Beyond just setting the bar for behaviour support

I have been preoccupied of late with what it means to be a behaviour support practitioner.

Last weekend, I settled down with a cup of tea to take in the new NDIS Quality and Safeguards Commission ‘competency framework’. Surely this eagerly anticipated guide would fuel my thinking, I pondered to myself.

And it was … interesting. It was somewhat reassuring. As a sole practitioner with a business mostly focussed on behaviour support, I need to make sure I’m meeting the requirements for registration.

At another level, however, it was also unsettling.

Unsettling because supporting people to better understand and address behaviours of concern is important work. Someone’s behaviour may mean that carers or staff are reluctant to leave the house with them. Anxious or unsure about how to support them in the community. Afraid they will hurt themselves.

In real terms, what this can mean for the person with a disability is that they end up leading an incredibly isolated life.  A life that gives little opportunity to learn new skills, have new experiences, to have fun, or to anticipate the day with pleasure.

If carers feel uncertain, worried or frustrated, this is not a positive support environment. We are all human. We react under stress, and make mistakes. We all will retreat to familiar (but often unhelpful) ways of responding. Ways that are usually more informed by a parent-child dynamic than one which recognises and responds to the person’s disability.

At worst, it can mean a revolving door of support for a person. For someone who needs carers that know them. For someone who needs to know their carers in order to feel safe in their environment.

Quality behaviour support provides a pathway out. It is proven way to reduce behaviours of concern. But what does quality support ‘look’ like?

To my mind, in order to deliver, the practitioner has to be highly skilled in engagement and observation. Skilled at analysing and building data systems. Able to develop robust hypotheses in new situations. Expert at identifying the right evidence-based strategies. Able to effectively meet the individual needs of carers. Adept at modifying systems and identifying areas to change and improve. Most importantly, they have to be deeply attuned to the fundamental human rights values that define the work.

They sound somewhat superhuman! I don’t claim to be all of those things I just listed. I do have my strengths. I do certainly aspire to improve. And an important part of that is recognising where I need to focus my development and seeing that through.

While each of the above skills are covered in the different competencies of the NDIS Commission’s framework, the level at which a practitioner needs to meet these standards is not set high. While I can understand that the market of practitioners needs to develop and grow in Australia, at the same time there is an incredible imperative for change.

The imperative is people who need the support. Who need a quality service at a level higher than that set in the NDIS Commission’s framework. In order to achieve change in that person’s life, the rubber has to hit the road at each point of the service.

A practitioner may be particularly skilled in analysis, but struggle to communicate their vision to others. Another practitioner may have the capacity to connect exceptionally well with support staff, but not lift their gaze above the information before them. Another person may be strong across many areas, but fail to see that the person’s quality of life has become worse.

Do we really imagine that one practitioner has all these skills? With the bar at ‘core’ competency set (somewhat) low in the NDIS Commission framework, can we take the risk with the outcome being no or poor change?

We may need to start thinking more creatively across the framework, and across the field of behaviour support. To identify levels of competency in skill sets, as well as base skills. To identify pathways towards core competency set at a higher standard, while still giving practitioners the opportunity to use their skills and develop further.

This might include building different skills sets into registration requirements. Perhaps identifying different categories of behaviour support practitioners (behaviour analyst, behaviour trainer, behaviour data clinician). Possibly create new fields of support in the NDIS price guide (‘behaviour assistants’).

These are just some late night, cup of tea musings. What drives me, however, is the knowledge of what is required to see that person out in the community, laughing, having fun.

If what it takes is that we need to expect more, and design our systems to ensure that a high standard can be met across multiple skill sets (including by different practitioners), then that’s what we need to do.

The business of quoting

Quoting in the world of NDIS, it’s a tricky business but one that needs attention.

There is a subtle interplay between what you can deliver and what the person has available in their plan.

There is, after all, no point quoting for 40 hours of (what you might regard as necessary work) if the person has 12 hours in their plan.

The discussion needs a ballpark.  Something to frame what a service provider can do, and what’s available to the person in their plan. Without this, neither party can really assess what is right for plan implementation.

What is a risk, however, is that the provider shapes their support only to what has been conceived and enabled in the plan. While this may be pragmatic, it doesn’t serve the participant. It also doesn’t help NDIS planners to really understand what is needed for participants in the scheme.

One way in which I have sought to address this is to be attentive to this ethical dilemma. My own internal ethical compass has to become part of the quoting process itself. After all, the quote is not just a piece of paper – it represents the beginning of a relationship.

In the end, if there are insufficient hours to deliver a quality service, this has to be stated up front. The quote has to be specific and focused on identifying needs only.

The bulk of the work might need to be directed into a report. While this is not immediately helpful to addressing systemic or sometimes pressing needs, it gives the participant a platform on which the person can stand at their next NDIS meeting. Giving all parties, including the NDIS planner, a clearer picture on what is needed to help.

A quote is never just a quote. It’s the opportunity to start a conversation and, potentially, a relationship of support that will extend well beyond the work itself.