Harry Lovelock
Senior Manager, Strategic Policy and Liaison
National Office

This year the APS has initiated the development of a Practice Guide to inform psychologists working in the disability sector about the body of evidence identifying alternative psychological interventions effective in the reduction of the use of restrictive physical and pharmacological practices used with people with disability. It is hoped that the Guide will also be useful for other health professionals to support interdisciplinary collaboration and systemic change within this field of practice. The reduction of restrictive practices has relevance across not only the disability sector, but in other areas of practice including rehabilitation, mental health, forensic, juvenile and aged care settings.

The use of restrictive practices is applied in a range of service settings to manage challenging behaviours. Inappropriate use of these forms of restraint on a person can be inhumane and harmful, resulting in physical and psychological injury that can have long-term implications. Yet for staff working in the front line, the existing work culture, lack of adequate resourcing and lack of training in other viable intervention options can result in the application of these approaches without consideration of less restrictive strategies.

In the course of consultation with the disability sector, it was evident that professional leadership was required to underpin the development and implementation of strategies to reduce the use of restrictive practices. The psychology profession, with its long history of positive impact upon behaviour change and expertise in the use of evidence-based psychological interventions, was seen as instrumental to achieve the longer term goal of changing workplace practices and improving the lives of people with a disability. The area of promoting evidence-based alternatives to restrictive practices in human services was recognised as an important area in need of the development of clear guidelines.

Development of the Practice Guide

Working closely with the Victorian Office of the Senior Practitioner in Disability and the Australasian Society for the Study of Intellectual Disability, the APS established an expert reference group to steer the development of the Practice Guide. The first stage of the project was the production of a discussion paper to assist the consultation process in developing the guidelines. The paper provided an overview of the literature, identified significant barriers for implementing evidence-based alternatives to restraint and/or seclusion in the disability sector, and raised questions for response. The discussion paper was distributed widely to key stakeholders and APS members were also invited to respond.

On the basis of responses to the discussion paper, a Practice Guide was drafted and distributed to stakeholders and then revised to integrate feedback. During the development of the Practice Guide, several experts in the area have made significant contributions. In particular, the APS would like to thank Keith McVilly, Morag Budiselik, Madonna Tucker, Lynne Webber, Nick Hagiliassis, Ewa Geba, Kim Meyer, Alan Hudson, Michelle Davies and the many APS members who have made submissions that have contributed to the Guide's development.

The Practice Guide, titled Evidence-based psychological interventions that reduce the need for restrictive practices in the disability sector - a practice guide for psychologists, provides recommendations for a number of aspects of practice, including:

  • Ethical considerations in working with challenging behaviours
  • Assessment of challenging behaviour in the disability field
  • Psychological interventions for clients presenting with challenging behaviour
  • Determining an appropriate physical environment
  • Managing concerns related to staffing
  • Working with a multi-disciplinary approach
  • Working with children and adolescents with a disability
  • Working with people with persistent self-injurious behaviours
  • Legislative and policy issues.

The Practice Guide is not considered a substitute for training and professional development in the use of assessment tools and psychological interventions, but rather provides support and direction to clinicians working in the disability sector, particularly when working in a collaborative multi-disciplinary team.

The draft Guide was presented at the recent APS Conference in Darwin where it was received very positively. Once the Guide has been finalised it will be made available to all APS members. It is intended that the Guide will then become the basis of further discussion with the Commonwealth and State jurisdictions and other professional organisations to promote its use, inform education and training strategies and review workplace practices.

New APS Interest Group

The development of the Practice Guide has been the genesis for the establishment of a new APS Interest Group on People with Intellectual and Developmental Disability and Psychology, which formally came into being at the APS Conference this year. The Interest Group has been established to formally oversee the implementation of the Practice Guide and provides a national forum for promotion of psychological interventions to enhance the lives of people with disability. Associate Professor Keith McVilly has been appointed as the inaugural Convenor of the Interest Group and more information can be gathered from the APS website (www.groups.psychology.org.au/piddp/).

InPsych December 2009