Guideline number:
Version:
Date of version:
Applies to:
Issued by:
Delegated authority:
Disability SA
Resource custodian:
Eligibility and Access Guidelines
Due for review:
Confidentiality:
DFC strategic objective:
GUI-SER-001
1.0
7 April 2008
All DFC
Disability SA
Lynn Young
Executive Director, Disability Services
Sue Deeprose
Program Manager, Service Coordination
March 2011
C1: public unrestricted
N/A
Printed version of this document may be superseded – Refer to online policies and procedure s for most current version.
1
Intent
The aim of these guidelines is to provide clear documented criteria for determining eligibility for
programs and services provided or brokered by Disability SA. In order to make sure we can provide
the best possible support to South Australians with a disability, their families and carers, we must
make it clear who is eligible for that support.
2
Context
Eligibility for Disability SA services is governed by sector–wide policy in relation to eligibility for
specialist disability services detailed in Eligibility for Disability Services: Sector-wide Policy (DIS/188).
Disability SA is the single government specialist disability service provider in South Australia for
people with:
•
intellectual disability,
•
neurological disability,
•
physical disability,
•
acquired brain injury,
•
autism spectrum disorder,
•
significant global developmental delay or
•
any combination of these;
and who have significant functional impairments.
Disability SA provides a wide range of programs and services. These include:
•
information and advice
•
service coordination
•
personal support and accommodation
•
equipment
•
specialised services
Disability SA does not have sole responsibility across all areas of disability services. In some
instances, there are agreed arrangements regarding service provision that ensure that Disability SA
does not duplicate services for specific disability client groups. These arrangements are as follows:
•
Novita Children’s Services
In the majority of instances, Novita Children’s Services undertakes services for children aged
0-18 with a physical or neurological disability or acquired brain injury.
•
Sensory Services
A number of sensory agencies provide a range of services for people with a sensory
impairment.
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Domiciliary Care SA
Roles and responsibilities between Domiciliary Care SA and Disability SA are set out in the
service eligibility protocol between Domiciliary Care SA and Disability Services.
Domiciliary Care SA and Aboriginal Home Care Services
Roles and responsibilities between Domiciliary Care SA, Disability SA and Aboriginal Home
Care Services in relation to Aboriginal people are set out in the Memorandum of Understanding
between Aboriginal Home Care Services, the former Metropolitan Domiciliary Care and
agencies of the former Options Coordination.
3
•
Autism SA
Roles and responsibilities of agencies working with people with autism spectrum disorder are
set out in the document Autism Spectrum Disorder: Services for People with Asperger
Syndrome and Higher Functioning Autism..
•
Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council
In the majority of instances, service coordination for Aboriginal people with disabilities living in
the APY lands is provided by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council.
Scope
These eligibility and access guidelines apply to all Disability SA services and programs, other than
information and brief assistance, and with the exception of the following programs:
•
Psychiatric Disability Support
•
Exceptional Needs/Management Assessment Panel
•
Supported Residential Facilities Program
These three programs have their own eligibility criteria related to specific target groups and program
aims, which are attached in Appendices 8.1-8.3.
Disability SA will provide information, advice and brief assistance to any person with an identified
disability and/or their carers making inquiries or seeking assistance from Disability SA. A person does
not have to meet eligibility and access criteria to receive information, advice and brief assistance.
4
Guideline Detail
4.1
Principles
These guidelines are based on the following principles. Decisions regarding eligibility and
access to Disability SA services should be consistent with these principles:
•
Person-centred
The person with a disability is at the centre of all decisions regarding their need for, and
access to, services.
•
Emphasis on capabilities and level of functioning
Eligibility is not determined by a person’s diagnosis alone. Determination of eligibility will
also take into account a person’s level of functional impairment, and the support they
require.
•
Level of need
Access to services is on the basis of need. A person’s level of need will be based on
information gathered from a variety of sources, including previous assessments,
specialist assessment and needs assessment.
•
Provision of assistance regardless of eligibility
Where a person is not eligible for services from Disability SA, or other services are more
appropriate, assistance will be provided to refer or link an individual with other services,
wherever possible.
•
No duplication of services
A person will not be eligible for a Disability SA service if they receive the same service
from another agency in relation to their disability.
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4.2
Access
Access to Disability SA services within scope of these guidelines is determined not only by
eligibility criteria, but also by other factors:
4.3
•
Priority of access
•
Scope of service response.
Eligibility Criteria
To be eligible for Disability SA services, the person must fit one (or more) of the following
criteria:
•
Children under 5 years of age who have significant global developmental delay
•
Children and adults with intellectual disability
•
Children and adults diagnosed with autism spectrum disorder (autism or Asperger
syndrome)
•
Children and adults with acquired brain injury
•
Children and adults who have a physical or neurological condition that cannot be
resolved with medical treatment.
In addition, as a result of the above condition(s):
•
The person experiences significantly reduced functioning in most of the following areas:
−
communication
−
self care
−
mobility
−
community access
−
health and safety
−
domestic activities
−
social
−
self direction
−
work and leisure.
•
The person requires assistance from a specialist disability service.
•
The disability is permanent or likely to be permanent (it may, or may not, be of a chronic
episodic nature and is not likely to resolve with medical treatment).
People over the age of 65 years who are referred to Disability SA will not be considered eligible.
4.4
Priority of Access to Disability SA Services
Disability SA provides a range of preventative programs, workshops and activities. However,
access to some services is on a priority basis and Disability SA assesses all need to ensure
that those in the most urgent need have access to services.
Decisions about priority of access include consideration of a range vulnerability indicators such
as homelessness, access to services, age, health and capacity of carer, family situation, and
isolation.
People in the following vulnerable groups are considered to have urgent need:
•
Children or young people under the Guardianship of the Minister
•
People with rapidly deteriorating neurological conditions
•
Aboriginal people with disabilities
•
People with disabilities in acute care settings awaiting discharge
•
People under 50 years of age in danger of being placed in a nursing home.
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4.5
Scope of Service Response
Some individuals with a disability or multiple disabilities have other factors impacting on their
functioning (such as high health needs, dementia, mental illness, drug and alcohol abuse). In
these instances multi-agency responses may be required. Where a person’s disability is the
principle cause of impairment, then Disability SA may undertake the role of lead agency, not
negating the responsibility of other agencies to provide services. Where a person’s disability is
not the principle cause of impairment but the person is eligible for Disability SA services, then
Disability SA’s role will be limited in scope.
4.6
Eligibility Processes
Assessment
Eligibility and intake assessment is conducted by the Disability SA Intake Team.
Eligibility is determined by gathering information, and previous assessments relevant to the
person’s disability and current functioning. This information will be obtained from the person
and/or their family. With consent, information will also be obtained from other professionals and
agencies (eg medical practitioners, allied health professionals, and psychologists). When a
person is referred to Disability SA on the basis of intellectual disability, or cognitive impairment
due to a brain injury or neurological condition, Disability SA may undertake or arrange a
psychological assessment to assist in eligibility determination.
In most instances eligibility determination will involve an assessment of functioning.
When psychological assessment is undertaken by Disability SA, the results will be documented
in a report that will be provided to, and discussed with, the person and/or their parent/guardian.
Eligibility decision
At the completion of the intake and eligibility assessment, one of the following eligibility
decisions will be made:
•
Eligible
•
Eligible with Review
•
Not Eligible
•
Not Eligible but Services Provided.
There are situations in which it may be difficult to make a definitive decision regarding a
person’s eligibility for Disability SA. In these situations there is provision to make the person
eligible but with a future review. A decision of eligible with review may be granted in situations
in which the extent and/or permanence of the person’s disability are unclear.
Exceptional situations may also arise where a person does not meet the eligibility criteria but
requires services that cannot be provided by another other agency. In these circumstances the
person may be deemed not eligible but be provided with services for a limited period of time. In
these situations a review date will be set to determine the need for ongoing services.
The intake worker who undertakes the intake and eligibility assessment, in conjunction with
other involved staff, will make a recommendation regarding eligibility.
Eligibility decisions will be ratified by the Intake Team Manager, with the exception of ‘Not
Eligible but Services Provided’, which must be approved by the Director.
The person and/or their parent/guardian will be advised of the eligibility decision in writing.
Review of eligibility status
As a major determinant of eligibility for Disability SA services is the significance of the person’s
functional impairment, a person may meet the eligibility criteria at one time but not at another.
As such a person’s eligibility status may be reviewed at any time.
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A person’s eligibility decision should be reviewed in the following circumstances:
•
He/she has been made eligible with review.
•
There is evidence to suggest that there has been a change in his/her functioning. This
may represent an improvement such that the person no longer meets the criteria for
significant impairment. Alternatively, a person may have experienced deterioration that
results in significant functional impairment.
•
Further evidence is available which suggests that the person either does or does not
have a condition consistent with eligibility. For example, a person diagnosed with
intellectual disability at a young age may have further assessment of intellectual
functioning that shows that they no longer meet the diagnostic criteria.
Review of eligibility decisions for people previously deemed not eligible may be initiated by the
person, or on their behalf, by making a re-referral to the Disability SA Intake team.
Review of eligibility decisions for people currently receiving services may be initiated by the
person, parent/guardians, service coordinators or other staff. The person and parents/guardian
must be informed and consent given to obtain any relevant information.
Decisions arising from eligibility reviews must be ratified by Disability SA Intake team.
Complaints
If the person is dissatisfied with the eligibility decision, a complaint can be lodged with the
Intake Manager. As part of the investigation of the complaint, the manager may call upon one
or more staff from within Disability SA with relevant expertise to give independent comment on
the decision.
If the person is still dissatisfied with the decision, the person will be advised of available
grievance mechanisms in line with Disability SA policy in relation to consumer complaints,
compliments and feedback. This includes information about the role of the Health and
Community Services Complaints Commissioner who is able to assist people – service users,
carers and service providers – to resolve complaints about health and community services,
when a direct approach to the service provider is either unreasonable, or has not succeeded.
5
Reference Documents and Links
5.1
Directive Documents
Eligibility for Disability Services: Sector-wide Policy (DIS/188)
5.2
Supporting Documents
Service Eligibility Protocol between Domiciliary Care SA and Disability Services
Memorandum of Understanding between Metropolitan Domiciliary Care and Disability SA
Aboriginal Disability Unit, and Aboriginal Elders and Community Care Services (Aboriginal
Home Care (AHC))
Autism Spectrum Disorder: Services for People with Asperger Syndrome and Higher
Functioning Autism.
Rapid Response: Whole of Government Services for Children and Young People under the
Guardianship of the Minister
DFC Statement of Reconciliation
Young People In Residential Aged Care Bi-lateral Agreement
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Definitions
Acquired brain injury is a brain injury acquired after birth. It may result from:
•
A traumatic head injury form a motor vehicle accident, assault, accident, etc
•
A stroke or cerebrovascular accident (CVA)
•
A brain tumour
•
An incident which causes lack of oxygen to the brain such as a near drowning experience, drug
overdose, or heart attack
•
Infections such as meningitis or encephalitis
•
Alcohol and/or substance misuse.
Intellectual disability – a person has an intellectual disability when they meet the following three
criteria:
•
Significant sub-average intellectual functioning as indicated by an IQ score of two or more
standard deviations below the mean.
•
Substantial limitations in an individual’s effectiveness in meeting the standards of maturation,
learning, personal independence and/or social responsibility
•
Cognitive and adaptive functioning deficits are manifest prior to 18 years.
Neurological disability is a condition, whether genetic or acquired, that affects the way the brain
processes information and communicates with the rest of the body; for example, the ability to produce
movement or the ability to process information. Examples include Multiple Sclerosis, Parkinson’s
Disease and Motor Neurone Disease.
Permanent or likely to be permanent refers to the irreversible nature of the disability, even though it
may fluctuate in severity over time; that is, it may be of a chronic episodic nature. A person will be
eligible if their underlying disability is permanent or likely to be permanent and they meet all of the
other eligibility criteria.
The disability will not be considered permanent where there is a need for specific health services for a
defined period following physical trauma or the onset of an acute episode of illness. A person in this
situation may only become eligible for disability support services once their medical needs have
stabilised and the long-term nature of their disability becomes apparent. Some conditions are not
considered to be permanent and therefore are not considered to be a disability.
Physical disability is a condition, whether genetic or acquired, that impairs the way the
musculoskeletal system and connective tissue work to create movement. Examples include:
Rheumatoid Arthritis, Spina Bifida, Cerebral Palsy, and Spinal Cord Injury.
Significant global developmental delay refers to a delay of the order of 25% in the majority of areas
of development (that is, fine and gross motor development, communication, socio-emotional
development, cognitive development and self care).
Specialist disability services refer to services specifically funded for people with a disability.
Support refers to the need for a significant and ongoing level of disability support. Disability support is
defined as one of the following specialist disability services covered under the Commonwealth State
Territory Disability Agreement (accommodation support, community support, community access,
respite or advocacy, information and alternative forms of communication) and equipment.
7
Risk
Lack of clear guidelines on who may or may receive services can result in inappropriate use of
resources and lack of clarity for consumers and the public about the assistance they can expect from
disability services.
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8
Appendices
8.1
Psychiatric Disability Service
The Psychiatric Disability Service was developed during 2006 and is one of the three programs
that operate from the Exceptional Needs Unit, within the Disability sector of the Department for
Families and Communities. The core business of the Psychiatric Disability Service is to fund
and coordinate packages of individual support, with a view to assisting people who have been
homeless to secure and maintain appropriate and sustainable accommodation. The Psychiatric
Disability Service is currently available only in the metropolitan area.
Referrals to the service can be made from the homelessness sector (government and
non-government).
Target Group
To be eligible for the Psychiatric Disability Service the person needs to meet each of the
following criteria:
8.2
•
Aged between 18 and 65.
•
Currently experiencing and/or have had a significant history of primary homelessness
(i.e. without conventional accommodation, sleeping in parks, streets, cars, squats or
makeshift dwellings).
•
Significant chronic functional impairments due to disability, ie:
−
psychiatric disability, that being the functional and social impairments that arise as
a consequence of mental illness (typically those individuals not receiving a service
from mental health), and/or
−
acquired brain injury or borderline intellectual disabilities (specifically those
individuals not eligible for mainstream disability services).
•
Complex needs associated with:
−
challenging behaviours
−
risk/s to themselves and/or others
−
unlikely to have their needs met by any single agency or service
−
chronic alcohol and other drug use
−
poor health
−
multiple disabilities.
•
In need of long-term support in order to maintain appropriate and sustainable
accommodation.
Management Assessment Panel (MAP)
Vision
People with exceptional needs will have the support to achieve citizenship within their
community.
Aim
To achieve the cooperation of the client, their families and service providers to develop an
integrated response to support the citizenship lifestyle.
Rationale
•
MAP was established to complement/value-add to services provided to clients across
agencies.
•
A referral to MAP is a last resort when service providers have not been able to achieve
the necessary outcome.
Target Group
•
Those at high risk of premature death and/or significant harm to self.
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Those who are a high risk and / or pose a high risk to others.
•
Those who repeatedly refuse services: those with whom engagement has not been
successful.
•
Those whose needs may be life long.
•
Those whose needs have been unable to be met at the regional level.
Eligibility Criteria
•
Those who fall into gaps in service eligibility, or have no access to services due to lack of
appropriate options and chronic semi-crisis existence.
•
People who receive services from agencies whose needs are beyond the capacity of the
agency to provide.
•
Those with high and complex multi-factorial presentations spanning several areas
including:
Department for Families and Communities
Department of Health
Department of Correctional Services and
Department of Education and Children’s Services.
MAP Intake Process
Anyone may enquire to MAP. All enquiries are taken by senior social workers and are
discussed by all members of the MAP team at a weekly intake meeting. In determining if an
enquiry should progress to a referral the following factors are considered:
•
Have the service providers shown they have made every effort to provide the optimum
possible service according to their own agency?
−
This will include efforts to work with the client, their family, other involved/relevant
services.
−
Has the enquirer engaged senior levels within agency, regional and central office
structures?
•
Is the client exceeding the capacity of families, carers or non-government agencies to
adequately address/meet needs?
•
Is the client falling through the gaps in service provision due to:
−
ineligibility based on diagnostic criteria
−
their refusal to engage with agencies
−
reluctance of agencies to engage
−
recidivism.
•
Is it possible for MAP staff to provide consultation to families, carers, agencies which will
assist them to link to appropriate supports rendering a referral unnecessary?
Once it has been agreed that an enquiry should progress to a referral, the enquirer is invited to
complete a referral form.
8.3
Supported Residential Facilities Program
Eligibility Criteria
The Supported Residential Facilities (SRF) Program provides allied health and disability support
services to residents living in Supported Residential Facilities who are assessed as having high
and complex unmet needs.
Assessment of a SRF resident may be requested by the person themselves or any other
interested person (eg a SRF proprietor, service provider, GP or family member) concerned
about the welfare of the individual.
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A SRF resident who is assessed as having high and complex unmet needs will be referred, as
appropriate, for the following assistance:
•
Disability support services of up to 3 hours per week, provided by designated contracted
providers.
•
Allied health services, provided by designated contracted community health services.
‘High and complex needs’ is determined by an assessment across various support needs
domains (including medical, behaviour, community safety, community living, personal care,
social isolation and general health) whereby unmet needs are rated low, medium and high for
each domain. A determination of ‘high and complex needs’ is made where an individual is
assessed to have unmet needs rated ‘high’ and ‘medium’ across several support domains.
A determination of ‘high and complex needs’ will also occur in instances where the resident:
9
•
has a dual disability
•
is aged 25 years or under
•
is aged over 80 years
•
has a tenancy at risk
•
or there are unique circumstances which may deem the resident eligible for support.
Guideline Approval
Content Author:
Resource Custodian:
Delegated Authority:
Date: 7/04/2008
Date: 7/04/2008
Date: 7/04/2008
Name: Rochelle Hay
Name: Sue Deeprose
Name: Lynn Young
Position: Manager,
Intake Team
Position: Program Manager,
Service Coordination
Position: Executive Director,
Disability Services
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