Submission No 72

INQUIRY INTO SERVICES FOR PEOPLE WITH AUTISM SPECTRUM DISORDER

Organisation: Department of Social Services

Date Received: 20 April 2016

Submission S072 Received 20/04/2016 Family and Community Development Committee

DSS also delivers employment and early intervention services to assist people diagnosed with autism, their families and carers. The submission provides data related

to these programmes as they are delivered in Victoria.

I wish you well with your inquiry and please do not hesitate to contact my office if you would like further information.

Yours sincerely

redacted

Finn Pratt

19 April 2016

Submission to the Victorian Parliamentary Inquiry into Services for People with Autism Spectrum Disorder

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Copyright notice

This document is licensed under the Creative Commons Attribution 4.0 International Licence
Licence URL: https://creativecommons.org/licenses/by/4.0/legalcode
Please attribute: © Commonwealth of Australia (Department of Social Services) 2015
Notice:

1. If you create a derivative of this document, the Department of Social Services requests the following notice be placed on your derivative: Based on Commonwealth of Australia (Department of Social Services) data.
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Notice identifying other material or rights in this publication:

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2. Certain images and photographs (as marked) — not licensed under Creative Commons

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Department of Social Services Submission to the Victorian Parliament’s Inquiry into Services for People with Autism Spectrum Disorder

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Table of contents

Contents

• Table of contents …………………………………………………………………………………….. v
• Executive Summary
• Introduction to the Department
• Accessing services and quality of service
  • Helping Children with Autism Programme
  • Autism Specific Early Learning and Care Centres (ASELCCs)
• Services in rural and regional areas
• Integration across governments and services
• Health services
• Workforce Issues
• Impact of the NDIS
  • The NDIS and Autism Spectrum Disorder
• Research into ASD and its prevalence
• Community Participation
  • Australian Disability Enterprises (ADEs)
  • Disability Employment Services (DES)
• Appendices
  • Appendix A: HCWA and ASELCC services funded by DSS in Victoria
  • Appendix B: Roll-out of the NDIS in Victoria from July 2016
  • Appendix C: Disability Employment Services Facts and Figures
• Acronyms
• Bibliography

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Executive Summary

This submission to the Victorian Parliamentary inquiry into services for people with autism spectrum disorder (ASD) addresses the terms of reference related to the availability and adequacy of services provided by the Commonwealth. Specifically, this submission is focused on services provided by the Department of Social Services (DSS)

DSS designs policy settings that underpin the development and delivery of a range of programmes that support people with disability, their families and carers to increase their wellbeing and independence, as well as to participate socially and economically in Australian society.

DSS delivers programmes that are specifically designed for people with ASD, with a particular focus on children, and broader programmes for people with disability, that include people with ASD.

DSS is the lead agency for the Commonwealth in the design and development of the National Disability Insurance Scheme (NDIS). Working in partnership with state and territory governments and other stakeholders, DSS is at the forefront of one of the most significant social policy and service delivery system reforms ever seen in Australia.

This submission focuses upon the NDIS, as well as DSS programmes that are delivered in Victoria:

• Helping Children with Autism (HCWA);
• Autism Specific Early Learning and Care Centres (ASELCCs);
• Australian Disability Enterprises; and
• Disability Employment Services (DES).

The HCWA programme aims to improve access to best practice early intervention, education and support for families of children diagnosed with ASD.

ASELCCs provide early learning programmes and support specifically for children aged up to six years with ASD or ASD like symptoms in a long day care setting. They also provide parents with support in the care of their children and give them the opportunity to participate more fully in the community.

Australian Disability Enterprises (ADEs) are commercial businesses providing supported employment opportunities to people with disability.

DES helps people with disability find work and keep a job.

The NDIS will eventually replace a range of Commonwealth funded disability programmes. While many of these programmes are not specifically designed for people with ASD, people with ASD may be accessing these programmes. NDIS participants will be able to access services through the NDIS when it is available in their area. People who are not eligible for the NDIS will receive continuity of support services, which will focus on assisting them achieve similar outcomes to those they receive under their currently disability services.

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The funding provided by the following programmes will gradually transition into the NDIS as it rolls out around Australia:

• Australian Disability Enterprises (ADEs);
• Work Based Personal Assistance;
• Helping Children with Autism;
• Better Start for Children with Disability;
• Mental Health Respite: Carer Support;
• Mobility Allowance;
• National Auslan Interpreter Booking and Payment Service;
• Outside School Hours Care for Teenagers with Disability;
• Personal Helpers and Mentors;
• Respite Support for Carers of Young People with Severe or Profound Disability;
• Remote Hearing and Vision Services for Children;
• Young Carers Respite and Information Service;
• Younger Onset Dementia Key Workers Programme;
• Continence Aids Payment Scheme (Department of Health programme);
• Support for Day to Day Living in the Community (Department of Health programme);
• Hearing Services Program (Department of Health programme); and
• Partners in Recovery (Department of Health programme).

Service delivery for people with disability, their families and carers is underpinned by a policy framework that aims to enable all Australians to ’maximise their potential and participate as equal citizens in Australian society’1. The National Disability Strategy 2010 – 2020 (the Strategy) outlines a ten-year plan for improving the life of Australian citizens with disability, their families and carers. The Strategy has six policy outcome areas:

1. Inclusive and accessible communities;
2. Rights protection, justice and legislation;
3. Economic security;
4. Personal and community support;
5. Learning and skills; and
6. Health and wellbeing.

The purpose of the strategy is to:

• establish a high level policy framework to give coherence to, and guide government activity across mainstream and disability-specific areas of public policy;
• drive improved performance of mainstream services in delivering outcomes for people with disability;
• give visibility to disability issues and ensure they are included in the development and implementation of all public policy that impacts on people with disability; and
• provide national leadership toward greater inclusion of people with disability.

1 Commonwealth of Australia, 2010, National Disability Strategy 2010-2020, DSS, Canberra page 3.

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The Strategy draws on the findings of extensive consultation conducted in 2008-09 by the National People with Disabilities and Carer Council and reported in Shut Out: The Experience of People with Disabilities and their Families in Australia2.

The Strategy looks beyond the specialist disability support system delivered by the Commonwealth, states and territories under the National Disability Agreement.

All states and territories have individual disability strategies; however, this is the first time in Australia that a national strategy articulates long-term goals across a number of key policy areas which impact on people with disability, their families and carers. It also provides leadership for a community-wide shift in attitudes to look beyond the disability.

Shut Out reported that people with disability wanted a whole-of-life approach involving coordinated and comprehensive planning between all levels of government and across all portfolios. The Strategy embodies this approach with all levels of government involved in both its development and implementation.

To address the challenges faced by people with disability in Australia, all governments have committed to greater collaboration and coordination3.

The development of the National Disability Insurance Scheme (NDIS) is considered to be a significant achievement under the Strategy4. DSS has responsibility for working in partnership with state and territory governments, people with disability, their families and carers and the Australian community to lead the design and development of the NDIS; which is one of the most significant reforms of service delivery arrangements ever seen in Australia.

The National Disability Insurance Agency (NDIA) has been established to deliver the NDIS. A reform of this magnitude requires a staged approach to implementation, to ensure that we get it right. As a result, trial or early transition sites in all states and territories have been established by the NDIA to deliver services under the NDIS.

The Victorian trial site commenced in 2013 and is located in the Barwon region, which covers the local government areas of the City of Greater Geelong, Colac Otway Shire, Surf Coast Shire and the Borough of Queenscliff. Transition arrangements for Victoria will see 100,000 people with disability enter the scheme by June 2019.

The demand for assistance from the NDIS for participants with ASD is being closely scrutinised by the community. DSS is funding research by the Autism Cooperative Research Centre to help establish a baseline of current assessment processes, which will contribute towards a national ASD diagnosis standard.

There is acknowledgement that academic evidence and research demonstrates that children achieve stronger outcomes with early intervention support5. DSS has, over time, developed a strong body of evidence to support our delivery of early

2 The report is available at: http://www.fahcsia.gov.au/sa/disability/pubs/policy/community_consult/Pages/default.aspx. 3 Ibid. 4 Commonwealth of Australia, 2014, Progress Report to the Council of Australian Governments 2014, DSS, Canberra; page 12. 5 National Disability Insurance Agency, 2016,NDIS Early Childhood Early Intervention Approach, NDIA, Geelong.

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intervention services for children with ASD6. Using this as part of its evidence base, the NDIA has developed the NDIS Early Childhood Early Intervention Approach to guide assistance under the NDIS for early intervention.

Employment services delivered through ADEs and DES offer supported and open employment respectively to people with disability; enhancing their community participation and contribution to Australian society. The Disability Employment Taskforce was established to review the entire disability employment system and develop a new National Disability Employment Framework to boost employment rates for people with disability.

Changes to the disability employment system will need to better align the system with the principles underpinning the NDIS. The Department has identified three main areas of improvement to the disability employment system:

• engaging with and better supporting employers;
• ensuring service providers can deliver high quality services; and
• empowering participants to make informed decisions.

Pilots to test these policy directions are already underway:

• the DES youth mental health pilot increases participant choice and control by allowing participants to spend some of their own funding; and
• the ongoing support and job plan trial is making ongoing support arrangements more flexible to better meet the needs of participants and employers.

DSS continues to work towards the full implementation of the NDIS, including the implementation of a Council of Australian Governments Disability Reform Council (COAG DRC) endorsed Market, Workforce and Sector strategy to support the disability services sector’s transition to the scheme; continuity of support for people assessed as not eligible for assistance under the NDIS; and accommodation support arrangements to help people with disability more flexibly seek accommodation that is appropriate to their needs.

6 KPMG, 2011, Reviewing the evidence on the effectiveness of early childhood intervention, FaHCSIA, Canberra, retrieved 4 March 2016 from: https://www.dss.gov.au/our-responsibilities/disability-and-carers/program-services/for-people-with-disability/better-start-for-children-with-disability-initiative/reviewing-the-evidence-on-the-effectiveness-of-early-childhood-intervention

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Introduction to the Department

DSS policies and services respond to people’s needs throughout their lives. We fund services and payments that assist families, children and older people, provide a safety net for people who cannot fully support themselves, enhance the wellbeing of people with high needs, assist those who need help with care and support a diverse and harmonious society.

Our mission is to improve the lifetime wellbeing of people and families in Australia. We pursue this mission through policies and services that:

• support people and families to participate economically and socially in Australian society;
• enhance the independence and wellbeing of people with high needs;
• foster community cohesion and promote civil society; and
• provide a safety net for people who cannot fully support themselves.

DSS has four core areas in which we seek to assist people:

• Social Security to ensure financial support for individuals and families who are unable to fully support themselves by providing a sustainable payments and concessions system.
• Families and Communities to promote stronger families and more resilient communities by developing civil society and by providing family and community services.
• Housing to increase housing supply, improve community housing and assist individuals experiencing homelessness through targeted support and services.
• Disability and Carers to promote improved independence of, and participation by, people with disability, including improved support for carers, by providing targeted support and services.

Accessing services and quality of service

DSS delivers the HCWA programme and the ASELCCs initiative as part of our focus on early intervention services for children with disability. In addition, the Early Intervention for Children with Autism Spectrum Disorders: Guidelines for Good Practice released in 2012 and the Autism Cooperative Research Centre activities demonstrate DSS’ commitment to an evidence-based and quality of service approach.

In relation to the NDIS, governments have agreed to the development of a national approach to quality and safeguards as part of the scheme.

There is agreement that the national framework should maximise the opportunities for people with disability to make decisions about their supports while also enabling them to live free from abuse, neglect and exploitation. The framework should also promote innovation, continuous improvement and best practice in the provision of supports.

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A nationally consistent quality and safeguards framework should mean that people interacting with NDIS can expect consistent standards and safeguards wherever they live in Australia.

DSS, in collaboration with the NDIA and state and territory governments, is leading the work to develop a system of quality assurance and safeguards, which will include complaints and critical incidents management.

Helping Children with Autism Programme

Since 2008, the Commonwealth Government has been committed to delivering the HCWA programme. The programme aims to improve access to best practice early intervention, education and support for families of children diagnosed with ASD.

State and territory governments remain the primary providers of early intervention services for children with disability and HCWA is intended to complement these services.

The support provided by the HCWA programme includes:

• funding to increase access to early intervention services for children aged up to seven years who are diagnosed with ASD;
• a national Autism Advisor Service to assist families and carers of children aged zero to seven years who are diagnosed with ASD;
• targeted playgroups (PlayConnect) across Australia for families and children aged zero to six years with ASD or ASD-like symptoms;
• a national programme of workshops (Early Days workshops) that deliver flexible and targeted support for families and carers of children aged zero to six years with ASD or ASD like symptoms;
• development of an ASD website7 as part of the Raising Children Network (RCN) that provides information, online resources and other interactive functions to parents, carers and professionals;
• Medicare rebates for diagnosis and 20 visits for early intervention treatments for children with ASD up to age 13 years;
• professional development (Positive Partnerships) for teachers and other school staff to support school students with ASD to achieve better educational outcomes; and
• workshops and online information for parents and carers of school-aged children with ASD.

HCWA is delivered jointly through DSS, the Department of Education and Training (DET) and the Department of Health (DoH).

The initial funding of the HCWA programme was $190 million over four years, however, there has been a commitment by Government to fund the programme beyond the four years and to transition funding to the NDIS, with DSS’ component of the programme costing on average approximately $73 million per annum.

7 http://raisingchildren.net.au/articles/autism_spectrum_disorder_overview.html

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The DoH component provides the Medicare rebates for diagnosis and intervention while the DET component provides the professional development for teachers and other school staff, as well as the workshops and online information for parents and carers of school-aged children with ASD.

DSS has responsibility for the major component of the programme (approximately 70 per cent) which is centred on an individualised approach to funding early intervention services. Eligible children receive an allocation of up to $12,000 that can be used to purchase services from providers that deliver eligible services and are members of the Early Intervention Service Provider Panel (Panel Providers).

Families are made aware of ASD and available services through a range of education and support services such as Autism Advisor Services, Early Days workshops, the ASD pages of the Raising Children Network website and PlayConnect playgroups.

More information about the HCWA programme can be found on the DSS website8.

Key HCWA Funding Figures and Data

As of 31 January 2016, HCWA has assisted more than 46,000 children, most of whom were diagnosed with an autistic disorder. Victoria has the highest numbers of children accessing the programme (14,763) followed by New South Wales (14,626).

Approximately $366 million has been spent on these children for early intervention services since 2008. Of this amount approximately $115 million was spent on children in Victoria, almost one third of the national expenditure for HCWA. Appendix A provides funding data for HCWA in Victoria.

Nationally, there are currently 2,771 panel providers approved to deliver services under the programme in 2,649 locations across the state. In Victoria, there are currently 917 panel providers in 876 locations.

HCWA Evaluation

In 2009, DSS contracted ARTD consultants (ARTD) to conduct a comprehensive evaluation of the HCWA programme in three phases over two-and-a half years (July 2009 to December 2011) to assess the extent to which the DSS components of the programme (the Autism Advisor Service, the Early Intervention funding and services, Early Days Workshops, the ASD specific website by the Raising Children Network, and the PlayConnect Playgroups) met the programme objectives; as well as to identify possible improvements to inform policy and decisions about the future direction of the programme.

The ARTD evaluation found the HCWA programme had a positive impact on children with ASD and their families. It increased access to early intervention services and supported families to understand ASD and interventions, and to make informed decisions.

ARTD also identified areas for improvement and made recommendations on where DSS could take actions to continue to improve outcomes for children with ASD and their families. In response, DSS has implemented a number of modifications

8 https://www.dss.gov.au/our-responsibilities/disability-and-carers/program-services/for-people-with-disability/early-intervention-services-for-children-with-disability.

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including changes to operational guidelines, an increased focus on communication between stakeholders, and reviewed access criteria for the Outer Regional and Remote payment to assist families living in rural and remote parts of Australia.

The evaluation was finalised in 2012 and the report was published on the DSS website.9

Autism Specific Early Learning and Care Centres (ASELCCs)

The Commonwealth Government established six ASELCCs10 to provide early learning programmes and support specifically for children aged up to six years with ASD or ASD like symptoms in a long day care setting. They also provide parents with support in the care of their children and give them the opportunity to participate more fully in the community.

Since 2008, ASELCCs have been providing intensive early intervention according to international best practice. The Victorian ASELCC is located in Melbourne: the La Trobe University Margot Prior ASELCC on the La Trobe University campus, Bundoora11.

The ASELCCs operate as ‘centres of excellence’, working to improve sector capacity, and conducting research into ASD, early intervention and early diagnosis.

More specifically, the ASELCCs:

• engage children with ASD or ASD like symptoms in quality learning and developmental experiences;
• provide children with individual support and intervention strategies to develop their capacity to participate in child care, early learning and education settings;
• provide children, in the year before formal schooling, with an ASD specific early childhood education programme;
• support children to transition and participate in further educational and therapeutic settings and in everyday life; and
• provide children with ASD or ASD like symptoms with opportunities for integration and interaction with other children.

Key ASELCC Funding Figures and Data

ASELCCs are funded approximately $850,000 per annum. Total funding outlays to the ASELCCS between 1 January 2016 and 31 December 2018 will be $15,549,000.

9 https://www.dss.gov.au/our-responsibilities/disability-and-carers/program-services/for-people-with-disability/hcwa-evaluation-summary-report. 10 ASELCCs were jointly implemented by the then Department of Education, Employment and Workplace Relations and DSS. DSS is responsible for the administration of the ASELCCs. 11 The other ASLECCs are located in Adelaide - the Daphne Street Child Care and Specialist Early Learning Centre, Prospect, Brisbane - the AEIOU ASELCC on the Griffith University’s Nathan Campus, Perth - the Jellybeans ASELCC in Warwick, Sydney - the KU Marcia Burgess ASELCC, Liverpool, and Burnie, North West Tasmania - the Alexander Beetle House ASELCC, Burnie.

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As at 31 December 2015, there were 213 children nationally enrolled at the ASELCCs, many of who attend on a part-time basis. Of these, 32 were enrolled at the La Trobe University Margot Prior ASELCC in Victoria. Appendix A provides funding data for the Victorian ASLECC.

Since opening in July 2010, the La Trobe University Margot Prior ASELCC has enrolled a total of 208 children.

ASELCC Evaluation

In 2009, DSS contracted O’Brien Rich Research Group to conduct an evaluation of the ASELCCs to assess the extent to which the ASELCC programme objectives were achieved, to identify possible improvements and to inform decisions about future directions and/or expansion of the programme.

The evaluation report, finalised in 2012 and published on the DSS website,12 reported that ASELCCs are providing quality and comprehensive services that are highly valued by families.

Services in rural and regional areas

The NDIA is working closely with states and territories to implement the Rural and Remote Service Delivery Strategy endorsed by COAG DRC on 13 November 2015.

The Rural and Remote Service Delivery Strategy underpins the development of strong and effective relationships with communities, drawing on mainstream, Indigenous and culturally diverse organisations to ensure that people with disability have access to suitable community based services or organisations. Development of the Rural and Remote Service Delivery Strategy built on the lessons from trial sites in delivering rural and remote services, especially in South Australia, Tasmania and the Northern Territory and will assist to develop mechanisms to grow, engage, sustain and lead local service delivery initiatives.

The NDIA will have a regional presence across Victoria as the NDIS is rolled-out over the next three years. Appendix B outlines the roll-out schedule for Victoria.

Integration across governments and services

Effective interaction between the NDIS and other service systems (e.g. education and health) is critical to ensure smooth transitions for participants into the NDIS and to avoid cost shifting, duplication and service gaps.

Integration of service provision between the NDIS and state government services are guided by the legislative framework for the scheme (the National Disability Insurance Scheme Act 2013 [NDIS Act] and Rules). A set of Principles, Applied Principles and Tables of Support were agreed by the COAG in April 2013 and were reviewed and updated in 2015.

The review recommended cross-sector coordination be strengthened throughout the Applied Principles. The review highlighted that all jurisdictions and the NDIA are committed to working together to ensure the interface between the NDIS and the mainstream systems work in a way that provides the best outcomes for participants.

12 https://www.dss.gov.au/our-responsibilities/disability-and-carers/program-services/for-people-with-disability/helping-children-with-autism/autism-specific-early-learning-and-care-centres-evaluation-report.

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The Governments and the NDIA worked closely to provide greater clarity of roles and responsibilities in the Tables of Support. The updated version is available on the COAG website13.

Health services

The health system is responsible for the diagnosis, early intervention and treatment of health conditions, including ongoing or chronic health conditions. This may involve general practitioner services, medical specialist services, dental care, nursing, allied health services, preventive health care, care in public and private hospitals, and pharmaceuticals (available through the PBS).

The health system is also responsible for funding time limited, recovery-oriented services and therapies (rehabilitation) aimed primarily at restoring the person’s health and improving the person’s functioning after a recent medical or surgical treatment intervention. This includes where treatment and rehabilitation is required episodically.

The NDIS will be responsible for supports required due to the impact of a person’s impairment/s on their functional capacity and their ability to undertake activities of daily living. This includes ‘maintenance’ supports delivered or supervised by clinically trained or qualified health professionals (where the person has reached a point of stability in regard to functional capacity, prior to hospital discharge (or equivalent for other healthcare settings) and integrally linked to the care and support a person requires to live in the community and participate in education and employment.

The NDIS and the health system will work together at the local level to plan and coordinate streamlined care for individuals requiring both health and disability services recognising that both inputs may be required at the same time or that there is a need to ensure a smooth transition from one to the other.

Education

The allocation of responsibilities between the NDIS and schools will be consistent with the legal obligations of schools and governments’ policy objectives for education, including:

• the compulsory nature of schooling;
• the current responsibilities schools have for reasonable adjustment, under the Commonwealth Disability Standards for Education; and
• curriculum planning, assessment and reporting requirements and requirements for students to receive the legislated number of hours instruction or meet class attendance requirements.

In recognising the universal and statutory role of the schooling system:

• schools will be responsible for making reasonable adjustments to personalise learning and support for students that primarily relate to their educational attainment (including teaching, learning assistance and aids, school building modifications and transport between school activities); and

13 https://www.coag.gov.au/node/497.

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• the NDIS will fund supports that the student requires due to the impact of the student’s impairment on their functional capacity and additional to reasonable adjustment (i.e. those not primarily relating to education attainment), including personal care and support and transport to and from school and specialist transition supports to and from school to further education, training or employment. Any funding arrangements for individual students will recognise the operational requirements and educational objectives of schools.

The NDIS and the school education system will work closely together at the local level to plan and coordinate streamlined services for individuals requiring both school education and disability services recognising that both inputs may be required at the same time or through a smooth transition from one to the other or across service systems.

Housing and Accommodation

The introduction of the NDIS provides people with disability more flexibility to seek accommodation that is appropriate to their needs, through a variety of supports to assist them to find and maintain housing. For example, NDIS participants can seek assistance with navigating rental markets, tenancy obligations and short-term transitional accommodation.

The NDIS also provides supports to make housing more accessible for people with disability, for example through home modifications (including ramps, rails or hoists), assistive products for household tasks (such as aids and equipment that may enable people with disability to undertake cooking, cleaning or home maintenance), and domestic services (including food preparation, linen services and cleaning for people who are unable to undertake these tasks). Additionally, for those with very high needs, the NDIS may be able to provide funding for specialist disability accommodation support.

At the November 2015 meeting of the COAG DRC, Ministers endorsed a pricing framework to guide the approach to this specialist accommodation in the NDIS. This framework was released by the NDIA on 30 November 2015 and is available from the website14. The framework provides guidance on for whom and under what circumstances specialist accommodation will be provided. Governments are working with the NDIA to develop further detail in relation to this framework.

The Specialist Disability Accommodation Initiative (SDAI) is designed to help address immediate community need for specialist disability housing in areas outside NDIS trial sites, as determined by geographic location or age cohort, by providing ‘top up’ funding. The SDAI is funded by the Sector Development Fund (SDF) within the NDIS. The SDF assists people with disability, the disability services sector and its workforce with the transition to the NDIS through capacity building, provider readiness and through diversifying the workforce.

The aims of the SDAI are to:

• increase the availability of accommodation for people with disability, who providers anticipate will be eligible for the NDIS, with a particular focus on those housed in inappropriate accommodation settings and those with ageing carers who are in need of a long-term, sustainable arrangement; and

14 http://www.ndis.gov.au/specialist-disability-accommodation.

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• identify project initiatives with self-sustaining specialist disability housing models which could be scaled up in the future.

Projects are being funded for the 2015-16 and 2016-17 financial years.

A request for information (RFI) was released in November 2015 seeking information on a range of innovative ideas for housing projects that could be piloted in the Barwon trial site. Following the RFI, the NDIA intends to engage in consultation and co-design with people with disability and other key stakeholders, and conduct a procurement process for the delivery of the pilot in Barwon.

Workforce Issues

Governments recognise that the success of the NDIS will depend on a strong and effective disability market, sector and workforce. Many activities are focussed on building capacity of the workforce to deal with increased complexity and a person-centred choice and control model, which is a key principle of the NDIS.

It is expected the disability employment workforce will need to more-than-double in size to an estimated 162,000 full-time equivalent (FTE) workers between now and full implementation in 2019-20 as a result of the NDIS. For Victoria, the current workforce is estimated to be close to 19,000 FTE and the expected required growth is estimated at 39,000 FTE by full implementation of the scheme.

Between 2006 and 2011, disability service providers successfully grew the workforce by 39 per cent compared to average growth in the wider health care and social assistance industry of 26 per cent. If current trends continue, net growth in the disability workforce will approach, but not equal, forecasts that assume a doubling in size by 2018.

In 2013 and 2014, research funded by the Australian Government in the Barwon NDIA trial site, investigated just how much working hours are changing under the NDIS.

The research found that the three organisations involved in the project employed the equivalent of 64 FTE staff in November 2013 and that this grew to 90 by November 2014. The rostering case study validates the proposition that the transition to the NDIS is having a significant effect on workforce requirements, the distribution of work, and the types of employment in the Barwon trial site. The three organisations involved in the rostering case study were trying hard to respond to the additional demand for services and the deployment of a workforce that reflected the time preferences of participants.

In 2015 the Integrated NDIS Market, Sector and Workforce Strategy (the Strategy) was agreed by the Commonwealth, states and territories and the NDIA to direct the joint work being undertaken for transition to full scheme.

Additionally, the Commonwealth Government has committed $146 million over five years to 2017-18 to the Sector Development Fund (SDF). The SDF will fund priority projects identified under the Strategy to enable people with disability to exercise choice and control, to develop a diverse and sustainable range of suppliers, and develop and grow a workforce which will adequately support people with disability into the future.

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DSS continues to work closely with the NDIA, and states and territories to ensure that planned activities, including workforce activities, are consistent with and complement the Strategy.

To assist in the development of a range of diverse and sustainable suppliers, activities are focussed on enabling existing and emerging suppliers to mature at an appropriate and sustainable rate; ensuring providers have access to information and supports to make an effective transition to the NDIS; providing an environment that promotes innovation in planning and delivery of supports; and building quality systems and ensuring effective safeguards are integrated into business systems.

Activities to build and develop the workforce to support people with disability into the future include assisting the sector to build a sustainable and diverse workforce; promoting careers in the disability support sector; encouraging innovative and efficient use of the workforce; ensuring that a sufficient supply of allied health and other professionals is supported; and enabling the development of a workforce with the skills, knowledge and values to support implementation of the NDIS.

DSS is also working closely with the aged care area of the DoH to take a collaborative approach to meeting the workforce demands of both sectors.

Impact of the NDIS

The NDIS represents a very significant change to the way people with disability are supported. The NDIS aims to ensure that people with disability receive supports based on their needs, have choice and control over that support and the costs are controlled through an insurance approach.

In the context of the NDIS, ‘insurance’ means adopting an insurance approach to the management of the scheme, so that the costs and risks of severe disability for a person are distributed among the wider community as a shared responsibility. This means that people with disability will not need to bear the costs of their disability on their own, and that all Australians will have certainty that if they or their family members are born with or acquire a disability they will get the support they need. An insurance approach also means taking a long term view of people’s care and support needs to ensure that they get the right support early, rather than waiting until they reach crisis point to help them.

Once the scheme is fully rolled out, it will provide support for about 460,000 people nationally who have a significant and permanent disability that results in a substantially reduced capacity to participate in activities of daily living. The scheme will enable these people to access the support that is reasonable and necessary to meet their needs.

Since 1 July 2013 the NDIS has been delivered in Victoria at the Barwon trial site in the Greater Geelong, Surf Coast Shire, Queenscliff and Colac-Otway local government areas.

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The Bilateral Agreement between the Commonwealth and Victoria: Transition to a National Disability Insurance Scheme was signed with the Victorian Government on 16 September 2015. The Bilateral Agreement covers the roles and responsibilities for the transition to full coverage of the NDIS in Victoria including:

• Participant transition arrangements;
• Financial contributions for transition;
• Continuity of support arrangements;
• Quality and safeguards; and
• Performance reporting.

By July 2016, all residents with significant and permanent disability in the Barwon area — about 5,000 people — will be covered by the scheme. The full roll-out of the scheme in Victoria will commence from July 2016 so that by July 2019 all eligible residents should be covered. More than 100,000 Victorian residents with significant or permanent disability are expected to benefit from the full roll-out of the scheme. The scheme has a staged approach to implementation across the state.

Table 1 — lists the service delivery start date by Victorian region

Appendix B outlines the local government areas for each region to provide more detail on the implementation schedule.

Transition of DSS Programmes to the NDIS

Funding arrangements for the NDIS are detailed in the bilateral agreements for transition between the Commonwealth and state and territory governments. In the design of the NDIS, all governments identified programmes that would transition to the NDIS as part of the implementation of the scheme.

DSS manages a number of these programmes on behalf of the Commonwealth Government that will transition to the NDIS including HCWA and ADEs. Since the

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commencement of the NDIS in 2013 HCWA and ADE participants residing in trial sites have been transitioning to the NDIS.

DSS entered into new grant agreements with the ASELCCs which will better capitalise on each centre’s strengths, align operations to the NDIS environment, and provide opportunities to research the efficacy and sustainability of the ASELCC model.

At the end of these agreements in 2018, DSS will be better placed to consider the transition of the ASELCCs into the NDIS.

The NDIS and Autism Spectrum Disorder

Under the NDIS Act, the NDIA Board must prepare a report on the operations of the NDIA each quarter and provide that report to the COAG DRC within one month after the end of that period. The NDIA Board’s last report was for the quarter ending 31 December 2015.

ASD is the primary disability with the highest percentage of support plans approved under the NDIS. Nationally, 31 per cent of support plans were developed for people with ASD (6,833 support plans against 21,915 total plans). Table 2 below provides comparative national and Victorian data for the primary disability categories under the NDIS.

Table 2 — National and Victorian data for the number of support plans and participants under the NDIS by Primary Disability as at 31 December 201515

Within the support plans for all NDIS participants, including people with ASD, the two most in demand approved interventions were for daily living and assistance with independence.

15 National Disability Insurance Agency, 2015, Quarterly Report to COAG Disability Reform Council 31 December 2015, Commonwealth of Australia, Geelong; pages 34 and 55.

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In Victoria, 22 per cent of NDIS participants record ASD as the primary disability, second to intellectual disability at 26 per cent16.

The average annualised cost of approved support packages for people with ASD across the NDIS is $26,93617.

The NDIS and an evidence-based approach

An evidence-based approach underpins the delivery of the NDIS. The Commonwealth, states and territories have been involved in reviewing the lessons learnt from the NDIS trials, taking into account the experience of participants, their families and carers and providers in the trial sites to help inform governments about the best way to transition to a full scheme.

The lessons learned from trial range from those requiring administrative change to improve efficiency during trial, to lessons that impact policy, design and implementation of the NDIS in transition and full scheme. This includes identifying the need for specific skills, resources and services for participants with ASD. There is also a focus to improve guidance and training for staff in providing appropriate supports for specific disability types, for example, the NDIA has established an expert group on ASD to help determine the evidence base for early intervention options for children.

Research into ASD and its prevalence

Research commissioned by DSS to support development and delivery of early intervention programmes for children defines autism as being a neurodevelopmental disorder beginning at birth or shortly after. The characteristic symptoms have been described as a triad of impairments involving delay and deviance in social and communicative development, along with restricted interests and repetitive behaviours. Certain sensory, motor and cognitive characteristics are also associated with autism18.

ASD covers diagnoses which include Autistic Disorder, High Functioning Autism, Asperger Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified. Children with these diagnoses all share the social and communicative symptoms which are the core of autism, but they vary in severity of symptoms and in level of functioning19.

A review of the evidence of outcomes of early intervention for children with ASD was undertaken in 2011 by Margot Prior and Jacqueline Roberts. This review was an update of the 2006 review by Prior and Roberts for the Commonwealth Department of Health and Ageing and covers new research from 2006 to 2011. The document also includes evidence-based guidelines for best practice in early intervention and a

16 Ibid; page 32. 17 Ibid; page 53. 18 Prior, M. and Roberts, J. 2012, Early Intervention for Children with Autism Spectrum Disorders: ‘Guidelines for Good Practice’ 2012, Department of Families, Housing, Community Services and Indigenous Affairs, Canberra; page 1. 19 Ibid.

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list of contacts for programmes across Australia. The Guidelines for Good Practice can be found on the DSS website20.

The guidelines indicate the eligibility of interventions for funding under HCWA, as well as provide advice regarding service delivery models for the ASELCCs.

DSS currently funds two research projects which are being conducted by the Autism Cooperative Research Centre. These projects are:

• Autism Spectrum Disorder Diagnostic Practices in Australia - $50,000. This study will examine diagnostic practices for ASD across Australia and help to establish a baseline of current assessment processes. This is an essential first step towards a national ASD diagnosis standard.
• Pilot Project – Transition of Children with Autism from Early Intervention Settings to Primary School - $278,000. This project aims to develop national guidelines for transition to school following early intervention.

Research is also an essential component of the ASELCC programme, with all centres being required to undertake assessments and record data. This data is utilised to provide clearer insight into the value of early intervention for children with ASD in a long day care or early childhood setting. Between 2015-16 and 2018-19, the ASELCC Research budget is $530,000 - $780,000 per annum.

Community Participation

People with disability are able to participate widely in their local community through two employment programmes delivered by DSS: ADEs and DES. It is widely recognised that there are many benefits to community and employment participation for people with disability including the opportunity to communicate and socialise with a wide range of people, the development of work-related skills and knowledge and of course, personal independence and the financial benefits of remuneration.

From 1 July 2013, the NDIA commenced funding supported employment for participants of the NDIS who work in ADEs. Once a supported employee has a plan approved under the NDIS, funding to support them in employment from DSS ceases as they will be eligible to receive funding under the NDIS.

Current DES provider contracts expire in March 2018, and work is currently underway to create a new model for disability employment services to replace DES. A series of consultations has taken place with a range of stakeholders, including consumer groups representing people with ASD, to help inform a new disability employment framework.

Australian Disability Enterprises (ADEs)

ADEs are commercial businesses providing supported employment opportunities to people with disability. These workers engage in a wide variety of work tasks such as packaging, assembly, production, recycling, screen printing, garden and landscaping jobs, cleaning, laundry services and food services. Across Australia there are nearly 300 ADE outlets supporting about 19,000 workers with disability, with 7 per cent of

20 https://www.dss.gov.au/our-responsibilities/disability-and-carers/program-services/for-people-with-disability/early-intervention-for-children-with-autism-spectrum-disorders-guidelines-for-good-practice-2012s.

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these supported employees reporting ASD as their primary disability. In Victoria there are 77 ADE outlets providing employment opportunities to just over 4,000 people with disability with 7.6 per cent reporting ASD as a primary disability.

Disability Employment Services (DES)

The Commonwealth Government provides the DES programme to assist people for whom disability is assessed as their primary impediment to gaining employment in the open labour market. This includes people with ASD. Under the programme, 134 organisations are funded through grants and contracts to help people with disability to increase their capacity to work; to obtain employment; and to maintain their employment in the open labour market. Two of these organisations have been contracted to specifically provide specialised assistance to people with ASD: Autism Association of Western Australia in Perth and NQ Competitive Employment Service in Townsville.

DES is delivered from over 2,100 sites across the country; is tailored to individuals’ needs and may include a range of assistance such as work experience, resumé and interview preparation, on-the-job and other training, job redesign, functional assessments and counselling. Other assistance is available to support employers in recruiting staff, including wage subsidies, disability awareness training, workplace adjustments including the purchase of electronic organisers, voice activated recorders, checklists, visuals instructions and workflow diagrams. Once employed, further ongoing support is available to help participants maintain employment, if required.

DES providers are a mix of large, medium and small, for-profit and not-for-profit organisations that are experienced in supporting job seekers with disability and experienced helping businesses to put in place practices that support the employee in the workplace.

Within DES, there are two uncapped, demand-driven services:

• DES-Disability Management Service (DES-DMS) is for eligible job seekers with temporary or permanent disability, injury or health conditions who are not expected to need regular, long-term support in the workplace, and
• DES-Employment Support Service (DES-ESS) is for eligible job seekers with permanent disability who are assessed as needing regular, long-term ongoing support in the workplace.

Nationally, 6,300 or four per cent of DES participants on the current caseload have ASD listed as their primary disability (refer to Appendix C, Chart 1). Victoria accounts for 1,186 or almost 19 per cent of these participants. As at 31 January 2016, 95 per cent (5,968 of 6,300) of participants with ASD, receive services from a DES-ESS provider. Since March 2010, almost 18,000 participants with ASD have commenced in the DES programme. Since March 2010, 2,204 Victorian participants of DES have been placed in employment or education21. Of these, 1,746 achieved a 13 week outcome and 1,32222 achieved a 26 week outcome (Appendix C).

21 The majority of these placements were in employment. 22 Participants who achieve a 26 week outcome also achieve a 13 week outcome.

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Appendix C outlines national data for the number of DES referrals, commencements, current caseload and exits with a primary disability of ASD as at 31 January 2016. Appendix C outlines national outcome data for DES participants with a diagnosis of ASD for DES-ESS and DES-DMS.

The Future of Disability Employment Services

Improving employment outcomes for people with disability is recognised as a priority both internationally, under the United Nations Convention on the Rights of Persons with Disabilities, and nationally, under the National Disability Strategy 2010-2020.

These obligations, in line with broader directions in disability policy, endorse approaches to disability service provision that encourage consumer choice, individually tailored support and also empower people with disability to make decisions that affect their own lives.

Across Government there has also been a move to increase competition and encourage a diversity of service providers in increasingly open marketplaces. Such measures are explored in the context of the provision of social services in the Harper competition policy review.

The NDIS is an example of a disability service that has embraced these two policy directions to improve services for people with disability. The NDIS has now rolled out in multiple trial sites across Australia and it is changing community expectations of the way disability services are delivered. DES was moved from the Department of Employment to the Department of Social Services to better align with and capitalise on the investment of the NDIS.

The Disability Employment Taskforce is currently preparing options for Government to assist in decisions about future directions for the whole disability employment system. Current DES contracts are due to expire in March 2018. This provides DSS with a good opportunity to explore how Government can better align the future DES service provision with other disability services and our international and national obligations.

Decisions about the future directions will need to be made with enough time for the sector to prepare for transition to the new arrangements. The work of the Disability Employment Taskforce is a current priority for DSS and further information will be available from the Department’s website23 as this work progresses.

23 https://www.dss.gov.au/our-responsibilities/disability-and-carers/programmes-services/disability-employment-services/disability-employment-framework-consultation

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Appendices

Appendix A: HCWA and ASELCC services funded by DSS in Victoria

Services funded under the HCWA and ASLECC programmes that are located in Victoria:

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Appendix B: Roll-out of the NDIS in Victoria from July 2016

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Appendix C: Disability Employment Services Facts and Figures

Primary Disability: ASD (Data as at 31 January 2016)

• since March 2010

The number of DES referrals, commencements, current caseload and exits with primary disability of ASD as at 31 January 2016 by state and territory.

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Outcome data for DES participants with a diagnosis of ASD for DES-ESS and DES-DMS by state and territory as at 31 January 2016.

• Since March 2010.

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Chart 1: DES participant breakdown by primary disability type on the current baseload as at 31 January 2016.

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Acronyms

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Bibliography

Commonwealth of Australia, 2010, National Disability Strategy 2010-2020, DSS, Canberra. Commonwealth of Australia, 2014, Progress Report to the Council of Australian Governments 2014, DSS, Canberra. KPMG, 2011, Reviewing the evidence on the effectiveness of early childhood intervention, FaHCSIA, Canberra. National Disability Insurance Agency, 2015, Quarterly Report to COAG Disability Reform Council 31 December 2015, Commonwealth of Australia, Geelong. National Disability Insurance Agency, 2016,NDIS Early Childhood Early Intervention Approach, NDIA, Geelong. Prior, M. and Roberts, J. 2012, Early Intervention for Children with Autism Spectrum Disorders: ‘Guidelines for Good Practice’ 2012, Department of Families, Housing, Community Services and Indigenous Affairs, Canberra.

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