The Australian National Disability Insurance Scheme funds positive behaviour support (PBS) for people living with disabilities with challenging behaviour support needs.

Led by Flinders University, a new study of 392 NDIS-registered behaviour support practitioners highlights the complexity of their role, calling for more support and training to carry out their work effectively – and, ultimately, provide better safeguards for people under the Australian scheme.

“The recent Disability Royal Commission reported an over-reliance on restrictive practices to manage behaviour and the need for adopting ‘person-centred’ and ‘rights-based’ approaches,” says Flinders University Disability and Community Inclusion senior lecturer Dr Alinka Fisher.

“However, PBS is a person-centred and rights-based approach, so this raises questions about whether its implementation in Australia reflects the intentions and rigour of evidence-based practice, and the capacity of the workforce to meet the aims of PBS in the current service system.”

The barriers outlined by behaviour support practitioners included current NDIS service systems – such as inadequate and inefficient resourcing, and difficulties engaging with stakeholders including the person, support staff and family members. They also reported limited PBS expertise across the sector as well as the need for more access to supports and practice guidelines.

“These insights are timely, with behaviour support under the spotlight and the need for systems reform now widely acknowledged,” says Dr Fisher, from the College of Nursing and Health Sciences at Flinders University.

The individualised funding model adopted by the NDIS may have unintended consequences for PBS service delivery, the research team warns, as PBS is promoted as an individualised and comprehensive approach that does not build upon important foundations of behaviour support.

“We need efficient behaviour support systems and a skilled workforce to enable best practice and safeguard a person’s rights and that takes sophisticated knowledge and skills and close collaboration with stakeholders.”

The study, published this month in the Australian Journal of Social Issues, suggests priorities to improve behaviour support systems and practices, towards promoting rights-based practices and reducing restrictive practices.  This includes:

• A shift toward tiered and system-wide PBS models, with funding allocated to building capable environments, active supports and community-based resources that address systemic issues and minimise the need for specialist intervention.

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  Reform of the individualised funding model, exploring options such as block funding for core support service and tiered funding models that provide additional resources based on individual needs.

• Increased transparency and accountability in funding allocations to ensure clear guidelines and reporting mechanisms to track resource utilisation and promote efficient use of funds.
• Streamlining compliance activities, implementing efficient and effective procedures that minimise administrative burden for PBS practitioners.
• Development and implementation of accredited PBS training programs, with standardised benchmarks and credentials for PBS practitioners (consistent with other professions) to ensure a skilled and qualified workforce.
• Investment in ongoing professional development, with regular training and support opportunities for practitioners to stay up to date on the best practice and evidence-based strategies.
• Establishment of a regulatory body for PBS, exploring options for an independent regulatory body outside the NDIS Quality and Safeguards Commission to oversee PBS practice and hold practitioners accountable.
• Development of clear roles and responsibilities for all stakeholders involved in PBS service delivery to avoid confusion and support efficient systems.
• Promoting collaboration between stakeholders, encouraging better communication and coordination between practitioners, the person, support providers, families and other relevant stakeholders.
• Reviewing and revising the NDIS practice standards and guidelines for PBS to ensure that policies and guidelines are consistent with best practice PBS and promote a rights-based approach to service delivery, which prioritises the involvement of people in their behaviour support planning.

The article, Positive behaviour support under the National Disability Insurance Scheme in Australia: Barriers, enablers and support needs from the perspective of practitioners (2024) by Alinka Fisher, Kymberly Louise, Katrina Reschke, Peter Kremer and Glenn Kelly has been published in the Australian Journal of Social Issues DOI: 10.1002/ajs4.316 https://onlinelibrary.wiley.com/doi/10.1002/ajs4.316

Also see: “It’s Opened My Eyes to a Whole New World”: Positive Behaviour Support Training for Staff and Family Members Supporting Residents With Dementia in Aged Care Settings (2024) by Alinka C Fisher, Katrina Reschke, Nijashree Shah, Sau Cheung, Claire O’Connor and Olivier Piguet  published in the American Journal of Alzheimer’s Disease and Other Dementias DOI: 10.1177/15333175241241168