JCPSLP Vol 18 no 2 July 2016

National Disability Insurance Scheme

Meeting the planning needs of people with complex communication needs Hilary Johnson and Denise West

The introduction of the National Disability Insurance Scheme (NDIS) in Australia is changing service provision for people with disabilities. The scheme has been operating at trial sites since 2013 and will roll out nationally in 2016. The aims of this paper are to explore some of the current challenges presented by this scheme in the provision of recommendations for change. Examples of lifestyle planning are outlined and essential elements highlighted to ensure adults with complex communication needs successfully identify their goals and receive the reasonable and necessary individualised supports they require in order to achieve life goals. Recommendations for the NDIS include specialised training for planners and inclusion of the person with complex communication needs in the process. Recommendations for speech pathologists include developing appropriate communication tools and resources for planners, individuals with complex communication needs, and advocates. S ervice provision for people with severe disabilities is rapidly changing within Australia due to the National Disability Insurance Scheme (NDIS). The National Disability Insurance Agency (NDIA) is an independent statutory agency, whose role is to implement the NDIS. A Commonwealth Government initiative, the NDIS was set up to redress the inequities people with disabilities face in receiving supports that have been described as “inequitable, underfunded, fragmented, and inefficient” (Productivity Commission, 2011, p. 2). The NDIS aims to improve outcomes for people with a disability through what was initially termed a three-tiered model. Tier 1 is aimed at all Australians to create more inclusive opportunities for people with a disability (Productivity Commission, 2011, p. 11.) Tier 2, now renamed Information, Linkages and Capacity Building (ILC), targets approximately 800 000 services for adults with complex communication needs and provide

people with a disability. The ILC aims to build community awareness and capacity building, assist primary carers or families to obtain information or referrals for service through mainstream services and community support groups, and provide local area co-ordination. Tier 3 is focused on providing individualised funded packages (IFPs) to enable eligible people with disability to receive the reasonable and necessary supports to achieve life goals. Funding will be provided to 460 000 people with a disability who need specialised individualised supports determined through a planning process (New South Wales Government, 2015). The IFPs have been piloted for eligible participants since July 2013 at various sites across Australia, with the full scheme scheduled to progressively roll out across New South Wales, Victoria, Queensland, South Australia, Tasmania and Northern Territory from July 2016 until 2019. Many of the participants targeted to receive individual support packages in the NDIS have complex needs and cognitive difficulties. The NDIS estimate that 60−70 % of participants have an intellectual disability (Bigby, 2014; Bonyhady, 2015). In Australia 2.9% (668 100) of the population have an intellectual disability, of which 417 100 people (or 62%) have a profound or severe core-activity limitation. Of these people with profound or core limitation, 67.3% have speech difficulties (Australian Bureau of Statistics, 2012). Not all of these people will be eligible for the NDIS as people who acquire a disability after the age of 65 years will receive funding for services through the aged care sector. The NDIA’s 2015 report of the trial data demonstrated that people with cognitive and associated impairment constitute a large number of those with established plans which reflects the population data (NDIA, 2015). For instance, “Autism and related disorders represent the highest proportion of approved plans overall, at 31%. The second highest proportion is represented by participants with intellectual disability (including Down syndrome and other intellectual/learning disability) at 25%” (NDIA, 2015, p. 29). As many participants will require communication supports (as clearly reflected in the top two diagnostic groups with completed plans), Speech Pathology Australia has recognised that the NDIS will have an impact on service provision and established a project officer, based at national office, dedicated to inform the profession and oversee developments (Olsson, 2015; Speech Pathology Australia, n.d.). Speech-language pathologists (SLPs) have commenced providing services in the trial sites, with some reporting positive outcomes. For instance, there have

KEYWORDS ADULTS COMPLEX COMMUNICA- TION NEEDS NATIONAL DISABILITY INSURANCE SCHEME PLANNING

THIS ARTICLE HAS BEEN PEER- REVIEWED

Hilary Johnson (top) and Denise West

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JCPSLP Volume 18, Number 2 2016

Journal of Clinical Practice in Speech-Language Pathology