Support Coordination: On the Money

Support Coordination is a big deal. At full rollout, we estimate that the NDIA will spend $770 million on Coordination of Supports. This is more than the total budget for Local Area Coordinators, who are expected to write and review plans for 80% of NDIS participants and fulfil a community development function. As the fourth largest support category by spend, Support Coordination is also larger than Assistive Technology, which was the topic of one of only two conferences the NDIA has ever hosted.

Yet with an estimated three quarters of a billion dollars projected to be spent on this support, guidance from the NDIA on what it should look like has been remarkably thin on the ground.

We meet a lot of organisations who are confused about what Support Coordination should look like. And we don’t blame them. For a rundown of the basics, see our earlier article, Support Coordination 101. The list below builds on the basics to demonstrate what Support Coordination should look like – and what it should not.

 

SUPPORT COORDINATION LOOKS LIKE:

Building capacity
The NDIA makes it very clear that Support Coordination is intended to be a capacity building support. The principle is that it is a time-limited support, meaning it is typically only funded for the first NDIS plan or during a major life transition (e.g. moving into supported accommodation) and these hours are then removed or substantially reduced in subsequent plans.

This is a big move away from traditional case management and means that the capacity building aspect of the support is vital. How is your practice set up to build people’s capacity to coordinate their own supports and participate in the community next year? Though many people are critical of this approach for being unrealistic, the risk remains that participants may not be funded for Support Coordination beyond the first year.

Engaging people the whole way along the funnel of NDIS choice
We often work with people to understand choice and control as a spectrum. Taking an NDIS plan from approval to implementation might involve 100 or more small decisions. Which providers will deliver which supports? Which informal or mainstream supports could or should I access? At which days of the week and times of the day? What am I looking for in a support worker? These are all decisions that may need to be making without paid support in future years so an effective Support Coordinator will engage (and empower) participants and their families and carers the whole way along the journey.

Linking participants to non-NDIS supports
Support Coordination is described in the Price Guide as assistance to strengthen participant’s ability to connect with informal, mainstream and funded supports. With the shifts required to transition over to NDIS, it’s easy to understand why many Support Coordinators are focused on the “funded supports” part of that sentence. But we would urge providers to look at how their practice is geared towards reducing people’s reliance on paid supports and exploring ways of making progress towards goals that don’t involve paid support at all.

 

SUPPORT COORDINATION DOESN'T LOOKS LIKE: 

Internal referral channel
Support Coordination should not be considered a strategy for referring participants to other supports in an organisation. This seems obvious to say and the NDIA have put guidelines in place to oblige providers to mitigate this potential bias but we still hear of an alarming number of providers coordinating supports for existing clients and simply rolling over existing arrangements, without engaging in conversations about what opportunities are available to them with their NDIS funds. This is problematic (to say the least) and a missed opportunity for participants who are paying for a support they are simply not receiving. It is also a problem we think the NDIA is likely to have to resolve in the future… 

A substitute for good planning conversations
We hear a lot of providers ask, “When participants have more control over when and how they spend their package, how do we ensure we get paid later in the year?

Some are looking to Support Coordination to solve this problem, thinking if they could only get their hands on the plan at the start, they could carve out their slice of the plan and reduce the risk of the participant not having the funds to pay them at the end of the year.

There are two problems with this. One is that “locking in” participant funds is the role of Service Bookings, not Support Coordinators. These are agreements made between providers and participants, which allow providers to lock in, prior to services being delivered, an agreed amount of a participant’s funding. These can be changed with 28 days notice.

Secondly, while it is certainly the role of Support Coordinators to ensure that funding is properly budgeted, it is also the role of Support Coordinators to build capacity of participants to make the most of the flexibility in their plans, meaning what is decided at the beginning of the year may change as the year goes on. If an organisation’s goal is to lock in funding, are they really the best party to be facilitating flexibility?

Case management
Although it is the NDIS support that most closely resembles traditional case management, the NDIA have been clear that this is not the role of Support Coordination. This certainly creates a gap for many participants who have previously counted a Case Manager as a valued member of their support network. There are some other NDIS capacity building supports that can go part of the way towards filling the gap of Case Managers (e.g. tenancy support, life transition planning, skills development, plan management) and it is also the role of Support Coordinators to build resilience in the participant’s support network,

  

FINDING THE RIGHT SUPPORT COORDINATOR

To participants and families reading this, our recommendation is to raise your expectations. Many participants are being automatically referred to a Support Coordinator, but if you are willing and able to take the time to find the right one for you, consider asking the Support Coordinators you are meeting questions like:

  • What stories can you tell me about times you’ve worked with people like me? (where the “like me” refers to whatever characteristics you consider to be most important, e.g. goals, interests, family or living situation, age, disability type, package size, support/medical needs)
  • What do you think success towards my goals would look like?
  • How will you manage any conflicts of interest or biases, for example if your organisation is a potential provider of another NDIS support for me?
  • Given how many hours of support coordination I have been funded for, how many hours do you imagine you will spend in the different parts of support coordination, i.e.
    • Talking with me about my goals
    • Showing me my options in service providers
    • Resolving points of crisis
    • Liaising with the NDIA or LAC
    • Drawing up service agreements
    • Connecting me to mainstream, informal or community supports 
  • What kinds of mainstream, community or informal supports have you connected people to in the past?
  • What are the meaningful differences between the providers you want me to choose between
  • How do you intend to build my capacity to coordinate my own supports?

 

ADVICE FOR PROVIDERS

Start as you mean (and will need) to finish.  Set up Support Coordination now with a capacity building, conflict of interest free, independent focus.  In the short term it may serve you to use Support Coordination to stream clients to your own services. In the longer term this approach is a recipe for disaster as participants will find providers who are genuinely interested in supporting them to pursue their best possible outcomes.

Support Coordination is too important (and too expensive) to be done poorly. We reckon it is one of the most important levers for facilitating the NDIS’ promises of choice and control and are running workshops next month in Melbourne, Sydney, Brisbane & Adelaide collaboratively build and promote best practice within sector.