Australian Disability Services Research Articles

A flawed model or weak implementation? A critical review of the approach to group homes taken by the Disability Royal Commission

Group homes have been an important option for people with intellectual disabilities leaving the family home or institutions. They were one focus of the Royal Commission on Violence, Abuse, Neglect and Exploitation of People with Disabilities. Much evidence was collected about harm experienced by people in group homes through submissions, and dedicated and other hearings about disability services more generally. In its Final Report the Commission considered group homes to be both a flawed model and subject to weak implementation similar to that identified across the Australian disability service system more generally. This article describes the Commission’s approach to group homes, the evidence heard, and its conclusions; and critiques its stance, processes, and recommendations, identifying links to the NDIS Review published after the Commission’s Report in 2023. The Commission’s recommended reforms to practice, and replacement of group homes with alternative options reflect current policy directions, but raise issues that will be important for implementation; including; uncertainty about alternatives to group homes, the risk of alternatives not having better outcomes and thus the loss of good services, risk of neglecting quality of support practice in new alternatives and recurrence of institutional practice in them, and potential negative impacts on existing residents of signalling group homes as a flawed model. The Commissions’ approach missed opportunities for appreciative enquiry about conditions that lead to good outcomes in some group homes. The article concludes by considering the benefits for people with intellectual disabilities of singling out long-term residents and people with complex or high support needs, together with the potential for a quicker pace of change that may result from the Commission’s work.

An argumentation analysis of testimony about positive behaviour support and chemical restraint in Australia’s Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

Introduction Australia’s Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (2019–2023) is examining, amongst many issues, how positive behaviour support (PBS) can address challenging behaviour and reduce the use of restrictive practices, particularly chemical restraint. This study explores the basis of the claims made about this during testimony. Materials and methods Applying existing recommendations for the study of Royal Commissions, this study uses argumentation analysis of testimony. Results Three central claims about PBS were identified: practitioners, behaviour support plans, and chemical restraint. Comparison with Australian research shows preparation of behaviour support practitioners is poor, behaviour support plans do not show a clear benefit to people with disability, and chemical restraint remains a persisting issue with no viable way forward. Discussion The analysis highlights the difference between perceptions of PBS and the current Australian evidence underlying it. The barriers to the promotion of PBS to address restrictive practices in Australian disability services prompts reconsideration of the policy expansion to address restrictive practices in other sectors.

Managing government commissioning and philanthropic expectations: earnings management in Australian nonprofit disability service providers

PurposeThe purpose of this study is to investigate the prevalence of earnings management in the Australian not-for-profit (NFP) disability service providers sector, as well as to understand the motivations for and implications of such practices. This research is important for stakeholders, such as members and funders, as well as the broader Australian community, considering the significant financial resources allocated to these organizations from the public purse.Design/methodology/approachThe authors employ a longitudinal dataset containing financial data from 154 Australian NFP disability service providers, collected over a two-year period (2015–2016). Through the analysis of detailed balance sheets and income statements, the authors seek to uncover evidence of earnings management practices in this sector. The study’s results provide valuable insights into the behaviour of the charitable human services sector.FindingsThe findings reveal that Australian NFP disability service providers engage in earnings management practices, primarily aimed at reducing reported profits to meet the normative financial expectations of stakeholders, such as public sector funders and philanthropists. The executives of these organizations strive to report profits close to zero, being cautious not to report a loss, which might raise concerns about their sustainability.Originality/valueThe authors contribute to the existing literature on earnings management in the NFP sector by focussing on Australian disability service providers, an area that has been under-researched due to a lack of suitable data. The results offer insights into the incentives and implications of earnings management practices in this sector and highlight the need for a revaluation of accounting standards, reporting requirements and audit arrangements applicable to the NFP sector.

The employment of people with lived experience of disability in Australian disability services

AbstractIn Australia there is a significant gap in employment rates between people with disability and those without. This is in the context of general gaps in the disability sector workforce, which has been the subject of recent policy concern. Our study critically investigates (a) data on the employment of people with disability in Australian disability services; (b) data on disability awareness training in disability services; (c) these results in the context of the National Disability Insurance Scheme (NDIS) National Workforce Plan: 2021–2025 and the NDIS workforce Capability Framework. We undertook a mixed methods study that brought together descriptive statistics from the National Disability Services Workforce Census data and qualitative content analysis of the NDIS National Workforce Plan and the NDIS workforce Capability Framework. We found that 50% of disability service organisations employ at least one person with disability in their organisations, with 20% employing less than three people with disability. Only 24% of organisations include a person with disability on their board, and 19% of organisations employ people with disability in management positions. Policy document analysis shows policies support key areas for increasing employment of people with disability and disability inclusion. Employment of people with disability at all levels of disability services remains poor in Australia. We argue that ‘soft’ approaches to addressing low employment levels need to be supplemented by harder approaches that take full advantage of the levers available to government through the operation of the NDIS.

Development and feasibility testing of an evidence‐based occupational therapy program for adults with both Down syndrome and dementia

AbstractThis paper describes the development of a home‐based occupational therapy intervention program for people with Down syndrome who experience early on‐set dementia causing a decline in their performance skills and increasing care dependency on their informal caregivers. A six‐step methodological process adapted from the Medical Research Council framework for developing and evaluating complex interventions was formulated to develop an evidence‐based occupational therapy program for people with both Down syndrome and dementia and their informal caregivers. The first two steps gathered evidence through systematic reviews of the literature and determined the scope of current occupational therapy practice. The gathered evidence was synthesised in step three to develop a client‐centred occupational therapy intervention program for persons with both Down syndrome and dementia and their informal caregivers. In steps four and five, opinions were sought from occupational therapists working in this area of practice on the content of the developed program and its feasibility within the Australian disability services context. The final testing step can be conducted in the future using a single‐case experimental design study. It is important to use rigorous frameworks and gather comprehensive evidence using multiple methods to develop interventions for small heterogeneous populations. The developed occupational therapy program for persons with both Down syndrome and dementia and their informal caregivers appears feasible to be implemented within the Australian disability services; however, funding limitations imposes barriers for its implementation in clinical practice.

How can coproduction help to deliver culturally responsive disability support? A case study from Australia.

How to improve access and quality of social services to respond to cultural diversity is receiving increased attention. Yet no approach to cultural responsiveness has been widely accepted. Coproduction has been championed in many service fields for better service outcomes and has the potential to inform practices for cultural responsiveness. This study explored how coproduction can be used to deliver culturally responsive social services. We conducted a qualitative case study and examined how an Australian disability service organisation operated a programme to improve cultural responsiveness with Australian Chinese people with disability and their families. The findings suggested that coproduction enabled the organisation to identify that the people with disability and their families considered services were culturally responsive when the staff were competent and committed to person-centred services. The coproduction contributed to continuous improvement of the services and revealed the qualities that were valued by the Australian Chinese service users. This study enriches the knowledge on coproduction by demonstrating the influence of the process of coproduction on outcomes for service users and providers. The study also contributes to the knowledge on cultural responsiveness by highlighting the elements of culturally responsive services valued by the service users. Coproduction could be more widely used for service development given its capacity to identify and respond to service needs. Practical implications for culturally responsive social services are that workforce training could focus on the principles of person-centred services and skills for working effectively with people from culturally diverse backgrounds.

What is good service quality? Day service staff's perspectives about what it looks like and how it should be monitored.

BackgroundAustralian disability services must comply with quality standards defined by federal government. Standards are abstract, focus on paperwork and rarely describe what good service quality looks like in practice. This research explored frontline day service staff's perceptions of good service quality to identify ways that it may be better monitored.MethodsUsing a constructivist grounded theory methodology, semi‐structured interviews were conducted with 9 frontline staff from 3‐day services. Interviews were recorded, transcribed and analysed for themes using constant comparison and line‐by‐line coding.ResultsFive categories of good practice were identified: collaborative hands‐on leadership, well‐planned services, respect for people with intellectual disabilities and their carers, a culture of continuous improvement and professionalization of the support worker role.ConclusionsResults align with research undertaken in accommodation services for people with intellectual disabilities, suggesting commonalities in frontline staff's perceptions of quality in both day and accommodation services.

NDIS Green Paper No. 6: Cost Differentials, Cost Pressures & Labour Competition Impacting Western Australian Disability Service Delivery

NDIS Green Paper No. 6: Cost Differentials, Cost Pressures & Labour Competition Impacting Western Australian Disability Service Delivery

Six Years and Counting: The NDIS and the Australian Disability Services System - A White Paper

This white paper utilises the observations and comments of a wide range of stakeholders and research about the implementation of the NDIS and its impact on the Australian Disability Services System. It is also informed by international experience and academic literature focused on economic models and policy frameworks that are similar to the NDIS. It has been six years since the commencement of the NDIS and it is now timely to step back and objectively assess what has and has not been achieved, including in terms of the 63 reports published that are relevant to the NDIS. In this context, this white paper is focused on describing a policy and practice framework necessary to realising the objectives of the Australian community in funding the Australian Disability Services System. Among other things, many policy leaders, stakeholders, even service users have taken for granted that market solutions will result in better services and outcomes for people with disability, while also improving the efficiency of supply and value for money for taxpayers.

Burdensome Administration and Its Risks: Competing Logics in Policy Implementation

Australia is currently undergoing significant social policy reform under the introduction of a personalized scheme for disability services: the National Disability Insurance Scheme (NDIS). This article explores the growing administrative burdens placed on disability providers operating under the new scheme, using an Australia-wide survey of the disability sector. The 2018 National Disability Services survey of the disability sector reveals that administrative burden is the most commented on challenge for providers. Moreover, providers linked this burden to questions concerning their financial sustainability and ability to continue to offer services within the NDIS. In this article, we explore the sources of these administrative burdens and their relationships with the institutional logics at play in the NDIS. In addition to documenting the impact of system change on the Australian disability service sector, this article raises questions regarding institutional hybridity within personalization schemes more broadly and whether they are a source of tension, innovation, or both.

NDIS Green Paper 3: Proxies for Risk - A First Line of Defence

The National Performance Benchmarking Project undertaken by Not-for-profits UWA personnel produced three annual sustainability reports analyzing service providers working in the Australian Disability Services Sector, each published in 2016, 2017 and 2019. This work also contributed to the National Disability Services Annual State of the Sector Reports.3 The data collected, and which continues to be collected, does not assist analysists in identifying prospective causes of service breakdown. However, the findings in these reports highlighted a number of areas which can be indicators of vulnerability in the context of the roll out of the NDIS — this document discusses these indicators and we have referred to them as “Proxies for Risk”. We consider them to be the first line of defense in the context of avoiding a breakdown in sustainability of service delivery as the NDIS rolls out and experimentation leads to learnings. The purpose of this Green Paper is to examine the proxies for risk identified out of the project and to provide a short-form analysis of the extent to which these proxies suggest that potential risks are being faced by service users in the NDIS. We also suggest that these proxies should be reviewed bi-annually or annually.

Listen, learn, build, deliver? Aboriginal and Torres Strait Islander policy in the National Disability Insurance Scheme

AbstractDespite an increased focus in recent years on Aboriginal people with disability within disability studies and advocacy, limited attention has been paid to Aboriginal people in Australian disability services policy. This article examines the consultation with Aboriginal organisations for the National Disability Insurance Scheme (NDIS), a new disability policy personalising care through individual service funding packages. The article interrogates how, and to what extent, the government has sought and incorporated the views of Aboriginal people with disability into NDIS policy. Using thematic content analysis, governmental NDIS‐related documents are compared with Aboriginal organisation submissions and public hearing transcripts, to identify tensions in perspectives regarding Aboriginal peoples' participation in the NDIS. The article concludes that governmental responsiveness to Aboriginal organisations in the NDIS operates from predetermined constructions of Aboriginality and disability.

Sharing the focus: engaging with support workers to include people with communication needs in research

Accessible summary This article is about university researchers and support workers working together when people with disabilities need support with communication to take part in research. This is one way to help people with disabilities to do this. We talk about a project we did to help explain six different ways of working together to help people with disabilities have more of a say in research. We found that if the person has a trusting relationship with the worker, the worker can help them understand the research, help them to tell the researcher what they think about the research and remind them about what they know is important to them. Sometimes problems can happen and people do not get good support from their workers. It is the job of the researchers to make sure that people with disabilities still have a say in the research. Summary Inclusive research is an increasing expectation to value and include people's voice in research and evaluations intended to benefit them. The active participation of people with communication support needs can be difficult due to the practical constraints of evaluations. One technique is to engage with workers who are familiar with the person, but this introduces risks, such as substituting voice and conflict of interests. We examine the effectiveness of this technique in ethnographic interviews by applying Nind's framework of core ideas in inclusive research (disrupting hierarchy; maximising participation and competence; enhancing authenticity; empowerment; accessibility, authorship and readership; and ethical considerations) to an evaluation of Australian disability services. We found that where support workers had a trusted relationship with the person, they could help them to choose to participate, consent and communicate their views. Disrespectful relationships introduced ethical risks during and after the interviews, which needed to be anticipated and safeguarded against.

Inclusion of adults with disability in Australia: outcomes, legislation and issues

This paper focuses on adults with disability and their inclusion in Australian society by examining various outcomes: community living, community participation and inclusive social roles such as open (competitive) employment, participation in university education, as well as use of generic community services like public transport. Australian disability services legislation provides clear support for inclusion, but implementation is inconsistent and segregated services remain common. Available outcomes data indicate that Australian disability service users are more to likely experience greater inclusion if they live in more normalised and less segregated settings. Australia has a history of segregated disability services and inaccessible community services that it is working to overcome. There is a growing but still a limited inclusion for adults in key adult roles such as open employment and university education. Significant progress has been made in areas as diverse as deinstitutionalisation and increased accessibility to public transport, but much remains to be done.

Autism following a history of newborn encephalopathy: more than a coincidence?

Between June 1993 and December 1996, 276 term newborn infants with encephalopathy and 564 randomly selected term controls were enrolled in a population-based study of moderate and severe term newborn encephalopathy (NE) in Western Australia. During comprehensive neurobehavioural and cognitive follow-up of all patients and controls at 3 years and again at 5 years of age we found an unexpected but strong association between NE and autism spectrum disorders (ASDs). A diagnosis of ASD by age 5 years was reached using criteria according of the Diagnostic Statistical Manual, 4th edition. Linking records to the Western Australian Disability Services Commission Register ensured that no child in the study with ASD was missed. By age 5 years, 37 (13.4%) infants with NE and one (0.2%) control had died. Among the 239 survivors of NE, 12 (5%) were diagnosed with an ASD. Of these, 10 (4.2%) met the full criteria for autism, one had pervasive developmental disorder-not otherwise specified, and one had Asperger syndrome. Among the 563 surviving controls, five (0.8%) were diagnosed with an ASD: three with autism, one with autism/possible Asperger syndrome, and one with Asperger syndrome. Compared with the controls, the children who had experienced NE were 5.9 times (95% confidence interval 2.0-16.9) more likely to have been diagnosed with an ASD.

Responsible Choice: The choice between no choice

This paper explores the way 'choice' is constituted by professional and support staff in naturally-occurring-talk within an Australian disability service. That choice is really the choice you have when you are not having a choice, a situation indicative of the wider social milieu and the disablism found in society. Membership Categorisation Analysis is used to highlight the moral reasoning which occurs in the everyday, based upon disablist norms. In light of this, critical reflection upon contemporary bioethics is used to suggest that choice as an expression of autonomy is not only contextual, but far more than the hedonistic approach adopted by Western disability services.

New Disability Services: The Critical Role of Staff in a Consumer-directed Empowerment Model of Service for Physically Disabled People

ABSTRACT Australian disability services have undergone a major review. Initiated by the government and now enshrined in new legislation, this review has significant implications for non-government social welfare organisations as major service providers in that it demands a significant service delivery reorientation. This paper describes one demonstration project involving four physically disabled persons, one female and three males, located in one domiciliary unit which signposts this new service direction and identifies it as a consumer-directed and empowering model. This is contrasted with previous institutional and care models of service. It identifies the staff role as important in this client-empowering model of service and raises a range of critical issues in the consumer-staff interface which enhances such empowerment. The paper suggests that where these staffing features and empowerment processes are lacking deinstitutionalisation may well have occurred without consumer empowerment being achieved.