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Times are a-Changin’ (ECEI): The NDIA Planning Discussion Paper

In our 3rd and final instalment, proposed changes to the Early Childhood Early Intervention pathways have our full attention.

By Rob Woolley

Updated 15 Apr 202415 Feb 2021

Or, perhaps more accurately for Early Childhood Early Intervention (ECEI), the pathway is a-resettin’. Change is afoot across so many areas of the NDIS, and ECEI is no different. The NDIA is currently consulting on some significant changes to the pathway, as part of the ECEI Reset project. Some of these changes would be significant, as discussed in our December article.

It’s worth emphasising that these are only proposals; which form one part of a wider NDIS consultation process. You can read our article on the planning paper here and access and eligibility paper here.  Everything is still up for discussion, so it’s business as usual for providers of early childhood support at the moment. Nevertheless, changes on the scale proposed are likely to have knock-on effects for ECEI providers in the broader NDIS marketplace.  

In this article, we’ll discuss the changes that might have the biggest impact on NDIS providers delivering ECEI supports.

 

SMALLER POOL OF PARTICIPANTS

Currently, ECEI Partners can deliver provisional early interventions to children with no NDIS Plan or even a formal diagnosis. While this is key to ‘early’ intervention, it has actually happened much less often than expected.  

One of the major changes in the Reset proposals is that more supports should be delivered by the ECEI Partners as Short-Term Early Interventions (STEIs). There is a stack of practical challenges against implementing this, but it makes sense overall. Existing ECEI plans call these ‘Tier 2’ interventions, but only 12% of children/families were receiving Initial Supports as of July 2020 despite around 20% of Partner time being dedicated to working with non-participants in the original contracts. 

STEIs, broadly speaking, are excellent value for the Australian ratepayer at an average of just $2000 per year where full NDIS Plans are usually much more than that. They are also tremendously useful in supporting and guiding families who may not need to leap into a full NDIS Plan yet. 

So, more light-touch early support delivered by expert ECEI Partners is generally a good thing, but it could have a significant impact on the NDIS marketplace, as there could be less demand in the wider market for early childhood intervention services. 

A key barrier relates to consistency and capacity with 19 ECEI Partners across 55 service areas all applying different approaches. In some areas, ECEI Partners delivered Initial Supports to 1% of children coming through the Gateway while in others it was as high as 32%. The knowledge, skills and experience of the professionals working in each ECEI Partner also varies across the country.

The cynic in me finds it hard to see this as anything other than the Agency trying to reign in ECEI spend and move more service delivery further inside their sphere of influence. When a child receives a full NDIS Plan, they are out of the door and in the market place which makes tracking efficiency difficult.                     

But hold up, cynicism. The other significant change to the scope of the ECEI Partners is an extension to the age range they work with. Currently, the ECEI Gateway works with children from birth to six years old, and the NDIA proposal extends this upper-age limit to nine with the aim of spanning and influencing the transition to primary school. 

This expanded age range, with the increased focus on STEIs, could also pose challenges for the market. Put simply, a wider age range could mean more children in the ECEI Gateway but a greater proportion would be accessing STEIs from an ECEI Partner and being referred out to mainstream services rather than receiving full NDIS Plans and picking a provider from the marketplace. While not necessarily a bad thing, it is something ECEI providers need to be aware of. 

 

FEWER CHILDREN ENTERING THE FULL SCHEME…AND MORE TRANSITIONING OUT

The NDIA isn’t exactly playing their cards close to their chest on this one. Currently, the numbers of children transitioning from ECEI to the full NDIS are causing grey hairs for the actuaries. Specifically, 97% of NDIS access requests from the ECEI Gateway were found to be eligible compared to 78% across the entire Scheme. The NDIA has been clear for a while that this is higher than expected; early drafts of ECEI Partner contracts included a since-removed performance target of no more than 50% of children moving to full NDIS. The NDIA is arguing that with more STEIs and stronger links with mainstream support, fewer children would exit the ECEI Gateway into a full NDIS Plan. 

Although ECEI has always been somewhat disconnected from the rest of the Scheme in terms of its slightly different approach, we don’t need to pretend that it and the NDIS exist in an economic bubble. We are all familiar with the concerns of budget blowout. Good early intervention is investing in the future, just like any effective insurance scheme. 

One of the NDIA’s consultation questions is “How can we make the process of transitioning out of the NDIS something to celebrate?” This, to me, feels like a question from another galaxy. The recommendations for transitioning out are peppered with ideas that feel closely linked to budget fears (exit rates for children aged 0-6 were at 2% at the end of 2019/20). Of course, there will be some families for whom the early interventions work fantastically well and concerns about a child’s development consequently evaporate. Other families will find exactly what they need in mainstream or community-based supports.

But some children will require the additional support and security of an NDIS Plan, and it’s this cohort that seems to be in a grey area with the proposed changes. The foundations of successful early intervention are built on consistency and strong relationships; it’s difficult to expect ECEI Partners to achieve this if they are under immediate pressure to support a child’s transition out of the Scheme. Providers often find themselves stretched to deliver high quality support with the limited funding of some NDIS Plans, and overlaying this desire from the NDIA to see more children exit the Scheme would add further pressure.

The idea of transitioning out of the NDIS as something to celebrate seems to cheapen the experiences of those children and families who enter the ECEI pathway and work their way through to a full NDIS Plan for good reason. They need it, and it’s a wise investment for the taxpayer.

 

MAINSTREAM LINKS

If children are transitioning out of the Scheme, and everyone has the streamers and cake ready because it’s a celebration, where do we go? Part of the current ECEI Partner role is to offer information, support and/or referrals to mainstream services such as preschools, supported play groups, health services, child protection, libraries, community events, and more. This happens, but it’s inconsistent. On average, ECEI Partners transition 3.8% of participants to mainstream services from a minimum of 0.3% in some areas up to a maximum of 12% in others. ECEI Partners have little opportunity to activate this broader connecting function, and families are often left to navigate central support interfaces themselves. ECEI Partners just don’t have the time, or, in some cases, the knowledge and expertise, to develop meaningful links with mainstream supports. 

Helping families connect with other support poses challenges, particularly in giving accurate information about available services and navigating the health system generally. Many providers feel the same frustrations in trying to find accessible and up-to-date information about mainstream supports and state government programs, if they exist at all. 

Until the practicalities of the Reset become clearer, we won’t know if more time can be freed up to do this groundwork. With families anxious, stressed and confused by the array of paths in front of them, it often falls to providers to give this guidance, particularly if the child has had an NDIS Plan but is now expected to access mainstream help. Local connections, knowledge and provider experience will become even more important for family and Scheme outcomes, but with no formal way of funding them.

 

GOALS AND EFFICACY

Currently, the NDIA can request reports from providers about support progress, and the Agency has also produced a template for an optional outcomes report. However, a major concern about the current ECEI approach is that there is little visibility of the effectiveness of the interventions that families purchase through NDIS Plans.

The Reset proposes the use of a mandatory outcomes report to evaluate the effectiveness of the supports being delivered. The template of the current optional report, introduced in September last year, is ten pages long. You read that right; ten pages without any service or participant information included. Many providers are more than happy to provide documentary evidence and assessment of how their interventions are working, but NDIS Plans need to fund this. A summary of progress and/or effectiveness report is already a central part of many intervention tools and approaches, and so we think that providers can expect more oversight from the NDIA on the effectiveness of ECEIs.

Some of this might make grim reading, but the work that ECEI providers do is vital to the long-term aims and success of the NDIS. Don’t forget that none of this is confirmed yet, and we encourage any providers who might be affected by the proposed changes to contribute to the consultation. Details are available here, and the Agency is accepting submissions until 10am on Tuesday 23rd February 2021. 

Make your voice heard!

Authors

Rob Woolley

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