• e, -%@ e© -™ -™ -f Aboriginal Health Council ee↔ -of South Australia Ltd.
• Submission to the Joint Standing
• Committee on the National Disability
• Insurance Scheme -Australian Health Council of South Australia Ltd. -March 2023

About Aboriginal Health Council of South Australia

Aboriginal Health Council of South Australia Limited (AHCSA) is the peak body representing Aboriginal Community Controlled health and substance misuse services in South Australia at a state and national level. Our primary role is to be the ‘health voice’ for all Aboriginal people in South Australia. AHCSA achieves this by advocating for the community and supporting workers with appropriate Aboriginal health programs based on a holistic perspective of health. AHCSA is a membership-based peak body with leadership watchdog, advocacy and sector support role with a commitment to Aboriginal self-determination.

AHCSA provides support to our 12 members, Aboriginal Community Controlled Health Organisations (ACCHO’s) to improve health outcomes for Aboriginal and Torres Strait Islander people of South Australia. We provide support to build capacity of the sector strengthening the

to broader health system.

Aboriginal Community Controlled Health Organisations

ACCHOs are incorporated Aboriginal organisations initiated by and based in a local Aboriginal community. ACCHOs contribute to improving the health and well-being of Aboriginal peoples through several pathways, providing employment and training, delivering accessible, comprehensive primary health care and social programs. ACCHO’s have extensive experience in working collaboratively with Aboriginal community members and have an innate understanding of best practice models to ensure effective and long-term engagement with communities so they are able to access a range of government programs, such as the National Disability Insurance Scheme. (NDIS}

NDIS AHCSA

AHCSA is working in collaboration with National Aboriginal Community Controlled Health Organisation to provide support for all member services to build capacity to deliver the NDIS for Aboriginal Community through the NDIS ready project. The project aims to increase the number of ACCHSs delivering services for Aboriginal and Torres Strait Islander people under the NDIS, and build

the capacity and capability of those organisations and communities.

The NDIS ready project also

• Promoies the NDIS to the Aboriginal Community,
• looks at ways to improve the underutilisation of NDIS plan within the community
• Explores ways to improve navigation of the NDIS system.

• Provides networking opportunities, sharing information, and finding solutions, within the

Aboriginal NDIS and disability sector.

Introduction

AHCSA welcomes the opportunity to provide this evidence to the Joint Standing Committee on the capability and culture of National Disability Insurance Agency.

AHCSA’s response to this inquiry includes predominately program experience working with the NDIA and feedback from our ACCHOs, registered Aboriginal NDIS providers and other Aboriginal Community Controlled Organisations as weil as Aboriginal people living with a disability or their

family members.

Despite the prevalence of disability in Communities, Aboriginal participants are still under

represented within the NDIS.

There are still thousands of Aboriginal and Torres Strait Iskander children and adults living with disability, who are eligible for NDIS and not yet a participant due to a range of issues, including navigating a system with complex processes.

There are millions of unspent funds in Aboriginal participant NDIS plans.

Priorities to address disability inequity

AHCSA supports the First Peoples Disability Network (FPDN) 10 Priorities to address disability inequity. Ten priorities to address disability inequity - FPDN

The plan should be based on the fen priorities identified by FPDN and be developed by using three

pillars:

• Build the capacity of communities and individuals fo understand their rights and entitlements

• Invest to create a First People’s Community Controlled service sector

• Develop and support an Aboriginal and Torres Strait Iskander workforce

Understanding Local issues and needs

Regional and remote areas often have significant shortages of culturally safe and appropriate services and service providers, sometimes there are no service providers at all.

It can be challenging to recruit and retain specialists, culturally safe healthcare workers and GPs to

remote and regional communities.

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As a result, community members are unable to obtain the health assessmenis and reports needed to complete NDIS applications and therefore have not approved an NDIS plan.

The high cost of attending specialist appointments and undertaking assessments and reports {particularly when undertaking psychosocial assessments) is expensive, sometimes costing thousands of dollars. Providing these documents can impact whether the person is approved and becomes an NDIS participant. Local planning does not always recognise the complexity of the local region or recognise a transient population. This can be especially challenging when proving a

disability in line with the legislation.

Recommendations

The NDIA invest in ongoing community education within the Aboriginal community controlled sector and expand to include the broader community including health care sector, early childhood, schools, and other stakeholders on how to navigate and access the NDIS.

This training should be developed in collaboration with the Local Aboriginal Community and ACCHO and ACCO sector. This will ensure training is relevant to the local Aboriginal community.

Consultation and Co-design

There is limited consultation and co-design with NDIS and the Aboriginal sector and with Aboriginal _ people living with a disability. If consultation does occur, if feels like it is there fo ‘tick a box’ without any real outcomes. There is aiso short timeframes and not all the sector is included in these consultations.

Recommendations

Key speakers at the table, consultation process needs to be more inclusive, to invite the CEOS and key staff of Peak organisations and Aboriginal and Torres Strait Islander Disability service providers.

The NDIA to form meaningful relationships with the engage with the Aboriginal Community. This could include involving the CEOs through existing networks such as AHCSHA and the South Australian Aboriginal Community Controlled Organisation Network (SAACCON) as a start.

Cultural safety

It’s identified and evident that the agency lacks cultural safety and is unable to demonstrate cultural safe behaviour. €.g. making assumptions on kinship arrangements, and systems, wordy

plans that are written in bureaucratic language and not person focussed.

AHCSA has provided several NDIS access training and information sessions to build capacity and knowledge when working with clients to gain access to the NDiS. We have had to do this ourselves as the current training offered by the NDIA is not suitable for many of our workers and does not include an Aboriginal lens. The NDIA offered training is very bureaucratic, power point heavy, legislation focused and does not allow time for discussion, real life examples. It does not provide

opportunity for group work or real life examples.

NDIA’s policies and processes NDIA’s policies and procedures feel to be focused to a mainstream context and do not take into

consideration diversity of cultures and communities.

Policies and procedure are not always applicable at the local level. NDIA planning does not always recognise the iocal barriers around workforce, accessibility issues of providers, and kinship

and family systems.

For example returning to country. The NDIS planners not having an understanding of the importance to support connection to culture and country and supporting activities such as retuming to country. This can have a significant effect on people’s social and emotional wellbeing and recovery. It has been identified from Aboriginal organisations that funds have dropped from

peoples plans to support returning to country.

Recommendation

That NDIA staff gain a better understanding of Aboriginal culture, but also that internal mechanisms

within the department support the implementation of this.

Additional considerations should be given to Aboriginal people living in regional and remote community when needing to provide supporting documents. Participants also report difficulties understanding their plans and knowing which funds are intended,

and for what purpose. This is particularly true for first-time participants of the scheme.

The use of certain language and processes can be inaccessible for participants.

Capacity, Communications and partnerships

Many of the NDIA teams work in silos without understanding key elements of other teams work. This makes it difficult for a coordinated approach and integration of services for the client. This results in enormous frustration for fhe Aboriginal Community Controlled Sector who are navigating the system. The agency on occasion have demonstrated unhelpful practices (for example when sought clarification on process, would be redirected to the website rather than a direct answer from the agency) Workers need to be trained appropriately, to be able to provide adequate information and to do their job properly for the NDIS program. NDIA staff turnover is high, in certain teams, this becomes de- humanised, the staff have to follow a script to not stray from the NDIS legislation.

Some further communications and partnership issues include: e Lack of response to general communications and emails and forwarding inquiries to different teams rather than finding the answer.

e At times there have been instances of a lack of professionalism and collaboration with the relationships with the Partners in the Community.

Recommendation

Consider developing a team in the NDIA who is dedicated to supporting the Aboriginal Community Controlled sector in delivering NDIS services. There is broad information on the NDIS website, however when seeking practical information to deliver NDIS services this does not happen.

Historically ACCHOs and ACCOs have had a focus on Primary Health care or other key matiers, not disability, therefore further assistance may be required when an ACCO is considering providing NDIS services

The large gap in culturally safe and appropriate disability services has been identified and acknowledged by the NDIA, across Government and the sector. The NDIA and other government departments need to work in partnership with the Aboriginal Community Controlled Sector to co-design strategies to address the barriers that make it difficult for our community. Shared decision-

making and working in genuine partnership {in line with Reform one of the National Agreement on

Closing the Gap}

Faceless agency

The NDIA has a reputation as being a ‘faceless organisation’ and this is particularly evident when there is no Partner in Community, where there is no on the ground agency for community members to contact. This compounds the issues around disability and appropriate access. This results in a faceless service with limited access and engagement. The 1800 number or going on-line is not suitable customer service for many of our Aboriginal Community members.

Recommendations

• Consider innovative ways to connect with community and provide an NDIS service such as expos or a Community Service Hub concept where services could visit a region on a rotating basis for two days - such as NDIS Planners, LACs, early childhood partners, Plan Managers, Regional Assessment services, Centrelink, Medicare, etc.
• Support coordination should be available to all first time Aboriginal NDIS participants— with an opt out option. Support coordination allows participants to better utilise and Understand their NDIS plans, especially where there is no NDIA office or LAC
• Increase consultation and co-design
• More Face to Face events

Appropriately funded Aboriginal Cultural Competency Training is mandated for NDIS and follows a cultural fitness approach — this is an ongoing journey of learning and listening service provision throughout Australia

Additional considerations should be given to Aboriginal people in regional and remote communities when providing supporting documents. Regional and remote areas often have significant shortages of culturally safe and appropriate services. It can be challenging to recruit and retain specialist, culturally safe, healthcare workers and GPs to remote and regional communities. As a result, community members are unable to obtain the health assessments and reports needed to complete NDIS applications and not approved an NDIS plan.

Invest in the Aboriginal Community Controlled Sector

There is insufficient support for the community connector workforce (Aboriginal Disability Liaison {ADLO) Officers and Rural Community Connectors (RCC). There is insufficient ADLO and RCC workforce. More investment is needed in the Aboriginal Community Controlled sector to have more

Other issues identified within the Aboriginal disability sector

e There is limited opportunity for culturally safe and appropriate respite and not enough mental health programs for adolescence.

e NDIAsystem barriers for Aboriginal Organisations to support local Mob to advocate for their needs / services

e Non-Aboriginal NDIS service providers not providing the supports they should be, even when they are getting paid to provide this function {i.e., Support Coordination}

e Culturally thin markets - Lack of support for ACCOs to become NDSI providers.

e The success of the Aboriginal Disability Liaison Officer {ADLO} program, the need for this to continue long-term and consideration of the Remote Community Connector Program to be provided by NACCHO, not the NDIA. This will support in the development and capacity building of local community members to navigate a western system. ALDO program also needs to be appropriately funded and include ACCOS

e AHCSA has been liaising with the NDIA fo increase the Rural Community Connector (RCCP) Program in SA. Until recently there was only one position in SA out of approx. 250 pasitions Nation-wide. We have been happy with the progress and working with this particular team within the agency.

e NDIA 1800 number for participants is not working (you can call three times in one day and get three different answers)

e More cultural awareness training {localised and practical, not online) to support NDIA workforce (i.e., planners, delegates etc)

e The NDIA is too big, so many departments which you have to jump through hoops to navigate

There is NDIA lack of investment or intention to incorporate the National Agreement for

Closing the Gap priorities for system reform

There needs to be a greater understanding from the NDIA that many ACCHOs have a primary health focus and are new to disability service deliver. They may also of missed out much of the support offered to other services during the transition to the NDIS.

The interface between NDIS and Education system needs to improve to ensure that kids with a disability are provided with safe, high quality and culturally appropriate supports so they can be supported to attend and remain in schools — it should not be the parents’ responsibility to ‘fix’ these government systems or feel like they have to pull their child out of school because it’s too hard.

Kinshio care arrangements and accessing the NDIS — there is no formal mechanism for many care providers / guardians to access the NDIS when family kinship care arrangements are in place (i.e. those that are not in place through DCP}

Lack of trust in the agency with a mainstream approach for Aboriginal people/ co locating certain government departments.

Some ideas moving forward

Support coordination should be available to all Aboriginal NDIS particioants— with an opt out option. Support coordination allows participants to better utilise and understand their NDIS plans.

AHCSA continues to provide support and advice to our members services who are considering becoming NDIS providers, which will see more cultural safe Aboriginal providers. This needs to occur in partnership with the NDIA, and more practical support from the agency when our members are looking to enter the market. The NDIS ready project funding has finished and there is no existing funding to support this continued work.

AHCSA continues to be funded to provide support and advice to our members’ services who are becoming NDIS providers, which will see more cultural safe Aboriginal providers and promote the NDIS to our community.

• AHCSA has been liaising with the NDIA to increase the Rural Community Connector {(RCCP) Program in SA. Previously there was only one position in SA out of over. 250 positions Nation- wide.

• A 2 day NDIS ready event was held in August 2023, bringing together a range of disability stakeholders, Aboriginal disability providers and our ACCHOs (the NDIA and partners also attended}. This was a successful event with many networks made and productive outcomes to move forward. We would like to see the NDIA continue to support these

events in the future.

• Wehave started a Community of Practice (CoP) with our members and other Aboriginal stakeholders across South Australia. This is an opportunity to network, learn and come up with practical solutions, strategies across both the NDIS our Aboriginal community members who have a disability but are not eligible for the NDIS. The CoP provides opportunities to produce formalised feedback to systemic and policy issues with the NDIS and disability effecting our community.

• client, obtained Medicare approval and had a written statement from the Department of Child Protection describing the Grandmother was representing maternal duties. The family chose not proceed with legal hearings to have this formally arranged/documented as the informal arrangements were effective for the situation. These documents will further be described throughout as the documents that would not suffice identification of legal representation to act on

• behalf of the participant.

• The initial complication occurred when the Access Request Form (ARF) required the legal guardian to sign on behalf of the participant — There was advice provided by a Partner in the Community organisation that the Grandmother would not be able to sign on behalf of the maternal mother. The form was signed through a mutual family member assisting the maternal mother to sign this, it was suggested that the maternal mother — There was significant risk of the maternal mother and

• Grandmother meeting in person.

• The participant was approved NDIS funding, however the identification that the Grandmother : provided was not effective and the maternal mother was addressed and all correspondence was provided too — Maternal mother was not to have contact with the participant due to safety concerns and was not in a position to act on his behalf as a representative, stated in the letter from

• the Department of Child Protection however this document was not sufficient for the NDIA.

• Due to the maternal mothers risk, there was no capability for consent forms to be completed for Grandmother to be nominated as a representative. This caused further complications during planning meetings, implementation and review — the Grandmother was unable to act on behalf of

• the participant and advocate for his needs/goals and services required.

• The Grandmother was required to represent for a plan review due to ineffective funding and culturally appropriate goals for the participant. Notifications of the situation were uploaded to the NDIA system to advise of the evidence that the Grandmother had from the Department of Child Protection and her role within the participants life — however this continued to be insufficient. Due to the complications and occurrences the Grandmother found rapport with local Aboriginal Health Services deteriorate due to frustration with the system and that the documentation that was suffice for one Government system was not for another — The Grandmother presented at the original Organisation with suicidal ideation and had verbally expressed that she would revoke the clients

• services through the NDIS due to the complexities when representing the participant.

NDIA management of partners in the community.

This case study demonstrates the lack of communication and guidance from the NDIA in regards to work practices standards with a Partners in the community organisation.

A Partners in Community organisation informed all local providers in country South Ausiralia in late 2022 on the that LAC’s are now unable to connect participants with providers. Instead, Participants will be directed to utilize the NDIS Portal / website or be offered a printed copy of the provider list.

The new direction that one particular Partner in Community is taking by sending participants to the NDIS provider list website and not taking the time to contextualise or localize this information is detrimental to Participants and their ability to utilise their Plans. This approach also goes against the information on the NDIA website “The NDIS also connects anyone with disability to services in their community” and is not in keeping with the NDIA’s Participant Service Charter.

The impacts of this change are far reaching. From our perspective, we see several areas of risk that this poses to not only the Participants, but also the Agency. These include:

1. Plan implementation failure if participants are unable to navigate the NDIS provider portal or interpret any written information provided to exercise their right to choice and control.

2. NDIA reputational risk as NDIS best practice standards direct LAC’s to:

a. connect people with disability to community supports and mainstream services, regardless of their eligibility to become a participant in the NDIS.

b. Build relationships in local communities to helo promote inclusion and improve the accessibility of services and facilities.

3. Aboriginal people and community’s becoming disillusioned with the NDIS process and choosing not to engage. This would place many vulnerable people at extreme risk of not receiving the appropriate supports required.

4, Market failure: Regional and remote areas have many unregistered NDIS service providers; as an example, therapy services. As you would be aware, unregistered providers will not appear on the NDIS portal / website. Therefore, the local LAC should include these providers on localized provider list to ensure participants were able to access services as detailed in their NDIS plans. Without this level of localised information, the NDIS service sector will not grow as required, with the danger of unregistered providers closing down or deciding not to provide NDIS services.

Moving forward and keeping Participants and their families at the center of all we do, we recommend the following:

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les PITC provide the localised connection and supports fo Participants through the LAC as a matter of urgency

2. The PITC work holistically with the whole family rather than individual participants, and provide reasonable support to empower families and build capacity to engage and focus on their NDIS needs

ae Culturally appropriate assessments to measure and assess the extent of a person’s need for further Allied Health Professional assessments to gain eligibility.

4, The PITC develop formal partnerships and / or MOU’s with the local Aboriginal Community Controlled Organisations if they have a gap in expertise in working with Aboriginal peoples

S: Where the PITC is ‘delivered by a mainstream organisation, they should have KPts that relate to Aboriginal employment

In future, we would also like to see the NDIA change the way in which they work with Aboriginal communities to align with their commitment to the new National Agreement on Closing the Gap. The National Agreement commits all governments to a new era of partnership and shared decision-making to close the gap in life outcomes for Aboriginal and Torres Strait Iskander Peoples. It recognises that Aboriginal and Torres Strait Iskander Peoples know what is best for their people and communities. It also acknowledges the unique strengths of Aboriginal and Torres Strait Islander Peoples’ knowledge and cultures are critical to driving real change. At the center of the National Agreement are four priority reforms to ensure governments change the way we work with

Aboriginal and Torres Strait Islander Peoples:

° Priority Reform 1: Formal partnerships and shared decision making

° Priority Reform 2: Building the community-controlled sector

° Priority Reform 3: Transforming government organisations

: Priority Reform 4: Shared access to data and information at a regional level.

From the NDIA’s perspective, the department could start to address some of the priority reforms by Ls Funding Aboriginal Community Controlled Organisations (urban, regional and remote) to provide LAC functions

2. Where number | is not possible, PITC’s should be mandated to work in genuine partnership with local Aboriginal Community Controlled Organisations

3. Where there is no PITC, the NDIA should work in genuine parinership with local Aboriginal Community Controlled Organisations.

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All ACCHO’s would be interested in furthering these discussions and how our organisation could work with the NDIA moving forward to ensure Aboriginal people living with a disability, their families and carers have the tools, resources and supports in place to thrive.