Submission
No 152
INQUIRY INTO SERVICES FOR PEOPLE WITH AUTISM SPECTRUM
DISORDER
Organisation: Swan Hill District Health
Date Received: 15 February 2017
Submission $152
. Received 15/02/2017 wan Hill
own
istrict Health Family and Community Development Committee
ny haspital ABN 24 314 338 210
Splatt Street, Swan Hill
PO Box 483, Swan Hill
8“ February, 2017 Victoria 3585 Telephone: (03) 5033 9300
Facsimile: (03) 5032 9528 www.shdh.org.au
Submission to Parliament of Victoria — Family and Community Development Committee — Autism Spectrum Disorder Services Inquiry — Swan Hill Hearing 14 February 2017.
Terms of Reference
Received from the Legislative Council on 6 May 2015:
To the Family and Community Development Committee to inquire into, consider and report, no later than 31 May 2016%*, on services for people with autism spectrum disorder in Victoria, including but not limited to —
a. the prevalence of autism spectrum disorder in Victoria; b. the availability and adequacy of services provided by the Commonwealth, State and local governments across health, education, disability, housing, sport and employment services;
CG the adequacy of services to be provided under the National Disability Insurance Scheme (NDIS);
d. evidence of the social and economic cost of failing to provide adequate services; and e. the projected demand for services in Victoria.
Swan Hill District Health
Swan Hill District Health (SHDH) is a rural health service covering a 100km radius area. SHDH is an integrated health service providing a range of services including acute, sub-acute, residential aged care, community (community health, HACC, CHSP) and outreach services to an estimated population of around 30,000 people.
Swan Hill District Health does not receive specific funding to provide services for those diagnosed with Autism Spectrum Disorder (ASD). However, the health service provides clinical services to people with an ASD diagnosis across all settings, either as part of their general health care or for specific issues associated with ASD. This is essentially funded through the State Community & Women’s Health, Home and Community Care (HACC) For Younger People (under 65 years), Commonwealth Home Support Program (65 years and over), and subacute or acute funding.
Swan Hill District Health provides Allied Health Services which include Speech Pathology,
Occupational Therapy, Physiotherapy, Podiatry and Dietetics. These are small Departments ranging from 3 to 6 EFT and required to provide services across Acute, Subacute, Aged and Community Health.
1|Page
Speech Pathology:
-
The SHDH Speech Pathology Department offers limited services to children (0-6 years) diagnosed with Autism Spectrum Disorder (ASD) under HACC and Community & Womens Health funding streams. Evidence Based Practice (EBP) supports the multidisciplinary management of these children under specialised early intervention services (i.e. Specialist Children’s Services, Noah’s Ark). Clients with an ASD diagnosis would typically be referred to these services. If these clients are seen prior to diagnosis, the role is to identify the need for further diagnostic assessment and assist families to access early intervention services. This may include assessment and ’generation of appropriate referrals. At present, clients who are accessing early intervention services are not eligible to access additional services through SHDH as there is no designated ASD or disability funding stream within our service.
-
Noah’s Ark and Specialist Children’s Services are the two services providing early intervention in the local area.
-
SHDH will soon commence limited services for children with funding through “Helping Children with Autism/HCWA” (children are able to access these services until their 7th birthday). This service will be available to children who are also accessing early intervention services, however have specific and identifiable communication goals and famllles wish to use this funding to access additional therapy for their children. This service has been developed to address the limited private service options available in this region.
-
The Speech Pathology Department provides assistance with the diagnostic process, however does not have the capacity to make a formal diagnosis. An “assessment only” service is provided in situations where a child is requiring Speech Pathology assessment as part of an ASD assessment. This occurs, with referral from a Paediatrician, when the child is having to wait for an extended period for the full multidisciplinary assessment and requires a diagnosis for funding for assistance in the pre-school setting. This is not ideal, as best practice requires a multidisciplinary assessment by a Paediatrician, Psychologist and Speech Pathologist as a minimum. The Department of Education and Training does not recognise ASD assessments which do not involve at least these three disciplines and therefore students are not able to obtain further funding when they commence primary school without this full team assessment.
-
Children who have commenced school are not eligible to access services through SHDH. The Department of Education and Training is funded to provide Speech Pathology input for school-aged children with ASD (through the Swan Hill Specialist School and mainstream schools). Children with ASD often require a high level of support and intervention during transition to school and there is high demand for speech pathology services across schools in the region.
-
SHDH does not have specific disability funding for children or adults
-
There is no specific funding allocated for services for adults with ASD. SHDH provides HACC services for younger people with disabilities living in the community. This is a time limited service for clients with identifiable goals and adults with an ASD diagnosis can be seen through this funding stream where there is a change in function i.e. communication or swallowing. Adult clients with an ASD diagnosis are eligible to access Speech Pathology services in the same way that any other adult client accesses our service and the Community Health Priority Tool is used at intake to determine priority. At times
21Page
“ assessment only” services are provided where there is no change in function but a communication assessment is required to assist in the development of care plans for the client etc.
e Speech Pathology may provide inpatient services to adults with ASD who present with a swallowing difficulty during their inpatient admission. Speech Pathology may also provide communication support recommendations for the duration of the admission.
e There is a visiting Speech Pathology service (one day per fortnight) funded through Scope (West Loddon Mallee Regional Communication Service) for adults with complex communication needs i.e. clients with disabilities accessing services through Murray Human Services or those living in Community Residential Units.
Occupational Therapy
e The Occupational Therapy. Department currently offers limited service to children with a diagnosis of ASD. Currently clients are funded under the streams of HACC For Younger People or Community & Womens Health funding.
e Occupational Therapy department are able to provide service to clients with a diagnosis of ASD of any age. However clients with an ASD diagnosis and who do not attend school would typically be referred to Early Childhood Intervention Service (locally Noah’s Ark or Specialist Children’s Services). If these clients are seen prior to diagnosis, our role is to identify the need for further diagnostic assessment and assist families to access early intervention services. This may include assessment and generation of appropriate referrals. At present, clients who are accessing early intervention services are not eligible to access additional services through SHDH.
e SHDH Occupational Therapy provides service to children who are school age and attend main-stream schooling from prep to Year 9. This can occur by the Occupational Therapist visiting the child at their schoo! with their teacher and/or school aid, or by families bringing their child to therapy sessions on site at SHDH.
e SHDH Occupational Therapy will soon commence limited services for children with funding through “Helping Children with Autism/HCWA” (children are able to access these services until their 7” birthday).
e The Occupational Therapy Department provides assistance with the diagnostic process, however does not have the capacity to make a formal diagnosis. An “assessment only” service is provided in situations where a child is requiring sensory assessment (Sensory Profile2) and intervention for children aged 2 — 13 as part of an ASD assessment. This occurs, with referral from a Paediatrician. However there is limited, if any, sensory processing services for adolescent clients and the practice is to refer these clients to CAMHS in Bendigo for service.
e Swan Hill Specialist School utilises Occupational Therapists from SCOPE Bendigo to provide sensory assessment and intervention to students in the school setting. There is a local private Occupational Therapy servicing the Swan Hill and Sea Lake areas, providing sensory assessment and intervention to young children.
3|Page
In regards to ASD diagnosis services, families may have to travel to Bendigo or Mildura (CAMHS, public funded and long waitlist or BEARS, private, which may not provide multidisciplinary assessment as recognised by the Department of Education and Training).
Limitations for sensory/ASD services include: Diagnostic services and assessment and intervention for children over the age of 16.
Physiotherapy
The Physiotherapy Department at SHDH offers limited services to children diagnosed with ASD under HACC and Community Health funding streams. Physiotherapy is not involved in diagnosis of ASD, however if ASD is suspected in an undiagnosed child, a referral to Speech Pathology or Occupational Therapy will be generated internally, for assessment. Children can be referred to physiotherapy for musculoskeletal conditions or developmental assessment; however this is not necessarily in relation to their ASD diagnosis. In this manner, these clients are seen under HACC For Younger People or Community & Womens Health. Children that are accessing early intervention services can access physiotherapy through their specialist services as needed, and are not typically provided through our services at SH DH. .
Barriers to access
e Lengthy or costly diagnostic process. Best practice indicates an ASD diagnosis should be made by a multidisciplinary team including paediatrician, occupational therapist, speech pathologist, and psychologist. Swan Hill has no local Paediatrician. A visiting paediatrician attends monthly. There is no child psychologist based in Swan Hill who can see children under school age. There is no multidisciplinary assessment service available in Swan Hill. Clients are often referred to CAMHS (Child and Adolescent Mental Health Service) or The Bendigo Early diagnosis Autism assessments and Referral Service (BEARS Clinic). The cost of BEARS assessment may be prohibitive for families and there is often a long wait time for assessment through CAMHS. If families are unable to pay for an assessment and therefore need to access public services, they often obtain funding (Helping Children with Autism HCWA) for services with limited time left before expiry of funds. The lack of local assessment services means that families also have to travel to obtain a diagnosis. An ASD assessment clinic can involve several assessment appointments in different locations and can be a lengthy and overwhelming process for families.
e . Limited options for private allied health input in Swan Hill. This means HCWA funded clients have often been unable to use their allocated funding or have limited choice. The limited private providers can also mean significant wait times for services or families have to travel to access services.
¢ Once families received their HCWA funding, it is their responsibility to arrange private therapy. Families report this is a confusing and overwhelming process as they attempt to navigate the system. In addition, in the rural setting, not all required allied health services are available in the private sphere.
e Limited options and choice for early intervention services.
e Limited access to specialist ASD services (i.e. Amaze) due to location.
4|Page
-
Swan Hill is a border town and providing services to NSW clients is problematic i.e. NSW clients are unable to access Early Intervention Services based in Swan Hill. The Early Intervention Service in NSW is substantially different to Victorian Early Intervention Services i.e. intereach, do not generally provide “therapy services”. Local Allied Health Services across the border within range of Swan Hill are either extremely limited or non-existent.
-
Often private providers cannot claim beyond face to face services with the client. This does no encourage collaboration with other multidisciplinary team members.
-
Workforce issues in maintaining an appropriately skilled and multidisciplinary workforce in a rural setting.
National Disability Insurance Scheme (ND/5/
Swan Hill District Health recognised issues in availability to access allied health services particularly Speech Pathology, Occupational Therapy and Physiotherapy for paediatric direct care. To address these issues an application was made to the Commonwealth for inclusion on the Early Intervention Service Provider Panel under Helping Children with Autism and Better Start panels in January 2017.
An allocation of 0.4EFT Occupational Therapy (HCWA & Better Start), 0.4EFT Speech Pathology (HCWA & Better Start) and 0.2 EFT Physiotherapy (Better Start) has been made with commencement of services from February- March 2017.
The HCWA and Better Start will transition into the NDIS which commences in Swan Hill from January 2019.
It is difficult to determine the overall impact with the introduction of NDIS. There may be the potential to enable provision of a more seamless service to clients with ASD diagnosis i.e. services may not have to cease involvement with a client at critical transitional times such as school commencement, however there are also risks including:
-
Consumer confusion about choosing services and reduced ability of consumers to navigate the system.
-
Provision of private services by new graduates or early career clinicians without ongoing supervision and mentoring
-
Sole practitioners providing services without access to a multi-disciplinary team as per best practice
-
Whether allocated NDIS funding for allied health services matches the overall costs for service delivery.
Paul Smith,
Executive Officer,
Primary Care Services,
Swan Hill District Health.
SIPage