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When the NDIA asked for submissions on the Coordination of Support Discussion Paper, I put my hand up. Why? I mean, nobody likes extra homework. But for me, there are two main reasons.
Firstly, I have worked in the mental health sector for 10 years. The Discussion Paper makes it clear that people with psychosocial disability make up a large proportion of support coordination customers. People with a primary psychosocial disability only make up 10% of the scheme participants. Nevertheless, this group is the most likely (84%) to receive Support Coordination funding. Support Coordination for people with psychosocial disability clocks in at $167m, which is 20% of all coordination of support funding.
Secondly, I have worked in the Northern Territory for 7 years. The Northern Territory is notorious for having the highest percentage of participants with support coordination in their plans (76%). With our unique demographics and 99% of our landscape being either remote or very remote, you can understand why support coordination plays such a critical role. It’s fair to say the transition to NDIS has been challenging here, but we love a challenge in the top end!
Support Coordination: the background
The role of support coordinators has evolved from a few sentences in the earlier Price Guides to the essential piece of the Scheme’s puzzle we see now. It has been crafted through the resourcefulness and drive of skilled support coordinators across the country. They have become the "creative arm" of the Scheme constantly pushing the flexibility of what lays within the Act, Price Guides and Guidelines to influence permanent changes.
Pricing: an outcome model
The Discussion Paper notes that the NDIA have limited information available to quantify the quality of support coordination. They are considering how better to align the price of support coordination with participant outcomes. The Paper asks if pricing can be determined, at least in part, based on the progression of participant goals and outcomes. For me, this is a hard no.
Setting benchmarks around participants achieving goals is not in the spirit of the NDIS for the same reason NDIS providers are not allowed to incentivise staff. Moreover, in practice, goal attainment is more likely delegated to other service providers such as community access, SIL or therapists who work towards goals with participants regularly.
Pricing cannot be determined based on the progression of participant goals and outcomes without ignoring the unique barriers and circumstances people face. This is especially relevant for people with a psychosocial disability whose lives are often highly complex and intersect with various mainstream services. For these reasons, support coordinators with monetary KPIs based on outcomes is a slippery slope.
New player: the recovery coach
The introduction of the psychosocial recovery coach is a giant step forward for the NDIS, and I’m sure a huge relief for the thousands of experienced mental health recovery workers whose skills have been under-recognised in the Scheme thus far.
For people working in the mental health field, the introduction of the recovery coach role is a rehash of the mental health case manager, Partners in Recovery (PIR) support facilitator or key worker roles that defined mental health supports before the introduction of the NDIS. Recovery-orientated care is a tried and tested model that is championed by mental health professionals across the globe and underpins the Australian Mental Health Standards. It’s based on the following principles;
- Uniqueness of the individual
- Real choices
- Attitudes and rights
- Dignity and respect
- Partnership and communication
- Evaluating recovery
The Price Guide acknowledges that the recovery coach role is designed to be a long-term relationship, with increased support at times due to the episodic nature of mental illness. This is different to support coordinators who are meant to connect people with the supports they need, without becoming a support people need. So, will the recovery coach role show that better relationships can achieve better outcomes for people with a psychosocial disability? Or that recognising the importance of trust and respect could be more cost-effective? Could all coordination of support roles be improved by incorporating more recovery-oriented practice or case management? I think you can guess what I think of that, but time will tell what the data shows.
Price limits
The Paper also asks for our opinion on the price limits for coordination of support. It’s hard to understand why the recovery coach role has been priced at a lower hourly rate than level 2 support coordination. If anything, the role is more skilled, and the supervision requirements are more significant. The inclusion of rates based on times and days goes some way to remedying this. However, the lower rate is already having an impact on the willingness of providers to offer this support – especially given the additional risks associated with staff being available out of hours and working alone. At a minimum, I think the standard rates for recovery coaching should be matched to level 2 support coordination to reflect the skills required and to support a developing market for recovery coaching, and I know many in the mental health sector share this view.
In years to come, I hope the NDIS will look similar to our Medicare System - a system so accessible that there will barely be any need for support coordination at all - however, this is decades away. Some people say I'm a dreamer, but I'm not the only one. If you have strong views on how support coordination can be improved for people living with a psychosocial disability, now is the time to speak up.
Daisy Clingan is an NDIS pioneer in the NT, a place that has always been at the epicentre of rollout challenges. Daisy has a focus on improving front-line worker experience and is passionate about human rights and zero tolerance for restrictive practice. Daisy has worked in the government mental health sector, large/medium not for profit organisations, international commercial businesses as well as small businesses and sole traders. Daisy draws from her lived experience of mental illness and her personal engagement with the mental health system. In 2018, Daisy was awarded the inaugural DSC 'Learn' award for outstanding NDIS Learning for the development of NDIS CREW Training, a highly innovative staff training model.