Written Submission to the Joint Standing Committee on the National Disability Insurance Scheme

Building 1, Level 2, 14 Aquatic Drive\nFrenchs Forest NSW 2086\nPO Box 361, Forestville NSW 2087\nT 02 8977 8341\nE rkerslake@autismspectrum.org.au\nwww.autism_spectrum.org.au\nABN 12 000 637 267

Thank you for the opportunity to provide a written submission in respect of the provision of\nservices under the Transitional arrangements for the NDIS\n Autism Spectrum Australia (Aspect) is Australia’s largest not-for-profit provider of services and\nsupports working with people with autism and their families. At Aspect, we believe that people on\nThe boundaries and interface of NDIS service provision, and other non-NDIS service provision, with\nparticular reference to health, education and transport services;\n Aspect recognises that it is critically important to establish service boundaries and by having\nstrength and this shines through in our work. We believe that every person of any age with a disability has the right to make age appropriate choices to have full participation and inclusion in society, to have respect for difference and acceptance as part of human diversity and to have equal opportunity. Our mission is to provide person centred solutions which are flexible, responsive and evidence informed with people of all ages on the autism spectrum. In our work we focus on the strengths and interests of people on the spectrum. We work in partnership with people on the spectrum, their families and their communities. We work to understand people on the spectrum from their perspective. Our approach is autism-specific. Our research focuses on best practice. We expect positive change and progress. Together we can achieve positive outcomes. Aspect is a national provider predominately providing services across the life span in NSW, ACT, SA and Victoria.

The boundaries and interface of NDIS service provision, and other non-NDIS service provision, with particular reference to health, education and transport services;

Aspect recognises that it is critically important to establish service boundaries and by having strong transparency this will assist individuals to have clarity around their expectations for service provision across government and non-government systems.

There are many examples where individuals are left without any services as they are refused state based services because they are able to access NDIS – even when the service is not included in their NDIS package. Being included in the NDIS scheme should not impact or exclude individual’s ability to access other government or non-government services.

INTERFACE WITH HEALTH\nIt is essential Health services and the NDIS work in partnership with clear transparency. Due to the ineffective application of section 24 and 25 for eligibility into the NDIS there are numerous individuals who are denied services from health and do not meet eligibility for NDIS and therefore are not able to receive any services. For young children health services have been at the forefront of helping families understand their child’s development, supporting diagnosis and providing intervention to children who typically would not meet the eligibility of the NDIS. However, many services are turning individuals away stating they should apply for the NDIS and no longer meet service access requirements. Eligibility for both Health and NDIS services need to be transparent and clearly articulated. It is important that severity, functional impairment and impact are differentiated. There is a need for a comprehensive range of universal services to be funded that can include screening services that will ensure that the people who should appropriately access

INTERFACE WITH HEALTH

The ECEI Approach aims to ensure that people who have complex disabilities receive timely information so they can get help accessing their plans while those without eligibility also get necessary assistance.

However, this approach isn’t funded enough to offer these processes universally. In some cases, health services might be better suited due to specific types of disabilities involved in individual’s plans because NDIs just act like funders; therefore providers usually handle clarification issues when negotiating service accesses for customers especially regarding psychological social services or early childhood interventions.

Another issue involves vulnerable family members unable advocate effectively within multiple systems potentially leading them missing out opportunities resulting high stress levels increasing chances of giving up children.

There are positive examples where Health professionals collaborate well alongside disability support workers ensuring participants’ welfare such as incorporating insights from disabled staff into hospital environments.

Recommendations:

• Implementation of resolution structures involving both Healthcare and Educational sectors regionally allowing voices heard throughout various services
• Supporting access towards resolving conflicts through appropriate channels
• Ensuring consistent communication between governmental bodies along with non-governmental organizations
• Establishing clear criteria determining whom qualifies receiving aid plus how one gains entry onto programs
• Prioritizing certain groups needing immediate attention over others based on urgency level
• Creating universal offerings providing screening tools helping direct individuals toward suitable routes according to personal needs

INTERFACE WITH EDUCATION

Since introduction NDIS made it harder delivering therapeutic sessions inside schools across different states/territories having varying expectations about what should happen there although we understand potential disruptions caused by numerous therapists working simultaneously during class hours. Therapy effectiveness increases significantly if integrated seamlessly among diverse contexts becoming part everyday activities rather than isolated events occurring only occasionally outside regular schedules. Many successful models exist without disturbing classroom operations including assisting youth socially situated situations at school premises itself requiring cooperation amongst educators, parents & clinicians aiming achieve practical beneficial results for kids involved.

Recommendations:

• Exchange knowledge regarding effective strategies supporting students within educational institutions
• Develop mutual understanding concerning anticipated roles played by all parties engaged in teaching process integrating therapy contributions appropriately

ACCESS FOR PEOPLE WITH PSYCHOSOCIAL NEEDS

This area presents considerable challenges particularly relating mental health requirements alongside other conditions especially autism spectrum disorder (ASD). Depending mainly upon primary diagnosis determines which government body handles support provision meaning young people diagnosed with multiple disorders face increased risks due insufficient transparency surrounding eligibility criteria affecting their ability obtain proper care timely manner despite FACS and similar entities intending assist children possessing NDIs plans assuming disability services would manage such cases adequately however this proves challenging when crises arise focusing primarily on psychological social aspects creating obstacles preventing families from acquiring needed assistance prompting discussions around relinquishment as possible solution gaining required help whenever necessary exists need strengthening collaboration between child protection agencies ensuring collective efforts directed toward safeguarding vulnerable households.

Exploring how clients change and how NDIS can support and be flexible

TRANSITION OF STATE AND TERRITORY SERVICES Whilst we appreciate that any transition process is very difficult the staged transition has lacked clarity and has been highly challenging for providers. There has been poor communication from governments and lack of clarity around funding reductions and expectations. With the residual funding unrealistic targets are being set and many NGO’s are working beyond the funding boundaries to try and support existing and new clients. Providing interim services is generally at a cost to the NGO and this has a significant financial impact on organisation. Many families and individuals are finding the process to enter the NDIS very time consuming and at times this has put a strain on the relationship the NGO has with the client as they are frustrated and expect organisations to continue services until the NDIS is in place which has a financial impact on the service providers. Providers are not being able to voice the concerns or provide details on the number of clients waiting for NDIS plans (Aspect Therapy has over 2600 clients awaiting eligibility or entry into the NDIS) as it is based on numbers transitioning not on numbers not yet to even apply for the NDIS or newly diagnosed individuals.

Recommendations: - Establish a transition plan and communicate it clearly to families and providers - Try to reduce the number of changes to processes and be transparent - Provide up to date information and KPI’s so organisations can establish the risk and true cost to continue to support clients - Acknowledgement that in the transition period organisations need bridging funding to cover all the costs of supporting families to access the NDIS

The consistency of NDIS plans and delivery of NDIS and other services for people with disabilities across Australia; Being an established provider across 4 states we have seen firsthand the significant variation and inconsistency of plans across ages and across and within regions. We see a large number of plans and it is evident that the skill of the individual planner has a significant impact on the quality of documentation and funding allocation. It is also dependant on the parents’ skills - if a parent is confident to advocate the plan will reflect while vulnerable families and those who do not have the skills or inclination to advocate strongly have reduced funding packages. It is also noted there are no minimal standards or expectations around the development of a plan or how many contacts must be made with an individual. Timelines for plan development are not adhered to and the process of plan reviews is not clear. It is also noted some planners need further training in disability to be able to develop goals and make appropriate decisions. Further funding needs to be available to support translation and interpreting services. We have noted similar findings when plans have been produced by Local Area Co-coordinator and NDIS planners.

Recommendations: - Clear expectations of the skills and experience and training for those undertaking the planning process - Clearer guidelines regarding reasonable and necessary supports - Some auditing of NDIS packages to identify areas of inconsistency and target these - Forums for hearing concerns of providers and action plans to address concerns - More support for vulnerable individuals and families to ensure that their needs are met in the planning process and that they utilise their packages.

The rollout of the Information, Linkages and Capacity Building Program; and any other related matters. The ILC funding implementation has been delayed and there has been limited clarity around the next tender process. Aspect strongly supports the ILC funding and understands this will enable services that fall outside the NDIS that are critical to continue to be delivered. As there is such a

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high volume of important services the process is highly competitive and due to the application process it has led to piecemeal approach rather than looking at the current gaps and meeting them.

RECOMMENDATIONS

• Data analysis of current service gaps to support decision making of future successful applicants.
• For funding to be greater than 12 months in duration with strong evidence of outcomes and sector impact.

OTHER ISSUES

Portal – service bookings and payment of providers

The changes to the portal in July 2016 have had a very negative impact on providers and participants. The service booking process is very inflexible and it is difficult for participants to access choice and control when providers are not able to edit service bookings. Issues that have been raised are often not followed up and resolved leaving organisations out of pocket for considerable time which threatens financial viability.

RECOMMENDATIONS

• Any major portal changes need to be trialled.
• Providers need to be able to edit service bookings directly
• Key contacts should be provided to organisations so that issues can be followed up

Work force issues

Ensuring there will be a high quality work force available to provide services is critical and the number of workers required is very large and finding high quality staff is difficult. Organisations need to provide a substantial investment in staff to equip them with the skills to provide services in a family centred – person centred framework.

RECOMMENDATIONS

• National snapshot of work force requirements and development of a work force plan in collaboration with tertiary and training organisations.

Relinquishments –

Families and carers who are at risk or considering relinquishment feel the only option is to leave the individual at a hospital. This impacts on the health system and reflects poorly on disability services.

RECOMMENDATIONS

• Need a strategy and facilities staffed to support high risk clients
• Implement a emergency response plan in collaboration with NGO’s and government agencies
• Expand providers skills in working with complex cases.

Rachel Kerslake National Manager Aspect Therapy

Maryanne Pease Southern Regional Manager Aspect Therapy

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