Speech pathologists and occupational therapists contribute directly to reducing and eliminating restrictive practices within a positive behaviour support (PBS) framework. By improving a person's communication and addressing sensory, functional and environmental needs, they help meet the unmet needs that often drive behaviours of concern — reducing reliance on restrictive responses. Authorisation of any regulated restrictive practice sits with state and territory frameworks, alongside the NDIS rules.
Key takeaways
- The NDIS Commission regulates five types of restrictive practice: seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint.
- Positive behaviour support is an evidence-, values- and rights-based approach focused on improving quality of life and understanding the reasons behind behaviour.
- Speech pathologists address communication; OTs address sensory, functional and environmental factors — both target the unmet needs behind behaviour.
- Authorisation of regulated restrictive practices is governed by state and territory frameworks; behaviour support plans with regulated restrictive practices are lodged with the NDIS Commission.
- The goal is reduction and elimination of restrictive practices over time, not their normalisation.
What are restrictive practices?
A restrictive practice is anything that restricts the rights or freedom of movement of a person with disability. The NDIS Quality and Safeguards Commission "regulates 5 types of restrictive practices" ():
These practices carry real risk to a person's safety, dignity and rights, which is why they are tightly regulated.
What is positive behaviour support?
Positive behaviour support is the framework within which any restrictive practice must sit. The NDIS Commission describes PBS as "an evidence, values, and rights based approach" that "focuses on improving a person's quality of life by understanding the reasons behind their behaviour and identifying ways to meet their individual needs," through strategies such as "teaching the person new skills," "making changes to their environment," and "providing guidance and assistance to the person's support team" ().
The logic is functional: behaviours of concern usually serve a purpose — to get something, avoid something, or communicate something. If we understand the function and meet the underlying need, the person no longer has to rely on the behaviour, and the supports around them no longer have to rely on restriction. This is precisely where speech pathology and occupational therapy contribute.
How do speech pathologists help reduce restrictive practices?
Speech pathologists address communication, which is one of the most common unmet needs behind behaviours of concern. When a person cannot make themselves understood — cannot ask, refuse, choose, or say they are in pain — distress is frequently expressed through behaviour. A behaviour that looks "challenging" may be the only available way to communicate.
Speech pathologists contribute by:
- Assessing communication and identifying how the person currently communicates, including unconventional signals.
- Building expressive options — speech, sign, symbols, communication boards or speech-generating devices — so the person can ask for and refuse things.
- Coaching communication partners so the support team recognises and responds to communication, reducing missed messages.
- Supporting choice and control, giving the person ways to influence what happens to them.
Giving someone an effective way to say "no," "stop," "I need a break," or "this hurts" can directly reduce the situations in which restriction is used. None of this is guaranteed, but it targets a genuine driver of behaviour.
How do occupational therapists help reduce restrictive practices?
Occupational therapists address the sensory, functional and environmental side. Many behaviours of concern are linked to a mismatch between the person and their environment — sensory overload, an inaccessible task, a poorly designed space, or a routine that does not work for them.
Occupational therapists contribute by:
- Sensory assessment and strategies to identify triggers (noise, light, crowding, touch) and reduce sensory distress before it escalates.
- Environmental modification so a person's home, school or day program is calmer, more predictable and more accessible — reducing the conditions that lead to environmental restraint.
- Functional skill building and task adaptation so daily activities are achievable, reducing frustration.
- Assistive technology and routine design that increase independence and predictability.
Because "making changes to their environment" is named by the NDIS Commission as a core PBS strategy, the occupational therapist's environmental and sensory work is central to the PBS plan, not an add-on.
How does this work as a multidisciplinary effort?
Behaviours of concern rarely have a single cause, so reducing restrictive practices is multidisciplinary. A behaviour support practitioner leads the behaviour support plan, but the unmet needs it addresses are often communicative (speech pathology) and sensory/functional/environmental (occupational therapy) at the same time. A child who melts down before lunch might be hungry, unable to ask for food, and overwhelmed by a noisy hall — three needs that three disciplines address together.
Coordinated assessment and shared strategies across the behaviour support practitioner, speech pathologist and occupational therapist make the plan more likely to meet the real drivers of behaviour, and therefore more likely to reduce the use of restriction.
How are restrictive practices authorised and regulated?
This is the part clinicians must frame accurately. Two distinct layers apply:
- NDIS layer (national). Providers delivering behaviour support and using restrictive practices must meet NDIS Commission requirements, including registration. A behaviour support plan that contains a regulated restrictive practice must be lodged with the NDIS Commission, and unauthorised or high-risk use is a reportable incident. The Commission also sets the Rules for implementing providers, the Rules for specialist behaviour support providers and NDIS behaviour support practitioners, and the Positive Behaviour Support Capability Framework ().
- Authorisation layer (state and territory). Authorisation to use a regulated restrictive practice is granted under the relevant state or territory framework. As the NDIS Commission explains, it is the role of the implementing provider to obtain authorisation for any regulated restrictive practice from the relevant state or territory body. Authorisation processes and rules differ between jurisdictions.
In short: the NDIS rules and the state or territory authorisation framework operate together. The intent of both is the same — that restrictive practices are used only as a last resort, with safeguards, and with a plan to reduce and eliminate them over time.
Evidence at a glance
State and territory authorisation requirements differ; always check the framework for the relevant jurisdiction. This article is general information, not legal advice.
Frequently asked questions
What are the five regulated restrictive practices?
The NDIS Commission regulates seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint ().
Who authorises the use of a restrictive practice?
Authorisation of a regulated restrictive practice is granted under the relevant state or territory framework, and the implementing provider is responsible for obtaining it. Separately, a behaviour support plan containing a regulated restrictive practice must be lodged with the NDIS Commission. Requirements vary by jurisdiction.
How does improving communication reduce restrictive practices?
When a person can communicate needs, choices, refusals and pain, the distress that might otherwise be expressed through behaviour can often be met another way. Speech pathologists build these communication options and coach the people around the person, targeting a common driver of behaviour. This supports — but does not guarantee — reduced use of restriction.
What is the occupational therapist's role?
Occupational therapists address sensory, functional and environmental factors — reducing sensory triggers, modifying environments, adapting tasks and increasing independence. Because environmental change is a core PBS strategy, this work helps reduce the conditions that lead to behaviours of concern and to restrictive responses.
Is the goal to make restrictive practices safer or to remove them?
Within positive behaviour support, restrictive practices are a last resort used with safeguards, and the explicit aim is to reduce and eliminate them over time by meeting the person's needs in less restrictive ways.
Working with Align Network
Align Network's and work alongside to address the communication, sensory and environmental needs behind behaviours of concern. To discuss multidisciplinary support, . Speak with Align Network's speech pathology and occupational therapy team.
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