THE COMMONWEALTH JOINT STANDING COMMITTEE ON THE NDIS
INQUIRY INTO THE NDIS EARLY CHILDHOOD INTERVENTION APPROACH
NSW GOVERNMENT SUBMISSION, JULY 2017
The NSW Government strongly supports work being undertaken by the National Disability Insurance Agency (NDIA) to commission an Early Childhood Early Intervention (ECEI) approach for the full scheme NDIS. NSW is working closely with the NDIA to implement a transitional approach to ECEI in NSW, recognising that the NDIA’s model has been informed by NSW policy and reform under Stronger Together, the NSW Government’s 10-year plan for disability services in NSW, 2006 – 2016 (Stronger Together). The transitional approach commenced operation in November 2016 and will continue to 30 June 2018. NSW expects that the NDIA’s approach to full scheme commissioning will be informed by experience during transition, as well as best practice evidence from NSW and other jurisdictions. The full scheme ECEI approach should: reflect the early intervention principles underpinning the NDIS include a strong interface with NDIA’s commissioning approach for Information, Linkages and Capacity Building (ILC) promote collaboration between ECEI providers, mainstream early childhood services, health and education systems and other community-based support providers. Close partnerships between the NDIS and mainstream services are particularly critical in the provision of pre-diagnosis and diagnosis supports, therapy and skills development to address a child’s developmental needs, as well as planning for the transition from early childhood support arrangements to mainstream school settings. The NSW experience under Stronger Together suggests that providing early childhood intervention supports based holistic, family-centred planning is critical to ensuring the best possible outcomes children with disability and developmental delay and their families. Evidence-based research demonstrates that quality early intervention in the early years of a child’s life reduces the possible need for longer term interventions, including reliance on formal supports.
EARLY CHILDHOOD INTERVENTION SUPPORTS UNDER STRONGER TOGETHER
Under the second funding phase of Stronger Together, the NSW Government committed $77.6 million over the five years from 2011 – 2016 to expand the delivery of early intervention packages for children and young people. In total, the second funding phase included $180 million investment in an additional 11,800 children, family and therapy places through the non government sector.1 This was part of a much broader range of investment in early intervention and community support strategies designed to provide targeted and person-centred supports across the life span, with a particular focus on achieving the best possible outcomes for people with disability at key life stage transition points. For children aged 0 – 8, the policy focus was on early detection and outreach to families to enable successful transition to school, to develop social connections, and assist mainstream services to provide therapeutic and inclusive environments.2 Mainstream services include
1 Stronger Together Two 2011–2016 outlined the NSW second five-year phase of the NSW Government’s 10-year plan under Stronger Together, providing $2 billion investment to reshape and improve the way people with a disability, their families and carers are supported in NSW. In December 2013 the NSW Government announced Ready Together, continuing the $2 billion ST2 reforms and expanding the investment in individualised supports. 2 Stronger Together: A new direction for disability services in NSW. The Second Phase 2011 - 2016, p. 22. 1
preschool, playgroups, long day care and other early childhood settings. Such settings provide increased opportunities to learn and develop positive social relationships. The approach also recognised the role of investment in early intervention in containing demand for higher cost specialist supports over time.
Strengthening supports for children aged 0 – 8 and their families
The NSW’s early childhood intervention strategy, Strengthening supports for children and families 0-8 years: Now and into the future, provided the framework for implementing growth in early childhood intervention services under Stronger Together. The strategy commenced in 2012, and signalled an increased focus on developing a sustainable support system for this life stage through enhancing partnerships and linkages between mainstream and specialist services. The strategy also challenged the notion that children with disability are best supported through a specialist disability system. Instead of pathways leading families to the specialist disability services, the strategy indicated the need for specialist supports to fit into the broader context of a child’s life. Key aspects of the NDIA’s current ECEI approach for children aged 0 – 6 have been informed by the NSW strategy, as well as the early childhood intervention model in Victoria. NSW early childhood intervention services implemented under the Strengthening Families strategy included strong focus on: planning, information and referral a family centred approach that recognises the strengths, needs and priorities of the child and their family therapeutic interventions and skill development to address developmental need. These supports are typically delivered in the child’s natural environments, incorporated into every-day tasks, recreational activities and routines coordination with mainstream early childhood services and other community organisations to promote community inclusion delivery of flexible support options and services that can be tailored to the differing needs of families.
Ability Links / Early Links NSW
Stronger Together also included additional investment in diagnosis support, and building the capacity of communities and mainstream services. This included a particular focus on building the interface between the specialist disability system, mainstream health system and early childhood services to deliver pre-diagnosis and diagnosis supports. Ability Links NSW (ALNSW) was established in 2013 to support the NDIS Hunter trial, and was followed by State wide expansion in 2014/15. There are currently 347 Linkers across NSW including 74 Aboriginal Linkers, and 79 Early Linkers who work with children and their families. ALNSW is now well established across communities in NSW and provides a locally based, first point of contact for Aboriginal people with disability, their families and carers, supporting them to connect with community and mainstream supports. ALNSW is underpinned by service design principles focused on coordination, community connectedness and empowering people with disability, their families and carers to have increased choice and control over their lives, outside of the specialist disability service system. An independent, three-year evaluation of ALNSW highlighted beneficial outcomes of this investment for families and children, as well as a significant economic benefit to the wider NSW community. In relation to young children (0-8), families engaging with ALNSW experienced a range of individual and community benefits, including improved self-esteem, family cohesion and community connectedness. Many families reported that a connection with community and mainstream services had a profound effect on the quality of their lives, enabling them to seek
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information or support for themselves and make better informed decisions about their child or their child’s future. During the transition to the NDIS, ALNSW is focusing on providing support for people who are not eligible for the NDIS (including family members and carers of NDIS participants) and people who have not yet transitioned into the scheme, to help them to connect with their community or with mainstream supports.
STRONG INTERFACE WITH ILC
In a full scheme environment, ILC will play a critical role in augmenting the NDIA’s ECEI approach by supporting families to understand and engage specialist and mainstream support options, as well as the building capacity of community and mainstream support systems to respond to the needs of children with disability or developmental delay. In late 2016, feedback about the NDIS and ECEI was obtained from over 160 early childhood services funded the NSW Department of Education. Feedback from many services highlighted the need for stronger collaboration and capacity building between ECEI providers, the early childhood sector and allied health professionals. NSW supports an increase in the level of investment in ILC, as well as a more strategic approach to ILC commissioning to ensure that investment supports the early intervention principles of the scheme, as well as the policy directions endorsed by all governments. In the short term, the NDIA’s commissioning approach should be undertaken in a planned way that initially leverages programs and activities in jurisdictions such as ALNSW that have a proven impact in local communities. A specific focus is also required on increasing the availability of supports in rural and remote areas, and responding to the specific needs of Aboriginal families and families from culturally and linguistically diverse backgrounds.
TRANSITIONAL ECEI APPROACH IN NSW
The NSW Government has worked closely with the Commonwealth and NDIA to ensure that children with disability or developmental delay continue to have access to early childhood intervention supports during transition to full scheme. The transitional ECEI approach in NSW recognises that a significant proportion of early childhood service providers currently funded by the NSW Department of Family and Community Services already provide elements of the NDIA’s ECEI approach. The transitional model utilises the existing capacity and expertise of these early childhood providers in order to: maintain established referral pathways ensure that children with developmental delay or disability can be supported in their local communities and mainstream services enabling greater awareness and social inclusion for children with a developmental delay or disability assist children with developmental delay or disability, their families and carers to build and pursue their goals, exercise choice and control, and engage with the NDIS where appropriate assist families to access reasonable and necessary support plans with minimal disruption enable new children to directly access known and trusted providers in their local communities build on best practice models of support, and support sector development and readiness for the NDIS. This is an interim arrangement which will be replaced by a full scheme ECEI model to be developed by the NDIA.
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NSW is working with the NDIA and transitional providers to monitor the approach and manage implementation issues as they arise. This has included monitoring the timeliness of support provision and data collection on participant intake and outcomes.
Impacts of ECEI during transition
During transition, the intake and profile of children aged 0 - 6 years in the NDIS has differed significantly across jurisdictions due to variations in transition phasing, mainstream interfaces, and program intake parameters. Early data from the Hunter trial, Nepean Blue Mountains and first year of full scheme transition suggests that the intake of children aged 0 – 6 in NSW has been consistent with NDIA Scheme Actuary’s Projections. There are no emerging cost pressures on the scheme relating to a higher than expected number of children being streamed into funded NDIS supports. On the contrary, a majority of children with NDIS plans in NSW have transitioned from NSW programs that have access requirements that align with the eligibility requirements for funded NDIS supports. NSW believes this trend reflects historical investment under Stronger Together in programs that include a strong focus on family capacity building and supporting children in mainstream and community settings. While it is too early to draw conclusions about the impacts of the ECEI approach in NSW on NDIS support pathways, the NSW experience suggests that over time the number of children requiring funded NDIS supports will decrease as ECEI providers become fully operational and children access low level supports without the need for a funded NDIS plan, or receive short term funded plans and then exit to mainstream and community based supports.
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