1. BoC
Communication Assessment for People who engage in Behaviours Of Concern (BOC) Module 1 : Introduction Overview
Hilary Johnson, Nick Hagiliassis, Barbara Solarsh,
Teresa Iacono, Jo Watson, Teena Caithness
This is Module 1: Office of the Senior Practitioner. It is a module to be completed prior to the workshop.
Learning Objectives for this short module are:
To identify the purpose of the Office of the Senior Practitioner (OSP), Department of Human Services, Victoria.
To explain Disability Act 2006 and the Victorian Human Rights and Responsibilities 2006 law and the resultant relationship to the OSP.
To identify the roles of the Office of the Senior Practitioner including the evaluation and monitoring of Restrictive Interventions
To identify that there are three resources that underpin the content of the Positive Behaviour Support training in Victoria.
To analyse the term Behaviours of Concern using the definition by Emerson 1995 or 2001 and McVilly 2002
To identify the stages of the OSP project Building the Foundations for Effective Communication for Victorians with BOC subject to Restrictive Practices
To describe how Behaviours Of Concern (BOC) have been defined over time (1991, 1992 then 2002)
Office of the Senior Practitioner, Disability Services, Victoria
Module 1 Office of the Senior Practitioner

2. Introduction Overview
BoC
Introduction Overview
Defines behaviours of concern
Sets out legal boundaries of when you can limit a person’s Human Rights
The Office of the Senior Practitioner was created in 2006 as a direct result of the Disability Act 2006 and the Victorian Human Rights and Responsibilities 2006 law.
Module 1 Office of the Senior Practitioner

3. BoC
Disability Act 2006
Protects the rights of people with a disability who:
show behaviours of concern
are subject to restrictive interventions and compulsory treatment
The Disability Act 2006 s (a).
The role is outlined under the Disability Act 2006
Significant legislative powers – unique position (within disability sector internationally) as the OSP is part of Disability Services and also has a statutory role combined = strong practice improvement focus and initiate research within a human rights framework.
Protect – the rights of people with a disability, especially those with restrictive interventions and compulsory treatment
Develop: guidelines and standards, links with other professional bodies
Provide: education and information to Disability Services Professionals, information about rights, advice to improve practice
Evaluate and Monitor: the use of restrictive interventions
Taken from Phiilips, Wilson & Wilson (2010)
The Disability Act 2006 (the Act) was proclaimed in the Victorian Parliament in July Prior to this date, all government-funded services that provided support to people with intellectual disability were required to comply with the Intellectually Disabled Persons’ Services Act 1986 (IDPS Act). This legislative change resulted in alterations to the way services are delivered to people with intellectual disability and challenging behaviour in Victoria. The legislative requirement for the development of behaviour support plans for individuals subject to restrictive interventions is to limit the indiscriminate use of interventions (McGillivray & McCabe, 2004)
Module 1 Office of the Senior Practitioner

4. Victorian Charter of Human Rights and Responsibilities 2006
BoC
Victorian Charter of Human Rights and Responsibilities 2006
Is a law with an agreed set of human rights, freedoms and responsibilities
Includes laws, policies and services provided by State, local government and other bodies
The Victorian Charter of Human Rights and Responsibilities 2006, (Freedom, Respect, Equality and Dignity)
Module 1 Office of the Senior Practitioner

5. Roles of the OSP Protects Develops Provides Evaluates & Monitors
BoC
Roles of the OSP
Protects
Develops
Provides
Evaluates & Monitors
PROTECTS:
The rights of people with a disability
Especially those with restrictive interventions and compulsory treatment (section 23(2)(a))
DEVELOPS:
Guidelines and standards (section 24(1)(a))
Links with professional bodies and universities (section 24(1)(f))
PROVIDES:
Education and information to DSPs (section 24(1)(b)
Information about rights (section 24(1)(c))
Advice to improve practice (section 24(1)(g))
EVALUATES & MONITORS:
The use of restrictive interventions (section 24(1)(h))
Module 1 Office of the Senior Practitioner

6. OSP Evaluates & Monitors
BoC
OSP Evaluates & Monitors
Restrictive Interventions (RI’s)
Seclusion
Mechanical restraint
Chemical restraint
Social Restraint
Behaviour Support Plans (BSPs)
Restrictive Interventions Data System (RIDS)
Seclusion – “sole confinement….day or night…in any room in the premises…doors or windows cannot be opened by the person from the inside…or outside…to a part of any premises….”
Mechanical restraint – “……devices to prevent, restrict or subdue a person’s movement……”
Chemical restraint –”….of a chemical substance to control or subdue the person…..”
Social Restraint – for example, the use of verbal instructions, which might reasonably be construed by the person to whom they are directed as intimidating or potentially abusive, which rely on eliciting fear to moderate a person’s behaviour.
Restrictive Intervention Data System (RIDS) every month disability service providers must report on use of restrictive interventions (type, duration, frequency, amount etc)
Restrictive Interventions must be documented in the person’s Behaviour Support Plan (BSP) – “a plan developed for a person with a disability which specifies a range of strategies to be used in managing a person’s behaviour including proactive strategies to build on the person’s strengths and increase their life skills”.
Restrictive Interventions – used to restrict the rights and freedom of movement of a person with a disability. Can only be used : to prevent person from causing physical harm to self/others, to prevent from destroying property where to do so could involve the risk of harm to self/others and if the RI/seclusion is the least restrictive of the person
Read the ASSID Official Position Statement Against the Use of Restrictive Practices in the Support of People who Have a Intellectual Disability May Note that this document also mentions containment and physical restraint and has a clear statement about what social restraint could include.
Read the Phillips, Wilson and Wilson (2010) article, Assessing behaviour support plans for people with intellectual disability before and after the Victorian Disability Act 2006.
Module 1 Office of the Senior Practitioner

7. Overriding Philosophy of the OSP
BoC
Human Rights and citizenship
Quality of life and wellbeing
Community Inclusion
Positive lifestyle and behaviour support
Dignity of risk
Building relationships and collaboration with key partners to enable change to occur
The following information has been provided by the OSP.
Module 1 Office of the Senior Practitioner

8. Other activities of the OSP
Provide training – sessions Human Rights, Risk Assessment, Chemical Restraint, Trauma, Attachment & Psychotherapeutic Interventions, Role of an Authorised Program Officer (APO)
Support on-line training through Disability Professionals Victoria
Positive Solutions in Practice articles enior_practitioner/positive-solutions-in-practice
Grants
Research

9. Resources quoted by OSP
BoC
The Office of the Senior Practitioner, Disability Services, Department of Human Services provides useful online resources, practice guides, practice advice and templates for practitioners, clinicians and direct support workers.
division/office_of_the_senior_practitioner
Much of the Positive Behaviour Support training (2 day + 1 day follow-up) and the e-learning module is based on three resources: McVilly (2002); DDSG (2005); Bloomberg, West Johnson & Iacono (2009)
Three resources mostly quoted on the OSP website are:
McVilly, K. (2002). Positive behaviour support for people with intellectual disability: Evidence-based practice, promoting quality of life. Sydney: ASSID. Downloadable order form available from ASSID site. ISBN
Developmental Disability Steering Group. Management guidelines: developmental disability. Version 2. Melbourne: Therapeutic Guidelines Limited; ISBN X
Available from Therapeutic Guidelines Limited Freecall
Bloomberg, K & West, D (2009) The Triple C: Checklist of Communication Competencies. Scope Victoria
Module 1 Office of the Senior Practitioner

10. Positive Behaviour Support e-learning (1)
BoC
e-learning course Positive Behaviour Support (1 hour) designed by the OSP for professionals
Costs $ 55 AUD
Go to DPV eLearning Centre companyId=dpv
Click on “Community Services”
Click on “Positive Behaviour Support for Disability Professionals”
Disability Professionals Victoria
e-learning coursePositive Behaviour Support e-learning course (1 hour)
Go to DPV eLearning Centre
Click on “Community Services”
Click on “Positive Behaviour Support for Disability Professionals”
The purpose of Positive Behaviour Support module is to provide Disability Professionals with some of the important skills and knowledge needed to design a behaviour support plan that works both to increase quality of life and reduce restrictive interventions. The module includes information about restrictive interventions that must be reported in Victoria to the Senior Practitioner, and the important components of good planning including:
An understanding of the possible reasons for the behaviours of concern
How to target interventions to reduce behaviours of concern and increase quality of life.
Ideas on how to make sure the interventions are implemented in the same way by all staff.
Ways to check that the interventions are making a difference and how to review and make changes to behaviour support plans as needed.
Module 1 Office of the Senior Practitioner

11. Positive Behaviour Support e-learning (2)
BoC
The purpose of Positive Behaviour Support module is to provide Disability Professionals with some of the important skills and knowledge needed to design a behaviour support plan that works both to increase quality of life and reduce restrictive interventions. The module includes information about restrictive interventions that must be reported in Victoria to the Senior Practitioner, and the important components of good planning.
Module 1 Office of the Senior Practitioner

12. Positive Behaviour Support e-learning (3)
BoC
This e-learning training includes:
An understanding of the possible reasons for the behaviours of concern
How to target interventions to reduce behaviours of concern and increase quality of life.
Ideas on how to make sure the interventions are implemented in the same way by all staff.
Ways to check that the interventions are making a difference and how to review and make changes to behaviour support plans as needed.
Module 1 Office of the Senior Practitioner

13. Challenging Behaviour - known as Behaviours of Concern (BOC)
Culturally abnormal behaviours of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit the use of, or result in the person being denied access to ordinary community facilities Emerson (2001)
This is one of the most widely quoted definitions of challenging behaviour or in Victoria, known as behaviours of concern (BOC). This quote comes from the text book
Emerson, E (1995). Challenging behaviour: analysis and intervention with people with learning difficulties. Cambridge: Cambridge University Press. The second edition of this book (2001) is available through Cambridge Press University.
Module 1 Office of the Senior Practitioner

14. Behaviours of Concern (BOC)
Any behaviour that:
is a barrier to the person participating in, and contributing to their community
undermines, directly or indirectly, a person’s rights, dignity or quality of life
poses a risk to the health and safety of a person and those with whom they live and work McVilly (2002)
The OSP training package Positive Behaviour Support: Getting it right from the start Version 2 (updated September 2009) DHS Victoria is based on this reference by McVilly 2002.
McVilly, Dr Keith R Positive Behaviour Support for people with Intellectual Disability: Evidence-based practice, promoting quality of life. The Australasian Society for the Study of Intellectual Disability Inc, Victoria, Australia
Module 1 Office of the Senior Practitioner

15. BOC: people with Developmental Disabilities 1991
Aggressive behaviour
hitting
biting
kicking
head-butting
spitting
slapping
pulling hair
Self Injurious Behaviour (SIB)
self-biting
pinching
scratching
hair pulling
Generally texts from the 1990’s refer to challenging behaviours as either inflicted on others or inflicted on self. Aggressive behaviours are those directed to others, that are hurtful. Self-injurious behaviours are directed to self, are forceful in nature and often leave physical evidence. (NIH, 1991)
National Institutes of Health (NIH) Treatment of destructive behaviors in persons with developmental disabilities. Washington, DC: Author
Usually challenging behaviour was seen as something that was a challenge to “the system” in which the individual was receiving a service. Most work had been done in the area of developmental disabilities and had come from a behavioural background.
Module 1 Office of the Senior Practitioner

16. Motivational Assessment Scale (MAS) Durand & Crimmins (1992)
BoC
Motivational Assessment Scale (MAS) Durand & Crimmins (1992)
Sensory Stimulation
seeking entertainment
seeking relief from boredom
Social Contact
seeking social interaction in general
seeking social interaction with specific people
Access to Tangible Items
having things that they want
having things that they need
getting things they can’t get independently
Avoidance of Demands
escaping things they don’t understand
escaping when can’t cope
The Motivational Assessment Scale, Durand & Crimmins (1992) viewed behaviours as falling into four main categories. These four theoretical categories suggested the possible motivation underlying the person’s behaviour. The 16 item questionnaire about a specific behaviour was designed to assist practitioners to being to develop hypotheses about a specific behaviour and to help in the formulation of an analysis of function or meaning for the behaviour.
How does this work. The Functional Behaviour Assessment is about gathering enough information about the behaviours. The steps are to define the behaviour as accurately as possible (intensity, frequency and duration), looking at what happened before (Setting events: triggers and warning signs), during (what did the person actually do? What did it look like?) and after the event (Results: what is the person getting from the behaviour). So after A-B-C Charts and STAR charts have provided data about specific behaviours. The MAS often then used, to help in determining the function of the behaviour. The four theoretical categories of the MAS provide the beginning of a hypotheses of why the behaviour is occurring. This is important in conducting a functional behaviour assessment (FBA). See downloadable form for conducting a FBA on the OPS website.
Purists in the behaviour support field believe that the four categories are too limiting and that behaviours will occur for very complex and varied reasons, not just the four that Durand and Crimmins suggested.
For further information look at the Positive Behaviour Support: Getting it right form the start Facilitators reference manual Version 2 (updated September 2009)
Module 1 Office of the Senior Practitioner

17. Behaviours of Concern forms McVilly (2002)
BoC
Behaviours of Concern forms McVilly (2002)
Internalised Behaviours
being withdrawn or inattentive
performing repetitive or unusual behaviours
enacting self-injurious behaviours
Externalised Behaviours
being disruptive
being destructive to property
being hurtful to others
Asocial behaviour
being unco-operative
enacting behaviours that others find offensive
The OSP training package Positive Behaviour Support: Getting it right from the start Version 2 (updated September 2009) DHS Victoria is based on this reference by McVilly 2002.
Taken from McVilly, Dr Keith R Positive Behaviour Support for people with Intellectual Disability: Evidence-based practice, promoting quality of life. The Australasian Society for the Study of Intellectual Disability Inc, Victoria, Australia pages 44 to 45
The form of the behaviour – the type or category
Internalised Behaviours
Being withdrawn or inattentive – behaviours that make it difficult for the person to be with other people and participate in groups eg: appearing shy, fearful, consistently tired, easily distracted, lacking motivation
Performing repetitive or unusual behaviours – behaviours that are frequently (even constantly) enacted and that impede other daily activities eg: pacing, rocking, twirling or sucking fingers or objects, etc
Enacting self-injurious behaviours – behaviours that have the potential to cause the person harm eg: head banging, pulling own hair, picking at skin, pulling out hair
Externalised behaviours
Being disruptive – behaviours that interfere with the activities of other people eg: clinging. teasing, interrupting, yelling and arguing
Being destructive to property – behaviours that result in the defacing or breaking of property or objects eg: hitting, throwing or burning etc
Being hurtful to others – behaviours that can cause physical or psychological harm to other people eg: hitting, kicking, punching etc
Asocial behaviours
Being un-cooperative – behaviour that involve refusals to comply with reasonable requests eg: to perform chores, to take turns in a group, to adhere to the law
Enacting behaviours that others find offensive – behaviours that offend, embarrass or up-set others whom might observe them eg; swearing, spitting, inappropriate social touch, public masturbation
Module 1 Office of the Senior Practitioner

18. Building the Foundations for Effective Commn for Victorians with BOC Subject to Restrictive Practices
Speech Pathology Australia conference 2010
BoC
1. Identify the foundations of effective communication assessment through the development of a resource kit to support assessment and intervention in relation to communication and behaviours of concern,
Increase the capacity of speech pathologists to provide practice support to direct disability staff and others involved in the support of people subject to restrictive interventions.
3. Undertake an evaluation of the tool kit in a natural practice setting i.e., a residential support service
The OSP has funded this project, “Building the Foundations for Effective Communication for Victorians with BOC Subject to Restrictive Practices”. This training addresses the second dot point.
Scope & OSP
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19. BoC
Speech Pathology Australia conference 2010
Assessment to inform intervention for behaviours of concern in people with acquired and developmental disabilities Hilary Johnson – Manager, Communication Resource Centre, Scope Teresa Iacono - Professor of Rural Allied Health, Latrobe University, Bendigo. Barbara Solarsh - Project Co-ordinator, Communication Resource Centre, Scope Nick Hagiliassis – Psychologist - Acting head of research, Scope Teena Caithness - Project worker, Communication Resource Centre, Scope Joanne Watson– Researcher – Scope
As part of this project a Communication Assessment Kit was developed and has been triaed across sites in Victoria. This is the title of the workshop held at the Speech Pathology Australia Conference There is a plan to upload items onto the scope website to easy access to materials and resources.
Scope & OSP
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20. Office of the Senior Practitioner
BoC
Office of the Senior Practitioner
Contact Details
(03)
Further information about the OSP is found on the website
Please complete your pre-reading quiz and bring it along to training on 4 November 2010.
Module 1 Office of the Senior Practitioner