Dear Sir/Madam
The Centre for Excellence in Child and Family Welfare (the Centre) welcomes the opportunity to make a submission to Inquiry into Market Readiness for Provision of Services under the NDIS.
The Centre is the peak body for child and family services in Victoria. For over 100 years we have advocated for the rights of children and young people to be heard, to be safe, to access education and to remain connected to family, community and culture. We represent over 150 community service organisations, students and individuals throughout Victoria working across the continuum of child and family services, from prevention and early intervention to the provision of out-of-home care. Many of our member organisations provide services to children with disability living with their biological families or in care arrangements, such as in a residential care setting.
We note the Terms of Reference and are particularly interested in the following elements of the Inquiry:
- participant readiness to navigate new markets
- the role of the NDIA as a market steward
- market intervention options to address thin markets, including in remote Indigenous communities.
The Centre is primarily concerned about the market readiness of the National Disability Insurance Scheme (NDIS) in relation to the provision of services to children and young people living in out of home care (OOHC).
We understand the context in which the marketisation of previously public service provision is occurring. We recognise the shift that is taking place from collective social welfare provision to markets and self-directed care.1 The NDIS is characterised by a ‘personalised’ model aimed at securing choice and control for individuals with a disability. It provides funding packages, based on an individual’s level of need and self-defined goals, to enable the purchase of services.
There has been little systematic research undertaken in Australia to identify the number of children in OOHC experiencing disability. While data collection has been difficult owing to the different definitions of disability across jurisdictions, studies indicate that children with disabilities are disproportionately represented in the child welfare system, due mainly to the heightened vulnerability of these children and exposure to trauma, maltreatment and neglect.2
In 2011, the Victorian Equal Opportunity and Human Rights Commission found that 14% of 4,064 Victorian children in OOHC had a disability.3 A disproportionate number of children with disability are in residential care placements compared with foster and kinship care.4
1 Carey, G., Malbon, E., Reeders, D., Kavanagh, A., and Llewellyn, G. (2017). Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme. International Journal for Equity in Health, 16:192. 2 Hill, K. (2012). Permanency and placement planning for older youth with disabilities in out-of-home placement. Children and Youth Services Review. 34 1418–1424; 3 Victorian Equal Opportunity & Human Rights Commission. (2012). Desperate measures: The relinquishment of children with disability into state care in Victoria. Carlton: Victoria. 4 National Disability Services. (2014). Out of home care Submission 54. Senate Select Committee on Out-of-Home Care.
These statistics are likely to underestimate the number of children in OOHC living with a disability, as many of these children have not been formally diagnosed or have not met official definitions. There is a high degree of variation in the literature regarding the prevalence of disability in OOHC and a distinct lack of any common measurement tools in this area.
Children and young people with disability who are living in care arrangements are a particularly vulnerable group. It is important to understand their experiences of the OOHC system and the ways in which workers and carers and the system can better support children and young people living with disabilities.
The NDIS will be responsible for the support of children with disability living in OOHC, whose support needs are greater than those of other children in care who do not experience disability. These supports may include therapeutic and behavioural supports, additional equipment or financial aid to support carers to sustain their caring role. The level of support should be ‘reasonable and necessary’ and reflect the needs of the individual child.
- participant readiness to navigate new markets
Children with disability in OOHC have less contact with family than other children in OOHC. A disproportionate number of children with disability are in residential care placements and they enter OOHC either through relinquishment or removal by child protection authorities due to the incidence or risk of neglect or abuse. Without family support or appropriate advocates and without adequate NDIS funding, it is not clear how children with disability in OOHC will be able to navigate new markets. They are not in a position themselves, and do not have family members who can act on their behalf, to shop around for different support providers and exercise choice. Carers and residential care workers need to be fully informed about the types of services that children and young people in OOHC are potentially entitled to under their plan.
- the role of the NDIA as a market steward
Under a ‘market stewardship’ approach the government does not directly control the way public services are delivered but instead oversee or ‘steward’ the market towards producing desired outcomes.5 The government monitors how the market is developing and performing, allocating appropriate resources to enable the market to perform and respond to change.
Children with disability in OOHC have multiple and over-lapping needs and without sufficient understanding of the issues, children with disability in OOHC may not receive the full suite of supports. The one size fits all approach of the NDIA will not be adequate. Children experiencing disability in OOHC are likely to be in contact with health, housing, education, and juvenile justice and community services at any given time. Extra services are required for housing, therapy, behavioural supports, chronic health issues, depression, anxiety, and disrupted schooling. This means a coordinated approach is particularly relevant to this population.
Given that children receiving early intervention supports are one of the largest participant groups in the NDIS, it is also critical that the NDIA builds an evidence base on early intervention to inform the types of intervention that are most beneficial and should be funded.
5 Gash, T., Panchamia, N., Sims, S. and Hotson, L. (2013). Making public service markets work: Professionalising government’s approach to commissioning and market stewardship. Institute for Government.
It is important to note that Victoria’s Disability Act 2006 does not include mental illness in its definition of the term. This has significant implications for children in OOHC, as mental illness is often cited as the primary disability facing children in OOHC.
- market intervention options to address thin markets, including in remote Indigenous communities.
The Centre welcomes initiatives to address the problem of too few providers to cater for the needs of cohorts with particularly challenging and complex needs. Children and young people with disability living in OOHC experience the co-existing challenges associated with disability and trauma, including removal from family. Children with disability in OOHC require a specific level and type of ongoing care and individualised support. The NDIS needs to consult with expert practitioners who work closely with the sector and are familiar with the challenges and complexities of children with disability in OOHC to be able to attract appropriate service providers with the ability to work with children in OOHC who have such complex needs and heightened vulnerability.
A recent study involving 22 children and young people aged between 7 and 25 years of age explored what helps children and young people with disability and high support needs to feel and stay safe in institutional settings.6 Factors contributing to participants in the study feeling safe included having a secure foundational space, feeling known and valued, having someone to confide in, avoiding contact with people they didn’t know, feeling able to tell someone if they felt unsafe, and having appropriate formal and informal opportunities to learn about how to be safe. The study indicates the need for institutional practices to support children and young people with disabilities to maintain contact with local communities and long-term support relationships. OOHC workers and carers need to monitor the nature and quality of support relationships in a concerted way to prevent or minimise the uncertainty and tension that can exist with high numbers of new people in the young person’s life. ‘At a systemic level, high staff turnover, the lack of training and skill in workers and managers, and increased trends towards casual staffing all increase risk’.7
The Centre strongly suggests that in the transition to a market driven system for service providers it is critical that those elements which support children with disability in OOHC are not lost. Wraparound services that coordinate services to fit around the individual child are particularly important. The NDIA needs to implement practical measures that support and reinforce what research shows to be good practice to mitigate the risks to participants associated with thin markets.
Kind regards
Deb Tsorbaris
Chief Executive Officer
6 Robinson, S. (2016). Feeling safe, being safe: What is important to children and young people with disability and high support needs about safety in institutional settings? Centre for Children and Young People, Southern Cross University. 7 Robinson, 2016, p. 10.