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Joint Standing Committee on the National Disability Insurance Scheme
Independent assessments

GRACE, Ms Christine, Manager, Advocacy Services, Ethnic Disability Advocacy Centre [by audio link]

ABDI, Mr Siyat Hillow, Systemic Advocate, Ethnic Disability Advocacy Centre [by audio link]


CHAIR: I welcome you both to the hearing today. Would one or both of you like to make some opening comments?

Ms Grace : Thank you very much for giving us the opportunity to be here today. Work in the metropolitan area is limited to people from a culturally and linguistically diverse background, but throughout Western Australia we provide advocacy for CALD people, and in regional and remote areas we also provide advocacy for people with disability from an Aboriginal background.

Mr Abdi : I might just add that there are a lot of issues within systemic advocacy that we struggle with all the time. We've got very much limited funding when we find that a group of people who have disability are facing some barriers and discrimination in society. These are some of the challenges, as a peak organisation in Western Australia, as we struggle to provide the systemic issues with limited resources.

CHAIR: Thank you. This inquiry is into proposed independent assessments. Can I ask one or both of you what knowledge you have of what's proposed by way of independent assessments? Has there been any consultation with your organisation?

Ms Grace : There has been some consultation with our organisation; however, that has been superficial.

Senator STEELE-JOHN: Chair, there's an echo on my end. I'm not sure whether you're getting it on your end?

Ms Grace : Yes. I'll put my headphones—

Senator STEELE-JOHN: I know what it is, Ms Grace. Mr Abdi's computer is echoing; his headphone set is picking up your commentary. If you disconnect your microphone, Mr Abdi, while Christine is speaking, that should solve the issue.

Ms Grace : I'll try that.

CHAIR: We can hear you loud and clear.

Ms Grace : That's better. To answer your question, we have had some consultation, but the consultation has been superficial. It has more been NDIA staff telling us what they are going to do or how they are going to present independent assessments.

CHAIR: On the basis of what you do understand, do you have concerns in relation to disabled people from an ethnic background and, if so, what are those concerns?

Ms Grace : Yes, we do have concerns about that. Firstly, it's our clients being able to build a trusting relationship with a person who's going to do the assessment, and it's the assessment tools not necessarily being appropriate to the clients that we see. When they're newly arrived as humanitarian entrants there are so many other trauma issues going on for them that it's very difficult for them to engage in a process of independent assessment.

The other concern we have is that one of the agencies that is going to provide independent assessments is actually a partner in a community agency. Even though that partnering community is not going to be able to provide assessments where it's providing local coordination services, there are still concerns that there is a significant conflict of interest there.

CHAIR: Just so I'm clear: the conflict of interest is because it's a LAC and an independent assessment provider?

Ms Grace : Yes, absolutely.

CHAIR: I'll go to Senator Steele-John now.

Senator STEELE-JOHN: I just want to draw that point out because that is something that we are uniquely experiencing—well, not uniquely, but I'm concerned about it in the WA context. The provider you'd be referring to there is AMP; isn't it?

Ms Grace : APM.

Senator STEELE-JOHN: APM, yes. The other one's the corrupt bank. APM are one of the eight that have been awarded the contract to do independent assessments and they have a company which is also an LAC provider. That's right, isn't it?

Ms Grace : That is correct.

Senator STEELE-JOHN: So we've got a situation where in a certain part of WA you'll be getting your independent assessment from an organisation that has a subsidiary company that is providing you with LAC support.

Ms Grace : That is correct.

Senator STEELE-JOHN: That's the nature of your concern in relation to conflict of interest?

Ms Grace : Yes. I will just pass over to Siyat. I know he's got something to add.

Senator STEELE-JOHN: Absolutely; take it away, Siyat.

Mr Abdi : The tools of independent assessments are widely known and understood by culturally and linguistically diverse people with a disability and their families. Some families who are not familiar with the government systems or may not be literate are therefore unable to fully grasp the significance or the importance of the assessment tools. These are very scientific tools. They are struggling with reading and writing and yet they are asked some questions that are out of their culture sometimes, which for them is very difficult to conceptualise. Interpreters are not used. Interpreters have to be utilised in the assessment process. The interpreters need specific training in terminologies used by the assessors. You can imagine that the interpreters themselves who are in professional interpreting services don't understand some of the terminologies from the allied health or the professional assessors, and also from the disability sector.

Most of our communities don't have a particular name in reference to disability. There are a lot of hidden disabilities which the communities are not able to understand themselves, yet they are using independent assessors using a very scientific model. It is more a medical model of assessment compared to what we know as a social model. This really presents challenges for our cultural and linguistically diverse population, and that is our concern.

Senator STEELE-JOHN: Thank you. Dr Abdi, I might just draw you out in the same way I did with Dr Rice when giving evidence earlier, just so that we are clear. So the tools, with their questions and format, that have been selected to form part of the Independent Assessment Toolkit, such as Vineland-3, CHIEF, WHODAS, et cetera, in your experience are culturally inappropriate for performing the task for which they were designed—either a diagnostic or a functional assessment of a disabled person. Is that what you are sharing with us?

Mr Abdi : What I am sharing is that the tools may be well-intended for certain specific purposes to get the information, but unfortunately the tools are not flexible enough to collect all the information in a holistic approach, where you get all the information from the person. The social aspect and environmental aspects are missing. The tools have a lot of gaps in terms of providing a comprehensive assessment of a disability situation.

Senator STEELE-JOHN: So they miss a lot. They fail to capture a lot of information in relation to the disabled person to which they have been applied.

Mr Abdi : Exactly.

Senator STEELE-JOHN: And that is when they are being used for their intended purpose as an instrument for diagnostic or capacity assessment?

Mr Abdi : Yes.

Senator STEELE-JOHN: Is it your view then, as the NDIS attempts to apply these for a function they were never designed for—that is, as data to feed into a calculation of funding—that these gaps will translate into gaps in funding? The assessment does not capture it, therefore the funding, based on the assessment, cannot reflect it.

Mr Abdi : Exactly. There is potential for our clients to miss out on funding. That means it might limit the ways they can access the funding, and they have a need to access that service.

Senator STEELE-JOHN: So as currently designed, the process would inherently result in the underfunding of diverse participants from diverse backgrounds because the tool does not appropriately meet the needs of diverse communities.

Mr Abdi : Exactly.

Senator STEELE-JOHN: Thank you. Have you had the opportunity to share these concerns with the agency?

Ms Grace : Yes, we have provided submissions.

Senator STEELE-JOHN: What has the response been?

Ms Grace : I don't think we have had any comprehensive response, other than that it goes into feedback and is still being considered.

Senator STEELE-JOHN: So there has not been much feedback?

Ms Grace : No.

Senator STEELE-JOHN: Dr Abdi, you raised the valid question of what an interpreter is meant to do with some of these questions when they are attempting to communicate concepts that are not easily transferable to other cultural contexts. Is it your view that, regardless of independent assessments, these tools need to be modified so that they are able to be used for their designed purpose before we would even consider using them in the way that is proposed by the government?

Mr Abdi : Yes, it can be modified, but my main point is to use the interpreters as part of a cohort group conducting the assessment. The interpreters, if they are educated and they are resourced, will be able to provide better information so that the assessor is able to pick up some of the needs of the clients. If you leave out the interpreters, the assessors will only use what information they have got from the questions, and some of the questions they administer in the assessment might be culturally inappropriate for our culturally and linguistically diverse communities.

Senator STEELE-JOHN: So the agency would have to either require the assessment company to pay for interpretive services or pick up the bill itself for interpretive services?

Mr Abdi : Yes.

Senator STEELE-JOHN: That leads to the slightly terrifying question: is there currently the capacity? Do enough interpreters exist in the communities you work alongside to meet the demand that would be created as a result?

Mr Abdi : The translating and interpreting section is working on that, trying to build the capacity of the institution. I think that will be able to be created. But quite a number of professional interpreters are still not involved in this sector. If they are involved in this sector that will be also a way of providing better service for our clients, who are struggling to understand the language.

Senator STEELE-JOHN: So you could develop the capacity within the sector, but it would take time to train and accredit those interpreters?

Mr Abdi : I think this can be accelerated to reach the levels where we find that our people are able to access the services.

Senator STEELE-JOHN: But it will take longer than, say, August, which is when the government hopes to introduce the legislation, to get this done. It would take a couple of years to develop that capacity, wouldn't it?

Mr Abdi : Yes, it would take a couple of years. But we have adequate resource personnel to hold until we reach the highest level.

Senator STEELE-JOHN: Thank you, Dr Abdi; that is useful.

CHAIR: Senator Brown.

Senator CAROL BROWN: Thank you for coming along today to give your evidence. Many of the questions I was going to ask you have already been asked and answered. You talked about consultation. Should the independent assessments be scrapped immediately? Is that the evidence you are giving here today? Or what is your view?

Ms Grace : Yes, we think the independent assessments are probably not the most appropriate way to go for our client group. However, there is something I would like to add. A lot of our clients are financially disadvantaged. When they do not have capacity to pay for assessments they are put on long waiting lists to access allied health professionals or functional assessments through the public health system. There have to be options or services that this group of clients can access when they have been accepted into the NDIS, or ways to provide evidence of disability to the NDIS when they are applying to become participants in the scheme.

Senator CAROL BROWN: Has your organisation given thought as to what the NDIA needs to do to avoid the long waiting list and out-of-pocket expenses? It appears that the path they have chosen is not supported unanimously by the sector and by the participants who have provided evidence. Have you given any thought as to what the NDIA should do instead?

Ms Grace : Not specifically as a group; we haven't got that far down the track. But I guess there should be some access. Our Community Connector teams currently work through the GPs to get access to a health-care plan, and from there they get a functional assessment or physiotherapy, or whatever is most appropriate for that client, to get the evidence to support their application to NDIS.    

Senator CAROL BROWN: Thank you; I appreciate that.

Mr WALLACE: Ms Grace and/or Dr Abdi, are the review processes that are available to participants who want to challenge the outcome of an assessment, both internally and externally, sufficient? If not, how can they be improved?

Ms Grace : I think they can.

Mr WALLACE: Can I add one thing to that?—specifically in relation to those within a culturally and linguistically diverse environment.

Ms Grace : Firstly, a lot of our clients do not even know they can ask for a copy of the plan in their own language. They are not being told that by the Partners In Community or NDIA staff who are developing the plan with them. We also find that if the client has not had access, for various reasons, to an independent accredited interpreter, often significant things will be missed in the plan. If those two things were done correctly in the first place, we would have a lot less reviews coming across our table. The review process can work if it is supported appropriately by advocacy. However, a lot of our clients are on the waiting list because they cannot navigate that process independently.

Mr WALLACE: Ms Grace, when you talk about the review process, are you talking about the internal review or a review to the AAT?

Ms Grace : The internal review process I am talking about at this stage. As a general comment, it does not work for a client group. The evidence of that is the number of clients we have waiting for reviews. As far as the AAT goes, it seems again that the staff member assessing that person's request may not be the most qualified in that area to make those assessments. Or it has gone to AAT simply because the client has not had the capacity to understand the information they have been given because it is often in English and they have not known what to do with it. Dr Siyat, did you want to add to what I have said?

Mr Abdi : Yes, I just want to add the fact that the internal reviews really take long—sometimes four to five months for NDIS to review the internal one, let alone the external one. You can imagine therefore a culturally linguistically diverse person who is waiting for three months or four months for his or her case to be reviewed when he or she has a desperate need to really access that service. So that's the kind of mechanism. What I want to add on this is that in the first place if our local area coordinators would have been more proactive and they would have engaged community in a better way, timely, then all this backlog of reviews would not have even occurred. But unfortunately the local area coordinators are not proactive. The whole system is fragmented in that the local area coordinators sometimes may not even talk to their participants and only call them after the end of their review. That means coordination is not well provided for the clients. And that's what really causes a lot of cases of our internal reviews. External reviews would only occur when our clients have conceptualised very well, understood very well, the issues that they are handling. We find that by the time they are crossing from the internal review to the external review it would have taken months and years. And that's the challenge in the system.

Mr WALLACE: Thanks very much for that evidence.

Senator STEELE-JOHN: Sorry, Chair, just one follow-up. I did put it in the WhatsApp. I apologise. Just very quickly to Dr Abdi before we go, following on from your answers to Mr Wallace, given what you've shared with us about the problems you've experienced with the current review process, are you concerned by the fact that currently under the model proposed all independent assessments are final and not subject to the review processes of the agency or the AAT? Is that something that you find concerning?

Mr Abdi : I'm very much concerned about that because most of our clients will really drop from the system.

Senator STEELE-JOHN: So you're worried about the fact that at the moment you've already got a situation where you are having to go through review processes that don't work too well? You've said the tools don't capture the needs of your community very well as it is, and now we have a system that might actually lock in those inequitable outcomes without any process to review it.

Mr Abdi : Yes, that is really failing the purpose of the NDIS, because from the beginning the NDIS was actually to bring self-control and self-management, management, and provide really flexible services for clients. But at the moment they find there is a lot of systemic logout and login relating to the services that they really desperately need to acquire and then that really brings a challenge.

Senator STEELE-JOHN: So there has to be a process of review and appeal wherever we land for it to work for your community?

Mr Abdi : I have no problem with the reviews—internal reviews and external reviews and all this appeal; no problem with that particularly—so long as the timing, the period for the review, is as short as possible, not to the extent of five months or six months or even one year when someone is desperately looking for a service.

CHAIR: Ms Grace and Dr Abdi, thank you very much for coming online and discussing this important matter with us. We appreciate it very much.

Ms Grace : Thank you for your time.

CHAIR: We will now go to the representatives of the Autism Association of Western Australia and the South West Autism Network.