Submission to the Joint Standing Committee on the National Disability Insurance Scheme

September 2020

Hutt St Centre 258 Hutt Street Adelaide SA 5000

Background ………………………………………………………………………………………………………………..3
General issues around the implementation and performance of the NDIS………………………..3
- 2.1 Initiating an Access Request ……………………………………………………………………………………………3
- 2.2 Meeting Evidence Requirements for an Access Request……………………………………………………..3
- 2.3 Local Area Coordinators …………………………………………………………………………………………………3
- 2.4 Choice and control…………………………………………………………………………………………………. 4
- 2.5 Complex needs ……………………………………………………………………………………………………………..4
- 2.6 Planning meetings …………………………………………………………………………………………………………4
- 2.7 Support Coordination and Service Delivery……………………………………………………………………….5
- 2.8 Case management for the NDIS……………………………………………………………………………………….5
- 2.9 The introduction of Independent Assessments………………………………………………………………….5
Recommendations ………………………………………………………………………………………………………6

1. Background

The Hutt St Centre is a Specialist Homelessness Organisation located in the Adelaide CBD that works with people who are homeless or at risk of homelessness to end their experience of homelessness, connect with relevant supports, and sustain their tenancies.

People with a disability are a growing sub-population of people who are accessing homelessness services. Since the full roll out of the NDIS in South Australia in 2018, there has been an increasing and emerging need for specialist homelessness agencies to assist and advocate with clients to access the NDIS and navigate its related processes. This emerging need has been associated with people with a disability in the homelessness sector experiencing disproportionate systemic, environmental and personal barriers to accessing the NDIS, and has demonstrated that this particular cohort of people are likely to require significant assistance, as well as both individual and systemic advocacy in order to achieve equitable outcomes from the NDIS.

This submission will specifically highlight the ongoing service delivery issues that exist issues for people with a disability who are homeless or at risk of homelessness. It will also highlight the additional NDIS performance issues experienced by people who have complex needs, limited decision making ability, and few informal support networks who can advocate on their behalf.

2. General issues around the implementation and performance of the NDIS

2.1 Initiating an Access Request

The Hutt St Centre continues to find that clients experience the NDIS Access process to be extremely complex and difficult to understand. The need for high level self-management[1], literacy, and self-advocacy skills in order independently navigate the NDIS access process currently prevents people with disabilities that significantly impact those skills, in completing the access process to a satisfactory level. As a result, self-initiated applications are often sub-par and therefore, rejected; and high level individual advocacy and support is then required in order to assist clients to complete a satisfactory NDIS application. The prevalence of disability types which can commonly affect self-management skills (e.g. psychosocial and intellectual disabilities, and neurological conditions such as brain injury, stroke, and dementia) within the homelessness sector are a strong a relational factor which affects people’s ability to initiate contact with and apply for the scheme.

2.2 Meeting Evidence Requirements for an Access Request

The NDIS operates on the assumption that people with disabilities have access to information about their disabilities, or have had extensive contact with the health system. For people experiencing homelessness or with extensive homelessness histories, this is often not the case. This results in people being unable to apply for the NDIS in the first instance despite being eligible.

Common reasons for clients having difficulty meeting the NDIS evidence requirements include: Sporadic contact with the healthcare system or lack of service relationship with a GP; limited or no access to medical reports; avoidant health-seeking behaviours; undiagnosed conditions (e.g. mental health conditions); and being unable to afford the additional costs associated with further assessments (specifically occupational therapy, private specialists and psychiatry).

2.3 Local Area Coordinators

Although supports in the community such as Local Area Coordinators (LACs) exist to provide assistance with NDIS access, the level and intensity of support required by clients with complex needs outweighs the support that can usually be provided by LACs. Additionally, LAC service models do not routinely provide outreach

[1] Self-management skills: the cognitive skills we use to learn, work and manage every day. These skills include memory; problem solving; planning and managing our time; regulating our thoughts, feelings and behaviour; understanding and processing information; making decisions; and keeping ourselves safe etc.

services and rely on the consumer seeking out their services, a factor which also limits the exposure and access vulnerable populations have to this service. As a general rule, it is our experience that clients are unlikely to know about, or make contact with LAC services independently.

2.4 Choice and control

The NDIS operates on the assumption that people with a disability either have the ability and desire to exercise choice and control in the scheme, or have access to supports that can assist them to exercise choice and control; but this is not always the case with the clients we routinely work with.

The absence of informal supports (family, friends etc.) is a significant factor affecting clients’ abilities to initiate and navigate the NDIS access process, and subsequent processes as a participant (planning and reviews). People without personal support networks rely more heavily on assistance from formal services and programs in order to initiate and engage in NDIS processes, and are likely to require more intensive assistance during those processes than someone who has additional supports in place. In the instance that people do not have access to either formal, or informal supports, there does not seem to be any assertive processes or safeguards in place by the NDIS to ensure the people in the most need are able to access the Scheme.

2.5 Complex needs

The complex needs of people with disabilities who are accessing homeless sector services are not fully accommodated by the NDIS at current. Although there exists a ‘complex needs pathway’, information regarding this pathway, including information about how to access it and what makes a person potentially eligible to use this pathway, is not sufficient via the NDIS website or through partners in the community.

The Hutt St Centre continues to experience issues with clients who have co-morbid alcohol or drug (AOD) issues being rejected by the NDIS. The people with disabilities who we work with can often have co-occurring issues which includes AOD use; brain injury from repeated and prolonged AOD use is also common, especially in older clients. Further to this, substance use disorder is also a recognised mental health condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While it is understood that the current NDIS access process requires clients to be able to ‘prove’ the impact of their disability on their daily life, the issues that arise from both a person’s disability/condition and their AOD use are often hard to separate, and thus can preclude them from accessing the NDIS entirely.

2.6 Planning meetings

Planners do not always appear to have knowledge of, or experience working with people with complex needs, and psychosocial disabilities. It also continues to be found that planners do not always ensure the client’s file/ background information is read before the appointment, resulting in clients having to ‘retell’ their story unnecessarily, lengthening the meeting process by going over information that has already been disclosed by the client in their application.

Time constraints and the pressure to complete an NDIS plan in a single meeting impact the congruency the final NDIS plan with client’s actual service needs. Although the planning process is described as being ‘flexible to people’s needs’ in theory (e.g. plans can be completed over several sessions), in reality, the high demand for planning meetings and long wait times for meetings result in this option rarely being implemented in practice.

The current planning meeting process relies on participants (or their advocates) being able to articulate goals that are “reasonable and necessary”, and also having enough knowledge about the available NDIS supports to suggest how these goals may be reached with NDIS funding. Because of this, the Hutt St Centre has continuing concern that people who do not have strong self-advocacy skills often end up with plans that do not meet their needs, which results in having to engage a lengthy review process.

2.7 Support Coordination and Service Delivery

The exclusion of case management in the NDIS is an ongoing issue for people who experience difficulties in the areas of self-management, communication and learning; have limited informal supports; and/or experience

episodic declines in their function. Although support-coordination has been marketed by the NDIS to support people with the aforementioned needs, it is routinely overlooked, underfunded, or not approved in the final NDIS plan despite being advocated for in planning meetings.

Further to the above, the delivery of support coordination can significantly vary from provider to provider, some of whom are not always assertive in making contact with clients. This is a concern for people with complex needs that impact their ability to self-identify when they are in crisis or need additional support (e.g. mental health is in decline, service delivery has broken down with providers etc.). Inadequate funding of support coordination has also been experienced to impact the ability of clients to be smoothly transitioned onto the NDIS from homelessness services despite their housing and case management goals being met.

2.8 Case management for the NDIS

The importance of the case management role to assist NDIS participants to unpack and address NDIS related issues continues to be highlighted in reference to the difficulty clients often experience in accessing the NDIS and also using their NDIS plans.

While homelessness services can undoubtedly provide short to medium term case management for clients with complex needs and disabilities, our service delivery with clients is often prioritised by meeting more immediate needs for safety and housing. Therefore, we believe that case management within the NDIS would be better placed to assist clients with high service needs to be adequately supported through the process of transitioning to the NDIS. Case management through the NDIS would also assist in mitigating some of the aforementioned issues (see 2.7 support coordination and service delivery), and provide a more streamlined approach to continuity of care, as well as greater opportunities for hand over between homelessness services and the NDIS.

2.9 The introduction of Independent Assessments

Lastly, we would like to raise the recent announcement by the NDIA regarding the introduction of compulsory independents assessments (IA) for both prospective NDIS applicants, and NDIS participants as part of the access and plan review processes respectively.

It is anticipated that the introduction of IAs will, for people who have limited ability to advocate for themselves and no access to informal networks to support them through the IA process, further exacerbate barriers to accessing the NDIS and to maintaining supports once on the NDIS.

It is unclear from NDIA announcements and data to what extent people from ‘priority cohorts’ and their needs were considered in the development of IAs. The publically available demographic data on the Independent Assessment Pilot (IAP) is ambiguous and it remains unclear to what extent that people with complex needs, additional vulnerabilities (e.g. homelessness) or limited support networks were included in the pilot. Further to this, the IAP results show that a relatively small percentage of people with psychosocial disabilities were included in the pilot (7%) and that only 5% of participants completed an IA in the access stage.

The currently proposed process which includes an assessment conducted by someone that the person with a disability doesn’t know, will likely be unmanageable for people with complex needs and behaviours; and could result in people opting out of the process altogether, despite their need for services. This process also misrepresents the importance of relationship based and trauma informed service delivery models for vulnerable cohorts of people with whom we work.

3. Recommendations

Recommendation 1. The National Disability Insurance Agency (NDIA) implement a more assertive and person centred NDIS access process for people with a disability that are experiencing homelessness/ at risk of homelessness who have:

Complex needs
limited capacity to make decisions, and limited informal support networks to assist them in making decisions and advocacy

Including:

Access to an NDIA funded Case manager who can support complex needs prospective participants through the Access process
Building capacity of Local Area Coordinators to work with people complex needs including incorporating outreach practices for people experiencing homelessness

Recommendation 2. The NDIA consider developing a Community Liaison Role for the Housing and Homelessness Sector similar to the current “Health Liaison Officer[2]” (HLO) and “Justice Liaison Officer[3]” (JLO) roles with the aim of:

Improving NDIS access for people experiencing homelessness
Providing strengthened relationships between front line homeless service workers and the NDIS
Assisting homelessness organisations to work with clients who are experiencing barriers to accessing the NDIS

Recommendation 3. The NDIS reconsider Case Management as a support to assist people who have complex needs and limited support to advocate for them on their behalf to more effectively navigate the NDIS; Or

More rigorously monitor the provision of support coordination for people who are additionally vulnerable to ensure their needs are being met by support coordination providers.

Recommendation 4. The NDIA provide more widely available and comprehensive information to the public about alternative support pathways for people who have complex needs (i.e. the Complex Needs Pathway). Additionally, the NDIA should investigate how they can better meet the access needs of people with disabilities who have complex needs and co-morbid conditions/vulnerabilities e.g. AOD use.

Recommendation 5. The NDIA proactively consult with people with disability who have lived experience of homelessness; people with complex disability needs and limited formal supports; and Specialist Homelessness Services to better understand the current service gaps and performance issues of the NDIS

Recommendation 6. The NDIA revisit the Independent Assessment Pilot specifically for people who have complex needs and limited informal supports, in order to validate that the conclusions of the original project findings and the introduction of compulsory IAs will not further complicate access issues for the aforementioned cohort. Until this review is complete, people who have complex needs should not be forced to undertake an IA as part of an access or review process unless they explicitly opt to do so.

[2] HLO: Employed by the NDIA to work within mainstream health settings to help the staff to understand the NDIS pathway and ensure those who are eligible for the NDIS do not stay in acute settings for lengthy periods of time once medically stable due to inadequate supports in the community.

[3] JLO: Employed by the NDIA to work within custodial facilities to help the staff to understand the NDIS pathway and ensure those who are eligible for the NDIS will have adequate supports in place when they re-enter the community

Challenges faced by people with disabilities who are homeless or at risk of homelessness in accessing the NDIS