Where Complex Care and Behaviour Support Meet

An NDIS participant may require tracheostomy care several times a week. Such a complex support need may cause distress that they may express through their behaviour, especially if they find it hard to communicate with speech.

This scenario now puts two responsibilities on the support worker. First, they have to complete the health-related task safely while providing positive behaviour support to reduce the participant’s distress and respect their needs or preferences.

The problem occurs when the providers responsible for different parts of a participant’s support are working with different information.

This guide will address that by discussing why complex care and behaviours of concern can overlap and how clinical and behaviour support can work together. It will also cover practical ways to reduce distress during care and what participants, families and carers can ask their providers.

What Happens When Complex Care and Behaviour Support Overlap?

The following will go into detail about likely outcomes when a participant’s health-related care and behaviours of concern become closely connected during support.

Two Types of Support for One Person

Clients with complex needs have a combination of physical, mental, or neurological needs that require constant and specialised management. This includes situations like psychosocial disability, mental health conditions, or epilepsy which means such a participant needs both basic caregiving and intensive hospital treatment.

In some cases, these individuals may display behaviours of concern during support services, but there are several reasons for that. It could be due to an unmet need, discomfort, pain, fear, difficulty communicating or something about the environment. This is where behaviour support practitioners come in, to understand the situation and curate the right plan for the support worker to implement.

While there may be a couple of allied health professionals handling a participant’s support, it doesn’t mean their clinical and behavioural needs suddenly become separate.

Why Separate Plans Can Create Problems

Let’s say a participant needs personal care at a specific time each morning. The clinical guidelines will naturally focus on completing the task safely while behaviour support plans identify rushed morning routines as a trigger for distress. If the worker does not have both pieces of information, they may follow one plan without understanding the other.

When that happens:

• The support worker may not recognise an established trigger
• The client may experience unnecessary distress
• The worker may not know the appropriate positive behaviour support strategies to handle the situation
• It makes the clinical task harder to complete
• Different providers may unintentionally give their workers conflicting instructions.

These scenarios emphasise why support coordination is very important. It holds the pieces together to make sure the care plan works as one unified system.

Why Clinical Tasks Can Trigger Behaviours of Concern

There are many reasons why examinations, observations, medication, injections, wound care, and other clinical tasks often feel invasive, unfamiliar, or painful.

Why Personal Care Can Be a Source of Distress

Here are the some reasons intimate care trigger distress:

• The participant may perceive the carer’s touch as physical assault if it comes without warning
• The person may feel embarrassed or ashamed when the caregiver undresses and bathes them
• The person may feel physical pain from support activities like putting on a jacket or being bathed with water that is slightly too hot.
• The caregiver may unknowingly re-enact the participant’s sexual trauma by undressing them
• The worker may not be familiar with the client, their triggers, and how they communicate preferences.

Find Out Why Participants Display Behaviours of Concern

There’s always a reason that explains why clients with complex needs display challenging or aggressive behaviour during care.

What often looks like aggression, refusal, or being uncooperative on the surface may be due to:

• Physical or clinical needs that are not met
• Neurological or cognitive impairment like confusion/disorientation, loss of executive functions, or frustration at being unable to communicate a specific need.
• Sudden changes in daily routines, unexpected shifts in temperature or lighting, and unfamiliar faces entering their personal space without warning.
• Fear, anxiety, or trauma triggers.
• Being hurried or rushed to match the worker’s shift schedule.

Why Distress Can Also Create Clinical Risks

Distress makes the brain switch to fight-or-flight mode and floods the body with stress hormones which can change how the physical body functions. For someone who needs complex care, that state of panic can easily become a medical emergency.

One risk is fast and shallow breathing which can make a patient receiving tracheostomy care choke on their mucus or trigger a sudden drop in oxygen levels.

Another complication distress can cause is blood pressure spikes which may result in autonomic dysreflexia in patients with spinal cord injuries.

Participants may suffer from internal bleeding, tears, or severe infections when they thrash around and accidentally pull out critical medical gear like feeding tubes, IV lines, or catheters.

Bringing the Clinical and Behaviour Support Plans Together

A participant may have a plan for clinical support and a separate one for behaviour support, but both can have information that affects the same support interaction. This is why this plan often clashes when the professional only understands their own area.

The aim is for different professionals and plans to work from a shared understanding of the participant. This means everything should revolve around their preferences, needs, communication and goals.

What an Integrated Approach Looks Like

The allied health professionals responsible for the separate funding categories/services in the participant’s NDIS plan need to understand how their work affects each other. If the clinical support specifies when personal care needs to occur, the behaviour support plan might identify that rushed morning routines can trigger distress. A coordinated team can then consider both pieces of information when planning support.

They should share information across both plans, use consistent positive behaviour support strategies, have clear responsibilities, and respect the participant’s preferences. There should also be predictable routines, communication between providers and the support workers knowing where to find and how to follow relevant instructions.

What Practitioners Should Discuss

They need to start with what causes distress and what can help the participant feel comfortable or in control.

The next topic should be figuring out how the person communicates pain, discomfort, refusal, fear or a request to pause.

Then, the behaviour support practitioners should talk about particular tasks, times of day, environments or approaches that increase distress.

Next up should be support strategies that workers should use before, during, and after difficult tasks.

They should also cover risk assessment to know what to consider and what support workers should do if they cannot safely continue support.

Lastly, they should have care team meetings to determine if the carers understand the strategies and have received the appropriate training.

Questions Families Can Ask

Families also have a role to play in making sure that clinical and behaviour support plans are compatible for the benefit of their loved one. They can ask questions like:

• Has the behaviour support practitioner reviewed the participant's clinical support needs?
• Have the clinical and behaviour support teams discussed known triggers and communication needs?
• Does the support worker know which strategies to use during difficult care tasks?
• What should happen if the participant becomes distressed during support?
• How are changes or incidents communicated between providers?
• When will the behaviour support plan be reviewed?
• Would a care team meeting help bring everyone together?

Practical Ways to Reduce Distress During Complex Care

Workers shouldn’t automatically treat distress during complex care as a behaviour problem to control. Their first question should be, ‘what might be making the situation difficult for them?’ The answer to that will determine the positive behaviour support strategy to adopt.

Build Predictability Into Support

Consistency makes potentially stressful care easier to anticipate. It could include:

• Sticking to the same routines
• Maintaining the same support workers where possible
• Calmly explaining what’s about to happen
• Giving advance warning of changes
• Avoiding unnecessary surprises.

Give the Participant More Control

This involves:

• Explaining before starting the task
• Offering the participant choices where it’s practical to do so
• Allowing the individual to communicate what they prefer
• Giving them reasonable opportunities to pause support
• Respecting the person's communication and choices while following the relevant clinical and safety requirements.

Which one you apply to what situation comes down to individual assessment.

Make Communication Easier

If the person has limited speech or another form of communication difficulty, the support worker can find them a reliable way to communicate. This can include adapting their communication style to using short, simple sentences, speaking slowly, or asking one question at a time. It may also involve introducing visual schedules, Augmented Communication devices, or offering binary choices.

The caregiver should also be able to actively listen and be able to decode behaviour as language. Communication becomes easier if they can recognise when the patient is trying to express pain, discomfort, fear, needing a pause, or refusal. It also reshapes the brain’s response to stress and helps the participant develop self-regulation skills.

Consider the Environment

Sometimes, positive behaviour support is changing the environment or the way support is delivered instead of trying to change the participant’s response. Look at the surroundings to figure out what’s likely causing distress and adapt it for the participant’s comfort.

Review What Happened After an Incident

The team can look at:

• what happened immediately beforehand
• what the participant was communicating
• what the worker did
• what helped the situation settle
• whether something about the routine or environment should change

Asking these will help the care team modify strategies based on the behavioural data gathered.

Restrictive Practices and Complex Care

A participant’s complex care may involve equipment, medication, and physical interventions that may restrict their movement or freedom. But it doesn’t automatically mean every single piece of equipment is restrictive, the purpose, effects, and circumstances matter.

It’s part of behaviour support plans, but they’re considered as a last resort instead of a core element of positive behaviour support.

What Counts as a Restrictive Practice?

It’s any intervention that restricts a person’s freedom of movement and it’s not limited to physically holding someone. These practices fall under these regulated categories;

• Seclusion
• Chemical restraint
• Mechanical restraint
• Physical restraint
• Environmental restraint.

Each category has a separate guideline for their use. If medicine, equipment, or intervention is being used to limit the participant’s movement or influence their behaviour, such a practice may need closer consideration.

When Equipment or Medication May Raise Questions

While restrictive practices may be authorised in certain situations based on risk assessment, the line between that and when it raises eyebrows is the purpose and effect. It could be devices that prevent access to parts of the body or medication administered with the intent to stop or reduce behaviours of concern. Sometimes, it’s other interventions where the purpose or effect is to restrict the person’s freedom.

Individual assessment is key here because it involves looking at the circumstances and determining whether a restrictive practice is the right step or an excessive one.

What Families Can Ask

Before a family member who is appointed as a legal guardian consent to the practice, they can ask the behaviour support practitioners questions like:

• Has this intervention been assessed as a restrictive practice?
• What is the purpose of the intervention?
• Does the behaviour support plan include it?
• What authorisation requirements apply in the participant's state or territory?
• Who implements and monitors the intervention?
• What’s being done to minimise its use?
• How can the participant express their preferences or concerns?

Finding and Preparing the Right Support Team

Staffing may get a bit complicated when someone has both complex care needs and behaviours of concern. It’s not simply about the number of workers offering support services, but their capability and consistency.

Why the Workforce Can Be Difficult to Build

A participant may need support workers with different types of capability. In the context of complex care, that means those with the relevant skills for delivering health-related support while knowing how to respond to behaviours of concern.

It becomes more challenging when the participant's support involves intimate care, communication difficulties, unpredictable distress or specialised health needs. The team providing that care needs the right combination of skills where each support worker is properly trained for the tasks they perform.

Train the Right People

Training doesn’t stop at handing the carer a copy of the behaviour support plan, it should cover:

• Training in the participant's positive behaviour support strategies
• Guidance from the behaviour support practitioner under an established clinical governance framework
• Relevant training for complex or high-intensity support
• Opportunities to ask questions
• Coaching or mentoring where appropriate
• Ongoing refreshers when the participant's needs or plan change.

Keep the Team Familiar and Consistent

Complex care becomes easier when the workers already understand the participant’s communication and there is consistency in routines. Familiar faces also mean there’s less need for the participant to repeatedly communicate their preferences and workers recognise early signs of distress. But there should be enough trained workers to provide continuity when someone is unavailable.

Give Workers Access to Behaviour Support Guidance

The care staff need to understand the participant’s support plan so they can adequately provide positive behaviour support. They also need to understand the strategies that apply and the behaviour support practitioner should be available for questions or clarifications where appropriate. Lastly, the carers should know how to report changes, incidents or concerns

Understanding Funding and High-Intensity Support

People with complex support needs may have more specialised services, frequent assistance, or workers with specific skills. The funding they get should reflect their needs and the families should understand how relevant supports are funded and managed before support services begin.

Where Intensive and Complex Behaviour Supports Fit

Complex behaviour support applies where a participant has frequent behaviours of concern that significantly affects their safety or wellbeing and requires intensive proactive or reactive strategies. On the other hand, high-intensity support involves specific higher-level personal support needs and requires appropriately skilled workers. The support should match the individual’s actual needs.

Although National Disability Insurance Scheme budget reductions will be introduced from 1st October, 2026, the NDIA has specifically stated that high-intensity and complex behaviour support won’t be affected.

What Families Should Ask About

These are the funding-related questions families can ask providers or support coordinators:

• What specific support does the participant's plan fund?
• How many hours of support are required, and how will that funding be monitored?
• Does the provider have workers with the required skills and experience?
• What happens if the participant's needs change?
• How will spending be tracked so the budget does not run out early?
• What costs will be charged and what will the service agreement cover?
• Who will coordinate different workers and services when the situation is complex?

Questions to Ask Your Providers

Choosing a provider for complex support requires more than availability. This is why families need to ask questions that show whether the provider understands the participant’s needs, communicates effectively with the wider care team, and can provide consistent support.

What to Ask the Behaviour Support Practitioner

These should center on the practitioner, assessment and the participant’s behaviour support plan:

• How will you assess the participant’s behaviours of concern?
• What information will you need from family members, support workers and allied health professionals?
• How will you develop and review the behaviour support plan?
• How will you measure whether the strategies are working?
• How will you involve the participant in decisions about their support?

What to Ask the Clinical Provider or Nurse

These should focus on complex care, clinical experience and safety:

• What experience do you have with the participant’s specific clinical needs?
• What training and competencies do your workers hold?
• How are clinical guidelines followed?
• How are changes in health or risk communicated?
• What is your approach to clinical governance and escalation?
• How will you coordinate with other allied health professionals?

What to Ask the Support Provider

The questions for this should address daily support services and whether workers can consistently implement the participant’s strategies.

• What experience do your support workers have with clients with complex needs?
• How will workers be trained to follow the behaviour support plan?
• How do you maintain consistency when workers change?
• How do you record and share behavioural data or incidents?
• How will you communicate with the family and wider care team?
• Who should the family contact if concerns arise?

Frequently Asked Questions

Can behaviour support be funded at high-intensity rates?

Yes, but it depends on who is delivering the support and how it is billed within your NDIS plan. The funding for behaviour support is split into two parts which are frontline support workers and specialist behaviour support practitioners.

Do I need separate clinical and behaviour support providers?

Not necessarily. Whether you use one or two providers for clinical and behaviour support depends on whether you want an all-in-one complex care provider or separate, specialist ones.

Can a bed rail be a restrictive practice?

Yes and it’s specifically classified as a mechanical restraint under governing structures like the NDIS commission. However, the line between a bed rail being a safety tool and illegal restraint depends on why and how it is used.

Can medication used to manage behaviour be a restrictive practice?

Yes, it’s a regulated restrictive practice that’s classified as chemical restraint. However, the primary purpose of the medication is what determines whether it’s a normal medical treatment or a restrictive practice.

How many support workers should someone with complex care needs have?

There’s no mandatory number. You just need enough to maintain a consistent care team and make sure there are backups that are well trained to cover for unexpected absences.

What can I do if my clinical provider says they don't handle behaviours of concern?

We recommend adding a specialist behaviour support practitioner to the team, enforcing care collaboration between different providers, or switching to an all-in-one complex care provider.

How can you reduce distress during personal care?

Make routines predictable, offer controlled choices, pause where it’s practical or safe to do so, create a low-stimulus environment, protect physical privacy, match the client’s pace, etc.

Getting the Right Support When Needs Overlap

Support planning becomes less simple when clinical and behavioural support needs intersect because families may need several professionals functioning with the same understanding of the participant’s needs.

This is where Support Network comes in; to help you find a provider that will coordinate support services, communication, and care. Visit our website to explore our complex care or behaviour support services or call 1300 671 931 to discuss your circumstances or support requirements.