier Professional Reports...................................................................




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Appendix B – Functional Behaviour Analyses.......................................................................................

Important information.........................................................................................................................




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BackgroundProvide info about the participant (taken from background interview by case coordinator) including:

Age Gender Location and living situation Disability Short history Care/support providers and time working with participant History – e.g. substance use, criminal justice history, trauma, family dynamics Personal strengths and interests What’s currently working?

(Please ensure this is in prose like a story – not dot points)

Purpose of reportThe key aims for the PBSP are:

1. To identify and understand behaviours of concern and to generate possible explanations including the purpose or ‘function’ of the behaviours which can inform recommendations and strategies.

2. Specify strategies which include changes to the person’s environment with the aim to reduce behaviours of concern and encourage alternate more helpful behaviours (functionally equivalent replacement behaviour).

3. Provide positive overarching recommendations to maximise behavioural outcomes and overall wellbeing for the participant.

4. Provide necessary reviews of existing Positive Behaviour Support Plans using current information as required.

Assessments Assessment was conducted using the following instruments and methods:

1. Interviews with key supports/caregivers for the participant – (DETAIL PERSON AND DATES)2. Direct observations – (DETAIL LOCATION E.G. HOME/COMMUNITY/SCHOOL AND DATES)3. Functional Behaviour Assessment

a. Person 1 (Name and date)b. Person 2 (Name and date) c. Person 3 (Name and date)

4. A compilation of previous reports provided for the participant from a range of professionals.

Please see Appendices for completed assessments and compilation of reports.

* Tools used (ONLY INCLUDE THIS SECTION FOR COMPREHENSIVE REPORTS – delete this section if interim or general)

Assessor: Practitioner Level Assessment type: Report date:




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(Core, proficient, advanced, specialist)

Functional Behaviour Assessment




Behaviours of concern List

1.

2.

3.

4.

5.

Please see more details in Appendix B.

Risk factors (identify risks associated if behaviours of concern were ongoing which will be the reasons behind the strategies – e.g. risks to self/others, interpersonal relationships, community participation, functional capacity, physical/emotional wellbeing. Add more rows as required)

Type of Risk Risk Description

Discussion (Reiterate the presenting issues here from Background briefly, and what their impact is on the person and those around them. Then describe the behaviours of concern, how they present, and detail implications (e.g. commonly targets other peers because he feels other are teasing him). This is the least important section, so don’t put too much effort in here but remember that this is where you can detail what it all means – so think holistically – are their physical/sexual/interpersonal etc. needs being met?) It is also OK to group Behaviours of Concern together i.e. physical and verbal aggression if they generally go together.

Behaviour of concern 1




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Discuss.


Discuss.


Discuss.

* Restrictive practices schedule (if no restrictive practices, retain the paragraph below – if restrictive practices are included use the below tables) and omit this paragraph.

There are no restrictive practices required at this time. However, if there is any use of unauthorised restrictive practice (for example, having to administer a PRN medication to manage behaviour or restrict access to parts of the home for safety of self or others), this would have to be reported to the Behaviour Support Practitioner and the NDIS Commission within 5 business days of the practice, as per the NDIS Framework and Standards. This PBSP outlines positive behaviour strategies that should reduce the need for restrictive practices, and these should be the standard approach for addressing any and all behaviours.

* Chemical restraint

Medication information below is not for Medication Administration purposes. Medication should only ever be administered from a current medication chart provided by a

medical doctor. Medication information in this plan should not be relied upon, as the type, dosage or frequency may change during the time that this plan is in place.

It is not compulsory to include the details of the medications here, however the details must be entered into the NDIS Commission portal when lodging this behaviour support plan.

This table is for recording the use of chemical restraint only Copy and paste this table for each chemical restraint being used

Implementing provider business name:

Implementing provider service location:

Administration type:

Choose an item.

Is authorisation required? Have authorisation and consent been received?

Authorisation and consent received from:

Choose an item. Choose an item. Choose an item.

Authorisation start date: Authorisation end date: Authorisation Status:

Click or tap to enter a date. Click or tap to enter a date. Choose an item.

Drug name: Dosage: Unit of measurement: Conditions / limits of use:

Choose an item.

Frequency: Route: Side effects:

Prescriber: Prescriber name: Date of last review by doctor:




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Fade out plan (this should outline how the restrictive practice will be gradually reduced based on when the behavioural goals outlined above are achieved)

* Environmental, Mechanical, Physical or Seclusion

This table is for recording the use of regulated restrictive practices other than chemical restraint

Copy and paste this table for each regulated restrictive practice being used

Implementing provider business name:

Implementing provider service location:

Administration type:

Choose an item.

Restrictive practice type: Sub-type (refer to appendix A): Sub-type if other:

Choose an item.

Is authorisation required? Have authorisation and consent been received?

Authorisation status:

Choose an item. Choose an item. Choose an item.

Authorisation and consent received from:

Authorisation start date: Authorisation end date:

Click or tap to enter a date. Click or tap to enter a date.

Fade out plan (this should outline how the restrictive practice will be gradually reduced based on when the behavioural goals outlined above are achieved)

Prevention and response strategies (examples provided for how to write – replace these. If behaviours present differently in different contexts, differentiate these and list strategies that should be used in each context, or if they are the same throughout then remove the below headings)

Behaviour of concern 1Description of behaviour, context, and function.

Who will implement

Behaviour goals

Functionally equivalent replacement behaviour

Rewards to reinforce replacement behaviour

Proactive Reactive




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IN HOME

Have sensory items on hand for person to fiddle with – this may be a soft stress ball or…

IN SCHOOL/OTHER

Give alternatives that person can visually choose from – have a list of tasks with a picture that person can choose from instead if he doesn’t want to do something particular

IN HOME

IN SCHOOL/OTHER

Behaviour of concern 2Description of behaviour, context, and function.

Who will implement

Behaviour goals


Rewards to reinforce replacement behaviour

Proactive Reactive

IN HOME

Have sensory items on hand for person to fiddle with – this may be a soft stress ball or…

IN SCHOOL/OTHER

Give alternatives that person can visually choose from – have a list of tasks with a picture that person can choose from instead if he doesn’t want to do something particular

IN HOME

IN SCHOOL/OTHER

Add extras as required




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Barriers to success (add in what will impact the effectiveness/success of the above strategies e.g. limitations to accessing the community, funding limitations, provider capacity, changes in circumstances, inconsistent implementation of strategies and/or environment, etc)

* Plan implementation and system supportsThe consistent and appropriate implementation of strategies within the reviewed PBSP will prove critical for the reduction of behaviours of concern. As part of the implementation of this PBSP, (PERSON’s) supports will receive training in the above strategies and will also receive information relating to restrictive practices and the consequences of unauthorised use. Once the PBSP is in place, Team Leaders for individual implementing providers will be asked to share all incident reports and other relevant data with Pirates/Wonderland Professionals Behaviour Support Review Coordinator. Post-incident reviews will be inclusive of the staff member, relevant stakeholders, and (PERSON) wherever possible to ensure that behaviours (and their outcomes) are addressed as a collaborative team and that the positive behaviour strategies can be added to or amended over time based on their success.

Summary (quickly review of the person and their behaviours and how the strategies have addressed the purpose of this report)

RecommendationsIn the process of completing this PBSP, our team of behaviour practitioners identified a number of recommendations to maximise ongoing wellbeing for (PERSON).

For example:

Recommendations for Medical support and review Recommendations for other professionals to support and review Recommendations for further funding via NDIS Recommendations for utilising person’s preferences, interests and strengths Recommendations for review dates – i.e. in 4 weeks and thereafter in 12 weeks and prior to

end of plan1. Brief summary of the recommendation: short elaboration2. Brief summary of the recommendation: short elaboration3. Brief summary of the recommendation: short elaboration




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* Declaration by participant/authorised representative & stakeholders (only include if this is a comprehensive PBSP)

I warrant that the above plan provides a realistic and supportive plan for the participant and demonstrates a commitment to their safety, the safety of others and includes instructions for a ‘fade out’ plan to reduce restrictive practices over time. I understand that a review process is also in place where I am able to provide feedback.

Name of Participant /Representative

Signature

Date

Job title

Name of Stakeholder

Signature

Date

Job title

Organisation

Name of Stakeholder

Signature

Date

Job title

Organisation

Name of Stakeholder

Signature

Date

Job title

Organisation

Name of Stakeholder

Signature

Date

Job title




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Organisation

Declaration by behaviour support practitionerI declare that:

I am duly authorised by the specialist behaviour support provider (as stated in this form) to submit this behaviour support plan.

I understand that this information is being collected by the NDIS Quality and Safeguards Commission (NDIS Commission) for the purposes of the NDIS (Restrictive Practices and Behaviour Support) Rules 2018.

I have read the NDIS Commission’s NDIS restrictive practices and behaviour support guidance and understand the requirements of registered NDIS Providers in relation to notifying the NDIS Commission of the use of regulated restrictive practices.

I understand that the NDIS Commission will, if required, use the information to undertake compliance and enforcement activities consistent with the National Disability Insurance Scheme Act 2013 (the Act) and any Rules established under the Act.

I acknowledge the NDIS Commission may share the information contained in the behaviour support plan with relevant Commonwealth, State, and Territory agencies including the Police.

To the best of my knowledge, the information provided in this behaviour support plan is true, correct and accurate.

I acknowledge that the giving of false or misleading information to the Commonwealth is a serious offence under section 137.1 of the schedule to the Criminal Code Act 1995.

Practitioner signature

Practitioner name and BSP ID

Date

Job title Behaviour Support Practitioner – Core etc.

Practitioner signature

Practitioner name and BSP ID

Date

Job title Behaviour Support Practitioner – Core etc.

Note: Once assessed under the Positive Behaviour Support Capability Framework, if the practitioner is considered suitable at a ‘core’ level they must be supervised by a practitioner at the ‘proficient’ level. If this plan has been completed by a ‘core’ level practitioner the supervisor must also complete the box below.

Supervisor signature

Supervisor name Toni Mehigan BSP Reg: A4241




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Date

Job title Behaviour Support Practitioner – Advanced/Specialist (Service Manager)

Appendices

Appendix A – Compilation of Earlier Professional ReportsInsert WORD DOC Table here




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Appendix B – Functional Behaviour Analyses(ONLY USE DROP DOWN OPTIONS - copy and paste the table below for each behaviour in this plan – add more tables for additional behaviours of concern)

Type Choose an item.

Description

Frequency / Duration

Intensity

Setting events

Triggers

Low risk scenarios

High risk scenarios

Function of the behaviour (BEHAVIOUR OF CONCERN) may provide (PARTICIPANT) with: 1. Blah 2. Blah 3. Blah


Behavioural goals (these should be observable and measurable and expressed in terms of the functionally equivalent replacement behaviour)




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Important informationThis form is modelled on the NDIS Quality and Safeguards Commissioner. By completing this form – you will be able to upload information into the NDIS Commission Portal. The structure of this form supports the purposes of section 23 of the National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018. This form seeks to collect information – including personal information – for the purpose of administering and enforcing the National Disability Insurance Scheme Act 2013 and the National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018. Please refer to the Privacy Collection Statement and the NDIS Quality and Safeguards Commission’s Privacy Policy at https://www.ndiscommission.gov.au/privacy. The NDIS Commission makes no representations about, and accepts no liability for, the accuracy of information in this document.




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https://www.ndiscommission.gov.au/privacy

Positive Behaviour Support Plan · Web view2020/06/11 · I declare that: I am duly authorised by...

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