The Queensland Government has developed an innovative response to deliver on Mr Carter's recommendations.
Listed below is the government's response to each of the 24 Carter recommendations. Or download the print version Queensland Government's response to Mr Carter's recommendations Queensland Government's response to Mr Carter's recommendations .
Table of contents:
Core recommendations
| Recommendation | Government response |
|---|---|
| 1.That a targeted service response for the proper care and support of the persons in Queensland with intellectual disability/cognitive impairment and challenging behaviour must reflect unambiguously the following operational principles which must be regarded as being of basic and fundamental importance | Supported. The government has applied the operating principles for the delivery of a targeted service response without exception in the design of the Specialist Response Service, which will respond specifically to the support needs of adults with an intellectual/cognitive disability who exhibit severely challenging behaviours. |
| •An individualised and flexible approach which provides for and specifically addresses the person's specific needs and the circumstances of the individual case is the unequivocal key element in the proper care and support for the person with intellectual disability and challenging behaviour | Supported. This will be an underpinning principle in service design. An individualised approach will be taken including the development and implementation of comprehensive multidisciplinary assessments, positive behaviour support plans. |
| •A coordinated and cooperative working relationship between the Department of Communities (Disability Services) and Queensland Health to the extent that a comprehensive multi-disciplinary assessment of the individual person requires both general health and psychiatric assessments | Supported. This principle is reflected in the proposed structure of an integrated professional assessment team comprising mental health and disability services practitioners. |
| •A comprehensive multi-disciplinary assessment process in respect of the particular person with a view to the development of an individualised positive behaviour support plan for that person | Supported. This principle is reflected in the diversity of disciplines and fields identified for the professional service teams. They include psychiatrists, neuro-psychologists, occupational therapists, speech and language pathologists, psychologists, psychiatric nurses and general practitioners (sessional). A framework for positive behaviour support will guide the operations of these teams. |
| •An ongoing effective interaction between the assessment process and the intervention process within the community which will require coordination and individualised plan management at regional level so as to ensure the effective maintenance and integrity of the total process in the best interests of the individual person | Supported. Five professional teams established as part of the new service will be based in key locations across Queensland. The teams will outreach across the state and work closely with service providers and direct support workers to support the implementation of individual support plans. Five individual response leaders (best practice brokers) will also be based in key locations across Queensland, They will coordinate services and case work for adults with severely challenging behaviour. |
| •This process of assessment, intervention and coordination and individual plan management will operate collaboratively across the whole sector and will be available to and accessible by both Disability Services and non-government service providers | Supported. The proposed new targeted response will be available to individuals supported through Disability Services provided and funded services. |
| •The incorporation of the above into a Queensland Centre for Best Practice in Positive Behaviour Support under the leadership and management of a high profile and highly regarded practitioner supported by a suitably qualified reference group. The leader should have an academic appointment | Supported. The Positive Behaviour Support System will be led by a centre of excellence. The leader of the centre will be a prominent clinician and will also ideally have links to academic institution(s). |
| •The Centre for Best Practice will develop as a centre of excellence in ensuring the proper care and support of persons with intellectual disability and challenging behaviour. It will also develop as a valuable research facility and itself become a valued research resource. Its role will include community development and education. Its functions are set out more fully in this report | Supported. The centre for excellence will play a lead role in informing policy development, conducting research and training. It will also coordinate applications seeking approval for the use of restrictive practices for the Queensland Civil and Administrative Tribunal. Disability Services start work on the Centre for Excellence after June 2007. |
| •The immediate establishment of suitable accommodation to enable an immediate and effective response in those cases which require emergency management | Supported. Planning and development of purpose-designed dwellings will begin in 2007-08 to make additional accommodation available. Planning for the construction of further new dwellings will begin in 2007-08 and construction will begin in 2009-10. |
| •The urgent and planned development of a range of accommodation options which respond to the need for secure care, transitional accommodation arrangements and community living for the target group | Supported. A plan for the design and construction of emergency/crisis, secure care and transitional accommodation options has been developed and costed. The development of the capital program will be staged over four years. Refurbishment of some existing dwellings will commence in 2007-08 to ensure availability of appropriate accommodation options as a matter of urgency. |
| •The recruitment and development of suitably qualified allied health and other support staff specifically for persons with intellectual disability and challenging behaviour and ensuring their ongoing training and professional development | Supported. A strategy is being developed for a national and international recruitment campaign to attract and recruit allied health professionals. Cooperative arrangements are planned with other agencies already implementing international recruitment of health professionals and para-professionals. |
| •The incorporation of the centre into and as a distinct specialist segment within Disability Services | Supported. The centre of excellence will be established as a separate specialist unit within Disability Services. The leader of the centre will report directly to the Director-General or senior delegate. |
| •A legislative framework which will ensure that the use of any restrictive practice in the case of a person with intellectual disability and challenging behaviour is independently approved and properly regulated and which will provide adequate legislative support as required | Supported. Amendments to the Disability Services Act 2006 will be developed to strengthen safeguards for people with an intellectual/cognitive disability who exhibit severely challenging behavior. An amendment to the Guardianship and Administration Act 2000 will provide powers for the Queensland Civil and Administrative Tribunal to approve and review individuals' plans proposing the use of a restrictive practice. It is proposed that the most intrusive of restrictive practices (containment and seclusion) will be independently approved by the Queensland Civil and Administrative Tribunal. All other restrictive practices will be subject to administrative approval through the service provider. Consultation on the proposed legislation is planned for later this year. |
| 2.That the functions of the Queensland Centre in Positive Behaviour Support shall be: | |
| •to advise on, develop and ensure the maintenance across Queensland of consistent and best practice service options for all persons with intellectual disability and challenging behaviour which expressly apply the human rights and service delivery principles expressed in the Disability Services Act 2006. | Supported. The centre of excellence will document and promote best practice locally, nationally and internationally. This will be aligned to the rights and service delivery principles outlined in the Disability Services Act 2006. The individual response leaders (best practice brokers) across Queensland will be responsible for ensuring all plans and services for people with an intellectual disability who exhibit severely challenging behaviour and who are subject to authorised restrictive practices are consistent with best practice guidelines. |
| •to facilitate the establishment, maintenance and ongoing review of a system of positive behaviour support for persons with intellectual disability and challenging behaviour, which is based on comprehensive assessment and targeted individualised intervention in the community and the plan management and coordination of those services | Supported. The centre of excellence will develop and drive implementation of a positive behaviour support system. Individual response leaders across Queensland will ensure coordination of appropriate services for targeted individuals with severely challenging behaviours. |
| •to continually monitor and review the quality of service delivery across Queensland to persons with intellectual disability and challenging behaviour. | Supported. The centre of excellence will monitor and review the quality of individual plans and their implementation. This new legislative and service option will be evaluated. Performance targets will be set for all aspects of the service. |
| •to liaise with and develop a positive working relationship with the relevant professional bodies engaged in the delivery of services to persons with intellectual disability and behavioural issues, such as the College of Psychiatrists, the College of General Practitioners, the Australian Psychological Society and other like bodies such as Queensland Centre for Intellectual and Developmental Disability | Supported. The centre of excellence will develop and maintain strategic networks with key professional bodies nationally and internationally. |
| •to develop and maintain the required early intervention strategies in respect of young children with intellectual disability and challenging behaviours and to ensure and maintain as a permanent ongoing feature of service delivery a continuum of care and positive behaviour support for this client group through increasing maturity and teenage years and young adulthood and for that purpose to coordinate government, non-government, relevant community agencies and professional bodies in responding to the individual needs of young persons in this group | Supported. The centre will be engaged as a stakeholder as part of a future whole-of-government strategy for children with high and complex support needs, which will be initiated in 2007-08 and with a particular focus on 14-17 year olds with severely challenging behaviour at risk of entering out of home care. |
| •to develop as a professional research resource to the disability sector in Queensland and to government and for that purpose to develop a research facility which will monitor best practice nationally and internationally and ensure that the details and all relevant data in respect of the Queensland experience is collected and retained | Supported. The centre of excellence will develop and maintain a research function, particularly through partnerships with tertiary institutions. |
| •to do what is necessary to ensure that suitably educated and skilled professionally developed expertise is available to efficiently service the individual needs of person with intellectual disability and challenging behaviour in Queensland and for that purpose to liaise with and develop a professional working relationship with (a particular tertiary academic institution) | Supported. The centre of excellence will work in partnership with tertiary institutions to improve undergraduate and postgraduate response to disability and particularly working with people who exhibit severely challenging behaviours. |
| •to develop and provide the relevant professional development and expert training for those who will work in the disability sector specifically as day to day professionals, carers and support personnel for those persons in Queensland with intellectual disability and challenging behaviour | Supported. The centre of excellence will develop and coordinate delivery of specialist training for all professional and support teams working with adults with severely challenging behaviour. |
| •to liaise with all relevant government departments and agencies, non-government service providers and disability peak bodies in the community with a view to establishing a whole-of-government and sector response and the effective collaboration and cooperation of all bodies concerned in any respect with the well being and development of those in Queensland with intellectual disability and challenging behaviour | Supported. The centre leader together with the individual response leaders across Queensland will be responsible for developing a whole-of-government response for people with an intellectual disability who exhibit severely challenging behaviour. The matter will be referred for the consideration of the CEO Committee on a Fairer and Safer Queensland. |
| •to develop as a valued community resource which can provide professional advice to any person, agency or government department which is concerned with the needs of any person in Queensland with intellectual disability and challenging behaviour | Supported. The centre of excellence will operate as a resource centre which can provide advice on the positive behaviour support model and best practice in intervention and support plans. However, it will not provide individual case management services. |
| •to provide a system of information sharing with and advice to the community generally and ensure that the community is better informed in relation to issues concerning persons with intellectual disability and challenging behaviours | Supported. The centre of excellence will have the capacity to implement information dissemination and communication strategies to promote positive behaviour support to improve sector and community awareness. |
Early intervention and prevention
| Recommendation | Government response |
|---|---|
| 3.That there be developed a whole-of-government strategy which will ensure a continuum of care and support for all persons in Queensland with disability/cognitive impairment and challenging behaviour from early childhood through the child's years of formal education to those of increasing maturity and adulthood through a process of inter-departmental co-operation and collaboration | Supported. This issue will be the subject of a future whole-of-government strategy for children with high and complex support needs, which will be initiated in 2007-08 and with a particular focus on 14-17 year olds with severely challenging behaviour at risk of entering out of home care. |
Accommodation and facilities
| Recommendation | Government response |
|---|---|
| 4.That what is known as the Basil Stafford Centre site be the subject of total planned redevelopment and renewal | Supported. The Wacol site where the former Basil Stafford Centre was located, offers a number of advantages such as a spacious, quiet, bushland environment as well as proximity to the mental health services of The Park Centre for Mental Health. The proposed new dwellings will be designed specifically to facilitate the effectiveness of assessment and of programs of therapeutic intervention and developmental support. The placement of adults in secure care dwellings will be approved through the Queensland Civil and Administrative Tribunal and time-limited with regular review and monitoring. |
| 5.That the Centre for Best Practice in Positive Behaviour Support be located away and separate from the Basil Stafford site and from any identifiable Disability Services departmental office or facility | Supported. Disability Services will commence to establish the centre of excellence after June 2007. The separateness of the team from other functions and programs will be reflected structurally in Disability Services. |
| 6.That there be provided at the redeveloped Basil Stafford site six emergency or crisis accommodation units suitably designed and appointed and that as part of or nearby to this accommodation an office facility for the Brisbane/Ipswich assessment units be provided. Smaller facilities may also be necessary at Townsville and Maryborough | Supported. The Wacol site redevelopment proposes the urgent planning and construction of a range of non-institutional, non-correctional, small, community-like accommodation arrangements to address the gaps in accommodation to this cohort of adults with severely challenging behaviours. Judge Carter's report emphasises the need to design the houses or units based around the needs of individuals in the cohort. Options will include emergency/crisis accommodation, secure options and transitional options in a variety of sizes and designs. The redevelopment will also ensure facilities are included for professional support services such as assessment and day activities. |
| 7.That the Purpose Designed Housing Project (also referred to as the "Places of Safety" project) be progressed urgently and that it have the capacity at first to accommodate at least 20 persons requiring secure care in a range of architecturally designed housing of various designs and styles and of various levels of security. This purpose designed accommodation of various sizes should be provided in different locations on the redeveloped Basil Stafford site. Similar secure accommodation may also be required at other places e.g. Maryborough and Townsville | Supported. The whole-of-government response includes the development of purpose designed accommodation for a minimum of 20 persons requiring secure care on the re-developed Basil Stafford site at Wacol. Disability Services will coordinate planning for the location, design and use of purpose-designed housing across the state based on current availability of purpose-designed dwellings and demand by location. |
| 8.The Purpose Designed Housing Project must have the capacity to accommodate those presently detained in a mental health service but who are not mentally ill and also the capacity to respond to the requirements of the Mental Health court in respect of persons who have intellectual disability but who are not mentally ill | Supported. The proposed capital works program includes the design and construction of some secure forensic care beds which will provide to the Mental Health Court an option other than a mental health facility for persons with a sole diagnosis of intellectual disability. These beds will become available from the end of Year 3 (2009-10). |
| 9.That before the redesigned Purpose Designed Housing Project be progressed there be an immediate comprehensive assessment of each of the persons whom it is intended to accommodate in order to ensure that the accommodation is designed so as to be more appropriately respond to the individual needs of those persons | Supported. All adults with an intellectual /cognitive disability who exhibit severely challenging behaviour who are eligible to receive services through the new Specialist Response Service will receive a comprehensive assessment and a positive behaviour support plan will be developed. If restrictive practices are recommended to manage severely challenging behaviours, the plan will require appropriate authorisation. Plans will be developed with regard for the most appropriate environmental context in which to provide intervention and support, whether that be an existing community living arrangement, a modified community living arrangement or available purpose designed dwellings. |
| 10.That the provision of accommodation in various designs for persons with intellectual disability, whether with challenging behaviour or otherwise be the subject of a capital works development program which will have the capacity to more appropriately respond in the future to the individual needs of those in the client group | Supported. A Disability Services Capital Works Development Program is proposed to develop innovative designs in dwellings to meet short and longer term needs of individuals with severely challenging behaviours. |
| 11.That in planning for immediate and future accommodation requirements the present tenancy arrangements and all matters relevant to the establishment of co-tenancies be the subject of comprehensive review | Supported. A Senior Officers Group including Disability Services and the Department of Housing are considering this issue. |
| 12.That the Innovative Support and Housing Project which is to provide transitional accommodation be comprehensively reviewed before further development occurs and that entry and exit criteria and the level of professional support required be reassessed in the light of this report and of the independent advice provided to Disability Services in November / December 2003 | Supported. An external evaluation of the Innovative Support and Housing Project is underway. The findings from that evaluation will inform further development of this initiative as well as inform the new purpose designed dwellings to be developed from 2007-08. |
| 13.That Disability Services urgently facilitate a review of the way in which community access is provided to persons with intellectual disability and challenging behaviour and in the course of so doing consult with those non-government organisations which specialise in the provision of this disability service | Supported. A review will be undertaken. |
| 14.That Disability Services and Queensland Health engage collaboratively in determining the preferable option(s) for accommodating those persons with intellectual disability only who are and have been for many years accommodated and cared for at Baillie Henderson hospital | Supported. Included in the terms of reference of the CEO Committee on a Fairer and Safer Queensland. |
Staffing issues
| Recommendation | Government response |
|---|---|
| 15.That the Centre for Best Practice in association with external agencies of international reputation ensure the proper training and professional development for all specialist staff and direct care providers across the sector | Supported. The centre of excellence will have the capacity to develop and coordinate delivery of specialist training for all professional and support teams working with this cohort. |
| 16.That specialist staff who are required to work with those persons whose challenging behaviour is most difficult in the accommodation providing higher levels of secure care, be specially trained and their conditions of employment be reviewed | Supported. The centre of excellence will have the capacity to develop and coordinate delivery of specialist training for all professional and support teams working with this cohort. The level of skills required by staff in the performance of their duties as part of the proposed new Specialist Response Service will be remunerated accordingly under the existing awards. |
| 17.That Disability Services take all necessary steps to ensure the employment of the required number of psychologists and other allied health professionals necessary to properly service the needs of those requiring specialist support | Supported. A Specialist Skills Recruitment Strategy is in development to undertake a national and international recruitment strategy for allied health professionals. Cooperative arrangements are planned with other agencies already implementing international recruitment of health professionals and para-professionals. |
Implementation
| Recommendation | Government response |
|---|---|
| 18.That the implementation of the report's proposals be executed as soon as possible and in accordance with a phased process of the kind suggested in the report. Since the core legislative proposal is necessarily tied to the implementation process, the development of the total reform be executed within a period of 2 years | Supported with modification. It is proposed that new legislative provisions to regulate the use of restrictive practices commence in 2008 and that the development of the new service delivery infrastructure commence in 2007-08 with the service being fully operational over four years to allow for the necessary scheduling of capital works. |
| 19.That the Honourable Minister for Disability Services consider a realignment of Disability Services' functions and structure in a manner consistent with the development of the proposed centre of excellence within Disability Services | Supported. Is being acted on. |
Legislation
| Recommendation | Government response |
|---|---|
| 20.That the Disability Services Act 2006 be amended to provide legislative support for the use of any restrictive practice identified as part of the development of the positive behaviour support plan for the individual in accordance with these principles: | Supported. Amendments to the Disability Services Act 2006 will be prepared to regulate the use of restrictive practices. Amendments will also be made to the Guardianship and Administration Act 2000 in relation to the powers for the tribunal to approve and review individuals' plans proposing the use of a restrictive practice. The details of the proposed legislative provisions will be the subject of consultation later this year. |
| •The human rights and service delivery principles set out in part 2 divisions 1 and 2 of the Disability Services Act 2006 are to be applied expressly to the extent that the same are relevant to this issue | Supported. The human rights and service delivery principles set out in part 2 Divisions 1 and 2 of the Disability Services Act 2006 will inform the intent and application of the proposed new legislative provisions. The general principles and health care principle in the Guardianship and Administration Act 2000 will also be applicable when making decisions and for the tribunal when they consider matters and make orders. |
| •Since the legislative focus is on the development of the individual person, and the services to be delivered have to be designed and implemented for the purpose of developing the individual and enhancing that person's opportunity for a quality life, restrictive practices can only be justified as part of a specific individualised positive behaviour and support plan which will be of benefit to the individual and which will assist in the achievement of that objective | Supported. Under the proposed legislative provisions, restrictive practices will only be applied:
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| •Any such plan for the care and support of the individual person must be developed by the appropriate specialists in association with the individual and where necessary his/her parent or guardian | Supported. Planning and decision-making in relation to people with a disability will continue to require the participation of guardians and/or informal substitute decision makers for that individual. |
| •Approval for such a plan, if it contains provisions for the use of restrictive practices must be given by an independent body consisting of persons with the requisite skill, knowledge and/or experience and such approval shall operate only for a limited time, at which time it shall be reviewed and the continuance or otherwise of the restrictive practice considered anew in the light of the material to be provided to the independent body. That independent body should be the Queensland Civil and Administrative Tribunal | Supported. The Guardianship and Administration Act 2000 will be amended to empower the Queensland Civil and Administrative Tribunal to approve and review plans which contain provisions for seclusion and containment and all other restrictive practices will be authorised administratively:
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| •Whilst the approval remains in operation, the use of the approved restrictive practice(s) shall be monitored by an independent person(s) who shall report to the independent body upon each review. This should be done as part of the Community Visitor Program | Supported. The Community Visitor Program will continue to play a role in visiting the dwellings of individuals who are subject to plans which contain provisions for restrictive practices applied by service providers. The visitors will observe and report on the use of those restrictive practices. |
| •That the use of restrictive practices be prohibited except as approved by the Queensland Civil and Administrative Tribunal in accordance with the above principles | Supported. New legislation will be prepared to regulate the use of restrictive practices. Amendments to the Guardianship and Administration Act 2000 will require an amendment in relation to the powers for the tribunal to approve and review individuals' plans proposing the use of highly restrictive practices. Under amendments to the Disability Services Act 2006 administrative authorisation of restrictive practices will be rigorous. The use of restrictive practices will only be lawful if authorised according to the provisions. The details of proposed legislation will be the subject of consultation later this year. |
| 21.That pending implementation of the core legislative provisions the amendment of the Disability Services Act 2006 provide defences to the offences of assault (S245 of the Criminal Code) and of deprivation of liberty (S355 of the Criminal Code) by declaring it to be lawful for any service provider to use a restrictive practice if it is reasonably necessary, to protect the person or any other person from the risk of injury or harm | Supported in principle. It is proposed that the legislative provisions for the regulation of restrictive practices commence from 1 July 2008. It is proposed that there be a provision in the proposed new legislative response that will provide appropriate legal protection for those who are using restrictive practices under existing policies consistent with the intent of the proposed new legislative provisions. The details of proposed legislation will be the subject of consultation later this year. |
| 22.That, subject to the approval of the Honourable Minister for Health, consideration be given to the amendment of the Mental Health Act 2000 in relation to the Mental Health Courts power in making a forensic order in respect of a person with intellectual disability to order that the person be detained other than in a mental health service | Supported. It is proposed to make an amendment to the forensic order provisions of the Mental Health Act 2000 to enable the Mental Health Court, which is deliberating an order in respect of a person with a sole intellectual disability to consider whether that person can be detained in a more suitable accommodation setting other than in a mental health facility. The drafting of the amendments to the Mental Health Act 2000 will commence in 2009-10 and enacted as purpose-designed Disability Services facilities for forensic secure care become available. Forensic secure care facilities in Disability Services would provide the Mental Health Court with appropriate options for secure and supervised care which caters specifically for the needs of people with an intellectual/cognitive disability and reduce inappropriate detention in mental health facilities. The details of the proposed legislation will be the subject of consultation later this. |
| 23.That the Honourable Minister for Disability Services refer to the Honourable Attorney-General and Minister for Justice and the Honourable Minister for Health the question of how best the criminal justice system should deal with those alleged offenders with an intellectual disability (but no mental illness) who are charged with a simple offence only and who may be unfit to plead or otherwise entitled to have the issue of criminal liability determined in the light of an apparent mental infirmity. | Supported. This is included in the terms of reference of the CEO Committee for a Fairer and Safer Queensland. |
Dual diagnosis
| Recommendation | Government response |
|---|---|
| 24.That the Centre for Best Practice has regard to the recommendations in the Report of the Dual Diagnosis Project 2002 (QCIDD) and consider the same for implementation in the light of this Report. | Supported. The findings of the Dual Diagnosis Project will inform the development of policies and procedures to guide the operations of the new service response. |
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