Independent Assessments Submission 241
Submission to the Inquiry into Independent Assessments by the Joint Standing Committee on the National Disability Insurance Scheme.
Submission by Eurobodalla Education and Therapy Services t/a “Muddy Puddles”
March 2021
Contents of the submission have been approved by the CEO and the Board of Muddy Puddles
Page 1 of 6
Background:
Muddy Puddles provides multi-disciplinary therapy services (including assessment and intervention), direct support and capacity building group programs for children and young people with disability. The not-for-profit charity organisation supports families in the Eurobodalla Shire located on the South Coast of NSW. The services offered by the not-for-profit organisation have grown in response to the big gap in services and support for people with disability in our region.
The Eurobodalla Shire has a high proportion of Aboriginal and Torres Strait Islander people (5.6% at 2016 Census) and disadvantaged people (index of relative socio-economic disadvantage shows Eurobodalla’s percentile score at 26 compared to NSW at 45). Building a trusted connection with these families and young people is imperative to successful intervention outcomes. The Muddy Puddles team has invested heavily in developing strong relationships with families and individuals to better understand their needs.
Key recommendations:
We agree with the four key recommendations made by National Disability Services (NDS) regarding the introduction of independent assessments:
- Immediately cease the rollout of independent assessments as currently planned.
- Undertake a robust and transparent outcome evaluation of the current pilot of the new assessment process. This evaluation must be independent of the NDIA, led by experts and co- designed with people with disability, their families and the organisations that support them.
- Undertake robust, independent and transparent trials of alternative approaches to improving consistency in access and planning-such as allowing a person’s existing health professionals to complete assessments using the same tools.
- Once the trials and evaluations are complete, engage in a meaningful co-design process with people with disability, their families and the organisations that support them to ensure a fair and consistent approach to both access to the scheme and planning and to ensure people with disability receive the support they need.
Detailed responses to the Terms of Reference:
Terms of Reference (a): the development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS;
Consistency with recommendations
In the 2019 Tune Review of the NDIS, Tune1 suggested NDIA create a new functional capacity assessment and also fund this assessment process. The expected outcomes were considered to be better and more consistent information from which decisions could be made about a person’s eligibility for the scheme or the supports provided for in their plan. NDIA has since created an assessment framework and toolkit for consistent functional capacity assessments.
1 Tune, D. (2019). Review of the National Disability Insurance Scheme Act 2013 report.
Page 2 of 6
- Tune review (p.66) recommended a number of key protections to be used with functional capacity assessments, namely that participants have the right to choose which NOIA-approved provider in their area undertakes the functional capacity assessment.
- Tune review (p.67) recommended that NDIA should not implement a closed or deliberatively limited panel of providers to undertake functional capacity assessments. Rather, the panel of approved providers should be dynamic and evolve to ensure the new approach does not drive disengagement. The NDIA should ensure the availability of appropriate providers of functional capacity assessments.
The NDIA’s recent proposal to outsource assessments of the needs of NDIS participants to single independent third-party non-government agencies would not be in line with these important recommendations.
We would like to suggest an alternative approach to engaging independent third-party assessors that would also satisfy the above two recommendations from Tune. A new registration category could be introduced into registered provider options that allows therapists to register as assessors and be able to claim for these services directly from the NDIA, as they do with other support categories. This would also allow the NDIA to draw on a broad range of expert allied health practitioners who continue to be subject to Quality and Safeguarding audits.
Our proposal is in line with the 2001 recommendations by the Productivity Commission (p.327)2; namely, that a pool of experienced therapists be approved as assessors but also a collaborative assessment process that draws on information from family, carers and health professionals known to the participant.
Quality and Safeguards Commission as monitoring body
The NDIS Quality and Safeguards Commission are well placed to monitor the assessment process to ensure impartiality and objectivity when assessments are conducted and recommendations made by service providers. Using the current Behaviour Support and Restrictive Practices governance framework of the Quality and Safeguards Commission as a model, a pool of independent practitioners could be engaged to provide peer review and assessment validation.
Avoiding conflicts of interest
It is unclear how additional factors resulting from a separate commissioned third-party organisation would be managed. These factors include considerations if the organisation is a for-profit structure and accountable to return a profit to shareholders. Performance indicators of the commissioned for-profit organisation could create a conflict of interest between satisfying the requirements of its own organisation and meeting the objectives and upholding the principles of the NDIA.
Inadequate pilot study
Results of the pilot program on independent third-party independent assessors reported participants to be 90 per cent satisfied with the experience. After being pressed by members of the Joint Standing
2 Productivity Commission 2011, Disability Care and Support, Report no. 54, Canberra
Page 3 of 6
Committee3 on the NDIS for transparency, this represented a 28 per cent response rate, with only 6 per cent4 being from NDIS participants themselves.
Terms of Reference (b): the impact of similar policies in other jurisdictions and in the provision of other government services;
The proposed Independent Assessments look similar to the aged care assessments. The concerns and issues related to this system should be well considered before rolling out a similar plan for NDIS participants.
Terms of Reference (c): the human and financial resources needed to effectively implement independent assessments;
Workforce shortage of experienced Allied Health Professionals in disability
Access determination and funding allocation are critical moments in the participant pathway and can be a reason for appeal if they seem inconsistent or unreasonable. It has been determined that therapists with a deep understanding of disability in its complexity are recommended for this role. Such experts sit in leadership roles within an array of organisations. Having access to a broad scope of therapists for the purpose of accurately making these assessment and funding decisions will require collaboration across registered therapy providers. An example of this level of sophistication, collaboration and independent review is the behaviour supports and restrictive practices arena. As previously mentioned the NDIS Quality and Safeguards Commission can monitor and hold providers accountable to the guiding principles and values of the NDIS.
It is already hard to recruit a sufficient number of health professionals trained in disability to service NDIS participants. An independent third-party organisation would be required to recruit experienced and expert therapists to conduct assessments. That would be in direct competition with therapy providers for staff. What alternatives will the successful organisation implement in the situation where they are unable to recruit an adequate workforce? Will this result in efficiency measures such as moving to all online interviews or their assessment being conducted by practitioners less fit for purpose?
Registration as an allied health practitioner requires a minimum number of practicing hours. Conducting assessments for NDIS access will not satisfy the criteria of practicing hours. Therefore, after three years it is unlikely the allied health practitioner will remain eligible for registration. They would not able to either provide services or to conduct independent assessments. This would have a significant impact on an already undersupplied workforce.
Terms of Reference (e): the appropriateness of the assessment tools selected for use in independent assessments to determine plan funding;
Assessment tools used seem heavily reliant on questionnaire and self-reporting. We question whether there is any evidence to show that this can be reliable/accurate in a vulnerable group without established trust or rapport with an assessor who is a stranger.
3 https:ljwww .sbs.com .au/ news/ se nators-q uestion-i ntegrity-of-p ilot-for -cont roversiaI-nd is-i nde pen dent-assessment-reforms 4 https://www.smh.co m. au/polit ics/fed era 1/just-not-ok-on ly-6-per-cent-of-nd is-t ria I-pa rt ici pants-comp leted-su rvey-2 0201221- p56p bc. htm I
Page 4 of 6
Terms of Reference (f): the implications of independent assessments for access to and eligibility for the NDIS;
With assessments being conducted by people with no prior knowledge of the history or functional capacity of a person, and without using information from their supporting professionals, there is a real risk of inaccurate assessments and inadequate access and funding determinations. This is quite likely to result in adverse health outcomes and subsequent legal issues.
Terms of Reference (g): the implications of independent assessments for NDIS planning, including decisions related to funding reasonable and necessary supports;
As mentioned above, the impact of inaccurate assessments would be significant for the long-term outcomes for participants. The NDIS is about capacity building and working towards goals that enable people with disability to participate fully in our communities. If we don’t obtain a thorough understanding of a person’s functional capacity and the limitations and barriers they face, there is a huge risk that they don’t receive the supports they need, or they receive inappropriate supports which lead to negative outcomes, including the breakdown of informal supports and deterioration of mental and physical health.
Terms of Reference (j): the appropriateness of independent assessments for particular cohorts of people with disability, including Aboriginal and Torres Strait Islander peoples, people from regional, rural and remote areas, and people from culturally and linguistically diverse backgrounds;
We are very concerned about the impact the proposed independent assessments would have on vulnerable groups in our community. Trusted relationships are required to reach positive outcomes for disadvantaged, CALD and Indigenous groups. There is a danger that persons with disability that are even more vulnerable because of their circumstances will disengage from the NDIS and never receive the support they need.
The pilot program included participants in metropolitan areas, without physical disabilities and with a low representation from CALD and Indigenous groups (7% CALD and 1% Indigenous). Evidence of effectiveness in regional and remote areas, complex disability and culturally vulnerable groups would seem pertinent information, which should be gathered prior to implementation.
The Tune review (p.67) identified a risk of functional capacity assessments is disengagement from ATSI and CALD and psychosocial disability individuals.
Terms of Reference (k): the appropriateness of independent assessments for people with particular disability types, including psychosocial disability; and
Without a thorough understanding of an individual’s body structure and function, and the impact a disability has on activities and participation, a person with a physical disability will be adversely affected when it comes to support planning.
We question the impact on the mental health and well-being of participants as a result of unknown therapists and organisations conducting a single access meeting. From our experience it can take years for a person with a disability to build trust in a therapy provider. Can there be full disclosure from the person with a disability in the assessments, which are largely questionnaires, to people or organisations in which there is not yet rapport or trust? We have heard from clients and our own team members with
Page 5 of 6
disability that they are concerned about the impact these assessments will have on their mental health and capacity to reach their goals.
Terms of Reference (l): any other related matters.
Governance by the Quality and Safeguards Commission, including behaviour supports and reporting of restrictive practices, has ensured that the rights of participants are understood, and actions of providers and community are monitored. Embedding a pool of therapists as approved assessors into these new robust systems may have several advantages over commissioning an independent third-party organisation, including:
- Monitoring and auditing practices and accountability
- Clear conduct and operational guidelines and expectations in line with rights of people with a disability
- Alignment of values and purpose
- Dynamic and broad options to allow an appropriate assessor/assessment for people with a disability, particularly Aboriginal and Torres Straight Islanders, people from cultural and linguistically diverse backgrounds or people with psychosocial disabilities.
Page 6 of 6