Provision of services under the NDIS Early
Childhood Early Intervention Approach
Early Education (EarlyEd) Inc.
EarlyEd is a well-established Sydney based early childhood intervention service supporting families from diverse backgrounds and children with a broad range of developmental delays, diagnoses and disabilities. EarlyEd recognises the role the early intervention (EI) sector plays in promoting the use of quality, culturally appropriate practices to support families to access intervention services early in a child’s life when there are concerns about delays in development or disability. EarlyEd commenced as an Early Childhood Early Intervention (ECEI) Transition Provider in November 2016 and therefore welcomes this opportunity to comment on its provision and of the outcomes evident so far.
The NSW ECEI Transition Provider approach has, in reality, only been operating since February 2017 (6months). It has been slow to implement and has been limited only to plan transition (“Gateway”) activities under directives from NDIS. Year 1 ECEI Transition Providers have not been in a position to deliver the full range of the early intervention services as in Nepean Blue Mountains Trial due to the slow roll out. It is necessary to allow for the full 2 years of implementation before we can evaluate the outcomes of this approach and consider any changes.
ECEI outcomes for children and families EarlyEd has already found evidence of positive outcomes of the ECEI approach. Families have had an increased opportunities to find out what is best practice in early intervention. Families have been supported to think about goals and outcomes not hours of service. Children’s NDIS plans are reflecting the developmental needs of children. Children are being supported into local mainstream and connected to community services. Families are aware of developmental risk areas and how to prepare for transition points. Families who no longer want disability services or are better serviced by mainstream services are being supported to access them.
Response to a. the eligibility criteria for determining access to the ECEI pathway; The criteria for access to the pathway needs to be open to all families concerned about their child. Eligibility about which services are required under the “gateway” into mainstream services or NDIS should reflect current definitions of global developmental delay. The key to a clear eligibility definition for developmental delay which will then support a child into NDIS is the wording “substantial and functional”. When a child had a mild - moderate delay in only one area then referral to health services will provide appropriate local services. When only the 4 current categories are used
i) self-care; (ii) receptive and expressive language; (iii) cognitive development; (iv) motor development; there is a risk of missing important areas of function.
Recommendation: Adding these 2 more areas would provide eligibility for all children that require intervention supports (v) emotional regulation and social interaction; (vi) sensory impairments These will pick up behavioural, pragmatic, social, restricted interests, hearing, vision and sensory processing difficulties. Difficulties in these areas can significantly impact development, learning and inclusion.
Response to b. the service needs of NDIS participants receiving support under the ECEI pathway;
EarlyEd will highlight 2 particular areas where ECEI has improved outcomes.
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Family supports / family –centred practice: The ECEI approach, as it is based on best practices in early intervention, recognises that family support is critical to achieving engagement in early intervention, early referral into main stream services, early NDIS take up by eligible families and holistic planning and intervention. A child’s intervention is delivered through family. ECEI supports ensure families can take on this role by
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answering family’s needs – builds resilience
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building their confidence - empowers
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developing their skills - capacity builds. NDIS is about person centred supports. Parents/ carers of children are not funded to be supported under NDIS. Recommendation: Maintain ECEI approaches to support families from the time they are concerned or receive a diagnosis.
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Holistic / Best practice Under ECEI families are often having their first experience of collaborative planning and goal setting. Unless they have accessed an early intervention service families can be in the situation where they receive a diagnosis and are sent out on their own to track down services. This gives a service not outcome focus to intervention. Recommendation: Families need providers with EI expertise to support them to plan and map out services that will achieve their child’s goals.
Often if the child is at school there are no supports in place for home/community life. Under ECEI these families are better informed and can to plan to assess their child’s needs in their daily life, trial systems and introduce supports at home. “Several children have come for planning who are in a special school. They are nearly six and have no verbal communication, have challenging behaviour and no Alternative, Augmentative Communication(AAC) system at home even though school is using Key Word Sign and / or a visual AAC system. Through ECEI families have been supported to think about how their child’s can have access to communication supports at all times.” Julia, EarlyEd ECEI early interventionist / speech pathologist.
Response to c. the timeframe in receiving services under the ECEI pathway;
Families are experiencing long waiting lists to obtain support under NDIS and slow progress through NDIS planning. This is distressing for families and they require ongoing contact and reassurance from ECEI staff.
Year 1 ECEI services in NSW are limited by NDIS capacity for plan approval and the current FACS transfer. It is important to note that the slow rollout of NDIS because of delays in starting the process, slow plan NDIS approval rates for children, the low levels of funding offered to organisations to staff services while concurrently providing of continuity of services for ADHC funded families and ECEI in NSW has meant that ECEI in NSW is still primarily focussed on planning. The number of children processed and rate of approval has been out of the Transition Provider’s control.
Recommendation: Adequately fund Transition activities on a short term basis so that ECEI’s can support families enquiring about NDIS.
Response to d. the adequacy of funding for services under the ECEI pathway; Response to e. the costs associated with ECEI services, including costs in relation to initial diagnosis and testing for potential ECEI participants; The current funding under ECEI in NSW is seriously underfunded. Early Intervention services funded under ADHC have always cost effectively used block funding across hundreds of children but under ECEI providers are being asked to concurrently
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provide continuity of service to ADHC funded families
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support NDIS to get ECEI started in NSW
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attend all NDIS meetings and training – average fortnightly since January 2017
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train all our staff about ECEI, create an ECEI team, keep staff informed
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inform families about ECEI (The first public ECEI information session given by NDIS was this week on 9.07.17)
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inform the sector about ECEI
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administer lists
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support families to reinterpret information from the NDIS hotline as well
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deliver ECEI NDIS planning
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ECEI implementation This has continued into Year 2. The number of children contacting EarlyEd for access and ECEI support (at 15 contacts a week) and the frustration levels of families increases every week. Costs: Travel: The costs of supporting families in the metropolitan area in their natural environments is under estimated.
Recommendation: The real cost should be established including time travel to the family environment travel reimbursement, parking and toll costs. ECEI funded appropriately will mean families will be less frustrated, need less support and “insure” (as NDIS in an insurance scheme) for smooth transition pathways, access to community and plans with targeted outcomes.
Response to j. the principle of choice of ECEI providers; Families need some choice in providers. Under the current NDIS planning models (ie Uniting) families not only have no choice in provider but no choice in planner. Under ECEI families have both. There is no real issue about conflict of interest as the ECEI Transition Provider – does not allocate funding – NDIS does this – does not select services for families – families do this.
Recommendation: ECEI Providers can continue to be current early intervention service providers.
- ECEI service guidelines should be set by NDIS
- NDIS should direct the planning to ensure consistent quality management
- a cap should be put on the number of children supported per agency and funding given to each agency will ensure no one agency can take on a dominant role in the community, reduce choice nor create waiting lists. Families need choice that reflects their cultural, local, religious, language needs.
Response to k. the application of current research and innovation in the identification of conditions
The ECEI Approach is strongly reflected in the delivery of ECEI services now. The National Best Practice in Early Childhood Intervention Guidelines underpin these good practices.
Recommendation: EI is a specialist area and requires specialised staff, supervision and evaluation. Funding is required to support early Intervention organisations to evaluate the current ECEI model using all relevant peak bodies for support, especially Early Childhood Intervention Australia. There is a need for be an independent review and evaluation of outcomes, efficiency and innovation.
Conclusion:
Expertise and experience regarding the needs of children with disabilities and delays and their family members, well established connections to local services and partnerships with local agencies (in particular early childhood education settings and schools) made undertaking ECEI in NSW an effective and appropriate approach to support families to determine their eligibility for NDIS and plan. EarlyEd recommends that to fully evaluate whether the model of ECEI delivered in NSW is demonstrating positive outcomes for families, is cost effective and capacity builds local communities it should be fully trialled and evaluated before tendering for alternative models.