Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

EXCEPTIONAL BONDS

Exceptional Bonds

Submission to the NDIS Independent Assessments Parliamentary Inquiry

31 March 2021

ARE FIFO INDEPENDENT ASSESSMENTS REASONABLE AND NECESSARY?

People want to feel heard, respected and supported, not categorised by a FIFO independent assessor they will only meet for 1 to 3 hours. There have been some reports of assessments being done in as little as 30 minutes!

The “Fly in Fly out” nature of what the government is proposing with these rush job FIFO Independent Assessments is dehumanising to people with disability. It denies them their human rights in being able to have their say about what they can and can’t do in a manner that is highly stressful. People with disability must be given a chance to have information relating to them and their needs assessed in a way that is fair, consistent and equitable, and enables targeted provision of funded supports. This does not mean that “robo-planning” just like that becomes best practice or the only option. An alternative standardised Comprehensive Assessment is described.

WHO IS EXCEPTIONAL BONDS?

Exceptional Bonds is an NDIS Registered Service Provider based in Queensland. We offer Support Coordination, Specialist Support Coordination, Therapy and Counselling and are known for our creative and innovative approaches in supporting people to have valued lives. Exceptional Bonds provides services to people with all types of disabilities, with a special expertise in supporting people with psychosocial disability.

Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

WHAT ARE THE PROPOSED CHANGES?

Under the proposed changes independent assessments are to be conducted for all people applying and being considered for eligibility to NDIS, and for existing participants for plan reviews. These independent assessments are to be completed by professionals employed through one of the 8 organisations who were successful in receiving government tenders to conduct these assessments.

The functional assessment tools to be used include:

For children 7-17 years:

Paediatric Evaluation of Disability Inventory computer adaptive test (PEDICAT)
PEDICAT with Autism Spectrum Disorders scales
Vineland 3
Participation and Environment Measure for children and youth

For children 1-6 years the same tools plus also option for Age and Stages Questionare-3 or ASQ-TRAK.

For adults 18+ years:

World Health Organisation Disability Assessment Schedule 2.0 (WHODAS)
Lower extremity functional scale
Vineland 3

The decision outcome from the functional assessment report will directly inform the NDIS planner of level and type of funding a participant may receive, and other evidence may not be considered such as specialist medical reports, comprehensive forensic reports, detailed allied health reports from existing therapists etc.

Additionally, the decision outcome of Independent Assessment is final and there is no review available via the Administration Appeals Tribunal (ATT)!

WHAT IS GOOD ABOUT THE PROPOSED CHANGES?

Having people trying to access the NDIS receive free standardised assessments to gather evidence, understand their functional capacity and make recommendations for eligibility is a more equitable approach.

The use of recommended standardised assessment tools such as WHODAS 2, Vineland 3, PEDICAT provides more consistency in the basis of what a functional assessment needs to include. There is currently a wide variation in the scope and quality of functional assessments that are provided for NDIS participants. Making a consistent requirement for functional assessments to include at least one of the recommended standardised assessment tools

Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

provides greater accessibility for planners in understanding a person’s level of function and then make informed decisions about level of need for funded supports.

Recognition of barriers people have experienced in accessing the NDIS scheme, including providing funding for assessments that people have previously had to pay for privately, and awareness of the impact of lengthy waitlist for first plan, plan review etc would be an improvement.

We are supportive of assessors needing to be qualified allied health professionals eg: OTs, psychologists, social workers, speech therapists, physiotherapists.

WHAT IS OF SIGNIFICANT CONCERN ABOUT THE PROPOSED CHANGES?

Having independent assessors will be stressful for many current participants who are already accessing the NDIS and require plan review, such as through a life crisis or change in circumstances. Many times, people with disability, their families, carers etc have described how agonising it is to have to tell your story over and over again just to prove you need support.

Any perceived benefits of reducing alleged “sympathy bias” are far outweighed by the benefits to the client of having an existing therapist they trust and who knows their recent history. Many crucial details WILL BE MISSED by independent assessors who have high numbers of assessments to work through in a week. An understanding of personal information, knowing compounding factors that a person with multiple diagnoses experience, being aware of complex psychosocial history, their lack of informal supports etc, allows assessments to be far more comprehensive. These are things that participants are far more likely to talk about with someone they already know rather than a FIFO assessor they will see for 30 minutes to 3 hours.

There is a significant danger that independent assessors may develop compassion fatigue from hearing so many accounts of clients in hardship as well as with significantly reduced capacity, that they may just see current and future prospective participants as more “cattle to stamp” and “just another number” instead of people with needs, stories, hopes and challenges.

With a pool of independent assessors there is a high risk that an assessor may not have particular knowledge of a type of impairment, or condition. Under the current model an existing therapist, either working with people first applying for NDIS or current participants is far more likely to be someone who has been chosen by the participant or their representative BECAUSE THEY HAVE THE SKILLS, EXPERIENCE, UNDERSTANDING AND EMPATHY to work with that particular individual. They know and consider their strengths, help them articulate goals, and have built trust and rapport over time to have the more personal conversations.

Lack of community consultation for such a major shift in NDIS processes. The NDIA consultation was of very narrow scope and timeframes very tight.

Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

Not having the ability to request a review of the decisions made in the independent assessment, such as through an appeals process to the AAT. This, in effect, discriminates against people with disability having the right to appeal and be able to have their say about matters of such significance to their daily life and their future. It implies that people with disability are less important than other Australians who, for example, can make an appeal to the AAT if they feel a Centrelink decision is incorrect or grossly unfair. A convenient loophole in the National Disability Insurance Scheme Act 2013 makes this possible that a determination from the Independent Assessment is final and not contestable. This is in stark contrast to the Centrelink process for Job Capacity Assessments, whereby a client applying for a Disability Support Pension is able to request a review of the decision outcome from their job capacity assessment.

The tools chosen for functional assessments are intended specifically for the purpose as described to specify a person’s functional abilities at the time of testing. The WHODAS 2.0 for example is designed to capture how much difficulty a person has with aspects of daily and community life for the 30 days up to when the assessment takes place. This does not evidence the full picture of changing circumstances and needs for people, particularly those with psychosocial disability whose condition/s may be episodic in nature. To use a test that captures a person’s degree of disability over a 30 day period is not the same as doing comprehensive review of previous reports, liaising with the person’s formal and informal supports and engaging with the person more broadly to understand their story, their goals, barriers they have experienced over time, their psychosocial history and consider risk factors that may impact on them.

Functional assessments done in a rush by FIFO assessors could potentially end up just being a copy and paste report. Consequently, participants may end up with plans that have too much or too little funding and being over reliant on services or have insufficient funds or major gaps in their plan. This may result in participants having to seek a review soon after the planning meeting. This is not in keeping with the original intent of the NDIS and actually ends up costing more due to incorrect planning. There is a further risk that participants could have their essential services not provided whilst waiting for the independent assessments to be redone IF the person or their nominee goes through a complaints process and the planner agrees that a new assessment needs to happen.

It is our opinion that the NDIS is misrepresenting the results of the review, undertaken in 2019 by David Tune AO PSM, in stating that it called for compulsory independent assessments. The Tune review recommended standardised assessments which is not the same as independent assessors who do not know the person, are not able to consider existing medical and allied health reports or take the time to really hear the person’s story and gather collateral information from formal and informal supports in a robust way. Particularly for people with psychosocial disability, who can at times present really well and have lack of insight into their complex mental health condition and what their needs are to maintain wellbeing, be safe, reduce barriers to participate in the community.

Further, the statement of “sympathy bias” is based on one cited research paper as being the total and absolute truth and neglecting the practice wisdom of a current number of allied

Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

health professionals who have extensive experience working directly with people with disability in both therapeutic and assessor capacities. Having a pool of contracted FIFO independent assessments is a very poor alternative. Many of these assessors will likely be less experienced professionals who have not had practical experience working with people with a broad range of different disabilities, needs, social and cultural backgrounds. For some people the most appropriate professional to complete a functional assessment with them would be a medical professional such as psychiatrist, Indigenous health worker, general practitioner, mental health nurse, or medical specialist.

There is significant risk of the focus moving to cost cutting Key Performance Indicators rather long term outcomes for real people, which may end up costing more in the long run. Contracted independent assessors will be expected to make decisions about individuals in a 30 minute to 3 hour interview that may take place over the phone. There are already mounting examples of participants who have gone through the independent assessment process, resulting in contested decisions and complaints. This adds to the cost in the long run with all the added complaints and review of decisions being made by assessors.

There may also be inefficiencies and overspending in requiring participants to go through an assessment process every time they need a plan review. What will the wait times for assessments be if there is just reliance on a pool of external FIFO assessors to complete many functional assessments at the same time? For individuals with more severe impairments and complex support needs, a functional assessment would be of more benefit to be done every four to five years. There likely won’t be too much difference in function within two years, it just ends up being stressful for the participant and an unnecessary cost.

EXAMPLE SCENARIOS WHERE THERE IS RISK FOR PARTICIPANTS

A woman with intellectual impairment of Culturally and Linguistically Diverse heritage to discuss her continence issues and the awareness of significant anxiety and possible overprotectiveness from her mother who is plan nominee. The woman has an Occupational Therapist from the NDIS service who has worked with the lady for a number of years and has a good understanding of the woman’s strengths and challenges as well as her psychosocial history. IF THE PERSON HAD CHOICE AND CONTROL, SHE WOULD CHOOSE THE OT TO DO THEIR FUNCTIONAL ASSESSMENT.
A man with schizophrenia is too ashamed and scared to seek dental care because of how many teeth he has missing and refuses to consider dentures, but is having trouble speaking clearly and being understood by others due to his dental problems (missing over half of his teeth). He is becoming increasingly socially isolated because he is having paranoia that people are laughing at him because of his unusual speech. But he wouldn’t discuss any of this with a FIFO assessor, his mental health case manager has changed yet again, and he has very intermittent contact with family and no informal supports apart from his girlfriend who also has schizophrenia.

Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

The person who knows him best is his psychiatrist, who has writes a comprehensive medical letter detailing the impact his schizophrenia can have on the gentleman’s daily life, as well as noting his more recent hospital admission and period of homelessness. The man also has a psychosocial assessment report from the mental health social worker who provided some intervention while he was itinerant. IF THE PERSON HAD CHOICE AND CONTROL, HE WOULD CHOOSE THE MENTAL HEALTH SOCIAL WORKER TO DO THEIR FUNCTIONAL ASSESSMENT.

The struggling parents of four children, the youngest of whom has been recently diagnosed with a complex progressive medical condition after experiencing some regression in behaviours and reduction of functional abilities with mobility. The parents are scared, overwhelmed and grieving and have no idea what their child’s abilities and challenges will be in 3, 6, 9 or 12 months. They have formed a trusting relationship with the physiotherapist at the children’s hospital who is compassionate, very experienced in paediatric physiotherapy and has worked with other children with the same condition. IF THE PARENTS HAD CHOICE AND CONTROL, THEY WOULD CHOOSE THE PAEDIATRIC PHYSIOTHERAPIST TO DO THE FUNCTIONAL ASSESSMENT FOR THEIR CHILD

A BETTER ALTERNATIVE: COMPREHENSIVE ASSESSMENTS

Comprehensive standardised assessments to be completed by allied health therapists who are preferably employed by organisations who are NDIS registered providers and meet quality standards such as ensuring staff have regular professional development and supervision. A separate category could be created in the NDIS price guide for Describing My Needs: Comprehensive Assessments, and these be given a standard price range e.g. equivalent to 15 hours of therapy. Exceptionally complex assessments may require a higher remuneration. Similarly, a further strategy to ensure quality and consistency in reporting could be for assessors to have done training modules and competency assessment via NDIA approved training (eg: Pearson Clinical) in the use of standardised functional assessment tools such as Vineland 3 and WHODAS 2.

This would enable a more highly skilled and larger pool of assessors available for participants and people wishing to confirm eligibility for NDIS. Local Area Coordinators could hold discretionary funding for people wishing to apply for NDIS to be able to receive a comprehensive assessment at no cost to themselves.

On some occasions a participant would be able to choose an existing therapist they are comfortable with, who understands their complex needs, psychosocial information, risk factors and interventions that will help the person with progressing their goals. Importantly, participants and prospective participants would be able to provide existing medical and therapy reports as well as invite more than one support person to their assessment appointment.

On other occasions there will be greater scope for a person or their plan nominee to identify an allied health assessor who has experience in working with others who have similar

Exceptional Bonds Submission to NDIS Independent Assessments Parliamentary Inquiry

functional impacts, knowledge and practice skills in engaging with and providing therapy to people with specific conditions such as Cerebral Palsy, Autism Spectrum Disorder, Acquired Brain Injury and Schizophrenia.

Comprehensive Assessments to inform funding outcomes must consider functional capacity, risk factors, psychosocial factors, barriers, support needs plus gain corroborating evidence such as by reviewing existing therapy and medical reports.

Comprehensive assessment reports would be provided in both a full and plain English summary to participants. Clients would have the right to question their assessment and ask for a review if they believe the information is incorrect or has omissions. NDIS decision outcomes for funded supports be subject to review via normal processes including to AAT.

This process would allow participants to include as many stakeholders to the assessment meeting as determined as necessary by the participant.

Additionally, offering the flexibility for there to be exemptions to an assessment process in certain situations and also enable on some occasions for a medical professional to complete assessments.