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Agency submission to the Disability Royal Commission:
Barriers to accessing disability services when people from a CALD background arrive in Australia.
Medical Barriers
No diagnosis Many people from a CALO background who live with a disability do not have a diagnosis when they arrive in Australia. This means that they are excluded from qualifying for a number of disability services that require a diagnosis in order to grant access to the service. The diagnosis is not accepted in Australia People from a CALO background can have diagnosis upon their arrival in Australia. However, this diagnosis will not be accepted in Australia. No matter how reputable the source of the diagnosis the person will have to go through the Australian medical system to obtain a diagnosis that will be recognised in Australia. Long wait times for a diagnosis A diagnosis through the Australian medical system can take years. The waitlist itself for a specific assessment required for diagnosis can be over 2 years in some cases. No paperwork or supporting evidence relating to their disability It is common that people from a CALO background will arrive in Australia with no supporting evidence that relates to their disability and health care needs. Paperwork and supporting evidence written overseas is not recognized If the person does have preexisting paperwork and assessments, they are in a different language and are written from a different medical perspective. Thus, they will not be accepted as viable medical evidence in Australia. Please note the department allows 12 documents to be translated upon a person’s arrival in Australia. Medical assessments conducted by International health agencies are not recognised UNHCR (United Nations High Commission for Refugees) and IOM (International Organization for Migration) conduct medical assessments before people come to Australia. However, these assessments are not recognised in Australia and will have no weight in helping people access disability services. Cost of assessments Referrals to a private service can be very expensive. An example is that an ASD assessment costs $19000. This cost means that some people are unable to afford this and will not be able to go through private services. They will instead have to wait years for an assessment through the public system. Early intervention is critical For children with a disability early intervention is critical. However, due to Australia’s long wait times children are missing out on support and treatment during this critical times. It is common for a child to have to wait one to two years on the waitlist to begin the diagnosis process that takes six months. Visa restrictions People on a temporary or bridging visa are not eligible for services such as the NDIS and the Disability Support Pension (centrelink payment). For people on these visas who live with a disability there are very limited or no options for support relating to their disability.
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Barriers to accessing information
Information sessions before arrival UNHCR or the Immigration department arrange information session for people before they arrive in Australia. During these sessions a number of services are discussed such as centrelink and public housing. However, they do not talk about the NDIS regardless of the fact that the department is aware when a person has a disability due to the medical records and assessments that are conducted. This shows that there is a major information gap when arriving in Australia for people from a CALO background who have a disability. This means that when people arrive they do not know that there are disability services in Australia because there is no disability service in their countries of origin. This means that upon arrival in Australia people with a disability and their families are not aware of their rights to access disability services, support workers and respite care. Disability support services are not the priority when people arrive in Australia There are a number of other basic and essential services that are prioritised such as housing and centrelink. These are lengthy and complicated processes and if the person lives with a disability, that need will be put last due to the other essential services that are needed. People being bombarded with information upon their arrival in Australia Both the amount and complexity of the information that is given to people upon their arrival in Australia can leave people very confused and unclear about the services available in Australia. Difficulty differentiating services Due to the number of services and their complexity some people are not able to differentiate between the services. An example of this is that when asked some people will not know what a Medicare card is and may think that Medicare and centrelink are the same service. Literacy, numeracy and language barrier A lot of information about the Australian system and the services within it are only available in English. The process to be linked with essential services is on line It is common for people from a CALO background to not know how to access services due to the applications being completed online. Lack of language access Some services are not aware of their federal and state obligations under the human rights act which require that people with a disability are able to access services. An example of this is that a person who was supported by an advocate from -was not offered an interpreter while going through multiple court ordered mental health services. This shows that if a person does not know how to ask for an interpreter, they may miss out on this right if it is not actively offered. How to access an interpreter Even if the service does offer interpreters the person may not understand how to ask for an interpreter or what option to press to access an interpreter. The option to select an interpreter is in English if someone does not understand a word of English they will not know what option to press. An example of this is a client who forgot her pin number and had no access to her money. An advocate from- helped her to call the bank with an interpreter to ask for her pin to be reset. The bank advised that the client can only call alone and use one of the banks interpreters. However, the client could not understand what option to press to get an interpreter. This shows the way that certain policies disregard the level of language barrier that some people face. Misinformation due to no language access GP clinics are legally required to provide an interpreter. In our experience they often do not do this. Due to their being a number of forms to fill in at medical clinics that include complex medical questions the client may not be able to understand the question or give accurate answers. This
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means they may miss out on essential medical care or have their medical needs inaccurately assessed.
Settlement services
Lack of disability specific training within settlement services While there are tiers of case workers to work with complex needs. People who work within the settlement field receive no disability specific training. Case managers may be unsure of where to refer clients for disability support. If clients are not referred to a disability specific service through the access point of settlement services they may not get the disability specific help they need. This means that people with a disability can fall between the cracks and miss out on be able to access disability services. Settlement services caseload Settlement service providers have been dealing with increased demand for support services. This means that workers have a very limited time to spend with each client. It is common for clients to have never met their case manager and have great difficulty getting hold of them. Due to technology barriers this can create a disconnection between the worker and client.
High turnover rate Due to a number of factors including the large caseload of settlement workers, there is a high turnover rate. This means that it is common for clients to go through multiple case managers during their settlement period which can be very disruptive for the client and lead to confusion.
Cultural barriers to accessing disability services
Different cultural understanding of disability An example of this may be that certain cultures have superstitious beliefs around cause and treatments of a disability. A person who has a disability may be isolated from the community and experience a high level of stigma. Stigma surrounding mental health conditions The stigma surrounding mental health conditions, diagnosis and treatment can act as a barrier to people from a CALO background accessing psychologists, psychiatrists and other mental health services. No understanding of the impacts of trauma The impacts of trauma can be both mental and physical- eg memory loss, chronic pain, sleep disturbances. The stigma directed towards the diagnosis of a mental illness in CALO communities can lead to a heightened sense of fear of a person disclosing their symptoms. This is due to stigma and a fear of being perceived as ‘crazy’ by their community. Fear of disclosing disability Some visas are based on a purely monetized view of a person. For example a 449 visa sub class was less likely to be granted if the person was to disclose their disability at the time of being assessed for this visa. This is due to the medical cost of having that person in Australia. Upon their arrival this sense of fear can be carried on and people will still be fearful to disclose their disability. While the department would not send people back to their country based on having a disability some people do not understand this and therefore do not feel safe to disclose their disability. Fear of interpreters being part of their community Due to the cultural stigma associated with certain mental and physical health conditions some people from a CALO background fear that the interpreter is part of their community and will share their private information with other community members. This acts as a barrier to people from a CALO background disclosing important information about their physical and mental health
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conditions. No last name assigned on arrival Within certain cultures people are not assigned a last name at birth. This can cause multiple issues upon their arrival in Australia as often a family name is a required field in Australia’s systems. The process of assigning a last name and changing all identity documents to match this last name is complex and long. Meeting 100 points of ID It is common for people from a CALO background to have multiple first names. This means that once a last name is assigned there are not enough allocated spaces on a Medicare card to include a person’s last name. The health care card must match the Medicare card which means the person is also unable to add their last name to their healthcare card. In this situation a person may be unable to meet the 100 points of ID required for a number of processes as their identity documents do not match.
Trauma not being viewed as a disability: The interaction of trauma and systems that are not trauma informed
we work with people who have become disabled from their repeated and prolonged experiences of trauma. These cohort of people experience a set of symptoms that are so debilitating that the person is un able to participate in society and will require lifelong support. While every individual’s experiences of trauma and the relating symptoms are unique, there are a set of symptoms that are commonly experienced by the people that we work with and are accepted by trauma research. These symptoms include yet are not limited to; poor sleep, nightmares, memory loss, depression, anxiety, high levels of emotional distress, suicidality, light headedness, inability to express oneself, hypersensitivity to noise and light, avoidance of any associations of the original trauma, fear, experiences of immobilization and shut down or rage and anger, internalized shame and guilt, uncontrolled crying, chronic pain conditions, nervous system and soft tissue degeneration, chronic fatigue, gut issues and autoimmune conditions. Many of our clients display some or all of these symptoms, however, access to schemes such as the NDIS, council support, carer relief and the disability support pension are extremely hard based on trauma symptoms.
As CALO/Disability advocates a large part of our work is navigating multiple Australian systems that are not trauma informed and deny access of support to people who suffer from debilitating trauma symptoms. What we see in our line of work is people who have no idea about the complex nature of trauma making decisions that deny access to support to people who need it the most. However, this is a systemic issue as the people who make the decisions are forced to follow rigid criteria’s that are incompatible with trauma symptoms warranting access to support.
People are often rejected due to their diagnosis and symptoms not aligning with rigid criteria’s that people must meet in order to access these schemes. Examples of where trauma symptoms and criteria’s conflict are as follows;
NDIS permanency criteria: Trauma symptoms are often not accepted as permanent as it is suggested that they could improve over time and there may be therapies that can ‘cure’ or drastically improve trauma symptoms.
NDIS Early intervention requirements: This requires that the person has explored early intervention of the diagnosis. Due to trauma treatment being inaccessible in their home countries there has often been no previous treatments explored.
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DSP Permanency criteria: This criterion requires the condition to be diagnosed, treated and stabilised. Meaning that the condition is not likely to get much better or worst over the next two years. This direct quote from centrelinks website highlights a barrier for people from a CALO background.
“If your condition has only just been diagnosed, or if you only just started treatment, Centre/ink will probably say that your condition is not ‘permanent’ even if you are very sick. It might be better to wait until you have had treatment before you lodge a claim for DSP.”
DSP: All possible treatments that could improve the condition have been explored There are a large range of treatments available for trauma symptoms and access to the DSP can require that the person has tried multiple treatments.
DSP: The condition has been treated and stabilised The criteria of a condition being stabilised often relates to the person being medicated and requires a medical practitioner’s confirmation that the condition is unlikely to get much better or worst over the next two years.
DSP: Work Capacity
Difficulty in getting specialists to confirm the person is unable to work over 15 hours per week. Trauma, symptoms, mental health and the general barriers that people from a CALO background may face (eg language, literacy) may not be looked upon as reasons that restrict work capacity.
Stigma: A barrier to accessing DSP Due to mental health being stigmatised and having no access to diagnosis or treatment of mental health conditions in a person’s home country. It can be a long wait time and treatment time before the person can apply for the DSP. This can come at a great financial cost to the individual and mean that their trauma symptoms only worsen due to the stress of not being able to access the DSP. It can also lead to financial problems and having to fulfil mutual obligations to qualify for job seeker.
VCAT: Being fit for the role of Guardianship and Financial administration: Some people from a CALO background have been through severe trauma and can become further distressed by VCAT processes. This could lead to VCAT deciding they are unfit for the role.
Housing: Special accommodation requirements: Special accommodation requirements are not accepted based on trauma symptoms. An example of this is that a person may become distressed in the confined space of a lift due to the specific trauma that they have experienced. However, this will not be looked upon as a medical reason could mean that a person would qualify for a special accommodation requirement.
The process of trying to gain access to schemes re-traumatising people we have to break the harsh reality of the system to people on a daily basis. We take people who are highly traumatized through processes that have the potential to be re-traumatizing. The experiences of some people from a CALO background are quite literally unspeakable to the individual; meaning they are not able to speak about these experiences due to the highly distressing nature of them. The assessments and reports required to access certain disability schemes require that the person speaks about their symptoms and in some cases recount the trauma that has led to these symptoms. In many of the countries that these people come from there is no dialogue around trauma and there are not even the words to diagnose and explain certain mental illnesses. The diagnosis of mental illness is highly stigmatized in certain countries and can lead to an individual
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being ostracized from their community. This lack of cultural understanding of trauma is a huge barrier to accessing mental health support for people of a CALO background.
This shows that the systems which are set out to help people can end up re traumatizing them, dragging them through a prolonged, expensive, confusing and distressing process only to reject their right to support and leave the person in a worst place then when they began the process of trying to access the scheme.
NDIS Access
Eligibility
Some visa subclasses are ineligible for the NDIS. This means that people with severe disabilities can be left without support for multiple years on end. No diagnosis Timeframe for diagnosis through the Australian medical system can be many years. Lack of supporting evidence There can be a lengthy timeframe associated with assessments and report writing. No specialists in place People from a CALO background can face financial barriers when trying accessing specialists. There is often a large cost associated with specialist appointments, report writing and transport to and from the appointment. NDIS specific language and criteria Medical practitioners can be unaware of this language and criteria. Transport barriers If a person is newly arrived to Australia they often have no car or understanding of how to use public transport. This acts as a barrier for people to get to appointments. For this cohort catching a taxi is the only option and can come at a great cost to the person. Language and literacy barrier If a person does not speak English and may also be illiterate they are unable to access and read information regarding the NDIS or to fill in forms. Technology barriers It is common for people from a CALO background to have no access to a computer or proficiency in using a computer. This means that they have no way to get the NDIS forms that are only available online. Some people from a CALO background also have no email address. Difficulty accessing the NDIS based on trauma symptoms and mental health conditions The NDIS often does not accept trauma symptoms as a Disability and the people who make the access decision often have no understanding of the impact of the severe and prolonged trauma that many people from a CALO background have faced. Early intervention requirements The NDIS want to know that all possible treatments that could improve the condition has been explored- if someone has just arrived they often do not meet this criteria (this criterion is disability specific- eg Cerebral palsy would not fall under this as it is medically understood as permanent). Distinction between healthcare system and the NDIS It is common for the NDIS to push the responsible of assessments and medical care onto the health system. The health system have limited resources and are sometimes either have no capacity or are unwilling to meet the NDIA’s requests (eg requests for multiple reports).
Once access to the NDIS is gained
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Support co-ordination hours Some people from a CALO background who either have no or very little proficiency in English are given no support co-ordination hours. This means that they are left being unable to utilise their NOIS funding or not utilising it correctly. Barriers they face include; having no understanding of how to utilise the funding so that it lasts throughout the whole plan duration, being unable to research medical practitioners, being unable to make appointment bookings, being unable to understand recommendations or how to conduct a plan review, having no knowledge of how to prove a change of circumstances. Clients told they do not need support co-ordination The NOIA representatives have told some people that they do not need support co-ordination hours as the LAC will help them. However, clients have reported that the only support that they get from an LAC is an email with links to support. Sometimes the person speaks no English so is unable to even read the email and it is common that they will have very low technical proficiency. It is common for LAC’s to ask our organisation where to refer clients. This is information that LAC’s should be familiar with particularly if the NOIA claim that they are able to act as support co ordinators. Internal reviews Internal reviews require gathering more evidence that concern a certain criterion. People may not know this, or understand the basis of the initial rejection. Barriers to understanding the scheme People from a CALO background face language, cultural and systemic barriers when trying to understand the NOIS scheme and their NOIS plan. Support coordinators and plan managers who have no understanding of the cultural barriers that people from a CALO background face can struggle to help the person overcome these barriers. Running out of funding People may not understand how to stretch out their funding over the plan duration and can use all of their funding hours early on. Plan reviews Plan reviews mean that the participant must gather evidence for each plan review. If a participant has no or limited Support co-ordination they may not understand this. Early plan reviews Even with insufficient funding if the review is not applied for within the first or last three months of the plan a change of circumstance must be proven. Participants may not understand this and practitioners may not clearly outline what the change of circumstance is. Funding being cut at plan reviews This could be due to a lack of new evidence as participants left with no or little support co-ordination may not understand they need to gather the new evidence.
Administrative Appeals Tribunal (AAT)
A complicated, lengthy and legal process. Barriers to understanding the legal language used throughout the AAT process The language used during the AAT process and particularly with the Statement of Issues (SOI) can be highly legal. If a person is self-represented, they may not understand the criteria that they need to gather evidence to meet. Even with a professional representative explaining it, there are still barriers to understanding. Lack of organisations capacity Many agencies are overwhelmed with AAT cases and even if client knows where to go to for support their books may be closed. This means that clients can be left self-represented. This system can pit
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lawyers against people who have a disability and face a number of barriers including; cultural/language/technology. Free legal services Legal aid are extremely limited in the amount of AAT cases that they can take on. This means that the majority of applicants who face financial barriers are left without legal representation. Practitioner barriers Medical practitioners are often asked to write multiple letters. Due to their limited capacity this evidence can get harder and harder to obtain from them. Practitioner’s may refuse to write letters and not respond to summons.
Financial Barriers
Reports cost money. The money taken to finance reports may come directly out of the applicants’ pocket or from their NDIS funding. An example of the cost is that one client was charged $990 for a report.
Transport
Getting to appointments to obtain more assessments and reports. Different cultures and religious beliefs Different, religious and cultural understanding of disability, mental health and wellbeing. The stigma’s associated with these definitions can cause issues in accepting the diagnosis and a denial of support needs and a lack of understanding of western centric medical support. Barriers to understanding rights and systemic structures The NDIS is a relatively newer scheme and this can mean that there are often changes which creates an inconsistency of information and services. Power imbalance Regardless of a person’s cultural background there is always a huge power imbalance at play during AAT cases. This power imbalance is even more apparent for people from a CALO background as there are further barriers to understanding the systemic structure, language barrier and challenges in understanding and interpreting legislative criteria particularly if the matter is self-represented. Financial cost to the NDIA Throughout these processes the NOIA spend huge amounts of money on; lawyers to represent the NOIA, Individual assessments and the costs of conferences. The irony is that this funding could instead be put into the persons plan, rather than the process which seeks to uphold the NDIA’s decisions of rejections or funding cuts. Delays in process The agency makes multiple requests for information that is already included in reports. This further delays the process.
Registrars
Registrars need to be given power at the conference stage as they are there purely as a moderator and even if the applicant is breaking down and has produced the requested evidence the registrar has no power to override the respondents decision. The legal representatives Although legal representatives have an obligation to act fairly, this is often unmet and the registrar has no power to override the applicants ongoing requests for reports and information.
Timeframe
The regular timeframe for and NDIS access case at the AAT is one to two years. Lawyers representing the NOIA will often delay the process further by not following the timeframes set out by the registrar and the applicant is simply made to wait.
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Hearing timeframe The is no limit to the timeframe in which a decision must be made at a hearing.- has a case that has been with the AAT for seven years and still has no resolution.
Stress
The AAT process is highly stressful for many people; this can lead to a worsening of the person with a disabilities condition or negatively impact their carers mental health. It is not uncommon for the applicant to experience extreme stress and anxiety; sleep disturbances and symptoms of a nervous breakdown due to the prolonged frustrations that can arise from the AAT process and the associated difficulties. Health concerns that arise from the AAT process People from a CALO background who either have a disability or have a family member with a disability and have no support from the NOIS often face severe financial challenges. People in this situation must self-fund all medical care and often the carer is unable to work due to the family members care needs. The several reports that are required to help the applicant meet the several statement of issues that are produced during the conference process come at a huge financial cost to the applicant. Many clients have reported that they now have to use their very limited medical sessions on the report writing that is required. This means that people are not only unable to receive support from the NOIS scheme yet the NOIA are actually causing people to miss out on their self funded medical support. The AAT process is also hugely time consuming meaning that if a family member is representing the person with the disability they have less time to care for the individual. These trends that are a direct result of the AAT process are putting people’s health further at risk and often leading to a further decline in someone’s mental and or physical health.
HACC PYP funding
Assessment process Clients are often referred to allied health for basic chat assessments with the goal of being referred to other services. No proper assessment The assessments for the HACC PYP is not being carried out by medical professionals. Rejection due to high needs If a person has high needs (for example cerebral palsy and non-verbal) the HACC PYP program will reject the application based on the person being high needs. If a person is not eligible for the NOIS based on their visa status this leaves the person with no support. Their only alternative to having no support is being admitted to a hospital for an indefinite stay. Support worker unable to weight bare we have encountered a severe limitation of the support workers who are funded by the HACC PYP funding. That limitation being that they are not able to weight bare. This is the primary support that is required by clients who need assistance with personal care and transfers. Cultural considerations If the person living with a disability’s carer is the opposite sex (eg son caring for mother) it is common that the person with a disability will not let their carer help them with personal care. This means that support workers being unable to weight bare acts as a barrier and produces safety concerns. Safety concerns There are many safety concerns that can arise from a client with high needs being left with no support. Examples of these include: a risk to a person’s safety when carrying out personal care, this includes a risk of falls and having no safety equipment implemented (eg shower chair and toilet
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chair). Safety concerns for carers With no safety equipment or support in place carers are left to lift and weight bare for the person they are caring for. This can lead to long-term health issues for the carers, such as injuries to the back.
HACC PYP manual
We have been unable to find the clause that speaks on rejecting clients due to being high needs. However, we find that this is a common reason to reject an application.
VCAT- Financial Administration and Guardianship
If a person is non-verbal and can’t sign their name If a person is unable to sign their name or give verbal consent they are unable to get a passport and have their own bank account. To be able to obtain these the person must be assigned a financial administrator or guardian.
Complexities
Once VCAT is involved there may be no going back. An example of this is that the application could be put in for financial administration and through the hearing process VCAT may decide that the person needs a guardian. Barriers to a person being involved in VCAT’s decision making process It is common that the person whom the decision is being made about is not present during the VCAT hearings. This means that huge life decisions can be made without the person participating in these decisions. Barriers to understanding If the person present at the VCAT hearing speaks no or little English and has a limited understanding of the Australian system it is common that the person does not understand what the hearing is about, what is happening or what decisions are at stake. Many of our clients have no idea that they have been part of a legally binding hearing. This often results from the fact that the hearing was via teleconference, and the clients struggle to differentiate between calls from a range of services of which they have very little understanding. Being fit for the role Some people from a CALO background have been through severe trauma and can become further distressed by the process. This could lead to VCAT deciding the person is unfit for the role. Sensitivity of the subject matter When deciding whether a parent is fit to be the guardian or financial administrator for their own child the matter can become quite sensitive. To have a VCAT lawyer make a judgement on the parent’s suitability for the role is problematic.
Understanding
If the person does not understand the role due to barriers (eg language) and they can’t express to VCAT what their role will be they may also be decided as unfit. Paperwork, yearly reports and audits There is a large amount of paperwork to fill in every year when a person is assigned as a financial administrator or guardian and a record of everything that is spent on the person must be kept (receipts, bank statements). People from a CALO background may face language and literacy barriers which makes this particularly hard. Anyone can be contacted If anyone who is contacted indicates that the person may be unfit for the role VCAT will consider this. External guardians being appointed
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When an external guardian is appointed a number of issues can arise. Examples of these include the external guardian over exerting control or the person who is under guardianship being placed in accommodation far away from their parents. Challenging cultural understanding of family responsibility People from A CALO background have very close-knit family units. External Guardians being appointed challenge this family model and can be culturally inappropriate.
Ombudsman
The p rocess to dispute state trustees is through the Ombudsman. However, no one in our team has been able to get the Ombudsman to take on our client’s case. Enquiry by the Ombudsman regarding state trustees
Fees
The state trustees charge fees for their services. These fees can be very expensive particularly if the person is unable to work and only receives Centrelink payments.
Complaints
If the persons whom money is being managed by the state trustee complains about the management of their money, the state trustee has the power to spend that person’s money to resolve the dispute. This means that funds from a person’s disability support pension can be used to fund fighting them in legal proceedings. Legal obligations We have been advised by state trustees that they are not obligated to tell the person when or how much of their money they are spending on resolving a dispute. Rather they are only obligated to send a yearly financial report to the person whose money they are managing.
Centrelink: Disability Support Pension (DSP)
Barriers: No diagnosis, no paperwork, no specialists in place, not able to pay for specialists, no car and no understanding of how to use public transport.
Eligibility
Temporary visas, bridging visas and other types of visa subclasses are not eligible for the OSP. It is a requirement of certain visa subclasses that once someone has been granted permanent residency they may still have to wait 10 years to access the OSP.
Language
If a person speaks no English they may find it hard to call a clinic to make an appointment and may not be able to communicate to the receptionist that they need an interpreter. Requirement for the condition to be treated and stabilised This criteria can be difficult to meet as for people from a CALO background there is often a lack of supporting evidence relating to past treatments. The condition being ‘treated and stabilised’ often pertains to the person being put on medication. This means that at a governmental level medicating people is being endorsed and is often a requirement to access government funding. People from a CALO background may not want to go on medication if it is related to mental health treatment due to cultural stigma. Gaining access to DSP based on mental health conditions and trauma symptoms This is particularly difficult as centrelink often does not accept the permanency of these conditions
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and want to see that every possible treatment option has been explored. Considering the cultural barriers to mental health treatments this can be a difficult criteria to meet.
Work Capacity
To access the DSP it must be certified by a medical practitioner that the person is unable to work over 15 hours a week for the next two years. Difficulty can arise in getting specialists to confirm the person is unable to work over 15 hours per week. Trauma symptoms, mental health and the general barriers that people from a CALO background can face (language, transport, technology) may not be looked upon as reasons that restrict work capacity. Mutual obligation requirements Unless on the DSP payment the person is required to meet mutual obligation requirements in order to access Centrelink payments. People from a CALO background can face barriers to understanding what they need to do or how to apply for jobs even if they are able to work. Programs of Support are not trained to support people with language barriers, cultural barriers and history of trauma. For example, while engaging with a program of support, one of our clients felt so helpless to engage she attempted suicide.
Medical exemptions Only valid for 3 months at a time. This means that people must go to their GP clinic every three months to obtain a work exemption.
Housing
Expectations set during information sessions When people arrive in Australia they can have unrealistic expectations about certain services. An example is that clients believe they will be able to get a free house through public housing soon after their arrival in Australia. The information shared in these sessions can be misleading as it is often not disclosed to the client that the person can be waiting for over ten years from when an application is put in to be offered a house through this scheme. This means that clients can become disappointed with the service providers due to their preexisting expectations. Being unable to utilise disability services due to inappropriate housing People may have disability services in place yet the services are unable to provide care in the home because the person is living in inappropriate housing. An example of this is that support workers are unable to work at the property due to no bathing facilities or unsafe housing. Issues with modification A person living with a disability may need modifications to the home to meet their needs. Landlords may reject these requests and social housing may also reject these requests. An example of the severity of the consequences that this can lead to is that a child living with a disability had to be showered outside in the winter due to the child not being able to access the bathroom. The child had to be showered in a shower chair and the support worker could not fit in the bathroom with the child. SDA (specialised disability accommodation) access Accessing SDA can be more difficult for people from a CALO background due to barriers in understanding and language. Paperwork, language and literacy barriers Applications for public housing require an extensive amount of paperwork. The language, literacy and barriers to accessing and using technology experienced by some CALO people make this process very difficult. Support for private rentals People who live on centrelink because they must care for a child with a disability are more likely to
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be rejected for applications for private rentals due to being unemployed. Risks for people with a disability are at higher risk If a person with a disability is to become homeless or forced to live in a temporary shelter they face a high health risk.
Education
Special education Some children are denied admission to special education if they do not have a diagnosis through the Australian medical system. Lack of funding Even in cases where there has been an exception to the criteria which requires a diagnosis, there is often limited funding available and the child is not able to access full time school hours without a diagnosis. Educational pathways for adults Some adults who arrive in Australia have never had the opportunity to go to school as they were unable to attend school in their country due to having a disability. AM EP is not accessible to people with certain disabilities eg non-verbal, hearing restrictions. Adult carers being unable to access education and English classes The NOIS often knock back requests for support workers if a child is under the age of 16 on the basis that the parents should be a full time carer for their child. This keeps the parents in a trap of being unable to access education or employment. Long wait times for childcare Childcare is offered through AM EP yet there are long wait times associated. This means that the carer may be unable to access English classes for some and will therefore experience a higher level of isolation. No interpreter provided at initial AMEP assessment It is common for no interpreter to be available at the initial assessment conducted by AMEP. This means that the person who is being assessed may not have the assessment explained to them. Transport barrier
Discrimination
Lack of understanding We have found that people who work within the system can exhibit a lack of cultural awareness and a lack of understanding of the barriers that people from a CALO background may face.
Language
If a person doesn’t know the language it is far easier for them to be discriminated against at every level.
Rights
People can be discriminated against unless they are actively provided support and informed of their rights. If someone is from a CALO background it can be easier to assume that they do not know the process or what their rights are and therefore they can’t challenge the system.
Centrelink
An example of how the above can play out is; during the pandemic when people went into a Centrelink office if they could not speak English or explain themselves at the door the people were turned back and told to go online. This shows how people from a CALO background can be discriminated against if they are not actively offered language support.
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Recommendations
Improving access to Disability services upon people’s arrival in Australia
Access to disability services based on diagnosis that were given overseas: We recommend that a policy is introduced that allows people to access disability services in the interim of gaining a diagnosis through the Australian medical system. This policy should allow assessments and diagnosis from reputable overseas medical professional to be accepted for a window of time upon a person’s arrival in Australia. This would allow for the person to access disability services while they are going through the Australian medical system to confirm their diagnosis. As previously discussed a diagnosis through the Australian medical system can take many years due to long waitlists and extensive testing and assessments.
Access to Disability Services for people who arrive in Australia with no Diagnosis: We recommend that a point scale which measures a person’s impairments is introduced. This impairment chart should be completed by a medical practitioner and upon a certain impairment score the person should be able to access disability services prior to receiving a confirmed diagnosis.
Automatic Visa exemptions for people who have a disability and are on certain temporary visa subclasses: We recommend that people who have a disability should be exempt from visa requirements and be able to access disability services prior to receiving their permanent residency.
Automatic priority list for visa processing: We recommend that people who arrive in Australia on a temporary visa and are flagged as having a disability should be put on an automatic priority list for the processing of their Permanent Visa.
Simplify and breakdown the information given to people upon arrival: We recommend that people are employed in the settlement sector to fulfill the role of educational support when people arrive in Australia. This support should include explaining the Australian system and the supports that are available in Australia. If the person who arrives in Australia is literate a hard copy of a simplified breakdown of all the supports available, how to access them and the relevant websites and phone numbers should be given to the person in their language of origin.
Services offering interpreters: Services must actively offer interpreters and inform clients of their rights. This will ensure that clients are educated about their rights and understand their right to an interpreter. Clients often do not know their rights within the Australian system meaning that they miss out on getting language support.
Auditing based on language: If a person does not speak English they must be provided an interpreter and we recommend that there are consequences if they are not. Organisations should be audited based on whether they have culturally inclusive practices. If there is evidence that an organisation has failed this section of the audit there should be consequences and their practice must seek to improve this element of cultural competency.
Discuss the NDIS during information sessions: We recommend that the NDIS scheme is discussed during the pre-arrival information sessions. This would ensure that people living with a disability know that there is disability specific support available in Australia.
NDIS
Implementation of assessment package: This package could come under an access assessment support package that runs over a stipulated period. The GP is able to refer people to the equivalent
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of an LAC to organize assessments to obtain whether the person is eligible for the NDIS. This assessment plan should include funding under capacity building to ensure that the person is able to access NDIS registered providers of their choice to obtain their eligibility to the NDIS. This recommendation would be far more cost effective than the AAT process and ensure that the person’s finances are not depleted in the process of proving their functional capacity and subsequent eligibility to the NDIS.
Support co-ordination: If a person is identified as being culturally diverse they should automatically receive support co-ordination hours. There should be no argument about the support co-ordination level. They should automatically receive increased support co-ordination hours to ensure that the support co-ordinator is able to spend time explaining the how the NDIS and involved services operate.
Include hours for a support worker in children’s plans: We recommend that the NDIS more readily provide support worker hours for children. This would ensure that their parents are able to access education and employment.
NDIA to employ a culturally diverse team: If someone who arrives in Australia is flagged as having a disability we recommend that they be automatically linked to a CALO specialist team within the NDIS. This team could supply information about the service and how to access it as well as having the power to make decisions on how to streamline supports for this person.
Visa exemptions: We recommend that the NOIA introduce a clause which allows visa requirement exemptions for people who have a severe disability and high care needs.
Paper applications: Due to the barriers that people from a CALO background can face we recommend that paper copies of the NDIS access request form and supporting evidence form be made available at community centres.
Language: We recommend that the NDIS access request form and supporting evidence form be translated into a number of languages to ensure that it is accessible to people who speak no or little English.
Administrative Appeals Tribunal (AAT)
Introduce and funding cap for the NDIA funding spent during AAT processes: We recommend that a funding cap is introduced. This would ensure that large amounts of the NDIA’s funding is not spent on the AAT process which seeks to uphold the NDIA’s decisions of rejections and funding cuts. This would allow a larger portion of the NDIA’s funding to be used to support participants who have a disability rather than fight against the person with a disability in an effort to prove that they are ineligible for the support that they have requested.
Funding provided to applicant for legal representation and reports: We recommend that the NOIA is obligated to provide the applicant with the same amount of funding and legal representation as the respondent (NOIA) is entitled to. This would ensure that applicants are not left self-represented, having to navigate highly legal content alone and financially drained from the cost of continually requested reports from practitioners.
Increases funding for legal aid: We recommend that Legal aid receive increased funding so that they are able to support a larger number of applicants going through the AAT process.
Increased organisational capacity: We recommend increased funding and capacity for organisations to support applicants going through the AAT process.
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Timeframe of the statement of issues: We recommend that there is a directive made which requires the respondent to produce the SOI within a certain timeframe before a conference.
Information sessions: We recommend that the respondent (eg NOIA, Centrelink) is obligated to organise an information session for any applicant who will embark on the AAT process. This session should include information regarding; the applicant’s rights, manage expectations around timeframes and the process, explain the structure of the AAT and how the cases will run, explain the concept of the statement of issues and individual assessments and differentiate the conferences, conciliation and hearings.
HACC PYP
Increase funding for HACC PYP programme: People of a CALO background make up a large proportion of participants to this programme due to being ineligible for the NDIS due to their visa status. If the person is rejected from the HACC PYP programme due to their needs being too high their only alternative to care is being admitted to a hospital. We suggest that the government increase the funding to the HACC PYP programme so that people do not have to be admitted to hospital or left without appropriate care. This will ensure that the person has the opportunity to stay with their family and in their home. From a monetary point of view this is also a far more cost effective option than an extended admission to hospital.
Assessments: We recommend that all medical assessments are carried out by people with a medical background. We recommend that allied health services carry out functional capacity assessments and grant a person access to HACC PYP based on these assessments.
High needs programme: We suggest that are high needs programme is implemented. Support workers who are part of this programme should be trained accordingly and be unlimited in the type of supports that they are able to offer eg able to weight bare.
Implementation of a cultural team: We recommend that HACC PYP hire a team that specialise in working with people from a CALO background and employ staff from a wide array of cultural backgrounds. This would help ensure that there are workers and support workers who can both understand the cultural barriers and speak an array of languages so that participants are able to communicate with their support worker.
VCAT
Participation and information: We recommend that the person with the disability is strongly encouraged to attend all hearings related to them. The person should also have the process clearly explained to them and be informed about the decisions that are at stake at all times.
Victorian Ombudsman: We recommend that a legal requirement is introduced which requires the Ombudsman to accept and investigate all complaint enquiries relating to financial administration and Guardianship.
Introduction of a specialized CALD unit in VCAT: If the decision of guardianship and financial administration is being made about a person from a CALO background the decision maker should have to complete cultural competency training at a bare minimum. Decision makers who work with this cohort need to make cultural considerations and ensure that culturally sensitive practice is employed. Ensuring that the person clearly understands what is happening during the process at all times and is able to access information in their own language.
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Re modelling of the way that the state trustees are run: State trustees directly deal with some of the most vulnerable cohorts of people. Due to this they need to move away from a company that is run to make profit and employ social workers to work with their clients. Either a social worker or state trustee should explain how the money of the person will be managed. This approach should incorporate face to face client involvement.
State trustees funding for complaints: We recommend that it be outlawed that a state trustee can use the person’s money who is making a complaint to resolve the complaint. We recommend that state trustees have separate funding for disputes to ensure that peoples finances are not depleted through them fighting for justice for themselves.
State trustees obligated to inform a person of how their money is being used: Introduction of a legal requirement that obligates state trustees to inform the person of any of their personal money that will be used. This would ensure that people are informed of the money that will be used to fight them in the dispute process.
Mandatory disability and cultural competency training for all state trustees.
Centrelink
Visa exemptions: We recommend that Centrelink introduce visa exemptions so that people with a severe disability who cannot work are able to qualify for the DSP despite their visa status.
10 year wait time from when Permanent residency is granted: Once Permanent residency is granted we recommend that Centrelink allow people to access the DSP immediately regardless of the persons visa subclass.
Expand criteria: We recommend that the criteria to meet the DSP is expanded to make the payment accessible for people suffering from mental health illnesses and trauma symptoms.
Understand trauma as a permanent disability: We recommend that the permanency criteria is adjusted to allow for trauma symptoms to qualify as ‘permanent’.
Early intervention and all relevant treatments: We recommend that special considerations are made for people of a CALO background regarding the early intervention requirements and the requirement that all relevant treatments that are likely to improve the condition have been explored. Both of these requirements act as a barrier to people who are newly arrived to Australia and can mean that the person is unable to access the DSP for an extended time until they have explored all relevant treatment options.
Rework ‘treated and stabilised criteria’: We recommend that this criterion is re worked to make the DSP more accessible to people who are not on medication. These criteria also requires that the condition is unlikely to get better or worst over the next two years. This can be difficult for practitioners to gauge as there can be a number of factors that can impact a person’s condition.
Housing
Government funded programme to increase the chance of being accepted for a private rental: Due to the barriers that many people from a CALO background who have a person living with a disability within their family can face. We recommend that a government incentive for private landlords and real estate agents to accept their application is introduced. This scheme should offer a government subsidy to be paid to the landlord upon the approval of an application.
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Housing modifications: We recommend the implementation of a government programme which funds and advocates for housing modifications to be made in order to meet the needs of people with a disability.
Special accommodation requirements: We recommend that these criteria be extended to include trauma symptoms as a reason to include special accommodation requirements.
Education
Acceptance to specialised education without a confirmed diagnosis: We recommend that certain health practitioners such as occupational therapists and paediatricians be able to carry out an assessment of a child’s functional capacity. If the child is assessed to meet a certain level of specialised support they should be granted admission to specialised education.
AMEP to offer classes for adults who have a disability: We recommend that AMEP make education accessible for people who live with a disability and cater to the educational needs of people who are non- verbal, hearing impaired and have restricted mobility.
Interpreters to be offered at all AMEP assessments: We recommend that an interpreter is offered at all initial assessments. This will ensure that a person who speaks no English has a clear understanding of what the assessment and how it will run.
Discrimination
We recommend that mandatory cultural competency training be undertaken in all fields that offer client facing work.