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2.0 Supporting People with Challenging Behaviour

Applicable to: All service agencies that receive funding under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 from the Ministry of Community and Social Services to provide the following adult developmental services and supports:

  • Supported group living residences
  • Intensive support residences
  • Community participation services and supports
  • Caregiver respite services and supports
  • Activities of daily living services and supports

This policy directive does not apply to Developmental Services Ontario organizations. 

Legislative Authority: Section 7(1) 1

Effective Date: May 1, 2017

Introduction

The Ministry of Community and Social Services (MCSS) wants people with a developmental disability to participate fully as citizens of Ontario. Its goal is to create a system of services and supports to help adults with a developmental disability to be more independent, to have more choice, and to be included in the community.

The ministry recognizes that most adults with a developmental disability do not have and/or display challenging behaviour. The behaviour interventions outlined in this policy directive are not meant for, nor are they appropriate for use with, people who do not have and/or display challenging behaviour.

Sometimes, a person may display behaviour as a means of expressing him/herself. Other times, a person may exhibit behaviour as a means of signalling that something is wrong, such as a physical health problem, or when a person’s environment is not meeting his/her needs1. In some cases, behaviour can relate to a person’s mental health, past abuse and/or trauma. Problematic behaviour can increase the risk of social isolation and decrease the quality of life of the person2. The Primary Care of Adults with Developmental Disabilities: Canadian Consensus Guidelines3, written by Dr. William F. Sullivan et al., and the associated Tools for Primary Care Providers and Tools for Caregivers4 by the Developmental Disabilities Primary Care Initiative, are valuable resources in assisting physicians, primary care providers, service agencies, and families or caregivers in assessing the behaviour of a person with a developmental disability . Copies are available at

http://www.surreyplace.on.ca/resources-publications/primary-care/

In instances where an adult with a developmental disability has challenging behaviour, it is important that the support the person receives to address his/her behaviour is well-informed, appropriate to the person’s needs, and safe, so that the person may take part in the community and live as independently as possible. The ministry also requires that service agencies take steps to ensure that agency staff has the knowledge and skills to react quickly and effectively in the event of a crisis situation, and to keep everyone as safe as possible in the area of the crisis situation.  

Definitions:

“Challenging behaviour” is defined in Ontario Regulation 299/10 as “behaviour that is aggressive or injurious to self or to others or that causes property damage or both and that limits the ability of the person with a developmental disability to participate in daily life activities and in the community or to learn new skills or that is any combination of them”.

A “crisis situation” is defined in the regulation as “a circumstance where,

(a)  a person with a developmental disability is displaying challenging behaviour that is new or more intense than that which was displayed in the past and the person lacks a behaviour support plan or the strategies outlined in the person’s behaviour support plan do not effectively address the challenging behaviour

(b)  the challenging behaviour places the person at immediate risk of harming themselves or others or causing property damage, and

(c)  attempts to de-escalate the situation have been ineffective.”

Purpose

This directive recognizes that, in some instances and perhaps by exception, intrusive measures are used with adults with a developmental disability who have and/or display challenging behaviour.

The purpose of the policy directive is to set out the ministry’s requirements regarding the use of intrusive behaviour intervention strategies by service agencies for adults with a developmental disability who have and/or display challenging behaviour.  This policy directive provides additional direction to Part III of Ontario Regulation 299/10, the regulation on quality assurance measures, made under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008.

This policy directive is intended to protect the safety, rights and well-being of adults with a developmental disability who have and/or may exhibit challenging behaviour, as well as the safety of others who may be in the environment and the agency staff who provide support. This directive is also intended to clarify expectations for staff training and promote consistency among service agencies regarding intrusive behaviour intervention with a view to assisting individuals to develop more positive behaviour, communication and adaptive skills, and to reduce, change or eliminate their challenging behaviour, in order to support their inclusion in the community.

Policy

Service agencies funded by the ministry are responsible for delivering services that promote the health, safety and well-being of people who are being supported.

The ministry supports an approach to behaviour intervention that uses the least intrusive and most effective evidence-based practices possible to address the challenging behaviour of a person with a developmental disability . Further, wherever possible, the ministry supports the use of non-intrusive measures in order to prevent and avoid crisis situations.

The ministry’s position is that physical restraint should be used solely as a last resort in crisis situations, or as identified in an individual’s behaviour support plan.

Definition:

A “physical restraint”, as an example of a type of intrusive behaviour intervention in Ontario regulation 299/10, includes “a holding technique to restrict the ability of the person with a developmental disability to move freely, but does not include the restriction of movement, physical redirection or physical prompting if the restriction of movement, physical redirection or physical prompting is brief, gentle and part of a behaviour teaching program.”

A service agency is responsible for the safe use of behaviour intervention strategies.  Behaviour intervention strategies should be used as outlined in the behaviour support plan for the person with a developmental disability who has challenging behaviour and in accordance with all legal requirements.


1 Bradley, E & Developmental Disabilities Primary Care Initiative Co-editors (2011). Initial Management of Behavioural Crises in Family Medicine. Available from: (accessed 22 September 2016).

2 Condillac, Rosemary A. “Behavioural Intervention and Developmental Disabilities” in I. Brown and M. Percy (Eds) Developmental Disabilities in Ontario. 2nd ed. (407- 419). Toronto: Ontario Association on Developmental Disabilities; 2003.

3 Sullivan WF, Berg JM, Bradley E, Cheetham T, Denton R, Heng J, Hennen B, Joyce D, Kelly M, Korossy M, Lunsky Y, and McMillan S. Consensus guidelines for primary health care of adults with developmental disabilities. Canadian Family Physician 2011; 57: 541-53. (accessed November 2, 2016).

4 Developmental Disabilities Primary Care Initiative. (accessed November 2, 2016).