Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

Many paediatric allied health providers are taking a wait and see approach with NDIS reforms. 

We get it. 

In just the last few months, we’ve faced:

• disappointing news about frozen pricing limits;
• the sudden passing of the new NDIS Amendment (Getting the NDIS Back on Track No.1) Act, which will will come into effect on 3 October 2024, with many new rules to come;
• a very short consultation about proposed transitional rules around “in and outs” for NDIS supports;
• conjecture about whether registration will become mandatory and, if so, whether existing professional registrations and certifications will suffice; 
• uncertainty around the implications of a new Foundational Supports regime; and
• sometimes unfair media and social media criticism, including wild generalisations about the motives and ethics of providers based on the poor behaviours of a few bad apples.

All this VUCA – volatility, uncertainty, complexity and ambiguity – can be paralysing. And it’s not as if we have a lot of spare time to ponder or plan for it all while supporting participants, families, and staff through difficult business conditions.

But, even if you’re not up for a full service delivery review right now, there are plenty of small things we can do – or at least start – to improve participant safety and service quality for the people who matter most: participants and their families. 

A. Taking small, positive actions can increase your sense of control in uncertain times and improve our care and services

Here are some simple quality improvement ideas we’ve extracted from the NDIS Quality and Safeguards Commission’s recent Quality support for children guide:

1. Improve families’ confidence in your team

• Ensure your register of Working With Children Checks on all staff is complete and up to date.
• Even if you are an unregistered NDIS provider, have your team complete NDIS Worker Screening Checks. (It seems likely these checks will become mandatory for most staff who interact with people with a disability.) 
• For each of your professional staff, run annual checks of the AHPRA registration and/or membership status with the NASRHP member peak bodies (as appropriate).
• Double check the currency and adequacy of your professional indemnity insurances and the status of insurance arrangements for each professional staff member. 
• Train all staff, in detail, on the NDIS Code of Conduct and remind staff they must abide by it. (This Code applies to both registered and unregistered providers.) 
• Consider incorporating the NDIS Code of Conduct and professional Ethics Code requirements into your existing organisational Code of Conduct so the key expectations are set out in one place.
• Review the NDIS Early Childhood Support Standards for early childhood support. (Although these apply to registered providers, there is no reason quality unregistered providers shouldn’t understand and comply with them.) 

2. Improve client decision-making supports

• Train (or refresher train) your staff to communicate with children in a range of ways that clients prefer, including through the use of assistive technology, augmented and alternative communication, and visual supports.
• Review the strategies and set-ups you use to support children to feel safe and calm in your workplaces.
• Think about how you can better support children to speak up when they are unhappy, uncomfortable or feel unsafe when working with your practice.

3. Enhance client privacy and dignity

• Review spaces for safety and ensure confidential conversations happen in private spaces.
• Review and communicate your privacy policy and confidentiality arrangements to families in an accessible way.
• Always ask for consent to share information with others and remember that consent can be withdrawn.

4. Improve client safety

• In addition to Working With Children Checks and NDIS Worker Screening clearances, make sure staff are trained at least annually in CPR/first aid.
• Institute a plain English Incident Management System. (For unregistered providers,  benchmark the policy to requirements of the NDIS rules.)
• Make sure your team members are trained about the laws relating to restrictive practices as they apply to your supports and practices.
• Review your emergency and disaster management procedures. (For unregistered providers, benchmark them to the standards required of registered providers.)

5. Improve transparency around competence

• Review and explain to families the scope of services you provide (and don’t provide), your qualifications to provide them, the associated costs, risks and benefits, and the expected timeline for supports.
• Increase the transparency of your disclosures to clients around staff qualifications and experience.
• Explain staff supervision and training arrangements to clients (and the public).
• Review and update your referral policies for when the services sought are outside of qualifications and experience. (Make sure there are no secret commissions or conflicts.)
• Review your Complaints Management System Policy. (For unregistered providers, benchmark it to the level required of registered providers under the NDIS rules.)

6. Improve the integrity, honesty and transparency marketing materials

• Review your marketing materials to ensure they are up-to-date, accurate and honest.
• Be clear about what families can expect and your terms of service: the who, what when, where, why and how much.
• Train your team to ensure that no one engages in “hard selling” practices or plays on family fears, e.g. around service scarcity and waitlists.
• Review the accessibility of consent forms and processes to make sure they are understood.
• Restate how you manage and avoid potential conflicts of interest.
• Increase the quality of your written reports, based on evidence-based assessments, that can be shared with families and other professionals working with clients.
• Do what you say you will do in a timely way – including revisiting policies on your timeframes for reports.

B. All too much right now? At least keep your eye on these 7 bigger themes

If you’re still intent on a ‘wait and see’ approach, at least pay attention to key themes underpinning many of the proposed reforms. Watch the following general trends because they are likely to affect your business planning and service delivery models in the longer term:

1. A focus on providers working more collaboratively with the family and the rest of the client’s support team – not in isolation – including with regular team meetings.
2. An emphasis on using evidence-based functional assessment tools to measure baselines and progress more rigorously.
3. More focus on goal-setting with families, skills measurements, and outcomes that promote increased participation.
4. A general preference for delivering supports in homes, in the community, and in education settings.
5. More direction to providers to:
   • provide strategies and tools that enable young children to take part in play, daily activities and routines (rather than doing therapy at the expense of play, rest and social opportunities); and
   • coach family members, educators, and support workers to use evidence-based strategies in real world situations.
6. An expectation that providers will honestly and transparently:
   • discuss supports that are unlikely to be funded by the NDIS; and 
   • help families find other ways to get help, e.g. through mainstream or community services.
7. A policy objective of reducing conflicts of interests and duplication of functions as part of proposed transition to “navigators”.

Bottom line

In the short term, allied health NDIS providers – including sole traders – should take small, incremental actions to ward off fears about the future of the NDIS, and increase service quality and safety standards and to improve our supports for participants and their families.

We should also start thinking about strategies to build tighter collaborative networks with other providers, deliver more services in home, school and community settings, increase the rigour of functional assessments and outcome measures, and, ultimately, eliminate over-reliance on NDIS-funding to secure our long-term success.