The NDIS is designed around individual participants, not around programmatic guidelines. The aim of the NDIS is to focus on a participant’s outcomes. Given that it’s all about individuals and achieving outcomes, how do organisations think about what service to provide and what the value proposition is for their service?
We have been helping organisations to think through these questions in the NDIS. And we haven’t found it easy. For a long time, the disability system has been structured around what a service looks like from the organisation’s perspective, not what the service looks like from the participant’s perspective.
In this article we share DSC’s approach to understanding what the NDIS can fund and what the value proposition is for each domain of services from the perspective of NDIS participants. These are similar to the NDIA’s support categories, though we have grouped them into only 7 categories (as opposed to the NDIA’s 15).
The seven domains of service in the NDIS that we have developed are listed below.
#1: Maintain family relationships
Participant value proposition: Services that help me stay connected to my family, including helping my family sustainably manage their care for me so we get to spend quality time together.
Scope of NDIS funding: The NDIS will be funding parental training in how to care for a child with disability; day programs and respite care; and in-home assistance to families to support their care for a person with disability.
The NDIS will only be funding in-home assistance for families when the support is needed because of the participant disability-specific needs. Age and community expectations of caring play a critical role in deciding how much care the NDIS will fund – for example, while all children aged less than 1 year require a carer to present at all times, an 18 year old child would not usually require a caregiver to be present which justified NDIS funding to support the caregiver.
Advice for service design: Organisations should begin with the value proposition of creating sustainable family care and design services that enable families to maximise the quality time they spend together. When providing services designed to have a ‘respite’ effect, organisations should be working towards a dual goal: making care sustainable for the carer while provide enriching activities for the person with disability.
#2: Gain skills and participate in education
Participant value proposition: Support that helps me to choose the right school and education setting, get ready and prepare for attending school, participate while I’m at school and further education, and help to move between schools and further learning.
Scope of NDIS funding: The NDIS will only fund supports in schools only if they are directly required due to disability. The types of services that can be funded include school readiness; assistance to transition between schools—primary to high school and to post-school education & training; and aids and equipment required both at school and at home.
The NDIS will not fund organisations to deliver support that most families with a child require, such as a standard level of child care or educational toys that help build general literacy and numeracy skills. The NDIS also won’t provide funds in participant packages to purchase services that schools are expected to deliver, such as giving extra support to students with disability through teacher’s assistants, modifying curriculum and building modifications in the school.
Advice for service design: Supporting children with disability to start school can be integrated into a range of programs for children, including allied health and behavioural services that are building children’s functional capacity across multiple areas.
There are also opportunities for non-traditional service providers to enter this space – think about the youth service that is supporting young people with cognitive impairments or mental health conditions accessing NDIS funds to help the young person achieve their goal of staying in school and working out the right post-school option for them.
#3 Live independently in my own home
Participant value proposition: The right help at the right time so that I can find and live in a home with the people that I want to live with, and can do as much as possible by myself without needing help.
Scope of NDIS funding: This type of assistance is well known within the disability sector, covering high intensity assistance of supported accommodation, down through to occasional drop in assistance, as well as home modifications and assistive technology. New for the sector is specialist tenancy support to help people sustain their tenancy and stay in their home.
There has been a lot of attention on where the NDIS should draw the line on housing-related supports – in particular, how many participants will get a ‘user cost of capital’ housing subsidy and what the NDIS’ expectations are for people sharing support compared with living alone. These questions are still being worked through but it is fair to say that that the NDIS is likely to fund options across the spectrum from 1-1 assistance in a person’s own home through to shared accommodation. It is clear that the NDIS is going to move away from institutional living—including from large residential centres and big group homes—towards small scale living.
Advice for service design: Independent living support will consume the most funding in the NDIS and there will be a wide variety of support options available in a mature NDIS. Organisations thinking about how best to meet the needs of participants should be working towards housing that is more integrated within communities and assisted by more flexible models of support, including more drop in assistance rather than 24/7 supported accommodation.
#4 Engage socially and be part of my community
Participant value proposition: Meet other people and contribute to my community through finding work and volunteering opportunities and being a part of the activities that happen in my community, by getting the skills I need, being connected to opportunities and getting help while I’m in the community.
Scope of NDIS funding: Service offering to meet these goals include the many activities that have traditionally been part of disability service funding, including recreational programs; assistance to access mainstream recreational programs; assistance to meet other people with disability and develop networks of support; social and communication skills capacity building; resilience and confidence to participate in the community; and mentoring and peer support.
The NDIS will be drawing a line between what level of assistance is needed due to a person’s disability and what the average Australian would pay for social and recreational activities. For these activities to be funded by the NDIS they need to either involve an additional cost because of the person’s disability or be very closely linked to time limited goals of building capacity.
Advice for service design: The traditional social engagement activities delivered by the sector were often an ongoing model of support that continued year after year. The NDIS will direct participants to focus on the individual goal being achieved through social and recreational programs. Organisations will increasingly need to show participants how the activity helps achieve the goal of being more connected with their community and ideally how this can become self-sustaining over time.
#5 Find and maintain employment
Participant value proposition: Contribute to my community and have personal worth and value through finding work and volunteering opportunities, by getting the work skills I need, being connected to opportunities and getting help to stay in work.
Scope of NDIS funding: The areas of assistance to find and maintain employment remains under-developed in the NDIS, however we do know that the NDIS will be funding work readiness’ training and skills building (that is specific to disability needs), career guidance & counselling and supported employment programs (e.g. Australian Disability Enterprises).
The NDIS will still be expecting employment service providers to play their role in supporting people with disability. While there will be areas where the NDIS and Job Active and Disability Employment Services funding streams meet, the NDIS will be drawing a boundary around direct employment seeking assistance and vocational skills training which won’t be funded by the NDIS.
Advice for service design: Finding and maintaining employment is increasing an important goal for the NDIS. Given Australia’s very low rate of employment of people with disability, there is huge scope for innovative and effective support models to help more people with disability into work or volunteering.
The most effective models are likely to be partnerships between employment services and NDIS-funded assistance where participant’s have a multi-year pathway that involves NDIS funding for capacity building, followed by more intensive assistance from employment services during job search and ongoing placement assistance.
#6 Improve and maintain day-to-day functioning
Participant value proposition: Improve my level of ability to do things by myself, by helping me to improve my physical functioning, social and independence skills.
Scope of NDIS funding: Therapeutic services will be funded to to maintain functioning or for early intervention (physiotherapy, occupational therapy, speech pathology). The NDIS will also fund dietician services, social work and counselling and a variety of skills building services in areas such as social, communication, independent living and travel and public transport training. Assistive technology and aids and equipment are also paid for by the NDIS to achieve these goals.
The distinction between health responsibilities and the NDIS are important in this area, where services that are for health conditions or acute treatment will stay outside the NDIS. Rehabilitation is a critical ‘boundary issue’, where the NDIS only starting to pay for therapeutic services once a person has achieved their rehabilitation goals after an acute accident/injury. The health system is expected to provide the initial rehabilitation and recovery services after an accident or injury.
Advice for service design: This area of NDIS activity is extremely focused on specific and time limited goals. Services need to be very clear about the goal their services are attempting to achieve and the indicators of success. This approach is already commonplace in allied health professionals in occupational and physical therapy, although will require a change in thinking in some more community-based disability services.
The sector’s ability to deliver evidence-based capacity building in social, communication and independent living skills is well developed. The absence of nationally agreed models and delivery approaches to build these skills opens a large opportunity for evidence based services to help people with disability be more independent over time. The NDIS’ insurance approach will be redirecting funding towards services that can demonstrate how they build skills that have measureable impacts on independence (and lower NDIS packages) over a person’s life.
#7 Make life decisions and have choice and control over services
Participant value proposition: Information and community activities that help me to build the skills and knowledge on how to live my life the way I want to live it, plus services and platforms that help me find the support I need to achieve my goals and live independently, and to manage my NDIS money.
Scope of NDIS funding: Improved capacity to make life decisions and have choice and control over services can be built through activities such as budgeting and savings planning, literacy and numeracy skill development and capacity building to independently manage their NDIS plan and coordinate their own support. Other activities to help in this area include individual or group assistance to develop a vision for life and plan for unexpected events and changes in family circumstances and crisis management and case management.
A new and unique opportunity in the NDIS is also created through funding to manage and coordinate a participant’s plan/services on their behalf, including by being a financial intermediary managing a participant’s NDIS funds.
Advice for service design: The NDIS’ actuarial, insurance-based approach makes capacity building an important area of focus for the NDIS. Services wanting to work with participants to build capacity for decision-making and choice and control will need to have evidence-based delivery models that objectively demonstrate how this assistance is helping participants exercise more choice and control.
Many people with disability have shown an interest in self-managing their supports. NDIS funds management services benefit from large scale delivery – providers thinking about entering this area are usually considering national platforms that will be serving thousands of participants.