Australian National Disability Insurance Scheme Research Articles

Perceived barriers and enablers to utilising the Australian National Disability Insurance Scheme for adults with an intellectual disability and their families: A scoping review.

The introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families. A scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis. The key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families. Although qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised.

Do Service Providers Play a Market Stewardship Role in Social Care Quasi-Markets and Should They?

Market stewardship of social care quasi-markets has been an important area of inquiry. While most focus has been on central government stewardship, local level actors can also play a role. Using a case study of the Australian National Disability Insurance scheme, this article focuses on both how service providers can be market stewards and whether they should be. Findings suggest that while some aspects of market stewardship are appropriate for service providers to perform, others may be better done by different actors. We propose a preliminary framework for distributed stewardship to help join up the work of local level actors with central agencies.

Regulating vulnerability: policy approaches for preventing violence and abuse of people with disability in Australian service provision settings

This article analyses policy frameworks designed to protect people with disability from harm in service provision settings and respond to their experiences of violence, abuse, neglect, and exploitation, with a focus on the Australian National Disability Insurance Scheme (NDIS). The creation of a new disability services market has facilitated greater choice and empowerment for NDIS participants, but has also exposed them to new risks and vulnerabilities. Drawing on feminist vulnerability theory, a policy audit, and qualitative research with seventeen key stakeholders, the article reflects on the need to incorporate more nuanced understandings of vulnerability in safeguarding policy and respond to the situational and pathogenic vulnerability created by the way systems and structures operate. It identifies opportunities to enhance the personal autonomy of people with disability through accessible pathways for complaints and justice, and greater focus on natural and mainstream safeguarding systems in complementing disability-specific systems.

Positive behaviour support under the National Disability Insurance Scheme in Australia: Barriers, enablers and support needs from the perspective of practitioners

AbstractThis paper examines the experiences of behaviour support practitioners providing positive behaviour support (PBS) under the Australian National Disability Insurance Scheme (NDIS), including perceived barriers and enablers of practice, and ongoing support needs. It reports on data provided by NDIS PBS practitioners (n = 392) in a cross‐sectional mixed methods survey employed to examine the characteristics and experiences of behaviour support practitioners working across Australia. Qualitative data from open‐ended questions were analysed using inductive thematic analysis. The key barriers to practice included “the current service systems,” “engaging and collaborating with stakeholders” and “limited PBS expertise across the sector.” Enablers of good practice related to “organisation systems and practice supports/tools,” “practice supervision” and “quality training and professional development opportunities.” Ongoing support needs identified included the need for “further PBS training,” “improved service systems” and “access to clinical supports and practice guidance.” Findings suggest that whilst some practitioners report positive experiences, a large majority experience significant barriers to their PBS practice. They describe potential supports to overcome these barriers, which emphasise the need for further PBS training, clinical supervision/oversight and more efficient service systems. Findings have implications for PBS practice, policy and research in Australia.

The changing narrative of early childhood intervention in Australia: Service providers’ perspectives on the implementation of the National Disability Insurance Scheme

The Australian National Disability Insurance Scheme (NDIS) completed its roll-out in 2020 with the objective of addressing the inadequacies of a fragmented and underfunded service system for people with disabilities. Under the scheme, young children with disabilities or developmental delay can now access services through the Early Childhood Approach, which is delivered by a range of not-for profit and for-profit organizations. Considering the significance of the resulting service system changes and the critical role of service providers, the aim of the present study was to examine their experiences in the State of Victoria. Forty-five service providers participated in interviews and focus groups which generated information grouped into four themes: (1) A changed orientation; (2) Early childhood intervention (ECI) practice; (3) ECI workforce; (4) The potential for a new system. Participating service providers reported several challenges in their quest to effectively support children and their families. It is concluded that for the NDIS to fulfil its promise and potential, revisions and adaptations of its systems and policies that incorporate the current ECI evidence-based knowledge and translation into real-world implementation are required.

Information provision by non‐government actors in the Australian National Disability Insurance Scheme: A key market stewardship function in social care quasi‐markets

AbstractThe use of quasi‐markets for the delivery of social care continues to grow internationally. This has presented considerable challenges regarding governance and stewardship of these markets, to ensure they meet policy goals. To date, both scholarship and practice on quasi‐market stewardship have mainly focused on the role of government. However, non‐government actors can also play important stewardship roles. For effective stewardship, there needs to be integration between government and non‐government actors in the system, not just a top‐down approach. This paper explores the stewardship role of non‐government actors in the Australian National Disability Insurance Scheme (NDIS) with a focus on the role of information provision as a key market stewardship function. Findings show non‐government information providers play important stewardship roles that increase choice and control for citizens, enhance market sufficiency, diversity, and innovation, and support other actors in the system. We argue for a shift in the conception of market stewardship as primarily a government activity and recommend the market stewardship actions of non‐government actors be better acknowledged, funded, and ‘joined up’ with the market stewardship role of government to enable social care quasi‐markets to operate more effectively.Points for practitioners Information provision by non‐government actors is a key market stewardship function in social care quasi‐markets. Market stewardship needs to be the responsibility of a much greater range of actors than government alone. A framework for ‘distributed stewardship’ can help join up the stewardship actions of non‐government actors with those of government to support information flows for more effective stewardship.

Decolonising the NDIS: a third space to account for First Nations' values

PurposeThis paper aims to investigate how embedding accounting techniques of cost and budgeting within the Australian National Disability Insurance Scheme (NDIS) potentially perpetuates colonial practices for Australian First Nations people living in remote areas. Further, the paper aims to explore how accounting might help to integrate the unique modes of accountability First Nations people have over disability care into the NDIS funding system. Ultimately, the aim is to discern whether accounting practices can be mobilised as a means to decolonising the NDIS framework.Design/methodology/approach This study uses a qualitative methodology to analyse public hearings from the Australian Disability Royal Commission. Drawing on Bhabha's (1994) concept of the “third space”, this study investigates how accounting techniques can be used to potentially decolonise the NDIS. This study also borrows Bhabha's (1994) concept of the third space to explore the potential for decolonising the NDIS through accounting techniques.FindingsFindings show that the accounting techniques pertaining to funding and costs embedded within the NDIS contribute to displacing and disconnecting First Nations people from their cultural practices and ways of life. Further, the analysis reveals that the NDIS funding system could help to decolonise the NDIS space if it were modified to incorporate First Nations' perspectives on accountability for disability care.Originality/valueThe case of the NDIS exposes glimpses of colonisation in contemporary Australia, where Western institutional and economic systems dominate over the structure and authority of the practice. In this paper, this study demonstrates that the accounting system used by the NDIS plays a role in marginalising First Nations people. However, accounting, as a technology of negotiation, could also be mobilised to enhance accountability for disability care outcomes and pave the way for decolonising public policies.

Impact of COVID-19 on Utilisation of Funds by People With Disabilities: Lessons Drawn From the Australian National Disability Insurance Scheme.

COVID-19 pandemic has affected everyone, especially people with disabilities (PwD). While there has been qualitative research on the impact of the pandemic on PwD in Australia, little quantitative evidence has been produced on the magnitude of this impact. A range of descriptive analytic methods are employed on the data merged from the National Disability Insurance Scheme (NDIS) and COVID-19 data on national, state, and regional levels to compare the expenditure of the NDIS participants who are in pandemic-affected regions and time periods with those that are not. Regression analysis is also performed to estimate the participants' utilisation of funds using explanatory variables drawn from the NDIS, COVID-19, and lockdown policy information. Our analysis reveals that: (1) the pandemic reduced expenditure of the NDIS participants by approximately A$ 31.2 million, equal to 8.85% of the total expenditure over five quarters for the state of Victoria (VIC) alone; (2) the contractions in expenditure lasted for up to two quarters during the pandemic; (3) the reductions in expenditure were largely associated with the limited mobility imposed via lockdowns compared to the impaired access to services; and (4) the spread of COVID-19 that led to restrictions on mobility of people had a bearing on utilisation of funds by NDIS participants in the subsequent quarter. COVID-19 has affected the expenditure of the PwD in Australia. We overlaid the NDIS data on the COVID-19 outbreaks to estimate the impact of the pandemic on expenditure and utilisation rate of the funds allocated to the NDIS participants. Our findings point to potential policy interventions to mitigate some of the adverse consequences of similar nationwide emergencies.

Challenges and adaptations of an intermediary: an exploration of support coordination in the Australian National Disability Insurance Scheme

Support coordination for people with disability and complex needs should assist in personalising and implementing individualised funded supports in a coordinated manner. Yet, this also relies on policy and organisational arrangements being conducive to good practice. Designed according to street-level policy research, this study sought to explore challenges and adaptations associated with the implementation of support coordination in Australia’s National Disability Insurance Scheme through interviews with 20 support coordinators and front-line personnel. Findings suggest that more explicit oversight of, and attention to, norms of practice and capacity to work collaboratively with choice and control are warranted to enhance support coordination.

Estimated Therapy Costs and Downstream Cost Consequences of iBASIS–Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia

The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. To estimate the net cost impact of the iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. iBASIS-VIPP intervention. To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child  for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.

Assistance Dogs for People with Younger (Early)-Onset Dementia: The Family Carer's Experience.

There is growing evidence for trained assistance dogs promoting the health, wellbeing, and quality of life of people in a variety of circumstances, including for those with dementia. Little is known about people with younger (early)-onset dementia (YOD) and family carers. As part of a larger study involving 14 people with YOD matched with trained assistance dogs over a two-year period, we report analyses of interviews with 10 family carers conducted on multiple occasions investigating their experience with an assistance dog. Interviews were recorded, transcribed and subjected to inductive thematic analysis. They told a range of experiences; the good and the challenging. Findings fell into three areas: the human-animal bond; relationship dynamics; and responsibility for caring. Concerns were raised with respect to the resources required of carers together with the financial resources needed to support an assistance dog. The study concludes that trained assistance dogs can play an important role promoting the health and wellbeing of both people with YOD and of their family carers. However, support needs to be in place as the circumstances of the family member with YOD changes and the role of the assistance dog as part of the family also changes. Practical (financial) support of a scheme such as the Australian National Disability Insurance Scheme (NDIS) could be important to sustaining such support.

A proposed remedy to the inequitable representation of nursing in the Australian National Disability Insurance Scheme

BackgroundThe National Disability Insurance Scheme (NDIS) is the policy framework that has enabled a revolution in disability related support funding in Australia. The framework includes assumptions related to which professionals are eligible to provide supports under the scheme and the relative fiscal value of these supports. AimTo identify how nurses are represented in the NDIS as laid out in relevant policy documents to identify assumptions embedded related to the pricing of nursing supports. MethodsPolicy analysis of the representation of nursing in the NDIS as presented in the NDIS documentation related to provider status within the Registered and Enrolled Nurse scopes of practice and pricing arrangements. FindingsProvider inequity is identified to exist as Registered Nurses, including Nurse Practitioners, are for the most part represented in a structure shared with Disability Support Workers and Psychosocial Recovery Coaches as opposed to other comparable professionals. Price limits are lower for services provided by nurses than other comparable, or less qualified, providers. DiscussionAn alternative representation and pricing arrangement is proposed with associated costings that would solve the issue of provider inequity and potentially increase access to nursing supports for people with disability in Australia. ConclusionThe current representation of nursing in the NDIS is limiting the availability of suitably qualified professionals to NDIS participants and restricting the market mechanism aimed for in the NDIS.

Researching vulnerable participants: The role of critical reflexivity in overcoming methodological challenges

In this paper, we critically reflect on the methodological challenges encountered during a qualitative research project that examined the effectiveness of the Australian National Disability Insurance Scheme (NDIS). We draw on Lewis and Mehmet’s (2021) approach that combines aspects of autoethnography and reflexivity to focus on three key areas, inclusive research, informed consent, and recruitment, which we have considered in terms of mistrust and the roles of the gatekeeper. This paper contributes to our understanding of researching vulnerable and marginalised populations and highlights learnings for marketers as they seek to identify how to adequately capture the voices of the often voiceless. Key implications include acknowledging vulnerability as a multi-dimensional concept, adopting a continual reflective approach, selecting appropriate channels of communication, and considering team dynamics before and during research implementation. By showcasing our learning experiences, we guide other market researchers who are interested in exploring similarly marginalised or vulnerable groups.

A discourse analysis of the representation of nursing in the National Disability Insurance Scheme pricing guide and eligibility criteria

<h2>ABSTRACT</h2><h3>Background</h3> The Australian National Disability Insurance Scheme (NDIS) is conceptually grounded in the social model of disability, which focuses on removing disabling structures of society to allow people with disabilities full participation and improved quality of life. The social model rests on a dichotomous relationship against a medical model and its focus on treating impairments, and incorrectly places nursing within this paradigm. <h3>Aim</h3> To undertake a discourse analysis of nursing as represented in the NDIS pricing guide and eligibility criteria, and to understand how the profession is conceptualised and valued within the scheme. <h3>Methods</h3> Informed by Lauclau and Mouffe's poststructuralist theory, a discourse analysis of the floating signifier of nursing against the dominant nodal point of the social model of disability was undertaken through a close reading of the NDIS pricing guide and eligibility criteria. <h3>Findings</h3> The nursing scope of practice is confined to physical/medicalised supports for people with disabilities. Nursing is excluded from offering therapeutic and behaviour supports and is structured and fiscally valued differently to other professions. <h3>Discussion</h3> Despite its base in holistic and person-centred care, due to its conceptualisation within the medical model, the full scope of nursing practice is restrictive within the NDIS. This misarticulation of nursing excludes key aspects of adaptive, therapeutic, and holistic practice which can improve health outcomes for people with disabilities. <h3>Conclusion</h3> The NDIS in its conceptual construction based on the social model of disability has upheld a vision of nursing inconsistent with practice relevant to caring for people with disabilities.

Exploring experiences with telehealth-delivered allied healthcare services for people with permanent and significant disabilities funded through a national insurance scheme: a qualitative study examining challenges and suggestions to improve services

ObjectivesIn people with a disability, or their caregivers, who reported suboptimal experiences, the objectives were to explore: (1) challenges with telehealth-delivered allied health services during the COVID-19 pandemic and (2)...

Market shaping: Understanding the role of non‐government actors in social care quasi‐market stewardship

AbstractAs market‐based responses to social care have grown in popularity across the world, the need for good stewardship of social care quasi‐markets is increasingly becoming a concern for governments. The market stewardship literature has focused almost exclusively on the role of government and central agencies. However, non‐government actors also play an important role in shaping quasi‐markets. We examine the market stewardship activities being conducted by non‐government actors in the Australian National Disability Insurance Scheme (NDIS), a large social care quasi‐market. Results show a wide range of non‐government actors are conducting both direct and indirect stewardship activities that are actively shaping the NDIS market. These include activities focused on both the participant side of the market such as advocacy and information provision and on the provider side such as connecting consumers with services, assisting providers with regulatory and administrative requirements and marketing for providers. We argue that for effective stewardship of the NDIS these activities need to be acknowledged and supported by central government. For this to occur we suggest development of a framework for distributed stewardship using principles of joined up government working. Such a framework could help inform stewardship actions across different personalisation quasi‐markets.

Advocacy as market stewardship in social care quasi-markets

ABSTRACT Quasi-market approaches to social care provision are being utilized across the world, with stewardship of these markets becoming an area of interest and concern for governments and scholars. The market-stewardship literature mainly focuses on the role of central governing bodies, however non-government actors also play important stewardship roles. This paper examines stewardship activities conducted by advocacy organizations in a social care quasi-market – the Australian National Disability Insurance Scheme. We argue effective market stewardship requires central agencies to support these activities and suggest development of a distributed stewardship framework joining up work of central agencies with local-level actors.

How personalisation programs can exacerbate socio-economic inequities: findings from budget utilisation in the Australian National Disability Insurance Scheme

BackgroundResearchers and policymakers are increasingly concerned that personalisation schemes in social and health care might be worsening social and health inequities. This has been found internationally, where better outcomes from such schemes have been found amongst those who have higher education and more household income.MethodThis study looks at one of the world’s largest personalisation schemes, the Australian National Disability Insurance Scheme. Using publicly available data we examine the allocation and utilisation of NDIS funds according to social gradient.ResultsWe find that the rate at which people with disability ‘spend’ or effectively use their disability care funds follows a social gradient. That is, those in areas of higher socioeconomic disadvantage are not spending as much of their allocated budgets on care services across the year compared to people in areas of higher socioeconomic advantage. This represents a clear issue of equity in the use of public money to people with disability in Australia.ConclusionWe argue that this points to the need to provide targeted supports for the use of disability care funds in areas of higher socioeconomic disadvantage. Without effective supports for fund use, the NDIS and other personalisation schemes may be positioned to worsen existing social inequalities.

Learning from machines to close the gap between funding and expenditure in the Australian National Disability Insurance Scheme

The Australian National Disability Insurance Scheme (NDIS) allocates funds to participants for purchase of services. Only one percent of the 89,299 participants spent all of their allocated funds with 85 participants having failed to spend any, meaning that most of the participants were left with unspent funds. The gap between the allocated budget and realised expenditure reflects misallocation of funds. Thus we employ alternative machine learning techniques to estimate budget and close the gap while maintaining the aggregate level of spending. Three experiments are conducted to test the machine learning models in estimating the budget, expenditure and the resulting gap; compare the learning rate between machines and humans; and identify the significant explanatory variables. Results show that machines learn “faster” than humans; machine learning models can improve the efficiency of the NDIS implementation; and significant explanatory variables identified by decision tree models and regression analysis are similar.

Perceptions About the Efficacy and Acceptability of Telephone and Video-Delivered Allied Health Care for Adults With Disabilities During the COVID-19 Pandemic: A Cross-sectional National Survey

ObjectiveTo investigate and compare perceptions about the efficacy and acceptability of allied health care delivered via telephone and video call for adults with disabilities during the COVID-19 pandemic. DesignCross-sectional national survey. SettingParticipants who accessed occupational therapy, physiotherapy, psychology, or speech pathology care via telephone or via video call from June to September 2020. ParticipantsFive hundred eighty-one adults with permanent or significant disabilities, or their carers, partners, or family members, who were funded by the Australian National Disability Insurance Scheme. InterventionsNot applicable. Main Outcome MeasuresExperiences (eg, safety, efficacy, ease of use) with telephone and video-delivered care. Data were analyzed by calculating response proportions and chi-square tests to evaluate differences in experiences between allied health professions and between telephone and video modalities. ResultsResponses were obtained for 581 adults with disabilities. There was no evidence of differences between experiences with telephone or video-delivered services or across allied health professions. Overall, 47%-56% of respondents found telehealth technology easy to use (vs 17%-26% who found it difficult), 51%-55% felt comfortable communicating (vs 24%-27% who felt uncomfortable), 51%-67% were happy with the privacy and/or security (vs 6%-9% who were unhappy), 74% were happy with the safety (vs 5%-7% who were unhappy), and 56%-64% believed the care they received was effective (vs 17% who believed it was ineffective). Despite this, 48%-51% were unlikely to choose to use telephone or video consultations in the future (vs 32%-36% who were likely). ConclusionsAdults with disabilities in Australia had generally positive experiences receiving allied health care via telehealth during the COVID-19 pandemic, although some experienced difficulties using and communicating via the technology. Findings indicated no differences between satisfaction with telephone or video modalities, or between physiotherapy, speech pathology, occupational therapy, or psychology services.