Department of Health and Human Services
DISABILITY, HOUSING AND COMMUNITY SERVICES
Review of the Disability Gateway
Final Report
Version: 1.0
November 2013
Contents
Acknowledgements
5
1.
Executive Summary
6
1.1
The Review
6
1.2
Major Findings
6
1.3
Recommendations
7
2.
Glossary of Acronyms
11
2.
Background
12
3.1 Drivers of Reform
12
3.2 Intent of the Gateway Model
13
4.
The Gateway Model
15
5.
The Review of the Disability Gateway
19
5.1 Objectives of the Review
19
5.2 Target Outcomes of the review
20
5.3 Outputs of the Review
20
5.4 Timelines
20
5.5 Methodology
21
The Disability Gateways in Operation
23
6.1 Disability Gateway Providers
23
6.2 Funding
23
6.3 Client and Service Use Profile
23
Key Themes and Findings
30
Focus Area 1 Awareness and Access
30
Focus Area 2 Consumer Experience and Perceptions
32
Focus Area 3 & 17 Information and Communication
35
Focus Area 4 Referrals
36
Focus Area 5 Intake and Assessment processes
38
Focus Area 6
42
6
7
Managing Demand
Focus Area 7 Active Monitoring
42
Focus Area 8 Local Area Coordination
45
8
9
Focus Area 9 Brokerage
49
Focus Area 10 Disability Consultants
49
Focus Area 11 Individual at the Centre
51
Focus Area 12
Cultural Proficiency
53
Focus Area 13 Supporting Inclusion
54
Focus Area 14 Disability Assessment and Advisory Team (DAAT)
55
Focus Area 15 Area Advisory Groups
56
Focus Area 16 Early Intervention and Working with Children
57
Focus Area 18 Data Collection and Reporting
59
Focus Area 19 Strategic Planning
59
Focus Area 20
Support Structures and Networks
60
Focus Area 21 Individual Support Packages / Individual Funding Unit
61
Future Directions
64
8.1 Continuous Improvement
65
Recommendations
68
9.1 Active Communication
68
9.2 Practice Frameworks and Support
68
9.3 Documentation of Workflows
69
9.4 Training and Workforce Development
69
9.5 Quality Frameworks
69
3
Acknowledgements
Acknowledgements
The contribution of the following individuals in preparing this Report is gratefully acknowledged:
Steering Committee
Mercia Bresnehan, Ingrid Ganley,
Noel Mundy, & Marita Scott
Project Team
Maryanne Lewis, Karen Bellette, David Mitchell, Angela Proposch
Special Thanks To:
Mary D’Elia, Denise Brazendale, staff from Baptcare, Mission Australia, DCS, FaHCSIA
service system workers and clients who contributed to the review.
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1. Executive Summary
1.1 The Review
The Disability Gateway was established in July 2010 in response to a need to establish a more
contemporary disability services sector in Tasmania. It was intended that the new model would be more
responsive to the needs of people with disability and that it would deliver high quality services in
partnership with a wide range of mainstream and specialist disability services.
Disability Gateway services are delivered by Baptcare in the South West and North and by Mission
Australia in the South East and North West
The review of the model commenced in late 2012. The review had 4 objectives:




assess the extent to which the Disability Gateway model is delivering the anticipated objectives of
disability reform
consider the extent to which the model is delivering improved outcomes for people with disability,
their families and carers
assess the extent to which the reformed service system is delivering value for money for government
provide advice to government on future direction and priority areas for further development.
Information to inform these objectives was collected from a wide range of stakeholders including:









People with disability, their families and support networks
Disability and Community Services (DCS)
Gateway providers – Baptcare and Mission Australia
Specialist Disability Services Sector
Advocacy Services
Peak organisations and advocacy groups
DHHS business units which interact with the Disability Gateway
The Australian Government
Tasmanian Government Departments who interact with the Disability Gateway.
A range of data collection methods were employed including Service Evaluation Reports from the
providers, use of existing customer satisfaction data, online surveys of people with disability and their
families, service system workers and 12 consultation forums held throughout Tasmania.
1.2 Major Findings
The major finding of the review is that the model as provided by Baptcare and Mission Australia is
delivering on the anticipated outcomes of the model. As intended the Disability Gateway is a visible and
transparent entry point for Disability Services. Over 12 000 clients have contacted the service. Many of
these have sought information and advice about programs, eligibility and other universal and specialist
services. The Disability Gateway has worked with over 3 500 clients to provide assessment, planning and
referral to specialist disability services and mainstream services.
The review has highlighted that after three years of operation there is a need for clarification and further
enhancement of the model through continuous service improvement. The findings from this review suggest
five areas for continuous improvement to be pursued by DCS in partnership with the Gateway providers,
Baptcare and Mission Australia.
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Executive Summary
These streams of work relate to:





Active Communication
Practice Guidelines
Documentation of Workflows
Training and Workforce Development and
Quality Frameworks.
The following diagram provides a conceptual representation of the model, influenced by the seven
principles of the reforms which initiated implementation of the model. Future operation of the model is
influenced by continuous improvement in the five areas represented by the upward arrows.
1.
5.
(Disability Assessment & Advisory Team)
2.
4.
3.
1.3 Recommendations
The recommendations for further action arising from the review of the Disability Gateway have been
determined to enhance achievement of the seven principles which underpinned the reform process which
led to the establishment of the model. These are: a focus on the individual, partnership, equity, inclusion,
access, cultural proficiency and strengthening individuals, families and support networks.
Active Communication
R1 - Develop a Communication Strategy to improve community and sector understanding about the role
of the Disability Gateway and how it works. The Strategy will focus on easy access and include key
messages relating to the current role of the model and transition to the National Disability Insurance
Scheme (NDIS) over coming years. The IFSS Review included a similar recommendation and there may be
efficiencies in developing a joint communication strategy.
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R2 – Develop and implement a style guide which clarifies the name and branding for the Gateway.
R3 - Review the DCS website to improve accessibility for users with disability, families, support and service
providers. Accessibility includes users ability to perceive, understand, navigate and interact with the web.
R4 - Promote the role of the Disability Gateway in assisting children (under 15) and integration of
functions between the disability and family support facets of the model.
R5 – Promote the client compliments and complaints processes for both DCS and Gateways.
Practice Frameworks and Support
R6 – Develop (or revise existing) Practice Frameworks and guidelines for major elements in the Disability
Gateway model to ensure alignment between practice and the seven principles which are central to the
Operational Framework for Disability Services. Practice frameworks to be developed for Intake and
Assessment, Active Monitoring, Local Area Coordination, Disability Assessment & Advisory Team (DAAT),
Disability Consultants, Brokerage and the Prioritisation Process.
R7 – Review DCS policy documents which support the Disability Gateway model. A key focus for this
activity is to ensure that policy documentation supports practice aligned with the principles in the
Operational Framework for Disability Services. This work will include, but is not limited to, the following
documents:


The DCS Access to Services Policy and Guidelines
The Common Assessment Framework (CAF) including alignment with the NDIS assessment tool
R8 - Promote practice frameworks and policy documentation to consumers and the service system.
R9 - Develop a quality assurance process for sharing and moderating service provision between
practitioners and areas. Two key focus areas for this recommendation relate to communication and
enhancing consistency in client experience of the model. Standardisation of practice to be actively pursued
where this is appropriate.
R10 – Work with mainstream services to improve their capacity to engage with and communicate with
people with disability. This recommendation will be undertaken within the context of the whole of
government Disability Framework for Action 2010 – 2015.
R11 – Review the process used for clients who require a complex system response, clarify the role and
develop a practice guideline.
R12 – Review Area Advisory Groups (AAGs) and clarify their future role.
Documentation of Workflows
R13 – Document key workflows for each component of the Disability Gateway. The goal of this activity is
to improve consistency and client experience of the model.
R14 – Document referral pathways including benchmarks for follow ups and feedback.
R15 – Define area service boundaries on an annual basis and document the processes for transfer of clients
between areas.
R16 – Document processes for consent and transfer of client information between services.
R17– Work collaboratively with stakeholders and the National Disability Insurance Agency (NDIA) to
streamline planning and services for young people who are entering or transitioning to adult services.
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Executive Summary
Training and Workforce Development
R18 – Work collaboratively to plan and implement induction and workforce development activities which
support the principles of the Operational Framework for Disability Services and enhance consistent
practice.
R19 – Continue existing strategies in building staff competence in working with Aboriginal Tasmanians and
people who are culturally and linguistically diverse.
Quality Frameworks
R20 – Develop a quarterly report to the Deputy Secretary Disability, Housing and Community Services
(DHCS) which indicates progress against achievement of recommendations included in the Review of the
Disability Gateway Final Report.
R21 - Develop Key Performance Indicators (KPIs) and qualitative measures for key components of the
Disability Gateway model. The focus of this process is to enhance client experience of the Disability
Gateway.
R22 - Streamline data exchange between DHCS and Gateways.
R23 - Develop a long term integrated data management system.
R24 – Explore options for a secure mechanism for the email or online exchange of client information.
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2. Glossary of Acronyms
AAG
Area Advisory Groups
ABI
Acquired Brain Injury
CAF
Common Assessment Framework
CALD
Culturally and Linguistically Diverse
CYS
Children and Youth Services (DHHS)
DAAT
Disability Assessment & Advisory Team (DHHS)
DCS
Disability and Community Services (DHHS)
DHCS
Disability, Housing and Community Services (DHCS)
DHHS
Department of Health and Human Services
IFSS
Integrated Family Support Service
IFU
Individual Funding Unit
ISP
Individual Support Package
LAC
Local Area Coordination
MND
Motor Neurone Disease
NDIS
National Disability Insurance Scheme
NDIA
National Disability Insurance Agency
SIP
Supporting Individual Pathways
SMS
Short Messaging Service: a system that enables mobile phone users to send and receive text
messages
TASDAS
Tasmanian Autism Spectrum Diagnostic Assessment Services (DHHS)
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2. Background
In 2007-2008 KPMG conducted a Review of Disability Services in Tasmania and found that the service
system was in urgent need of reform. The report which included a number of recommendations was used
to develop the Operational Framework for Disability Services (2009).
The Operational Framework provided the basis to reorient the Disability Service system to support
greater responsiveness to the needs of people with disability and a stronger alignment with best practice.
The focus of the Framework was to create a shift in the provision of specialist disability services within
Tasmania, focussing on building partnerships with people with disability, their families and carers, and the
community sector.
One of the key recommendations from the review of Disability Services was that all remaining government
managed direct service delivery be outsourced to the community sector, so that government could focus
more on purchasing services, resource allocation, strategic planning and quality assurance.
Another significant recommendation from the Review was that a single visible point of access to services on
a local basis was required to create a more integrated and coordinated service system, known as the
Gateway Service. Extensive consultation occurred between Disability Services, people with disability and
their families and carers and the community sector to develop the disability Gateway model.
The Disability Gateway Services were established in July 2010, integrating it with the existing IFSS Gateway
that had been operational since August 2009. Both the IFSS and Disability aspects of the Gateway are
managed by Baptcare and Mission Australia.
In the interests of clarifying any confusion, it should be noted that a Gateway and Family Support Services,
Midterm Review Report was published in February 2012. The focus of this review is the disability
component of the Gateways.
3.1 Drivers of Reform
The Operational Framework for Disability Services (2009) provided the strategic foundation upon which the
Disability Gateways were conceived and established.
The Operational Framework articulated the following vision for the future:
“Over the next three years, the emphasis will be on creating a more contemporary Disability
Services system; that is, a service system which is more responsive to the needs of people with
disability, delivers high quality services and that, through partnerships with other services, supports
and communities, can enable access and inclusion.”
The Framework further expanded on seven key areas:
Governance – provides clear direction, strong management and integrated leadership for Disability
Services. Joint governance arrangements at the state-wide and regional levels engage Disability
Service providers, other health and human services, and people with disability, their families and
carers.
Planning – planning by location processes to ensure services are targeted to the needs of
communities, and individuals, families and carers.
Resource allocation – new resource allocation formula to consider relative population need and
risk, historic inequities in services access, reasonable costs of service deliver, and enables consistency
in funding amongst the providers within a region.
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Quality – quality systems measure performance and support improvement in outcomes for
individuals, organisational compliance with standards of good practice and sector-wide health,
innovation and growth.
Accountability – service providers accountable for achieving meaningful outcomes to people with
disability.
Service delivery – a continuum of contemporary service options, which will ensure a better match
between need and intensity of support.
Visible entry points (Regional Access and Coordination) – enable improved access to
specialist disability supports, and other health and human services, as well as a centralised approach
to the management of demand at the regional level.
Implementation of the Operational Framework was underpinned by seven key principles which were
subsequently included as principles in funding agreements with the Disability Gateway Providers:
1.
2.
3.
4.
5.
6.
7.
A focus on the individual – disability services are flexible and responsive to the needs of people
with disability, their families and informal support networks, placing them at the centre of service
delivery. Supports should reflect the individual needs, goals and aspirations of people with disability.
Partnership – people with disability are partners at all points in the journey – in policy
development, planning, service delivery, workforce training and in evaluating effectiveness. Individuals
their families and informal support networks actively participate in decisions which affect their lives.
Equity – people with disability have the same rights as other citizens to participate in all aspects of
the community and life. Universal services, such as generic education, health, family services and early
childhood services, provide access to people with disability, their families and support networks, to
support quality of life and build potential.
Access – people with disability are able to access a range of disability services that are appropriate
to their needs. Priority of access is given to those who are most vulnerable, and whose needs cannot
be met through universal services and informal support.
Inclusion – people with disability, their family and support networks are embraced as belonging,
sharing responsibility, and contributing and adding value to the Tasmanian community. There is a
strong emphasis on building the knowledge, understanding and capacity of the wider service system
to support people with disability.
Strengthening individuals, families and informal support networks – this recognises the
benefits of service models that promote individual capacity, and build and maintain family and
community resilience.
Cultural proficiency – improving the access to Disability Services for Aboriginal and culturally and
linguistically diverse (CALD) people with disability, their families and carers, through tailoring
services to the particular needs of Aboriginal and CALD populations.
3.2 Intent of the Gateway Model
The primary purpose of the Gateway Service was to enable system navigation and coordination at the
regional level. The intent was that people with disability, their families and support networks could contact
the Regional Gateway directly or be referred by health or other professionals (i.e. general practitioners,
teachers).
A single agency within each region (or consortia of agencies) would take responsibility for managing the
Gateway Service.
It was envisaged that the Gateway Service would provide the following functions:

a visible and transparent point of entry to Disability Services
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

information and advice, including:
-
informing individuals and referring agencies about the range of programs, program eligibility and
referral processes, and
-
providing information about other universal and specialist services within the region
intake, including at the broad level:
-
undertaking an assessment within reasonable timeframes
-
asking referring agencies to provide (with consent) relevant information which may assist the
assessment, and
-
consulting with other professionals regarding needs and risks and the appropriate responses

facilitating demand management. As indicated in the Review of Disability Services: “there are currently a
range of methods used by agencies to manage demand. There will need to be a collaborative approach to the
management of demand in order to maintain the flexibility to respond to the needs of people with disability
seeking support”

referral to other agencies which can best meet the individual’s support needs and individual goals and
aspirations

providing a short term response, where the individual, their family and/or support network have
immediate needs, which the broader disability service system is unable to meet

data collection, including key information to support:
-
national reporting requirements, and
-
regional planning, i.e. difficulties experienced in terms of referral/access – such as system capacity
issues (e.g. waiting lists for services) and system gaps (e.g. lack of early intervention services)

service coordination

self-directed planning of services, and

early intervention, monitoring and follow-up for individuals who are generally self-managing.
To support equity of access to Disability Services, each Gateway Service would be required to implement
consistent processes of eligibility determination and prioritisation.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
4. The Gateway Model
The disability component of the Gateway Service was established in July 2010 integrating it with the already
existing IFSS Gateway that had been in operation since August 2009.
The Disability Gateway Service is managed by Baptcare and Mission Australia. The term for funding
agreements with these providers was from 1 July 2010 to 30 June 2013 and has recently been extended
until 30 July 2016.
Gateway Services are located in each regional area of the state, North, North West, South West and South
East.
A significant point of difference between the IFSS and Disability Gateway models is that, other than
brokerage, the Disability Gateway does not hold funds for provision of services for clients with disability.
Baptcare and Mission Australia were funded under the Disability Gateway model to provide the following
services:
Access to Services

An accessible and visible community intake point for consumers with disability and their families,
guardians and carers.

Services to be delivered by the following means:
 A “shop front” or office for consumers to “drop in” or visit in person during business hours
between 9.00am and 5.00pm Monday to Friday inclusive. The shop front must be accessible by
public transport (if available) and have accessible disabled parking spaces for consumers, their
families and their carers
 A 24 hour 7 day per week, 365 day statewide telephone service to be available and provided to
consumers at no or low cost. The telephone service will direct consumers to an after hours
emergency contact within the Department of Health and Human Servcies (DHHS) depending
on the consumers’ needs. (NB: DHHS after hours contact was suspended in 2012 after a
review found that it was nolonger required).
 Through other emerging technological solutions including but not limited to email, SMS and
telephone call back.
Intake & Assessment







Respond to consumers’ enquiries
Provide information and advice to consumers, their families, guardians and carers and referral
agencies concerning the range of specialist disability services and generic services within the local
area
An initial assessment (using the Common Assessment Framework) for each consumer within
reasonable timeframe to determine the relevant response to the consumers’ needs
A targeted assessment which will include accessing consumer data from referral agents and which
will be used only to assist the organisation to meet the consumers’ needs
Determine consumers’ eligibility to receive services under the Disability Services Act (2011)
Referral to other organisations which can best meet the support needs and individual goals and
aspirations for the consumer
Undertake assessment in collaboration with the consumer to identify the basis of a person centred
plan.
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Active Monitoring






By providing a “needs based contact point” for consumers who contact the organisation for
information yet do not require regular coordination of services
Provide service to consumers who choose to coordinate their own services
Maintain a register or waiting list for services based on a consumers’ assessed priority of need when
services capacity does not meet demand. This Needs Register will be used by the organisation to
determine priority in resource allocation as services become available. The information will also be
provided to the Department’s Area Advisory Group at those times as agreed
Ensure that the prioritisation of consumers is consistent, fair, transparent and based on priority of
need
All consumers who cannot access services when required and are placed on the Needs Register
must be supported by the organisation through regular communication and advice. The organisation
will seek an interim solution if the needs increase but a service is still not available
Providing support to consumers at key transition points in their lives, such as school leavers, and
people transitioning into accommodation or day option placements.
Local Area Coordination






Ongoing “person centred planning” as a result of the Targeted Assessment prior to referral to
services
Services will be directed to consumers living in the community independently or with family and to
those consumers who require ongoing contact to access services. Services are not intended for
those consumers who are primarily served in a group home environment
Case management for consumers who require ongoing support to access and stay connected with
services
Consult with the Department’s co-located Disability Consultant when required to provide case
management or coordination for consumers who require a complex service system response
Development of a “person centred plan” in collaboration with the consumer that will consider a full
range of informal supports, community supports and universal services and specialist services that are
available and which meet the needs of the consumer
Use a “person centred approach” in a manner that engages the consumer and their families.
Communication Plan and Advisory Group membership


Develop and implement a communication plan that establishes communication, information sharing
protocols and service delivery parameters between the Department and in particular the DCS Area
Offices, other Gateway Service Providers, other organisations involved in providing specialist
disability services, generic services or any other service that may be relevant to the needs of the
consumer
The organisation will join and participate as a member of the Department’s Area Advisory Group.
Brokerage Services

Brokerage services are those services provided to consumers and funded by the organisation to fulfil
a short term or emergency need and which cannot be met by the broader disability service system
or funding arrangements.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
Disability Consultant (Co-located)

DHHS will provide a co-located Disability Consultant who will be physically located within the
Gateway Service location. The Consultant is an employee of DHHS and provides specialist disability
services advice and support to the organisation and will assist with complex system and service
responses, collaborate in the analysis and interpretation of data and prepare reports and referrals
relating to DHHS and the organisation.
Data Reporting

The organisation will collect and transmit data as required by the Department. This may include
measures of performance of the Gateway and information to support local, state and national
planning and/or performance purposes.
Service Principles
Funding agreements also articulated the six service principles outlined in the Disability Services Operational
Framework relating to: a focus on the individual; partnership; equity; access; inclusion; strengthening
individuals, families and informal support networks; and cultural proficiency.
The model is built around client choice and control and is designed to ensure that the right service is
available at the right time for clients in need. Clients have the right to choose when to access the Gateway.
Clients can re-engage with Gateway as their support needs change or if they require assistance with key
transition points in their lives. This means that clients may come into contact with Gateway multiple times
for brief periods of support or for more intensive engagements. Whereever possible the Gateway will
allocate clients to the same worker that they have previously had contact with. It is critical that at each
point of engagement a re-assessment of needs occurs to ensure that the Gateway has an up to date
understanding of the client’s needs and what has changed since the previous engagement.
Consumer Outcomes
Funding agreements also set out the following outcomes to be pursued for each consumer:

Support and coordination of services that are reflective of the person’s strengths, needs, goals and
aspirations within a person-centred and self directed approach

Support to access generic community services such as health, early childhood, housing, education and
family services that are reflective of inclusive practice

Increased community responsiveness to people with disability, enabling greater participation in the
local community by building relationships with generic services

Easy access to advice and information about services in their local area

Assessments and planning that is purposeful and centred on the person

Referrals to services that are relfective of identified needs, goals and aspirations in accordance with
the appropriateness of service

Greater opportunties for increased access and inclusion into the local community

Proactive transition assistance in life-stages into adulthood

Equity in access to resources allocated on the basis of need

Development and maintenance of the service user’s informal support networks and stability of the
person’s environment through coordination of services or case management when appropriate.
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Individuals, Families, Service
Providers, Other Services
Referrals
Area Gateway
Phone – 1800 171 233
Walk up to “shop front”
Generic Community
Services
Screening
Assessment
Child Protection
Services
One-off Crisis
Family Support
Response
Services
Targeted Disability
Assessment
Page 18 of 69
Refer to other
Active
Refer to other
services
Monitoring
services
Refer to specialist
Local Area
Refer to specialist
Disability Service
Coordination
Disability Service
Refer to Resource
Refer to Resource
Team
Team
Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
5. The Review of the Disability Gateway
5.1 Objectives of the Review
The objectives of the review of Disability Gateways project were to:
1. Assess the extent to which the Disability Gateway model is delivering the anticipated objectives of
disability reform
2. Consider the extent to which the model is delivering improved outcomes for people with disability,
their families and carers
3. Assess the extent to which the reformed service system is delivering value for money for government
4. Provide advice to Government on future directions and any priority areas requiring development.
It was intended that the review would address issues including, but not limited to the following:

the effectiveness of the Disability Gateway model (noting that the model operates within its allocated
budget)

the operation of the Gateway model, specifically the following aspects of the model:
o
intake and eligibility
o
Active Monitoring
o
local area coordination, including case management
o
Needs Register
o
allocation processes (Individual Funding Units (IFUs), filling of vacancies – accommodation and
community access)
o
interface with family support services in the context of outcomes for people with disability and
their families

the role of the co-located Disability Consultant

performance information and the adequacy of information systems and reporting

the interface with other community sector providers, including mainstream services and referral
pathways

service demand, including projections of future service capacity and funding

outcomes for people with disability, their families and carers in terms of:
o
client satisfaction
o
resolution of complaints and compliments.
It is important to note that the Disability Gateway model is required to operate within a specified budget
and that the Gateway providers do not hold the funds to provide specialist disability services. These
services are funded individually by DHHS, DCS.
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5.2 Target Outcomes of the review
The following outcomes were identified as the Target Outcomes for the review of Disability Gateways
Project:
1. Develop an understanding of the perceptions of people with disability, their families and support
networks relating to: service experience, levels of satisfaction and how individual outcomes for people
with disability have been influenced by the Gateway
2. Measure whether or not the Disability Gateway is delivering intended system outcomes and the impact
of the model on achievement of disability reform objectives across geographic areas
3. Develop an understanding of the effectiveness of the relationship between the Disability Gateway,
provider networks and the broader service system
4. Demonstrate value for money of the Gateway Model
5. Identify areas for improvement and service gaps (noting that resource constraints impact on the model)
6. Provide advice to Government about future directions and priority areas for development
5.3 Outputs of the Review
The Outputs to be delivered by the Review of Disability Gateways Project are:

Project Business Plan

Project initiation briefing for the Minister

A Communication and Consultation Strategy

A Project Background Paper – reflecting anticipated reform objectives, outcomes of the model and
levels of service

A Project Research Methodology

Service Evaluation Reports from the Disability Gateway lead providers

A Research Output Report

A draft report for consideration by the Steering Committee and Reference Group

A final report to the Steering Committee

Minute to the Minister to communicate key recommendations of the review

Key findings presentations
5.4 Timelines
Initial planning for the Review commenced in July 2012, however the project itself did not commence until
the Steering Committee met and approved the Project Business Plan, Communication Strategy and
Research Methodology in September 2012. Application of the Research Methodology commenced in
October 2012 with all data collection and consultation activities completed by the end of January 2013.
Data analysis and report writing were undertaken by DHHS, Disability Services throughout February to
September, 2013.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
5.5 Methodology
Development of methodology for undertaking the Review comprised three activities:

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
Identification of Units of Analysis – who would need to be consulted with or invited to participate in
the Review
Identification of Data Collection Methods – how information would be collected to inform the Review
Identification of Focus Areas which would guide application of data collection methods
Units of Analysis
The following provides a list of groups who were identified as desirable participants in communication and
research activities:
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People with disability
Families and support networks of people with disability
DCS
Gateway Providers – Baptcare and Mission Australia
Specialist Disability Services Sector
Advocacy Services
Peak Organisations and Advisory Groups
DHHS Business Units which interact with the Disability Gateway
The Australian Government
Tasmanian Government Departments which interact with the Gateway
Data Collection Methods
A range of methods were utilised for the collection of information to inform the review. These included:

Service Evaluation Reports – Baptcare and Mission Australia were considered partners in
undertaking the review and their perspectives on how the model is operating were integral to a robust
review of its operation. Each provider was asked to provide a usage profile and an assessment of the
model based on information gathered from, service data, case studies, client consultation, worker
experiences or other means they felt were appropriate. DCS provided a template to assist with
preparation of the reports

Case Studies – Case studies were requested from Baptcare and Mission Australia. It was anticipated
that these would reflect client experiences of the model – where it had worked well and where it had
not. Providers were asked to provide case studies which illustrated various routes possible in the
model

Consumer Survey / Interviews – From March to May 2012, Baptcare undertook an extensive
independent research project measuring the consumer experience of their clients and this data has
been used to inform the Review. In Baptcare’s survey interviews were undertaken with 250 consumers
taken from a random sample of 1200 client records. At the time of designing the research methodology
it was anticipated that the same randomised sampling methodology could be utilised by Mission
Australia and DHHS, Disability Services to measure the consumer experience of Mission Australia
clients. Upon further investigation of this method the costs associated with the research project and
the timeframe required to complete the research (at least 6 months) excluded this method as a viable
data collection mechanism within the timeframe available to the Review. Nevertheless the Baptcare
Client Satisfaction Survey provided a valuable source of data regarding consumers experience of the
model.

Individual interviews – If required the data collection methodology allowed for one on one
interviews with clients or service providers if they were unable or it was not appropriate for them to
participate in other data collection activities. No individual interviews were requested or undertaken.
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
Service System Survey – Utilising Survey Monkey an online survey was implemented in December
2012, closing on the 21 December. This survey sought non-consumer views about how the model was
working both from a consumer perspective (how did they think it was working for clients) and from a
service delivery perspective (how was it working for them). The survey was publicised via the DCS
website, via emails to all DCS staff, DCS stakeholders, specialist disability providers, Mission Australia
staff, Baptcare staff and mainstream services. 221 responses were received.

Consumer Survey – This method of data collection was added to the research methodology when it
became apparent that an extensive telephone based survey was not going to be feasible. The survey
was implemented in December 2012, closing on 21 December. This survey sought the views of people
with disability, their families and carers about how they felt the Disability Gateway model was working
for them. The survey was publicised via forum participants, via the DCS website, via Disability Gateway
providers and via an email to the DCS stakeholder list. 41 responses were received.

Consumer and Service Sector Consultation Forums in the North, North West, South East
and South West – 3P Consulting was engaged to facilitate and report back on 12 consultation forums
with consumers and DCS staff. The purpose of these forums was to seek qualitative feedback on
consumer and service sector experience of the Disability Gateway model. Despite promotion of the
forums through the DHHS web site, Disability Gateway providers and emails to all disability service
providers the turn-out for the four consumer forums was disappointingly low. A better turnout was
experienced at the four service provider forums and forums with DCS staff. The forums were held in
each area of the State in late November and early December 2012.

Reference Group Focus Session – 3P was also engaged to facilitate and report back on a focus
session with the Project Reference Group. This session allowed the participants to consider
preliminary feedback from other collection mechanisms and to discuss this material in more depth. The
session was held in December 2012.

Consultation with Government Partners – It was initially conceived that a forum would be held
with a range of Government Services with which the Gateway interacts to provide feedback on their
experience of the model. As an alternative to the forum, partners were contacted individually in writing
and staff were invited to participate in the service system online survey.

Individual Submissions – As anticipated most stakeholders chose to participate via the forums or
online survey. If they chose to do so stakeholders were also welcome to make an individual submission.
This option was used by three organisations.

Review of Existing Quantitative and Qualitative data - existing quantitative and qualitative data
sources were used to inform the client and service profile.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
6 The Disability Gateways in Operation
The purpose of this section is to provide a picture of how the Disability Gateway has been implemented
and how it is operating.
6.1 Disability Gateway Providers
Baptcare and Mission Australia have been funded to provide Disability Gateway services since its inception
in July 2010. Baptcare provides Disability Gateway services in the South West and North and Mission
Australia provides these services in the South East and North West.
Baptcare and Mission Australia work with an extensive network of mainstream and specialist disability
support organisation who provide services to over 6 500 Tasmanians with disability.
6.2 Funding
Funding for the Disability Gateway is recurrent.
A second funding agreement with Baptcare and Mission Australia has been agreed for the period
1 July 2013 – 30 June 2016.
For 2013-2014 $4.96 million has been made available to fund the Disability Gateway Services. This includes
$2.5 million to Baptcare for services in the South West and North and $2.46 million to Mission Australia
for services in the South East and North West. This is inclusive of $104 550 of brokerage funds to each
organisation.
6.3 Client and Service Use Profile
How many clients are accessing Disability Gateway services?
Interpreting the number of clients accessing services requires a clear understanding of the meaning of
substantive and non-substantive cases.
Non-substantive cases are cases of service to clients that are short (ie. less than 2 hours) and no detailed
information is recorded about the client or the service provided. A substantive case is one which requires
greater than two hours of services and would typically proceed for further assessment, planning and
referral.
Disability Gateway providers report that in their first three years of service they received more than
16 500 contacts from clients. The majority of these (69%) were non-substantive, whilst over 5 197 were
substantive interactions with a client.
During the first six months of the model demand at the Disability Gateway was extremely high as clients
transitioned over to the new service arrangements and there was interest in the new model. Baptcare and
Mission Australia report that many more people have contacted the service than was anticipated at its
inception. This initial high level of demand has stabalised over time, however Disability Gateway providers
report that current demand is approximately double the projected demand.
The following table illustrates the number of substantive contacts received at the Disability Gateway since
its inception (1 July 2010) to 30 June 2013:
Substantive
North
North West
South West
South East
Total
1 115
1 556
1 123
1 403
5 197
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At any given time the Disability Gateway Local Area Coordinators are actively supporting around 660
individuals and their families to access services, coordinate support and address current and future needs.
It is interesting to note that both Baptcare and Mission Australia report that many more people have
contacted the service than was anticipated at its inception.
How many assessments have been undertaken by the Disability Gateway?
All substantive clients have an initial screening assessment using the Common Assessment Framework
(CAF). For many this assessment begins at the first point of contact with the Gateway and establishes
information relating to eligibility, individual and family needs and matching to the most appropriate service.
Ideally use of the CAF minimises the need for clients to repeat their story across multiple services.
The Disability and Family Services Gateway are collocated with the Integrated Family Support Service. This
collocation means that initial assessments are holistic, that is, the client is simultaneously assessed for all
their support needs and are triaged through to the services they require. An individual may find that they
are simultaneously referred to both disability and family supports.
Between 1 July 2010 and 30 June 2013 Baptcare and Mission Australia had undertaken 5 197 assessments
utilising the CAF. An additional targeted assessment was undertaken with 69% of these.
Mission Australia report that between 1 July 2010 and 30 September 2012 they had undertaken 1 823
assessments utilising the CAF. In the same period Baptcare report that 1 835 clients were assessed using
the CAF. An additional targeted assessment was undertaken with 1 218 (66.8%) of these. More recent
figures indicate that in the 9 months to March 2013 Disability Gateways had undertaken 770 targeted
assessments.
A targeted assessment is designed to collect information about the needs and circumstances of the client to
enable the person with disability, with assistance from their Local Area Coordinator, to identify their goals
and aspirations, strengths, services and supports to meet identified needs. The targeted assessment builds
on the information already collected in the CAF. The targeted assessment is reviewed and updated at each
new contact with the Gateway or when new information is provided by or for the client.
Timeliness of assessments
It is difficult to quantitatively report how long it takes to complete an assessment. There are a number of
reasons for this:


the time it takes to complete assessments can vary considerably depending on the information
provided by the client and factors such as whether or not the client was previously known to
Disability Services. As such assessment may take only one or two days or it may take up to 30 days
if supporting evidence is required from health practitioners.
referral to the DAAT may expand the timeframe for completion of the assessment. For example:
adaptive behaviour assessments may take around two weeks, a referral for behavioural intervention
/ support may take upwards of several weeks, with the DAAT worker remaining in contact with
the family for weeks or months, an activity / daily living assessment can vary considerably depending
on whether or not the client needs a behavioural plan, a health plan and / or social work support.
How many people are on the Needs Register?
Once the need for, and eligibility for, specialist services is identified clients will be included on a Needs
Register. This may occur after the initial or targeted assessment. Additional needs may be added after
further assessment or whenever new information is provided. Some applications and referrals may occur
immediately whilst for other service types the person may be on the Needs Register for a particular service
for a considerable period of time.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
As at May 2013 there were 380 people on the Needs Register for Individual Support Packages (ISP). 245 of
these were for new packages of care and 134 are top up packages of care, that is, additional hours of
support. There were 181 individuals listed on the Needs Register for community access. 38 individuals are
on the Needs Register for one-off support and 31 for equipment. As at February 2013 there were 121
people requiring urgent accommodation and there were an equal number waiting for accommodation but
whose current situation was not rated as urgent. It is important to note that the same individual may
appear on the Register multiple times for different needs.
How many clients are being actively monitored?
Active Monitoring involves support for people with disability who are generally self-managing, who do not
have an immediate need or who do not have an ongoing relationship with a funded disability service
provider, but who may be at-risk if their current situation changes. Active Monitoring takes the form of
proactive and regular contact to ensure that all is well with the client, identify changing needs and emerging
risks and to facilitate access and referral to services if the need arises. Active Monitoring allows
interventions to be put in place that prevent people going into crisis. All clients who are on the Needs
Register are actively monitored. Active Monitoring generally takes place at intervals (3, 6 or 12 monthly)
and using a method nominated by the client.
As at May 2013 there were 794 clients across the State who were being Actively Monitored.
How and how many clients are accessing brokerage?
Brokerage funds are most often used to assist people who are homeless or at risk of becoming homeless
but may be used for other reasons in exceptional circumstances. Brokerage is often utilised when the
carers mental and emotional health is impacted significantly, leading to a situation where the carer feels
they are no longer able to provide the level of support required. In these situations brokerage is utilised for
the provision of either out of home or in home respite. This respite is put into place until a more
sustainable solution is identified and implemented. Brokerage has also been used to purchase emergency
accommodation when out of home respite is at capacity, this situation may require personal care to be
purchased. A decline in the health of the primary carer may also mean that the person with disability
requires support until the carer is well or additional ongoing support if the carer is unlikely to recover. In
these circumstances brokerage is used until other supports or sources of funding can be secured.
Between the launch of the Disability Gateway model and 30 June 2013, brokerage had been accessed 157
times.
Who are the Disability Gateways clients?
Overall people with Intellectual Disability represented around 50% of all clients of the Disability Gateway.
Clients with Physical Disability were the next largest group (around 13%). Clients with Autism and clients
with Acquired Brain Injury (ABI) each made up about 4% of Disability Gateway clients. Some interesting
regional difference in clients accessing the Disability Gateway include: the prevalence of ABI was three
times greater in the South and there significantly higher levels of clients with intellectual disability accessing
the Disability Gateway in the North West than other areas.
In all areas the majority of clients were male, around 55%. Males are also more prevalent in younger age
groups, eg. 60% of under 25 clients in the North West were male and 64% of under 25 clients in the South
East were male.
The age profile of clients indicates higher numbers of clients in the under 25 age group in all areas,
particularly in the Northern Gateway. Baptcare suggested this profile related to the stage clients may be at
on their support journey. For example, younger clients may be just entering the support system and
require more support, whereas clients in older age groups may have achieved a level of stability meaning
that they do not experience sudden shifts or changes in their circumstance.
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Around 2% of clients of the Disability Gateway were recorded as being Aboriginal or Torres Strait Islander.
It should be noted however that there were a significant number of people for whom this information was
not recorded.
Around 2% of clients report that they were born in a country other than Australia and the use of
interpreters was only required infrequently, e.g. Baptcare used an interpreter only nine times during the
first two years of the Disability Gateways operation.
Are clients using both the IFSS and Disability components of the Gateway?
Both Disability Gateways are integrated with the IFSS / Family Support Gateway. Providers report that
there are numerous examples where there have been interactions across the two facets of the Gateway
and following initial assessment clients may be referred to a range of services. It is difficult to quantify the
number of interactions. Indicative data suggests that this is at least 200 plus cases.
Where are clients coming from?
Baptcare report that they currently have over 30 different in-coming referral sources. Over the entire
period, DHHS was the dominant source of referrals, primarily as clients transitioned at the start of the
model from the old Disability Services model. Community welfare services are the next most dominant,
followed by parent or guardian and family or friend. Self-referrals are also a considerable source of
referrals.
Mission Australia report that community service agencies are their primary source of referrals (28.5%
across both sites), followed closely by Government agencies, primarily DHHS (26.4%). Self-referrals
accounted for 12.2% of all referrals, whilst a guardian accounted for 9.9% and carers and families 8.4%.
Other sources included health or hospital (6.1%), Education agency (6%) and private practitioners (2.3%).
Reasons for use of the Disability Gateway
Across the two Disability Gateways a range of reasons were listed relating to why clients were accessing
the Disability Gateway. It should also be noted that many clients may be seeking multiple services or may
approach the Disability Gateway with very little idea about what they need or what is available. Reasons for
contact the Disability Gateway included:
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accessing support to live in own home
information and advice
access to specialist assessment or services
access to mainstream assessment or services
respite
access to supported accommodation
community access and recreation
aides and equipment
employment / work experience.
What services do Disability Gateway clients receive?
Disability Gateway clients are referred to a wide range of specialist and universal services and supports.
The types of services received include:


Community Access – working with individuals to develop individual plans and work towards
achieving their goals in a broad range of areas including recreation, leisure, social activities, skill
development and vocational pathways
Accommodation Services – residential including large residential support (>20 places), group
homes, in-home accommodation support
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013

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Advocacy Services – services designed to enable people with disability to increase the control they
have over their lives through the representation of their interests and views in the community
Information and referral services - whilst this is a core function of the Disability Gateway a range
of services across the community also provide disability specific and generic services or promote
disability awareness
Supporting Individual Pathways (SIP) – provides disability-related support and services to enable
young people to access a range of options and opportunities once they have left school including
planning, further education and vocational education, work placements or voluntary work
Intensive Support Service – supports a small group of clients who have highly challenging behaviours
which cannot be met in other parts of the service system
Individual Support Programs – Packages are designed to assist people with disability to live and
participate in their communities and may provide or fund activities including:
o assistance with coordination and transition planning
o personal care and supports to complete everyday tasks
o support to participate in a leisure activities or pre-vocation courses
o respite
o equipment
o home modifications
o community access (day support)
o other services or goods required by a person to meet disability related need.
The Disability Gateway service prioritises clients for packages when funding is available and the
Individual Funding Unit allocates and manages packages of support.
Younger people in residential aged care program – supports outcomes for younger people who live
in residential aged care settings or who are at risk of entering residential aged care.
Respite – providing short term and time-limited breaks for families and other voluntary care givers
of people with disability. The aim of respite is to assist in supporting and maintain the primary care
giving relationship, while providing a positive experience for the person with disability. Respite may
occur in the individuals own home or in a centre. Recreational respite delivers a range of flexible
non-centre based respite and recreational options to children and young people with disability.
Children’s Therapy – this includes a range of services delivered across DHHS, Department of
Education and the community sector.
Tasmanian Autism Spectrum Diagnostic Assessment Service (TASDAS) – provides comprehensive
diagnostic assessments for children and young people displaying behaviours that may indicate an
autism spectrum disorder. The team also provides recommendations regarding intervention
planning in collaboration with families and local service providers.
DCS Area Teams – these teams consist of a co-located disability consultant, a community
partnerships team and a Disability Assessment and Advisory Team. The teams assist in developing
service responses for more complex clients, assisting the Disability Gateway where there is lack of
clarity around eligibility and complexity in relation to referrals. The teams also provide specialist
advice, assessment, intervention and education to people with disability, their families and carers.
Each team comprises a mix of allied health professionals, including: specialist disability nurse, social
worker, psychologists, speech pathologists and occupational therapists.
Equipment and assistive technology.
As presented in the following table, in 2011/12, 8 619 instances of service were provided by specialist
disability service providers (Disability Services National Minimum Data Set). This was a slight increase from
2010/11 in which 8 394 instances of services were provided.
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Number of services provided by service type 2010/11, 2011/12 & 2012/13
2010 / 11
%
2011 / 12
%
2012/13
%
Large residential (>20)
122
1.45
118
1.37
118
1.13
Small residential (7-20)
20
0.24
24
0.28
19
0.2
Hostels
87
1.04
72
0.84
56
0.6
Group Homes (<7 places)
506
6.03
517
6.00
522
5.7
Attendant care / personal care
133
1.58
123
1.43
122
1.3
In-home accommodation support
454
5.41
505
5.86
544
6.0
Other accommodation support
2
0.02
1
0.01
1
0.01
Therapy support for individuals
134
1.60
129
1.50
149
1.65
Regional resource and support team
3 280
39.07
3 372
39.14
3 213
35.6
Case management, local coordination
1 318
15.70
1 513
17.56
1 873
20.8
Other community access
158
1.88
173
2.01
220
2.4
Learning and life skills
1 329
15.83
1 304
15.14
1 344
14.9
Recreation / holiday programs
326
3.88
304
3.53
314
3.48
Own home respite
81
0.96
73
0.85
69
0.76
Centre based respite / respite homes
295
3.51
223
2.59
234
2.59
Host family respite / peer support respite
9
0.11
7
0.08
6
0.06
Flexible respite
142
1.69
161
1.87
198
2.19
Total
8 396
100
8 619
100
9 002
100
As the following chart illustrates, the most frequent service provided in 2012/13 was ‘Regional resource
and support teams’ which accounted for 35.6% of services. ‘Case management and local coordination’
accounted for 20.8% of services. The third largest group of services was ‘learning and life skills’ (14.9%).
Proportion of services provided by servcie type
Flexible respite
Host family respite / peer support respite
Centre based respite / respite homes
Own home respite
Recreation / holiday programs
Learning and life skills
Other community access
Case management, local coordination
Regional resource and support team
Therapy support for individiuals
Other accommodation support
In-home accommodation support
Attendant care / personal care
Group Homes (<7 places)
Hostels
Small residential (7-20)
2012/13
2011/12
2010/11
Page 28 of 69
Large residential (>20)
0
5
10
15
20
25
30
35
40
Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
Non-engagement with Services
All services are voluntary and promote the concept of self-direction in choice and control over access to
services. The Disability Gateways do not have a mandate to require that people accept services. Gateway
providers report that they employ ‘assertive outreach and active engagement’ strategies to build rapport
between staff and the person with disability, carers and key others. Staff work intensively and flexibly to
build trust and respect. Despite these strategies Disability Gateway providers have indicated that between
10% and 12% of clients do not engage with the services to whom they are referred.
A typical scenario where a client may withdraw or disengage from Gateway services might occur where a
client has been referred by a family member or carer and the person with the disability themselves may not
want to engage with services as they do not see the imperative for the contact or have the capacity to
identify themselves as needing the services.
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7 Key Themes and Findings
This section provides a summary of key themes and output from data collection activities undertaken as
part of the review of the Disability Gateway.
Because a number of recommendations were common across a range of focus areas these have been
included in section 8 and 9.
Focus Area 1
Awareness and Access
Description
The review sought to gauge whether or not the current Disability Gateway arrangements provided an
accessible, visible and transparent entry point for disability services.
Themes
Public Awareness
A consistent message in feedback from stakeholders was the need for further marketing and promotion of
the Disability Gateway. Although Baptcare, Mission Australia and DCS have engaged in a significant amount
of promotion of the Disability Gateway there remains a lack of knowledge about the service’s existence,
confusion about the different elements of the Gateway, its relationship to Government, how the Gateway
model works and the roles played by the personnel with whom clients may work at the Gateway. The
following comments from the online survey of those who work in the service system illustrate this issue:
“Clients accessing this service do not usually know where to find the Gateway and do not know what
services are available via Gateway. If referral is appropriate, an explanation regarding the Gateway and
services available has to first be provided in order that the client / parent can make a decision regarding
consent to refer”
“It needs to be promoted more, people outside disability providers rarely know about it”
“Our members do not know where the Gateway is…. there are many communication issues and we
suggest a public relations strategy as a priority”.
Some in the service system did note the efforts undertaken by the Disability Gateway to increase public
awareness:
“The Gateway manager is making credible efforts to address deficits in community knowledge” (service
system worker).
Feedback from consumers and people who work in the service system reflects confusion relating to the
name of the Disability Gateway. There appears to be uncertainty if its name is simply ‘Gateway’, the
‘Disability Gateway’, Mission Australia or Baptcare. This confusion is exacerbated by signage at Gateway
premises and in the language used on forms and correspondence.
Physical Access
In general feedback from stakeholders was that physical access to the Disability Gateways had been well
addressed. Although the Northern Gateway office is located with Centrelink and other Australian
Government services, feedback indicated that the Northern Gateway could be more centrally located.
Additionally, car parking at the North West Gateway was sometimes an issue.
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Ease of Finding the Gateway
The Baptcare Client Satisfaction Survey randomly sampled 250 clients and asked them “How easy or
difficult was it for you to find the first contact points for the Disability Gateway Services?” The majority,
(76.8%), found accessing the first contact points as ‘very’ or ‘fairly’ easy. This result suggests that more
intensive marketing with the community may further increase access to the Gateway. This result is
consistent with message from the review data collection which reflected that physical access was fine once
you found the Gateway but that finding it in the first place was sometimes challenging because of unclear
signage:
“The Disability Gateway is hard to locate. It relies on clients being comfortable contacting via telephone”
(service system worker).
Improving services in regional and remote locations
The Disability Gateway providers both reported pursuing collaborative strategies in improving access for
clients in regional and remote areas. The following is an example of the innovate strategies the services are
using to extend the reach of services:
“Both the North West and South East Gateways cover huge regional and rural areas of Tasmania and that
can encompass up to three hours in travel distance, or may need to be accessed by plane in the case of
particularly remote areas. To ensure a regular presence in these areas, Gateway has entered into
collaborative partnerships with other service providers.
Gateway staff members have been creative in delivering services in these areas, sharing resources to ensure
good outcomes for clients. In the North West, Gateway has worked closely with Carers Tas. to establish the
‘Coffee Club’ where clients can meet with Gateway or LAC staff every two months. The Coffee Club
operates from the Queenstown Hub and attendees have free access to the available facilities. The South
East Gateway is in partnership with the Salvation Army in the New Norfolk area and frequents their venue
on a weekly to monthly basis depending on capacity” (Mission Australia Service Evaluation Report
2012).
Statewide Phone Contacts (1800)
Disability Gateway providers both report that the majority of first time contacts are via the 1800 number
with a small number of ‘walk up’ first time contacts.
The South East Disability Gateway has experienced ongoing issues relating to the diversion of calls intended
for the South East Disability Gateway to the South West Disability Gateway. This occurs because of the
diversion being based upon the location of the Telstra exchange and mobile tower points. Mission Australia
is continuing to work with Telstra to resolve this issue. It was suggested that there were also difficulties for
people calling from outside their local area eg. whilst in hospital:
“The phone system is difficult because it depends where you are calling from” (service system worker).
Baptcare and Mission Australia have been proactive in putting in place solutions that minimise disruption for
clients. This process includes a staff member completing the targeted assessment and when practical,
transferring to the other Gateway to reduce the requirement for a client to have to repeat their story.
Service Boundaries
An ongoing issue is the delineation of boundaries between South East and South West relating to the
suburbs of Granton and Molesworth. Further clarification of who has responsibility for servicing clients in
these areas is required:
“The issue of regional split continues to rear its head, on average 3 or 4 times a year” (DCS worker).
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“One of our clients was referred back and forth between Gateway services because he lives in Granton”
(service system worker).
Focus Area 2
Consumer Experience and Perceptions
Description
This focus area looked at consumer perceptions relating to the Disability Gateway. E.g. Approachability,
willingness to help, knowledge and courtesy, trust and confidence, knowledge / expertise, ability to
communicate in a way the consumer understands, focus on the consumer, inclusion of family and support
people, complaints and compliments. This section deals with overall consumer perceptions of the model.
Themes
Survey of Client Perceptions
In 2012 Baptcare undertook an extensive client satisfaction survey. Results from this survey reflect high
levels of satisfaction with accessing the Gateway, the high level of satisfaction with intake processes and
outcomes, the active involvement in their needs assessment, and support from Local Area Coordination.
Further, the majority of respondents are very satisfied with the Gateway and felt a sense of security
knowing the Gateway service is available when needed. The following comments from Baptcare’s research
reflect consumers positive experience with the model:
“Every single question I asked was answered and anything she couldn’t answer she followed up with me
within the hour, she was just amazing”
“Conversations with Baptcare have well explained what they can and cannot do and keep us informed of
their follow up with other agencies. They seem to go out of their way to help”
“I thought they were wonderful, took it all on board and got everything in place straight away”
“We really didn’t have any idea where to turn and they steered us in the right direction”.
In the Baptcare survey overall satisfaction with intake scored 7.5 out of 10 (based on those who recalled
contact with the worker) and the overall satisfaction with the Gateway scored 6.9 out of 10.
Understanding the role of the Disability Gateway, roles of staff, processes and funding
arrangements
In their service evaluation report Mission Australia noted a growing confidence from consumers in
consulting with the Disability Gateway and that this was evidenced by an increasing number of re-referrals
and by clients recommending the Disability Gateway to friends.
Despite the significant efforts that both Baptcare and Mission Australia have directed into community
education about the Disability Gateway, there was consistent feedback across all data collection methods
about a lack of understanding of the Disability Gateways overall role, the roles of staff, processes and
funding arrangements. This lack of understanding appeared to have had a negative impact on consumers
experience of the Disability Gateway. Those providing feedback suggested that there is a need for
improved and ongoing education and information provision to both consumers and service providers.
Ongoing work with service providers may help to address situations where clients have unrealistic
expectations about what the Disability Gateway can do for them, particularly with regard to funding. Such
situations may lead to clients feeling that they are getting the ‘run around’, missing out on something and
are confused about who to trust. There appears to be a misconception by both consumers and service
providers that funds are held by the Disability Gateway providers and they are exclusively responsible for
the prioritisation process and allocation of funds. In reality funds are held by DCS and whilst prioritisation
is undertaken by the Gateway, DCS have an oversight role in the prioritisation process and allocation of
funding.
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One advocacy service suggested that pictorial documentation could be developed for clients with
intellectual disability and that face to face communication was particularly important for this group.
Feedback, Review and Complaints
Both Baptcare and Mission Australia have formal processes in place for recording feedback and for the
review of decisions and both report that they use feedback to inform improvements to processes,
communication and service delivery. DCS also have a process for escalation of complaints once they have
been reviewed by the relevant community sector organisation. Despite the existence of these mechanisms,
feedback indicates that clients were not aware of their existence or how to access them. A small number of
respondents queried the independence of the processes.
Recording Information and Paperwork
Feedback from Mission Australia clients (in Service Evaluation Report) indicates some frustration from
consumers about the amount of questions asked by Disability Gateway staff and the amount of paperwork
which needs to be completed. This may indicate that clients need better understanding about why
information is being collected.
Face to Face Vs. Telephone Contact
The majority of first contacts to the Disability Gateway are via the 1800 number and subsequent contacts
are either phone based or by visit to the Gateway or a nominated alternative location.
All Stakeholders and the Disability Gateway service providers acknowledged that there was a more positive
service experience when services were provided on a face to face basis. Face to face contact assisted with
building a more positive and trusting working relationship, including having needs more fully understood.
Ability to re-enter when new needs arose
Clients have the choice to engage when they need to and disengage when they feel confident:
“It gave me knowledge for future decisions and services that may be available” (Consumer).
Some feedback expressed concern that consumers and service providers did not understand the reengagement process when new needs arose. Some respondents had difficulty with what they referred to as
the stop/start model and felt that they had to retell stories and provide basic details even though they had
been clients previously.
“We did not appreciate having to continually tell our and our son’s story to different people, as we had to
keep going back to intake all the time” (parent)
In the Baptcare client satisfaction survey 80.3% of clients thought that they would access the Gateway in
the future if they needed to and 72% reported that they felt safe and secure knowing the Gateway is there
for them.
Some respondents expressed a preference for establishing a longer term relationship with a single staff
member. This result might relate to different staff as they progress from intake to other functions in the
model. Results from the Baptcare Client Satisfaction Survey provide some perspective on this issue. When
asked 80% of clients and 70% of proxies (eg. parents or other carers) reported that they had dealt with
only one Local Area Coordinator during their experience.
Knowledge of staff
Both Mission Australia and Baptcare appear to have invested significantly in recruiting and training staff with
disability knowledge:
“Baptcare has employed suitable intake workers and LACs with a range of qualifications and experience
suitable to undertake their roles. Our minimum expectation is a tertiary level qualification, with a degree, or a
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diploma with a minimum of two years’ experience working in the sector. Additionally, Baptcare has a rigorous
orientation program to support staff as they transition into Gateway or LAC roles, as we understand that
these roles require not only formal training but a positive attitude and culture, especially with regard to person
centred, strengths focussed practice. Baptcare provides comprehensive internal training to all disability services
staff. The training begins at orientation” Baptcare Service Evaluation Report.
Despite these recruitment and training strategies feedback was received from consumers, service providers
and DCS staff that some Disability Gateway staff did not have sufficient knowledge about disability or the
disability service system. Results from the Baptcare Client Satisfaction survey indicate that 74% of
respondents thought that their intake worker was knowledgeable and 71% that the intake worker
understood their needs. A particularly positive result from the Baptcare survey was that 89% of clients felt
that their intake worker treated them with respect and 82% that they felt listened to.
One submission described the ideal worker as: “someone who had perseverance, persistence and tenacity
for the vital service they provide”. Another provider strongly recommended the employment of people
living with disability, which would add to diversity in the Disability Gateway but also provide unique insights
into barriers for people living with disability.
Some respondents felt that the dual role of the Gateway was problematic because clients could end up
speaking with staff with little knowledge or understanding about living with disability. The reverse of this
feedback was also received from some families, that the dual role meant that better service was received
because workers were able to provide advice about disability and family assistance.
Timeliness
There was consistent feedback through the forums and survey responses about how long it sometimes
took to get back to stakeholders or follow up on outstanding issues. Stakeholders reported that they
understood that the Disability Gateway itself may be waiting on information. However, there was an
expectation that where there were unavoidable delays that a follow up contact would be made to let the
stakeholder know what was happening. In Baptcare’s client satisfaction survey 72.3% responded that their
queries were followed up in a timely manner.
Case Study: Miriam
Miriam is a 24 year old who lives with her mother (52), father (50) and sister (23) in Southern Tasmania. She also has
a brother who lives on the mainland. Miriam has a diagnosis of Down’s Syndrome and Autism and requires a high level
of support and care within the home, mostly provided by her mother, father and at times sister. During the day,
Miriam attends a day service for five days per week, whilst both of her parents work.
Miriam’s sister is planning to move out of the family home reducing the level of home support. This is one of the
reasons why Miriam’s father contacted the Gateway. He wanted to explore respite options. During the assessment
process it was determined that Miriam’s parents were interested in considering future accommodation options.
Miriam was an existing client of Disability Services and so with consent, the intake worker established an active file for
her. The intake worker undertook a home visit with a LAC to discuss Miriam’s current and future needs. Following
this visit, the intake worker referred Miriam for over-night respite so that her parents were able to take trips to the
mainland to visit their son and provided the family with information regarding supported accommodation providers
within the community. The intake worker (with consent) added Miriam to the future supported accommodation
Needs Register. Miriam is currently being ‘Actively Monitored’ every six months and this is aimed at reducing the risk
of a breakdown in Miriam’s current carer arrangements. Active Monitoring will allow the family to alert the Gateway
when they are ready for Miriam to be placed on the current supported accommodation Needs Register.
During initial contact with Miriam’s father (phone call to the Gateway) he was quite confused about the service the
Gateway provided and how this was the same or different from previous Disability Services. Miriam’s father was also
confused as to how Baptcare was linked to the Gateway. The intake worker took the time to carefully explain the
new system to Miriam’s father and provided him with information brochures during the home visit and explained
Baptcare and the Gateway Services involvement with his daughter once again.
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Focus Area 3 & 17
Information and Communication
Description
Although identified separately in data collection activities there is a considerable commonality between
these focus areas and they have therefore been rolled together for reporting purposes.
The Information Focus Area sought to look at the accuracy of information provided, timeliness of
responses, follow ups, and the clarity / usefulness of written or verbal information.
The Communication Focus Area sought to assess the effectiveness of information sharing and
communication between DCS, Gateway providers, specialist disability service and generic services.
Themes
Relationships
Both Baptcare and Mission Australia have invested significant effort in building relationships and
partnerships with each other, with DCS and with the Service System:
“From a service provider’s point of view communication is very good” (service system worker).
These efforts have been made with the goal of improving networking, consistency, coordination and
understanding of the Disability Gateway model and its processes. It appears that on the whole these efforts
have been positive and rewarding. However, as previously reported under Focus Area 1, there continues
to be a lack of understanding about the Disability Gateway model and its processes from both consumers
and service providers. Both Mission and Baptcare have identified an ongoing need for information sharing
and promotion of the Disability Gateway with consumers, specialist and generic service providers. It is also
suggested that a tailored Disability Gateway website would create a central point for all parties involved to
access consistent information.
Timeliness of Communication and Follow Ups
In terms of day to day communications both Baptcare and Mission Australia report communications are
consistently provided in a timely way but that there are occasionally delays in accessing information from
other service providers. Results from Baptcare’s client satisfaction survey showed that 72.3% of
respondents reported their queries were followed up in a timely way and 76.8% reported their LAC met
their needs in a timely manner. These results indicate there is room for improvement in this area.
In consultations, consumers provided feedback that they had experienced delays in receiving responses or
follow ups on some issues. Some expressed frustration about delays in returning emails or phone calls and
confusion about whether or not the Disability Gateway was waiting on information from someone else or
whether they had simply being overlooked:
“I have no idea if any follow up past the initial referral is usual but it is odd not to have heard back”
(consumer).
Consumers provided feedback about wanting more consistent and regular feedback on active issues, even if
the communication is that ‘we are still waiting for XYZ’.
Some service and DCS staff provided feedback that the timeliness of responses was inconsistent, i.e. some
staff would call back and provide feedback but others would not.
“I thought they were wonderful, took it all on board and got everything in place straight away” (consumer).
Feedback from both consumers and service providers suggested that communication relating to decision
making needed to be consistent and transparent. It is unclear if these results indicate actual delays in
providing feedback or misunderstanding on the part of consumers about when and how feedback will
occur.
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Fax and email communication
A consistent message from both service providers and DCS staff related to the inability of Baptcare to use
email to transfer information between organisations. Without encryption, both the Northern and SE
Disability Gateway require that information is provided via fax. Baptcare has advised that this is due to
privacy regulations. If encryption is not used by the organisation, information provided by email may be
traceable and can be read by external parties. Without encryption technology it cannot be guaranteed that
information is secure. This was the most frustrating issue for service providers in the North:
“Disability Gateway staff are not allowed to email information with clients name which makes
communication difficult” (service system worker).
Accessibility of Written Material
Both consumers and DCS staff provided feedback that written communication materials, e.g. brochures,
handouts and forms were not accessible for many clients. It was felt that these materials needed to be less
text heavy and available in a range of different formats depending on the nature of the client’s disability and
their capacity to understand the complexity of the material.
Case Study: Jade (client, aged 10), Kim and Paul (Parents)
The initial enquiry was made by Kim who had arrived in Tasmania ahead of her husband and daughter who were
relocating from interstate. Kim wished to establish Jade as a client at Gateway and set up support services. The family
were moving to southern Tasmania because of Jade’s high support needs. Kim provided documentation to determine
eligibility. Respite was identified as the primary support need and a referral completed. Kim confirmed all current
support needs were being met so the family agreed to be placed on Active Monitoring with contact to be made at
four or five month intervals, mainly for school holiday enquiries, linkages or referrals.
Kim contacted the Gateway to enquire about school holiday programs. Kim attended a meeting at Baptcare with the
intake worker and LAC to ascertain further support needs. Contact was made with an organisation that provides
learning and leisure services to people with intellectual disability and the school holiday program coordinator. A letter
was sent to Kim summarising the outcomes of the meeting and necessary actions with contact details.
Focus Area 4
Referrals
Description
This focus area looked at whether the referral process was working well to link people with disability, their
families and support networks with the specialist disability or mainstream services they need. It sought to
identify any barriers or issues relating to timeliness or processes.
Themes
Public Awareness
As with other focus areas some stakeholders expressed uncertainty about how the referral process
worked.
Consumer and Service System Perspectives
Both Mission Australia and Baptcare were positive about the referral process overall. In their consumer
survey, Baptcare found that the referral process is working well to link people with disability, their families
and support networks with the specialist, or mainstream service they needed. The Baptcare consumer
survey found that of those people who received a referral, 81.4% felt that the referrals were relevant to
their needs. 73.2% felt that the referral was of a high standard.
“They helped me when I needed it. I was quite shocked at how prompt they were and how they helped me
out at the time. There seemed to be no queue for services” (consumer).
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In the online survey of the service system, results were positive about the capacity of the Disability
Gateway to link people with disability with specialist disability services and to a slightly lesser degree to
mainstream services. They were also positive about referrals occurring within appropriate timeframes. The
results indicate less agreement that referrals provided a clear plan for the person being referred or that the
referral constrained all the information the service provider needed without having to go back to the
Disability Gateway for more information.
Clarity of the process
Feedback was received that the referral process works well where Disability Gateway staff know the
service well and make appropriate and timely referrals. However, some service system workers suggested
that the lack of clarity about the referral process or lack of knowledge about the sector sometimes
resulted in inappropriate referrals both from organisations to the Disability Gateway and from the
Disability Gateway to other organisations.
Service system workers commented they didn’t understand why some referrals were rejected and
suggested that options for enquiry about the reasons for not accepting a referral were limited.
Advocacy services provided feedback that referrals to their service were sometimes not about advocacy
but for clients who required support and case management.
Some service providers commented that they have experienced repeat referrals, where a referral was
made for a client who was already a client of the service. This is not necessarily something that the
Disability Gateway can address as clients may not recall all the services they use.
These issues suggest that the referral process itself is working well but that the process needs to be better
documented and understood.
Inconsistency
All stakeholder groups suggested that there was inconsistency in referrals between different workers and
inconsistencies between the different Gateways. Service system workers also commented that sometimes
the referral was accompanied with a plan for the individual but sometimes not.
Communication Process
One provider commented that regular meetings between the Disability Gateway and DAAT had assisted
with presentation of new referrals and tracking of existing referrals.
In the online survey a number of respondents suggested that the success of the referral was dependent on
the communication skills of individual people rather than a clearly stepped out process.
Referral Options
Both providers and stakeholders in the forums identified lack of options / services to refer to as an issue.
Gateway staff often felt they bore the brunt of blame for the lack of services.
Disability Gateway providers reported that staff routinely explore community based options first prior to
making referrals to specialist disability services. They also reported that referrals extended beyond existing
health and disability service pathways to include a broader range of service providers.
Complex clients
In the online survey of service system workers, comments indicated difficulties in getting services to accept
a referral where the person with disability also had mental health issues or conditions such as dementia.
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Feedback after a referral
Service system stakeholders suggested they would like acknowledgment of referrals and more follow up
after a referral was made to find out what was happening with the client. One of the Disability Gateway
providers suggested that this is an area requiring further information sharing. Once again, it appears that
this issue relates to understanding of the process, but is also related to understanding about consent to
share information and privacy. Some felt that the onus is on the client to provide feedback to the
organisation or person who had made the referral, on the other hand, some felt that the Disability
Gateway should provide this feedback but they could not do this without the consent of the client.
Further Assessment after referral
Service system workers provided feedback that when a client is referred to their service they often
undertake their own assessment to obtain missing information. This meant that clients were being assessed
multiple times. Service providers reported that clients were frustrated about having to repeat information
they had already given to the Disability Gateway. Some Disability Gateway and DCS staff questioned
whether other service providers were using the information which accompanied referrals or were starting
from scratch. It is suggested that organisations should build on the information about eligibility, support
needs and urgency gathered by the Disability Gateway. If organisations need additional information to
determine how they should support the client, this assessment should build upon the information included
in the CAF rather than starting again from the beginning.
These issues reflect confusion about the purpose of the CAF and suggest that further work may be
required to raise understanding about the intent of the CAF and how it is to be used.
Self-directed Referrals to mainstream services
Some service system workers felt that clients should be able to self-refer to mainstream services if they had
the capacity to do so, but that sometimes the service wouldn’t take them on if they hadn’t come via the
Disability Gateway. This issue relates to mainstream services understanding the role of the Disability
Gateway and the client’s right to be self-directed.
IFSS / Disability Gateway colocation
One of the Disability Gateway providers suggested that the integration of IFSS and the Disability Gateway
had positively opened up cross referral pathways for clients.
Focus Area 5
Intake and Assessment processes
Description
This focus area sought perspectives on initial assessment (Common Assessment Framework), targeted
assessments, and accuracy in identification of needs and preferences. It looked at: whether or not
assessments were purposeful and person centred, consumer participation, eligibility determinations, sharing
of information between services, consultation processes with professionals regarding needs and risks,
timeframes and whether or not processes were understood by consumers.
Themes
Assessment Processes
There was considerable positive feedback about the intake and assessment process:
“The initial experience was wonderful and the young woman I spoke with was empathic, supportive and
encouraging” (Consumer).
“Conversations with Baptcare have well explained what they can and cannot do and keep us informed of
the follow up with other agencies. They seem to go out of their way to help” (Consumer).
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Both Disability Gateway providers outlined their use of specific tools and processes to ensure transparency
and consistency for intake and assessments. These tools were used to identify goals and progress
discussions about future pathways::
“Baptcare views every person as unique and consequently develops a personalised response for every client at
first contact… a trained and experienced practitioner undertakes an initial assessment to determine the
range of supports required. At the first point of contact if the person is in crisis an immediate response is
developed such as ensuring safety of children, securing housing or stabilising a financial issue. Once urgent
issues are addressed a more comprehensive and targeted assessment is undertaken. This is where a
comprehensive personal plan is developed focussing on the individual goals. The most suitable referral
pathway and support continuum is put into place” (Baptcare Service Evaluation Report).
As with other aspects of the model, some consumers provided feedback reflecting a lack of understanding
about the assessment, prioritisation process and what stage they were at in the process:
“It was not immediately evident to the client if they were in the early stages of initial intake, moved into
assessment (determination of eligibility), or being referred to another service or having their needs reviewed”
Baptcare Service Evaluation Report).
Some consumers reported a perception that the assessment process seemed targeted towards what was
available rather than what the client actually needed. Service providers also suggested that assessment and
planning processes should have a greater focus on strengths.
Balancing choice and control with advice
One Disability Gateway provider provided feedback that finding a balance between offering client / carer
control and choice with providing much sought after support and advice can be challenging. They reported
that some clients indicated that they would prefer solid advice from a worker especially during times of
crisis as their decision making ability decreases under stress:
“At times of high stress clients decision making abilities reduce and they can become defensive and frustrated
with a client directed approach” Baptcare Service Evaluation Report.
“Because there were too many people trying to tell us what we wanted and then we were trying to tell them
what we wanted and it just didn’t penetrate and I nearly tipped my lid” (Consumer).
On the whole, consumers reported that they felt they had control over the decision making process for
referrals that suited their needs (74.2% Baptcare client satisfaction survey).
Common Assessment Framework (CAF)
Service providers reported that while the CAF had been reviewed to make it more user-friendly, there
were still issues to be overcome:
“Whilst the current version adopts a number of the requested changes there is still considerable work to
enhance the operational effectiveness of the tool… The tool continues to suffer from repetitiveness and the
lack of a user friendly interface frustrates workers and continues to create delays and inefficiencies impacting
on client services” (Baptcare Service Evaluation Report).
Gateway providers also suggested that parts of the CAF were unwieldy. The CAF needs to be completed
fully and accurately for it to be useful.
DCS staff suggested that correct use of the CAF required that staff ask the right questions. It was suggested
that whilst the tool was person centred, it seemed to be filled in from an issues perspective and therefore
did not accurately reflect the client’s needs. It is Baptcare’s view that the skill of the practitioner is essential
as this can ensure that a more positive approach is achieved.
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There are indicators that the CAF is not being used across the disability sector as intended and that it is
not well understood.
Establishing Eligibility
It appears that Disability Gateway providers have worked consistently to develop tools for establishing
eligibility and building collaborative partnerships with DCS teams:
“The North West has worked collaboratively with the DAAT team over the past 12 months to set up
fortnightly meetings where staff can present referrals for eligibility advice and also present and track referrals
from Gateway and LAC” (Mission Australia Service Evaluation Report).
Some stakeholders provided feedback that the process for determining disability was overly complicated:
“The process involved in registering a child with a recognised disability (Down Syndrome) was complicated
and lengthy” (consumer).
There appear to be some differences in understanding about the process of gathering of evidence. For
example, Baptcare reports that they usually ask the clients to provide consent and that they will assist in
gathering information.
Despite significant effort when the Disability Act was released, there remains an ongoing lack of
understanding about the core functions of the Act and understanding about the eligibility criteria contained
in the Act. For some service system workers this lack of understanding has contributed to frustration with
the intake, assessment and referral process.
“There are high expectations on referring agents to provide lengthy reports in different formats but very
little clear information about eligibility criteria. This means that we waste the clients time and our own by
referring to Gateway, providing reports and filling in forms, waiting and then being knocked back. It would
be better to have clear and consistent eligibility criteria in the first place” (service system worker).
One worker suggested workshops as a way of improving knowledge in this area:
“I feel there continues to be a lot of ambiguity around eligibility – some workshops with ‘scenarios’ across
Gateways and DAAT may help to strengthen this” (service system worker).
The following comments from service system workers also reflect clients difficulties in establishing
eligibility:
“The level of paperwork and specialist input and reports required in order to confirm their disability is
extremely difficult for many clients with complex needs and service providers are feeling as though they
have to fight tooth and nail to evidence and confirm primary disability in order to access Gateway support”
“Some clients have given up trying to access services as they did not have easy access to evidence of
disability”
“The Gateway assumes people are competent to gather assessment material from their doctors etc. if
people have no evidence of disability they have asked the consumer to organise it, this is too hard for many
people”.
Face to Face Vs Telephone processes
Advocacy services provided feedback that initial screening seemed to be mainly conducted by telephone
which was extremely challenging for some clients. They suggested that alternatives should be freely
available. This perspective is at odds with that of the Disability Gateway providers who suggest that
alternatives are always offered and that they frequently do initial screening face-to-face via a home visit or
by inviting the client to attend the Disability Gateway office:
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“For clients with differing needs or for whom outreach services are more appropriate, staff are able to meet
at a location of the client’s choosing, for example in the client’s home or at the Coffee Club. Consumers are
always given the option of having someone with them with whom they feel comfortable” (Mission Australia
Service Evaluation Report).
“Baptcare staff all utilise an outreach model of service delivery. Often client contact occurs within the home
enabling staff to mentor and model appropriate strategies and build rapport. Support services are made
more accessible particularly for those who are socially or geographically isolated” (Baptcare Service
Evaluation Report).
These differences in understanding about the availability of alternative methods for contact suggests the
need for further promotion.
Information Sharing and Consent processes
Feedback was provided that some clients, particularly those with intellectual disability, did not understand
the consent process. Service providers also suggested that when consent was provided information was
often not transferred. Service providers provided feedback that referrals were not always accompanied by
the CAF or assessments.
Inconsistency
Service providers suggested that assessment processes did not appear to be consistent between workers
and services statewide.
Experts and professional advice
One of the central principles of the model is that the client is at the centre. Baptcare reports that the client
is viewed as the expert in their own care and that this sometimes means that there is a need to balance
conflicting information between service providers, clinicians, clients and carers. Some providers were
critical of the Disability Gateway not accepting their assessments or referrals:
“The IFSS team as well as the LAC clearly did not take seriously our concerns (from trained mental health
professionals, with clear and significant repercussions. This is hugely unsatisfactory. We are unsure why our
assessment and recommendations were not taken seriously” (service system worker).
“There needs to be greater acceptance of clinician’s recommendations to prevent cases escalating” (service
system worker).
Central to the model are the principles of choice and control by people with disability over their lives and
the services that they receive. At times participant choices are in conflict with those that professionals or
family members perceive should happen. This creates challenges for the Gateway and LACs who are
committed to empowering participants throughout the assessment, planning and implementation stages of
involvement.
Clinicians often feel their referral and assessment should be enough to make someone eligible. However,
under the Act further information is required. It is also important to evidence there is enough information
relating to eligibility to meet the Act. This ensures transparency, consistency and equity.
The Disability Gateway provided feedback that some professionals seemed reluctant to share information
or gave a low priority to preparing information for the Disability Gateway:
“Baptcare has experienced some service providers and health professionals have been reluctant to share
information. There are a number of reasons given, for some it is not viewed as a priority to prepare the
information and others have viewed it as a cost and as such have tried to charge either the clients or
Baptcare directly for the time it takes to prepare reports” (Baptcare Service Evaluation Report).
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Focus Area 6
Managing Demand
Description
This focus area sought perspectives on consistency, equity, transparency and flexibility in the prioritisation
of need, noting that, unlike the NDIS, it is a resource limited system where demand outstrips funding and
thus requires the prioritisation of need.
Themes
Transparency
There is general agreement that the current model is more transparent than the previous arrangements.
However some feedback suggested there was room for further transparency and explanation about how
decisions were made.
Equity
The consultation process highlighted a number of concerns relating to equity. Firstly, service providers,
consumers and others who made submissions to the review felt that positive outcomes sometimes had
little to do with need or the process and more to do with who your LAC was and the relationships they
had with service providers. They felt that service providers did not always provide an equal service from
equally skilled practitioners based on need. Secondly, there was a perception that it was still possible to
queue jump if the client, family or carers actively lobbied DHHS or the Minister. The Disability Gateway
providers also identified this circumvention of the system as a potential issue and that they have been
proactive in raising this as an issue with the Department who had been responsive in eliminating this
activity. There appeared to be agreement that this was not currently occurring but that there is still a
perception from service providers that it happens. Due to the regionalised funding allocation and
prioritisation of funding it is possible that consumers may compare region to region and compare their own
personal circumstance with others from a different area who received a different outcome. They may be
left asking the question ‘why were my needs not seen as equal or as high a priority than others?’. In fact, the
difference is not related to difference in priority process or model but rather the funding available per
region and the different levels of demand.
Realistic expectations
Although Disability Gateway providers reported that they clearly communicate where there are no
services available for eligible clients, there was a perception from service providers that the Disability
Gateway needed to be more up front with clients where there was very little chance of them actually
receiving a particular service or where there was likely to be a significant delay. They also felt clients
deserved to know the reasons why there would be delays in receiving a service.
Focus Area 7
Active Monitoring
Description
This area sought to assess the effectiveness of the model in four areas:

support for people with disability who are self-managing but who may need support from time to time
with specific issues

whether or not the Needs Register provided an effective mechanism for monitoring needs, identifying
interim solutions and alleviating crisis responses

supporting people with disability at key transition points

providing capacity for monitoring and allocation/ reallocation of available resources.
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Themes
A valuable and evolving process
Overall the process of Active Monitoring was viewed positively as a means of facilitating updates to support
when circumstances changed:
“Baptcare receives very positive feedback about the Active Monitoring from clients and carers. It is viewed as
a valuable resource that supports with greater independence and confidence. This is an effective process for
monitoring and managing prioritisation of the Needs Registers” (Baptcare Service Evaluation Report).
Mission Australia reported that management of Active Monitoring has evolved over time and that they had
needed to be innovative in managing caseloads. This has included the creation of a discrete Active
Monitoring role which monitors and maintains contact with clients:
“The Active Monitoring role has been extremely helpful to the LAC team as well as a consistent contact for
service providers. Gateway has received a lot of positive feedback regarding this position and it has both
streamlined services and enabled Gateway to ensure all clients are receiving a dependable service” (Mission
Australia Service Evaluation Report).
Understanding of Active Monitoring
As with many other areas, stakeholders identified the need for further education to increase understanding
about Active Monitoring and the Needs Register.
Consistency
Some concerns were raised by stakeholders about consistency in application of the Active Monitoring role
and that it appeared to be used differently between different areas.
Transition Points
Disability Gateway providers report that there have been some significant positives resulting from Active
Monitoring including the identification of supports and key transition points such as transitioning from
school or employment or moving into accommodation when home circumstances change. They further
reported that Active Monitoring has contributed to good working relationships with partners e.g.
Department of Education and allied health professionals.
Some stakeholders, particularly parents, provided feedback that the model did not assist in identifying
ongoing needs and that more assistance was needed with transition.
Case Study: Joe
Joe was referred by a senior secondary college to the Gateway. Joe’s mother confirmed that support had never been
provided for him outside of his school. Joe who has an intellectual disability with autism and epilepsy was assessed as
eligible for disability services. Consultation was undertaken with Joe, his mother and college about Joe’s training,
support, employment, community access and most suitable pathways. It was determined that Joe would be suited to
attend a Polytechnic from Monday to Thursday and a learning and leisure day program on Fridays. ISP funding was
applied for, and successfully obtained for the Polytechnic, but initially funding was not available for the 1 day a week
placement. The intake worker pursued the avenue of attending the learning and leisure program on Fridays and
successfully negotiated a place and Joe was placed on Active Monitoring to provide support whilst he transitioned
across from school to the Polytechnic and the day program.
During the transition the opportunity to support Joe with transport training was identified. This would provide him
the confidence to catch public transport to his campus and relieve the burden on his mother who had five other
young children. A successful transition occurred for Joe to the Polytechnic and one-off funding was successfully
obtained for Joe for transport training.
Further contact with the Polytechnic identified the need for Community Access Funding to transition Joe to learning
and leisure services in 2013 to continue his engagement and interaction with community, people and learning.
Joe and his mother, have more confidence in ‘what the future offers’ and this has been gained through the
collaboration of his family Baptcare and services.
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What worked particularly well was the Active Monitoring which allowed Baptcare to be in regular contact with Joe.
This supported the building of the relationship between Baptcare, other service providers and Joe. Furthermore,
Baptcare’s strength based focus has been able to successfully facilitate educational and community access pathways and
help to achieve personal growth of this client. This process has provided much needed support to Joe’s family.
Allocation of holiday program funding
One of the most frequently and actively discussed issues in consultations related to the way ongoing needs
for school holiday respite/ activity / vacation care were handled. Parents felt that they should not have to
recontact the Disability Gateway each holiday period and that as long as the child’s needs had not changed
Active Monitoring would identify an upcoming need at certain times of the year. School holidays were also
noted as a period of stress for parents by providers and they outlined efforts to improve this situation:
“School holidays become an occasion to dread for parents/ carers and at intake many last minute updates
are received as to when and where programmes are being offered and frantic parents. Carers are calling to
find out if their child will get a place. Efforts have been made to streamline this situation e.g. early contact to
services offering respite programmes to ascertain a timetable. This has improved the communication and
empowered the intake workers to provide up to date information” (Baptcare Service Evaluation Report).
In one consultation a question was raised about why the system couldn’t flag particular needs at certain
know timeframes. This question reflects a lack of understanding about how Active Monitoring works
because the Disability Gateway already have a system which flags client transitions or changes that may
impact on their lives.
It is suggested that this problem emerges from the way school holiday activities are funded and that lead
times once funding is confirmed are not long enough.
Frequency and method of contact
Disability Gateway providers report that Active Monitoring is always sought directly with the client, carer
or family. Service providers may be contacted after contact with the client to seek additional information.
Clients are asked how often they would like to be contacted and by what method. A system is also in place
for tracking Active Monitoring and flagging when contact is required. Despite this process, feedback was
received from stakeholders that contact should be more frequent. This feedback may reflect that service
providers and consumers do not understand how Active Monitoring works:
“No one has contacted me about any ongoing support or respite. I am close to tearing my hair out but
there is no one to help” (consumer).
“I would like a definition of ‘Active Monitoring’ which we are on but have not been contacted in 18 months
at least and have had no reply to two calls” (consumer).
“Active Monitoring is working well as long as those people who are waiting for allocation shave their needs
continuously reviewed, so that they do not simply sit on a register” (service system worker).
Capacity
Disability Gateway providers reported that managing the case load for Active Monitoring can be challenging
due to significant demand on resources.
In the end it is about funding
In the online survey a number of service system workers provided feedback that whilst the Active
Monitoring process itself is OK in the end it had significant shortcomings associated with lack of services
and funding:
“Although I had problems with access to services it’s not entirely the fault of Gateway services”
(consumer)
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Case Study: Sue
Sue is 41. She has a number of chronic illnesses, chronic pain and severe rheumatoid arthritis. Sue was referred to
Gateway in October 2010 by the social work department of the Royal Hobart Hospital as she was in need of a
wheelchair hoist for her car.
Sue lives alone in a Housing Tasmania flat and has 30 hours ISP support through Independent Health Services.
Sue is being Actively Monitored and has agreed to receive phone calls from her LAC support worker every three
months.
In July, Sue informed her LAC that she would be travelling overseas to visit family and that she would be away for
approximately 13 weeks. She was aware that if she stayed any longer she would lose her Centrelink Benefit and may
have to reapply for her disability support pension.
In November her LAC attempted to contact Sue by phone, but was unable to contact her and left a message on her
answering machine. A further contact was made in late November and again a message was left on her phone. A letter
was sent to her in early December, asking her to contact her LAC if she needed further support.
Sue contacted her LAC support worker a few days later and explained she was relieved that the LAC had persisted in
trying to contact her because she was overwhelmed and was not sure what to do. Her overseas trip had not gone
well, she had been hospitalised for a period of time and was not allowed to fly home until her health had stabalised.
On her return she had been admitted to the RHH.
Sue advised that due to her being delayed in returning to Australia her DSP had been suspended and she now had no
income. Additionally, she had issues with Housing Tasmania as her unit was due to be inspected before her lease
would be renewed. She was now unable to pay her rent and was concerned that if her rent fell into arrears she would
be evicted.
Sue’s LAC sought consent and made contact with the Centrelink outreach social worker to request that Sue be
visited in hospital with the view to having her Centrelink benefit restored. The LAC also sought consent to contact
Housing Tasmania. Contact was made, a new lease was then faxed through to Baptcare and taken to Sue in hospital
where the document was signed and returned to Housing Tasmania. Additionally, the LAC worker advocated for a
rent repayment plan to ensure no further financial hardship was experienced.
It is evident that the Active Monitoring calls and follow up letter were of great benefit to Sue. Her LAC worker was
able to visit her in hospital, assess her immediate needs, make contact with the appropriate services and have her
needs met.
Focus Area 8
Local Area Coordination
Description
This focus area looked at support for community based individuals with accessing and staying connected
with services, interface with the specialist disability service system and generic services, definition and
understanding about the role.
Themes
Overall Perceptions of Local Area Coordination
The concept of LAC is very positively perceived by all stakeholders and for most working with a LAC has
worked well. The Baptcare client satisfaction survey highlights that 83.7% of clients were satisfied with the
LAC service.
Disability Gateway providers report that the role has evolved over time and is continuously improving as
LACs build networks and relationships with the sector and generic services:
“The awareness building and case conferencing by the LACs has facilitated a broader knowledge of those
operating generic services and this is facilitating a better outcome for clients than that experienced two years
ago” (Mission Australia Service Evaluation Report).
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“Where multiple service providers are involved in providing support Baptcare use case conferencing to identify
who the most appropriate lead service and to ensure supports are delivered in a holistic manner. There is a
greater involvement of localised services, in particular, Neighbourhood Houses for community connection,
education programs and personal development:” (Baptcare Service Evaluation Report).
It also appears that client confidence and understanding about the LAC role has increased over time,
particularly with regard to recontacting the LAC when new needs emerged:
“Client confidence with the LAC team has grown, with an increasing number of clients returning back through
the Gateway for minor needs and they are content for the LAC to leave again when their goals have been
achieved. More clients are re-presenting now with singular needs/goals and fewer multi-goal requests. Clients
are also ringing or consulting with the Active Monitor to confirm that their course of action is the right one”
(Mission Australia Service Evaluation Report).
There was however feedback that the role is highly person dependent and as a result the experience of
consumers can be inconsistent:
“The good ones are great” (service system worker)
Understanding the Role
Disability Gateway providers continuously engage in awareness building and education regarding the
Disability Gateway and the LAC role.
Stakeholders provided feedback that there was a need for further articulation about the processes
associated with the role, its key duties and accountability in terms of decision making. It was suggested that
better understanding about LAC may alleviate perceptions of inconsistency in the way the role is
performed by different LACs and in different areas.
One of the Disability Gateway providers also suggested that further clarity regarding the parameters of the
role would remove misconceptions about the role e.g. that the LAC holds funds. Baptcare also suggested
that there is some confusion about the role of LACs in Tasmania compared to similarly named roles in
other States, particularly regarding provision of systemic community development which they perceive is
not a central part of the role of LACs in Tasmania.
Case Coordination vs. Case Management
There appears to be a wide variety of understandings about definitions and meanings of terms such as
‘casework’, ‘case management’ and ‘case coordination’.
Disability Gateway providers report that there is often an expectation that the LAC will provide case
management rather than case coordination. This issue is particularly problematic where the client is in crisis
or where there is significant complexity. A variety of stakeholders suggested that case management was a
possible gap in the model and needed to be looked at more closely. In feedback at the forums some
attendees felt that case management was a necessity whilst others had felt that it reduced the ability of
clients to be self-directed. In the online survey of service system workers there were a significant number
of comments relating to misunderstanding about the LACs role in long term case management. Some
stakeholders did not understand that LACs do actually have a case management role:
“For more complex clients with many stakeholders involved, case management is required. Sometimes there
is a cast of thousands and no one is coordinating and taking the lead to manage the situation” (service
system worker).
Feedback in the online survey of the service system also highlighted confusion regarding case management.
It highlighted concerns that there are many clients who need more support than can be provided under the
current model:
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“Not all clients fit neatly into an Active Monitoring model. These clients may have difficulty in reaching out
for support because of the very nature of their disability, (e.g. self-direction issues, problem solving issues,
communication issues). This leads to situations worsening and can place demands on other systems which
could have easily been avoided with a more proactive approach. Of all the issues with the Gateway the lack
of Case Management services, for those clients who need this service is the greatest area of failing”
(service system worker)
“Specific case management is needed for many complex clients” (service system worker)
“There is confusion about who is to support clients who live in supported accommodation but have complex
needs that the accommodation provider feels unable to meet” (service system worker).
Clearly these results demonstrate confusion regarding language and confusion regarding the role of LACs.
LACs do in fact undertake case management but this is not well understood by consumers or service
system workers.
Needs based support
Disability Gateway services are provided based on a client’s need. When a client is stable, a client can
choose to move to Active Monitoring or cease their services and when needed re-engage with support.
For some clients the process of re-engagement appears to have caused confusion amongst clients who are
used to or who would like an ongoing relationship with a single LAC.
“People need to build a relationship with a LAC before they can trust the service and both parties need to
have more frequent contact” (service system worker).
Disability Gateway providers have been consistent in ‘closing clients’ when their goals have been achieved
and commented that this has contributed to greater independence for the client in their decision making
and limited the opportunity for dependency to build on individual workers:
Experience, Knowledge and Creativity in LAC
There were many positive comments about experiences with LACs. On the whole LACs were seen to be
experienced, knowledgeable and responsive to client needs:
“I’ve got much more support and more people supporting me than before. I’ve got a whole wider community
now – my church, my family, my friends from school” (consumer).
“The service and knowledge is consistent with our immediate needs and the feedback is more than
adequate” (consumer).
However, one of the strongest messages in the entire review relates to variability in the success of LAC
because of the person fulfilling the LAC role. The following comments illustrate this feedback:
“The person I dealt with had no idea about disability” (consumer)
“You have to know exactly what is available to ask for as it will not be offered and unless you constantly
chase up there is no progress made” (consumer)
“Some LACs in my experience are not educated enough or experienced within the sector to provide
information. I have had to provide information and guidance on what they need to do” (service system
worker)
“Communication with LACs is difficult to generalise, some are fantastic but others not – consistency is an
issue” (service system worker)
“It is difficult to communicate when workers are part time, very busy and don’t return calls. The quality and
knowledge of LACs vary significantly” (service system worker).
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Because of this issue of variability there is a perception that equity in access to services is compromised.
The following quote summarises this perception:
“A positive outcome is more dependent on having a good relationship with a particular LAC and them
having a positive relationship with specific service providers rather than all clients receiving an equal service
from equally skilled practitioners and service access being based on need” (service system worker).
A number of suggestions were made to address the perceived lack of knowledge and skill in some workers.
These included introducing a standardised skill set, skills development, mentoring and supervision by staff
with more experience.
Funding
A number of comments were made about difficulties faced by LACs because they could only work within
the funds available:
“My Local Area Coordinator is fantastic but there is only so much they can do as Baptcare do not have
access to enough funding to meet the needs of myself and many other people in my situation” (consumer)
“It must be a very difficult job to do because the LACs are basically beating their heads up against a brick
wall. The purse strings are held by the government so even with the best intensions my LAC is not able to
access the support (essential equipment and more ISP hours) I require to be able to meet my basic human
rights. All my LAC can do is fill out the appropriate paperwork and keep advocating for me each time a
dribble of funding is released” (consumer).
Case Study: Max
Max is 29 years old and has Asperger’s. In the past Max has declined support and has refused to engage with services
contracted by DCS. Max did not trust people and did not want services in his home. He felt he was managing fine on
his own.
Max was referred through to LAC as he was about to become homeless due to issues with his neighbours. The inside
of his unit was chaotic and it had become a fire risk. Max repeatedly complained about his neighbours to Housing
Tasmania, saying they were too loud. When visiting Max he would allegedly hear the neighbours talking, he would ask
his visitors if they could hear the voices. Max was later admitted to the psychiatric unit by police after he threatened
to kill his neighbour. Max’s medication was reviewed and it was decided his medication regime was unsustainable and
addictive. Max’s medications ceased and he was prescribed a mood stabiliser to address his condition.
Whilst Max was in the psychiatric unit police investigated his unit finding stolen property. A number of items were
confiscated and Max was charged with stealing.
After being discharged from hospital, 3 hours of ISP were secured for tenancy support. A Guardianship Administration
Board (GAB) application was submitted and a public guardian was appointed to manage his housing issues. Max
reluctantly agreed to engage with the support service contracted.
Max became distressed and depressed, his possessions had been taken, his medication altered and there were a
number of new people in his life. He was not coping well with the number of changes.
In the beginning Max would not engage, all conversations were directed via his advocate, she had become his voice
and only support. Max refused to actively engage with anyone and his advocate would often ask for clarification of the
LAC role as there appeared to be some uncertainties and misunderstandings.
With LAC support, over time, Max engaged more frequently with his support worker. Max no longer appeared to be
doctor shopping and was accessing the community during the day, when previously he only went out at night time.
Max has begun to eat healthier food and is engaging with his support worker and other services within the
community. The medication Max is taking appears to be working; he is stable and sleeping at night time. Housing
Tasmania has extended his lease for 6 months. His parole officer is pleased with his progress and is engaging with him
as directed. The public guardian is looking to revoke the current GAB Order. Max no longer requires a LAC and has
been moved to Active Monitoring.
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Focus Area 9
Brokerage
Description
This focus area looked at whether or not brokerage arrangements are providing a mechanism for relieving
unanticipated or crisis situations.
Themes
An effective tool
Both Mission Australia and Baptcare provided feedback that brokerage has been an effective tool in
alleviating crisis and that it is generally only used when all other options have been explored. Brokerage has
allowed earlier intervention to sustain accommodation and independent living. The use of brokerage has
allowed space in which more appropriate longer term planning can take place. Feedback was provided that
the second iteration of the brokerage guidelines provided much needed clarity.
Inflated costs
Concern was raised that costs had been inflated by service providers where brokerage funds were used.
This is because where brokerage funds are used service providers charge on a casual rather than DHHS
unit price. It is suggested that some service providers view the brokerage ‘pool’ as unlimited.
Brokerage used to cover shortfalls in ISPs
There was concern from Disability Gateway providers that undue pressure was being placed on the
brokerage available because it has been used to cover short falls in ISP hours eg. respite. This results in
services being provided at casual rather than unit pricing.
Concealing Service Gaps
There was also concern from Disability Gateway providers that the use of brokerage was concealing
service gaps, e.g. emergency accommodation, limited funding for in home support and respite, and a lack of
suitable long term accommodation:
“With the rising cost of living and the vulnerable nature of the client group there is potential that many more
disability clients will experience accommodation crisis” (Baptcare Service Evaluation Report).
Requests for General Financial Assistance
Disability Gateway providers report that they are approached with requests to use brokerage to assist
clients with payment of general living expenses. This reflects some confusion between the IFSS brokerage
model which has broader parameters. These requests have not been funded as they are outside the
guidelines.
Information and Awareness
As with many facets of the model, service providers and DCS staff provided feedback that there appears to
show a lack of understanding about the brokerage guidelines and transparency around decision making. The
brokerage guidelines are produced by DCS and available to the public on the DHHS website.
Focus Area 10
Disability Consultants
Description
This focus area looked at definition of the role, support provided by the role, its value as a conduit
between the Disability Gateway, DCS and other agencies, flow of information, support for LAC and the
Disability Gateway in complex negotiations, and the value of co-location.
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Themes
An essential part of the model
All stakeholders were very positive about the role of the Disability Consultants, using terms such as vital,
critically important, and highly valued:
“The best part of the split between DHHS and the Gateway are the excellent disability consultants”
(service system worker)
One Disability Gateway provider suggested that the disability consultant is a critically important conduit
between the Disability Gateway, DHHS and other agencies. The role is seen as particularly important in
supporting highly complex clients and in supporting relationships with government and funded providers to
clarify responsibilities. Many service providers spoke positively about the role and the wealth of experience
that individuals who are fulfilling the role have and how invaluable this role has been.
An evolving role
In the online survey of service workers a number of comments were received about how the role of
Disability Consultants appears to have evolved significantly over time, particularly as the Disability Gateway
and associated processes have become better established. There was some confusion about how the role
was defined, particularly relating to responsibilities of Disability Consultant and Local Area Coordinators.
There were concerns that the roles had evolved differently in the various Areas.
Awareness
Once again awareness of the role was raised by a number of stakeholders. Service providers expressed a
need for an overview of this role and what it did and did not do clarity around decision making, protocols
and processes.
Availability
One of the Disability Gateway providers suggested that increased demand on the Disability Consultant to
provide support to the broader sector has inevitability lead to a reduction in their availability to the
Disability Gateway. They have suggested it would assist in terms of timely access and consistency of
consultation processes to have specific days and time the consultants are in the office and available to staff:
“Contact is not easy, as the disability consultant is busy, which limits their ability to provide guidance in a
timely manner” (service system worker).
Communication
One of the Disability Gateway providers suggested that communication would by strengthened by having a
regular weekly meeting between the Team Leaders and the Disability Consultants. This has occurred in the
North and has been found to be beneficial in ensuring that all communications are in writing and every
referral has had a dedicated focus.
Reliance
The feedback is that the Disability Consultant is an essential element of the Disability Gateway model and
as such there appears to be a significant reliance on them across a range of issues. Some concern was
expressed about key person dependency and the consultants spreading themselves too thinly:
“The consultants have become the default system and the level of work expected of them is far beyond the
original role – they are viewed as problem solvers and in many cases they are given problems that should
be resolvable within the Gateway” (service system worker).
A number of service system workers suggested that more consultants are needed.
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Case Study: Anna
Anna was referred to the Disability Gateway by the local council and initially went to child protection and then the
co-located Disability Consultant. The LAC team leader and the Disability Consultant decided on a collaborative
approach due to the many issues this family was facing and the urgent need for a positive outcome. The Disability
Consultant focused on the family unit and the team leader focussed on Anna.
Due to the poor condition of the family home the local council considered that the property was not fit for
occupancy, meaning the family would become homeless. In conjunction with the council the LAC team worked with
the family to implement an intensive cleaning schedule. The team was able to include the whole family including
extended family members. Brokerage was used for some of the work as it was considered unsafe for anyone not
properly trained. Over a month-long period the house was returned to a safe state. The family expressed considerable
pride in the work they had achieved. A highlight for them was showing the LAC family photos that had been
unearthed in the clean-up.
Initially it was unclear how often Anna had been able to leave the house other than to visit other family members’
homes. After discussion with Anna and the family the LAC team was able to offer some recreational and social
activities in which Anna may like to participate. The LAC was able to ensure the home environment was safe for Anna
and that her medical needs were being met. The family took great pride in keeping appointments. It became apparent
that the family required ongoing support and monitoring. Anna is now on the Needs Register for two hours ISP per
week and is also part of Active Monitoring to maintain contact with services.
The local council provided positive feedback about the work the Disability Consultant and LAC team had been able to
complete with the family.
Focus Area 11
Individual at the Centre
Description
This focus area sought to examine if services were being delivered in a way that placed the person at the
centre, reflecting individual strengths, needs, goals and aspirations.
Themes
Client at the centre
Both Mission Australia and Baptcare provided information about their service delivery approach, ensuring
that the client is at the centre of all decision making and planning, working to promote choice and control.
“The one person that holds the key to all the information is the client themselves. Baptcare find a way to
communicate directly with the client to the best of their abilities” (Baptcare Service Evaluation Report).
Both Gateways encouraged active participation, personalisation of interventions and the use of strengths
based approaches. The goal setting process was viewed positively as a catalyst for identifying the individuals
aspirations. Case conferencing was also identified as a positive way of ensuring that the clients goals and
aspirations were clearly articulated to all parties.
Case Study: Paul
Paul resides in a supported accommodation service and had disengaged from his community access supports. His
supported accommodation provider and family members had raised concerns that he was exhibiting risky behaviours
in the community. The family request some support in managing the situation.
LAC became involved to assist in assessing the current situation. A case conference was arranged inviting all people
involved including Paul (the client) to discuss the concerns. Paul participated in further assessment and identified his
dissatisfaction with the community access and an interest in employment. He was enrolled with a disability
employment service and began exploring work placements alongside his community access placements.
There has been a successful transition to his work placement however there is still the need to seek a longer term
employment option.
On the whole service providers were also positive about the individual being at the centre of the model.
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Some service providers were critical about the Disability Gateway consulting with family and service
providers rather than consulting with the client when they were capable of participating. Some clients have
reported to advocacy services that they have not met their LAC. Disability Gateway providers have stated
that this is not possible. Baptcare provided feedback that in some instances families and service providers
have resisted direct communication between the Disability Gateway and the clients. On the other hand,
with consent from the client, consultation would be undertaken with the client’s family and support
providers as part of an holistic assessment.
Providers were positive about the introduction of self-directed funding in Tasmania and can see the benefits
this will bring for people with disability with increased choice and control.
Clients Views Vs Family and Carers Views
There was feedback from both Mission and Baptcare that they find the balance of involving clients and their
carers in the planning process a challenge at times, particularly when the views of the clients are different
to that of the people supporting them. The expectations and opinions of the client and the carer are often
different.
Comments were also received that some clients and families found it difficult to articulate what they
wanted and were happy to accept advice.
Information Sharing
Mission Australia outlined ongoing efforts to educate stakeholders about the role of LACs in facilitating
client planning and strengths based approaches, particularly relating to the length of time that LACs stay
involved with clients. They identified this as an area requiring ongoing work as services and clients are
constantly changing.
Skilled Staff
Disability Gateway providers indicated that the skills of staff are continuing to develop, particularly in
obtaining information from the client to facilitate planning. Some service providers suggested that further
training is required, particularly for staff who appeared to have little knowledge of the adult service system.
Further Development
It is clear from the feedback provided that there are still significant differences in interpretation of what
constitutes person centred planning.
Disability Gateway providers suggested a number of ideas for further improvement including, development
of tools to assist clients in completing their goals without support, improved process for clients to present
to the Gateway if they required additional support.
A number of stakeholders commented on the need for face to face contact in planning. Baptcare research
also supports this finding. However, current funding for the model means that phone contact is used more
than face to face contact.
Communication
Disability Gateway providers commented that service providers are increasingly willing to accept and value
feedback provided by the Gateway on behalf of the client. This has allowed the Gateway to advocate on the
client’s behalf about an agreed plan. Face to face communication is the preferred method for many clients
and service providers.
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Case Study: Bob
The LAC became involved with Bob, who has Motor Neurone Disease (MND) in August 2011. Bob’s symptoms had
increased and his health and independence were declining. The LAC met with Bob and listened to his concerns
regarding his decline and how best to assist or facilitate maintaining his independence.
Bob decided that he would require extra support hours, hoping that this would enable him to remain living
independently for longer and to give much needed respite to his friends who acted as his primary carers. With Bob’s
consent, the LAC arranged meetings and discussions with Bob and his current service providers, MND case manager
and his personal support service provider. Unfortunately the service provider already known to Bob announced they
would be unable to continue support as they would not be able to cover any additional hours of support gained for
Bob.
The LAC empowered Bob with all current documentation and information relevant to his area to support his decision
making around choosing a new provider. This involved lengthy discussions on what they could offer and how best
each provider would suit his growing needs. Bob and his primary carer remained in complete control and were
supported in deciding how his future support would be delivered. Assistance was given to Bob to develop the plans he
needed and wanted implemented, and in selecting staff that were to be involved and to try and predict any decisions
that Bob may to have made on his behalf in the future.
The LAC applied for extra ISP hours and emphasised the importance of the extra funding to maintain and support
Bob’s request to be as independent as possible in the final stages of his illness.
During the final stages of Bob’s illness the LAC was able to walk alongside Bob in collaboration with his primary carer
friend, his Palliative Care Team, his MND case manager, and his personal support provider to ensure as much of his
self-directed plan as possible was implemented and his dignity protected. It was of the upmost importance for the
LAC to be able to assist and respect Bob in empowering him to fulfil his wishes to remain in control of his life and
final wishes for as long as possible.
It was a great honour to be thanked in Bob’s eulogy for the support that Mission Australia and specifically the LAC
had provided and for the support they had provided to Bob through his final journey of life.
The MND society later requested that the LAC give a presentation at their state forum on ‘Getting it Right’ for
people with MND. The LAC was happy to accept, present and help celebrate Bob’s life on reflection.
Focus Area 12
Cultural Proficiency
Description
This focus area sought perspectives on whether the Disability Gateway model embraces and promotes
access for Aboriginal Tasmanians with disability and people with disability who are culturally and
linguistically diverse.
Themes
Cultural Competence
Both Baptcare and Mission Australia appear to have invested significantly in building a platform of cultural
competence at both a strategic and operational level. This is reflected in building the cultural competence
of staff and creating operational environments that celebrate and respect diversity and social inclusion. They
also appear to have a focus on continuous improvement and knowledge building in this area. One provider
stated:
“It would be great to have a better understanding of the needs of Aboriginal people and how we could
work with the community to support people with disability”.
Staff members have access to training and induction practices that build and support cultural awareness and
competency.
Where appropriate the providers have worked with Aboriginal organisations and cultural groups to
develop suitable care and service delivery models.
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Interpreters
Disability Gateway providers highlighted issues with use of interpreters that are common to many services
who use interpreters in a relatively small community. At times there have been difficulties in accessing an
interpreter from a specific culture and/or dialect. They also highlighted that clients may not experience the
feeling of freedom to discuss issues without judgment from the interpreter, particularly if the client is from
a culture with only a small representation in Tasmania as they may be known to each other in the
community.
Focus Area 13
Supporting Inclusion
Description
This focus area considered whether the Disability Gateway model contributes to building knowledge,
understanding and capacity of the wider service system to support people with disability. It sought feedback
about whether the model assists in maximising opportunities for people with disability to access and
participate in their local community.
Themes
Maximising Opportunities
There appeared to be agreement that the person centred planning process has worked as a mechanism for
identifying client goals and aspirations relating to accessing and participating in the community. Using the
goals identified by clients the Disability Gateway has worked to access generic services and to be creative
in facilitating the support of providers. Disability Gateway providers list numerous examples of
opportunities for community participation delivered via community programs, volunteer opportunities, notfor-profit and community organisations. In part the facilitation of goals has involved working with
organisations to improve their knowledge and understanding about working with clients with disability.
Baptcare provided feedback that the significant number of non-substantive calls to the 1800 Disability
Gateway is an indicator of increased opportunities for community participation and referral.
Both providers report that they have built a growing database of options and contacts for community
participation. They also report that the service system is responding to the identified goals of clients by
expanding the range of program options on offer. Whilst they suggest there is further work to do in this
area the options provided are more inclusive and are continuing to be explored by clients.
Options in Rural and Regional Areas
Disability Gateway providers reported that there are significantly fewer opportunities for participation in
rural and regional areas.
This was across a range of services including accommodation, day support and respite options:
“The North West is significantly underrepresented in areas such as group home placements. There is no
weighting for rurality in the minimal new funding allocations” (service system worker).
Accessing Mainstream Services
Disability Gateways report that they have developed partnerships with specialist and mainstream service
providers to establish strong networks and alliance partnerships that allow them to streamline clients
seamlessly through the critical referral pathway achieving high quality outcomes for clients. However,
service providers and DCS staff reported that disability support clients faced difficulties in accessing
mainstream services and that this was an area requiring development. Their perception was that both those
referring and mainstream services needed better knowledge and motivation to work with clients with
disability and that the referral process needed to be more active including follow up after the referral.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
Focus Area 14
Disability Assessment and Advisory Team (DAAT)
Description
This focus area looked at the flow of information – from Gateway to DAAT and DAAT to Gateway,
opportunities for liaison and information sharing, access to the DAAT, whether roles and functions clear,
direct referrals, assessments, timeliness, definition of the role, consistency and understanding.
Themes
A valuable complementary Role
The DAAT role is viewed as an important complementary service to the Disability Gateway. Both Disability
Gateway providers and service providers reported good working relationships with the DAAT and a
particular appreciation of the expertise they are able to provide. This relationship has been fostered via
regular formal meetings.
“Fortnightly meetings cover eligibility, referrals, community needs, complex cases and referrals in hospitals….
This process has opened up communication and contributed to closer working relationships between services.
Referrals are followed up in a timely manner and there is regular communication on how referrals are
progressing” (Mission Australia Service Evaluation Report).
Some feedback was provided that the processes and protocols used by the DAAT could be more
transparent and better communicated.
Communication
There was considerable positive feedback about communication between the Disability Gateway, service
providers and DAAT. One provider gave feedback that there was some room for improvement in
communication with consumers, particularly in relation to changes to support plans.
Understanding of the role
As with many aspects of the model feedback was provided that more information about the role was
required, e.g. a brochure or information sheet outlining the role and capacities of the DAAT. The online
survey of workers in the system revealed confusion about the role of the DAAT including comments that
the role and descriptions of the role seemed to vary significantly from area to area:
“I deal with DAAT SE and SW, they provide different explanations of their roles – if they don’t have a clear
understanding of their own role the rest of us have no hope of having a clear understanding of their role”
(service system worker).
“I am not sure even the DAAT team themselves know their role” (service system worker).
Improving processes
Disability Gateway providers and DCS staff provided feedback that there had been significant
improvements in the functioning of DAAT. Regular meetings between services had been a major
mechanism for achieving this. It was suggested that further improvements were needed in the area of data
recording and in development of a process for short consults. One specific suggestion related to the
development of joint training opportunities for LAC/Disability Gateway, DAAT and the Disability
Consultant. This suggestion was based on the perceived benefits that have emerged from joint training that
has taken place in the IFSS, Family Services Gateway and Child Protection services.
Feedback was also provided that the DAAT services were not delivered consistently across the state. It
was suggested that clearer procedures, protocols and transparency in relation to decision making would
help to improve consistency.
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Referrals
Disability Gateway providers reported that the referral process was working well for them, facilitated by
regular meetings, good communication processes and the development of data sharing processes. One
issue of concern raised by service providers related to mainstream services not accepting referrals unless
they came via the DAAT. This had the potential to lead to overload for the DAAT teams.
Other feedback suggested confusion about the process of referring to the DAAT:
“Access to the DAAT team is confusing. Information on how to refer to them changes depending on who
you talk to within the Gateway” (service system worker).
Assessment vs. ‘Gatekeeping’
There was some perception from service providers that the DAAT assessment process was overly
stringent and acted to buffer services rather than let everyone who should be eligible through even if there
were no services available to assist them.
Focus Area 15
Area Advisory Groups
Description
This focus area looked at AAGs including: joint planning, information sharing, identifying services gaps and
resource allocation and building networks. It sought perspective on whether or not AAGs have helped with
education about the services Disability Gateway provide and opportunities to promote the Disability
Gateways services.
Themes
Not working as intended
Overall feedback relating to the Area Advisory Groups is that they are not working as intended. The
groups have worked well in supporting networking and information sharing but have not assisted in
identification of service gaps, resource allocation or planning. It was questioned whether these networking
and strategic functions were compatible within the same structure or whether they needed to be
separated.
Lack of Strategic Focus
The perception is that the AAGs are not contributing to planning at a strategic level. Because the focus has
been on operational networking rather than strategic system planning, those attending the meetings are not
at a senior level and no longer have the capacity to act strategically. The following quote captures this issue:
“There is no capacity in the current framework to discuss and address service gaps and issues that might
lead to improvements in client outcomes from a regional perspective” (service system worker).
One suggestion was to revisit the terms of reference for the AAGs to determine what activities the group
is and should be pursuing. This would allow a plan to be put in place to redirect the group’s activities and
the meeting content.
Feedback from a number of stakeholders suggested that a shift to a strategic focus would not occur
without sufficient resourcing and leadership.
Membership
There was some criticism that membership of the AAGs appeared to be a closed shop and was not open
to all, particularly to consumers.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
Focus Area 16
Early Intervention and Working with Children
Description
This focus area sought feedback about whether or not the Disability Gateway model had increased
opportunities for early intervention, in particular appropriate and timely referrals. It also looked at whether
or not the child was at the centre, family focused practice, assessment functions, identification of need for
referrals to IFSS, interactions between IFSS and the disability component of the Gateway.
Themes
Interactions between IFSS and LAC
There was consistent feedback that the IFSS and Disability Gateway model are working well together and
that the dual approach has positive outcomes for clients. A perceived benefit in this model is the sharing of
information between IFSS and the Disability Gateway and a pooling of support as required:
“Disability and Family support Gateway staff often liaise with each other to determine the appropriate
referral pathway and in some case the family may be referred to both services depending on the need”
Mission Australia Service Evaluation Report.
There appeared to be a clear understanding between the two teams about their roles and responsibilities.
Gateways seem to strongly advocate the benefits of early intervention as improving outcomes for children
and their families. Some service providers suggested there is still a tendency to want to allocate the client
to IFSS or the Disability Gateway rather than working cooperatively.
Disability Gateway noted issues working with Children and Youth Services (CYS) despite the integration of
IFSS. There seems to be varied expectations about who case manages children in care with disability and
questions about if this is the role of the LAC or CYS. This concern was also raised by service system
workers in the online survey. Gateways also feel that there is a lack of planning for young adults leaving
care, and an assumption from CYS that LAC will have found accommodation for people when they turn 18.
Case Study: John
John is the father of three children and is separated from his partner. At the time of referral John was caring for his 7
year old son (his older children were with other family members). John was struggling to manage parenting and there
had been several notifications of neglect of his son reported to Child Protection Services. John and his son live in their
own home but it was extremely poor condition, including damage to windows, no cooking facilities or heating. John
was neglecting his own care. John has an acquired brain injury that has left him with poor cognitive functioning. His
son was inadequately supervised and his aggressive behaviour was poorly managed. John’s supports included the local
Neighbourhood House and his ageing parents. John’s supports further deteriorated when his father died suddenly. His
father had cared for both John’s mother who has dementia, John and his son.
A referral was made to IFSS to assess and manage the safety and care of John’s son. However, it became clear that
John’s capacity to care for his son without support was very limited. IFSS made a referral to the Gateway for
assessment of John’s eligibility for specialist disability services. Assessment was undertaken by DAAT. This assessment
identified that John was in need of support to manage his own activities of daily living, a full package of 35 hours of ISP
was recommended.
The care of his son was becoming increasingly difficult. The universal services that were in place e.g. local
Neighbourhood House, school and family were finding it difficult to manage keeping the son safe. A case conference
with the family, providers and child protection followed and plans were put in place to assist both John and his son.
John was allocated a 13 hour ISP package, although 35 hours had been recommended. This package was to assist him
maintain his personal care. John and his son moved back in with John’s mother who also received a support package
from aged care. Together they were able to manage on a daily basis. John’s son mostly lives with John but also with
other relatives. This has assisted in keeping him much safer than in his previous situation. John remains linked into the
local Neighbourhood House.
This case highlighted a lack of services and resources to support adults with disability who need long term support
with parenting.
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Transition issues
There was feedback from service providers, the Disability Gateways and consumers that there is a gap in
services for children transitioning to adult services:
“I feel that there is not enough support for children with disability leaving school and the fact that a child
may miss out on funding for activities beyond the school gate due to having a permanent safe home with
their parent is unfair if not discriminative” (consumer).
“When people are leaving school no one is taking a holistic approach to the individual time and life”
(service system worker).
Lack of after school childcare options, community access and employment options were noted.
Gateways also identified issues with Department of Education for children who have significant behavioural
issues and are at risk of being excluded from school:
“Schools often leave it too late to gather information and do not seek appropriate reports prior to seeking
services. Gateways then operate under a crisis model due to poor early interventions” (service provider).
Gateways also noted the stress families face when they are told that they do not have enough support at
the school for their child to attend full time and need to find alternative arrangements for their child as ISPs
cannot be used for support at school:
“It is disappointing that everything is seen in dollar terms. My child has a price tag apparently”
(consumer).
Gateways interactions with early intervention services
One of the Advocacy services reported that there needs to be clarity around how the Gateways interact
with early intervention services. Baptcare identified that often they don’t get referrals until children are
around age 10 and that families are often unaware of respite options that may be available to them:
“One of the challenges is to obtain earlier referral to Gateway. Some parents will manage behaviours until
they reach a crisis point or schools refer. An earlier referral will enable strategies for behaviour management
to be put into place and appropriate referrals to services including respite and funding to occur” (Baptcare
Service Evaluation Report).
Service providers reported that they feel Gateways have a good understanding of the needs of the children
they are referring on and their referrals are comprehensive.
Boundary Issues
Baptcare reported that there are some issues when Government departments do not agree on the
responsible owner for funding. This occurs where there are a range of services delivered to children who
have disability and a high level of risk and they are bordering on the statutory system. This results in
parents, providers and foster parents being passed around the system and not having adequate supports in
place.
Gateways have found that there has been a lack of clarity between DAAT (DCS) and the Education
department in relation to which Department is responsible for the assessment of needs in relation to the
individual’s disability and educational needs which has impacted on the child’s access to education. This
assessment is viewed as key to early interventions that ensure inclusion in school environments and
education needs are met.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
Focus Area 18
Data Collection and Reporting
Description
This focus area looked at data collection and information systems support: service delivery, reporting and
planning requirements. It also considered, if data collection process and reporting requirements understood
by the Gateways.
Themes
Data Collection supports service delivery not reporting
In general, Disability Gateway providers felt that their data collection processes supported operations
sufficiently but that there are difficulties in providing information to DHHS to inform contract monitoring
and the Disability Services National Minimum Data Set.
Difficult and Time Consuming
Disability Gateway providers described the process of reporting as ‘difficult and time consuming’. Requests
were frequently at odds with the operational nature of the data collected and required significant time to
analyse data. Their experience was that requests were irregular making it difficult to plan ahead, came from
multiple sources, often with significant crossover and were required within very short timeframes. A
specific difficulty arose when they were asked to report only on activities funded by DHHS. Given the client
focus of current data recording arrangements these were difficult to separate from those funded by
multiple or other sources.
Data Reporting Tools
Providers reported that a user-friendly tool for providing information to DHHS across a range of programs
is currently lacking.
TasDIS
Providers reported delays at the end of each quarter for entry of new referrals into TasDIS. TasDIS does
not notify providers and service organisation at the opening of a new quarter and on occasions this has
created difficulties.
Working on improvements
Disability Gateway providers and DHHS have established a working group to discuss data collection and
reporting issues and are working towards a resolution.
Ideas for Improvement
A number of suggestions were provided for improving current arrangements. These included:

Establishing a calendar of data requests including key parameters agreed utilising a framework that
supports operational efficiency and current contract requirements

Consider investment in a disability specific data base

Alignment of systems with the incoming NDIS data management systems.
Focus Area 19
Strategic Planning
Description
This focus area considered whether or not there was capacity for service providers to provide input into
‘big picture’ planning for the disability services system.
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Themes
Mechanisms for input are lacking
Whilst it was anticipated that the Area Advisory Groups would provide opportunity to participate in
strategic planning activities Disability Gateway providers and service provides suggested that this has not
eventuated as the AAGs have had a more operational and networking focus. Stakeholders reported that
they would like to see a better mechanism for participating in developing the ‘big picture’. One of the
Disability Gateway providers suggested that a review of the AAG could help in creating a structure that is
more strategic and effective in providing a framework to discuss and address gaps within areas and across
the state.
Needs Register
Service providers suggested that the Needs Register could be further analysed to provide a picture of
future and unmet needs. It was also suggested that this data could be used to identify emerging clients
groups, e.g. clients with an acquired brain injury due to drug abuse, stroke or accidents, clients with
comorbidity eg. concerns relating to alcohol, mental health, aged care, and drug use.
NDIS Uncertainty
The creation of the NDIS is creating some uncertainty in future planning for current Disability Gateway
providers. Concerns were also identified in relation to the challenge of managing services during the
transition.
Questions on data use for planning
During the consultation process some service providers had questions relating to how data was used to
identify service duplication or gaps. They also questioned whether or not data from Needs Registers was
analysed and used when policy decisions were being made.
Focus Area 20
Support Structures and Networks
Description
This focus area looked at networks, structures or groups which have been established to support the
model or which may be needed to support the model.
Themes
Meetings and Forums are beneficial
Disability Gateway providers and service providers gave input about a range of meetings and forums which
have been established to improve understanding about the Disability Gateway, network and progress
operational outcomes for clients:
“These meetings are beneficial as they bring the providers together to ensure that a client with the highest
priority support needs are effectively supported and enables system planning on the basis of demand”
(service system worker).
Statewide Differences
It appears that different structures and groups have evolved throughout the State. Disability Gateway
providers have suggested that some differences in allocation and prioritisation process have been necessary
in the SW and SE Gateways due to the unequal mix of available providers SW versus SE and the need to
provide equity of access for clients who live across the south.
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Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
Practitioners Network
Baptcare and Mission Australia have established a statewide meeting of their managers and team leaders
across the state. It is also suggested that a statewide LAC practitioner’s network is explored to assist with
development and training of the staff members and provide a forum for establishing agreed key
responsibilities.
Focus Area 21
Individual Support Packages / Individual Funding Unit
Description
This focus area sought perspectives on whether the prioritisation and allocation process is working and
asked a number of questions relating to the balance between need and resources, the regional / population
method of distributing funding vs. needs split for distribution of funding, communication process, policies
and guidelines and options for addressing issues.
Themes
Working within existing resources - availability of funding
Disability Gateway providers reported that overall the system of prioritisation and allocation works well
with individuals and families are generally supportive of the process.
However, both noted that current levels of funding were challenging to manage:
“Staff struggle continuously to find sustainable options to meet the needs of clients and families” (Disability
Gateway provider).
“Staff are often blamed when service providers expect more funding on behalf of clients to provide support
or are not happy with the funding rate. This sometimes leads to staff feeling caught in the middle as
Gateway only facilitates support for, rather than directly funding clients” (Disability Gateway provider).
They provided feedback that the current level of funding is not meeting demand and at best only meeting
the needs of clients in crisis or who were a high priority:
“This means in some regions, only crisis and higher priority people are receiving funding. The current
funding does not allow the system to be proactive in funding low to medium priority clients and this means
that without supports being funded, at some point, the need of many of these clients becomes higher or
reaches crisis” (Disability Gateway provider).
Overall feedback from consultation forums was that the lack of funding negatively influences stakeholders
perceptions about the success of the Disability Gateway model:
“The level of perceived angst relating to the Disability Gateway model is, in part, influenced by the resource
issue for the sector and therefore not within the control of the Disability Gateway” (service system
worker).
“Expectations by people accessing our service around availability of funding are not being met due to lack
of funding from DHHS” (service system worker).
It appears that significant creativity is used in an effort to maximise the use of the funding available, e.g.
splitting the hours available so that multiple people are assisted rather than only one person getting all the
hours.
Service providers were not positive about funding arrangements with criticism of the funding available, and
the overall process for managing packages. Some service providers reported that they were being asked to
deliver services at rates that were not sustainable.
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A clear message from all was that more money was needed:
“I understand as a collective there is only so much funding with the disability sector to go around. I can only
pray that the NDIS is a success and eliminates this issue” (consumer).
“There is still not enough funding for services. The Gateway staff were great but there is still nowhere for
me to get respite” (consumer).
One provider raised concerns that the current unit pricing process would encourage service providers to
be more selective regarding the clients that they accept into their services. This relates to the
establishment of a standard rate irrespective of complexity. It was suggested that this issue impacts on
choice for clients who wish to transfer to an alternative provider as services are unwilling to take them on
for the funding available.
The prioritisation process
Disability Gateway providers reported that overall the prioritisation and allocation process works well
when it is collaboratively managed and that this is the case most of the time. Some difficulty was identified
where agreed timelines were not adhered to, primarily because of funding availability, and that this had
occasionally created a stressful working environment for Disability Gateway staff.
It appears that when clients unexpectedly enter crisis the allocation of resources to address the crisis
means that other clients who were ‘next in line’ may miss out or have to wait longer, thereby creating
further pressure on their current arrangements.
Feedback from service providers suggests a lack of clarity about the process of reallocation of unused
hours.
Regional Allocation
There were a number of comments that the regional allocation of funding was illogical and that funding
should be based on demographics and need. Service providers gave feedback that there appeared to be
inconsistencies across regions relating to the interpretation of level of priority. There were some
perceptions that the current regional allocation meant that overall funds were not equitably distributed on
a needs basis. Given the equalised funding allocation it is possible for consumers to compare region to
region and compare their own circumstances with others form different regions. Without understanding
the context of priority and demand in each region, clients may ask the question, ‘why were my needs not
seen as equal or as high a priority as others’.
Regional Differences
A number of stakeholders suggested that there needed to be greater transparency in relation to
procedures and decision making as there appeared to be differences in application of the guidelines across
the state.
Relationships
Disability Gateway providers were very positive about the working relationship between themselves and
the IFU:
“The IFU and LAC have an excellent working relationship fostered by open communication and
understanding. The effective support given form the IFU is greatly appreciated. The timely manner in which
questions or queries are answered is also greatly appreciated” (Disability Gateway provider).
Disability Gateway providers also suggested that regional meetings to discuss local issues and concerns
should continue and that it would also be helpful to have a state-wide meeting to discuss the terms of
reference, processes and deadlines.
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Banking of hours
Service providers expressed some lack of understanding relating to the process of ‘banking hours’. There
were particular concerns about how this process is monitored and reviewed.
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8
Future Directions
The Disability Gateway has been acknowledged as contemporary best practice in the delivery of disability
services in Australia and was used as a model in the development of the NDIS. The Disability Gateway has
been implemented as intended and feedback from the review confirms that its implementation has
significantly improved outcomes for clients. Baptcare and Mission Australia have embraced the principles
upon which the model was built.
It is also clear however, that after three years of operation there are some areas where further
development and fine tuning are required. Development is also required to ensure alignment and a smooth
transition in support between the current and future (e.g. NDIS) model.
The findings from this review, as reported in section seven, suggest five areas for continuous improvement
to be pursued by DCS in partnership with the Gateway providers, Baptcare and Mission Australia. These
streams of work relate to:





Active Communication
Practice Guidelines
Documentation of Workflows
Training and Workforce Development and
Quality Frameworks.
The following diagram provides a conceptual representation of the model, influenced by the seven
principles of the reforms which initiated implementation of the model. Future operation of the model is
influenced by continuous improvement in the five areas represented by the upward arrows.
1.
2.
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5.
(Disability Assessment & Advisory Team)
4.
3.
Mid-term Review of Disability Gateways Review Report : Draft - Version: 1.0 – November 2013
8.1 Continuous Improvement
8.1.1 Active Communication
A recurring theme across many focus areas in the review was a lack of understanding about how the model
works and the roles of key participants. In a number of areas lack of understanding and incorrect
expectations impacted negatively on the service experience.
It is anticipated that the creation of accessible communication messages and materials will assist both
consumers and stakeholders in accessing and understanding services thereby improving their experiences
and perceptions of the model. To this end the development of a comprehensive communication strategy is
recommended (see R1, R8).
The ongoing transition to the NDIS model requires the development of communication strategies which
help consumers and other stakeholders to understand what the new arrangements mean for them, now
and into the future (See R1).
Findings indicated that some stakeholders were confused about the name of the Disability Gateway. To
assist in creating a district identity a recommendation has been included for development of a style guide
which will clarify the name and branding for the Gateway (See R2).
The internet is an increasingly important resource for all stakeholders who are seeking information about
disability services. Because of this a recommendation has been included that the DCS website be
redeveloped to improve accessibility in terms of web users ability to perceive, understand, navigate and
interact with the web (See R3).
The review highlighted that the capacity of the Disability Gateway to assist children (in particular those
under 15) is not well understood by parents, carers or service providers. For this reason a specific strategy
has been included to promote this role, including understandings relating to the dual functions of the
Gateway in assisting people with disability and families (See R4).
Despite the existence of compliments and complaints mechanisms within both DCS and the Gateways,
review findings indicate that awareness of these processes needs to be further promoted. To this end a
recommendation relating to the promotion has been included (See R5).
8.1.2 Practice Frameworks and Support
The Disability Gateway model is underpinned by seven principles which are embedded into the way the
services are to be provided. These principles are:




A focus on the individual – disability services are flexible and responsive to the needs of people with
disability, their families and informal support networks, placing them at the centre of service delivery.
Supports should reflect the individual needs, goals and aspirations of people with disability.
Partnership – people with disability are partners at all points in the journey – in policy development,
planning, service delivery, workforce training and in evaluating effectiveness, individuals , their families
and informal support networks actively participate in decisions which affect their lives.
Equity – people with disability have the same rights as other citizens to participate in all aspects of the
community and life. Universal services, such as generic education, health, family services and early
childhood services, provide access to people with disability, their families and support networks, to
support quality of life and build potential.
Access – people with disability should be able to access a range of specialist disability services that are
appropriate to their needs. Priority of access should be given to those who are most vulnerable, and
where needs cannot be met through universal services and informal supports.
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


Inclusion – people with disability, their family and support networks are embraced as belonging, sharing
responsibility, and contributing and adding value to the Tasmanian community. There is a strong
emphasis son building the knowledge, understanding and capacity of the wider service system to
support people with disability.
Strengthening individuals, families and informal support networks – this recognises the benefits of
service models that promote individual capacity, and build and maintain family and community
resilience.
Cultural proficiency – improving the access to disability services for aboriginal and culturally and
linguistically diverse people with disability, their families and carers, through tailoring services to the
particular needs of aboriginal and cultural and linguistically diverse populations.
Given the importance of these principles it is essential that they are reflected in practice. To this end a
recommendation has been included that Practice Frameworks either be developed, or revised if they
already exist, to ensure alignment between the principles outlined above and current practice. These
Practice Frameworks will cover core functions of the model including intake and assessment, Active
Monitoring, local area coordination, DAAT, disability consultants, brokerage and prioritisation processes
(See R6).
It is essential that practice is based on clearly articulated and evidence based policy. For that reason a
recommendation has been included to develop or revise key policy documents which support practice and
are well aligned with the reform principles (See R7).
Given feedback in the review relating to consistency between practitioners and areas, a recommendation
has been included aimed at promoting communication and consistency in client experience of the model.
Where appropriate, standardisation of practice should be actively pursued (See R9).
Feedback from the review indicates that further work is required with mainstream services to improve
their capacity to engage with and respond to the needs of people with disability. The Tasmanian
Government Disability Framework for Action provides an appropriate context for implementation of a
recommendation relating to improved interaction and services (See R10).
There are many facets of the model related to working with clients who require a complex system
response, particularly for Local Area Coordination and Disability Consultants. There was significant positive
feedback about this work, however, many stakeholders did not appear to understand the nature of work
undertaken or even awareness that it happened at all. These results indicate the need for further
promotion of this work and the need for a practice guideline (See R1 & R11).
Area Advisory Groups have operated well in developing networking between service providers, however,
there were questions in the review findings relating to membership and a lack of strategic focus for these
groups. It appears that the role for Area Advisory Groups needs to be more clearly defined (See R12).
8.1.3 Documentation of Workflows
In tandem with the development of practice frameworks it is recommended that further work be
undertaken to document workflows for key components of the Gateway model. Such documentation
would articulate the sequence of work relating to particular functions, with the goal of enhancing
consistency. Workflows would identify key points where information needs to flow between different parts
of the model or outwardly to consumers or other services. Documentation would also illustrate points of
interaction with the NDIS. The documentation of workflows would also identify processes for client
consent and transfer of client information between services (See R13, R15 & R16).
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The review findings indicate that on the whole stakeholders were positive about the way referrals were
working in supporting the Gateway model. There were however some issues relating to understanding
how the process worked, follow-ups and feedback. Whilst promoting understanding of the process can be
included in the Communication Strategy discussed earlier, the documentation of workflows would assist in
clarifying practices relating to follow-up post referral and feedback (R1 and R14).
Young people transitioning from school to adult services were identified as a particular group for whom
streamlined planning and services were important, however it is acknowledged that many of the supports
for these young people are moving to the NDIA (See R17).
8.1.4 Training and Workforce Development
Staff induction and workforce development are important mechanisms for ensuring that services are
delivered in a way which honours the reform principles and in ways which are consistent between
practitioners and areas. This ensures that the continuous improvement activities outlined above do not
become frameworks and documents existing only as dust gatherers on a shelf, but that they are used
competently by the staff and service system workers who are central to the operation of the Disability
Gateway model. Recommendations are therefore included around planning and implementation of
induction and workforce development and continuation of ongoing strategies to develop competence in
working with Aboriginal Tasmanians and people who are culturally and linguistically diverse. (See R9, R18
& R19).
8.1.5 Quality Frameworks
Whilst this review of the Disability Gateway has provided direction for a range of continuous improvement
activities it will be important to monitor progress against achievement of recommendations. To that end it
is recommended that a quarterly report is prepared for the Deputy Secretary Disability, Housing and
Community Services (DHCS) which will summarise progress against achievements (See R20).
It is recommended that Key Performance Indicators (KPIs) are developed where appropriate to accompany
practice frameworks (See R21).
Both DCS and Gateways have been working collaboratively over time to improve data exchange and
reporting capabilities between partners. To this end two recommendations relating to streamlining data
exchange and development of a long term integrated management system have been identified (See R22
and R23). The ability to securely exchange client information is fundamental to smooth operation of the
model. A recommendation to explore a mechanism for online exchange of information has therefore being
included (See R24).
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9
Recommendations
The recommendations for further action arising from the review of the Disability Gateway have been
determined to enhance achievement of the seven principles which underpinned the reform process which
led to the establishment of the model. These are: a focus on the individual, partnership, equity, inclusion,
access, cultural proficiency and strengthening individuals, families and support networks.
9.1 Active Communication
R1 - Develop a Communication Strategy to improve community and sector understanding about the role
of the Disability Gateway and how it works. The Strategy will focus on easy access and include key
messages relating to the current role of the model and transition to the NDIS over coming years. The IFSS
Review included a similar recommendation and there may be efficiencies in developing a joint
communication strategy.
R2 – Develop and implement a style guide which clarifies the name and branding for the Gateway.
R3 - Review the DCS website to improve accessibility for users with disability, families, support and service
providers. Accessibility includes users ability to perceive, understand, navigate and interact with the web.
R4 - Promote the role of the Disability Gateway in assisting children (under 15) and integration of
functions between the disability and family support facets of the model.
R5 – Promote the client compliments and complaints processes for both DCS and Gateways.
9.2 Practice Frameworks and Support
R6 – Develop (or revise existing) Practice Frameworks and guidelines for major elements in the Disability
Gateway model to ensure alignment between practice and the seven principles which are central to the
Operational Framework for Disability Services. Practice frameworks to be developed for Intake and
Assessment, Active Monitoring, Local Area Coordination, DAAT, Disability Consultants, Brokerage and the
Prioritisation Process.
R7 – Review DCS policy documents which support the Disability Gateway model. A key focus for this
activity is to ensure that policy documentation supports practice aligned with the principles in the
Operational Framework for Disability Services. This work will include, but is not limited to, the following
documents:

The DCS Access to Services Policy and Guidelines

The Common Assessment Framework (CAF) including alignment with the NDIS framework
R8 - Promote practice frameworks and policy documentation to consumers and the service system.
R9 - Develop a quality assurance process for sharing and moderating service provision between
practitioners and areas. Two key focus areas for this recommendation relate to communication and
enhancing consistency in client experience of the model. Standardisation of practice to be actively pursued
where this is appropriate.
R10 – Work with mainstream services to improve their capacity to engage with and communicate with
people with disability. This recommendation will be undertaken within the context of the whole of
government Disability Framework for Action 2010 – 2015.
R11 – Review the process used for clients who require a complex system response, clarify the role and
develop a practice guideline.
R12 – Review Area Advisory Groups (AAGs) and clarify their future role.
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9.3 Documentation of Workflows
R13 – Document key workflows for each component of the Disability Gateway. The goal of this activity is
to improve consistency and client experience of the model.
R14 – Document referral pathways including benchmarks for follow ups and feedback.
R15 – Define area service boundaries on an annual basis and document the processes for transfer of clients
between areas.
R16 – Document processes for consent and transfer of client information between services.
R17– Work collaboratively with stakeholders and the NDIA to streamline planning and services for young
people who are entering or transitioning to adult services.
9.4 Training and Workforce Development
R18 – Work collaboratively to plan and implement induction and workforce development activities which
support the principles of the Operational Framework for Disability Services and enhance consistent
practice.
R19 – Continue existing strategies in building staff competence in working with Aboriginal Tasmanians and
people who are culturally and linguistically diverse.
9.5 Quality Frameworks
R20 – Develop a quarterly report to the Deputy Secretary Disability, Housing and Community Services
(DHCS) which indicates progress against achievement of recommendations included in the review of the
Disability Gateway Final Report.
R21 - Develop Key Performance Indicators (KPIs) and qualitative measures for key components of the
Disability Gateway model. The focus of this process is to enhance client experience of the Disability
Gateway.
R22 - Streamline data exchange between DHCS and Gateways.
R23 - Develop a long term integrated data management system.
R24 – Explore options for a secure mechanism for the email or online exchange of client information.
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