sally nepean transition service coordinator senior speech pathologist
TRANSCRIPT
The interface of health & disability: working with the NDIS
Sally Nepean
Transition Service Coordinator Senior Speech Pathologist
Background
• Senior Speech Pathologist – Trauma outpa7ent rehabilita7on team; Barwon Health – Private prac7ce; registered NDIA & TAC provider
• Coordinator Transi7on Service Transi7on
– The Transi7on Service supports young with a complex disability and their families as they move from child health services to adult health services.
– ‘Transi7on’ is the process of providing educa7on and skills-‐development opportuni7es for the young person as they move between the child and adult services.
– It aims to help the young person develop independence and responsibility for their own health care.
What is health?
‘Health is a state of complete physical, mental and social well-‐being and not merely the absence of disease or infirmity’ World Health Organisa7on (WHO) -‐ 1948
The main determinants to our health are:
-‐ Socioeconomic status -‐ Educa7on
-‐ Physical Environment -‐ Employment condi7on
-‐ Support from people around you -‐ Culture
-‐ What we do and how we manage -‐ Access and use of health services
-‐ Gender
What is disability?
An umbrella term for impairments, ac7vity limita7ons and par7cipa7on restric7ons. Disability is the interac(on between individuals with a health condi7on (e.g. cerebral palsy, Down syndrome and depression) and personal and environmental factors (e.g. nega7ve aWtudes, inaccessible transporta7on and public buildings, and limited social supports). WHO – International Classification of Function (ICF) 2001
Health & Disability
While some health condi7ons associated with disability result in poor health and extensive health care needs, others do not. However all people with disabili7es have the same general health care needs as everyone else, and therefore need access to mainstream health care services. Ques7ons to take away
How can health services and disability services work together? How do we define our service roles?
Consumer-‐centred care
Care that is respecYul of, and responsive to the preferences, needs and values of consumers. Based around the fundamental concepts of:
a) the care provided b) partnerships and collabora7on between care professionals’ current
and future pa7ents, residents, clients, carers, families and the community.
Principles • Respect for consumers’ values, preference and expressed needs • Informa7on, communica7on and educa7on • Involvement of family and friends • Coordina(on and integra(on of care • Physical comfort • Emo7onal support and allevia7on of fear and anxiety • Access to care • Con(nuity and transi(on Picker Ins7tute “Eight Picker Principles of Pa7ent-‐Centred Care”.
Na7onal Disability Insurance Scheme
The Na7onal Disability Insurance Scheme (NDIS) is a new way of providing community linking and individualised support for people with permanent and significant disability, and people with severe and persistent mental illness in limited circumstances. The NDIS will deliver a life-‐long approach to support people with disability through individualised planning processes to iden7fy the reasonable and necessary supports you need to enable you to achieve your goals.
Na7onal Disability Insurance Scheme
• Barwon trial site commenced July 2013
• People aged up to 65
• Barwon
– 3839 access requests
– 3202 eligible (85%)
– 322 ineligible (8%)
– 315 other
• 90% of Transi7on Service clients have an ac7ve NDIA plan; those that
don’t live outside the NDIA catchment area
Where is health?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total NSW SA TAS VIC
Prop
ortio
n of plans with
mainstream su
pport
Education Self-‐care Community and social life General Tasks and Demands Other
Figure 3. Types of mainstream supports accessed in par6cipants plans
Na7onal Disability Insurance Agency – Quarterly Report to COAG Disability Reform Council; 30 September 2014
Challenges / Barriers
Communica(on
With the health service • The NDIA ini7ally refused to communicate with the health
services and their clinicians in the Barwon trial site. Communica7on was with the par7cipant only.
With the par(cipant • Change of staffing not communicated to par7cipants • Progress of plans not provided freely • High-‐level of health literacy required
Long-‐term solu7ons
Communica(on
With the health service • A growing acknowledgement of health’s role as a
mainstream service • Collabora7on and advice sought from health services – a
work in progress • Star7ng to make our way on to par7cipant plans
With the par(cipant • Ongoing issues with length of 7me to implement plan and
provision of progress updates • External supports can now request this informa7on on
behalf of the client
Challenges / Barriers
Access All applicants required to complete an online ‘access checker’ • Jus7fica7on of the permanency of your disability • Jus7fica7on of the impact of your disability • Requires suppor7ng documenta7on from the health service • Access to the internet • High-‐level of health literacy, wrijen & communica7on skills
Long-‐term solu7ons
Access
• Access can now be completed face to face with an NDIA rep • Support staff to access appropriate paperwork • Ongoing work required to ensure wrijen informa7on is
accessible by all • Ongoing educa7on regarding permanency of an injury i.e. ABI
Challenges / Barriers
Lack of consumer capacity
• Clients don’t always know what they need -‐ Cogni7ve impairments: limited insight into their needs / goals
-‐ Communica7on impairments -‐ Inappropriate plans drawn up & services missing
• No collabora7on with long-‐term therapists or service providers (health & disability)
• No funding for case management
Challenges / Barriers
Primary Disability NSW SA TAS VIC ACT NT WA Total
Total 2,648 1,839 838 3,318 103 31 103 8,880
Au(sm and Related Disorders 22% 40% 30% 24% 19% 3% 28% 27%
Cerebral Palsy 5% 6% 7% 4% 10% 16% 8% 5%
Deafness/Hearing Loss 3% 4% 0% 1% 3% 0% 1% 2%
Developmental Delay 3% 14% 2% 6% 6% 6% 0% 7%
Down Syndrome 5% 4% 7% 5% 12% 6% 6% 5%
Global Developmental Delay 2% 12% 2% 3% 1% 6% 7% 5%
Intellectual Disability 21% 0% 34% 22% 23% 6% 26% 19%
Mul(ple Sclerosis 2% 0% 0% 3% 3% 3% 1% 2%
Schizophrenia 6% 0% 1% 5% 1% 0% 0% 4%
Other Intellectual/learning 5% 6% 6% 3% 5% 6% 9% 5%
Other Neurological 13% 2% 6% 10% 8% 23% 9% 9%
Other Physical 5% 3% 2% 3% 6% 16% 4% 4%
Other Psychiatric 3% 0% 2% 6% 0% 0% 0% 3%
Other Sensory/Speech 4% 8% 1% 3% 4% 6% 2% 4%
Table 1.1.1.(b) Informa6on about par6cipants with approved plans, split by primary disability
Na7onal Disability Insurance Agency – Quarterly Report to COAG Disability Reform Council; 30 September 2014
Long-‐term solu7ons
Consumer Capacity
• Informa7on from long-‐term service providers now considered (to an extent)
• Gradual changes to accessibility of wrijen informa7on – focused work required here
• Further work needed to support ini7al planning process; considera7on of who is involved, how this is delivered
• Providers role is to ‘enable’ the par7cipant and family to par7cipate in planning conversa7ons, rather than ‘direct’
• Introduc7on of ‘support coordina7on’
Challenges / Barriers
Whose role is it?
Specialist assessment of skills and needs
• Inter-‐disciplinary & mul7-‐disciplinary care not supported in the model • Collabora7on with long-‐term therapists (health & disability) not sought • Referral to inappropriate services for assessment • Assessment of equipment needs • Therapeu7c supports – max 10 sessions per year
Where does the skill set sit in your region?
• Au7sm • Behaviour management • Spinal cord injury • Acquired brain injury
NDIS guidelines: Health v Disability
Guidance on when supports rela(ng to health are most appropriately funded The NDIS will be responsible for necessary and reasonable supports related to a person’s ongoing func7onal impairment and that enable the person to undertake ac7vi7es of daily living, including maintenance supports delivered or supervised by clinically trained or qualified health prac77oners where these are directly related to a func7onal impairment and integrally linked to the care and support a person requires to live in the community and par7cipate in educa7on and employment. The NDIS will not be responsible for:
– Funding 7me-‐limited, goal-‐oriented services and therapies: • Where the predominant purpose is treatment directly related to the person’s
health status, or • Provided aoer a recent medical or surgical event, with the aim of improving
the person’s func7onal status, including rehabilita7on or post-‐acute care
NDIS guidelines: Health v Disability
Therapeu(c support, including assistance by allied health professions and therapy delivered by a therapy assistant under the supervision of the therapist:
• NDIS: • Maintenance care where the primary purpose is to provide ongoing support for a par7cipant in
order to maintain a level of func7oning including long term therapy/support required to achieve small incremental gains or to prevent func7onal decline,
• To improve func7oning in an early interven7on context
• Other par(es: where it is a 7me limited interven7on to improve func7oning following an acute event, medical treatment or accident (e.g. to improve func7oning immediately following a stroke or acquired brain injury)
• Assistance to increase func(oning (rehabilita(on) specialist allied health, rehabilita7on and other therapies for people with recently acquired condi7ons such as newly acquired spinal cord injury or brain injury, un7l the par7cipant has achieved the maximum level of achievable func7oning and the remaining allied health support is for the purpose of maintenance
NDIS guidelines: Health v Disability
Assistance in managing life stages, transi(ons and supports, can be funded by the NDIS or by the health/mental health system. In determining which system is more appropriate, the system that is delivering the majority of supports is usually more appropriate to assist in the coordina7on of these supports.
• NDIS: assistance where the majority of the coordina7on and transi7on supports relate to supports funded by NDIS, or to non-‐clinical supports,
• Other par7es: assistance where the majority of the coordina7on and transi7on supports relate to supports funded by the health system.
Opera(onal Guideline – Planning and Assessment – Supports in the Plan – Interface with Health (v 1.0) Publica7on date: 16 January 2014
How can we work together?
Set-‐up clear communica(on pathways
• Working with the NDIA to provide consumer-‐centered holis7c health/disability support
• Get to know the local team • Development of service agreements between health & disability • Develop repor7ng formats between services Service promo(on
• Increase the NDIA’s awareness of your service • Presenta7ons at professional development sessions • Educa7on sessions • Wrijen informa7on – brochures, pamphlets
How can we work together?
Service delivery
• Communica7ng all informa7on in accessible formats
• Empower people with disabili7es to maximize their health by providing informa7on, training, and peer support – capacity building
• Promote community-‐based rehabilita7on (CBR) to facilitate access for disabled people to exis7ng services.
• Iden7fy groups that require alterna7ve service delivery models, for example, targeted services or care coordina7on to improve access to care.
Questions ???
References
NDIA Strategic Plan 2013-‐2016 -‐ hjp://www.ndis.gov.au/document/671 NDIA Quarterly Reports -‐ hjp://www.ndis.gov.au/document/754 hjp://www.melbournecitymission.org.au/docs/default-‐source/cmag/news/cmag-‐presenta7on-‐9-‐oct-‐2014-‐3.pdf?sfvrsn=0 hjp://www.ndis.gov.au/sites/default/files/documents/og_plan_assess_supp_plan_interface_health.pdf