Restraint minimisation - what do we need to consider for ACC and DSS Assessors

Sarah Boyt 1:26
We're just gonna give it to 902903 to give everybody an opportunity to get here and then we'll begin our presentation for today.
Sarah Boyt 3:30
OK, welcome.
Welcome to our presentation today on restraint minimisation and thank you so much for taking the time to join us.

Sarah Boyt 3:39
We just like to begin this morning with an opening karakia.

Sarah Boyt 4:18
My name is Sarah and Pauline and I are clinical service advisors for enable New Zealand.

Sarah Boyt 4:23
Our colleague Shania is joining us today and as kindly running in supporting all IT aspects for us.

Sarah Boyt 4:30
Thank you, Shania and our colleague Krista, who was also a clinical services advisor, is going to help manage the Q&A.

Sarah Boyt 4:37
Thank you, Krista.
During our session today, you are invited to pop any questions or comments into the Q&A.

Sarah Boyt 4:46
We have allocated time to address these near the end of the presentation.

Sarah Boyt 4:50
Please note there are quite a few people tuning in today, so we will endeavour to get to all your questions.
However, if that's not possible, we will respond to as many as possible post our webinar today.

Sarah Boyt 5:04
Also, just to let you know, we are recording today's session.

Sarah Boyt 5:08
You hopefully all have our resource accessible to you.
If not, you will see an attachment in your chat section.

Sarah Boyt 5:15
To access this, we will be referencing the flow chart throughout the second half of this presentation.

Sarah Boyt 5:21
So please do have this handy to refer to.

Sarah Boyt 5:27
Pauline and I are part of a team of experienced occupational therapists and physiotherapists.

Sarah Boyt 5:32
Our mission is to support disabled people and their far no to live everyday lives in their communities and homes.

Sarah Boyt 5:40
We aim to do this by effectively managing access to the equipment and modification services on behalf of Icahn, Ministry of Disabled People and also ACC

Sarah Boyt 5:52
So just a little bit about our backgrounds.

Sarah Boyt 5:56
Umm I am a physiotherapist and have a background in Pediatrics working in special schools and the wider Auckland area.

Sarah Boyt 6:03
Over the past 15 years, I recently relocated to the South Island and have been employed as a member of the Fire Kaha advisory Team with enable New Zealand for almost two years, Pauline.

Pauline Lazarus - NZPT 6:16
And I'm also a physiotherapist with a fairly generalist adult background.
I'm a member of the AC equipment team and have worked at enable New Zealand for four years.

Thanks Sarah.

Sarah Boyt 6:31
Lovely.
Next slide, please.
OK, the intent of this presentation will be to help establish a consistent approach to providing safe and quality care in relation to tailored solutions that may limit a person's normal freedom of movement and to highlight the parts of the current standard

Sarah Boyt 6:50
We expect a relevant to our practice.
The objectives for today include to be aware of the most recent New Zealand standard concerning restraint, provide you with and highlight relevant resources.

Sarah Boyt 7:05
Highlight that some of our commonly prescribed equipment could be at times limiting a person's normal freedom of movement and the consideration that needs to be given to this.

Sarah Boyt 7:17
We started looking into this area.
As we noted, inconsistencies when reviewing situations potentially involving restraint, this has led to us researching the current standards and considering how we apply them to our work.

Sarah Boyt 7:34
Next slide please.

Sarah Boyt 7:38
So solutions that could be a restraint, I'm sure you have all have examples of equipment solutions that you have come across where you considered if the solution could be a restraint.

Sarah Boyt 7:51
As an example, adding a tray to a seating solution with the intent to provide additional positioning support or to enhance the use of a person's functional skills can be a great solution for some people.

Sarah Boyt 8:05
But if that person can normally sit to stand independently and they are not able to release and remove that tray on their own, the question posed is have I now in fact restrained them?

Sarah Boyt 8:18
Keep this example in mind whilst we move through our slides.
We hope to highlight ways to clinically reason through proposed solutions with direction from the current standards and potentially flag things we may not be currently considering when it comes to restraint.
Next slide please, Pauline.

Not pitaya health and disability services Standard was published in 2021 and came into effect in February 2022 on Manatu Holder Ministry of Health website and a video by Doctor Ashley Bloomfield.

He quotes this standard, outlines what we can expect in New Zealand to ensure we provide high quality and safe health and disability services.
The standard is applicable for a wide range of providers, and certain providers are required to comply with the standard and are audited against relevant sections of the standard.
For example, providers of overnight hospital inpatient services and age related residential care and disability services, to name a couple.

It also notes it is also fit for use by home and Community support services.
Thus, I expect the standard relates to all of our work.

Next slide please. Chennai.
On the slide, you can see the principles of the standard and there are further details in the document itself if you want to explore.

Next slide please. Chennai.
Additionally, the principles of Tetris TO White Hungy have been formative in developing this standard.
Tino Rangatiratanga can be translated as the right to self determination.

Next slide please.

Can I?

Outcome 6 in the standard refers to restraint and seclusion, and as per the slide, services shall aim for a restraint and seclusion free environment in which people's dignity and mana are maintained.

Next slide please, shanya.

The outcome statements in the next three slides are formatted in three columns which talk to from left to right.

What all people can expect from the services and support they receive?
What mildy can expect from the services and support they receive and the commitment of service providers doing their part to deliver the best quality care and services?
And this outcome 6.1 Hector Kounga heady.
I have highlighted the following, ensuring the person is free from restrictions TE T partnership to gain mana enhancing and least restrictive practices that we demonstrate the rationale for the use of restraint and the aim being elimination.

Next slide please, shanya.

Outcome 6.2 heading yard haumaru I have highlighted the need to adapt when things change for that person, for example via a review or reassessment.

The at least restrictive options are used.
First partnership.

Restraint being a last resort and consideration of alternatives.
Next slide please.
Outcome 6.3 arotake going now or to hedya.

I have highlighted sharing of restraint, experiences and monitoring and review to influence, inform and improve practice.
Of note, we haven't talked to Outcome 6.4 on seclusion, as this did not appear relevant over to you, Sarah.

And next slide please.

Sarah Boyt 12:37
Thank you, Pauline.
We would like to highlight the following definitions from this current standard restraint when assessing a person for a solution, we must always consider does this limit the persons normal freedom of movement in all clinical reasoning?

Sarah Boyt 12:55
Restraint elimination.

Sarah Boyt 12:57
Thorough assessment is key to restraint elimination, and I'll talk to this in a later slide.
Restraint Episode elimination is the goal as per the current standards.

Sarah Boyt 13:09
However, it is acknowledged that this will not always be possible if elimination is not possible.
Consideration and documentation of all other considered options is essential to ensure the solution in place is the least restrictive option and the restraint episode has a clear planned purpose.

Sarah Boyt 13:30
Next slide please.
So what is normal freedom of movement?
A pelvic positioning belt on a person who is unable to sit to stand independently without it does not limit their normal freedom of movement.

Sarah Boyt 13:48
This same solution on a person who normally can sit to stand independently and does not have the fine motor skills to release the bout does have their normal freedom of movement limited by the solution.

Sarah Boyt 14:01
It is not the equipment, but the individual persons functional ability that determines if a piece of equipment often intended for safety, support or function has also become a restraint to that person.

Sarah Boyt 14:15
We will work through some other examples together shortly.
Next slide please.
So how do we incorporate these current standards into our everyday clinical reasoning?
This is a resource we have developed to help us work through individual cases, ensuring the current standards are considered and the least restrictive option is being used.

Sarah Boyt 14:43
There is a copy on the resource and a copy in your chat.
We would like to take a couple of minutes to talk through this and then work through some examples.
Thorough assessment is key to restraint elimination.
So what does this look like?
It needs to be person centred, open quote it all with the person, family and Fano, other specialists and with those involved in supporting that person.

Sarah Boyt 15:11
Functional abilities need to be assessed.
What can the person do independently?
What can they achieve with assistance?
Has the bigger picture been taken into account, including cultural considerations and both social and environmental factors such as medications, mental health or emotional state, or the general physical setup of that person's living space?

Sarah Boyt 15:36
Once we have all of that information and a solution in mind, we now ask the question, does the proposed solution have the potential to limit this person's normal freedom of movement?
If no, run with it and document as per normal.
If yes, the following then needs to be considered.
What is that person's normal functional ability?
Could another option meet the need that doesn't limit normal freedom of movement?

Sarah Boyt 16:04
What else has been considered?

Sarah Boyt 16:06
Sometimes equipment solutions may not actually be needed.
What has been discounted and why remember least restrictive options are to be used in the first instance.
Who else may need to be involved?
Have you peer reviewed your case with a colleague or a clinical advisor?

Sarah Boyt 16:26
Elimination is the goal as per current standards.
However, it is acknowledged that this will not always be possible, so at this point, if a solution that does limit a person's normal freedom of movement is deemed essential after thorough assessment and all other options considered and discounted, then that is called a restraint episode.
Node if a restraint episode is indicated.
There must be clear documentation to support the clinical reasoning around this decision and a review date scheduled so that our solutions adapt and change as people and their situations adapt and change.

Sarah Boyt 17:09
Sometimes restraint episodes are needed.
That is OK, our job is to keep people safe.
However, safety is not the only consideration.

Sarah Boyt 17:20
Next slide please.
These are some examples of equipment that are often used to keep a person safe, aligned or well positioned.

Sarah Boyt 17:32
However, it needs to be considered if they may also contribute to a restraint episode.
This is where the flow chart can be a helpful resource in guiding our thinking around this with the first thought being will the addition of this solution limit this person's normal freedom of movement as highlighted earlier?
The answer to this question is dependent on that particular person's normal independent functional ability.
Whether something does limit someone's normal freedom of movement is not always obvious at first glance, and this is where peer review alongside your clinical analysis is really helpful and potentially the use of the flow chart we just shared.

Sarah Boyt 18:17
Next slide please.
OK.
So we're gonna look at a scenario using the flow chart.
I'll give you a break from my voice and a minute just to read the slide on the screen.

Christa Roessler 18:38
While that happening, Sarah, I think a lot of people haven't been able to open the flow chart in the attachment.
So we'll definitely email that out to everyone.

Sarah Boyt 18:48
Lovely.
Thank you.
Christa, our IT support will get on to that for you all, apologies.
Lovely.
So with keeping that and that information in the in the case study in mind, we will work through it together.

Sarah Boyt 19:06
So after a thorough assessment of the solution of sorry, after a thorough assessment, the solution of a safety sleep Rep was proposed, and if we reference the flow chart, we ask the question, does this solution limit this person's normal freedom of movement?

Sarah Boyt 19:23
What is this child's normal functional ability?
Can they normally transfer in and out of beard?
Do they normally have independent bed mobility?
The answer in this case was no, so the addition of the safety sleep wrap does not limit them from doing something they would normally be able to do.
Least restrictions up least restrictive options.
First, padded bed sides were considered and trialled in this instance.
However, they were not successful in resolving the presenting issues, who to involve?
This solution has not come about as a result of challenging behaviour.
Therefore, NESC needs assessment services coordinator and explore behavioural support services.
Input is not required if you are working within the fire.
Ha ha.
Criteria.
It was indicated that a peer review took place and that the child's family and wider therapy team were involved.
In this case, the solution proposed was deemed the most successful, least restrictive option, allowing for some movement but not extreme ranges to support safe positioning and the essential function of sleep.

Sarah Boyt 20:39
In this case, the main question does the solution limit the persons normal freedom of movement made us think of movement in two different ways, posing the following questions for our further thinking.
Is involuntary movement considered normal and is it normal for that person?
As you know, these questions can only be considered on an individualized case by case basis for the person in question, no two people and their situation are the same.

Sarah Boyt 21:13
Next slide, please.
Tania in over to you, Pauline.

Thank you, Sarah.
I will use the flowchart to talk through assessment and solution considerations for this scenario.
I'll give you a minute just to have a read.

So the assessment likely needs to involve Fano carers and wider the wider interdisciplinary team, as well as the person themselves.

Umm and to include understanding of the recent history and why this person is now wanting bed rails, has something changed for them?
For example, a change in medication environment or carers.
We also need to know if the person has episodes of confusion or memory loss to consider whether they may attempt to climb over the rails and risk falling from a greater height.
And assessment of their bed mobility and their ability to transfer out of bed if they can transfer independently, rails would limit their normal freedom of movement and would be considered a restraint.
For potential solutions to consider least restrictive options, first we need to ask ourselves, is an equipment solution needed at all?
Or may the issue be resolved with a non equipment approach, for example a medication review or carer training at the least restrictive options first could include call bells or intercoms to call for assistance side support rails wider.
Sorry, wider beds, ultra low beds.
Floor fall mattresses and sensor pads.

It is essential you note the options considered and discounted in your report.
In this case, in this scenario, we did support the bed rails.
The falls for the cupboard injury, where from falling out of bed, so it linked to that and this person wasn't able to transfer independently and didn't look like they were going to get that ability back.
Thanks, Sarah.
Over to you and next slide.

Sarah Boyt 23:46
Thank you, Pauline.
So assessors will be working in either the fire car, HA or ACC funding spaces.
I'm just going to note some ficar specific points.
Firstly, we acknowledge the language in EMS and NASC documents hasn't been updated to reflect the current language being used in the current standards.

Sarah Boyt 24:09
You will see the you will still see the word enabler which is not referenced in the current standards.
There is a table as part of the 2015 NASC interface document that clearly states what solutions are considered restraint and which pathway must be followed when challenging behaviour has been identified as an EMS assessor, working with people with challenging behaviour, you will need to be aware of this.

Sarah Boyt 24:39
If a solution has been identified as a restraint and challenging behaviour is in play, then consultation with the NASC is mandatory.
The NASC will determine if a referral to explore behavioural support services is appropriate at the yes box at the end of the flow chart.

Sarah Boyt 25:00
If accessing the fire haha.
Funding stream and challenging behaviour has been identified.
You will need to consult with the nest at this point.
Consultation must take place before funding can be approved for any solution.
I'm just going to hand over to Pauline to go over some ACC specific points.

So for ACC assessors, if the proposed equipment is to help manage challenging behaviour.
Consultation with ACC Behavioural Support Services is recommended to consider the least restrictive options first.
For example, a behaviour strategy rather than an equipment solution.
And the behavioural support services will indicate the solutions that they support.

Next slide please.
So take home points from this presentation.
Here are the main points we expect will be useful whether an intervention limits a person's normal freedom of movement is pivotal when considering whether the intervention could be a restraint.

It is a situation and scenario.
Sorry, it is the situation in scenario that needs taking into account and no two people's situations are the same.
Hence whole of life and person centered assessment are crucial.
Peer review could be with a colleague or a clinical advisor.
If a person's normal freedom of movement is likely to be restricted, your documentation needs to include the options considered and discounted.
The relevant parties involved and the outcome of their input.
Elimination is the goal.
However, some situations, sorry.
In some situations, a solution that is a restraint may be required.
If this is the case, plan a review for that person at a later date, as people's needs do change.
Next slide.
So Christa may have already answered some of your questions.
I'm and if, as noted by Sarah, if we're unable to get to your questions and time we in the time we have, please go back to your question and add your email address.

It.

So we can email you a response.
So what questions do you have for us?

So at the moment there's there's no questions in the Q&A at the moment.
Margaret just commented in the chat about limiting freedom of movement can easily become seclusion.

So I don't know if you want to comment on that at all.
Umm, that's just a statement I think.

Yeah, I agree, Sarah.

Sarah Boyt 27:51
Agreed.
Agreed.
And yet well noted.

Yep, and.
That's there isn't any other specific questions.
A couple of people have asked about whether we can send the slides.
We can definitely send the flow chart.
We're sending the slides out as well, Sarah and Pauline.

I I think we can.

Yep.
Umm.
So Abby is just asked about housing mods about the use of housing mods, gates that prevent an individual from leaving spaces, example children running out on the road.

Is this a restraint?
Is that something you want to talk about, Sarah or Pauline or is?

Sarah Boyt 28:33
That's so I can address that from the fight.
Haha.
Space.
So yes, as we noted with the the documents, the nest interface documents and the pathways, yeah, there are clear a few reference those documents.

Mm-hmm.

Sarah Boyt 28:47
It clearly states their what they consider a restraint and whatnot, and often those are solutions required when challenging behaviour is involved.
So just.
Differentiating those two pathways?
I guess so.
When challenging behaviour is in play, the is on the five haha side a a process to follow and I am pulling.

Sarah Boyt 29:11
Would you like to comment for the ACC funding channel?

Umm, I don't believe there's a particular process to follow for the, but just as I said, you'd be liaising with them behavioural support services.

OK.
Thanks for that.
Hopefully that's answered your question.
Abby Jasper is interested about a definition for a restraint episode.
Bit more specific detail I guess than what was discussed in the presentation.

Sarah Boyt 29:46
So I guess historically we may have said that if we are.
Restricting someones movement to enable them to better function.
We would have maybe just said this as an enabler and carried on.
So I guess what we're making very clear is that wording is no longer in the current standards and we're calling a restraint episode as a restraint episode.
So if what you are doing is limiting someone's normal freedom of movement, it is a restraint episode.
And what I guess we are sharing is when you're coming for funding for these solutions, we need it clearly documented.
Umm that you've gone through the steps to consider why this is?
It's not that.
Like we said, elimination is the goal, but we acknowledge in the standards acknowledge it's not always possible.

Sarah Boyt 30:37
So yes, if you have limited someones normal freedom of movement, it is a restraint episode.
Yep, and an episode will.

I think just no. Sorry.

Sarah Boyt 30:45
Sorry, Christa, I just give for a specific purpose for a start and a finish time.

No, no, you're right.
I was just about to say I think it's the that there's an end point to.
It is probably why it's called an episode more specifically now because it is not an ongoing situation, isn't it?
That's it's not something that should be in place forever.
It needs to be reviewed.

Sarah Boyt 31:08
Clear documentation of when and why.
Yes, absolutely.
Thank you, Christa.

So somebody also asking whether a cost to set a cost effective solution would win over the solution being less restrictive?
Does a cost effective solution win over the solution being less restrictive?

I from ACC perspective, would say the least restrictive option trumps everything.

Sarah Boyt 31:36
And on the whaikaha side, we would 100% agree if the least restrictive option is going to cost more money, we would say overall that was a bit of value for money where our first and foremost consideration is to the guidelines and the standard.
Regarding restraint, we would not want you to feel like you had to propose a solution for at least a cost if it had greater restrictive qualities to it.

Umm.

Sarah Boyt 32:02
If there was a least restrictive option that would meet the need, that was more expensive, least restrictive.
Would Trump every time.

Umm.
Somebody Jordan is asking if somebody is asking to be restrained.

Is that a restraint?
So person requesting to be restrained.

I believe so, yes.

Sarah Boyt 32:24
If it.

And the reading that I've done.
Umm.
And also I think it quite clearly states that or somewhere I've read might be in the document itself or it might be have been mentioned in the cubro webinar, can't remember and it also.
If a founder member is asking for a particular piece of equipment that will restrain the person that is also deemed a restraint.

So it's back down to the documentation, isn't it?
And just being clear that even if a person's asked to be restraint, that the whole process has been followed.
So that's reasonable.

Sarah Boyt 33:05
Correct restraint is restraint, even if the person has asked for it.

Yep.

Sarah Boyt 33:10
Yeah, and.

Yep, no, I think that's right.

Sarah Boyt 33:13
Yep.

So somebody else is asking whether we can use this justification in rest homes, and I'm not sure what they mean by this justification specifically, and I don't have a name on that question.

So I think Sarah and Pauline, you'd probably repeat the same message that a restraint is a restraint and the process needs to be followed. Umm.

They may still be referring to the cost effective versus the.
Least restrictive.

I'm not sure can't.
Can't clarify that, sorry, yes.

Maybe, and that would be a conversation.
Depends whose funding would be a conversation to have with the whoever the funder is of the equipment.

But don't rest homes also have a responsibility to follow the standards.

Absolutely, absolutely.

Yep.
OK.
Yep.
So somebody else also doesn't have a name against it, would what would count as evidence of consultation with nascent in the NASC ENT is an email enough.
In terms of a consultation.

Sarah Boyt 34:21
Consultation with the nest.

I maybe that's what is intended.
It just says NASC ENT NASC int.

Sarah Boyt 34:31
At apps absolutely.
Look, it's a case by case scenario.
If we needed more information at the point when you're, umm, either way, if you're request gets picked up through the advice channel or at service request stage, it may get picked up for review.
Sometimes a phone call is sufficient.
Sometimes an email is sufficient, and then sometimes if it's a more complex situation we we will require more documentation.

Sarah Boyt 35:00
But initially, if you've had a concern, if you've had a chat to the nest and you can confirm that you've spoken to them and they do not require a referral to behaviour support services, stick with that with the first instance and we'll work from there.

Sarah Boyt 35:16
We are never wanting to ask you to do more paperwork than as absolutely necessary.

Sarah Boyt 35:23
We will.
We are conscious of that and to work with you throughout the process and not be sending you an every which way direction and to grab paperwork if we can use what you've already provided in that initial advice request.

And it was meant to be NASC.

Sarah Boyt 35:41
Yeah, no problem, no problem.

That's been clarified.
UM.
Kate has asked if there is no longer restraint in enablers and I think you might just wanna repeat the point around the new standard.

Sarah Boyt 35:55
Yeah.
So we're just like to point out that we know if you've been around for a while, the term enabler is widely used when considering restraint.
So I guess we'd just like to point out in these current standards that definition and that word has been completely eliminated.
It is no longer there, so restraint is restraint.

Sarah Boyt 36:16
It's not an enabler.
It is a restraint and then the reasons around it are to be clearly documented and like we said, it's a restraint episode.
It's for a purposeful meaning at a time and a place with a start and a finish.
So if we are restricting someones normal freedom of movement, we acknowledge that's what we're doing and we know why we're doing it.

I'm just.
I'm just going through.
We've still got a few minutes.
The person who had asked about somebody asking to be restrained.
The specific example was somebody who is of sound mind asking to be tied to her commode at night time.
All day you've offered other options, so I think just you'd reiterate that you would still want to make sure everything's well documented and the process has been followed.

Sarah Boyt 37:08
Absolutely.
And the fact that person can give their own verbal consent and of a sound mind as as a great addition to your documentation.

Sarah Boyt 37:16
And we of course always consider what the person wants and the first and foremost.

Right.
I will just go through and maybe pick out a few key things, and this is probably a good one.
The wait list for explorers so long that children are really delayed in receiving services, are we able to apply for equipment that could be considered restraint while the children are on the wait list?
That's you, Sarah.

Sarah Boyt 37:40
Yeah.
Look, we we are aware and we have made five car hire aware and I knew this would come up.
What I will endeavour to do is get some updated comms on that so we are aware of the issues.
If you would like to feed that back officially through the enable channels, that can always be something to do to help get that heard, but I can acknowledge that the clinical service advisory team have flagged this with WHAIKAHA and at present the comms are keep you you know, no, we can't take shortcuts.

Sarah Boyt 38:22
And we do understand it's frustrating and it's putting some families and children and really unsafe situations.
We are aware of it and we are asking for direction from whaikaha, how we can address this.

Sarah Boyt 38:38
We do acknowledge that the number of families and children accessing that service has grown significantly and the idea of that service initially just to give you some background, was to ensure that restraint solutions couldn't be put in place without a collaborative approach.
So again, it's one of those systems where the intention was really, really good.
But as the number of people requiring access to the surface has grown, the surface hasn't growing with the population, so we are aware of it.
We have flagged it with them and we will continue to do that on your behalf and we we acknowledge how hard it is.
I'm sorry we can't be of more assistance with that one.

There's a couple of questions about buckle guards, harnesses, seat belts, mostly in car, travelling in a car and challenging behaviour as well and so anti escape buckles.

Sarah Boyt 39:30
Yeah.

Are they a restraint?

Sarah Boyt 39:38
Uh.
The on the fire car has side restraint in a vehicle is 100%.
A OK restraint is restraint.
It's how it's supposed to be.
You do not need to go down the nest behavioural support service for that restraint in a vehicle is how it is supposed to be and we support that without the need for further consultation.

I think again, if anybody's unsure about something, definitely ring to discuss it.
Sarah, would you say on case by case basis?

Sarah Boyt 40:09
100% you do not need to wait in line for a process.
All the professional advisor contact details for both ACC and WHAIKAHA can be found on the website and we do really welcome phone calls or emails to talk through specific scenarios to assist you in guide, make sure you're doing the minimal paperwork possible for each person you're trying to support.

Sarah Boyt 40:34
Yes, thank you, Christa.

Alright.
Shall we wrap it up?

Yep, there is some further questions, but I think we might see if we can email responses to those.

Thank.
Yeah.

Thanks, Christa.

Sarah Boyt 40:45
And we would definitely endeavour to do that.
Thank you everybody for your questions.

Uh-huh.

Sarah Boyt 40:49
It's really appreciated.

Next slide please, should I?
So this as a replication of what is on the information sheet.
Once we can get that to you, it includes links for nipah.
Sorry, not paerewa, I'm link for a cubro webinar which talks more so to restraint and care facilities.

And even if you're not working care facility, I found it really helpful for my understanding of the standard and some of the case studies are applicable outside the, you know, in other situations as well and and for the EMS assessors, we have the links for the NASC document and EMS manuals.

I'm clinical advice wise for gaining clinical advice.
We've included Accessibles email addresses for the Auckland area for Whaikaha and our teams email addresses.

Our Enable 800 number and webpage links with our direct dials for both our ACC team, ACC Advisors and EMS Advisors.

Next slide please.

So we hope this information has been helpful and thought provoking and we are keen to hear feedback for the session and ideas for further webinars.
Please use the contact details on the resources or the attached document to provide this feedback or ideas.
I will close with a karakia.

Restraint minimisation - what do we need to consider for ACC and DSS Assessors

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