NDIA Accountability Project

Submission 60 — Department of Communities — Inquiry into support for autistic children and young people in schools

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Education and Health Standing

Committee – Inquiry into support for Autistic children and young people in schools

Submission by the Department of Communities

July 2023

Acknowledgement of Country and People

The Department of Communities proudly acknowledges Traditional Custodians throughout Western Australia and recognises their continuing connection to their lands, families and communities. We pay our respects to Aboriginal and Torres Strait Islander people and cultures, and to Elders past, present and emerging.

Inquiry Terms of Reference

The Education and Health Standing Committee (the Committee) will inquire into support for Autistic children and young people in schools.

In particular, the Committee will consider:

  1. The prevalence of Autism in WA and projected demand for support in schools.

  2. Current support available for Autistic students in WA schools, including consideration of how:

    a. evidence-based practices are implemented across the school system; and

    b. school supports are co-ordinated with other service areas to respond to the needs of Autistic students and their families.

  3. Strategies in other jurisdictions that support school systems to respond to the needs of Autistic students, and the applicability of those strategies to WA.

About the Department of Communities

The Department of Communities (Communities) is Western Australia’s major human services department that brings together vital services and functions that support individual, family and community wellbeing.

Communities works collaboratively with partners across government and the community services sector to deliver disability services, child protection and family support, housing, community and regional initiatives.

Communities has responsibility for eleven Ministerial portfolio areas:

  • Child Protection
  • Prevention of family and domestic violence
  • Community Services
  • Women’s Interests
  • Disability Services
  • Seniors and Ageing
  • Volunteering
  • Youth
  • Housing
  • Homelessness
  • Early Childhood Education.

Communities provides direct services to adults with intellectual disability, some with comorbid autism, and through the child protection portfolio, children in care, a significant proportion of whom would have a disability.

The Australian Institute of Health and Welfare reported that in 2020–21, data on disability status was available for 63 percent of children in out-of-home care and about 30 percent were reported as having a disabilityi.

The Office of Disability

The Office of Disability was established within Communities in 2021 to promote the rights and interests of people with disability and the disability sector more broadly.

The Office of Disability provides disability sector stewardship, advice on State and Commonwealth systems, and drives work and innovation to advance inclusion and participation of people with disability in Western Australia. It provides leadership to implement, monitor and further develop A Western Australia for Everyone: State Disability Strategy 2020–2030 (State Disability Strategy), a 10-year whole-of-community vision to protect, uphold and advance the rights of people with disability living in Western Australia.

The Office of Disability has led the development of this submission.

Prevalence of Autism in Western Australia

NDIS data from 31 March 2023 shows that 37 per cent (or 18,848) of 50,994 NDIS participants in WA had Autismii. 47 per cent of NDIS participants in Western Australia were under 18 years old. Autism is the most common disability among NDIS participants under 18 years across Australia (54 per cent)iii. Young children with Autism are the largest cohort driving growth in NDIS participant numbers.

It is challenging to estimate the prevalence of Autism Spectrum Disorder (ASD)iv1 in WA, however comparison across datasets over the last 15 years indicate that prevalence is rising (Figure 1).

Figure 1: Estimate of prevalence of ASD in Western Australia, composite of multiple sources of information.

[Graphic: Graph illustrating the estimated prevalence of ASD in Western Australia across multiple datasets from 1985 to 2020]

Equitable access to accurate diagnosis is important in driving good outcomes for individuals.

In WA, diagnostic assessments to identify disability to access supports from the Department of Education or the National Disability Insurance Scheme (NDIS) remains a State Government responsibility. For Autism this diagnostic responsibility is shared by Communities (operationalised by the Neurodevelopmental Disability Assessment Service

[NDAS]), and the Department of Health’s Child Development Services across the Child and Adolescent Health Service and Western Australian Country Health Service.

Commonwealth funding through Medicare rebates is also available to the private sector for diagnostic assessment services.

Inconsistent diagnostic protocols for the assessment of Autism are considered a possible factor contributing to the increase in prevalence rates. The National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders (National Guideline) was introduced in 2018 as a national standard for the assessment and diagnosis of Autism. Some diagnosticians in Western Australia shifted from the Western Australian Autism Diagnosticians’ Forum’s (WAADF) Guideline to align with the National Guideline. WAADF Guidelines require assessment by three professional disciplines to determine a diagnosis of Autism, against a single discipline assessment required by the National Guidelines. Application of the National Guideline in WA means that the assessment of Autism is on the same terms as those in other jurisdictions, and allows for a broader range of professional disciplines to undertake assessment and diagnosis beyond the scope of the WAADF Guidelines.

The need for accurate assessment and diagnosis is important to enable an individual’s needs to be understood to inform appropriate interventions and referral pathways. Also critical is access to timely assessment to enable early intervention to commence at a very young age. Lengthy waiting lists for assessment and diagnosis disproportionately impact individuals with greater complexity and vulnerability (for example Aboriginal children; children in lower socio-economic areas, children in care).

Policy and legislative context

This submission emphasises the broader policy and legislative context and the implications for the delivery of support for Autistic children and young people in schools. This includes key Federal policy reform and WA legislative reform processes outlined below:

The Independent Review of the National Disability Insurance Scheme (NDIS)

The Independent Review of the NDIS (the Review) was announced on 18 October 2022. The Review aims to 1) examine the design, operations and sustainability of the NDIS covering issues outlined in the full-Scheme bilateral agreements between the Commonwealth and jurisdictions; and 2) examine ways to build a more responsive, supportive and sustainable market and workforcev.

Key aspects of the Review include scheme governance arrangements and the impact and interface between the NDIS and other related policies and systems, including mainstream services. An aspect the Review is considering is how children with disability should be supported. Early feedback to the Review Panel has identified the importance of best

meeting the needs of all children with development concerns, developmental delay and disability due to a lack of access to other service systems for familiesvi. The Independent Review Panel’s final report is expected in October 2023.

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People

with Disability

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Disability Royal Commission) commenced in April 2019.

Communities is the lead agency for engagement with, and coordinating government agencies input to, the Disability Royal Commission for the Western Australian Government.

The scope of the Disability Royal Commission is extensive and includes education and learningvii. The final report is due to be released 29 September 2023 and Communities expects that the final report’s findings and recommendations will be of relevance to Western Australia. This is foreshadowed in the interim report’s findings published October 2020, which identified issues related to education and learning, including access to education; violence and abuse in education settings; and safe, quality and inclusive educationviii. It is expected that the Disability Royal Commission final report findings will have some interface with the NDIS Review outcomes.

NDIS Financial Sustainability Framework

On 28 April 2023, National Cabinet agreed to develop a NDIS Financial Sustainability Framework to introduce an annual growth target of no more than 8 per cent by 1 July 2026 to contain the total cost of the Scheme, with further moderation of growth as the Scheme maturesix.

At the Disability Reform Ministers Meeting on 23 June 2023 all Ministers agreed on the need to have a sustainable growth trajectory for the NDIS to support equity and fairness for all Australians who are living with disability.

National Autism Strategy

The Commonwealth allocated $4.9 million in its 2023-24 Budget for development of a National Autism Strategyx. The National Autism Strategy will aim to ensure relevant parts of the system are responsive to the needs of autistic people, by adopting a coordinated approach across all levels of government and service areas. The State Government will have a significant role in achieving the intended Strategy outcomes, including:

  • Improved service integration and coordination between all levels of government
  • More inclusive education, employment and health services for people with Autism.

National consultations to inform the development of the National Autism Strategy will commence later in 2023 and be guided by a newly formed National Autism Strategy Oversight Council, comprising ten community and sector representatives and six Commonwealth officers.

Reform of WA disability legislation

Communities is undertaking a process to reform WA disability legislationxi. The Disability Services Act 1993 (DS Act) is the current legislation pertaining to the provision and regulation of state-led disability services and related matters in Western Australia. Consistent and contemporary reforms are required to ensure WA disability legislation is appropriate to meet the modern needs and expectations of the community.

Communities commenced a consultation process with a consultation paper released in February 2023. Key areas for consultation include:

  • principles applicable to, and the safeguarding of, people with disability
  • access and inclusion
  • ongoing service provision for specific cohorts.

The consultation feedback will inform the development of new legislation.

Supporting Autistic children and young people in

schools

The Western Australian Government’s investment in the NDIS has a significant role in enabling equitable access to early childhood intervention for children throughout the state, including children living in regional and remote areas. However, WA’s geographic size and population distribution presents significant challenges in the provision of NDIS services under the standard NDIS market model. Low market concentration due to insufficient demand, cost of service delivery and/or or NDIS pricing in regional, remote and very remote areas sees a limited number of service providers attracted to remote regions. Access to services is further limited by the dearth of providers providing culturally appropriate services for Aboriginal and culturally and linguistically diverse communities. Additionally, in regional and remote areas support for students with Autism in school and use of their NDIS individual plans is limited by the lack of disability support services.

WA needs to ensure its approach to supporting children and young people with Autism complements the NDIS and maximises WA’s investment in the NDIS to support eligible West Australians.

Development of any initiatives must ensure Western Australians with Autism are represented and work with agencies to identify and design the support they need, irrespective of complexity, location or cultural background.

Conclusion

Estimating the prevalence of Autism in WA is difficult; however analysis indicates that the prevalence is rising and young children with Autism are identified as the largest cohort driving growth in NDIS participant numbers. Equitable access to accurate diagnosis is critical to achieving good outcomes for individuals. The National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders (National Guideline) provides a national standard for the assessment and diagnosis of Autism. Appropriate implementation and individual protections could strengthen effectiveness in their application. Assessment and development of supports for Autistic children and young people in schools should consider the broader policy and legislative reforms currently underway, and co-design future directions with Western Australians with Autism.

Endnotes

i https://www.aihw.gov.au/reports/child-protection/child-protection-australia-2020-21/contents/out-of-home- care/characteristics-of-children-in-out-of-home- care#Most%20children%20in%20OOHC%20in%20Major%20cities ii https://data.ndis.gov.au/reports-and-analyses/participant-dashboards/autism iii https://www.ndis.gov.au/media/6006/download iv ASD is the acronym for autism spectrum disorder. This umbrella term was created in 2013 by the American Psychiatric Association and covers: