8.1
The committee learned that participants’ success in obtaining supports that match their needs may depend on their ability to advocate for their needs, or the ability of their support networks to do so. However, particular factors besides a participant’s disability may affect their ability (or the ability of their support network, if they have one) to advocate for a plan that will meet their needs. Submitters and witnesses noted that these factors may include:
Poor literacy, including health literacy.
Coming from culturally and linguistically diverse (CALD) backgrounds.
Being Aboriginal or Torres Strait Islander.
Being in out-of-home care.
8.2
For example, the Public Service research Group UNSW Canberra argued that factors that drive inequities in general—such as age, gender, health, ethnicity, education, socioeconomic status, residential location, and household structure—have become ‘fault lines’ in National Disability Insurance Scheme (NDIS) plans. Similarly, Mr Peter Tully from Every Australian Counts told the committee that particular groups of people with disability may be disadvantaged in the planning process, with planning even ‘entrenching disadvantage’:
[T]his scheme is turning into a dual-track system, where people who have advocates or families in their corner, or who are more well-resourced and more well educated, can get one set of outcomes…while those people who don’t have those things, who perhaps come from a culturally or linguistically diverse background, who have more complex needs, who maybe come from an Aboriginal or Torres Strait Islander background, who don’t have families in their corner to go in to bat for them, are getting a…poorer set of outcomes. If we don’t do something to address this issue, of people who need more help as they move through the system, we’re going to end up entrenching disadvantage instead of working to counter it.
8.3
Consultation feedback to the 2019 Review of the National Disability Insurance Scheme Act 2013 (NDIS Act) led by David Tune AO PSM (Tune Review) similarly suggested that people with disability who have support to navigate the NDIS tended ‘to achieve better outcomes than those who do not have the help they need to navigate the system by themselves’. The Tune Review argued that supported decision-making ‘is particularly important for people with limited capacity to make decisions or self-advocate’. The Tune Review recommended that the Commonwealth Government provide ‘additional funding for people with disability to navigate the NDIS’ of around $45 million over three years to 2022–23.
8.4
This chapter outlines issues raised about planning for particular groups of participants who, because of vulnerability factors, may experience problems during the planning process that many other participants do not. These groups include the following:
Participants with psychosocial disabilities.
Participants with other disability types.
Participants experiencing family violence.
Aboriginal and Torres Strait Islander participants.
Participants requiring early intervention.
Children and young people.
Participants from low socio-economic backgrounds.
Participants in custodial settings.
Participants in out-of-home care.
Participants from CALD backgrounds.
Participants with complex needs.
8.5
The chapter also outlines the evidence the committee received proposing that the NDIA promote planner expertise in certain disability types or for certain groups of participants. It concludes with the committee view and recommendations.
Participants with psychosocial disabilities
8.6
One participant called for ‘real change in the NDIS…I want it done as quickly but as carefully as possible because speaking from my own experiences, the NDIS is failing participants with psychosocial disability’.
8.7
Submitters and witnesses outlined the following issues arising during the planning process that may be particularly relevant for participants with psychosocial disability:
Planner questions not taking into account the impact of psychosocial disability.
Limited planner understanding of psychosocial disability.
The planning process overly relying on functional assessments.
Planners not considering the episodic nature of some psychosocial disabilities.
Planners not including supports for psychosocial disability.
The need for support coordination.
8.8
One participant outlined the impact of a planner asking them closed questions that did not take into account the impact of psychosocial disability on their level of functioning:
The planner’s questions were all closed questions like,
“Do you drive a car?”
If I said yes that would be viewed as being too functional. If I said no that would be untruthful. The answer is yes but only when I am well enough to leave the house, have the concentration to drive, when I know the route and in quiet traffic. The planner was only interested in a yes or no answer and that was unfair.
8.9
The Mental Illness Fellowship of Australia (MIFA) also suggested that planners may not be asking the right questions to determine the functional impact of psychosocial disability on a participant. As an example, MIFA outlined that a planner might ask a participant in a planning meeting whether they can cook, to which a participant might answer yes. Without further questioning, which could reveal that the participant eats instant noodles every meal, the planner might assume that the psychosocial disability has a limited functional impact on the participant.
8.10
Multiple submitters suggested that planners continue to show a lack of understanding of psychosocial disability and its impacts, such as the impact of anxiety on participants during planning meetings. For example, Amaze argued that there is a lack of understanding among planners ‘of the high occurrence of mental health concerns and autism’. Some parents had reported to Amaze that planners assumed that depression and anxiety are ‘just part of autism’ and not adequately funded mental health issues in plans.
8.11
Kelmax Disability Services recommended that the NDIA have specialised planners for psychosocial disability. Others called for increased capacity building and/or training on how to plan for participants with psychosocial disability. Roundsquared also recommended that for the NDIA to consider creating a mental health peer worker role within planning teams ‘to improve their understanding of recovery, social inclusion, stigma and how mental illness can impact on the participant’s physical health, economic and employment status and their social and community engagement’.
8.12
One participant suggested that planners were relying on criteria related to function that were more relevant for someone with a physical or intellectual disability and ‘almost irrelevant’ for a participant with a mental illness:
Being able to function in life is so much more than being able to shower, drive myself to appointments, cook meals, shower myself and all the other things the NDIS refers to as ‘functioning’. I can be extremely unwell mentally and still appear to be quite ‘functional’ according to the NDIS. Someone like me who is intelligent, well-educated and who has knowledge and insight into their mental illnesses can appear to be far more functional than they actually are. The reality is that most of the time, I am very depressed, easily distressed and can quickly become suicidal, yet I still push myself through each day just to exist.
8.13
The Australian Psychological Society suggested that planners were ‘inappropriately’ determining the type of psychological interventions participants needed, rather than relying on experts to do this. The issue of planners disregarding expert reports is outlined in Chapter 6.
8.14
Other submitters called for planners and plans to take into account the episodic nature of some psychosocial disabilities and to allow for greater flexibility in funding and service use.
8.15
Some evidence suggested that supports for psychosocial disability were being deliberately excluded from plans. The Australian Psychological Society stated that it was ‘aware that planners have been known to actively advocate against the inclusion’ of psychological supports and interventions for psychosocial disability. It further informed the committee that where NDIS plans included behaviour support interventions, they may provide limited time and little or no funding for training of staff and family members to build capacity.
8.16
Dr Tony McHugh, a Senior Policy Adviser at the Australian Psychological Society, argued that there is a ‘frequent failure to include psychology interventions in NDIS plans for those with psychosocial disability, even where those participants have a clearly documented need for those interventions’. He stated that the Australian Psychological Society has ‘clear evidence’ of ‘active advocating by planners against the inclusion of psychology interventions in plans and/or in favour of the provision of interventions by other providers’.
8.17
MIFA acknowledged ‘the ongoing good work that the NDIA is doing to address the inadequacies that exist for participants with psychosocial’ disabilities accessing the scheme. However, it argued that ‘further enhancements are needed’, including funding for support coordination in all plans for people with psychosocial disability, given participants with psychosocial disability are more likely to need additional support to implement their plans. The National Mental Health Commission (NMHC) suggested that people with psychosocial disability may be more likely to need additional support to implement their plans, in which case support coordination would be particularly useful.
8.18
Kelmax Disability Services suggested that because many therapists working with people with psychosocial disability take a recovery oriented approach, their reports when articulating a person’s needs and goals may not align with the language of the NDIS, leading to the participant not securing appropriate funding. This issue is outlined further in Chapter 6.
8.19
A further issue outlined in evidence concerned the impact of reduced funding for supports for participants with psychosocial disabilities, which may increase the risk of relapse, increase costs to the health system through admission to mental health units, and cause deep distress to participants and their families. The issue of funding for supports is outlined further in Chapter 3.
8.20
The Council of Australian Governments (COAG) Disability Reform Council in October 2019 reported that it had agreed to improve the experiences of participants with psychosocial disability who are in the NDIS:
The Council agreed to an approach to improve the access and experience for participants with psychosocial disability in the NDIS and to address interface issues between the NDIS and mainstream mental health systems. The Council’s discussions underscored the importance of improving access to the NDIS for people with psychosocial disability through a range of strategies, and the need for effective interaction between the NDIS and the clinical mental health system through a coordinated approach to care, information sharing and concurrent supports, which are critical to optimising outcomes for people requiring both mental health treatment and psychosocial disability support. The Council welcomed the establishment of a Psychosocial Disability Recovery Framework, with a strong focus on recovery and supporting episodic needs, noting that this would be developed in consultation with states and territories.
The NDIA’s position
8.21
The NDIA informed the committee in answers to questions on notice provided in January 2020 that the national roll-out of psychosocial awareness training for the planning workforce was completed in June 2019 and is now included in its New Starter Program of training. It further advised in October 2020 that it has a team of Strategic Advisors that provide expert advice in a number of areas, including psychosocial disability, to help ‘NDIA Planners to make informed and appropriate decisions regarding supports for participants’.
8.22
Since July 2020, the NDIA has made available psychosocial recovery coaches to support participants with psychosocial disabilities ‘to take more control of their lives and to better manage the complex challenges of day-to-day living’. Participants, according to the NDIA’s website, are able to choose a recovery coach with lived experience, or a recovery coach with learned knowledge of psychosocial disability and mental health.
8.23
The NDIA also in a publicly available document on the psychosocial recovery coach program, stated that, in consultation with jurisdictions and Mental Health Australia, it has identified the following priority areas for improvement in how it addresses psychosocial disability:
Improving the NDIS access process.
Better responses to the episodic nature of psychosocial disability.
The introduction of evidence-based psychosocial disability supports into the NDIS to improve social and economic participation for persons with psychosocial disability.
8.24
The NDIA has committed to developing a national framework for recovery-oriented psychosocial disability services in the NDIS, to be released in 2021.
Participants with other disability types
8.25
The committee received a large body of evidence from advocacy groups outlining concerns and suggestions for groups of participants with particular disability types, in addition to participants with psychosocial disabilities.
8.26
Other evidence expressed concern about planning for participants with multiple disabilities. For example, ADACAS Advocacy emphasised the importance of planners recognising ‘that there is typically both a cumulative but also a compounding impact where a person has multiple disabilities …and/or health issues/ and/or other stressors’, and proposed that planners work with participants to look at the compounding impacts of multiple disabilities and health issues.
8.27
First Voice argued that children with multiple disabilities are often granted insufficient funding, ‘well below the sum of the cost of the services needed for each of their disabilities’. It recommended that ‘early intervention supports for children with multiple disabilities be determined for each disability separately’.
8.28
This report does not examine issues raised about planning for these groups in detail, given that many of the issues and solutions proposed mirror the issues and solutions outlined elsewhere in this report that are relevant for participants in general. However, evidence provided by these groups and participants is outlined throughout the report and was used to inform the committee view and recommendations.
Participants experiencing family violence
8.29
A further issue mentioned was planning for participants experiencing family violence, particularly women.
8.30
Women with Disabilities Victoria (WDV) expressed concern that planners do not have sufficient training in recognising and responding to family violence, even though ‘the rate, length and severity of violence against women with disabilities is extremely high’. WDV noted that the ‘Convention on the Rights of Persons with Disabilities requires that state parties recognise that women and girls with disabilities are at a particularly greater risk of violence, abuse and exploitation’.
8.31
Ms Leah van Poppel, the Chief Executive Officer (CEO) of WDV, pointed to research indicating that women with disability experience more violence in proportion than men with disability, or persons without disability. She argued that planners should have training equipping them to deal with instances of family violence:
[W]omen who have experienced domestic violence previously say that planners are not necessarily alive to some of the issues that might come about from having a family member in a planning meeting. Particularly in the instance where a woman with disability is experiencing family violence, one of the ways that that violence can express itself is by denying access to services or trying to limit those and increase the woman’s dependency on informal support...
As an example, we heard a story of a woman whose partner took one of the small wheels off the front of her wheelchair while she was still in bed. There are some family violence services and disability services who would go: ‘He’s just removed a part. Maybe the wheelchair was faulty.’ But that is actually restricting that woman’s movement completely, and that is a form of violence.
8.32
WDV recommended that the NDIA should ‘institute clear processes and training around using a risk assessment tool to assess family violence for women with disabilities’, with these processes also applied for participants who need Supported Independent Living (SIL) supports in their plans.
8.33
This committee recommended in its interim report that the NDIA ensure that all persons involved in the planning process receive training in domestic violence awareness. The Australian Government in its response to this recommendation stated that:
With respect to training in domestic violence awareness and support, the NDIA has a mandatory eLearning module on Family and Gender Based Family Violence Prevention for all staff and will consider further options.
Aboriginal and Torres Strait Islander participants
8.34
As of September 2020, 6.6 per cent of participants identified as Aboriginal and Torres Strait Islander peoples.
8.35
Issues highlighted in the inquiry concerning planning for Aboriginal and Torres Strait Islander participants included the following:
The number of Aboriginal and Torres Strait Islander participants with a plan.
The need for Indigenous planners.
Culturally appropriate planning and cultural safety.
Language and communication.
The appropriateness of planning meetings held via phone
Need for support coordination.
The impact of thin markets on remote Aboriginal communities.
8.36
Occupational Therapy Australia noted ‘the relatively low number of NDIS plans for Aboriginal and Torres Strait Islander peoples’ in some parts of Australia compared to the total number recorded as having a disability. It suggested that the NDIA may need to adopt ‘a greater focus on the cultural safety of Aboriginal and Torres Strait Islander peoples accessing NDIS support’, and working with community partners to engage family members in the planning process.
8.37
The Aboriginal Health Council of South Australia (AHCSA) called for the NDIA to develop strategies to build a strong Aboriginal workforce, particularly planners, arguing that it ‘is well-documented that there is a higher success rate for government initiatives when Aboriginal people are involved and employed in meaningful roles’. It highlighted one case study in South Australia where a local Aboriginal person was employed as a local area coordinator (LAC), leading to increased trust in the NDIS and increased community participation. It suggested that the NDIA have designated Aboriginal Planners to work specifically with Aboriginal participants.
8.38
The National Aboriginal Community Controlled Health Organisation (NACCHO) proposed that the NDIA establish Indigenous cultural safety accreditation standards for providers to meet and gain certification, and that all NDIA staff, contractors, LACs and planners be required to have completed a minimum level of cultural awareness training. It also recommended that the NDIA develop a strategy to develop a workforce of Aboriginal and Torres Strait Islander planners.
8.39
Other evidence highlighted the need for culturally appropriate services for Indigenous people with disability. For example, AHCSA suggested that ‘Aboriginal people will only access those services where they feel culturally safe and prefer to use Aboriginal community-controlled health services when available’.
8.40
Somerville Community Services, an organisation operating in the Northern Territory that works with NDIS participants who identify as being of Aboriginal descent, drew the committee’s attention to the question of whether planners are taking into account Aboriginal participants’ connection to family, country and culture:
Many of these people were born in remote communities and due to their high level support needs had no other option but to relocate to urban areas to access essential supports. An emotional connection to family, country and culture remains an enduring feature in the lives of many of these people and should be considered in the development of participant plans. Our experience is that many planners do not fully understand these connections for Aboriginal people who may have not lived on their country for many years. We have received inconsistent advice on whether ‘return to country’ for short visits to connect with family, or participate in ceremony, is funded under the NDIS as some planners have considered those visits as a holiday rather than a cultural, necessary and reasonable support requirement.
8.41
Community Mental Health Australia outlined feedback it had received from a community managed organisation stating that assessment and planning ‘is not culturally appropriate with NO resources for [Aboriginal and Torres Strait Islander participants] other than “simple English” which is still quite challenging’.
8.42
Somerville highlighted that many NDIS participants in the Northern Territory are Aboriginal who speak English as a second, third or even fourth language. As such, Somerville argued, access to interpreters for these participants ‘is a reasonable and necessary support’ that may be needed during pre-planning as well as when accessing allied health assessments and developing therapy plans. Somerville called for ‘immediate consideration of the incorporation of funding for interpreters into participant plans’ where the participant does not speak English as a first language.
8.43
Services for Australian Rural and Remote Allied Health noted that although telephone meetings may be carried out in rural and remote areas, these may not be culturally appropriate. It highlighted the suggestion that planning meetings ‘be held face to face and preferably with locals who have established relationships within the community’ particularly for ‘rural and remote Aboriginal and Torres Strait Islander communities’.
8.44
AHCSA provided one example of a participant who, at the end of a planning meeting, was asked to choose a support coordinator ‘by showing the participant a poster with the names and associated logos of all available’ support coordinators. AHCSA also argued that no explanation was offered to the participant as to what a support coordinator is. ‘It was at this point,’ AHCSA submitted, that a representative from a local health service, who accompanied the participant to the meeting, ‘pointed out that one of the organisations had never serviced that particular community’.
8.45
NACCHO submitted that approximately 75 per cent of Aboriginal and Torres Strait Islander participants require support coordination, compared to
25 per cent of other participants. It called for support coordination to be given to all Aboriginal and Torres Strait Islander participants.
8.46
While the issue of thin markets for rural and remote areas is discussed in greater detail in Chapter 9, the inquiry received evidence outlining the impact of thin markets on, particularly, remote Aboriginal and Torres Strait Islander communities. Early Start Australia argued that a short-term focus on costs and requiring providers to quote and compete with other providers every time they need to visit a community did not allow providers to build critical relationships with clients or ensure continuity of service. It suggested block funding charter flights would allow providers to make regular bookings and ensure all participants needing supports would receive them. Early Start Australia also proposed that community members, including families, be provided training and support in therapy settings to provide non-professional support to participants, with on-going support at a distance.
The NDIA’s position
8.47
The NDIA has an Aboriginal and Torres Strait Islander Engagement Strategy which, as of January 2020, was under review. This Strategy is a ‘statement of the [NDIA’s] commitment to walk with Aboriginal and Torres Strait Islander communities in delivering’ the NDIS. The NDIA stated in the Strategy that it aims ‘to develop a collaborative planning and working model to inform practice which can meet the needs of Aboriginal and Torres Strait Islander peoples with disability, their families, carers and communities’. The Strategy notes that the NDIA provides ‘cultural competency training to its staff and partners’ and recognises the importance of country, culture and community.
8.48
The NDIS also has a National Community Connectors Program (NCCP) ‘for community groups who might need additional support to access the NDIS because of social, cultural and economic barriers’, including Aboriginal and Torres Strait Islander communities. Community Connectors, along with LACs and Early Childhood Partners, support participants and their families during pre-planning, planning and plan review meetings and provide assistance to participants throughout the planning and plan review process.
8.49
The NDIA provided the committee with an outline of its efforts to ensure the scheme is ‘accessible and effective’ for participants who are Aboriginal and Torres Strait Islander peoples:
The government committed $20 million to extend the NDIA’s Community Connectors Program to support and assist hard to reach communities to navigate the NDIS. It is anticipated this will increase to 121 Community Connectors covering 344 remote communities. Additionally, specific urban and rural Local Government Areas will be targeted for the expansion based on need... The NDIA is working closely with a range of stakeholders, such as Aboriginal Community Controlled Organisations, to develop approaches to service delivery models that are culturally appropriate and utilise local capacity and capability.
While there may be similarities in the cultures and languages of Aboriginal and Torres Strait Islander people, it is also essential to recognise that participants, families, communities and informal supports also have their own unique needs. The NDIA is working to ensure that communication and information about the NDIS is locally tailored, culturally responsive and community appropriate. The NDIA Aboriginal and Torres Strait Islander Engagement Strategy was release in March 2017 and is currently under review.
8.50
AHCSA noted the success of the Remote Community Connector program ‘to facilitate culturally appropriate engagement, improve understanding of the [NDIS] and enable better plans to be developed’. It indicated its support for the increased number of positions around Australia but expressed its disappointment that there was ‘no intention to increase the numbers of Remote Community Connectors across South Australia. In fact, two of our communities have had funding for these positions withdrawn’.
8.51
On 2 July 2020, the Minister for the NDIS, the Hon Stuart Robert MP, announced that the NCCP would be expanded, following a commitment to a $20 million expansion in November 2019. The focus of the program, according to Minister Robert, is to engage and support people with disability from four specific population groups, including Aboriginal and Torres Strait Islander communities.
Participants requiring early intervention
8.52
As of September 2020, 7,977 children were receiving support in the Early Childhood Early Intervention (ECEI) gateway, which is a special pathway for some children aged 0–6 who may not need to go on to make an access request to the NDIS. Major themes that arose in evidence concerning participants who need early intervention included the following:
Underfunding for supports.
Planners questioning the value of early intervention.
Plans not including particular supports.
8.53
One of the main issues that submitters raised was wait times for children between meeting access criteria and receiving a plan, given the importance of early intervention for young children. Noah’s Ark Inc noted that the process of referral to the NDIS through to determining eligibility through to planning can take ‘many months for families, sometimes almost a year, wasting crucial developmental opportunities at a time when the brain is developing rapidly’. Noah’s Ark Inc also argued that the “‘early’ has been lost from early childhood intervention’ and that this length of time in ‘a child’s neural development is far too long to sacrifice for this planning approach’. It contended that the ‘current system of planning is not working and is wasting crucial time in a child’s development and limited resources in the scheme’.
8.54
Amaze echoed this, recommending that the ‘NDIA should adhere to the set guideline of prioritising plan development to within six weeks for children under six with a developmental delay’.
8.55
In one instance, the committee was informed, it took 18 months for a child to receive their revised first plan, between applying for the NDIS, having their first planning meeting, receiving a plan, getting a plan review and appealing to the Administrative Appeals Tribunal for an external review. The mother of this participant suggested that the NDIA triage early intervention because ‘this is a critical time period which research has consistently shown to be of utmost importance in shaping the child’s ability to speak, engage socially, and ultimately participate’ in the community.
8.56
Several submitters suggested that some planners may not be aware of the value of early intervention. Autism Aspergers Advocacy Australia argued that that senior NDIA officials have ‘said the advice on evidence-based early intervention for autistic children is “contested”‘. The AEIOU Foundation similarly noted that some planners expressed their own opinions on the validity and worth of things such as early intervention.
8.57
Other submitters contended that plans for children in the ECEI pathway often do not adequately take into account the following:
Family related goals, including goals related to building family capacity.
The need for early intervention to be delivered within the child’s natural learning environments.
8.58
Further, Early Start Australia submitted that ‘in early intervention therapy services, we see plans with significant core funding provided, but with very little funding allocated for therapy services’. Because of funding variations, it argued some children may have funding for as little as an hour a month of therapy, while others may receive 3–4 hours a week, despite having similar goals and needs and being the same age. Early Start argued that there ‘is no evidence at all to support sporadic therapy intervention and it is unlikely positive outcomes can be achieved with this approach’. Further, it argued that a small amount is spent for young children with autism, increasing up to four times as they approach adulthood. Early Start contended that this ‘is the wrong approach and is not consistent with the principles of an insurance scheme designed to support the right interventions in early childhood to prevent…lifetime support’.
8.59
Early Childhood Intervention Australia Victoria/Tasmania argued that compared with the past, the key worker model is much less likely to be chosen or incorporated into plans, meaning families no longer have access to an adequately experienced and qualified practitioner who has a deep understanding of the child and the family and will advocate on their behalf.
8.60
Another issue raised concerned planner expertise. Noah’s Ark Inc provided an example of a family who transitioned from the ECEI pathway to the NDIS and had a planning meeting with a LAC without experience in the sector, who rejected most requests for support. As a result, Noah’s Ark Inc argued, the participant was no longer to attend school without his mother, who could not ‘re-engage with the NDIS and experience the trauma of her first meeting with the LAC’. Noah’s Ark Inc ‘highly recommended’ that the NDIA recruit staff with qualifications in early childhood education or therapy and experience working with young children with disabilities.
8.61
Scope (Aust) Ltd argued that in Victoria, the transition from state government services to the NDIS ‘has been complicated by a shift away from the established Early Childhood Intervention (ECI) service model’, leading to ‘poorer outcomes for many children aged 0–6’. Scope contended that ‘plans are not always developed by someone with sufficient expertise. Planning for children aged 0–6 should always be undertaken in collaboration with skilled ECI practitioners’.
Tune Review
8.62
The Tune Review suggested that the timeframes proposed in the Participant Service Guarantee may lead to low-quality plans that do not take into account the range of support networks and professionals needed to inform plans for children needing early intervention. It suggested that ‘another model is needed to ensure early intervention supports flow as soon as practical’ even before a family begins plan implementation. As such, it proposed that the NDIS Act be amended so that the NDIA can fund early intervention support for children before a plan has been approved, so as ‘to develop family capacity and ability to exercise informed choice and control’.
8.63
The Australian Government supported this recommendation and stated that further detail in line with the intent of the recommendation was ‘being considered as part of the NDIA’s current strategic review of the Early Childhood Early Intervention (ECEI) approach’. It also stated that the NDIA was looking at how to increase Early Childhood Partner capacity and capability.
The NDIA’s position
8.64
As of September 2020, the NDIA had commenced a review of the implementation of the ECEI approach and stated that it intended to ‘consult widely on this project, including with families, peak bodies, the early childhood sector, and state and territory governments’.
8.65
The CEO of the NDIA, Mr Martin Hoffman, at the hearing in October 2020 informed the committee that wait ‘times have been substantially reduced’ to an average of 42 days for children to receive their first plan.
Children and young people
8.66
Some evidence concerning children and young people as a group raised distinct, separate issues to those raised about participants requiring early intervention (who are under the age of seven and may not be full NDIS participants yet). These issues included the following:
The need for plans for children and young people to take into account developmental stages.
Wait times for assistive technology (AT).
Plans focusing on individual therapies rather than community-based supports.
The need for the NDIA to provide communications and published information that recognises the level of younger participants.
The need for family members to also be supported to help a child learn.
8.67
Noah’s Ark Inc argued that ‘the focus, design and expertise of the NDIA does not reflect the population it is serving’, with almost half of NDIS participants being under the age of 19. As such, it proposed that the ‘NDIA develop its expertise in working with children and young people through developing expert advisory committees’, as well as develop ‘branches specifically focussed on children aged seven to 12 years and 15–18 years’.
8.68
On the issue of developmental stages, Children and Young People with Disability Australia (CYDA) argued that the children and young people with disability have ‘distinctly different’ service needs to adults with disability, meaning that targeted strategies are required. It called for ‘targeted information and phone support for families of children and young people with disability’, arguing:
[T]here is a key information gap about how the NDIS will support child and adolescent development across the different stages of childhood, adolescence, transition to adulthood and adult life. There is the need for evidence-based tailored information with a developmental lens for different stages in life, for example 0 to 6 years, 7 to 14 and 15 to 25 years.
8.69
CYDA reported that some child participants may experience long wait times to access assistive technology and equipment, providing the following quotes from families of participants:
It took over twelve months to get new ankle foot orthotics for my daughter—I had to go to my local Member of Parliament…My daughter was 6 years old and had been wearing them since she was 3 years old. I also had to fight for a budget in her new plan for a replacement set… Planners are too ‘insurance focused’; I am trying to build my daughter’s capacity NOW so she is a more capable adult—but all the planners can see is trying to save money.
Waiting over 18 months for essential equipment for my son’s physical disability has been a joke. He has also been in a too small wheelchair for two years…Thankfully now the new wheelchair is being made, but two years of my son being in a too small wheelchair has caused physical pain and issues and increased anxiety. NDIS is supposed to help the participant, not make them worse.
8.70
CYDA contended that plans were focusing on individual therapy, rather than other, community-based supports such as swimming and Riding for the Disabled. CYDA argued that ‘what drives development is children’s meaningful participation in everyday activities and environments’, and that individual therapies should not be exclusively prioritised over other forms of support.
8.71
Noah’s Ark Inc also suggested that the NDIA review its communications and published information ‘to adequately recognise the level of participants aged under 19 years’.
8.72
Noah’s Ark Inc further proposed that the key adults spending time with a child may need professional support to understand the child’s complex learning needs:
An approach in which all the learning is supposed to happen during the therapy session by a professional will not be effective. For example, if the only way a child learnt language was through a fortnightly visit from a language teacher then they would not learn to talk. Language needs constant interaction in which to develop. The same is true of other aspects of children’s development.
8.73
As such, Noah’s Ark Inc made the following arguments about planning in relation to children:
The current planning approach does not demonstrate an understanding of the factors that impact on a child. It considers the child in isolation from their environment. It does not recognise how children develop. It does not show any indication that early intervention for young people should be a matter of urgency. It needs to be redesigned with appropriate professional advice immediately...The NDIS cannot provide the complex and ongoing type of planning process that children and young people need. Children and young people require a dynamic model of planning that responds to the fact that they are developing and changing.
8.74
CYDA proposed that the NDIA should update the approach of the NDIS to childhood ‘by building on the differentiated ECEI approach for younger children and formally recognising the importance of the middle childhood and adolescent periods for children’s development’.
The NDIA’s position
8.75
The NDIA informed the committee in October 2020 that its New Starter Program includes training for planners and LACs on how to undertake planning conversations about changes to participants’ circumstances, including particular developmental and life changes:
Discussion about changes in circumstances incorporates changes in life stages relevant to the particular participant, such as the transition of participants into (primary) and out of (secondary) formal schooling and participants who are ready to transition out of the family home into supported or independent living arrangements, or out of supported care into independent living.
Technical and subject matter experts in the NDIA Early Childhood Services team also provide specialised training for all planners and Early Childhood Early Intervention (ECEI) Partners who develop plans for participants 0–6 years.
Participants from low socio-economic backgrounds
8.76
A number of submitters highlighted that participants from low socio-economic backgrounds with limited education and support may not be able to advocate for their needs relative to participants who are well-supported and/or are able to navigate the complexities of the NDIS, particularly requested reviews. Autism Spectrum Australia suggested that ‘the participants who receive inappropriate levels of funding often [have] the least capacity to ask for reviews, or…the means to go through the appeals process’. Families from low socio-economic backgrounds, it submitted, ‘are struggling to access diagnostic services…if they cannot pay for private assessments…Waitlists for assessment services, both public and private, are lengthy’.
8.77
Maurice Blackburn Lawyers expressed concern that the NDIS ‘is creating different classes of beneficiaries, and this in turn is creating an access to justice issue’. It suggested that there is a divide between participants ‘who have the wherewithal and financial resources to access expertise that will enable them to judge whether or not their plan is fair, and those who lack those resources’. In particular, some participants may not be able to afford supporting reports from allied health professionals and medical experts, which may then impact on the outcomes of their plans.
8.78
As outlined in other chapters, the NDIA recently announced that it will be introducing free independent assessments ‘which will give a simpler, faster and fairer basis for making decisions about access to the NDIS and plans’, particularly where participants are unable to afford consulting with experts to obtain expert reports and recommendations for the supports that would best suit them in their plans. Mr Peter Broadhead, the Group Manager of Participants and Performance at the Department of Social Services, acknowledged that the current planning process may not be fair for participants with less resources, and emphasised that independent assessments may go some way towards addressing unequal planning outcomes:
There’s some evidence to suggest that at the moment, because not everybody has the same access to professionals and the same resources to gain information et cetera, those with more resources might be better able to make applications than those with less resources, and that’s not a fair outcome. So moving to independent assessments in this way will actually yield a more level playing field for people to ensure that what we get is information about people’s functional capacity; it isn’t in some way, shape or form limited by their ability to assemble that from the various sources they currently have to go to.
Participants in custodial settings
8.79
Other submitters discussed particular issues relevant for participants in custodial settings (it should be noted that Chapter 5 discusses the interface of the NDIS and state/territory criminal justice systems in greater detail).
8.80
For example, National Legal Aid suggested that without ‘proactive discharge and pre-release planning’, NDIS participants in custodial settings may have their discharge or release delayed, or they may be more vulnerable to re-offending or readmission if they are discharged or released with inadequate supports in place.
8.81
National Legal Aid recommended that the NDIA increase the number of specialised, trained planners working in institutional environments, such as prisons and mental health inpatient settings. It stated that it ‘welcomed initiatives to introduce specialised planners and skilled support coordinators to assist clients with complex needs, particularly in institutional settings’. However, it called for an increase in the number of these planners and their training, and emphasised the importance of planning processes taking into account ‘the participant’s long term plans upon release and informal support networks’.
8.82
As outlined in Chapter 2, The Housing Connection reported that the ‘NDIA has advised us not to provide services to people who have no funds in their plans’. The Housing Connection argued that this advice leaves cohorts of participants ‘at risk to themselves and others’, including participants at risk of contact with the criminal justice system who have exhausted their funds. The Housing Connection argued that not delivering ‘a service that places someone at risk of harm is not acceptable’.
8.83
As discussed in Chapter 5, which examines the interface of the NDIS with state-based out-of-home care systems in greater detail, the COAG Disability Reform Council in October 2019 agreed that the NDIA would introduce Justice Liaison Officers (JLOs) in the states and territories to provide ‘a coordinated approach to supporting NDIS participants in youth and adult justice systems’. The Disability Reform Council ‘also agreed that targeted resources and training will be developed and implemented to improve the coordination of supports for NDIS participants interacting with the justice system’.
8.84
The NDIA stated in October 2020 that there are 17 JLOs currently working across all jurisdictions in Australia. JLOs, it informed the committee, help justice staff working in custodial facilities to ensure that potential and existing NDIS participants nearing release have appropriate disability supports in place for their transition back to the community.
Participants in out-of-home care and guardianship arrangements
8.85
A small body of evidence concerned child guardianship and participants in out-of-home care. For example, The South Australian Child and Adolescent Health Community of Practice in its submission drew the committee’s attention to children under the guardianship of state ministers:
The NDIS does not specifically prioritise services to this group of children and young people, and does not recognise issues such as Post Traumatic Stress Disorder, disruptive behaviour, language impairment and other issues specifically related to the early neglect and trauma these children have experienced when considering eligibility for the NDIS.
8.86
Cobaw Community Health suggested that some planners may not have training or experience in working with other government systems, leading to negative impacts on participants who may have a ‘long history’ with the out-of-home care, child protection and disability services systems.
8.87
As discussed in Chapter 5, which looks at the interface of the NDIS with state and territory child protection systems, in June 2019, the COAG Disability Reform Council announced an agreement ‘to work together to improve the service experience of families with children who are unable to live at home’, with all governments committed to providing ‘stable and supported arrangements for children living outside the family home’.
8.88
Since September 2019, the NDIA has funded 24/7 staffing for children living in accommodation outside the family home in addition to disability supports.
8.89
Mr Martin Hoffman, the CEO of the NDIA, also informed the committee that in its consultation process for independent assessments, ‘we are establishing a smaller sub-working group to go through…what we do for people who may have genuine trauma in their background’, which may be a concern for the process of independent assessments in particular, and ‘how we handle the provision of information from existing professionals who may be involved with the person, and take that into account’.
Participants from culturally and linguistically diverse backgrounds
8.90
As of October 2020, 9.2 percent of NDIS participants identified as culturally and linguistically diverse.
8.91
A number of submitters and witnesses suggested that participants from CALD backgrounds may be at a disadvantage in the planning process. Most of this body of evidence concerned issues with language and accessing interpreters.
8.92
The committee learned that participants from culturally and linguistically diverse backgrounds may struggle to access or understand information about the NDIS and about planning, meaning that they may not be well-prepared for a planning meeting or may struggle to understand goals written in the language of the NDIS. For example, People with Disabilities WA submitted that some participants from CALD backgrounds ‘have said that they do not understand the process and what is expected, and are often ill prepared for the meeting with the planner’.
8.93
The Housing Connection outlined an example of a Korean-speaking participant who spoke no English, whose request for his new plan to also include a Korean-speaking support coordinator was declined, with the reason that he was only eligible to be funded for a support coordinator once. Despite the participant’s lack of English, he was forced to communicate with all his service providers and approve invoices without a support coordinator. The Housing Connection reported that when he contacted the NDIA with the support of a staff member from The Housing Connection, he ‘was unable to answer or comprehend any NDIS related terms, ended up crying, and became verbally abusive due to the frustrating circumstances’.
8.94
Northcott noted that new participants continue to access the NDIS for the first time, including those from CALD backgrounds. It suggested that at a minimum, ‘having planners that have good skills and knowledge of other languages and cultures would assist this process’, and the NDIA could use targeted approaches to encourage more people from CALD backgrounds to become planners.
8.95
Scope (argued that something ‘as simple as having a suitable interpreter available during planning can be a critical factor in shaping the way that the final plan emerges’. However, the committee was also informed that despite the NDIA updating its processes and information on participants’ right to access interpreters, staff may not be aware of this. AMPARO Advocacy argued that NDIA staff, ECEI services and LACs may provide inaccurate information on interpreting to participants and ‘are often unaware of their obligation to have plans translated into the person or their family’s language if this is required, citing that this is “not possible”‘. AMPARO Advocacy also suggested that although participants and their families may prefer a specific interpreter because of stigma and issues of confidentiality, in practice it is very difficult to request a specific interpreter, meaning some LACs may be reluctant to do this despite the participant, their family or advocate asking them to do so.
8.96
Noah’s Ark Inc provided one example of a family where the mother of a participant required an interpreter and the father spoke conversational English. The family, Noah’s Ark Inc reported, ‘was not offered an interpreter and it was only by chance that the father was at home as he did not know that the meeting had been arranged’. Without an interpreter present, the father assumed that the meeting was a pre-planning meeting and expected that a Key Worker would be invited to a second session. However, the family subsequently received a completed plan via post.
8.97
AMPARO Advocacy suggested that planners were not leaving phone messages for participants if they did not answer the phone unless the participant included their surname on their voicemail message. It submitted that many participants and families from CALD backgrounds may not have adequate English proficiency to do this, or may not understand how to do it. Further, planners will only attempt to contact a participant three times, it argued, meaning that ‘people with CALD backgrounds with disability are falling through the cracks and without additional support, not accessing the NDIS’.
8.98
AMPARO Advocacy suggested that pre-planning may be especially helpful for participants from CALD backgrounds, as many people from this group may not have been connected to specialist disability services in the past and so may attend planning meetings with little understanding of what they are able to access. Further, it suggested that the NDIA currently provides few resources translated into languages of new and emerging and refugee communities to help participants from these groups prepare for their planning meeting. The issue of pre-planning is discussed separately in Chapter 12.
8.99
The Royal Australasian College of Physicians stated that currently there is no funding available in plans for language services, ‘which has implications for all people with low English proficiency or communication difficulties’. Queensland Advocacy Incorporated proposed that the NDIA ‘provide funding for translation services for CALD participants in planning and to engage with support coordination services’.
The NDIA’s position
8.100
The NDIA has a Cultural and Linguistic Diversity Strategy, published in 2018, which ‘focuses on ensuring that the NDIS is delivered in a manner that respects and takes into account the language and cultural needs of individuals needed to achieve full participation in the NDIS’. The priority areas of the Strategy include making information accessible; increasing community capacity and broadening consumer choice; and enhancing cultural competency with the NDIA and its partners. By 2019, the Strategy states, the NDIA’s goal was to:
continue to build its understanding of the interests and needs of people with disability from Culturally and Linguistically Diverse backgrounds when exercising choice and control;
embed this understanding in the design, planning, development and administration of the NDIS, while ensuring the financial sustainability of the Scheme; and
continue to enhance the quality of the NDIS experience for participants and providers in a way which supports cultural and language needs.
8.101
As of early 2020, the NDIA was progressively rolling out training programs focused on improving the service experience of, among others, participants from CALD backgrounds. The NDIA advised the committee in October 2020 that its Community Connectors Program, outlined above in the section on Aboriginal and Torres Strait Islander participants, also focuses on CALD communities.
Participants with complex needs
8.102
As outlined in Chapter 2, the committee in its interim report recommended that all participants with complex support needs be immediately streamed to an NDIA delegate to develop their plan and funding package. The Government supported this recommendation and noted that the NDIA’s new Complex Needs Pathway provides participants with complex needs ‘additional, tailored support in all aspects of their NDIS experience’. Participants in the Complex Needs Pathway complete their planning meetings with an NDIA delegate.
8.103
Benefits, according to the Victorian Office of the Public Advocate, arising from the Complex Needs Pathway are shorter timeframes of plans being delivered—usually within a week—and the built-in funding flexibility of the plans, in which funding can be adjusted without the participant needing to go through a full plan review, because planners are given authority to make these adjustments.
8.104
However, a number of concerns were expressed during the course of the inquiry about planning for participants with complex needs, among them:
Limited or no knowledge that a Complex Needs Pathway exists.
Uncertainty about which participants the NDIA defines as having complex needs and how to access this pathway.
Concern that experienced planners had been moved to the Pathway, impacting the quality planning for other participants.
Training needed for planners working with participants with complex needs.
8.105
One submitter advised that it had not seen any evidence of a complex pathways team, noting that two requests for participants to be given access to the pathway had ‘not been acknowledged, no feedback was provided, and they also received inadequate plans’.
8.106
Other submitters expressed confusion about what the term ‘complex needs’ means, who is eligible and how participants can access this pathway. For example, Multiple Sclerosis Australia noted that some participants who the NDIA deems complex, ‘intensive’ or ‘super intensive’ have their planning completed by an NDIA planner. Others may have a LAC involved in planning discussions, ‘only then to have the planning work repeated when it became obvious that the participant’s needs were “intensive”‘. Multiple Sclerosis Australia questioned how the NDIA determines whether a participant is ‘intensive/super intensive…and can this process be improved?’
8.107
Scopeargued that the term ‘complex needs’ is often used interchangeably with ‘complex disability’, and is not well defined or understood. It provided the following definition:
Complex needs arise from the interrelationships between individuals, environments and systems and often result from multiple and concomitant issues. Complex needs can include any combination of disability and physical health/medical conditions, mental health problems, challenging behaviour, alcohol or drug issues, contact with the criminal justice system, Aboriginal or Torres Strait Islander background, use of augmentative and alternative communication, a history of being placed in (or leaving) state care (i.e., child protection services; there are large numbers of children with disability in out-of-home care), homelessness or being at risk of homelessness.
8.108
ConnectAbility Australia argued that each planner has a different interpretation of what complex needs is. It raised an example of a participant at risk of sexual abuse from family members, who had other government departments and professionals involved. However, according to ConnectAbility Australia, this ‘case was still not deemed complex by [the NDIA]. If this case does not qualify[,] what does?’
8.109
People with Disabilities WA suggested that the understanding of NDIS planners of complex needs ‘appears often to be limited and finite’. It argued that complexity ‘can be more than the pointy end situations that may involve mental health, homelessness or justice interface’, and may include:
Multiple service providers.
Parent or carer capacity.
Families who have other members in the same home with disabilities or mental illness.
Refugee families who have experienced trauma.
Families from cultural and linguistically diverse (CALD) backgrounds.
Individuals who have complex needs with communication or behaviour
Multiple areas of support within a plan.
8.110
The Office of the Public Advocate (Victoria) informed the committee that its delegated guardians ‘often report that persistent advocacy is required to enter’ the Complex Needs Pathway, and that sometimes its staff must still escalate the issue with senior NDIA staff. It called for the NDIA to ‘develop a streamlined process’ for participants to enter the Complex Support Needs pathway, from when participants first access the NDIS.
8.111
The Royal Australasian College of Physicians called for health professionals to be able to refer participants directly to the Complex Support Needs Pathway, as well as ‘the introduction of expert resource teams to support services where the needs of participants are highly complex’ and for the NDIA to develop ‘a transparent set of standards, competencies and frameworks in order to reduce any unwarranted variation and to allow for accurate evaluation of outcomes’.
8.112
Several submitters acknowledged that planners within the Complex Needs Pathway had the expertise to work with participants with complex needs, and recognised the importance of liaising with other agencies involved in a participant’s life. However, these submitters suggested that because experienced planners have been assigned to the Complex Needs Pathway, this has ‘reduced the level of experienced planners’ working with other participants.
8.113
Others called for greater transparency on the kind of training that is provided to planners working with participants in the Complex Needs Pathway, or for planners in this team to have access to a group of experts to advise on the needs of participants with complex needs.
8.114
National Legal Aid proposed that more time should be taken and greater assistance given to participants with complex needs in the preparatory stages of planning. Further:
If information is needed to evaluate support needs, participants should be given the support to collect it. For participants with complex needs[,] intensive independent case management in the lead up to a planning conversation could significantly improve the quality of plans and the efficiency of the planning process.
The NDIA’s position
8.115
The NDIA in its submission to the inquiry in 2019 outlined the training and experience of planners working with participants who have complex needs:
The majority of NDIA planners working with complex participants have a minimum of five years’ experience in high-level case coordination, and a relevant professional qualification in disability, mental health, allied health, social work, education, justice or health/human services.
In addition, the NDIA has invested heavily in training recently as the Pathway reforms have been rolling out. NDIA planners and partners undertake a range of training programs prior to supporting participants.
8.116
The NDIA further explained that the Complex Support Needs pathway ‘acknowledges the range of primary and secondary situational and personal factors that contribute to the impact of complex support needs of a participant’. These, it stated, can include involvement in other government service systems and transition to return to the community following hospitalisation or incarceration. The pathway, it submitted, has national responsibility for young people in residential aged care, children with supports at risk, and state and Commonwealth clients transitioning to the NDIS who have been determined as high risk referrals, and involves:
Stronger connections with other services, such as existing providers and other government services, through dedicated liaison roles.
Dedicated, specialised NDIA planners who have strong experience in high level case coordination and allied health experience.
Access to a specialised complex support needs Practice Lead who can provide professional clinical advice and support to develop plans.
Skilled support coordinators.
A stronger focus on implementation, monitoring and review of participant plans.
8.117
The NDIA informed the committee that as at September 2019, there were ‘8,400 participants in the complex support needs pathway across the Complex, Voluntary Out Of Home Care and [young people in residential aged care] streams’. It further noted that around ‘one third of participants with a primary psychosocial disability will receive support through this pathway’, and the full pathway was expected to be completed by 30 December 2019.
8.118
The NDIA also asserted that it currently has a two year national Exceptionally Complex Support Needs Program, in addition to the Complex Needs Pathway, for adult NDIS participants ‘who present to key emergency services because of a breakdown of their disability supports’, with the referral service phone line available only to approved referrers, including key emergency services.
Planner expertise in certain disability types or groups
8.119
The inquiry received evidence outlining concerns that planners do not understand the specific needs of participants with some disability types, leading to poor decisions about what to approve and fund in plans.
8.120
Autism Spectrum Australia noted ‘a steady improvement in the quality of plans, and this is particularly the case with early childhood plans where there is greater consistency and quality’. However, it also argued that ‘participants and families are often desperate to get a certain planner because the planner has expertise and understanding’ so that a participant is not negatively impacted by planner who does not have the appropriate skills. When planners are inexperienced, or have little understanding of disability and limited support, it suggested, there are ‘gross inequities for participants, including funding levels in plans that range from grossly inadequate to excessive’.
8.121
Ms Suzanne Gannon, Senior Manager of Residential and Community Options at Uniting Vic. Tas., suggested that ‘the allocation of planners, based on their specific knowledge, whether it’s lived experience or qualifications, to participants will enhance the planning experience for everybody’. Similarly, Ms Kirsten Deane from Every Australian Counts told the committee that:
People certainly tell us that they understand planners and LACs can’t know all things about all disabilities all of the time, but they have to know where to go to get help. They would like teams of specialised planners who deal in particular areas and have a more comprehensive understanding of the issues.
8.122
Mr Alan Smith from AEIOU Foundation noted that while it is impossible to ask for planners to be experts in every type of disability, a panel of expert advisers could assist where planners’ lack of knowledge was impacting planning decisions:
We’re asking these planners to be experts in all disabilities and understand everything, and they can’t physically understand it all….Possibly a solution is to have specialist advisers in each of the areas. We used to have the autism adviser program, but that has been wound back over the years. Having specialist advice to the planners may assist in that process and make things a little bit smoother for families moving forward.
8.123
Exercise and Sports Science Australia proposed that the NDIA ensure ‘plans are reviewed by allied health professionals and/or experts in particular disabilities before being approved’. It suggested that this involvement would help to ensure ‘a thorough assessment of the consumer’s needs, an understanding of the condition and progression of the disease and the appropriate support required’.
8.124
Other evidence proposed that planners have access to expert reference groups or panels so that they would be able to better understand the needs of participants, the impact of particular disability types and what supports would be best appropriate.
8.125
As outlined in Chapter 2, the committee’s interim report made the following recommendation concerning planner training and expertise in certain disability types or groups:
Recommendation 9
The committee recommends that the National Disability Insurance Agency (NDIA) ensure that additional training and skills development is provided to all persons involved in the planning process (particularly NDIA officers and LACs), to ensure that all such persons:
are familiar with a range of disabilities experienced by participants, and develop specialisation in particular disability areas;
are familiar with allied health expertise;
understand the specific needs of Aboriginal and Torres Strait Islander participants, and participants from culturally and linguistically diverse backgrounds, to ensure that they are able to deliver culturally appropriate services; and
receive training in domestic violence awareness.
8.126
The government in its response outlined its current training programs, including ‘disability specific and targeted service delivery training programs’, as well as ‘programs focused on disability and cultural awareness to improve the service experience for Aboriginal and Torres Strait Islander peoples, people who identify as LGBTIQA+, and people’ who are from CALD backgrounds.
Committee view
8.127
The committee welcomes the NDIA’s work over the past three years to improve the experience of particular groups of participants, including participants with complex needs, Aboriginal and Torres Strait Islander participants, participants from CALD backgrounds and participants in custodial settings, among others. The committee acknowledges that the information outlined in this chapter about the pathways, strategies and programs for particular groups of NDIS participants who may experience disadvantage is only a brief overview of the complex and detailed work that the NDIA has undertaken, and continues to undertake, to address entrenched disadvantage for some participants from these groups.
8.128
The committee further commends the NDIA for its recent reforms in the area of psychosocial disability—including by providing participants with psychosocial recovery coaches—and for its efforts to develop a national framework for recovery-oriented psychosocial disability services, to be released in 2021. Given that this framework is still in the process of being developed, the committee is hesitant to make any recommendations in this area, save for underlining the importance of plans which recognise the episodic nature of many forms of psychosocial disability, and of providing appropriate supports for people with psychosocial disability. The committee will continue to observe this area of reform and will provide further comments and recommendations in the future if it considers, on the basis of feedback from participants, advocacy groups and organisations, that this is necessary following the reforms already underway.
8.129
The committee also notes recent reductions in wait times for children to receive their first plan after an access decision has been made. A further issue the committee remains concerned about is wait times for assistive technology, which may particularly impact children who are growing and whose physical development may quickly render pieces of assistive technology obsolete. The committee encourages the NDIA to improve its wait times for children in particular, both in terms of the time needed to receive a plan and to approve assistive technology.
8.130
The committee recommends that the National Disability Insurance Agency improve its wait times for children, particularly the time taken to produce a plan following an access decision and to approve assistive technology.
8.131
The committee was concerned that plans may not adequately take into account children’s developmental stages. The committee does not consider that providing New Starter training for planners in how to hold conversations with participants about developmental stages and key life transition points is sufficient to ensure that plans are appropriate for children and young people, given that children and young people and their families may have only limited knowledge about how their disabilities may impact their developmental stages and key life transition points. The committee recommends that the NDIA develop templates or guidelines for planners to ensure that plans for children take into account key developmental stages and life transition points.
8.132
The committee recommends that the National Disability Insurance Agency develop, publish and implement templates or guidelines to ensure that plans for children and young people take into account key developmental stages and life transition points.
8.133
The committee also notes the importance of plans for children and young people including capacity-building supports for family members to help participants achieve their goals, noting that an hour of therapy once a month, when a child is growing, is not necessarily enough to ensure that the therapy is as effective as it could be. The committee has addressed the issue of capacity-building separately in Chapter 4, but it encourages the NDIA to ensure that it is also considering capacity-building for family members to support participants to achieve their goals.
8.134
On the matter of participants from low socio-economic backgrounds being disadvantaged during the planning process, the committee, while holding some reservations about certain aspects of independent assessments, considers that the provision of these, free of charge, will go some way towards addressing inequality in terms of participants’ ability to advocate for supports or their access to support networks. This is also the case for participants in out-of-home care, though the committee also notes the importance of planners receiving training on trauma-informed care. On the matter of participants in custodial settings, the committee notes the recent introduction of Justice Liaison Officers, and has made specific recommendations concerning planning in this area in Chapter 5.
8.135
The committee reiterates its recommendation from the interim report that all planners must receive training on how to identify and address family and gender-based violence, and acknowledges that the NDIA already has a mandatory eLearning module for this purpose. However, the committee agrees with the Australian Government that it could explore further options to improve training in this area.
8.136
The committee is aware that particular issues may arise for participants experiencing family violence—for example, that they may feel more comfortable working with a planner of a particular gender, and that some participants may have particular support needs because of the concern that a perpetrator may locate them if they use mainstream disability services. As such, the committee recommends that the NDIA increase its family violence training for planners in general, including in how to identify family violence and what referral services are available; that planners be able to refer participants experiencing family violence to the Complex Support Needs Pathway; and that the NDIA ensure that the Complex Support Needs team include planners trained in how to plan for participants experiencing family violence.
8.137
Further, the NDIA should ensure that it makes planners of a particular gender available to participants where they request this, and ensures that it asks participants whether they would prefer planners of a particular gender when booking in planning meetings. The committee considers the NDIA should take a proactive approach in this matter, given that some people who have experienced family violence may be uncomfortable specifying the preferred gender of their planner up-front.
8.138
The committee recommends that the National Disability Insurance Agency:
increase its family violence training for planners in how to identify family violence and what appropriate referral services exist;
ask participants before their planning meetings if they have a preference for a planner with a particular gender;
create a team of specialised planners within the Complex Support Needs pathway who are specially trained in how to plan for participants experiencing family violence; and
ensure that planners and Local Area Coordinators are able to refer participants who they suspect are experiencing family violence to this pathway.
8.139
The issues outlined in this report facing Aboriginal and Torres Strait Islander participants are complex and multi-faceted. The committee acknowledges the work the NDIA has undertaken to improve planning for these participants, including the introduction of the Community Connectors Program and planner training. The committee recognises that the Aboriginal and Torres Strait Islander Engagement Strategy has been subject to review this year, and recommends that the NDIA finalise this review and update the strategy to address the issues raised in this report for this group of participants.
8.140
The committee recommends that the National Disability Insurance Agency finalise its review into its Aboriginal and Torres Strait Islander Engagement Strategy and update the strategy to address the issues outlined in this report for Aboriginal and Torres Strait Islander participants.
8.141
Similarly, the committee also notes that the Community Connectors Program applies to participants from culturally and linguistically diverse backgrounds. Evidence highlighted the importance of participants having access to interpreters during planning meetings, and access to information about planning and the NDIS that they can understand. The committee recognises that the NDIA had a Cultural and Linguistic Diversity Strategy, but this now appears to be out-of-date, given that its goals were intended to be achieved by 2019. The committee recommends that the NDIA review this strategy and update it to address the issues raised in this report.
8.142
The committee recommends that the National Disability Insurance Agency review its Cultural and Linguistic Diversity Strategy and update it to address the issues outlined in this report.
8.143
The committee notes that the national roll-out of the Complex Support Needs pathway is a recent innovation, and that the main issue raised in evidence to this inquiry about this pathway concerned the lack of information available on who is eligible to access it. As such, the committee recommends that the NDIA make available on its website detailed information for participants, their support networks, advocacy groups, support coordinators and other relevant organisations outlining who is eligible for this pathway and how the NDIA defines the term ‘complex support needs’.
8.144
The committee recommends that the National Disability Insurance Agency publish information about the Complex Supports Needs pathway, including about who is eligible, and how the National Disability Insurance Agency defines the term ‘complex support needs’.
8.145
Finally, on the issue of planners developing expertise in particular areas, including disability types, the committee recognises that this has happened for, in particular, planners working in the Complex Support Needs team, but may in some instances have led to a loss in expertise among planners working with other participants. However, the committee is still of the opinion that planners should be encouraged to develop expertise in disability types to ensure that they ask the appropriate questions of participants, use appropriate communication styles and develop a holistic plan that will address participants’ needs beyond clinical and therapeutic interventions. The committee reiterates its recommendation from the interim report, that the NDIA should ensure that additional training and skills development be provided to all planners and LACs involved in the planning process to ensure that all such persons are familiar with different disability types and are able to develop specialisation in particular disability areas. The committee considers that planners should be encouraged through training and skills development to develop specialisation in planning for particular groups of participants, including those groups outlined in this chapter.
8.146
The committee recommends that the National Disability Insurance Agency develop and implement a mechanism to encourage planners to develop specialisation in particular types of disability or particular groups of participants.