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Specialist Response ServiceBlueprint

Investing in Positive Futures

making a difference for people with a disability

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Disability Services Queensland – Positive Futures – Specialist Response Service Blueprint

Contents

Purpose of this document 5

Investing in Positive Futures 6

Key elements of the Specialist Response Service 7Centre of Excellence for Behaviour Support 7

Specialist Response Service teams and functions 7

Purpose-built positive environments 8

Legislative base for the Specialist Response Service model 9Disability Services Act 2006 9

Guardianship and Administration Act 2000 9

Guardianship and Administration Tribunal 10

Adult Guardian 10

Community Visitor Program 10

Specialist Response Service model 11

1. Centre of Excellence for Behaviour Support 12Vision 12

Mission statement 12

Functions 12

Policy research and research in behaviour support 13

Learning and development 13

Centre of Excellence for Behaviour Support 14

Interface between the centre and Specialist Response Service teams 14

2. Specialist Response Service principles 15Vision 15

Mission statement 15

Values 15

Target group 15

Service delivery principles 16

Safeguarding the individual’s rights and liberties 17

Person-centred planning approach 17

Family and natural support networks 17

Quality of life 17

Positive behaviour support 17

Active support model 18

Collaborative practice 19

Interdisciplinary team model 19

Case management 20


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3. Specialist Response Service teams and functions 21Individual Response Leaders 21

Specialist Response Service specialist teams 21

Assessment 23

Positive behaviour support plan 24

Approval and consent 25

Intervention 25

Monitoring 25

Review and evaluation 26

Transition from Specialist Response Service 26

Mental Health Assessment and Outreach team 26

4. Purpose-built positive environments 28Objective 28

Accommodation styles 28

Service model for purpose-built positive environments 29

Forensic orders 30

Direct support staff model 30

Specialist Response Service implementation 33

Specialist Response Service within a continuum of service delivery 34

Evaluation 35Outcome evaluation 35

Process evaluation 35

References 36

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Purpose of this documentThe Blueprint for the Specialist Response Service is designed to facilitate planning between the new Specialist Response Service teams and service providers who provide services to adults with an intellectual or cognitive disability who exhibit severely challenging behaviour. The Blueprint has also been written for all practitioners involved in Specialist Response Service initiatives. The Specialist Response Service will commence operations from a small base in 2007–08 and build to full capacity in 2011. Regional variations and operational resources may see Specialist Response Service services differ once teams are operational.


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Disability Services Queensland is committed to ensuring people with an intellectual or cognitive disability who exhibit severely challenging behaviour are supported appropriately. Our dedicated staff do this by providing a safe environment for the person and the community in a way that recognises the person’s rights and needs.

Almost two per cent of Queenslanders have an intellectual or cognitive disability. Within this group there are a small number of people with severely challenging behaviour. This behaviour can result in these people presenting a significant risk of harm to themselves, their carers, their families or the community.

Disability Services Queensland already provides an array of support options for these people through direct services and those it funds in the non‑government sector. Recently, these services have been supplemented by initiatives such as the Innovative Support and Housing Program and the construction of purpose-built housing. This accommodation supports people with an intellectual disability whose complex needs make it difficult to support them in standard community living arrangements.

Additionally, Intensive Behaviour Support teams have been established to assist with developing behavioural change.

In 2006, concern that this group’s complex needs were not being met led the Queensland Government to appoint the Honourable W.J. Carter QC, retired Justice of the Supreme Court of Queensland, to review current services. Mr Carter was also asked to report on the legislative and support options available. Following the tabling of this report, the Queensland Government adopted its recommendations and provided funding to establish the Specialist Response Service. This new service fits into the continuum of services operated or funded by Disability Services Queensland.

I congratulate all who have been involved in creating this new environment for the sector.

The Honourable Lindy Nelson-Carr MP Minister for Disability Services

Investing in Positive Futures

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The Queensland Government, through Disability Services Queensland, is significantly investing in a ground-breaking service response by establishing the Specialist Response Service.

The Specialist Response Service will provide a range of services that will support some of the most vulnerable members of society — people with an intellectual or cognitive disability who exhibit severely challenging behaviour.

The Specialist Response Service will support adults with an intellectual or cognitive disability, who:

• receive services funded or provided by Disability Services Queensland

• exhibit severely challenging behaviour that is likely to result in significant injury or extreme distress to themselves or others

• are subject to or at risk of becoming subject to restrictive practices.

Delivery of this new service response will involve a new Centre of Excellence for Behaviour Support, Specialist Response Service teams and purpose-built positive environments. The principles underpinning this response will reflect statutory requirements under new amendments to the Disability Services Act 2006 and the Guardianship and Administration Act 2000.

Centre of Excellence for Behaviour Support The Centre of Excellence for Behaviour Support will be established under the leadership of a highly regarded clinician, academic or researcher. The centre will position Queensland as a world leader in research, policy and training in positive behaviour support. It will develop tailored support programs for the care and support of people with an intellectual or cognitive disability who exhibit severely challenging behaviour. It will also provide training and resources to workers operating in primary intervention circumstances.

The centre is being established through a partnership with the University of Queensland and will be located at the University’s Ipswich Campus.

Specialist Response Service teams and functions The Specialist Response Service is a new, innovative and evidence-based support model that will focus primarily on the best possible outcomes for individuals. The key goals of the service are to reduce reliance on the use of restrictive practices and to maximise the involvement of the target group in community life.

The service will function as a specialist clinical service that will operate in close collaboration with service providers.

Six Specialist Response Service teams will work with services funded or provided by Disability Services Queensland across the state. The teams will be comprised of highly trained and experienced disability and mental health practitioners from a range of backgrounds across the social, behavioural and health sciences and related fields.

The primary focus of the teams will be to work directly with clients together with direct support staff, family and networks. They will encourage positive behaviour support and increase participation in community life through skills development, behaviour support strategies and supporting people to participate in meaningful daily activities.

The service will be supported by the establishment of a Mental Health Assessment and Outreach team to provide assessment and consultancy services to people receiving support.

This team will not replace mainstream mental health services for adults with a diagnosed mental illness. The Specialist Response Service Mental Health Assessment and Outreach team will work with other Disability Services Queensland and public mental health services. A protocol to guide this interaction will be developed.

Key elements of the Specialist Response Service


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Purpose-built positive environments Purpose-built accommodation will be constructed to meet the needs of people in the target group. These positive environments will complement therapeutic interventions for these adults and will facilitate positive change. These dwellings will not provide a ‘home for life’.

Accommodation facilities will include:

• accommodation that will provide different levels of secure care, dependent on the person’s needs

• forensic secure accommodation facilities for people placed under a Mental Health Court forensic order

• emergency or crisis accommodation to be used as a short-term arrangement for people who have no other available accommodation

• other variable accommodation arrangements within local community settings.

The purpose-built accommodation will be staffed by Specialist Response Service direct support teams. These teams will comprise staff who are highly skilled in direct support services for adults within the target group.

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Specialist Response Service operations are linked to statutory requirements under amendments to the Disability Services Act 2006 and the Guardianship and Administration Act 2000. These amendments establish a framework to safeguard the rights of adults in the target group and to regulate the use of restrictive practices for those adults.

Disability Services Act 2006The objectives of the Disability Services Act 2006 support the Specialist Response Service delivery model in its efforts to respond to the needs of adults in the target group. The objectives of the Act are:

• to acknowledge the human rights of people with a disability by promoting their inclusion in community life generally

• to ensure disability services provided by and funded by Disability Services Queensland are safe, accountable and respond to the needs of people with a disability.

The human rights principle and service delivery principles set out in the Act reinforce service providers’ responsibility to provide a service environment that responds to a person’s needs in a manner that is the least restrictive of their rights and opportunities.

The amendments to the legislative framework are based on the human rights principle which also underpins the Specialist Response Service model. While the legislative framework must balance protection for the individual against the inappropriate use of restrictive practices and protecting others from harm, the overall objective must be the person’s wellbeing. Inherent in this is a need to:

• safeguard the rights of adults with an intellectual or cognitive disability who may require restrictive practices

• regulate the use of restrictive practices for these adults

• provide a transparent and accountable authorisation process that requires:

appropriate levels of assessment –

development of a planned response –based on the least restrictive alternative and formulation of a positive behaviour support plan.

• ensure appropriate approvals and consent for the use of any restrictive practices (the level of approval and consent required will depend on the nature and type of the restrictive practice being used)

• ensure monitoring and review (the use of restrictive practices as part of an approved support plan will be time limited and subject to review).

Guardianship and Administration Act 2000 The Guardianship and Administration Act 2000 promotes the involvement of substitute decision makers to protect the rights of adults who have an impaired decision-making capacity.

In contentious and complex matters where the adult’s rights are at risk, the Guardianship and Administration Tribunal can review a decision or ratify a proposed exercise of power by an informal decision maker.

The Act is also based on the principles that formal and informal decision makers exercising their powers must do so in a way that least restricts the adult’s rights.

Amendments to the Act in relation to approval and review of restrictive practices reflect the Guardianship and Administration Tribunal’s new powers to independently approve and review individual positive behaviour support plans where containment and seclusion are proposed.

The Guardianship and Administration Tribunal will also appoint guardians for restrictive practices who will be required to consent to the use of physical, mechanical or chemical restraint. This will occur once the service provider has developed and verified the positive behaviour support plan.

The amendments also authorise service providers to use restraint with short-term approvals where there is an immediate and serious risk of harm.

Legislative base for the Specialist Response Service model


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Guardianship and Administration TribunalUnder the amendments to both Acts, Individual Response Leaders will screen referrals to Specialist Response Service teams and applications to the Guardianship and Administration Tribunal for the proposed use of containment or seclusion (and any other restrictive practice).

Appropriate protocols and referral processes will be developed in conjunction with the Guardianship and Administration Tribunal to ensure smooth progression of applications.

Adult GuardianThe Adult Guardian is an independent statutory officer who operates under the Guardianship and Administration Act 2000. The Adult Guardian’s role is to protect the rights and interests of individuals with impaired decision making capacity. The Adult Guardian may:

• exercise discretion to investigate if there is exploitation, abuse or neglect of an adult with impaired decision-making capacity

• suspend the powers of an attorney under an Enduring Power of Attorney if the Attorney is found to be not adequately protecting the adult or is abusing, neglecting or exploiting the adult

• following suspension of an attorney, act as personal attorney and the Public Trustee as financial attorney for three months, and then apply for further orders

• apply to the Guardianship and Administration Tribunal to obtain a warrant to remove an adult who is being abused, exploited or neglected

• make decisions on health matters on behalf of an adult with impaired decision-making capacity.

The Adult Guardian can be appointed as a guardian by the Guardianship and Administration Tribunal. If the Adult Guardian agrees, as a last resort, he or she can be appointed as a personal attorney under an Enduring Power of Attorney or Advance Health Directive.

Community Visitor ProgramThe Guardianship and Administration Act 2000 is the legislative base for the Community Visitor Program. The program is designed to safeguard the interests of individuals with impaired decision-making capacity or a mental or intellectual disability who live in certain facilities.

In the disability sector, a visitable site is a place where a person lives and receives services from:

• Disability Services Queensland

• a service which is wholly or partially funded by Disability Services Queensland or Queensland Health

Visitable sites are defined for each sector in the Guardianship and Administrative Regulation 2000. It is not optional for an accommodation facility to be visitable. A facility’s tenancy arrangement does not define or determine visitable site status.

The Specialist Response Service purpose-built positive environments and any other Specialist Response Service site will be visitable sites. This will enable the Community Visitor Program to maintain close contact with the service.

New policies and procedures developed to ensure compliance with the legislation and best practice in positive behaviour support will be in place to guide service providers and the Specialist Response Service.

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Specialist Response Service model

The Specialist Response Service model is based on contemporary, evidence‑based practice as part of a positive behaviour support system. The overall Specialist Response Service initiative consists of the four elements outlined previously:

1. the Centre of Excellence for Behaviour Support

2. Specialist Response Service principles

3. Specialist Response Service teams and functions

4. purpose-built positive environments.

Features of the Specialist Response Service model include:

• integrated service delivery that promotes an ecological, person‑centred and holistic approach to supporting adults who exhibit severely challenging behaviour

• collaborative interdisciplinary practice that will inform assessment, planning and service delivery

• involvement (in assessment, planning and support) of families, advocates and support staff

• the use of strategies that address the cause of the challenging behaviour rather than seeking only to deter or suppress

• implementation of interventions and strategies by those who best know the person, supported by ongoing direct behaviour support from expert practitioners

• employment of highly trained and experienced staff who are provided with significant levels of staff development, support and supervision

• where appropriate, provision of accommodation in living environments which have the capacity to meet the person’s needs

• access to services for highest‑priority people as referred under the requirements of the legislation

• a comprehensive response.


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VisionTo position Queensland as a world-class leader in research, policy and training in positive behaviour support.

Mission statementTo provide access to research, training and support to establish firm foundations for best practice in service delivery across the disability sector.

Functions The centre’s key functions are policy research, research in behaviour support, service evaluation and training.

The centre will lead research to guide innovative programs for the support of people in the target

group. The broader disability sector, both government and non‑government, will be able to access information provided through the centre. The centre will also operate as a resource centre, providing specialist training for Specialist Response Service specialist teams and service providers and their support staff to ensure all teams working with adults in this target group are equipped with up-to-date and appropriate knowledge, skills and tools to operate effectively in primary intervention circumstances.

The Centre Director will guide centre staff in the development of positive behaviour support systems and programs for practitioners working with adults in this target group.

The following diagram illustrates the centre’s key functions.

1. Centre of Excellence for Behaviour Support

Evidence generated

Existing evidence? Training

Families

Practitioners(government

/non-governmentorganisations)

People withchallengingbehaviour

Research questions and issues

Service and practiceResearchprojects

and serviceevaluation

Policy

Tertiaryinstitutions

Researchinstitutes

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Policy research and research in behaviour supportThe centre will research policy areas to inform policy development and policy directions across the disability services sector, as well as other relevant sectors.

Policy areas the centre is likely to investigate include:

• reduction in and elimination of the use of restraints and restrictive practices

• effective communication supports for people with complex communication needs

• policy frameworks across disability services, health and the criminal justice system

• clinical case management models

• ethical frameworks for safeguarding human rights

• prevention and early intervention strategies

• workplace planning and development for working with adults in this target group

• services evaluation.

Research areas the centre is likely to investigate include:

• the sustainability of change for the individual and family

• assessment methodology

• causes of challenging behaviour, interventions and their clinical effectiveness

• medication — its use and effects

• holistic methodologies

• measurement of transitions and transformations

• systems of data collection and analysis to inform practice development and service improvement

• staff behaviour and increasing competency levels.

Learning and developmentThe centre will provide advice on the development and delivery of tertiary education and workforce training to enhance the skills and competencies of those working within the disability sector. In particular, the centre will help to develop the skills required for behaviour analysis as well as develop active support and positive behaviour support models for adults in this target group.

The centre will have responsibility for developing and delivering statewide training to government and non-government service providers. Training will initially focus on teams which support people with an intellectual or cognitive disability who exhibit severely challenging behaviour and who may be subject to intrusive restrictive practices.

The centre will draw on the experience and advice of a management board which will assemble policy, research and service delivery expertise from across the tertiary and disability services sector.

The centre will be located within the University of Queensland to ensure that its research and training programs will be linked to research of international significance and best practice. It will be established during 2007–08 and build over the following two years. The centre’s proposed staffing structure follows on the next page.


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Interface between the centre and Specialist Response Service teamsThe centre will liaise with Individual Response Leaders. These leaders will be the conduit between Specialist Response Service teams and service providers, providing the core support the teams will need to provide an effective service response.

The following diagram describes the relationship between the centre, Individual Response Leaders and Specialist Response Service teams:

Centre of Excellence for Behaviour Support

Centre for Excellence

SRS teams Individualresponseleaders

• Data analysis, research and evaluation• Practice development • Professional skill development

Centre Director

Principal policy and research officers

(three positions)

Finance and administration

officer

Administration support officer

Director, Policy

Research

Director,Research in Behaviour

Support

Director,Learning

and Development

Principal learning and development

officers(three

positions)

Businessmanager

Executive assistant

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VisionTo provide innovative and evidence-based services and support to make a positive difference and assist adults with an intellectual or cognitive disability who exhibit severely challenging behaviour to maximise their quality of life and their community life.

Mission statement The Specialist Response Service aims to make a positive difference to the quality of life for adults in the target group through:

• the use of positive behaviour support to maximise the adult’s participation in their community

• the application of evidence‑based research to guide practices in positive behaviour support such as assessment, plan development, plan implementation and review

• flexible and tailored supports that respond to the person’s complex and changing needs, including accommodation

• a primary support model that involves working directly with these adults and their natural networks during all phases of support

• an interdisciplinary practice model and clinical case management in positive behaviour support

• skilled, experienced staff with regular access to training and development.

Values The Specialist Response Service values are consistent with the concepts for positive behaviour support that underpin the model’s practice framework. This model emphasises working, wherever possible, within a person’s usual accommodation and support environment and their natural networks to achieve improvements in community living. The Specialist Response Service values focus on:

• community living for all individuals

• the rights of all individuals

• ethical practice

• quality of life for all individuals

• collaborative and flexible approaches to working with individuals

• sustainable improvement and change for all persons receiving a service through the Specialist Response Service.

Target group The service targets adults with an intellectual or cognitive disability who:

• receive services funded or provided by Disability Services Queensland

• exhibit severely challenging behaviour that is likely to result in significant injury or extreme distress to themselves or others

• are subject to or at risk of becoming subject to restrictive practices.

2. Specialist Response Service principles


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Safeguarding rights and liberties

Positive behaviour support

Collaborative/ integrated practice

Clinical case management

in positive behaviour support

Family and natural support networks

Active support model

Person-centredplanning

Quality of life

Communityparticipation Social roles

Person with a disability

Removal of barriers

to participation

Service delivery principlesThe Specialist Response Service shares many of the general service principles underpinning disability services outlined in the Disability Services Act 2006. The service’s primary focus is on outcomes for the adults it supports.

The Specialist Response Service is a new, innovative and evidence-based support model aimed at improving the quality of life for those people within the target group who generally lead unacceptably impoverished and restrictive lives.

The key goals of the service are to reduce reliance on the use of restrictive practices as a means of managing severely challenging behaviour and to maximise community participation, personal development and the development of natural networks and relationships for these adults.

The service will function as a specialist clinical service that will be effective only when it operates in close cooperation with service providers to ensure a tailored and comprehensive person-centred planning process is in place. While the Specialist Response Service will be reliant on service providers to conduct broader lifestyle planning, there are seven principles embedded within the Specialist Response Service that will facilitate the service’s goals.

These principles are:

• highly individualised and comprehensive person-centred planning processes

• regard for the differing communication styles of persons with complex communication needs

• collaborative case management based on a person-centred approach

• implementation of support strategies that are based on an understanding of the person and the function of their behaviour through relevant interdisciplinary assessment

• maximising community participation, personal development and the development of the person’s natural networks and relationships

• safeguarding the rights and liberties of people with an intellectual or cognitive disability

• ensuring that if restrictive practices are used, they will be part of a plan that focuses on positive supports for the person and be the least restrictive alternative in terms of the person’s freedom. They will only occur in circumstances where approval and consent are obtained, and where, if decisions are made that restrict the person’s liberty, decision makers will ensure they have followed a transparent and accountable process.

The following diagram captures the core aspects that will be incorporated into Specialist Response Service service delivery.

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Safeguarding the individual’s rights and liberties Given the characteristics of the Specialist Response Service target group there will be times for some people when the positive behaviour support approach will occur within a secure or involuntary care context. Additionally, therapeutic and behaviour management services delivered through Specialist Response Service may require the use of restrictive practices.

In cases when participation in services may be involuntary, service delivery principles will focus strongly on safeguarding the rights of all people who receive a service.

People should only be subjected to restrictive practices where this form of intervention will benefit them. Benefit is defined in terms of maximising an individual’s quality of life and increasing his or her opportunity for social participation. Beneficial treatment includes, but is not limited to, assisting people to reduce their risk of self-harm and harm to others.

Person-centred planning approachThe person-centred approach supports the basic human rights of the individual to be an active member of society and to achieve a good quality of life based on their aspirations and lifestyle preferences.

It is based on the premise that services will be designed to accommodate a person’s right to independence, choice and social inclusion.

This puts the person at the centre of planning, recognises that their individuality will be respected and aids the development of personalised supports. It also recognises the value of the person’s existing informal and formal networks and focuses on developing sustainable supports.

When developing positive behaviour support plans, Specialist Response Service specialist teams will maximise the opportunities the individual is provided with to make choices, achieve greater community involvement and maintain contact with friends and family.

Family and natural support networksRecent research shows that building family and natural supports has a significant and positive effect on the individual’s quality of life (Bramston, Chipuer and Preety 2005). Research also indicates that increasing the range of social contexts from which a person may derive potentially supportive network members is important (Forrester‑Jones, Carpenter, Coolen‑Schrijner 2006).

Where appropriate, the Specialist Response Service will work to increase and reinforce the involvement of family and natural support networks to better identify and meet the needs of adults in the target group.

Quality of lifeOne of the service’s primary objectives is to ensure that individuals with an intellectual or cognitive disability who exhibit severely challenging behaviour are afforded an acceptable quality of life.

Positive behaviour supportPositive behaviour support is a values-led approach to achieving behavioural change. It combines applied behaviour analysis alongside support that values the person’s role in society — social role valorisation support (Emerson and McGill 1989).

Positive behaviour support is described as:

“…characterised by educational, proactive and respectful interventions that involve teaching alternative skills to problem behaviours and changing problematic environments. It blends best practices in behavioural technology, educational methods and ecological systems change with person-centred values in order to achieve outcomes that are meaningful to the individual and to his or her family” (Bambara, Dunalo and Schwartz 2004).


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It is a system of individualised assessment and intervention that aims to change features of a person’s social environment and to then change the functional relationship between triggers, behaviour and its consequences. Research shows that positive behaviour support has the potential to have a positive effect on reducing challenging behaviours (Emerson 2007).

The essential characteristics of positive behaviour support that will guide Specialist Response Service teams in working with individuals will:

• have the goal of enhancing community presence, choice, personal competence, respect and community participation, rather than behavioural change in isolation

• be based on an understanding of why, when and how behaviours happen and what purposes they serve

• focus on altering triggers for behaviour to reduce the likelihood it will reoccur

• use skills teaching as a central intervention

• focus on changes in quality of life as both an intervention and an outcome measure

• have a long‑term focus, which recognises that challenging behaviour is often of a long-term nature and successful interventions need to be maintained over prolonged periods

• have an interdisciplinary focus reflecting the fact that challenging behaviours are often determined by varying factors and displayed in multiple forms

• reduce or eliminate the use of punishment approaches

• include both proactive strategies for changing behaviour and reactive strategies for managing behaviour.

Active support modelWhile active support has not been specifically evaluated as an intervention for challenging behaviour, Emerson (2007) believes there are good theoretical grounds for assuming that active support should have a beneficial effect on persons who receive this support. There is also clinical data showing favourable results from combining active support with positive behavioural interventions. It is therefore

anticipated that, through the implementation of personally tailored positive behaviour support plans, augmented systems of communication and management of the social context, the Specialist Response Service will be able to achieve positive outcomes for these adults.

The active support model was developed and has been implemented in group homes in the United Kingdom. Active support encourages adaptive behavioural responses through a focus on a tailored approach to planning for the purpose of shaping support around the complex wants and needs of the person.

Evaluation has shown that when the model is used it results in staff providing more direct support to people. It also enables individuals to engage in higher levels of participation in activities and is associated with people experiencing higher levels of social, personal, household and leisure activities (Felce, Jones, and Lowe 2002).

The active support model is a group of related procedures that focus on the way group home staff work with individuals and the organisation. The emphasis is on the direct support that enables individuals to participate actively in everyday activities (Stancliffe, Harman, Toogood and McVilly 2005). The related procedures outlined by Stancliffe et. al (2005) include:

• systematic planning of individual opportunities for daily activities for each resident

• staff planning their own division of responsibility for supporting each person’s daily activities

• staff being taught to use effective methods for supporting a person’s participation in activities, not just verbal prompting

• staff providing attention and praise to people who are occupied constructively

• active monitoring by staff of opportunities provided to individuals on a daily basis.

Specialist Response Service teams, both professional and direct support teams, and service providers working directly with adults receiving a service through Specialist Response Service will be encouraged to use the active support model.

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Collaborative practice To ensure quality and efficiency of service delivery, Specialist Response Service teams will operate within a collaborative practice framework to achieve:

• better levels of information in relation to adults supported by the service

• better understanding of the intellectual or cognitive impairments and mental health conditions of these adults and how these may contribute to challenging behaviours

• higher levels of expertise in the development of interventions and support plans and the management of these adults

• higher levels of transparency in assessments and decision making in relation to adults receiving services

• better outcomes in meeting the assessed needs of these adults.

Collaborative practice models are based on the premise that:

• complex service delivery requires cross-agency policy development

• new systems, processes and management are necessary to support more effective problem solving across agencies

• innovative models require different ways of working

• new management structures are needed to support flexible decision making and responsive service delivery that is focused on outcomes for the target group and the community

• quality lifestyle is dependent upon the complex relationship between social, economic, natural and built environments.

Interdisciplinary team modelIntegrated and collaborative practice underpins the service delivery model intended for Specialist Response Service teams.

The teams will use a collaborative practice model that is aimed at preventing service duplication, providing enhanced productivity of practice. Components of this practice model include team members:

• working in a cooperative and coordinated manner

• being action‑learning focused

• contributing to joint communication and decision‑making processes for the benefit of their clients

• demonstrating competence in group processes and dynamics

• pooling knowledge based on specific expertise and skills to support and augment the contributions of other team members

• understanding and respecting the roles of other team members

• being clear about responsibility for group functions

• being committed to common goals for the outcomes for adults receiving a service

• building relationships and networks with other professionals and stakeholders.


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Case management The Specialist Response Service does not assume case management for clients. This rests with service providers.

The Specialist Response Service recognises and acknowledges the role and current supports provided by service providers. When providing services to individuals the Specialist Response Service will work within this framework.

Additionally, as part of its practice framework, the Specialist Response Service will provide clinical case management for the period of time an individual receives a service through the Specialist Response Service. This will not replace the holistic assessment and support planning that is the responsibility of service management and that should occur for persons receiving disability services operated or funded by Disability Services Queensland.

This clinical case management in positive behaviour support will be provided by and coordinated through the Specialist Response Service. The model moves beyond the view of the case manager as a systems coordinator, service broker or supportive carer.

The process will involve engagement with the individual, assessment, planning, links with resources, consultation with families and carers, interdisciplinary collaboration with professional staff and crisis intervention.

It will encompass collaborative interdisciplinary processes that coordinate and integrate:

• functional assessments

• behaviour analysis

• development of support plans

• facilitation of interventions

• monitoring and review

• outcome measurement

• crisis prevention and management.

Functional assessments will be informed by a bio-psycho-social model. This model proposes that a person’s experience is comprised of a biological component (that is, disability and genetic predisposition), a psychological component (that is, cognitive factors and psychopathology) and a social component (that is, culture and surroundings).

The clinical case management process will use clinical expertise, personal involvement and environmental interventions to address the overall maintenance of a person’s physical and social environment. The model aims to ensure services provided through the Specialist Response Service are individualised, integrated and remain responsive to the person’s changing needs.

The process of delivering comprehensive, interdisciplinary assessments and developing individualised, flexible intervention strategies will require efficient and effective coordination and individual plan management at the regional and local level. Individual Response Leaders and Specialist Response Service team members will facilitate this process with service providers.

It is acknowledged that service providers supporting individuals in the target group may require assistance in providing case management to:

• facilitate identification of immediate and long-term needs and planning for supports and services responsive to individual need

• coordinate input from the person, family, service providers and advocates to develop long-term planning based on the principles of person-centred planning

• progress implementation of the person’s plan.

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Individual Response LeadersThere will be six Individual Response Leaders, each located with a Specialist Response Service specialist team. These positions will report directly to their local Regional Executive Director of Disability Services Queensland and will closely liaise with the Director, Specialist Response Service Implementation Branch to ensure consistent approaches are maintained across the state.

Individual Response Leaders will provide leadership across the disability and health sectors in clinical practice provided to adults in the target group, and in the reduction in the use of restrictive practices to manage challenging behaviours. They will contribute to the strategic development of the Specialist Response Service statewide and lead the development of evidence-based clinical practice by the Specialist Response Service at a regional level.

The Individual Response Leaders will develop networks with senior colleagues in other agencies to assist in coordinating a local response which allows, where possible, the individual to remain within their community. With their team, they will work collaboratively with service providers supporting people who receive care through the Specialist Response Service and, where appropriate, with the Mental Health Assessment and Outreach team. They will be the conduit between these teams and the Centre of Excellence for Behaviour Support in relation to coordination of policy, practice, evaluation and training issues.

Individual Response Leaders will also ensure there are effective consultation mechanisms with funded service providers, families and carers so they have input into the operations and directions of the Specialist Response Service teams. At a local level they will screen and prioritise referrals to their teams and source assessment and planning services to ensure the service response is coordinated across disability and mainstream services.

Specialist Response Service specialist teams Specialist Response Service specialist teams will work with individuals with severely challenging behaviour who are receiving, or at risk of receiving, high‑level restrictive practices such as containment and seclusion. The teams will comprise highly trained and experienced professionals from a range of disciplines that may include, but not be limited to, psychology, occupational therapy and speech and language pathology. They will promote positive behaviour support to individuals in the target group at the local level and the person’s existing place of residence wherever possible.

Specialist Response Service specialist teams will conduct functional assessments and develop positive behaviour support plans for their clients. When these plans have been authorised for implementation, the team will work with service providers at the local level to implement the planned strategies.

The primary focus for local teams will be to work directly with adults in the target group and their direct support staff to facilitate positive behaviour change. This work will assist the person to maximise their community participation, personal development and the development of their natural networks and relationships. Service providers will ensure that the person’s family and natural networks are integral to the planning and development process.

These goals will be facilitated through a combination of skills development strategies, opportunities to engage in meaningful activities on a daily basis, and behaviour management strategies aimed at reducing reliance on the use of restrictive practices. Specialist Response Service teams will work alongside service providers, coaching and modelling their staff in implementing the interventions and strategies outlined in the positive behaviour support plan. This approach is aimed at ensuring the high level of skills adults gain are maintained by service providers when the adult transitions from the Specialist Response Service.

3. Specialist Response Service teams and functions


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For some people, other factors, such as environmental modification and medical intervention, may help contribute to a positive change for them. The teams will maintain close links with a person’s case manager.

There will be six Specialist Response Service specialist teams which will provide statewide coverage. In most instances, these teams will be located with Disability Services Queensland regional teams in Brisbane, Gold Coast, Sunshine Coast, Ipswich, Rockhampton and Townsville. Additional Specialist Response Service team members will be located within regional teams in Cairns, Mackay, Maryborough and Toowoomba. These team members will provide ‘on the ground’ initial links with adults in the target group and their service providers and work collaboratively to undertake assessments with their respective Specialist Response Service teams and local professionals.

Each Specialist Response Service specialist team will be managed by an Individual Response Leader. Each team will comprise a mix of specialist staff (practitioners with varied backgrounds and skills) with services coordinated by a principal clinician as team leader.

Specialist Response Service specialist teams will be supported by a Mental Health Assessment and Outreach team, located in South-East Queensland with a capacity to outreach to other areas of the state.

Specialist Response Service team members will require skills and competencies that will enable them to contribute to functional and ecological assessments, behaviour analysis, active lifestyle support, and effective clinical case management.

Other competencies for team members will include knowledge of research and best practice in positive behaviour support and knowledge of safe, ethical and respectful use of restrictive practices. Team members will also require an understanding of their role in supporting and strengthening the skills of direct support teams, and have demonstrated experience in integrated and collaborative practices, and have a commitment to achieving community living for people in the target group. The professional backgrounds of team members will be diverse and their practice framework will be collaborative. A program of clinical support and supervision will be developed and available to all team members.

At the local level, the primary function of the specialist teams will be to establish and maintain a system of positive behaviour support. This will be achieved in collaboration with the Centre of Excellence for Behaviour Support and will ensure that effective assessment and intervention protocols and practices are in place and accessible across the disability sector. The teams will also work with the Guardianship and Administration Tribunal and the Office of the Adult Guardian to ensure coordinated implementation of the service model.

The system of positive behaviour support comprises a range of core activities as outlined in the following diagram. Specialist Response Service specialist teams will be directly involved in all of these activities.

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AssessmentFollowing referral to the Specialist Response Service and an initial screening assessment to determine the level of service required, specialist staff will conduct comprehensive functional assessments for people who are receiving, or deemed to be at risk of receiving, restrictive practices. These practices could include containment or seclusion, chemical restraint or some forms of mechanical or physical restriction to manage their challenging behaviour. These assessments are conducted to consider all the factors and aspects of the person that may be contributing to their situation.

Staff from a range of disciplines across the social, behavioural and health sciences will contribute to these assessments as and when required. Information from each assessment, including outcomes and recommendations for treatment and interventions, will be integrated into the assessment report.

A functional behaviour analysis will also be conducted to determine what function the behaviour serves for the person. When identified, strategies can be developed to build alternative ways of meeting the person’s needs that do not involve challenging behaviour.

The assessment outcomes collated via functional assessment reports then will inform the development of individual positive behaviour support plans.

Clinical case management

Multidisciplinary functional

assessment

Individual positive behaviour

support plan

(as part of the individual plan)

Review and evaluation

Intervention

Plan approval/consent

process

Monitoring(by Specialist Response

Service team and Community Visitor Program)


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Positive behaviour support planA positive behaviour support plan contains an array of elements, is based on a functional assessment, and is aimed at producing a broad range of outcomes (LaVigna and Willis 2005). The plan recommends multifaceted strategies for working with an individual with the aim of producing enduring changes in challenging behaviour.

O’Brien and O’Brien (1991) indicate that the effectiveness of a positive behaviour support plan in addressing a person’s challenging behaviour is ultimately measured by clinical validity — by the effects the interventions proposed by the plan have on:

• the person’s quality of life

• their increased independence

• their competencies

• their social and community presence

• participation and productivity

• personal empowerment and choice

• relationships

• support networks.

Positive behaviour support plans are based on assessment outcomes and incorporate all of the services and strategies the person needs to address the challenging behaviour. This is achieved through removal of the behavioural barriers to quality of life outcomes which, in turn, reduces the occurrence and episodic severity of the behaviour and should therefore eliminate the need for restrictive practices (LaVinga 2007).

Outcomes should be able to be measured by:

• improvement in quality of life

• social validity reflected by the approval of the goals and methods by the person, their family, staff, advocates and the community

• significant reduction in the occurrence of target behaviour

• significant reduction in the episodic severity of target behaviour

• elimination of restrictive practices and conditions

• avoidance of negative side effects of any restrictive practices

• generalisation across time and settings.

The plans require the participation of families and decision makers in their development. Service providers should facilitate this participation in the planning of the person’s social network. Plans should also provide information to further develop the skills and capabilities of the families or carers to meet the complex needs of these people.

Positive behaviour support plans will be living documents and subject to changes based on information reflecting the success, or lack of success, of the plan and any changes in the person’s behaviour and life circumstances.

Plans will be:

• monitored continually

• evaluated regularly based on consistently collected, collated, observable and measurable data

• revised when data indicates specific trends or effects.

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Approval and consentWhen positive behaviour support plans have been developed an appropriate level of consent must be obtained before plans are approved. Justification for the use of restrictive practices will be documented in the plans. The amendments to the Disability Services Act 2006 and the Guardianship and Administration Act 2000 outline the requirements in relation to approval and consent for all restrictive practices.

While not all recommendations for the use of restrictive practices will require the same level of approval and consent under the legislation, positive behaviour support plans recommending the use of containment or seclusion will be required to be submitted to the Guardianship and Administration Tribunal for approval prior to implementation.

Applications for the use of restrictive practices that require approval will require assessment reports and positive behaviour support plans developed by appropriately qualified or experienced persons. The Guardianship and Administration Tribunal will consider if there is reasonable likelihood that, if approval for the use of restrictive practices is not given, the person’s behaviour will cause harm to themselves or others. The tribunal will need to be satisfied that containing or secluding the person in compliance with the plan is the least restrictive way of ensuring the safety of the person and others.

The Guardianship and Administration Tribunal will also appoint guardians for restrictive practices who will be required to consent to the use of physical, mechanical or chemical restraint once the positive behaviour support plan has been developed and verified by the service provider.

InterventionDuring the intervention phase, Specialist Response Service teams will facilitate the implementation of the plan, aiming to equip the relevant carers and support people with the skills and knowledge to implement the behaviour support plans through an integrated process of training, feedback and ongoing support. Specialist Response Service teams will work with the adult and direct care staff in the person’s place of residence to implement the strategies and interventions outlined in the plan.

This ‘hands on’ training and support will ensure highly trained and competent staff are working with individuals receiving a service through Specialist Response Service. The teams will work with both Disability Services Queensland-provided and funded services in assessment and planning and in the implementation of positive behaviour support interventions.

According to LaVigna (2007) a comprehensive functional assessment that meets the required defined assessment standards can be understood as a detailed risk assessment. A non‑linear, multifaceted positive behaviour support plan can be understood as a risk management plan.

The plans will focus on minimising the episodic severity of the behaviours, using the least restrictive procedures possible.

MonitoringAll positive behaviour support plans will be monitored during the implementation phase. In visitable sites, the Community Visitor Program will sight plans containing any form of restrictive practice. Their role will be to observe that the strategies and procedures outlined in the plan are being employed by direct care staff.


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Review and evaluationReview and evaluation of positive behaviour support plans will be a continuous process to determine their suitability and effectiveness. This will ensure that the strategies selected reflect the person’s changing needs.

Specialist Response Service teams will regularly conduct formal reviews of the plans that employ restrictive practices and will produce a review report for the Guardianship and Administration Tribunal’s consideration. This report will have supporting evidence recommending the restrictive practices either be continued or cease.

Transition from Specialist Response ServiceThe decision to transition a person from the services provided by the Specialist Response Service team to capable and prepared support teams will occur on an individual basis and be made in accordance with the person’s needs.

It is envisaged that transition will occur slowly. Over time, service providers will play an increasing role in delivering the supports and interventions put in place for people who receive a service through the Specialist Response Service. The Specialist Response Service will then provide a monitoring and support role for a period of time.

Mental Health Assessment and Outreach team As a specialist, tertiary mental health program for adults in the target group, the Mental Health Assessment and Outreach team will provide quality consultation and liaison services. These will assist Individual Response Leaders and Specialist Response Service specialist teams to safely manage those adults who are subject to interventions requiring the use of restriction and restraint.

Successful intervention for that vulnerable group of people who will receive a service through the Specialist Response Service should encompass treatment responses that include medical interventions. Poor health and limited access to health care for adults with an intellectual disability are well documented. The needs of adults with a dual diagnosis of an intellectual disability and mental health condition are best represented by the bio-psycho-social model. Their needs can and do change over time.

Services require a cohesive and cooperative response from a range of agencies and professionals to achieve a continuum of care for these adults. Elements of a successful service system that responds to the mental health needs of adults with an intellectual disability include:

• interdisciplinary teams with experience in addressing both the mental health and primary health care needs of adults with an intellectual disability

• a cross‑agency approach to dual diagnosis in terms of education and training of professionals and direct service delivery staff who work with adults with a dual diagnosis

• enhanced communication networks between mental health and disability services and all other service providers including housing, education and criminal justice.

The Mental Health Assessment and Outreach team will comprise a small, specialist, community‑based team, including psychiatrists, a neuropsychologist, clinical nurse consultant and general medical practitioner. There are up to 12 full-time-equivalent positions in this team.

The team will provide assessment and consultancy services to people who are receiving a service through Specialist Response Service. It will work collaboratively with local service providers, facilitating and supporting primary care providers, particularly general practitioners.

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The team will also work collaboratively with Specialist Response Service teams in respect of:

• advice and information regarding challenging behaviours and mental health conditions

• specialist assessments, positive behaviour support plan reviews and provision of second opinions related to restrictive practices

• interventions about specific issues — for example, the transition of an individual back to the community following in-patient treatment, case management or brief specialist intervention.

General medical practitioner services will be accessed through special arrangements with public hospitals or private practitioners.

The Mental Health Assessment and Outreach team will function under a ‘hub and spoke’ model with the ‘hub’ located in South-East Queensland and some capacity in regional areas. The team has a statewide service brief.

In year three (2009–10), it is anticipated that one of the team’s psychiatrists will be based in Townsville to service the central to northern regions of the state. This person will work closely with Specialist Response Service teams based in Townsville and Rockhampton.

A service level agreement will be developed between Queensland Health and Disability

Services Queensland for the team’s administration and clinical management.

The team’s establishment does not preclude the continued response provided by existing mental health services currently accessed by the disability sector. All Disability Services Queensland regional teams will continue to develop and maintain links with their local mental health services.

The Specialist Response Service Mental Health Assessment and Outreach team will maintain close links with Queensland Health’s Mental Health Services. Protocols and referral processes will be developed to ensure an efficient service response for adults receiving a service through Specialist Response Service.

Priorities for team operations will be determined by Individual Response Leaders on a regional basis. Procedures for team operations and its interface with other Specialist Response Service teams and training will be provided by Disability Services Queensland.

This relationship chart illustrates the interface between the Individual Response Leaders, Specialist Response Service specialist teams, the Mental Health Assessment and Outreach team, the Director, Specialist Response Service Implementation Branch, the Centre of Excellence for Behaviour Support and Disability Services Queensland Regional Executive Directors.

Regional executive directors

Mental Health Assessment

and Outreach team

Specialist Response Service

specialist teams

Centre of Excellence for

Behaviour Support

Director, Specialist Response

Service Implementation

Individual response leaders


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ObjectiveThe Specialist Response Service acknowledges the importance of appropriate environments in facilitating positive behaviour support. A range of purpose-designed accommodation options will be constructed to meet the needs of people requiring a specialist response. The positive environments will be constructed in a manner that offers a robust physical environment while supporting opportunities for skills development and effective therapeutic intervention in a home-like atmosphere. Emphasis will be on transition and these environments will not provide permanent accommodation for residents.

These purpose-designed arrangements will be used where community living arrangements have broken down due to severely challenging behaviour and where a targeted, therapeutic built environment is required to stabilise behaviour and facilitate positive change for an individual.

The design of these environments will be informed by the needs of the people likely to be accommodated. They will also include accommodation facilities that meet the requirements for people detained under a forensic order. Community-based activity will be a priority and accommodation will be designed to facilitate meaningful activity on site.

In the case of the Wacol site, a master planning process will incorporate changed road and infrastructure systems, stimulating environmental features and user-friendly access and movement within the site.

Accommodation stylesThe capital works program will commence in 2007–08 with a view to completion by 2010 –11. It will provide the following range of purpose-designed accommodation options:

• Accommodation will be constructed at the Wacol site to provide varying levels of secure care depending on the needs of the people who may require that accommodation. The building program will commence in 2007–08 with the refurbishment of existing villas.

• It is planned that in 2009–10, forensic secure accommodation will be designed and constructed on the Wacol site to provide structured, high‑to‑medium secure accommodation arrangements that address the requirements of people placed under a forensic order by the Mental Health Court. These environments will incorporate both a structural and service-oriented approach to ensure the safety of individuals, staff and others. The environment will also enable the development of appropriate skills that will assist the person to move on to other options once the duration of their forensic order has passed.

• The final stage of development will be in 2010–11, which will see the construction of purpose‑built, variable secure accommodation. These will be developed as clusters of dwellings. Accommodation arrangements will not always operate in a fully secure mode. The focus will be on managing unstable and challenging behaviour and developing people’s skills to enable them to return to the community. The level at which accommodation will be secured on a day-to-day basis will be determined according to how best to support the adults living in the environment.

4. Purpose-built positive environments

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• Emergency or crisis accommodation will provide structured environments that can be used as interim arrangements for people who have encountered an emergency or crisis situation and have no alternative accommodation option. This accommodation is likely to be on the Wacol site and in other regional locations that have not been finalised at this point. This accommodation may not be available until 2010–11.

• The final stage of regional development is planned for 2010–11. It will also include provision for variable secure community arrangements in regional locations that have not yet been finalised. This accommodation will provide short to medium-term structured accommodation options within local community settings. These dwellings will primarily be used for individuals who are able to reside in community settings and who require an alternate environment within which to receive focused therapeutic intervention or where a person needs support to trial a less-secure community arrangement. The design of these dwellings will enable the application of varied levels of secure environmental support and flexible service approaches to supporting individuals.

Service model for purpose-built positive environmentsDiffering service models and staffing structures will be necessary for the various Specialist Response Service environments — for example, the forensic secure model and staffing arrangements are likely to differ from the variable secure arrangements or emergency or crisis arrangements.

Specialist Response Service accommodation arrangements will operate under an active support model and will be underpinned by service principles that focus on individual outcomes and enhancing quality of life. They will also focus on reducing reliance on the use of restrictive practices to manage challenging behaviour.

As part of the service model for each type of arrangement, and to ensure referrals are appropriately targeted, target group and entry criteria will be developed where:

• community living arrangements have broken down due to severely challenging behaviour (that is, emergency or crisis situations)

• a targeted therapeutic built environment is required to stabilise behaviour and effect positive change for an individual (that is, variable secure arrangements)

• a forensic order recommending that an adult be accommodated is put in place (that is, forensic secure arrangements).

People in the target group will access purpose-built positive accommodation following an assessment by a Specialist Response Service specialist team, where it is identified that a targeted, therapeutic environment is required to effect change for an individual.

As part of the implementation of effective therapeutic interventions, people residing in the positive environments and direct support professionals who are servicing these arrangements will be actively supported by professional input from Specialist Response Service teams located at the Wacol site.


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Forensic ordersPeople with a sole diagnosis of an intellectual disability may fall under the provisions in the Mental Health Act 2000, which deal with criminal charges and forensic patients. The Mental Health Court may make a forensic order for an alleged offender if it decides they were of unsound mind at the time of the offence, or either temporarily or permanently unfit for trial. The effect of a forensic order is that it gives authority for a person to be detained in an authorised mental health service for treatment or care. Regular monitoring by the Mental Health Court (or Mental Health Review Tribunal) occurs as part of their ongoing treatment.

The Mental Health Court, or the Mental Health Review Tribunal, also has the power to order limited community treatment when it makes or reviews a forensic order, which enables the person to reside in the community with active monitoring by a mental health service.

Adults with an intellectual or cognitive disability who are on a limited community treatment order may be users of disability services, either as residents of accommodation support services or accessing various community support services. In these cases, there will be direct links between Specialist Response Service specialist teams, the Disability Services Queensland Mental Health Assessment and Outreach team, Individual Response Leaders and the Mental Health Court. Appropriate communication protocols will be developed between all teams to ensure an efficient and effective service response is provided to these individuals.

Adults with an intellectual or cognitive disability placed on a forensic order (with no limited community treatment) must be referred to a mental health facility under the conditions of the Mental Health Act 2000. Proposed amendments to the Act and the construction of the new forensic secure units, as part of the Specialist Response Service, will provide some options for adults with a sole diagnosis of intellectual or cognitive impairment who are eligible to reside in these units.

Direct support staff modelAlthough staff may be predominantly based at a particular dwelling, it is envisaged that direct support professionals will work across the full range of environments at the Wacol site. It is expected that they will spend at least three months of every year working in one or more of the other dwellings on the site or in a community arrangement to ensure the further development of their own skills and also the sharing and transfer of skills to other staff within the sector.

There will be two types of direct support professionals at the Wacol site:

• Residential care officers will be based on the existing role profile for these roles currently employed by Disability Services Queensland. The profile has been adjusted to reflect the range of environments within which staff will work and the skills they will require. They will work alongside the adults in the target group to assist them with personal care, housekeeping and daily activities. By doing so, they will help the adult to develop their skills to their full potential. Residential care officers will provide 24‑hour shift coverage in the dwellings. Additional support will be provided by the second group of staff, the Specialist Response Service team leaders.

• Specialist Response Service team leaders will require specialist competencies in direct accommodation support practices, behaviour analysis and the development, implementation and amendment of behaviour support strategies and plans. They will be focused on the technical aspects of behaviour support and management, taking on the role of modelling and coaching staff in good practice in behaviour support.

Direct support professionals will also be supported as required by the Mental Health Assessment and Outreach team and the Specialist Response Service specialist team that will be located at the Wacol site.

Specialist Response Service direct support teams will assist the transition of residents to community living arrangements.

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Both Specialist Response Service team leaders and residential care officers will be expected to actively contribute to the assessment process including the analysis of behaviour, plan development, risk management and review processes. They will need to be able to safely employ restrictive practices in accordance with legislated requirements and be highly skilled in working alongside people in the target group to develop positive supports with a focus on enhancing quality of life for the person.

All direct support professionals will have access to training and support provided by Specialist Response Service specialist teams and the Centre of Excellence for Behaviour Support.

Service managers will be employed to oversee administrative and clinical therapeutic arrangements within the houses. Additionally a senior manager will complete the management structure for Specialist Response Service positive environments. The senior manager will report directly to the Director, Accommodation Support and Respite Services, Disability Services Queensland.

The senior manager will link closely with the Centre of Excellence for Behaviour Support through Individual Response Leaders and will use these avenues to provide input regarding staff training needs.

Working collaboratively is essential to ensuring the successful application of therapeutic intervention. Ideally, the senior manager and service manager will have a professional background so they are able to support Specialist Response Service direct support teams and build a solid understanding of the link between built environments, therapeutic intervention and direct support.

Given the collaborative working arrangements that will be required between Specialist Response Service positive environments staff and Specialist Response Service specialist teams, effective working relationships will be established and maintained between Disability Services Queensland’s Accommodation Support and Respite Services and Community and Specialist Services staff in the regions.

Specialist Response Service direct support teams will have diverse backgrounds and skills and their practice will be collaborative with specialists, community and family. They will be provided with initial and ongoing training, including on-the-job training and in-service training opportunities, to better equip them for their pivotal role in achieving positive outcomes for the people they support. They will be part of the larger team that actively participates in research-based practice.

The rollout of staff will occur progressively over four years. Recruitment for direct support professionals and management positions to service stage one of the unit refurbishment commenced in 2008. Further staff will be recruited in 2008–09 for stage two of the unit refurbishment. At that point there will be no further growth for direct support professionals until 2010–11 when it is planned that staff will be recruited to service the forensic secure and secure beds at Wacol. The recruitment process for these direct support professionals will commence in 2010.

The Specialist Response Service direct support professionals play an important role in achieving best practice. Direct support professionals will provide direct support to individuals receiving a service through Specialist Response Service specialist teams and who have been relocated for a period of time to one of the Specialist Response Service purpose-built positive environments. Most direct support professionals will be attached to these Specialist Response Service accommodation options on the redeveloped Wacol site. However, some of these officers may work alongside local community support teams when a person is transitioning back into a community living arrangement.

These staff will provide active lifestyle support within a program that has the health and wellbeing of the person as its central focus. Working as part of a team, they will assess the individual’s needs, abilities, preferences and aspirations to contribute to the development of positive behaviour support plans and will ensure the use of any restrictive practices are in line with this plan.


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Specialist Response Service direct support professionals will work alongside and will be supported directly by Specialist Response Service specialist teams and the Mental Health Assessment and Outreach team.

Team leaders will be encouraged to promote the active lifestyle support model and to share their skills, knowledge and expertise in supporting eligible adults with residential care officers through an informal support network and through specifically targeted workshops.

Specialist Response Service team leaders will model the values and principles of positive behaviour support to establish safe and sensible contexts for positive behaviour support applications. Their input will also be critical to the successful delivery of interventions outlined in positive behaviour support plans.

Staff recruited to Specialist Response Service direct support teams will require special skills and abilities to enable them to engage with adults with impaired decision‑making abilities, their families and advocates. They will display values that contribute to a positive support model for persons with severely challenging behaviour, and understand the interface between the least restrictive alternative principle and working within a risk management framework.

This will require ability, knowledge, understanding and experience in relation to providing behaviour support within potentially stressful and intense working environments. High-level expertise in positive behaviour support and challenging behaviour will also be necessary to ensure the successful implementation of the strategies and recommendations outlined in the person’s behaviour support plan.

Specialist Response Service implementation The Specialist Response Service Implementation Branch within Disability Services Queensland will coordinate the implementation of the legislative, policy and service responses that target adults with an intellectual or cognitive disability who exhibit severely challenging behaviour. It will be responsible for monitoring the expenditure of funds allocated for this initiative and reporting to government on all relevant issues relating to the implementation of policy and service responses.

The branch will work in partnership with all government agencies, non‑government organisations and disability peak bodies to consult and progress program coordination. To ensure coordinated implementation of the new legislative and service response, the branch will work with the Guardianship and Administration Tribunal and Registry and the Office of the Adult Guardian. They will also have significant contact with Disability Services Queensland funded services in relation to planning the rollout of the initiative.

The Specialist Response Service Implementation Branch will provide leadership and direction to the operations of all Specialist Response Service teams at a regional and local level. The team has responsibility for developing the process of cultural change that underpins the introduction of the Specialist Response Service model, ensuring a consistent approach across the state, and developing standardised practice frameworks until the Centre of Excellence for Behaviour Support is fully operational. In addition, the branch will lead the development of programs in partnership with the centre.

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Learnings from the Dual Diagnosis Project (2002–03) between Queensland Mental Health Services and Disability Services Queensland and funded disability service providers have prompted several considerations for the Specialist Response Service in establishing working partnerships with key agencies. These include:

• Inevitable differences in organisational cultures and must be bridged when working across organisations.

• Systemic interagency and interdisciplinary protocols and procedures should be developed and agreed before commencing collaborative partnerships with other agencies, where appropriate.

• Sustainability of the Specialist Response Service model will require understanding of the model and support for the model at all levels across the agencies.

• Depending on the nature of the collaboration, positive relationship building between participating agencies is important.

• Dedicated staff to lead and manage the collaborative approach to ensure the Specialist Response Service model is sustained is vital.

• Early mediation in disputes and disagreements between stakeholders including substitute decision makers and advocates for the individual is essential.

The Specialist Response Service program and accompanying accommodation model does not have a correctional focus. The service is not intended for people remanded in custody and waiting to go to trial or a Mental Health Court hearing or who have received a custodial sentence. In these cases, residential and program responsibility remains with Queensland Corrective Services or Queensland Health if they have been regulated under the Mental Health Act 2000. Issues such as recognition, prevention and diversion will remain the primary responsibility of the Department of Justice and Attorney-General.

Similarly, while the Specialist Response Service will have a mental health capacity it will not operate in the context of a mental health facility.

Most individuals receiving a service through the Specialist Response Service will continue to access the existing continuum of responses provided through Disability Services Queensland’s Accommodation Support and Respite Services, Community and Specialist Services, Innovative and Support Housing arrangements and non-government funded service providers’ accommodation support. For most, provision of a service through the Specialist Response Service will occur within the individual’s existing accommodation service.

A Memorandum of Understanding between Queensland Health and Disability Services Queensland (2005–08) will set out an agreed framework for cooperation and collaboration between the two agencies and a commitment to work together to assist people with a disability who are in need of services from both agencies to have appropriate and timely access to a coordinated system of services and supports relevant to their assessed needs.

The Specialist Response Service model builds on this agreed framework and goes beyond coordination of services by the two agencies to provide an integrated service response for individuals with mental health issues receiving a service through Specialist Response Service. For example, the Specialist Response Service response that requires multidisciplinary assessment using the skills of both mental health services and disability services and professional support will need to be supported by protocols and procedures for an integrated service response.

Specialist Response Service within a continuum of service delivery


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Outcome evaluationAn outcome evaluation of the Specialist Response Service will be conducted by external consultants in year four of Specialist Response Service operations.

To protect the evaluation’s integrity and ensure it is perceived as credible and unbiased, the outcome evaluation will be managed by the Specialist Response Service Implementation Branch.

This evaluation will investigate if Specialist Response Service strategies and activities have been successful in helping adults in the target group to reach their goals and the extent to which these goals were reached.

This evaluation will, at a minimum, collect information about:

• the effectiveness of Specialist Response Service processes

• the effect of the service on the target group

• the outcomes for individuals who have received a service through Specialist Response Service.

Process evaluationA process evaluation will be coordinated by the Specialist Response Service Implementation Branch after the service’s first 12 months of operation.

The major benefit of undertaking a process evaluation is that it enables a better understanding of how the program is operating, enabling enhancement of the program if any processes and/or activities are not contributing to the expected outcomes of the program.

This method of evaluation:

• focuses on the links between model elements

• analyses how well they are linked together

• measures what is done by the program and the people who use the services.

Considerations for the terms of reference for all Specialist Response Service evaluations will need to include the slow build of service over the four years of the program. In the first year of operation, the primary focus will be on recruiting staff, establishing teams and outlining operational practices.

Evaluation

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ReferencesBambara, L M, Dunlap, G & Schwartz, I S (Eds) 2004. Behavioural Support: Critical Articles on Improving Practice for Individuals with Severe Disabilities. Pro.ed, Austin, Texas.

Bramston, P, Chipuer, H & Pretty, G 2005. ‘Conceptual principles of quality of life: An empirical exploration’, Journal of Intellectual Disability Research, 49(10), pp. 728–33.

Emerson, E 2007. Blueprint for the Specialist Response Service: Investing in Positive Futures. Comments by Professor Eric Emerson, University of Lancaster, UK and University of Sydney, Australia.

Emerson, E 2001. Challenging Behaviour: analysis and intervention in people with severe intellectual disabilities. Cambridge University Press, Cambridge.

Emerson, E & McGill, P 1989. ‘Normalisation and Applied Behaviour Analysis: values and technology in services for people with learning difficulties’, Behavioural Psychotherapy, 17, pp. 101–17.

Felce, D, Jones, E & Lowe, K 2002. ‘Active Support: Planning Daily Activities and Support for People with Severe Mental Retardation’, in Holburn, S & Vietze, P M (Eds), Person-Centred Planning: Research, Practice and Future Directions, Paul H Brookes Publishing Co., Baltimore, pp. 247–69.

Forrester‑Jones, R, Carpenter, J & Coolen‑Schrijner, P 2006. ‘The Social Networks of People with Intellectual Disability Living in the Community 12 Years after Resettlement from Long‑Stay Hospitals’, Journal of Applied Research in Intellectual Disabilities, 19(4), pp. 285–95.

LaVigna, G W 2007. Blueprint Notes — Final Comments by Dr Gary LaVigna, Director Institute for Applied Behaviour Analysis, Los Angeles, California.

LaVigna, G W & Willis, T J 2005. ‘A Positive Behaviour Support Model for Breaking the Barriers to Social and Community Inclusion. Learning Disability Review and Behaviour Support, 16‑23.

O’Brien, J & O’Brien, C L 1991. More than just an address: Images of organisation for supporting living agencies’, in LaVigna, G W & Willis, T J 2005. A Positive Behaviour Support Model for Breaking the Barriers to Social and Community Inclusion, op. cit.

Stancliffe, RJ, Harman, AD, Toogood, S & McVilly, KR 2005. Australian Implementation and Evaluation of Active Support, Centre for Development Studies, Sydney.

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Further informationFor further information about the consultation feedback on the Specialist Response Service, please phone the Disability Information Service or visit the Disability Services Queensland website.

Freecall: 1800 177 120* Fax: 3896 3467 Telephone typewriter (TTY): 1800 010 222* Web: www.disability.qld.gov.au Email: [email protected] Post: GPO Box 806 Brisbane Q 4001* Calls from mobile phones are charged at applicable rates.

Need help making phone calls?Contact the National Relay Service (NRS) on 1800 555 677. This service is free.

Other languages and formatsIf you need the assistance of an interpreter, please contact the Translating and Interpreting Service, TIS National on 13 14 50 and ask to be connected to the Disability Information Service.

This document is available in alternative formats (including large print) on request. If you would like a copy in another format, please contact the Disability Information Service on 1800 177 120* or email [email protected]

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