NDIA Accountability Project

Improving Support Coordination, Allied Health and SDA Provider Workforces

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SUMMER

FOUNDATION

Joint Standing Committee

INQUIRY INTO

April 2020

ACKNOWLEDGEMENTS

We would like to thank all of the Summer Foundation team for their assistance and support in the rapid production of this submission, including George Taleporos, Penny Paul, Robin

Zakharov, Megan Topping, Lee Cubis, Tom Worsnop, Andrea Lockwood, Cath Bucolo, Virginia

Mitsch and the Upskill and Health Community of Practice. Ro Roberts was instrumental in pulling all the content of this report together.

TABLE OF CONTENTS

SUMMARY ………………………………………………………………………………………………………………….. 3

RECOMMENDATIONS …………………………………………………………………………………………………. 4

SUMMER FOUNDATION ………………………………………………………………………………………………. 6

IMPROVING SUPPORT COORDINATION, ALLIED HEALTH AND SDA PROVIDER

WORKFORCES …………………………………………………………………………………………………………… 8

SUPPORT COORDINATION ……………………………………………………………………………………………. 8

ALLIED HEALTH PROFESSIONALS ……………………………………………………………………………….. 11

SPECIALIST DISABILITY ACCOMMODATION …………………………………………………………………. 13

WORKFORCE DEVELOPMENT IN THE HEALTH/NDIS INTERFACE ……………………………… 15

ACAT WORKFORCE …………………………………………………………………………………………………….. 19

NDIS WORKFORCE ……………………………………………………………………………………………………… 21

SUPPORT WORKERS ………………………………………………………………………………………………….. 22

ATTACHMENT 1 ………………………………………………………………………………………………………… 24

ATTACHMENT 2 ………………………………………………………………………………………………………… 25

ATTACHMENT 3 ………………………………………………………………………………………………………… 26

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  2

SUMMARY

The Summer Foundation has extensive experience in understanding workforce issues associated with supporting people with complex disability needs. Our submission is based on innovative models of professional development in collaborative practice, competency and capacity building and peer support, with expertise in working alongside and building the capacity of the NDIS, health and Specialist Disability Accommodation (SDA) provider workforces. It is informed by close collaboration with people with complex support needs.

We identify problems and provide solutions relating to 2 of the Inquiry’s Terms of Reference:

d) The role of the State, Territory, Commonwealth Governments in providing and implementing a coordinated strategic workforce development plan for the NDIS workforce

e) The interaction of NDIS workforce needs with employment in adjacent sectors including health and aged care

This submission recommends measures for workforce development and capacity building for support coordinators, allied health professionals, Specialist Disability Accommodation providers, health services staff from managers to discharge planners, Aged Care Assessment Team (ACAT) members and disability support workers.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  3

RECOMMENDATIONS

Recommendation 1: In consultation with support coordinators and allied health workers, the NDIA to fund industry development measures including access to training and resources and membership of Communities of Practice. Delivery of training and resources should be accessible face-to-face and online to enable access from all locations.

Recommendation 2: The NDIS Quality and Safeguards Commission to investigate potential conflicts of interest arising from service providers operating as support providers, support coordinators and housing providers, and the impact that this may be having on choice and control for NDIS participants.

Recommendation 3: The NDIS Quality and Safeguarding Commission continues to fund capacity building of the SDA provider sector to ensure compliance with the NDIS Practice Standards and NDIA SDA Rules.

Recommendation 4: Health services in all jurisdictions, jointly with the NDIA, to invest in the undertaking of a needs analysis such as that piloted in the Department of Health and Human Services (DHHS) Victorian Leaving Hospital Well project, and identify opportunities for system integration or alignment, workforce capacity building, change management processes and governance and internal policies, similar to those offered in the Summer Foundation training package.

Recommendation 5: The NDIA to release the NDIS Hospital Framework as soon as possible.

Recommendation 6: The NDIA to provide training for ACATs in implementing the Aged Care Assessment Supplementary Guidelines for Young People with Disability, July 2019, until the YPIRAC Action Plan is implemented.

Recommendation 7: The NDIA to monitor the performance of the Complex Support Needs Pathways Planners in:

  • Engaging early with people with complex needs at risk of RAC admission

  • Engaging early with health and ACAT to plan for and identify solutions at the local level

  • Providing quick assessment of NDIS and SDA/SIL/AT eligibility through approval of an interim plan and provision of non-RAC housing options

  • Fund industry development measures including access to training and Community of

Practices

Recommendation 8: The NDIS to ensure that participants have adequate access to experienced Complex Support Needs Pathways Planners (and other relevant NDIS staff) in a timely manner.

Recommendation 9: The NDIS to ensure Complex Support Needs Pathways Planners are

resourced with the most current information on NDIS rules and operational changes to ensure compliance, and monitor its effectiveness.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  4

Recommendation 10: The NDIA to adopt strategies to:

  • Increase the capabilities and skill level of disability support workers (DSW) through improved access to professional development, peer networks and work conditions

  • Build the capacity of people with disability to identify skilled DSW who meet their needs

  • Establish an evidence base for a skilled and experienced workforce to support people with complex disability support needs

  • Promote the development and use of Participant Led Videos as evidence-based person-centred training tools

    Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce 5

SUMMER FOUNDATION

Established in 2006, the Summer Foundation works to change human service policies and practices related to young people (18-64 years old) living in, or at risk of entering residential aged care (RAC) facilities.

Our Vision is that young people with disability and complex support needs live where and with whom they choose, with access to high quality housing and support options that enhance health, wellbeing and participation.

Our Mission is to create, lead, and demonstrate long-term sustainable systems change that stops young people from being forced to live in RAC because there is nowhere else for them.

Strengthening the NDIS workforce is essential to achieve the targets of the Young People in

Residential Aged Care Action Plan 2025 (YPIRAC Action Plan). NDIS planners, support

coordinators, allied health professionals, support workers, discharge planners and other key health sector professionals are critical to the provision of the effective supports needed to end the admission of younger people to aged care, and to assist young people living in aged care to transition to live in the community.

This submission is informed by the Summer Foundation’s extensive research and training activities, including three recent projects:

  1. Upskill is a support coordination workforce training and peer support program designed to increase capacity of support coordinators and allied health workers. The program includes a series of training modules being rolled out nationally, peer network opportunities, a Community of Practice, and a Support Coordination Referral directory (attachment 1).

  2. DHHS Leaving Hospital Well: Health collaboration Project1 is a Victorian initiative to assist in building the capacity of local health networks (LHNs) to interface with the NDIS. The project includes the following key components:

a) Needs analysis study carried out in 20 regional and metro LHNs. It provides an in-depth analysis of problems affecting health services staff in their interaction with the NDIS. It identifies solutions such as training needs and capacity building resources and requirements to strengthen the health and NDIS workforces engaged with people with high and complex disability support needs. The study found that problems experienced in all LHNs in the health/NDIS interface, were greatly compounded for regional health services.

b) Delivery of an individually tailored education program to each LHN, which included online and face-to-face delivery (attachment 2).

c) Development of NDIS and health resources d) Secondary consultation e) Health and NDIS Community of Practice 3. Participant let videos (PLV) have the potential to improve the delivery of supports for people with disability and maximise outcomes by enabling people to have choice and control, set their

1 Summer Foundation (2020). Leaving Hospital Well: Health Collaboration Project, Victoria. Unpublished Project Report.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  6

own goals and direct their supports. Evidence shows that PLV have considerable benefits for capacity-building for the disability support workforce. The Summer Foundation conducted a research and training project which demonstrated high levels of satisfaction and confidence with this approach (attachment 3).

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IMPROVING SUPPORT COORDINATION, ALLIED HEALTH

AND SDA PROVIDER WORKFORCES

Terms of reference d) The role of the State, Territory, Commonwealth Governments in providing and implementing a coordinated strategic workforce development plan for the NDIS workforce.

SUPPORT COORDINATION

PROBLEM

Lack of investment in skills and knowledge The growth in the support coordination workforce has seen many disability support workers transition into a support coordination role without the necessary skills and knowledge to support people with complex needs – often the culture and skills mix of these practitioners differs from what is required by the support coordinator function. There is anecdotal information about poor quality support coordination services and therefore wasted funds for NDIS participants. This is the result of a lack of clarity of required skills and competencies for support coordinators and lack of professional development opportunities which align service and function with the needs of participants and improve service quality.

Low workforce supply Finding skilled and experienced support coordinators who can work with people with complex disability support needs has been identified as a current challenge by NDIS participants, hospital staff, RAC staff and by the NDIA.

The Leaving Hospital Well needs analysis found that people with complex disability needs, and the health services staff working with them, could not identify or access enough skilled support coordinators. In hospital settings, many support coordinators were unsure of their roles and responsibilities and relied on health staff for NDIS education. In the main, they lacked knowledge of the NDIS and how to assist people with complex needs to identify housing options, or where identified, to transition to new housing.

Lack of professional support As a new role, support coordination lacks the industry and workforce associations of more mature professions, with no peak body or industry group. While some support workers may be engaged with professional bodies for social workers or occupational therapists, there are vast differences in the support and professional development needed for support coordinators working with complex disability needs.

If relevant professional development is identified, such as workshops provided by the Summer Foundation’s Upskill service, support coordinators must often either seek financial support from their employing organisation or self-fund in order to participate.

Support coordinators often are self-employed or employed in small organisations. Relying on individual organisations to develop internal training and professional capacity building is inefficient and leaves room for immense variation between organisations. Likewise, there are limited opportunities for peer support for support coordinators outside of Upskill.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  8

Conflict of Interest

The role of support coordinators is to help participants navigate the market and choose a support provider. When the support coordinator is employed by an agency providing other NDIS supports such as core supports, and/or disability housing or SDA, there is an inherent conflict of interest.

People with disability are best served by an independent support coordinator, free of any conflict of interest. Support coordinators employed by a Disability Service Provider providing housing and SIL may be less likely to support the person to explore the full range of housing options that might be available - instead, offering them options that are provided by their organisation. We also know that having multiple providers and people in a person’s life is an important safeguard against abuse and neglect. This is particularly true for people living in group homes and other congregate settings.

Feedback from young people in RAC indicates that independent support coordinators are often of a higher calibre than those employed by a multi-NDIS support provider agency.

Lack of business acumen for sustainability and growth Service providers delivering support coordination are struggling with high organisational overheads, an inability to effectively connect with the more suitable participants in the market and a lack of contemporary service delivery models. This undermines sustainability of providers and results in remuneration, caseload and support issues that reduce job satisfaction or staff moral and increase turnover within the workforce.

SOLUTION

Capacity-building for support coordinators is paramount to ensure that the YPIRAC Action Plan targets are met. Strategies such as those developed by the Summer Foundation are required to address the skills shortage, lack of a professional and peer support and grow the workforce.

The Summer Foundation’s Upskill program (attachment 1) provides a multi-pronged approach to support coordination capacity-building. It is currently being rolled out nationally. It aims to:

  • Document a model of support coordination good practice

  • Build capability of support coordinators through a series of 7 training modules

  • Grow the support coordination workforce and diversify the skills base

  • Assist support coordination organisations to implement efficient systems to ensure sustainability

  • Build the capacity of people with disability to choose an appropriate support coordinator

A growing feature of the Upskill program is the establishment of a Support Coordination Community of Practice (COP). The COP enables enhanced networking and peer support in a facilitated environment.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  9

Recommendation 1: In consultation with support coordinators and allied health workers, the NDIA to fund industry development measures including access to training and resources and membership of Communities of Practice. Delivery of training and resources should be accessible face-to-face and online to enable access from all locations.

Recommendation 2: The NDIS Quality and Safeguards Commission to investigate potential conflicts of interest arising from service providers operating as support providers, support coordinators and housing providers, and the impact that this may be having on choice and control for NDIS participants.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  10

ALLIED HEALTH PROFESSIONALS

PROBLEM

Allied health workers are essential workers in all stages of the engagement of people with complex needs with the NDIS. They frequently play a key role in the assessment and pre planning processes across the continuum of settings - equally in hospitals and in community services (e.g. community rehabilitation programs, transition care programs, community care, rehab in the home etc).

The allied health workforce is still adapting and expanding its skills to meet the requirements of the NDIS. It is facing many challenges.

  • The workforce is too small. Although there are projections of future workforce demand

in the DSS NDIS Boosting Local Care Workforce website

(blcw.dss.gov.au/demandmap/), there has been no rigorous study to establish demand.

  • Change management processes are patchy and not well supported across the allied health sector.

  • The knowledge and proficiency base is not adequately developed, moreover the implementation of knowledge and skills development is not universal.

  • Most health settings lack a specialist position in disability and complex needs that collaborates with and supports allied health workers in the NDIS context.

  • The allied health workforce is not equipped to deal with the changes required within acute and sub-acute hospital services and in community services to interface with the NDIS. It needs both a more expansive skill set and targeted support to deal with change.

SOLUTION

Professional development and change require a collaborative approach. The Victorian Department of Health and Human Services (DHHS) provides a promising example that addresses the problems through the development of an Allied Health Capability Framework Disability and Complex Support Needs (DHHS).2 Based on a co-design approach between state government, professional bodies and practitioners, the framework aims to build capacity of allied health professionals to improve service quality, access to care, and increase service provider readiness to manage the NDIS transition. It guides allied health workers on how to work ethically and collaboratively across professions and service systems. The framework describes 12 capabilities and observable behaviours.

2 DHHS (2020) Draft Allied Health Capability Framework - Disability and Complex Support Needs. Unpublished.

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The framework then provides proficiency measurement at 3 levels. It recognises the important role that a highly skilled and professional allied health workforce has in delivering the NDIS. As it emphasises the need for additional post-entry level professional qualifications, it is an approach that has potential for enforcing professional standards and attracting more allied health professionals to work with people with complex needs. The framework is now in its final stage of considering expert panel feedback.

Recommendation 1: In consultation with support coordinators and allied health workers, the NDIA to fund industry development measures including access to training and resources and membership of Communities of Practice. Delivery of training and resources should be accessible face-to-face and online to enable access from all locations.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  12

SPECIALIST DISABILITY ACCOMMODATION

PROBLEM

Low knowledge base of SDA providers The establishment of the SDA market is still in its formative stages. New SDA providers are entering the market with little understanding of complex disability support needs or knowledge of specific impairments. New providers often come with expertise in property development, real estate and investment with no understanding of disability or complex needs or conversely experience in delivering social housing, but not necessarily in-depth experience in housing development or provision for people with complex disability support needs. The SDA provider industry is diverse, drawing from established disability providers, NFP housing providers (e.g. community housing), private investors and developers.

All SDA providers must meet the NDIS Practice Standards for SDA, covering requirements around tenants’ rights, service agreements, choice and control about other NDIS services and coordination of in-home support services. Much of the new SDA workforce, however, lacks experience working within the NDIS. SDA providers who already have a background in disability services are familiar with service provision in the pre-NDIS world where there were limited protections of individual’s housing rights.

Since the SDA framework was established in the NDIS in 2016, there have been frequent revisions of rules and guidance, which lead to difficulties in building knowledge and confidence. The interface between the SDA Practice Standards and state and territory regulation residential tenancies adds further complexity.

Support coordinators do not have the skills to help participants to seek SDA funding or to support those with SDA funding to assess ‘sustainable’ rather than ‘unsustainable’ SDA/housing options. Additionally, there is insufficient choice in the market which exacerbates the confusion for people with disability.

Emerging human rights housing practice The SDA module of the NDIS Practice Standards covers the key concepts of rights-based, person-centred service delivery, but does not explain ‘how’ to do this beyond basic policy and procedural requirements.

SDA supply is in a very slow transition from the pre-NDIS disability housing system dominated by shared arrangements (80% of enrolled SDA housing is pre-NDIS housing; a significant proportion of these dwellings are enrolled to house 4 or more people). Larger shared housing models create challenges for SDA providers to deliver on and support the individual rights of occupants.

Some cohorts of SDA tenants e.g. those with cognitive and intellectual disability, present additional challenges to providers. Skill base and knowledge for specific impairments needs to be developed within the SDA workforce.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  13

Training of SDA providers has not been widely established because the market is still establishing clarity around what rights-based, person-centred housing services actually look like (and for different cohorts). Once established, good practice can follow. There are challenges around enabling choice and control, but empowering people as consumers and responding flexibly to their needs.

SOLUTION

There is a pressing need for capacity building for SDA providers about NDIS aims, objectives and principles, the nature of complex disability support needs and what ‘good practice’ looks like. It must cover SDA Practice Standards, legal obligations, and human rights and person centred practice. This training will enhance the SDA workforce competencies and strengthen the market of SDA provision.

Training is needed to build awareness of SDA tenants’ rights, for example the risks of limited choice and control where the SIL provision is pre-determined because the provider delivers SDA housing, SIL supports and even support coordination. Training should include best practice examples of SDA housing provision demonstrating the separation of SDA and SIL provision. Training is also required to support the SDA workforce to empower tenants as consumers through their SDA agreement. Meeting this obligation within a human rights perspective requires appropriate knowledge, skills and access to resources.

Through its ‘Welcome Home’ Initiative, the Summer Foundation is currently developing an education and training package for registered SDA providers. It aims to support them to understand their obligations under the NDIS SDA Practice Standards; and to recognise and build their capacity to deliver high quality, rights-based, person-centred SDA services to NDIS participants.

Recommendation 3: The NDIS Quality and Safeguarding Commission continues to fund capacity building of the SDA provider sector to ensure compliance with the NDIS Practice Standards and NDIA SDA Rules.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  14

WORKFORCE DEVELOPMENT IN THE HEALTH/NDIS

INTERFACE

Terms of Reference e) The interaction of NDIS workforce needs with employment in adjacent sectors including health and aged care

Catastrophic accident or illness is a common cause of people acquiring permanent impairments that result in complex disability support needs. Extended hospital admissions following such events, due to lack of accessible housing options, can put people under the age of 65 at risk of admission to residential aged care. Since the introduction of the NDIS, health professionals have experienced significant challenges in understanding, interaction and integration with NDIS processes and workforce. The recent Victorian study Leaving Hospital Well has highlighted that hospital staff across all levels of the organisation/operation face problems including governance, resources, staff competency, staff capacity, collaboration and networking.3 It is likely that these problems exist in other jurisdictional health systems.

PROBLEM

Inadequate governance structures Health service executive and management often have a limited understanding of the NDIS, its practice implications and the impact on staff. Dedicated governance structures, policies, resources, tools/templates, pathways etc are not commonly in place, nor do they integrate with the NDIS. These are necessary to provide sustainable foundations for the change and knowledge management that health services must undertake to work effectively in the NDIS interface.

Health services are typically connecting with the NDIS on an ad hoc basis. This impacts on staff wellbeing, poor patient outcomes, length of stays and health resources as a result of limited knowledge and decision making. This creates a siloed understanding of the NDIS within health services across units, sites, inpatient and community settings.

In addition, health services and the NDIS do not have formalised protocols for NDIS funded support services coming on site.

SOLUTION

Health services are better placed in their interface with the NDIS when they have appointed an NDIS project lead and dedicated funding. The Leaving Hospital Well project found that those with NDIS specialist/project leads were more progressed in their capacity to work with the NDIS than those without. The new Health Liaison (HLO) role in hospitals is also designed to build capacity in the interface and build on local health services policies and processes.

3 Summer Foundation (2020) Leaving Hospital Well: Health Collaboration Project, Victoria. Unpublished Project Report.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  15

Health services need to establish dedicated internal governance structures to ensure organisational leadership for their change and knowledge management process. Structures to embed robust interface policies and procedures include an executive group with NDIS portfolio and an NDIS steering committee or reference group.

PROBLEM

Health services lack resources

The majority of metro and all regional LHNs did not have an ‘NDIS champion’ network. All health services required assistance with documentation, tools and templates, particularly in regional areas where there has been minimal interaction with the NDIS to date.

Half of all metro and the majority of regional services had challenges with tools that document division of roles and responsibilities, and templates for supporting evidence reports for NDIS funding, pre-planning, assistive technology (AT) and home modifications, and templates to support specialist disability accommodation (SDA) eligibility applications. The lack of NDIS forms or information provision requirements contributes to the confusion and frustration of health services.

Some health services have made the decision not to contribute staff time to compiling reports for SDA access, and therefore SDA eligibility is significantly less likely to be determined as efficiently as it could be. With no consistent practice or process guidelines across the state, health services are also taking different stances on equipment hiring/prescription.

Health staff need access to a range of tools and templates from the NDIS or designed with local NDIS offices/planners. LHNs need to set up an ‘NDIS champion network’ of nominated staff across the LHN health services to champion the change. The network must assist health staff to access and implement tools and templates such as those guiding reports for SDA eligibility.

Health staff lack skills and capacity Some health staff have been offered minimal or no formal NDIS education. Consequently, staff competencies in working with people with disability and the NDIS are low. There is limited understanding and application of NDIS language such as ‘reasonable and necessary’ supports, and of new housing options and funding under the NDIA, including SDA, Medium Term and Short-term Accommodation funding.

Health staff had limited understanding and experience of the NDIA’s Complex Support Needs Pathway. In the absence of sufficiently skilled NDIS planners, health staff are expected to be the ‘experts’ in NDIS planning, to understand NDIS ’language’, use correct terms and recommend costings for participants’ plans.

Escalation of discharge barriers related to the NDIS are a key issue. Health staff had limited knowledge about how to escalate and to whom, particularly if the issue needed external escalation. Health services are struggling to maintain NDIS expertise within their services, with many health services relying on one or two staff, easily lost with staff turnover.

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Discharge planners are experiencing the additional demands of:

  • Stress resulting from pressure to free up beds and avoidance of referring participants to

RAC

  • Unstructured decision making
  • Inconsistent NDIA procedures around pathways as processes or rules change
  • The variable level of knowledge and skills of NDIS planners
  • Lack of collaboration and clarity of roles for health and the NDIS
  • Delays in the release of the NDIS Hospital Framework. The Framework needs to include:

o acknowledgement of flexibility in role definitions for HLO role

o clarity on roles and responsibilities for support coordinators

o processes for specialised planners

o ability to fast track, synchronise timeframes for health and NDIS processes, including eligibility determination, and

o establishment of clear contact point in health

  • Compromised staff wellbeing due to unstable and uncertain workload and lack of support.

SOLUTION

The release of the NDIS Hospital Framework is needed to establish a position of Executive Sponsor for NDIS within health; disseminate education, training resources and opportunities such as webinars, use of Summer Foundation training tools; build capacity and confidence of staff; ensure that there is rigorous evaluation of education and material sessions and materials, and support research into staff wellbeing.

Many Health services would benefit from undertaking a staff capacity building process covering the following steps:

  • Completing a service wide survey to ascertain staff competency levels in NDIS

  • Establishing a ‘champion’ network to disperse information and lead change within organisation

  • Completing an education and training plan (attachment 2)

  • Developing an orientation process and resource

  • Incorporating NDIS as a core competency set for health staff working with people who are NDIS eligible

  • Developing a communication plan to deliver key NDIS messages to staff Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce 17

  • On completion of Summer Foundation education and training, assessing staff capacity to adopt a train-the-trainer model to build sustainability

  • Supporting health practitioners to join the Summer Foundation Leaving Hospital Well Community of Practice, a national online platform for health professionals to share their expertise, identify best practice for working with people with disability and complex support needs and build evidence and knowledge to contribute to better hospital discharge outcomes for younger people at risk of aged care admission.

Recommendation 4: Health services in all jurisdictions, jointly with the NDIA, to invest in the undertaking of a needs analysis such as that piloted in the Department of Health and Human Services (DHHS) Victorian Leaving Hospital Well project, and identify opportunities for system integration or alignment, workforce capacity building, change management processes and governance and internal policies, similar to those offered in the Summer Foundation training package.

Recommendation 5: The NDIA to release the NDIS Hospital Framework as soon as possible.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  18

ACAT WORKFORCE

PROBLEM

Failure to observe ACAT guidelines The YPIRAC Action Plan target states that no people under the age of 65 are entering residential aged care by 2022. By this date, Aged Care Assessment Teams (ACAT) would no longer be required to assess younger people for aged care.

Until this target is reached, the role of ACAT assessors for people under 65 years is overseen by a set of guidelines (Aged Care Assessment Supplementary Guidelines for Young People with Disability, July 2019) aimed at ensuring ACATs prioritise exploring age-appropriate accommodation and supports. However, there is inconsistent application of these guidelines. In some circumstances, ACAT assessors are not requiring NDIS participants to have a plan in place prior to being assessed and approved for residential aged care.

Anecdotal evidence from the Summer Foundation’s Leaving Hospital Well project has revealed that ACAT assessors in Victoria are adopting one of 2 responses:

  • Either defaulting to using the ‘urgent circumstances’ category for assessing younger people at risk of aged care admission which results in fast admission to RAC without the assessor carrying out an adequate determination of the availability of alternative (community-based) housing options, as required in the guidelines; or

  • Rejecting referrals for ACAT assessment, which results in longer stays in hospital. Both of these responses lead to unsatisfactory discharge outcomes for younger people and fail to further the YPIRAC Action Plan targets of reducing admissions to residential aged care.

SOLUTION

Until the YPIRAC Action Plan is implemented, ACAT assessors require training and support from the NDIA in application of relevant guidelines.

In order to ensure that younger people are not admitted to aged care and can be discharged from hospital to suitable accommodation, the NDIA must improve its capacity for quick assessment of eligibility for the NDIS and for SDA, Supported Independent Living (SIL) and Assistive Technology (AT). It must adapt the capacity of the NDIS planning process to enable planners to engage quickly with participants in plan development and obtain NDIA approval of interim plans. The NDIA has recently centralised processes to streamline such approvals during COVID-19, the outcome and impact of this new process is yet to be seen.

The NDIS Complex Support Needs Pathway must enable specialist planners to collaborate with ACAT assessors to ensure that alternative housing options are adequately explored, and younger people can receive timely discharge from hospital.

Collaboration at the local level is required to enable fast and adaptable solutions to be identified for individuals, in line with both NDIA, ACAT guidelines and the LHN environment. The Summer Foundation has identified examples of good collaborative practice between the NDIS and ACATs.

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Recommendation 6: The NDIA to provide training for ACATs in implementing the Aged Care Assessment Supplementary Guidelines for Young People with Disability, July 2019, until the YPIRAC Action Plan is implemented.

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PROBLEM

Failure to ensure workforce continuity Health staff are often advised that NDIS planners are unavailable requiring them to delay coordination of hospital discharges. Some Victorian hospitals in the Leaving Hospital Well project reported that there was limited access to planners over the previous Christmas/early January period in particular, resulting in cessation of NDIS planning from early December 2019.

NDIS planners not briefed Health staff commented that NDIS planners had not been regularly briefed on NDIS changes including housing and disability supports. Health workers were called on to ‘be experts’ and advise the NDIS planners where there were gaps in information or inexperience in working with people with complex disability support needs.

SOLUTION

Accessibility of Complex Support Needs Pathways Planners to NDIS participants and health staff is required to ensure that participants do not experience delays in their planning supports.

Complex Support Needs Pathways Planners require continuous briefing on developments and changes in NDIS rules, processes and operational guidelines.

Recommendation 7: The NDIA to monitor the performance of the Complex Support Needs Pathways Planners in:

  • Engaging early with people with complex needs at risk of RAC admission

  • Engaging early with health and ACAT to plan for and identify solutions at the local level

  • Providing quick assessment of NDIS and SDA/SIL/AT eligibility through approval of an interim plan and provision of non-RAC housing options

  • Fund industry development measures including access to training and Community of

Practices

Recommendation 8: The NDIS to ensure that participants have adequate access to experienced Complex Support Needs Pathways Planners (and other relevant NDIS staff) in a timely manner.

Recommendation 9: The NDIS to ensure Complex Support Needs Pathways Planners are

resourced with the most current information on NDIS rules and operational changes to ensure compliance and monitor its effectiveness.

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  21

SUPPORT WORKERS

PROBLEM

Undersupply of support workers There are currently not enough disability support workers (DSW) to meet the needs of people with disability. In a hospital setting, the undersupply of DSW who are trained to support people who have complex disability needs results in significant delays in discharge from hospital.

Since the rollout of the NDIS, the DSW role has had the largest increase in casualisation, the largest number of vacancies and the biggest reduction in experience levels in the disability sector4. This has resulted in high staff turnover and low job security. While this has provided opportunity for greater choice and flexibility for people with disability, it has created additional challenges in adequately training DSW, continuity of DSW and barriers to meaningful workforce development.

DSW roles are potentially perceived as a low-value profession. Factors including poor pay, lack of barriers to entry, and misperceptions or lack of clarity of what the role entails contribute to this perception. There is limited participant capacity building to support people with disability to engage and train DSW appropriately.

There are limited barriers to becoming employed as a DSW, enabling anyone to engage in this work with no formal training. While it is important that additional barriers are not placed to gaining entry into the workforce, it needs to be recognised that training is essential for people with high support needs to ensure that services are provided appropriately.

Although capacity building and seeking the views of people with disability is increasingly understood to be important for person-centred best practice, there is limited evidence to inform the development and implementation of training resources led by individuals with disability.

People with significant cognitive and/or communication difficulties have complex and changing abilities, needs and priorities. Often, they have reduced capacity to exercise choice and control and direct their supports at times where supports need to be responsive to the situation or behaviour.

There has been an increase in the availability and accessibility of technology, however there is a significant gap in the utilisation of technology by people with disability to have a voice in directing their lives and establishing their needs and preferences. Further capacity building is required for both people with disability and DSW on the potential solutions technology can offer.

4Mavromaras, K., Moskos, M., Mahuteau, S., Isherwood, L., Goode, A., Walton, H., … Flavel, J. (2018). Evaluation of the NDIS: A Final Report, (February). Retrieved from https://www.dss.gov.au/sites/default/files/documents/04_2018/ndis_evaluation_consolidated_report_april_2018.pdf

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  22

SOLUTION

Addressing the undersupply of skilled DSW and the lack of participant led training materials requires several strategies.

People with disability need to be at the centre of training and workforce development. Courses need to involve people with disability as trainers and as experts in the field. Training courses must to be informed by an evidence base around what people with disabilities need and what makes a good support worker from a service user perspective. While there are a number of courses currently available, the quality of resources is low and not evidence-based.

Research approaches, informed by people with disability and DSW, are critical to develop an evidence base on required DSW skills. The Summer Foundation is currently undertaking a research project to explore the lived experience of what makes a good DSW. It looks to establish the behavioural indicators of the required attribute and skill set. Once these skills are better understood, this knowledge can influence system-wide changes with the development of training and resources. The research also aims to understand other factors, external to the individual DSW, that influence the quality of paid disability support.

Participant Led Videos (PLV) are an effective, innovative tool that gives people with disability and complex needs the opportunity to direct the training of their support workers utilising their self-described goals. Based on recent research carried out by the Summer Foundation in partnership with La Trobe University (funded by the Innovation Workforce Fund), evidence shows that PLV have considerable benefits for capacity-building for DSW. Utilising the positive findings from people with complex needs and disability sector professionals, the Summer Foundation has developed a series of written and digital resources. Similarly, in 2019, the Summer Foundation implemented a further research and training project which demonstrated high levels of satisfaction and confidence with this approach (attachment 3 for an outline of the research).

Recommendation 10: The NDIA to adopt strategies to:

  • Increase the capabilities and skill level of disability support workers through improved access to professional development, peer networks and work conditions

  • Build the capacity of people with disability to identify skilled DSW who meet their needs

  • Establish an evidence base for a skilled and experienced workforce to support people with complex disability support needs

  • Promote the development and use of Participant Led Videos as evidence-based person-centred training tools

    Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce 23

ATTACHMENT 1

•••  •••   •••  •••  •••  •••   •••  ••• ••   •••  •••   •••  •
  • • :: UpSkill

For NDIS Support Coordinators

& Allied Health Professionals

The Summer Foundation has developed the “UpSkill” initiative to support capacity participants with complex support and housing needs. (https://www.summerfoundation.org.au/project/upskill/).

This project seeks to build the capacity of the support coordination workforce by:

  • Building a rigorous evidence base on quality practice - built from the existing literature and continuously expanded during the project through an evaluation partnership with

La Trobe University

  • Developing and disseminating knowledge and tools, including case studies of successful aged care avoidance and exits from aged care; and a toolkit for support coordinators working with young people in aged care

  • Curating an online Community of Practice of expert support coordinators who are specialising in supporting young people to avoid or exit aged care

  • Empowering participants with complex needs to shape the market through journey mapping and a connection service to access a suitably qualified network of support coordinators regardless of where they live

Participating in UpSkill training provides support coordinators and allied health professionals with a vital peer networking opportunity. Workshop participants will be invited to join the UpSkill referral directory so that the Summer Foundation can refer people with complex disability to skilled support coordinators and allied health professionals.

TRAINING MODULES

Module 1: NDIS and housing Module 2: Evidence for SDA outcomes Module 3: Working with people in the hospital setting Module 4: Working with younger people in aged care Module 5: Transitioning into SDA Module 6: Living well in the community Module 7: NDIS 202

Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce  24

ATTACHMENT 2

Leaving Hospital Well Unpublished Study

Support Offered                   Who                             Time

Consultation and support to finalise           • Summer Foundation (2 x staff)        1 x 8 hours

development of recommended • 3-4 key staff policies, processes and resources

NDIS 101 Webinars                          • Summer Foundation                4 x 10-minute videos.

• Overview                                   •  All staff                               Accessible at any time.

• Access                                *Compulsory prior for those               • NDIS 101 Webinar Link

  • Planning attending NDIS Foundations training

  • Implementation NDIS Foundations • Summer Foundation 6-hour sessions (2 to be delivered)

  • Become an NDIS expert • Allied health, medical, team

  • Getting the language right leaders, operation managers

  • Best practice discharge planning NDIS Train the Trainer Summer Foundation 6-hour session (1 to be

    • Championing the change • Champion network delivered)

(representative of whole health service)

Specialist Disability Accommodation      Summer Foundation                  3 hour workshop

  • SDA specific education • Social Work/Occupational Therapy staff with high exposure e.g. • Case reflection subacute/transition care staff)

  • Report writing

  • Housing plans Support Coordinator and health Summer Foundation 4 hour workshop

collaboration workshop • 15 x Support Coordinators

  • Networking and collaboration (maximum).

  • Health related NDIS interface • 1-2 x key staff from health coordination service

    Community of Practice (COP) • Summer Foundation Community of practice

    • Web based education • Any LHN staff working within the education/reflective practice

    • Collaboration and networking NDIS/health interface. sessions held bi-monthly via

  • Secondary consultation “zoom” online meetings.

  • Slack – an “anytime” online platform, to share NDIS updates and post practice questions relating to hospital based NDIS interface issues.

  • Community of Practice Link Collaboration workshop • Summer Foundation 4 hours

  • Working together to get better outcomes • 4-5 key staff from Eastern Health

  • NDIS providers

  • Support coordinators

  • Housing organisations Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce 25

ATTACHMENT 3

PARTICIPANT LED VIDEOS

In 2018, La Trobe University and the Summer Foundation, funded by the Innovation Workforce Fund, co-designed, piloted and evaluated Participant Led Videos (PLV) with 5 participants with disability and significant cognitive and/or communication impairments. The series of written and digital resources developed are available on the Summer Foundation website.

An initial independent evaluation completed by La Trobe University used semi structured interviews to document multiple perspectives and obtain quantitative and qualitative data from 5 primary participants, 5 close other supporters and 4 staff facilitators. All participants reported high levels of satisfaction with the PLV process. The usefulness of the approach was also highly endorsed. Thematic results revealed the importance of people with disability having their voice heard and taking control in directing their lives, personal growth through participation and engagement, and feeling validated through the experience. The evaluation concluded that the production and use of PLV has much potential to improve the delivery of support and maximise outcomes by enabling people to have choice and control, set their own goals and direct their supports.

In 2019, the Summer Foundation piloted a project training disability sector professionals (n =

  1. to facilitate the development of PLV. A mixed method approach was used, and quantitative analysis revealed high levels of satisfaction, understanding and confidence in supporting individuals to develop a PLV. Qualitative analyses supported the positive feedback on the PLV training as well as highlighting barriers to implementation (lack of time and resources, difficulties with gaining consent, having limited editing skills and supporting people with complex communication needs).

    Summer Foundation | Submission to NDIS Joint Standing Committee | Inquiry into NDIS Workforce 26