10 disability support chapter7

8/12/2019 10 Disability Support Chapter7

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7 Assessing care and support needs

Key points

The assessment process would:

assess the nature, frequency and intensity of an individuals support needs,regardless of how these might be met. While the process would be person-

centred and forward looking, it would be focused on what was reasonable and

necessary

consider what willingly and reasonably could be provided by informal carers.nformal carers who met a large share of a persons support needs would receive

their own assessment if they wish

translate identified needs into a persons individualised package to be funded bythe !"#, after taking account of natural supports.

The !"# would periodically re-assess peoples needs as their circumstances

changed, especially at key transition points like leaving school, getting a $ob, moving

out of home, or losing a natural support.

% coherent package of tools &a 'toolbo() should be employed to determine thesupport needs and funding for a person covered by the scheme. "ifferent tools

would be suited to particular needs for support &for e(ample, the need for aids and

appliances compared with attendant care). %ny tools used by the !"# should be

rigorous, valid &testing what they purport to), reliable &giving consistent results) and

cost-effective.

*overnments should not delay implementation of the scheme in the absence of

'perfect tools. The !"# would use the best available tools in its initial stages, with

the later development of better tools.

+(cessively tough use of the assessment tool would be unfair, but 'loose use would

threaten scheme sustainability. To guard against both:

assessments would be conducted by allied health professionals approved orappointed by the !"% and trained in the use of the tools. They would becontinually assessed for their appropriate use of the assessment tools

the assessments would not be 'rubber stamped. rior to making budgetarydecisions, the !"% would confirm that the particular assessment followed theappropriate protocol, and was consistent with a 'benchmark range of assessedneeds for other people with similar characteristics. "eviations outside the normwould require further investigation

any tools employed would be continually monitored and refined.

CHAPTER 7:ASSESSING CARE ANDSUPPORT NEEDS

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7.1 Introduction

One o# t$e pri%ar& #unctions o# t$e NDIS 'i(( )e to pro*ide indi*idua(ised+ #undedsupports, A ro)ust process #or deter%ining '$o gets '$at 'i(( )e critica( #or )ot$sc$e%e users and ad%inistrators, T$e assess%ent process %ust pro*ide a reasona)(&c(ose esti%ate o# a person-s support needs and t$e resource a((ocation to ac$ie*et$e%, It s$ou(d a*oid )eing too generous or too toug$, T$e process %ust )e #air+rigorous and sa#eguard against e.aggerated c(ai%s o# support needs,

At t$e %ost genera( (e*e(+ t$e assess%ent process 'i(( )e a)out identi#&ing t$esupports t$at 'ou(d a((o' a person to #u(#i( a range o# #unctions+ suc$ as participatein t$eir co%%unit& in /eeping 'it$ persona( goa(s and aspirations, Ho'e*er+ t$ere

are %an& issues to reso(*e regarding t$e design o# t$e assess%ent too(0s1 inc(uding:

'$at is )eing assessed+ and across '$at 2do%ains- or range o# (i#e acti*ities0section 7,31

t$e purpose o# t$e assess%ent process )e&ond indenti#&ing an indi*idua(-ssupport pac/age 0section 7,41

desira)(e #eatures o# assess%ent too(s+ suc$ as *a(idit&+ re(ia)i(it& and rigour0section 7,51,

Ha*ing regard to t$e intended ro(e o# assess%ent too(s in t$e conte.t o# a NDIS+ it isuse#u( to t$en consider:

t$e range o# too(s current(& a*ai(a)(e 0section 7,61

'$et$er a sing(e too( 'i(( )e uni*ersa((& appropriate or '$et$er t$e sc$e%es$ou(d e%p(o& a 2too()o.- 0section 7,1,

T$e re%ainder o# t$e c$apter considers a range o# issues re(ating to t$e too(s- use+suc$ as:

'$o s$ou(d conduct assess%ents 0section 7,71

'$en+ o*er t$e course o# an indi*idua(-s (i#e+ assess%ents s$ou(d ta/e p(ace0section 7,81

'$et$er carers s$ou(d $a*e t$eir o'n assess%ent 0section 7,91

$o' a 2t&pica(- assess%ent process %ig$t 'or/+ and t$e i%portance o#ca(i)ration and c$ec/ing to ensure #airness and sc$e%e sustaina)i(it&0section 7,;1

$o' to ensure t$at too(s are app(ied rigorous(&+ inc(uding sa#eguards andprocesses #or adapting and re#ining t$e% o*er ti%e 07,1

t$e transition to a #u((& de*e(oped too()o. 0section 7,31,

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7.2 What is being assessed?

Needs, ants and aspirations

An o)*ious #irst ictoria-s Transport Accident Co%%ission 0TAC1 and t$e NS? @i#eti%e Care andSupport Aut$orit& 0@TCSA1 $a*e t$is as t$eir o)ecti*e, In t$ese sc$e%es+ t$eassess%ent process #ocuses on needs rat$er t$an 'ants, T$e TAC #or e.a%p(e+states: 2T$e needs o# e*er& person are di##erent+ and t$e TAC (oo/s at eac$ caseindi*idua((& '$en deter%ining '$at to pa&- 0TAC 3;1, ?$i(e t$e NS? @TCSA

notes t$at 2&ou 'i(( get '$at &ou need+ not t$ings t$at are si%p(& nice to $a*e-0@TCSA NS? 3;1,

=ut de#ining and deter%ining 2need- is )& no %eans straig$t #or'ard, T$ere is adanger t$at peop(e 'i(( ratc$et up t$eir c(ai%s #or support )& presenting 'ants asneeds,

T$e United Nations $as noted t$e co%p(e.it& in*o(*ed:

De#ining and deter%ining need is easier said t$an done, It is not *a(ue#ree+ as '$o

deter%ines it+ $o' it is deter%ined and #or '$at purpose it is done+ 'i(( a(( a##ect t$eoutco%e, Neit$er t$e %et$ods used to identi#& needs nor t$e concepts o# socia( needs$a*e )een c(ear(& de#ined, 0ESCAP 3;;41

A si%i(ar *ie' 'as put )& Ang(icare Austra(ia:

T$roug$out t$e socia( po(ic& and ustice $istories needs $a*e p(a&ed an integra( ro(e #ort$e p(anning and de*e(op%ent o# po(ic& and progra% responses, Ho'e*er o*er t$ecourse o# t$ose $istories t$ere $as ne*er rea((& )een a consensus on '$at needs are andt$ere is e*en %ore contention o*er t$e deri*ation o# particu(ar t&pes o# needs,0su), 695+ p, 1

A nu%)er o# acade%ics suc$ as Bas(o' 09651+ Har*e& 09741 and =rads$a'09731 $a*e atte%pted to 2unpac/- t$e concept o# need, O# t$ose+ per$aps=rads$a'-s 'or/ is t$e %ost in#or%ati*e #ro% a socia( po(ic& perspecti*e,=rads$a' distinguis$es )et'een #our t&pes o# socia( needs nor%ati*e+ #e(t+e.pressed and co%parati*e 0)o. 7,1, T$is #ra%e'or/ is re(e*ant in disa)i(it&

po(ic&, As Ang(icare o)ser*ed:

t$e needs identi#ied )& =rads$a'+ particu(ar(& percei*ed #e(tF and nor%ati*e needsresonate %ost c(ose(& 'it$ t$e t&pes o# need identi#ied )& Ang(icare Austra(ia net'or/%e%)ers, 0su), no 695+ p, 1


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o( ./ !npac"ing the concept o# need

radshaws framework involves four different ways of thinking about 'need.Nor$ati%e needis defined by reference to 'appropriate standards or required levels of

services or outcomes determined by e(pert opinion. ndividuals or groups falling short

of these standards are defined as being in need. ut normative need is by no means

absolute, as radshaw observes, normative need 'may be tainted with a charge of

paternalism. 0oreover, e(perts may have different and possibly conflicting standards.

&o$parati%e needis determined by comparing the resources or services available in

one area 1 be it a community, a population group or individual 1 with those that e(ist

in another. % community, population group or person is considered to be in 'need if they

have say more health or social problems, or less access to services, than others. The

main problem with the concept of comparative need are its two underlying assumptions1 first, that similarities e(ist between the areas and second, that the appropriate

response to the 'problem is to align service levels. This need not hold true, for

e(ample, when both areas e(perience chronic shortages for a particular service.

'e(tneedhas a sub$ective element and is defined in terms of what individuals state

their needs to be or say they want. t can be defined easily by asking current or

potential service users what they wish to have. ut felt need by itself is generally

considered to be an inadequate measure of 'real need. 2or e(ample felt need can be

inflated by users own high e(pectations.

)*pressedneedis defined in terms of the services people use. t is based on what

can be inferred about a person or a community by observing their use of services &orwaiting lists for services). % community or person who uses a lot of services is assumed

to have high needs. While a community or person who does not, is assumed to have

low needs. ut e(pressed need is influenced by the availability of services 1 a person

cannot use or put their name down on a waiting list for a service that is not offered.

Source: radshaw &/34).

Taking account of aspirations

?$i(e t$e assess%ent process 'ou(d pri%ari(& )e a)out assessing an indi*idua(-sneeds+ it s$ou(d not disregard t$eir aspirations, T$e Co%%ission sees %erit in t$eapproac$ e%p(o&ed in t$e United ingdo% '$ere)&:

T$e purpose o# a co%%unit& care assess%ent is to identi#& and e*a(uate an indi*idua(-spresenting needs and $o' t$ese i%pose )arriers to t$at person-s independence andor'e(( )eing, Once e(igi)(e needs are identi#ied+ counci(s s$ou(d ta/e steps to %eet t$oseneeds in a 'a& t$at supports t$e indi*idua(-s aspirations and t$e outco%es t$at t$e&'ant to ac$ie*e, 0U Depart%ent o# Hea(t$ 3;;+ p, 3;1

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T$e intention 'ou(d )e to assess 2reasona)(e and necessar&- support needs+ )ut'it$in t$is o)ecti*e+ t$e assess%ent process 'ou(d consider peop(e-s aspirations,

T$ere 'as so%e support #or t$is approac$ a%ong participants:>a(ued Independent Peop(e support t$e Co%%ission-s #indings t$at assess%ent s$ou(d

)e #ocused on needs and in particu(ar+ reasona)(e needs, ?e agree 'it$ t$eCo%%ission-s #indings t$at indi*idua(-s aspirations s$ou(d a(so )e ta/en into account,0>a(ued Independent Peop(e+ su), DR943+ p, 91

+spects o# (i#e

Indi*idua(s (ead %u(ti#aceted (i*es and so a second


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genera( tas/s and de%ands carr&ing out sing(e or %u(tip(e tas/s+ organisingroutines and $and(ing stress

%aor (i#e areas carr&ing out responsi)i(ities at $o%e+ 'or/ or sc$oo( andconducting econo%ic transactions,

Eac$ o# t$e nine do%ains 0#or e.a%p(e %o)i(it&1 consist o# #acets or )(oc/s 0suc$ as'a(/ing and %o*ing1 'it$in '$ic$ are nested groups o# second+ t$ird andso%eti%es #ourt$(e*e( categories 0#igure 7,1,

2igure ./ -he Internationa( &(assi#ication o# 'unctioning, isabi(ityand /ea(th%ctivity and articipation "omains &showing the details behind one heading

'mobility)

Source: The World 5ealth 6rganisation, 72 6nline, http:88apps.who.int8classifications8icfbrowser8.

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T$e IC is a co%pre$ensi*e and ro)ustframeworknot an assess%ent too( itse(#,T$e ?HO 0'$ic$ de*e(oped t$e IC1 noted t$at:

T$e IC is i%practica( #or assessing and %easuring disa)i(it& in dai(& practiceJt$ere#ore+ ?HO de*e(oped t$e ?HO Disa)i(it& Assess%ent Sc$edu(e 0?HODAS 3,;1to address t$is need, 0KstLn et a(,+ 3;;+ p, 41

T$e i%p(ication is t$at rat$er t$an rep(icate a(( e(e%ents o# t$e IC #ra%e'or/+ an&assess%ent too( 'ou(d incorporate t$e )est %i. o# indicators or re(e*ant do%ains o#need, T$e pre#erred assess%ent too(0s1 'ou(d sti(( )e consistent 'it$ t$eo*erarc$ing IC #ra%e'or/,

In addition to enco%passing e(e%ents o# se(#care+ co%%unication and %o)i(it&+ t$e

assess%ent process s$ou(d inc(ude aspects o# (earning and app(&ing /no'(edge+ andco%%unit& and socia( participation, To do ot$er'ise+ %ig$t %ean t$e support needso# so%e indi*idua(s 'ere s&ste%atica((& o*er(oo/ed:

Ban& in t$e Autis% popu(ation #re


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so%e sources o# disa)i(it& t$at resu(ted in signi#icant and una%)iguous care andsupport needs suc$ as


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=ut in#or%a( care arrange%ents need to %o*e to a %ore e


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t'o $ours+ and t$e cost o# attendant care 'as M4; per $our+ t$eir )udget 'ou(d )eM35; per 'ee/ 08 $ours . M4; per $our1,

As )udgets 'i(( )e attac$ed to assess%ents+ it 'i(( )e i%portant #or t$e sc$e%e to%onitor patterns in assess%ents to test '$et$er t$ese re*ea( an& un'arranted cost

pressures 0#or e.a%p(e+ t$ose arising #ro% de#ects in t$e assess%ent too( orper%issi*e use o# t$e instru%ents1, 0T$e need #or+ and )ene#its o#+ s&ste%atic c$ec/sare discussed #urt$er in section 7,,1

eter$ining suitabi(ity #or se(#directed #unding

T$e assess%ent p$ase 'ou(d su)stantiate t$e capacit& o# t$e person or carer to se(#

direct #unds, T$is 'ou(d not )e a #eature o# t$e assess%ent too( per se+ '$ic$ 'ou(d)e a)out identi#&ing needs+ )ut 'ou(d )e part o# t$e interaction 'it$ t$e person 'it$a disa)i(it& during t$e assess%ent p$ase,

3ro%iding a re#erra( to other sche$es

Under t$e current #rag%ented s&ste%+ %an& progra%s $a*e uni


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The NDIS acts as the sole assessment point and agent sa& t$e in#or%ationco((ected *ia t$e NDIS assess%ent 'as su##icient to a(so esta)(is$ t$at an

indi*idua( 'as entit(ed to a disa)i(it& par/ing per%it+ t$e NDIS cou(d act as anagent#or state and territor& road aut$orities and issuet$e per%it,

The NDIS acts as the sole assessment point and provides a referral sa& t$ein#or%ation co((ected *ia t$e NDIS assess%ent 'as su##icient to esta)(is$ t$at anindi*idua( 'as a(so entit(ed to a disa)i(it& par/ing per%it+ t$e NDIS 'ou(d

pro*ide a re#erra( and state and territor& road aut$orities 'ou(d issue t$e per%it'it$out underta/ing an assess%ent o# t$eir o'n,

The NDIS shares information with other departments and or agencies and

government-funded service providers subject to strict privacy safeguards sa&

t$e in#or%ation co((ected *ia t$e NDIS assess%ent partly satisfied t$ein#or%ation re


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9alidity and reliability

In order #or assess%ent too(s to )e genera((& considered e##ecti*e+ t$e& %ust )e )ot$*a(id and re(ia)(e, T$e /e& aspect o# assessing *a(idit& is to pose t$e


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igour

As Harries 03;;81 notes+ a di(e%%a #or #unding )odies in t$e conte.t o#indi*idua(ised #unding is t$at so%e indi*idua(s 'i(( o*erstate t$e e.tent o# adisa)i(it& in order to recei*e increased (e*e(s o# #unding, 0T$is need not )e )& t$e

person 'it$ disa)i(it&, Under current arrange%ents+ #or e.a%p(e+ ser*ice pro*iders%ig$t #ace an incenti*e to o*erstate peop(e-s needs to get %ore #unding,1 In so%ecases+ peop(e %ig$t )e conscious o# '$at ot$ers recei*e and %a& in#(ate t$eir o'nc(ai%s,

An Austra(ian stud& conducted )& Guscia et a(, 03;;)1 in*estigated '$et$erassess%ent too(s o)tained di##erent resu(ts #or di##erent purposes, T$e& #ound t$at

t$e assessed support needs o# indi*idua(s 'ere %uc$ greater '$en t$e& 'ereassessed #or #unding purposes co%pared to '$en t$e& 'ere assessed #or researc$

purposes,

T$ere are a nu%)er o# 'a&s to reduce t$e ris/ o# suc$ 2ga%ing-, T$ese inc(ude t$euse o# pro#essiona( assessors+ care#u( ca(i)ration and gate/eeping and t$e%onitoring o# data, =ut t$e c$oice o# too(s can a(so a##ect t$e scope #or ga%ing,Harries 03;;81 notes t$at t$e use o# o)ecti*e and audita)(e %easures o# need canreduce t$e ris/ o# ga%ing, It $as )een suggested t$at t$e use o# o)ecti*e #unctiona(%easures are potentia((& (ess suscepti)(e to %anipu(ation and t$ere#ore %a& )e %oreappropriate(& suited to #unding purposes 0D&son et a(, 3;;; as reported in Guscia3;;a and Harries 3;;81,

?$ere peop(e recei*e an entit(e%ent to supports rat$er t$an a )udget to purc$aset$ose supports+ t$e incenti*e to o*erstate needs is reduced, or e.a%p(e+ a person'ou(d #ace (itt(e incenti*e to e.aggerate t$eir need #or assistance in s$o'ering+ i#t$at on(& resu(ted in %ore s$o'ers 0rat$er t$an a )igger )udget1,

+pp(icab(e

App(ica)i(it& re#ers to '$et$er t$e too( can )e app(ied to a particu(ar target group,So%e too(s #or e.a%p(e+ target particu(ar disa)i(ities suc$ as inte((ectua( disa)i(it&+'$i(e ot$ers target peop(e o# certain ages+ suc$ as c$i(dren, Gi*en t$e target

popu(ation o# t$e NDIS 0c$apter 41+ t$e assess%ent too(s 'i(( need to )e app(ica)(e#or indi*idua(s o# di##erent ages and 'it$ a 'ide range o# (e*e(s+ t&pes andco%)inations o# disa)i(ities,

It is i%portant t$at an& too( not un#air(& discri%inate against peop(e #ro%

Indigenous or et$nic co%%unities, As noted )& T$e >ictorian E


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and Hu%an Rig$ts Co%%ission+ 2assess%ent too(s and processes %ust )e cu(tura((&ro)ust- 0su), DR886+ p,41,

A nu%)er o# participants raised concerns a)out t$e app(ica)i(it& o# assess%enttoo(s, T$e& 'ere 'orried t$at t$e assess%ent too(s e%p(o&ed )& t$e NDIS 'ou(d#ai( to capture #u((& t$eir particu(ar needs,

T$e Co%%ission considers t$at t$e NDIS s$ou(d on(& use a too( to assess t$e needso# particu(ar groups '$ere its re(ia)i(it& and *a(idit& $a*e )een esta)(is$ed #or t$atgroup, Recognising t$e i%portance o# app(ica)i(it&+ /e& groups $a*e a(read& )een'or/ing 'it$ t$e de*e(opers o# assess%ent too(s, or instance+ t$e Ro&a( Societor t$e =(ind is current(& 'or/ing 'it$ t$e Uni*ersit& o# Ade(aide on t$e DStart

Assess%ent Tria( 0su), DR83+ p, 41,

3racticabi(ity

Practica)i(it& re#ers to t$e a)i(it& o# a too( to )e app(ied in a gi*en situation orconte.t 0O'en et a(, 3;;61, In t$e case o# a NDIS+ a too( 'i(( )e used #or )ot$screening prospecti*e users and deter%ining an indi*idua(-s pac/age o# supportsand t$e )udget associated 'it$ %eeting t$ose supports, In t$e #irst instance+ a too(t$at is


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T$e %aorit& o# nationa( and internationa( urisdictions do not %a/e pu)(ica((&a*ai(a)(e t$e a(gorit$% t$at is used to co%pute assess%ent scores into resourcea((ocations, As %uc$ as greater transparenc& is re


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out(ine a pre#erred assess%ent process, T$is rese%)(es t$e option e%p(o&ed in t$eUnited ingdo%, =ut it is not c(ear t$at t$is response $as reso(*ed t$eir porta)i(it&

and interurisdictiona( e


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Boreo*er+ so%e too(s #ocus on a narro'er su)set o# disabilitiest$an is re(e*ant #ort$e sc$e%e, T$e unctiona( Independence Beasure #or e.a%p(e+ is designed

pri%ari(& to )e used in re$a)i(itation settings+ '$i(e t$e Supports Intensit& Sca(e istargeted at assessing support needs o# indi*idua(s 'it$ inte((ectua( disa)i(it&, =ot$ICAN and DSTART are intended to assess t$e needs o# a )roader group o#indi*idua(s+ t$oug$ )ot$ are sti(( in t$e re(ati*e(& ear(& stages o# de*e(op%ent andare not &et 'ide(& used, Bore detai(ed descriptions o# t$e %ain support needassess%ent too(s can )e #ound in Appendi. =,

Table ./ 8u$$ary o# re(e%ant assess$ent too(s

Tool Intended purpose andtarget population

Life areas ordomains covered

Ease ofadministration(assessment time)

Current use

"-#T%=T %ssess needs,capabilities andaspirations of people>resource allocation

%dults with differenttypes, levels andcombinations ofdisability

medical and

health

activities of daily

living

behaviour

functional skills

personal risk

environmental

factors

5ierarchical modelwith short and longassessmentoptions

0ainly for use bytrained assessor

&?@-3; min)

eing trialled by the#outh %ustralian*overnment

20 %ssess an in$uredpersons function

%dults in rehabilitationsettings. &Wee-20caters for children)

self-care

sphincter control

locomotion

transfers

communication

social cognition

Trained assessorwith some clinicalqualification&medicine, alliedhealth, nursing)

&around A; min)

Bsed internationally

-7%! %ssess and report onthe support needs ofpeople with intellectualor multiple disabilities

&the developers arecurrently investigatingthe tools application tothose with traumaticbrain or spinal cordin$ury)

physical health

mental and

emotional health

behaviour

health andsupport services

applying

knowledge

communication

self-care,

domestic life

mobility

interpersonal

relations

life long learning

community andsocial life

Trained facilitatorguides a semi-structured groupself-report process

5ierarchical modelwith short and longassessmentoptions

&A;-/4; mindepending oncomple(ity ofneed)

7urrently used bysome !*6s and byteams withingovernment in somestates


5


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7ontinued ne(t page

Table ./ &ontinued:

Tool Intended purpose andtarget population

Life areas ordomains covered

Ease ofadministration(assessment time)

Current use

7% %ssess adaptive andmaladaptive behaviourto determine type andamount of supportneeds

7an be used fordetermining eligibility,planning and in

funding reports

%daptive andmaladaptivebehaviour with theformer covering:

motor skills

personal living

skills

community living

skills

social and

communicationskills

%ssessor requiresno formal trainingbut should self-study manual

&4;-A; min)

Widely used in theBnited #tates

## %ssess frequency,type and duration ofsupport needed.

%dults with intellectualand developmentaldisabilities

ehavioural,medical, and lifeactivity with thelatter covering

home living

community living

lifelong learning

employment health and safety

social activities

protection C

advocacy

#taff resource useis intensive.Trained staffrequired forreliability

&/ hour but can beup to 4.@ hours)

Bsed by severalstates in the B# anda number of7anadian provincesas well as in around/? other countries

#!% 0easure the supportneeds of individualswith different disabilitytypes and levels ofseverity in receipt ofaccommodation andday support services

personal care

physical health

behaviour support

night support

social support

%ssessor requiresno specialisedtraining but musthave goodknowledge of theperson

&/;-4; min)

5as been used in!#W to guidefunding of residentialand day supportservices, and wastrialled by the #outh%ustralian

*overnment


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7. + sing(e too( or a 6too(bo*?

T$e assess%ent process 'i(( need to )e app(ica)(e #or indi*idua(s o# di##erent agesand 'it$ a 'ide range o# (e*e(s+ t&pes and co%)inations o# disa)i(ities, Ho'e*er+ asnoted in t$e pre*ious section+ %an& current assess%ent too(s tend to )e de*e(opedon t$e )asis o# a sing(e disa)i(it& t&pe 0suc$ as inte((ectua( disa)i(it&1 or ser*ice t&pe0suc$ as attendant care or $o%e %odi#ications1 and so (ac/ t$e #(e.i)i(it& or )readt$o# co*erage re


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'a& 0t$oug$ so%e $a*e se(#report e(e%ents1, T$e e*idence s$o's t$at t$isproduces $ig$er rates o# re(ia)i(it&,

=ut se(#assess%ent is increasing(& )eing ad*ocated as a 'a& o# acti*e(& in*o(*ingand e%po'ering ser*ice users, And a nu%)er o# participants in t$is in


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/o accurate is se(#assess$ent?

T$e desira)i(it& o# se(#assess%ent $as not )een 'e(( e.p(ored in t$e area o# $ea(t$and (ess so in t$e area o# socia( support, One %aor stud& 'as conducted )&Gri##it$s et a(, 03;;61 0co%%issioned )& t$e Nationa( Hea(t$ Ser*ice in t$e Unitedingdo%1, Gri##it$s et a(-s researc$ suggests t$at t$e accurac& o# se(#assess%ent insocia( care re%ains (arge(& untested:

No e*a(uations o# t$e accurac& o# se(#assess%ents in t$e do%ains o# co%pre$ensi*e or(i#e and socia( s/i((s 'ere #ound, 03;;6+ p, 931

?$i(e t$e suita)i(it& o# se(#assess%ent in socia( care $as not &et )een rigorous(&e*a(uated+ ear(& e.perience #ro% t$e U $as re*ea(ed pro)(e%s 'it$ its use, A

re*ie' o# t$e Indi*idua( =udgets Pi(ot Progra%%e #ound t$at case %anagers 'erenot con#ident t$at se(#assess%ent a(one 'ou(d ade


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support needs+ a nu%)er o# researc$ reports are cited #ro% t$e U indicating t$at t$ereis a need #or caution in proceeding 'it$ se(# assess%ent+ and in particu(ar+ t$at t$ere isa(read& e*idence to suggest s&ste%atic distortions in se(# assess%ent depending on t$et&pe o# disa)i(it& and de%ograp$ic c$aracteristics, It is stated+ in our *ie' correct(&+t$at se(# assess%ent re%ains (arge(& untested Since se(# assess%ent 'ou(d $a*e

)ene#its in ter%s o# dignit& and independence #or t$e person 'it$ a disa)i(it& '$o isassessing t$eir o'n needs it is a 'a& o# assess%ent t$at s$ou(d )e in*estigated, 0Dr

Nei( ir)&+ su), DR;;+ p, 31

oes se(#assess$ent de(i%er greater user in%o(%e$ent and

partnership?

One o# t$e rationa(es #or se(#assess%ent is t$e *ie' t$at it pro*ides greateropportunities #or se(#de#inition o# needs and desired outco%esJ and increasedopportunities #or users to deter%ine #or t$e%se(*es $o' t$e& 'ant t$ose outco%esto )e ac$ie*ed,

=ut as Gri##it$s et a( cautioned:

=ene#its s$ou(d not )e assu%ed and in particu(ar t$e use o# se(#assess%ent s$ou(d not)e e


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aintaining pro#essiona( ob;ecti%ity

In order to pro%ote independent outco%es+ assessors s$ou(d )e dra'n #ro% anappro*ed poo( o# a((ied $ea(t$ pro#essiona(s, Assessors s$ou(d a(so )e independento# t$e person )eing assessed to reduce t$e potentia( #or 2s&%pat$&- )ias, T$is %eanst$at $ea(t$ pro#essiona(s GPs and ot$ers 'it$ past treat%ent and supportresponsi)i(ities #or t$e person+ 'ou(d not underta/e assess%ents, It is c(ear #ro% t$ee.periences o# >CAT appea(s on TAC )ene#it decisions t$at treating pro#essiona(sare o#ten p(aced in an in*idious position '$en as/ed )& t$eir patients to %a/e anassess%ent t$at deter%ines t$e person-s e(igi)i(it& #or )ene#its,

Participants e.pressed so%e concerns a)out t$e independence o# assessors+

pre#erring to $a*e so%eone 'it$ /no'(edge o# t$e indi*idua( underta/ing t$eassess%ent,

in %& *ie'+ ta/ing t$e assess%ent process too #ar a'a& #ro% e.perts '$o $a*e t$e)est *ie' o# t$e needs o# t$e person '$o is (i*ing 'it$ t$e disa)i(it&, I t$in/ it 'ou(d )e'rong to co%p(ete(& re%o*e treating doctors #ro% t$e assess%ent process, I 'ou(dsuggest t$at an& assess%ent s$ou(d )e %ade ta/ing care#u( consideration o# t$e e.pertad*ice pro*ided )& an& treating doctors, 0Pau( PetrieRepar+ su), DR988+ p,51

As noted e(se'$ere in t$is c$apter+ '$i(e t$e indi*idua( underta/ing assess%ents'ou(d )e independent+ it 'ou(d i%portant to in*o(*e ot$er interested parties 0a so

ca((ed circ(e o# support1 in t$e assess%ent process, Idea((&+ t$ese 'ou(d )e peop(e'$o 'ere #a%i(iar 'it$ t$e care and support needs o# t$e indi*idua(+ t$e& %ig$tinc(ude #a%i(& %e%)ers+ carers and direct support pro#essiona(s, Boreo*er+ t$eassess%ent process 'ou(d dra' upon e.isting %edica( reports,

As in Ne' ea(and+ assessors 'ou(d )e %entored in t$eir #irst si. %ont$s o#assess%ents+ and a(( assessors 'ou(d )e regu(ar(& assessed to ensure co%para)i(it&o# outco%es, T$is 'ou(d pre*ent assessors #ro% de*e(oping t$eir o'n criteria #orassess%ent+ and a*oid outco%es suc$ as 2s&%pat$etic )rac/et creep-, Assessors

'ou(d )e appro*ed or appointed )& t$e NDIA #or t$e purpose o# conducting NDISassess%ents and t$eir approac$es to assess%ent 'ou(d $a*e to )e a(igned 'it$ t$eo)ecti*es o# t$e NDIS 0'$ic$ is anot$er reason '$& a person-s genera( practitioner'ou(d not )e a suita)(e assessor1, Assessors 'ou(d )e proper(& trained in t$e use o#t$e too(s and in (istening to t$e input o# participants,

Ban& participants 'ere supporti*e o# assess%ents )eing underta/en )& an appro*edpoo( o# a((ied $ea(t$ pro#essiona(s, Ho'e*er+ t$e& a(so pointed to t$e need #ore.perience+ particu(ar(& 'it$ respect to %ore co%p(e. cases:

our e.perience s$o's t$at t$e *ast %aorit& o# assess%ent decisions o# t$is /ind arestraig$t#or'ard and non contro*ersia( )ased on a*ai(a)(e in#or%ation+ conte.t and#unctiona( assess%ents, It is t$e co%p(e. and 2)& e.ception- situations '$ic$ re


24/37

%ore resource intensi*e process, An assess%ent pane( 'it$ t$e option to dra' onspecia(ists is suggested, 0>ictorian Coa(ition o# A=I Ser*ice Pro*iders Inc,+su), DR8;5+ p, 81

7. When shou(d assess$ents occur?

=e#ore )eing a)(e to access indi*idua((& tai(ored supports+ ne' entrants to t$esc$e%e 'ou(d undergo an initia( assess%ent, T$at process is intended to pro*ide ad&na%ic account o# an indi*idua(-s support needs+ so t$at t$e needs o# peop(e '$o$a*e #(uctuating and or (onger ter%s conditions are proper(& ta/en into account,E*en so+ it 'ou(d not )e possi)(e to anticipate a(( c$anges to an indi*idua(-s care

and support needs o*er ti%e, T$ese c$anges 'ou(d need to )e identi#ied t$roug$ aperiodic reassess%ent o# need, Reassess%ents 'i(( )e an i%portant 'a& o# %a/ingsure t$at peop(e are a)(e to access t$e rig$t %i. o# supports at t$e rig$t ti%e,

T$e ti%ing o# reassess%ents depends on a nu%)er o# #actors+ suc$ as t$e nature o#t$e disa)i(it&+ t$e age o# t$e person and an& %aor (i#e transitions, =ut it is possi)(eto identi#& so%e ti%e(& opportunities #or reassess%ent,

or c$i(dren ac


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reassess%ent o# need s$ou(d occur regu(ar(& enoug$ to ensure responsi*eness toc$anges o*er t$e (i#e course, 0Do'n S&ndro%e >ictoria+ su), 593+ p, 41

?$ere an indi*idua(s disa)i(it& %a& undergo c$ange degeneration or i%pro*e%ent+reassess%ents and re*ie's s$ou(d )e a*ai(a)(e as needed, 0"out$ Disa)i(it& Ad*isor&Ser*ice+ su), 587+ p, ;1

?$i(e $a*ing an up to date picture o# care and support needs is i%portant+ it s$ou(dnot resu(t in unnecessari(& )urdenso%e processes 0su)s, 587 and 31, Buc$ o# t$ein#or%ation co((ected at t$e initia( assess%ent 'ou(d sti(( )e re(e*ant in areassess%ent conte.t+ '$ere t$is is t$e case+ it s$ou(d )e used,

It is c(ear #ro% su)%issions t$at a )a(ance 'i(( need to )e struc/ 'it$ respect to

conducting reassess%ents, On t$e one $and+ reassess%ents need to )e su##icient(re


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8hi#ting the e$phasis toards e((ness

One o# t$e %aor criticis%s o# t$e current s&ste% is t$at is not #or'ard (oo/ing, It#ai(s to anticipate c$anges in peop(e-s needs o*er ti%e+ 'it$ t$e resu(t t$at %an&

peop(e are eit$er unsupported or poor(& supported t$roug$ %aor (i#e transitions, Ita(so #ai(s to s&ste%atica((& e.p(ore 2'$at %ig$t )e-, Opportunities #or i%pro*ingindependence or #unctioning are not s&ste%atica((& assessed on eit$er an indi*idua(or group (e*e(,

NDIS supports s$ou(d )e pro*ided in a 'a& t$at %a.i%ises an indi*idua(-s#unctioning and independence, T$at does not %ean t$at peop(e s$ou(d go 'it$outt$e support t$e& need+ )ut rat$er t$at t$e& s$ou(d gain a greater sense o# contro(

o*er t$eir (i*es, It cou(d )e as si%p(e as an attendant carer 2doing t$ings 'it$- aperson rat$er t$an 2doing t$ings #or- t$e%,

In so%e cases+ t$at %ig$t %ean indi*idua(s 'i(( need to (earn or re(earn t$e s/i((snecessar& #or dai(& (i*ing, or t$ose indi*idua(s '$ere s/i((ing or res/i((ing is notappropriate t$e ai% 'ou(d )e to %ini%ise #unctiona( (osses or #uture dependencies,0As %ig$t )e t$e case 'it$ so%e degenerati*e conditions,1 T$e assess%ent process'ou(d )e a 'a& o# identi#&ing t$ese opportunities, T$is s$ou(d )e a pri%ar& #ocuso# t$e assess%ent process '$en peop(e #irst enter t$e sc$e%e or '$en t$e& arereassessed #o((o'ing sa& a period o# i(($ea(t$,

T$is approac$ is si%i(ar to t$at adopted in a nu%)er o# ot$er urisdictions, ore.a%p(e+ t$e NS? Attendant Care and P$&sica( Disa)i(it& Unit 0ACPDU1 operate a2transition %ode(- '$ic$+ is designed to pro*ide c(ients 'it$ an opportunit& to )ui(ds/i((s, ?$i(e not ai%ed e.c(usi*e(& at an& particu(ar c(ient group+ it is t$oug$t t$atindi*idua(s 'it$ an ac


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I# t$e NDIS is to do t$is e##ecti*e(&+ t$e assess%ent process %ust not on(& #ocus ont$e supports needed to %aintain t$e person in t$eir present situation )ut a(so on

t$ose re


28/37

assistance 'it$ (ongter% (i#e(ong p(anning+ particu(ar(& #or adu(ts 'it$inte((ectua( disa)i(ities (i*ing at $o%e 'it$ e(der(& parents3

#a%i(&si)(ing counse((ing '$ere t$ere are $ig$ (e*e(s o# carer stress,

Responses to #a%i(& needs s$ou(d )e tiered+ 'it$ re#erra(s to (oca( support groups#or t$ose 'it$ (ess signi#icant needs+ and access to NDIS#unded specia(istassistance '$ere t$e needs 'ere $ig$,

T$is is not a no*e( approac$, A nu%)er o# urisdictions $a*e carer assess%ents orare 'or/ing to'ards t$e%, or e.a%p(e+ in t$e U+ carers '$o pro*ide+ or intend to

pro*ide+ a su)stantia( a%ount o# care on a regu(ar )asis can re


29/37

7.10 /o assess$ent $ight or" in practice

T$e proposed structure o# t$e NDIS as a centra( point o# assess%ent and re#erra( 0asout(ined in #igure 7,31 'ou(d )e a %aor i%pro*e%ent o*er t$e #rag%ented s&ste%sseen in *arious urisdictions, Boreo*er+ it is not a co%p(ete(& ne' concept+ as its$ares %an& si%i(arities 'it$ Tas%ania-s recent(& i%p(e%ented Gate'a&, T$esesi%i(arities $a*e )een noted )& )ot$ t$e State Go*ern%ent and organisationsin*o(*ed in de(i*ering t$e Gate'a&:

In genera(+ t$e proposed %ode( o# operation #or t$e NDIA re#(ects t$e 'a& in '$ic$ t$eGate'a& ser*ices operate in Tas%ania in ter%s o# assess%ent and re#erra( o# peop(e'it$ disa)i(it& to specia(ist and %ainstrea% ser*ices, 0Tas%anian Go*ern%ent+su), DR;43+ p, ;1

As per our presentation to t$e Co%%ission in Ho)art on 5 Apri(+ 3;+ =aptcare 'is$esto $ig$(ig$t t$e si%i(arities o# t$e Report-s proposed %ode( to t$e ne'(& i%p(e%entedTas%anian Disa)i(it& and a%i(& Support Gate'a& T$e Gate'a& is a centra(isedinta/e point #or peop(e 'it$ a disa)i(it&, T$e inta/e point pro*ides a sea%(ess entr&

point to a )road range o# co%%unit& support ser*ices as it is de(i*ered t$roug$ aco((a)oration o# integrated co%%unit& ser*ice organisations, T$e Gate'a& pro*idesin#or%ation and options t$at assist peop(e to na*igate t$e s&ste%, =ased on aco%pre$ensi*e assess%ent+ 'e c$anne( peop(e into %ainstrea% or specia(ised supports&ste%s as is appropriate to t$eir needs, 0=aptcare+ su), DR788+ p, 1

T$e Tas%anian e.perience 'i(( )e a use#u( e.a%p(e o# $o' to i%p(e%ent structura(c$anges si%i(ar to t$ose proposed )& t$e Co%%ission, T$ose in*o(*ed in de(i*eringt$e Gate'a& s&ste% note t$at %uc$ o# t$e #eed)ac/ recei*ed regarding t$e #irst%ont$s o# s&ste% $as )een positi*e 0su), DR7881,

3ractica( considerations

It is (i/e(& t$at peop(e '$o approac$ t$e NDIS #or #unded supports 'i(( $a*e arange o#


30/37

to engage ear(& on in t$e process+ to t$in/ a)out t$eir care and support needs and$o' t$e& %ig$t )est )e %et, T$e in#or%ation pac/age 'ou(d a(so inc(ude

in#or%ation on t$e option o# $a*ing a Disa)i(it& Support Organisation 0DSO1 assistt$e% to i%p(e%ent t$eir support pac/age, Bateria( s$ou(d )e pro*ided in a range o#accessi)(e #or%ats suc$ as D>Ds and )roc$ures,

What should I !ring

?$ere possi)(e 0and 'it$ t$e indi*idua(-s per%ission1 t$e sc$e%e s$ou(d %a/e useo# e.isting %edica( reports, Idea((&+ peop(e see/ing indi*idua(ised supports 'ou(d%a/e t$ese a*ai(a)(e at t$e initia( screening stage,

Who is involved

Indi*idua(s s$ou(d $a*e scope to in*o(*e ot$er interested parties 0a so ca((ed circ(eo# support1 in t$e assess%ent process, Idea((&+ t$ese 'ou(d )e peop(e '$o 'ere#a%i(iar 'it$ t$e care and support needs o# t$e indi*idua(+ t$e& %ig$t inc(ude carers+#a%i(& %e%)ers+ and direct support pro#essiona(s, Indi*idua(s cou(d a(so e(ect toin*o(*e DSOs 0#igure 7,41

"o# long might it take

Indi*idua(s s$ou(d not $a*e to 'ait e.cessi*e periods #or t$eir care and supportpac/age to )e #ina(ised, ?$ere possi)(e+ strea%(ined processes s$ou(d app(&, T$eNDIA s$ou(d report annua((& on t$is %etric,

7


31/37

2igure .4 8uggested initia( assess$ent process


79


32/37

2igure .A 8uggested assess$ent process #or tier 2ollowing on from figure .4

0


33/37


1


34/37

What happens if I dont agree #ith the outcome

o((o'ing t$e assess%ent o# support needs+ indi*idua(s 'ou(d )e in#or%ed o# t$eirsupport pac/age, T$is step 'ou(d detai( t$e nature+ #re


35/37

Data 'ou(d )e co((ected to assess t$e re(ia)i(it& and *a(idit& o# t$e assess%enttoo(s+ and t$e too(s 'ou(d )e su)ect to a regu(ar c&c(e o# e*a(uation and i#

necessar& reca(i)ration, T$e assess%ents 'ou(d not )e 2ru))er sta%ped-, Prior to %a/ing )udgetar&

decisions+ t$e NDIA 'ou(d con#ir% t$at t$e particu(ar assess%ent #o((o'ed t$eappropriate protoco(+ and 'as consistent 'it$ t$e 2)enc$%ar/- range o# assessedneeds #or ot$er peop(e 'it$ si%i(ar c$aracteristics, De*iations outside t$e nor%'ou(d re


36/37

in t$e a)sence o# 2per#ect- too(s, According(&+ t$e NDIS 'ou(d use t$e )est a*ai(a)(e

too(s in its initia( i%p(e%entation p$ase+ 'it$ t$e (ater de*e(op%ent o# )etter too(s,

Working within the framework of the International Classification of

Functioning, Disability and Health (ICF), the assessment process undertaken by

the DI! should identify the supports re"uired to address an indi#idual$s

reasonable and necessary care and support needs across a broad range of life

acti#ities, and should take account of an indi#idual$s aspirations and the

outcomes they want to achie#e%

&he assessment process should be a #aluable inter#ention in its own right, rather

than 'ust an entry point to supports% &he process should

draw on multiple sources of information, including

information pro#ided by the indi#idual with a disability, including theiraspirations and re"uirements for supports

information pro#ided by an indi#idual$s circle of support, including familymembers, carers and direct support professionals

information on the current support pro#ided both formally and informally

current medical information on the person with a disability

assess the nature, fre"uency and intensity of an indi#idual$s support needs%

&he process should be personcentred and forward looking and consider the

supports that would costeffecti#ely promote people$s social and economic

participation, rather than only respond to what an indi#idual cannot do

determine what supports outside the DI* people should be referred to,

including referrals to +ob *er#ices !ustralia pro#iders

consider what reasonably and willingly could be pro#ided by unpaid family

carers and the community (natural supports$)

translate the reasonable needs determined by the assessment process into aperson$s indi#idualised support package funded by the DI*, after taking

account of natural supports

pro#ide efficiently collected data for program planning, high le#el reporting,

monitoring and 'udging the efficacy of inter#entions%

&he assessment tools should be #alid and reliable, relati#ely easy to administer

and e-hibit low susceptibility to gaming% &he tools should be employed nationally

to ensure e"uitable access to nationally funded support ser#ices (and allow

portability of funding across state and territory borders when people mo#e)%

4

RECOBBENDATION 7, RECOBBENDATION 7,3 RECOBBENDATION 7,4


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!ssessments should be undertaken by trained assessors engaged by the DI!% &o

promote independent outcomes, assessors should not ha#e a longstandingconnection to the person% &he DI! should continually monitor and e#aluate

assessors$ performance to ensure comparability of outcomes and to a#oid bracket

creep$%

&he DI! should periodically reassess people$s need for funded support, with a

focus on key transition points in their li#es%

Where an informal carer pro#ides a substantial share of the care package, they

should recei#e their own assessment if they wish% &his should seek to identify

their #iews on the sustainability of arrangements and the ways in which the DI*should support their role, including through the initiati#es recommended in

recommendation ./%0%

&he consultation with the family as part of the assessment process should also

e-plore the need for

assistance with longterm planning, particularly for adults with cogniti#e

impairments li#ing at home with elderly parents

family1sibling counselling where there are high le#els of carer stress%

2esponses to family needs should be tiered, with referrals to local support groups

for those with less significant needs, and access to DI*funded specialist

assistance where the needs were high%

&he DI* should establish a coherent package of tools (a toolbo-$), which

assessors would employ across a range of disabilities and support needs

(including planning and acti#e support, attendant care, aids and e"uipment, and

home modifications)%

&he assessment tools should be sub'ect to ongoing monitoring, as well as a

regular cycle of e#aluation against best practices, including the ICF framework,and, if necessary, recalibration% &he scheme should ha#e systematic internal

mechanisms to ensure that anomalies can be analysed and addressed%

&he DI* should use the best a#ailable tools in its initial implementation phase,

with the ongoing de#elopment of bestpractice tools%

RECOBBENDATION 7,5RECOBBENDATION 7,6RECOBBENDATION 7,RECOBBENDATION 7,7RECOBBENDATION 7,8RECOBBENDATION 7,9RECOBBENDATION 7,;

10 disability support chapter7

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