Lamp
Inc
Disability Care Australia
Practical Design Project
Foreword
Western Australia not being a signatory to Disability Care Australia was a
real issue in the progress of this report. Political dissonance led to many
people questioning whether the legislation would be relevant to people with
a disability and their carers in the state. The introduction of the My Way
service on a trial basis while this project was underway also added to the
confusion. Government employees were unable to be involved in the NDIS
project as they could not be seen to be supporting the content.
Those people with disability and their carers who participated in this
project were supportive of Disability Care Australia and could not
understand why Western Australia was not involved. It was felt that the
experience of Local Area Co-Ordination in the state could assist with
planning and implementation of the national scheme.
At the Senate Inquiry in Perth resounding support was given to the
legislation by people with disability, carers and service providers. The
Every Australian Counts Campaign and Bolshy Divas were prominent in
their support.
Workers from disability services were unsure initially how the change to
Disability Care Australia would affect their role. However, when the
legislation was outlined and explained in more detail, excitement at the new
possibilities was evident. The coming together of mental health service and
disability service was seen as a complex issue which would need careful
management.
For ease of reading significant limitations are highlighted in green, training
resources orange and significant findings and innovative ideas in blue.
I would like to thank all the people who supported this project and myself
in the process. The views expressed in the report are those of the author
and in no way necessarily reflect the views of Lamp Inc. or the funding
body.
Pam Small OAM, B App Sc (Leisure Sciences), Research Officer
Funded by the Australian Government Department of Families, Housing, Community
Services and Indigenous Affairs
The opinions, comments and/or analysis expressed in this document are those of the
author or authors and do not necessarily represent the views of the Minister for
Disability Reform and cannot be taken in any way as expressions of government policy.
Table of Contents
Contents
Foreword ............................................................................................................................................................ 2
Table of Contents ............................................................................................................................................... 3
Introduction .................................................................................................................................................... 4
Project Outline ............................................................................................................................................... 5
Methodology .................................................................................................................................................. 5
Location ......................................................................................................................................................... 6
Demographics ................................................................................................................................................ 6
Aboriginal and Culturally and Linguistically Diverse Populations ............................................................... 6
Individual Funding ......................................................................................................................................... 6
Self-Managed Support ................................................................................................................................. 10
Person Centred Planning .............................................................................................................................. 15
Organisational Challenges ........................................................................................................................... 22
Carers ........................................................................................................................................................... 28
Well Ways Carer Education Suite.............................................................................................. 30
Access to Services by Aboriginal People and Torres Straight Islanders ..................................................... 33
Access to Services by People from Culturally and Linguistically Diverse Backgrounds (CaLD) .............. 40
2. Knowledge ..................................................................................................................................... 43
3. Strategy ........................................................................................................................................... 43
4. Action .............................................................................................................................................. 44
Emotional intelligence consists of four attributes: .......................................................... 44
Building Community Capacity .................................................................................................................... 46
Issues for Rural and Remote Areas .............................................................................................................. 49
Transport .................................................................................................................................................. 49
Lack of Services ....................................................................................................................................... 51
The Limitation of Time ............................................................................................................................ 52
Lack of Choices in Community Opportunities ........................................................................................ 52
References ........................................................................................................................................................ 54
Appendix A ...................................................................................................................................................... 57
Appendix B ...................................................................................................................................................... 59
Acknowledgements .......................................................................................................................................... 59
Introduction
The World Health Organisation (WHO,1980) published the International
Classification of Impairments, Disabilities and Handicaps which was used
for many years to define disability, the current definition being the
International Classification on Functioning, Disability and Heath (ICF) which
the WHO consider is a bio-psychosocial model of disability that ‘synthesises
what is true in the medical and social models’ (WHO 2002). Harris (2008)
described the change in policy as ‘The ICF mainstreams the notion of
disability by acknowledging that most humans will experience some degree
of impairment during their lives. It concentrates on the ‘disabling’ impact
of the environment – that is, on those physical, social and/or cultural
factors that limit a person’s functioning. Under its people have
‘impairments’; it is the environment that ‘disables’. It is a rights-based
model with the onus on policy makers to ensure that persons with
impairments enjoy the same quality of life as everyone else.’
There has been a noticeable shift from people with disability being invisible
in the general community to a presence in most areas of community life.
This trend has been driven in the main by the disability rights movement
with a key focus being the right to have an independent life as an adult,
sometimes using paid support instead of being institutionalised. Most
recently there has been a range of rights-based philosophies which call for
people with disability to be given control over their lives and make their
own decisions. The movement from institutionalisation to independent
living to inclusion in community life has been well documented by the
Disability Services Commission of Western Australia (DSC) (Jenkinson,
2008).
Here we are more concerned about the rights of people with disability to
choose the life they wish to live and being given access to the supports they
need to achieve their own goals. In the UK and several other parts of the
world, person centred thinking; planning and reviews have emerged as
ways of creating change within services, and are featured in government
policy. The introduction of the National Disability Insurance Scheme (NDIS)
in Australia is the Australian Government response to the need for change
in the way people are provided with support for their disability needs.
The NDIS will be managed by an Agency focused solely on that purpose.
Assessors who will be employed by the Agency will assess the needs of
those who apply and allocate a budget to them to enable them to purchase
the services they require. This system is a major change for Australia from
the historic method of providing funding to disability services that in turn
provided what they believed people needed, based on consumer feedback.
The concept of the NDIS relies on disability services being able to change
the way they work to provide personalised services based on individual
planning to achieve specific outcomes.
Project Outline
This project was funded by the Practical Design Fund under the National
Disability Insurance Scheme (NDIS) to:


-
-
Undertake scoping of target groups and consult with key stakeholders and
undertake research of relevant data.
Prepare and develop appropriate material and resources for the
information/training guideline package to include:
Transition issues and their impact on the disability sector in areas of rural
and remote service provision;
Strategies to address limited community infrastructure availability in
regions and geographical isolation;
Explore pathways for equitable access to all service users including
Indigenous and Culturally and Linguistically Diverse populations;
Identify and work to reduce challenges of current service culture (from
block grant to person centred services);
Best practice for organisational policy and procedures to manage change;
Explore alternative work practices for the delivery of quality flexible service
models at a local service level to the individual which are innovative,
responsive and sustainable;
Identify a range of practical, innovative and responsive solutions which are
adaptable, accessible and clearly defined to allow people with disability to
actively engage in the planning and delivery of their required service.
Methodology
A literature search was undertaken to review models of individual funding
in Australia and overseas which led to identification of innovative ways of
designing individual support plans, carer support models and training for
support workers. Innovative ways of managing the changes required by
agencies to adjust to individual funding were also researched and useful
resources identified.
An interview styled approach was used to support a guided and focussed
conversation with consumers, carers and service providers.
Local agencies in rural and remote areas providing support were
interviewed to identify processes and training needs in support workers.
The interviews also identified issues affecting recruitment and service
provision within those areas, transition issues for organisations, in
particular, management of change and policy requirements.
Workers engaged to provide access to services by Aboriginal people were
also interviewed to ascertain their preferred ways of working and suggested
improvements.
A community workshop was planned to be held with people with
disability and carers to have input into the project, however after
extensive publicity and personal approaches to service providers, the
workshop had to be cancelled due to lack of enrolments.
To give perspective to the findings, a brief overview of the nature of the
research area follows.
Location
The lower south west profile area covers approximately 17,821 square
kilometres (Australian Bureau of Statistics 2012b) and incorporates six Local
Government Authorities (LGAs) including the Shires of Augusta-Margaret
River, Boyup Brook, Bridgetown-Greenbushes, Busselton, Manjimup and
Nannup. The region stretches from Walpole in the south to Wilga in the
north and from Margaret River and Leeuwin-Naturaliste National Park in the
west and Tonebridge in the east. Of the six
LGAs the Shire of Manjimup covers the largest expanse of land covering
approximately 39.44% of the total area (ABS 2012b).
Demographics
The age distribution across the population in the lower south west area is
similar to that across Western Australia except for between the ages of 15
and 30—where there are a lower percentage of people represented in this
age range (ABS 2012b).
There is also a higher percentage of people over the age of 65 compared to
the state-wide population distribution.
This is consistent with the area being a popular retirement destination.
Aboriginal and Culturally and Linguistically Diverse Populations
About 18 per cent of the population in this area was born overseas, which is
below the WA average of 31 per cent (ABS 2012b).
Approximately 4 per cent of the lower south west population speaks a
language other than English at home (ABS 2012b). This is significantly
below the WA average of 21 per cent.
People who identified as Aboriginal and Torres Strait Islander in the 2011
Census (ABS 2012b) represent 1.63 per cent of the population in the lower
south west profile area. This is below the state-wide figure of three per
cent. The proportion of population who identified as Aboriginal and Torres
Strait Islander ranged from 0.21% in Bridgetown-Greenbushes to 2.68% in
Manjimup.
Individual Funding
Within the NDIS people living with disability will receive funding to
purchase the supports they need to live a meaningful life. This approach
will give control to the individual to choose the services they require and
select their own method of support.
To manage their own funding, people can become an employer by gaining
their own Withholder Payer Number and becoming an identity with the
Australian Tax Office. The person would then be responsible for Workers
Compensation Insurance and Public Liability Insurance, paying tax for the
employee and superannuation. In this situation the person with a disability
would be responsible for all industrial relations matters and management of
their staff.
People with severe disabilities who may not be able to manage their own
funding can form a micro board with family and friends who are involved in
the person’s life and future. Micro boards usually comprise five to seven
people who are committed to knowing the person and having a reciprocal
relationship with that person. Board members undertake their role in a
voluntary capacity.
Each micro board supports one person with a disability and that person is
the central focus of the micro board. Every decision reflects the person's
goals, dreams, needs and desires and uses person-centered planning and
thought. The micro board also helps the wider community of citizens,
service providers and business people to have a relationship with the
person, and to benefit from their contribution.
Micro boards can be used to undertake small business or microenterprise
to provide employment for the person and use the funds raised to build
capacity and support.
An interesting program on Radio National describes the life of Cameron
who has a micro board and now has his own business. This is an
innovative way of improving the life of the person being supported and
raising extra financial support, which should be able to grow with the
NDIS.
http://www.abc.net.au/radionational/programs/360/cam-can/2955864
In Western Australia, the first Local Area Co-Ordinator (LAC) was appointed
in 1988. By 2003, when the first review of the LAC service was undertaken,
the entire state of Western Australia was covered by the service.
The review identified strengths and weaknesses of the system expressed by
LACs. Strengths included relationship building with clientele, the values
framework of the system, community relationships and flexibility.
Weaknesses included rapid expansion, increased bureaucracy and
administrative requirements, funding role, changed management
arrangements and insufficient support for LACs.
A weakness expressed by one interviewee in this project was that “our
money is sent to the organisation that provides support, so we often don’t
know what our budget is which limits our ability to forward plan. It is
impossible to make plans and dream if you don’t know what you are going to
get.”
Another interviewee expressed her frustration with the LAC system because
as an ageing parent of two men with an intellectual disability, the DSC was
expecting her to manage budgets and do individual planning for both. One
son had a severe disability and was in hostel accommodation in Perth until
the hostel closed down in the days of deinstitutionalisation. The family
purchased a house for him in their home town and he was given funding for
twenty four hour care. This man had lived in his own home and learned
new skills such as going to bed when he was ready to, toileting and other
personal care. After twenty three years of independence his funding has
been cut and the agency who has been managing his budget, a for profit
organisation, has been refused the 15% usually paid for administration.
This man is now in respite care until his parents can find a solution to the
situation. The mother explained that it was due to burn out of live in staff,
who went on sick leave, the agency managing his budget brought in agency
staff because it was not possible to attract trained staff in the town. Hence,
the budget did not last for the year and a request for more funding was
refused, resulting in the agency refusing service. The mother is now faced
with a situation where she has to start planning all over again and try to
secure her son’s future. Her concern was what would happen to him when
either she or her husband passed on.
This story highlighted several issues for the NDIS, particularly the need
for a guarantee that funding would not be cut, the need for emergency
funding to assist with crisis situations, the unreal expectation that elderly
parents can manage their ‘children’s’ lives forever.
The story also highlighted the difficulty in finding trained support
workers in rural areas.
An organisation in Perth was established by parents and families to
overcome this dilemma. Planned Individual Networks Inc. (PIN) works on
the Canadian model of Planned Lifetime Advocacy Network (PLAN). The
organisation provides individual facilitation at $35 per hour for 4-6 hours
per month to build and maintain a personal network around the person with
disabilities.
PIN also offers a useful book for parents concerned with the future for their
families. A member of the organisation explains "I can understand anyone
avoiding planning for the future. It is easier to stay where it feels safe but it
does not do anyone any good. The first step is always the hardest but once
you take the first step you wonder why you didn't do it a long time ago. Do
yourself and your loved ones a favour and make your next step a read
through Safe and Secure. You'll never look back."
( Margo McAdam, parent and Lifetime Member of PIN, 2013)
‘The book has had major contributions from a number of Western
Australian professionals to embrace our state and federal environment. This
edition is the only Australian guide for families who are concerned about
the future wellbeing of their family members with disabilities. It combines
stories of hope and inspiration and is a practical 'hands on' resource
designed to support future planning for people with disability.’ Safe and
Secure Six Steps to Creating a Good Life for People with Disability
(Etmanski, Al et al, 2008) is available from the PIN website at a cost of $35.
www.pin.org.au
Further information and other resources can be found on the Canadian
Planned Lifetime Advocacy Network (PLAN) website at: www.plan.ca
In 2013, a new program was introduced entitled My Way where some Local
Area Co-Ordinator staff will be based in non-government organisations.
‘The My Way project builds on the Local Area Coordination program which
has been supporting West Australians with a disability and their families
and carers since 1988. My Way is the next step in the Disability Services
Commission’s journey towards personalised, individualised services. This
self-directed supports and services project will empower people with
disability, their families and carers to plan in a way that will give them
greater choice and control over the supports and services they wish to
access.
My Way Coordinators (MWCs) assist people with disability to plan, organise
and access supports and services which enhance their participation in and
contribution to their local community.
In addition, MWCs work with family members and others involved in
supporting people with disability so that they are strengthened and
supported in their caring role.
MWCs actively support positive partnerships between people with
disability, families and carers, local organisations and the broader
community to build a more inclusive community.
My Way Coordinators are available to people with disability who are eligible
for Commission provided and funded services and live in one of the four
My Way project locations: Cockburn/Kwinana, Hills, Goldfields or Lower
South West.
Each MWC works with up to 50 people with disability, providing
personalised, flexible and responsive support.’
(Disability Services Commission, October 2012)
The project has been developed in consultation with more than 1,000
people and includes feedback and knowledge drawn from people with
disability, their families, carers and disability sector organisations. My Way
is being monitored and evaluated from the outset with lessons learnt from
the project used to develop new ways of providing services.
At the time the Lamp Inc. NDIS project began My Way had just started in
Western Australia and our request to survey co-ordinators was overruled
by the DSC Head Office. Discussions with people with disability and their
carers revealed that there was confusion about the NDIS because the new
My Way system had just begun. People in the state were unwilling to
embrace both systems at the same time and were confused about the
nature of the NDIS and its relevance to them because the Western
Australian Government had not signed off on the agreement.
Self-Managed Support
In Control Australia is a group of individuals and organisations who aim to
bring about systematic policy change in Australia to enable individuals with
disability and their families to self-manage their support. In Control
recommends the following principles for direct funding:
Independent Living: I can get the support I need to be an independent
citizen.
Individual Budget: I know how much money I can use for my support.
Self-Determination: I have the authority, support or representation to make
my own decisions.
Accessibility: I can understand the rules and systems and am able to get
help easily.
Flexible Funding: I can use my money flexibly and creatively.
Accountability: I will tell people how I used my money and anything I have
learnt.
Capacity: My capacity is assumed, and I can also get information and
support to build my vision of what is possible in my life. (In Control,
www.in-control.org.au )
This will require a change in thinking from providing services from which
people choose, to facilitating what people choose to do. Service provider
organisations will need to look at their values, culture and structure, as will
workers in these services.
Michael Kendrick brings this issue to a personal level by stating ‘that the
core beliefs held by professionals, policy makers, and support workers will
define how they work. So change and reflection on the system and culture
we work in must happen at every level, and we must act and work and
relate to people with disability in a true belief of person centeredness as
our value base’. (Kendrick, 2000).
Natural supports will become vital to maintaining independence, freedom
of choice and a sense of belonging. Workers will need to become more
familiar with how to facilitate these aspects of normal life. The trend of
taking people to visit community activities will need to change to fostering
individual choice and facilitating people to develop meaningful
relationships within the community.
Community inclusion has long been a focus in the leisure industry and
many resources are available to assist support workers and people with
disability to access community activities, meet new people and become part
of their local community.
Peer support is another way of providing information and education about
how to self-manage funding and support.
An important role for Local Area Co-Ordinators will be to build support
through any avenue available to them. Putting people with disability
and/or families in touch with each other can enable transfer of
knowledge and enhance the skills needed to build capacity.
People using direct payments in the UK and participating in an evaluation
of the scheme told the researchers ‘that having support to build their
confidence to take them up was vital, including information about how they
can be used. For some people this meant information about purchasing
support directly from care providers, while for others it meant access to
options that removed or reduced their responsibilities as an employer. In
addition, knowing that ongoing support would be available if things went
wrong and having someone to turn to who had “been there and done it”
were seen as pivotal factors in making it feel possible to “take the leap”.’
(Bennett and Stockton, 2012 sourced from:
www.thinklocalactpersonal.org.uk )
People4people is a not-for-profit organisation in the UK which has
responded to the need for trained support staff to support people with
direct funding. The organisation offers a matching service designed to
connect employers with personal assistants (support workers), so they can
work together to satisfy their individual needs. The organisation assesses
the needs of both parties, and support them through the recruitment and
employment process, providing optional ongoing support throughout the
life of the personal assistant employment.
The organisation also provides training and directs consumers to
government funding for training of support workers.
www.people4people.org.uk
This is an innovative way of overcoming the shortage of trained staff in the
support worker area. By funding a separate organisation to provide training
and matching, with full involvement of the consumer, the issue of conflict
of interest is overcome for the organisation, worker and consumer.
The issue of lack of trained support workers was raised by organisations
in rural and remote areas in particular. Training costs were also
identified as an issue if the organisation does not receive funding under
the NDIS.
Shared management may also be an opportunity offered within this model.
Shared management is where an organisation takes the responsibility for
paying staff, meeting legal employment responsibilities and acquittal of
funds used for support. This allows the person with disability to remain in
control of their own support requirements and removes the need for
becoming an employer and understanding the legal obligations associated
with managing government funding.
The Disability Services Commission (DSC) encourages organisations that
have preferred provider status to offer shared management.
‘Most people with an individualised funding allocation from the
Commission have their support managed and provided by a prequalified
disability sector organisation. Some people with Community Living or
Family Living manage their funding allocation through an agreement with
their LAC. Disability service organisations are encouraged to offer shared
management which enables individuals and/or families to have directive
control over matters related to their supports and funding. Some people
have their funding allocation transferred to them by the organisation and
they manage the use of these funds and acquittal in accordance with the
shared management agreement. Where the individual and/or family elect to
take on shared management, negotiation occurs between the individual
and/or family and the organisation to achieve a shared agreement. This
enables each party’s requirements, expectations and responsibilities to be
clearly established and subsequently documented in a signed shared
management agreement. Shared management gives those people who want
autonomy an opportunity to have greater control. It requires a good
relationship between all parties to ensure the right balance of support is
provided.
(Sourced from www.dsc.wa.gov.au)
In Western Australia, My Place is an organisation which provides a range of
services to people who receive individualised funding from the Disability
Services Commission (DSC). Options provided include Shared Management,
Shared Co-Ordination and Provider Management. Support is arranged or
provided around an individual plan called My Plan.
DSC pays 15% above the individualised funding to My Place to provide these
options, while the individual pays $8,350 per annum for Shared CoOrdination or Provider Management.
This arrangement provides security for the organisation to continue to
provide services and a professional delivery of services guarantee. The
organisation is subject to monitoring, as are all DSC funded services to
ensure that the service is provided within the framework of the Disability
Service Standards under the Disability Services Act (1993).
Further information about services offered by My Place can be obtained
from their website at www.myplace.org.au .
With individualised funding being introduced under the NDIS, for people
with disability who have a personal budget to purchase services, there will
be new choices and decisions to be made. Support workers where required
could be employed directly by the consumer, with shared management
through a disability service provider, through an Agency who supplies the
workers or through an organisation who employs the support workers
according to the person’s plan.
The following chart sourced from www.disabilitydirectory.net.au shows the
differences between organisational, agency, supported and direct
employment of support workers.
Organisational
An organisation
undertakes to
provide PSWs
according to a
plan.
Selection and Organisation
recruitment of conducts all
appropriately recruitment,
PWD has
trained and
limited say in
work ready
which PSW will
staff
be provided.
Basic
arrangement
Negotiation of
terms of
employment
Organisation is
responsible, and
PWD has no
role. Will
generally need
to comply with
Fair Work Act
and relevant
award. Terms
apply to that
employee for all
work carried
out, so
flexibility is
limited.
Agency
Supported
An agency makes An organisation
PSWs available
provides a range of
upon request.
supports to PWD in
the employment of
PSWs.
Agency recruits
Organisation may
their own
assist PWD to recruit
workers. PWD
their own staff, or may
may express a
facilitate, or manage
preference for a
the process.
certain PSW, and
subject to
availability, the
agency may
provide this
worker.
Agency is
Organisation assists
responsible, PWD PWD with negotiation
has no role. Will of terms.
need to comply
with Fair Work
Act and relevant
award. Terms
apply to that
employee for all
work carried out,
so flexibility is
limited.
Direct
PWD is directly
responsible for all
aspects of
employment.
PWD directly
recruits their own
PSWs.
PWD negotiates
terms directly; needs
to understand the
legislative and other
requirements for
compliance. Can
negotiate terms
directly with PSW
where in the best
interests of both
parties.
Organisation may
assist PWD to put in
place appropriate
arrangements for
direct employment, or
may handle
employment
arrangements.
Agency pays all. Organisation may pay,
Salary, taxes, Organisation
or may assist PWD to
superannuation, pays all.
set up appropriate
leave payments,
mechanisms to pay
insurances etc.
directly.
Organisation
Agency charges a Depends on
Cost to PWD
charges a fee, percentage of cost, arrangement in
funding
whether a
on top of PSW
place. May be a one
percentage of
wages, to include off fee for set up, or
cost, or a fixed superannuation,
may be similar to
fee, on top of
insurance, and
organisational or
PSW wages, to administration.
agency for ongoing.
include
superannuation,
insurance, and
administration.
Agency trains
Depends on
Training of staff Organisation
trains staff.
staff.
arrangement in place.
Employer
Occupational
Health and
Safety
Compliance
Organisation is Agency is
employer. PWD employer. PWD
signs timesheets signs off on
only.
invoices issued by
agency and pays
from funding.
Organisation
Agency conducts
conducts checks, checks, training,
training, audits audits and ensures
and ensures
compliance.
compliance.
Organisation is
Ongoing
management of responsible for
rostering,
staff
supervision,
performance
management.
Salary
negotiation
Depends on
arrangement,
organisation may
assist with setup, or
take ongoing
responsibility for
compliance.
Depends on
arrangement.
Agency is
responsible for
rostering and
supervision.
Performance
management is an
internal matter, as
staff are contracted
out for specific
hours/shifts, and
not for ongoing
employment.
Organisation
Agency
Depends on
manages.
manages. Additio arrangement.
Additional costs nal costs passed
passed on.
on.
PWD is employer.
PWD pays.
PWD pays all costs,
no additional
charges.
PWD responsible for
ensuring staff are
receiving training,
whether directly,
prior to employment,
or through another
arrangement.
PWD is responsible
for compliance.
PWD is responsible
for rostering,
supervision,
performance
management.
PWD manages.
Direct funding places a higher responsibility on the individual for accounting for
expenditure. Accurate records need to be kept and reporting dates adhered to.
Where an agency or organisation is involved, they will produce such records and
meet accountability criteria.
Concerns were raised in the project regarding job security and entitlements for
support workers where individual contracts were used.
Person Centred Planning
Central to these changes is the need to develop and further refine the
ability of staff to undertake person centred planning and follow those plans
to fruition. It is a new mindset that requires not only a change in work
practices but a change in the ways staff think and act. There are many
documented tools that can be used to achieve this aim and assist the
worker who facilitates the planning process. If possible it is desirable for
the person with the disability to create their own plan however, a facilitator
is often used to guide the process and ensure that all possible options are
explored. A facilitator should also ensure that everyone involved applies
themselves to the task at hand and act as mediator if conflict occurs.
Elements required for an individual to complete their own plan include
talking to other people, friends, relatives, acquaintances about the
proposed plan, researching information via brochures, community
directories, internet etc., experiencing different activities then making
informed choices. If appropriate, supports need to be identified and
options for purchase sought. Where necessary, legalities associated with
employing support need to be researched and details of the job description
established. Direct employment of support workers allows the person with
disability to choose their own staff and employ them to meet the needs
they identify.
Workers involved in the process of individual planning or person centred
planning as it has become known, need to be aware of the values base and
skills they require to participate successfully, these include:










a sound values base that respects the right of the person with a disability to
choose freely from all options and develop a meaningful life pattern;
good listening skills;
an understanding of the role of facilitator and mediator;
a willingness to learn from others;
an ability to take action where required;
connectedness or being a part of community themselves;
a personal commitment to person centred planning and review;
recognition of the role of informal supports in a person’s life and the
difference from paid support;
sound professional boundaries;
A ‘can do’ attitude.
Well respected author and trainer Helen Sanderson offers several useful
tools on her website and provides training courses for workers. Although
Helen is based in the UK she has offered some training in Australia.
The following tools were downloaded from
www.helensandersonassociates.co.uk
doughnut sort, this tool when used in individual planning helps to sort out
the necessary supports in the inner circle, the desired supports which lead
to creativity and judgement;
sorting important to/for, this will give an indication of what is important
to make the person happy, content and fulfilled, and what is necessary for
health and safety and being valued;
matching staff, a structure to look at both what skills/supports and what
people characteristics make for a good match
relationship circle, this tool will identify family, home and other paid
supporters, work and education support and friends and non- paid
relationships. Particularly useful as a guide to development and
possibilities for inclusive activities;
communication charts, give insight to how a person communicates and can
assist with identifying when a person is becoming unwell in the case of
mental illness;
learning log, directs people to look for ongoing learning. A structure that
captures details of learning within specific activities and experiences.
Identifies what needs to stay the same and what needs to be different
around how we support someone;
communication learning logs, provide a way of learning about someone’s
communication when family and staff are unsure of what is being said;
sorting what’s working/not working, analyses an issue or situation across
different perspectives. Clarifies what to build on (maintain or enhance) and
what to change. Particularly useful in conflict situations;
4+1 questions, gives a structured way for everyone to be listened to and to
describe what they have learned. Another useful way forward;
decision making agreement, used to increase the power and influence
people have in their lives. Helps us to think about decision making and
increasing the number and significance of the decisions people make;
presence to contribution, helps us move existing activities to become
possibilities for meeting new people, making connections and contributions
rather than just being present;
dreaming, helps people to think about their future dreams and how to
begin moving toward them;
person centred reviews, a person-centred approach to meet, review
progress and agree actions;
person centred teams, a way to use person centred practices to develop
how we work as a team;
positive productive meetings, a way to use person centred practices to
improve our meetings. This gives us a meeting process for sharing
information, thinking together and agreeing actions.
These tools can be used in isolation according to the skills and needs of the
individual and should be seen as separate from each other but may be used
in tandem or grouped together to inform the decision making process.
Further information on each tool is available in book form or free
downloads from. www.helensandersonassociates.co.uk
A further resource for staff to use in person centred planning are the tools
on the Think and Plan web site. This site allows the person to fill in the
tools online and either save them to their own computer or print them out.
The tools offered include three options for one page profiles, used to
identify characteristics and interests of the person seeking support and
staff members. The purpose of filling in one page profiles for staff is to
assist with the matching process when new people join the service.
Compatible matching is very important in the person centred approach
because likeminded people are more likely to have good community
contacts and share interests in similar activities.
One page profiles can also be used to decorate the entry to a service office
so people can immediately identify staff and know a little about them when
they first meet. This can be done by framing and hanging the profiles on a
wall or making a file to leave on a coffee table.
The site also offers a support plan, complete with tools for each stage of
the plan. Tools for person centred reviews and community connections, a
set of tools that focus on community, and how to work together to enable
everyone to be contributing members of their communities. To access
these tools the person simply creates their own account which is free of
charge and completes the appropriate tools to suit their needs. This can be
achieved alone or with support from staff as required.
www.thinkandplan.com
A useful resource for staff training was published by the State of Victoria;
Department of Human Services in 2012 entitled ‘Supporting decision
making A guide to supporting people with disability to make their own
decisions’. This book is also published on www.dhs.vic.gov.au . The guide
includes Policy and legislation context; Decision making spectrum; Decision
making principles; Substitute decision making; Principles in action and
offers the following additional resources which can be accessed by pasting
the link into your browser:
Total Communication – Person Centred Planning, Thinking and Practice
http://www.pcp-in-hampshire.org.uk/documents/downloads69.pdf
A Positive Approach to Risk Requires Person Centred Thinking
http://www.helensandersonassociates.co.uk/media/15308/a%20positive%2
0approach%20to%
20risk%20requires%20person%20centred%20thinking.pdf
Supported Decision Making: A guide for supporters
http://www.paradigmuk.
org/Resources/9/2/9/Supported%20Decision%20Making%20(Final%20Online
%20Version).
Pdf
Review is an important part of the person centred approach and involves
everyone who is part of the plan including the person themselves, carers
and family and support workers. Preparation for the review is important
prior to considering the plan. Progress needs to be reported and the plan
adjusted according to changes achieved. The review should be outcomes
focused and serves as a check to see whether the person is receiving the
support they need to live their life as they choose and achieve their goals.
As goals change, amendments are made to the plan as agreed by the person
with a disability.
Helen Sanderson (op cit.) produces a booklet called ‘Outcome Focused
Reviews’ which is a useful tool to assist the consumer to prepare for the
review. This booklet can be found free of charge on:
www.helensandersonassociates.co.uk
In Western Australia there is an umbrella organisation which focusses on
the development of individualised service models called WA Individualised
Services. Inclusion WA is a member of this organisation and provides
inclusive services in recreation and sport with a focus on individual choice
and facilitation into community groups and associations. The organisation
also provides education and assistance to sporting groups who choose to
make their activities more accessible to anyone with a disability. The
following training is available through this group to support workers with a
particular focus on individual support:
‘Professional Boundaries
This workshop is an open discussion on the professional boundaries
between the support worker and the individuals they work for, and
determining the necessary steps to prevent boundary violations. This is a
topic that asks the participants to define what a good “working
relationship” is, and how it differs from being a “friend” of the people they
work with.
Community Inclusion Training
This workshop relies on drawing parallels. You will think about a good life
in the context of community, drawing from your uniquely human
experience to consider the way connections with others are made and
enhanced. This same thinking will then be analysed based on what we know
about the people we support. This workshop will encourage you to think
about your version of a fulfilling life, and relate that to what others may see
as a rich life for themselves. The entire premise of this workshop is about
exploring the richness of life and the ways we can support others to share
in that richness.’
Further information can be obtained by visiting: www.inclusionwa.org.au
Training in the provision of services to people with mental health issues
has remained separate from the disability sector in most cases. The West
Australian Association for Mental Health (WAAMH) has a training calendar
each year to enhance the skill development of the mental health workforce
within the sector. A selection of courses offered includes:
Social Inclusion, Mental First Aid and Working with Aboriginal People.
WAAMH also offers Certificate IV in Mental Health in partnership with
Psychiatric Disability Services of Victoria (VICSERV) this program is funded
by the National Workforce Development Fund and is a subsidised program
thus reducing the total fee payable.
Certificate IV in Mental Health (CHC405012) is a national qualification that
makes up one level of the National Community Services and Health Training
System. This national system has been developed by the combined efforts
of government and non-government agencies, union representatives and
professional bodies as well as workplace representatives on a national
project team. It provides training options for a career path for employees in
a range of sectors in Community Services and Health.
This specialist, nationally recognised course has been developed by
VICSERV and is specifically designed for people currently working in the
community managed mental health sector. To enrol in the program the
participants need to be currently working in the sector (in a full time, part
time or casual capacity). (WAAMH web site)
This comprehensive course covers the following topics:
Orientation to Community Managed Mental Health
Work effectively in mental health settings.
Work effectively in the alcohol and other drugs sector.
Reflect on and improve own professional practice.
Apply understanding of mental health issues and recovery processes.
Work within a relevant legal and ethical framework.
Being a Community Mental Health Worker – Recovery Practice
Establish and maintain communication and relationships to support the
recovery process.
Conduct assessment and planning as part of the recovery process.
Work collaboratively to support recovery process.
Assess and respond to individuals at risk of suicide.
(Participants will also receive the Applied Suicide Intervention Skills (ASIST)
certificate when they complete this unit of competence)
Working & advocating effectively with consumers, carers and families
(electives)
Providing services to clients with complex needs
Advocate for clients
Facilitate consumer, family and carer participation in the recovery
process
Working Effectively in a Community Health Environment
Contribute to WHS processes.
Work effectively with culturally diverse clients and co-workers.
Work effectively with Aboriginal and/or Torres Strait Islander people.
Further information on training available through WAAMH can be found at
www.waamh.org.au/training
The Mental Health Workforce Advisory Committee (MHWAC) has undertaken
a project to deliver professional development to mental health workers
online. Mental Health Professional Online Development (MHPOD)
currently has forty eight topics with strong links to the National Practice
Standards of the Mental Health Workforce (2002). Each topic includes an
overview, knowledge check, activity, in-practice section and a list of
resources. A national pilot has recently been completed with nongovernment organisations that provide support to people with mental
illness with each state and territory represented. Lamp Inc. successfully
applied to trial the program in Western Australia and found the training
extremely useful for support workers. Lamp Inc. is a small organisation
covering the South Western area of Western Australia from a base in
Busselton. As such, training is not easily accessed and the self-paced online
option proved to be very successful.
Planning is currently under way to roll out the MHPOD training resource to
the non-government sector. To remain informed on this development
register with the following website www.mhpod.gov.au .
Queensland Council of Social Service Inc. (QCOSS) also offers e-training.
The e-training resources include eight units of competency that sit within
the Australian Quality Training Framework and two learning modules that
are designed for independent learning and professional development. The
resources include learning content, training activities and assessment items
for eight units of competency in the Community Training Package CH02:
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Utilise specialist communications skills
Work within a legal and ethical framework
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Respond holistically to client issues
Work effectively with culturally diverse clients and co-workers
Participate in workplace safety procedures
Facilitate co-operative behaviour
Participate in the work environment
Work within the administrative protocols of the organisation
For further information on training and other opportunities visit
www.communitydoor.org.au
The Mental Health Recovery Star is a tool for workers to assist with
individual planning focussing on the recovery model. The Star was
developed by the Mental Health Forum in the UK and Triangle Consulting.
The Star focusses on ten areas of life including:
Managing Mental Health
Relationships
Self-care Addictive Behaviour
Living Skills Responsibilities
Social Networks Identity & Self-esteem
Work Trust & Hope
Each area of lifestyle is assessed using the Ladder of Change to identify
what stage the individual is at in each area, using five steps from stuck to
accepting help to believing, learning and finally self-reliance. The Ladder is
used to determine how to change what is not working.
This tool provides the means to ensure support is effective and to capture
evidence that it is. Measuring outcomes has become increasingly important
to funding bodies, service providers and people receiving service alike. The
Star provides evidence of such outcomes and allows service providers to
evaluate what they do and whether it is effective and to learn from the
experience. Service users also benefit by becoming more optimistic about
what they can achieve. The Star provides proof that services work and
enables users and staff to discuss important issues, assess where they are
now and where they are going.
The Star can be downloaded from www.outcomesstar.org.uk the Star can
also be used on-line. A licence fee applies for organisations and training is
recommended to enable organisations to apply the tool effectively.
Training is available from Triangle Consulting and registration in Australia
can be made on their website www.outcomesstar.org.uk/australia-andnewzealand .
Lamp Incorporated is an organisation providing community based nonclinical services to people who have any form of diagnosed mental health
issue and carers of people with mental health issues. The organisation
offers the following support services within a recovery framework:
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Day 2 Day Living Skills
Community Education and Training
Carer Support Programs
Well Ways
Housing Support
Youth Services
One-to-One Independent Living Support
Services are offered around person centred plans entitled ‘Stepping Stones’
designed to encourage the individual to plan their personal goals and
aspirations. ‘Steps for Carers’ is used to assist carers to design their own
plan and guide their own Self-Care Action Plan. ‘Room 226 Youth Program
Creating a place for u’ an assessment tool for young people to ascertain
their own directions, set goals to improve many areas of their life and
commit to change.
Training in the use of these tools is available by contacting Lamp Inc. by
email llound@lampinc.org.au or on their website at www.lampinc.org.au
Organisational Challenges
The National Disability Insurance Scheme (NDIS) is the largest and most
significant social policy reform in a generation. The Scheme will change the
face of disability services from a siloed approach where block funding was
provided according to service and/or disability type to an individualised
funding approach where an amount is allocated to an individual. One of the
major changes is the inclusion of people with all types of disability
depending on their level of support requirements rather than type of
disability.
Under the National Disability Insurance Scheme (NDIS) it is proposed that
funding will be provided to individuals to purchase supports according to
their assessed needs. Assessment will be undertaken by workers employed
by government under the Scheme, therefore, the assumption being made
here is that an Individual Support Plan will be in place at the time the
individual approaches a non-government service provider. This will require
a change of thinking and culture in current disability services and a move
to the person centred approach for those who have remained in the older
model of program based service provision. In turn, this will affect workers
by requiring them to change their approach to service delivery.
The issue of job security for support workers was raised by those
interviewed in this process. Concern was raised about jobs becoming
more casual and thus limiting job security and financial security for
workers.
Management of these changes will require significant effort from Boards of
Management, executive staff and managers to ensure resources are made
available for consultation leading to policy changes, staff training and
cultural management.
Before change can begin an organisation needs to know where it sits within
the proposed new structure. As the framework for the NDIS was not in
place at the time of writing, the UK example was useful again. A self-check
document entitled ‘Progress for Providers-checking your progress in
delivering personalised services’ (Sanderson, 2010) is available to
download on the Helen Sanderson website (op cit). The simple selfassessment tool has eight sections. These are:
1
2
3
4
5
6
7
8
Leadership and strategy.
Creating a person-centred culture.
Community focus.
Supporting planning and review.
Finance.
Human resources.
Marketing.
Reviewing and improving our service.
The document allows management to assess where the organisation sits
within a framework of person centred service delivery and to plan future
actions to improve each area of business. Feedback from managers about
the above assessment tool was that while it was a useful tool for the
organisation, people in management needed more detail on how managers
use person-centred approaches with individuals receiving support and their
teams. A further resource was developed entitled ‘Progress for Providers –
checking your progress in using person centred approaches (managers)’
(Sanderson, 2011). This resource is divided in four sections looking at:
1 The knowledge and skills required for person-centred thinking and
approaches.
2 How to help people have choice and control in their lives.
3 Creating a person-centred culture within a team.
4 Action planning tools and resources.
This resource allows managers to focus on person centred planning and
ensure that the whole team is aware, skilled and functioning within that
model. Again the booklet can be downloaded free of charge from
www.helensandersonassociates.co.uk .
A consumer participation toolbox was created in Queensland by the
Queensland Alliance for Mental Health Inc. in 2012. The package entitled
‘NGAGE’ is a set of tools and approaches to support organisations to create
additional opportunities for meaningful consumer engagement.
Ten non-government organisations providing support to people with mental
health issues were engaged to undertake process mapping on one process
in their organisation. The NGAGE Toolbox provides you with ten discreet
processes that were identified by the pilot project participants, but that are
common or frequent features of service delivery:
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Agreement Breach Process
Communicating and Working with Families
Client Participation Committees
Marketing and Promotion
Open Days and Recruitment Participation
Consumer Engagement in Team meetings
Incident Management
Informal individual Planning
Personal Planning 1
Personal Planning 2
Process maps were used to show the steps to complete a process and the
roles responsible for completing those steps, firstly in a current process
map then a proposed process map. A procedure was then written to show
how the proposed process would be completed.
The NGAGE Toolbox is available in hard copy and will also be available
online from www.communitydoor.org.au this tool could be used to provide
a pathway for change within organisations needing to manage the change to
individual funding and involving current service users in the process.
A major concern of the managers interviewed for this project was the
idea that people might choose to move to another service and take their
funding with them thus leaving the original service vulnerable to closure.
This was a particular concern for those small services in rural and
regional areas given the need to drive long distances to provide service
and the relatively low populations of people with disability.
Two existing tools were identified to assist managers to assess their
organisation’s ability to allocate resources, these tools were used by a UK
service called Dimensions and reported in the book
‘Making it Personal for Everyone From Block Contracts Towards
Individual Service Funds’ (Scowan and Sanderson, 2011).
Scowan and Sanderson found that the Care Funding Calculator (CFC)
allocation ‘gave a much better reflection of what support people needed
and the support they were getting day-to-day. The Resource Allocation
System (RAS) was quite subjective and was seen to tempt the person to
choose the box that gave them the most support possible in any given
situation, leading to an over-estimation of the amount needed for certain
individuals.’
In the planning process towards change, Dimensions found themselves in a
situation where they needed to reduce their running costs in order to
achieve their aim.
‘Faced with a situation of having to find a way of reducing costs by up to
10%, the service went forward to identify:
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each person’s share of the funding we received from our purchasers
what support and other costs were necessary as a result of elements of the
service being shared, broken down between core support and other shared
costs
where and how Dimensions’ core costs should be allocated
ways of enabling each person to maximise their control over their resources
once they had paid their share of the shared costs’
(Scowan and Sanderson, 2011)
Dimensions managers found that as they progressed with their planning, it
became clear that ‘the breakdown of existing costs opened up opportunities
for dealing with traditional routes of funding more creatively and flexibly’.
They found that working to the new approaches for financial arrangements
would not require extensive changes to their financial systems. The service
also developed an enhanced understanding of what constitutes active and
passive support.
A pleasing outcome for the service was that ‘the ‘in my personal control’
element of funding developed clearer focus and understanding of support
for the staff team. The principles of support and its funding reinforced the
person-centred approaches and reduced the potential for over-supporting
people.’ (op cit. p19).
Over-support can easily occur when services are focussed on selfmanagement and maintaining a presence in the consumer’s life rather than
working together towards improvement. Whereas, when individual
planning and person-centred approaches are used the focus of staff time
becomes the quality of life being experienced and what action has occurred
towards achieving positive outcomes as expressed by the individual.
Management of these changes requires a strong belief in the rights of
consumers to make their own choices and purchase support to achieve their
own outcomes. Maintenance of the organisation then becomes secondary.
Staff training was identified as an area of concern for managers in an
environment where the organisation is not funded for that purpose.
Transitional funding was considered necessary for organisations to
introduce intensive training in person centred planning and review.
In Europe it was found that there was a need for an online platform of
learning to support the international drive towards person centred planning
and service delivery. Three distinct levels of competence were included in
the curriculum according to Doose (2011);
1. A basic level, which introduces the training participants to person centred
approaches,
2. A facilitation level, which enables training participants to professionally
guide, document and reflect on person centred processes and
3. A multiplication level, which enables training participants to facilitate
seminars and training events on person centred approaches and inform and
influence change at organisational and strategic levels.
(Lunt & Hinz eds, 2011)
In Western Australia it was found that Local Area Co-Ordinators received a
high level of training and were given time to improve their skills. Whereas,
non-government organisations struggled with allocating time and resources
to staff training and where it did occur, support time to consumers had to
be reduced due to low staff numbers. This was seen as an imbalance that
could be overcome by making government training more accessible to nongovernment organisations.
The NDIS should include an allocation for staff training to assist
organisations to adjust to the new system of funding and strengthen the
supports available to people with disability and their carers.
Change management is one of the most difficult areas of management
because change does not happen in isolation, it impacts the whole
organisation around it and all people within the organisation are touched by
it. Change is often seen as a threat particularly to those who need to and
choose to work within the organisation.
With the NDIS coming into effect, management need to be addressing
change in the very near future, it takes time to change long-held beliefs and
practices. Boards need to be kept informed of the changes in government
policy and the new approach to disability in Australia. Policy review will be
essential to ensure that the organisation is ready to receive consumers who
are choosing to purchase their services from the organisation. Policy
review however, cannot happen in isolation; prospective and existing
consumers should be involved and given an opportunity to express their
views.
Senior staff must be committed to the change to ensure that the messages
they send to other staff are relevant and clear. Involvement at all levels is
ideal however, not always possible, particularly when part-time and casual
employees are used to offer support. Traditionally, the support worker role
in Australia is poorly paid and has become more casualised as time goes by.
This is a major issue that will need addressing as the role demands more
training and understanding of the nature of individual funding and the new
ability of the consumer to purchase their own services and where desired,
employ their own support.
The change from block funding to individualised funding needs particular
attention to budget influences and a sound knowledge of core costs in order
to allocate time and costs effectively.
An example of how to measure costing for support to people with mental
illness is attached at appendix A. This example can be used to break down
the costs of support depending on level of need.
An innovative system being explored by Lamp Inc. is ‘Social Return on
Investment’ (SROI), designed in the United Kingdom by the SROI network,
the system has 7 principles being:
1. ‘Involve stakeholders
Understand the way in which the organisation creates change through a
dialogue with stakeholders.
2. Understand what changes
Acknowledge and articulate all the values, objectives and stakeholders of
the organisation before agreeing which aspects of the organisation are to be
included in the scope; and determine what must be included in the account
in order that stakeholders can make reasonable decisions.
3. Value the things that matter
Use financial proxies for indicators in order to include the values of those
excluded from markets in same terms as used in markets.
4. Only include what is material
Articulate clearly how activities create change and evaluate this through the
evidence gathered.
5. Do not over-claim
Make comparisons of performance and impact using appropriate
benchmarks, targets and external standards.
6. Be transparent
Demonstrate the basis on which the findings may be considered accurate
and honest; and showing that they will be reported to and discussed with
stakeholders.
7. Verify the result
Ensure appropriate independent verification of the account.’
(Sourced from www.thesroinetwork.org )
SROI measures change in ways that are relevant to the people or
organisations that experience or contribute to it. It tells the story of how
change is being created by measuring social, environmental and economic
outcomes and uses monetary values to represent them. This enables a ratio
of benefits to costs to be calculated.
In the same way that a business plan contains much more information than
the financial projections, SROI is much more than just a number. It is a
story about change, on which to base decisions, that includes case studies
and qualitative and financial information.
Lamp Inc. will be undertaking a SROI analysis in co-operation with the
accounting firm who provide audit services to them each year. This will
demonstrate a commitment to change and give a sound rational for funding
together with direction for the organisation.
Carers
The role of the support worker should be to provide support where
voluntary support is not available. The value of the carer is well recognised
in Australia and has been supported through several developments
including legislative recognition. Western Australia was the second
jurisdiction in the world to legislate support for carers through the Carers
Recognition Act (2004). Since that time all states, territories and the
Australian Government have passed similar legislation recognising the role
of carers.
In particular, carers in rural and remote areas stressed the need for the
NDIS to recognise the role of carers and acknowledge the additional cost
of caring in these areas in their assessments.
One of the carers interviewed for this project stressed the added financial
burden placed on carers in rural and remote areas. This person has a
daughter with mental health issues which are often erratic and need
attention from her psychiatrist in Perth. The cost of attending
appointments in Perth at $60 each way when using her own vehicle and the
additional cost of supporting her daughter (when she is well) to attend
community activities, places a huge demand on her household budget. She
also stressed there is little money left for holidays and the basic needs of
the rest of the family.
Informal providers of assistance
Providers of informal assistance (Graph 30) were typically close family
members. In the case of adults with disabilities, this was most likely to be
partners (41%) or children (28%) while parents (18%) were more likely to be
providing help with children, regardless of their age (many elderly parents
provide assistance to adult children).
Reliance on informal assistance from family and friends was particularly
noticeable for the three core-activities (Graph 31):
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of all those receiving informal assistance with self-care, 51% received this
help from partners and 23% from parents;
of all those receiving assistance with mobility, 44% received help from
partners, 27% from children and 18% from parents; and
of all those receiving assistance with communication, 64% received help
from their parents.
Close family members also tended to provide the most informal assistance
with non-core activities (Graph 32):
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partners provided the greatest amount of assistance in most of the non-core
activities;
parents provided the most assistance for cognitive or emotional tasks (40%);
and
children tended to provide less help for cognitive or emotional tasks and
health care than partners or parents, but next to partners, provided the
most help with paperwork (30%), household chores (28%), property
maintenance (31%) and meal preparation (29%).
(Disability Australia, Australian Bureau of Statistics, 2009)
Carers provide a valuable service which is often preferred by the person
with a disability to employing paid support. There needs to be recognition
of this contribution and an acknowledgement that it cannot be replaced by
paid support.
Education, peer support and adequate respite to allow carers to have
holidays and live their own lives are essential to maintaining this level of
unpaid support. The following resource was found to be particularly
important to carers in Western Australia.
Well Ways Carer Education Suite
Well Ways is a family education program facilitated by carers. The Well
Ways suite of programs is designed to increase the capacity of families,
carers and friends to care effectively for themselves, other family members
and their friends living with mental illness. The course provides informal
workshops involving group discussions, videos and practical
demonstrations which are designed around adult learning principles.
Current research evidence and the experience of families who have lived
with mental illness combine to help families in a way that purely medical
information cannot. The family-to-family model offers the opportunity to
benefit from the wisdom and experience of family educators.
‘The program includes:
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Up to date information about anxiety, depression, bi-polar disorder,
schizophrenia, obsessive-compulsive disorders, schizoaffective disorder
and dual diagnosis (drug and alcohol abuse and mental illness).
Information about mental health services available to you and your family.
Practical insight into behaviour associated with mental illness and
strategies to respond effectively.
Practical frameworks to improve communication and problem solving skills.
The dilemmas and complexities of the caring role.
Well Ways Carer Education suite of programs includes:
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Building a Future – Well Ways 8 week Program. This program is suitable
for families, friends and carers of people with mental illness.
Snapshot - an introductory Well Ways 7.5 hour Program presented over 2
days. This program is suitable for families, friends and carers of people with
mental illness.
Duo - a Well Ways 6 week Program. This program is suitable for carers,
families and friends of people with mental illness and co-existing substance
use (dual diagnosis- drug/alcohol and mental illness).
MI Recovery – is a Well Ways Program suitable for the person with the
mental illness, facilitated by people with a lived experience of mental illness.
(Sourced from www.mifa.org.au/well-ways-suite )
A new addition to the Well Ways program is currently being developed in
Western Australia. This resource is directed at carers and called ‘Creating
your own Wellness Recovery Action Plan’ (WRAP). The plan covers:
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Identifying early warning signs;
Noticing the stress triggers;
Identifying helpful coping strategies;
Developing a medication regime;
Involving others;
Relapse management.
(BOICO Well Ways facilitators, BOICO Carers, Pam Gardner, Lyndel Taylor,
unpublished) www.boico.org.au
This is a truly grassroots developed publication designed to assist carers
living with the influence of mental illness to develop their own management
plan and improve their life.
Under the umbrella of Carers Australia, Carers WA is an organisation
created specifically to support carers. Peer support occurs through a range
of workshops described below.
‘Types of Workshops
Join one of Carers WA’s interactive workshops if you would like to take
some time out with other carers and share your experiences whilst gaining
invaluable information and skills.

Support and Services for Carers
accessing the right help can significantly impact on a carers ability to cope
with all the challenges they face in their day to day lives. This workshop is
aimed at providing carers with information on what support and services
are available. We also discuss the importance and relevance of the Carers
Recognition Act.

Safety Essentials
How safe is your home? Are you risking serious injury or harm to yourself
or the person you care for? In this workshop carers will identify the risks
associated with their caring role and explore ways to reduce hazards.

Maintaining Healthy Relationships
the caring role is often challenging and stressful, which can have an impact
on relationships. This workshop will look at the impacts caring has on
relationships and how carers can improve the way they communicate to
assist them in maintaining healthy relationships.
Carer Wellbeing
This workshop looks at why carers need to care for themselves too! Carers
often focus all their time and energy on the person they care for, ignoring

or forgetting about their own health and wellbeing. This goal-focused
workshop gives carers an opportunity to think about the various ways they
could improve their wellbeing.

Practical Matters Forums
Financial Issues, Community Services, Power of Attorney, Respite. What do
they all mean? What questions do I need to ask? How do I plan for the
future and why? All of these questions will be addressed and more. Our
Practical Matters Forums allow carers to meet and chat to a range of carer
services all in the one place! They are held four times a year throughout the
metropolitan area.
(Sourced from www.mifa.org.au/well-ways-suite )
The Mental Illness Fellowship of Australia also provides an interesting local
information service to assist carers and people with disability to find local
supports and services they need.
‘On Wednesday 10th October 2012, On World Mental Health Day the Mental
Illness Fellowship of Australia (MIFA) launched Mi Networks. Mi Networks
has 80 locations within Australia and comprises an information service to
allow consumers and carers to find their nearest disability support services
and community services.
The Mi Networks logo and the service promise that goes with it will be a
guarantee of genuine support, accurate information and assisted referral to
the best local services available.
Our Promise
A place you are welcome -- We promise to treat you like a person, not a
number. We will always have time to listen, question and discuss. We want
to know how you are, what you need and how we can help.
Peer Support -- Many of our staff and volunteers have lived experience:
either living with mental illness or as the carers of someone with mental
illness. We are people with similar experiences and we will have some
understanding of what you are going through.
Relevant Information -- We offer tailored and up-to-date information to
assist you, your family members, friends and carers. If we don’t have the
information you require, we will help you find it.
Community Networks--We are linked into our local networks and have
established strong and supportive working relationships with other
services. We are connected to a broad range of programs, supports and
information.
A National Network --We offer a range of one-on-one and group support
programs for you, your family members, friends and carers across
Australia. If we can’t assist you on-site at one of our locations, we will
connect you with someone who can.
Personalised Referral -- We will refer you to the services and supports that
best meet your needs. This may be a program we offer or it may be
provided by someone else. We will support you to find the best fit for you.’
(Sourced from www.mifa.org.au/mi-networks-0 )
The above website also offers an array of leaflets covering many topics of
interest for carers and consumers.
Access to Services by Aboriginal People and Torres Straight
Islanders
Many studies have been undertaken to determine why Aboriginal people do
not access mainstream services including disability services. Most cite
cultural misunderstanding and lack of relevant information as being the
major reasons.
Salvatori (2010) describes how the feeling of cultural misunderstanding,
combined with broad disadvantage and negative past experiences can be a
powerful deterrent to seeking support:
When accessing mainstream services, the effects of trans-generational
trauma can be evidenced when clients feel inferior, shamed,
misunderstood, not educated enough and feel that they have no voice.
Aboriginal people have different ways of communicating and thinking and
feel that the Aboriginal 'way of being' is not understood. Feelings of
intimidation, racism and fear due to past history often stand in the way and
keep our clients from using mainstream services. Many do not feel safe.
Some Indigenous Australians who want to engage with the disability system
may be constrained by a lack of knowledge about the necessary
requirements (such as paper work and personal information), or lack
confidence or understanding of their rights or entitlements.
In its report, the Disability Sector Health Check Committee (2007) paid
particular attention to the issues confronting Aboriginal people. It
specifically requested Disability Future Directions to include:
‘A strong focus on making mainstream services and specialist providers
welcoming, accessible and responsive to the needs of Aboriginal people
with disability and their communities (Recommendation 42).’
In her summary paper Disability Future Directions 2025, Trish Harris
acknowledged that ‘the notion of disability as deficiency and/or
abnormality has significant cultural implications. As reported in the
monograph on Aboriginal people with disability, Indigenous people have
spoken of its potential to devalue those with disabilities and of its
dissonance from their own worldview. The same was said to be true of
some CaLD populations.
(Harris, 2008)
In 2006, the Disability Services Commission developed a five-year plan to
promote substantive equality. The major work undertaken by the
Commission to date includes the Getting Services Right information and
resource package (2006) and the Reconciliation Action Plan (RAP) (2007);
funding for an Aboriginal officer to work with agencies to help implement
these initiatives; the pilot project at the Mirrabooka LAC office.
Another useful resource published by the Disability Services Commission in
DVD format: Getting Services Right for Aboriginal people with disability
and their families.
An interview was undertaken with an Aboriginal outreach worker based in
the GP Down South office in Busselton and this was her conclusion
’that employment of an Aboriginal worker enabled people to approach
the service with confidence and she was able to encourage those who did
not use mainstream services to use them. She was also able to advocate
on behalf of people who did not feel confident to attend appointments
alone or were unsure where to go.’
This seemed to be the best approach to encourage Aboriginal people to use
mainstream services because the worker was able to overcome any cultural
differences between the service provider and the customer. Expansion of
this service into the non-government sector would in time serve to educate
all service providers to understand and adjust their services to the
Aboriginal population.
The worker interviewed did however point out a recent experience of their
service where there had been racism at a local mainstream service. GP
Down South went to the service and provided on-site cultural awareness
training but only four staff attended; it would seem that compulsory
attendance would be necessary to achieve the desired outcome.
Peeters, 2010 also stressed the need for Aboriginal staff in her description
of the Marumali Program: An Aboriginal Model of Healing in Working
Together: Aboriginal and Torres Strait Islander Mental Health and
Wellbeing Principles and Practice. ‘The support and information we need is
not taught in universities and cannot be obtained from non-Indigenous
people, no matter how ‘culturally competent’ they are. It can be a barrier to
our healing process if a non-Aboriginal counsellor dabbles in core issues for
our recovery, such as our Aboriginal identity or reclaiming our spiritual
heritage. For this, we need authentic Aboriginal input, which reflects the
diversity in Aboriginal cultures, not ‘mainstream’ interpretations of what it
is to be Aboriginal.
A vast range of resources for Indigenous Cultural Awareness Training
(ICAT) is available on http://www.healthinfonet.ecu.edu.au/relatedissues/disability/resources/practice-resources .
Gilroy (2008) and the NDS (2010) suggest a number of features that are
likely to increase the usefulness of ICAT to service providers, including:





being locally focused
being practical in nature and relating specifically to disability services
involving the local community in training
providing information on important people (such as elders) and
organisations (such as other not-for-profit service providers or aboriginalowned businesses) with whom to establish networks
covering other relevant topics such as appropriate communication styles,
appropriate topics for conversation, myths and misconceptions, cultural
taboos or sensitivities, and gender roles (such as men's business and
women's business).
(Cited in Disability care and support, Productivity Commission Report,
2011, section 9)
In 2007, the Mental Health First Aid for Aboriginal and Torres Strait
Islander Program was launched. This 14 hour course runs with instructors
who are Aboriginal people with experience working with mental health
problems. The course materials were constructed with extensive input
from stakeholders in Aboriginal mental health. The materials include DVD’s
developed by and with Aboriginal people, and a manual containing
information that has been tailored to the needs of Aboriginal people,
particularly those living in rural and regional areas.
(Mental Health Foundation Australia, www.mhfa.com.au )
A further resource for training for disability service workers was published
by the Department for Human Services in Victoria in 2011, Enabling choice
for Aboriginal people living with disability: Promoting access and
inclusion ‘confirms the department’s commitment to improving the access
and participation of Aboriginal people with disability and their families.
The principles emphasise the importance of including Aboriginal people
with disability within policy development, planning and service delivery
considerations across all disability services, funded organisations and
providers.
The principles for practice are grouped around three key themes: culture
and community; individuals and families; and building organisational and
community capacity.
This resource is one tool that disability sector organisations and
practitioners can use to strengthen their response to Aboriginal people with
disability and their families, in providing services that:





are more culturally competent
recognise the complex social health challenges and disadvantage
experienced by many Aboriginal people
are developed through partnerships with Aboriginal communities and
organisations
use self-directed approaches that enable and support Aboriginal selfdetermination
involve Aboriginal people with disability themselves in naming problems as
well as shaping solutions.
During the development of this tool, direct feedback from Aboriginal people
reinforced that they want equal access to both universal and targeted
services. To support this, the principles are based on fundamental, goodpractice approaches that include:
o
o
o
o
o
o
building respectful relationships over time
information sharing and active listening
a whole-of-person approach
shared planning, inclusive of family and community
collaborative decision making
timely follow through.’
(Sourced from www.dhs.vic.gov.au )
Features of this manual include the Historical and cultural context;
Disability within the Aboriginal community; Aboriginal communitycontrolled organisations; Self-direction and self-determination; Principles
for practice; Becoming a culturally competent disability service.
An innovative approach to service delivery in a remote, regional location in
Kalgoorlie, Western Australia showed a unique approach to housing for a
group of young people with severe and profound disabilities.
Nulsen, a metropolitan agency, in partnership with Goldfields Individual
and Family Support Association (GIFSA) in Kalgoorlie undertook a
development to move people of Aboriginal descent from inappropriate
housing in nursing homes in Kalgoorlie to a purpose built group home with
funding support from the Young People in Residential Aged Care (YPRAC)
program of the Disability Services Commission. The Project Manager,
Caroline Watt was employed with a four and a half year grant to establish
the group home in conjunction with the Goldfields Individual and Family
Support Association (GIFSA).
Six people with severe and profound disabilities were to be housed in the
group home and all had Aboriginal heritage. An Aboriginal Reference
Group of elders and family members was formed to advise the project and
remain involved to this day. Caroline stressed the importance of
recognising that Aboriginal people have the expertise to exercise this role
and provide valuable advice about cultural matters, including
appropriateness of land and positioning of the group home.
After a long process of elimination, two blocks of land in a golfing estate
were purchased for the project by the Department of Housing and work on
the building began. The purchase of the land ensured a positive image for
the house in a culturally valued position. Design for the building was
sourced from the eastern states and building began.
An Aboriginal traineeship was secured to ensure some Aboriginal staff were
employed and funding was secured to employ an Aboriginal Liaison Officer.
Formal training was given to staff by specialist therapists and experienced
staff from Perth. Cultural training was sourced from local information and
on-going training was provided by video link-up with training programs
offered by Nulsen in Perth. Working with community services such as Silver
Chain and Kalgoorlie Hospital, the manager and liaison officer ensured that
specific health and management issues were understood.
When the house was completed, Aboriginal elders blessed the house and
work began to initiate the move. An arts grant was secured to employ a
local artist who assisted the residents to design and complete a large
artwork to hang in the new house. The art piece depicted the journey each
resident had taken to the house. Specifically designed furniture and
equipment was sourced from Perth and transported to Kalgoorlie.
Sustainability is an on-going issue and local specialist services such as
speech therapy, physiotherapy etc. need to be encouraged to work with the
residents.
Person centred planning was undertaken with each resident and quality of
life measures taken before the residents moved into the house. A further
measure will be taken after six months living in the group home and
reported on. This research has been undertaken from a source external
from Nulsen.
The partnership between Nulsen and GIFSA proved to be very successful
with Nulsen providing training, therapy and initial project management and
GIFSA being the service provider and responsible for the day to day service
provision. Nulsen won the recent Count Me In Award for Governance and
Leadership specifically for this partnership with GIFSA.
A particular strength of this project and an innovation which could be
transferred and used with the NDIS is to provide specialist training to
hospital and other existing services in rural and remote areas to assist
them to meet the needs of people with disability in their catchment areas.
Specialist training could be provided through existing disability support
services in metropolitan and regional areas. This would provide security
for those people living in rural and remote areas and reduce the need for
expensive travel.
Stopher and D’Antoine (2008) discussed the issues faced by Aboriginal
people accessing disability services, particularly in remote areas. They
recommended several solutions to the lack of specialist services in those
regions:
‘The Commission has been acutely aware of the difficulties of providing
specialist disability services to people living in rural and remote areas and
has sought to complement the state-wide Local Area Coordinator (LAC)
network with a range of strategies including:
1. funding and training family support services in rural and remote
areas to provide culturally responsive services and actively engage
Aboriginal people across their contracted geographical area;
2. adopting cross-agency approaches to service provision in remote
communities, for example funding Home and Community Care services to
provide additional specialist disability services;
3. employing Aboriginal workers in remote Aboriginal communities to
complement the visiting Local Area Coordinator service and to
provide respite and other services;
4. assisting with development of the Aboriginal therapy assistant
model to enable more effective provision and follow through of therapy to
remote communities which receive 6-weekly visits or less;
5. appointing Aboriginal staff in supervisory and local LAC positions in areas
of high Aboriginal density.’
1. The most effective way to improve access to services was found to be
taking a three pronged approach:
2. Services to employ Aboriginal people to encourage families to join
services.
3. Work in conjunction with Aboriginal workers employed by other
services, i.e. Aboriginal Outreach Workers.
4. Develop partnerships with Aboriginal groups and services for cooperation and referral.
Services can show a willingness to engage with Aboriginal people by
undertaking a Reconciliation Action Plan.
Reconciliation Action Plans are easily accessed and available to
organisations to assist them to consider their role in making services more
accessible.
‘Reconciliation Action Plans (RAPs) are about turning good intentions into
real actions. A RAP is a business plan that uses a holistic approach to create
meaningful relationships and sustainable opportunities for Aboriginal and
Torres Strait Islander Australians.
Since the launch of the RAP program over 300 Australian corporations,
governments and community organisations have joined the RAP community
and now 11 of Australia's top 20 businesses have RAPs.
We’ve found that by focusing on respect and relationships, sustainable
opportunities can be created. That’s the simple formula that makes our RAP
program so successful.
Since 2006 the RAP program has grown to include 300 organisations
ranging from big corporations to community groups and schools.
A RAP publicly formalises an organisation’s contribution to reconciliation
by identifying clear actions with realistic targets and is developed in
consultation with Aboriginal and Torres Strait Islander communities,
organisations and leaders.
RAPs are also about embedding cultural change within a whole organisation
through building good relationships, respecting the special contribution of
Aboriginal and Torres Strait Islander peoples, and creating opportunities.
We believe that strong relationships based on respect will lead to
opportunities for the organisation, and for Aboriginal and Torres Strait
Islander peoples.
Starting your RAP journey is easy. Simply register your details and
download the RAP toolkit.’
(Sourced from www.socialinclusion.gov.au/resources)
Seven Aboriginal people were interviewed in this project, four people
attending a celebration of the anniversary of the day of the “Apology”,
two workers in the health field and one outreach worker. Interestingly
the people interviewed stated that they had their services and did not
need to be included in generic services.
The two workers were employed in Bunbury, the nearest regional city and
both felt that there was a need for their services to work better with
generic services.
The results of these discussions begged the question whether Aboriginal
workers employed in generic services would be a better approach than
building separate services alongside government services. It would seem
that having separate Aboriginal services was again categorising people
and acting contrary to the aim of “Closing the Gap”.
Managers of generic disability services felt it was unfair of government
funding bodies to insist that they provide service to a percentage of
Aboriginal people when they funded segregated services in the same
geographical area for that purpose. Given the demography of the
research area, which showed a relatively low percentage of Aboriginal
people, the assumption that they would attend generic disability services
appeared to be unfounded.
Access to Services by People from Culturally and Linguistically
Diverse Backgrounds (CaLD)
The Australian Bureau of Statistics outlined the multicultural nature of the
Australian population from the 2011 Census as being ‘over a quarter (26%)
of Australia's population was born overseas and a further one fifth (20%)
had at least one overseas-born parent.’
www.abs.gov.au
The Australian Multicultural Advisory Council was officially launched by the
Minister for Immigration and Citizenship in December 2008. The role of the
Council was to ‘provide the Minister for Immigration and Citizenship and
the Parliamentary Secretary for Immigration and Multicultural Affairs with
advice on:




social cohesion issues relating to Australia's cultural and religious diversity
overcoming intolerance and racism in Australia
communicating the social and economic benefits of Australia's cultural
diversity to the broad community
issues relating to the social and civic participation of migrants in Australian
society.
On 30 April 2010, the Australian Multicultural Advisory Council (AMAC)
presented its advice and recommendations on cultural diversity policy to
government in a statement titled The People of Australia.
Sound policy rejects all measures that encourage long term dependence. It
assures all Australians of the same basic rights and in return for this
assurance, it demands that all who make their home here owe their loyalty
to this country and must respect the democratic rights and liberties of all
and uphold and obey the law. This is multiculturalism: the determined
efforts of government, with support from the wider community, to make
multicultural Australia fair and just, democratic, harmonious and
functional. Properly understood, multiculturalism can be seen as an
essential contribution to national prosperity and strength. In keeping with
this ambition, multiculturalism constitutes the nation’s resolve to provide
opportunity and security for every citizen, regardless of background,
culture, religion or gender; and to assure all who live here of the right to
live in keeping with their cultures and languages.’
(Downloaded from www.immi.gov.au )
The Council went on to recommend how the Australian Government should
proceed with policy and ensure that all Australians embrace
multiculturalism, particularly in programs and services:
‘The cultural, linguistic and religious diversity of Australia’s population
should not mean that programs and services are less accessible. It is the
duty of government to see that all citizens are able to participate in
programs and receive the services to which they are entitled, regardless of
their cultural background. Where programs and services are not being used
by Australians because of cultural or language difficulties, such programs
need to be delivered by organisations culturally and linguistically able to do
so. That is not a matter of providing an advantage not available to all
Australians, but rather ensuring that all Australians are treated equally.
The council recommends:
That neighbourhood and community organisations be encouraged and
resourced to provide greater opportunities for people of all backgrounds.’
(AMAC, 2010, recommendation 8)
The Australian Multicultural Advisory Council (AMAC) is an existing
resource that could be used to provide advice and input to the NDIS.
The relatively new inclusion of asylum seekers and refugees in the
multicultural mix of Australia presents new challenges for workers in
disability services. This applies in particular, to those who have been
exposed to trauma and/or torture. This will often materialise in poor
mental health and a variety of symptoms of mental illness. The Association
for Service to Torture and Trauma Survivors (ASeTTS) offers advice to
people working with refugees in the format of discussion papers. They
recommend that:
‘All survivors should be assessed for the risk of self-harm. Given the highly
traumatic backgrounds of many survivors surprisingly few people indicate
that they are at risk. However some of the newly arrived asylum
seekers are showing severe signs of stress and seem to be at greater risk of
self-harm, possibly for several reasons. Often the trauma is more recent;
the journey here has been hazardous; the detention experience
has often been traumatic; many asylum seekers do not know the
whereabouts or wellbeing of their family members and even if they do they
cannot apply for their family to join them; and they do not know about
their own future in Australia. All of these factors seem to make them more
vulnerable to mental health problems.
(Sourced from www.asetts.com.au
Working With People From Other Cultures)
Several issues particularly relevant to recently arrived refugees were
highlighted in mental health issues and strategies for specific cultural
groups produced by Mindmatters in their resource entitled Community
Matters (Draft2012).

Refugees and asylum seekers are at high risk of mental health problems as
a direct result of the refugee experience and displacement.

Trauma and loss may have profound and on-going effects on people who
migrate to Australia as refugees. They may experience post-traumatic
stress disorder, depression and chronic grief and manifest a variety of
severe symptoms.

Refugees face many obstacles in accessing treatment for psychological
trauma and mental illness in both the pre- and post-migration period. There
may be an absence of culturally, linguistically, and spiritually appropriate
means of addressing psychological and emotional pain.

Stressors experienced in the host country include: loss of family, friends
and possessions; poverty; and experiencing marginalisation and racism.

Experiences that exert a negative effect on children during war are: the
violent death of a parent, witnessing murders or torture of family members,
separation from family, migration, terrorist attacks, child soldier activity,
bombardments and shelling, physical injuries and famine.

One of the unique post-migration challenges faced by refugee children and
youth is differential rates of acculturation between themselves and other
members of their families.
(Downloaded from www.mindmatters.edu.au )
According to this resource, during the school years, children from diverse
backgrounds may be confronted by perceived differences from
the mainstream culture, by language difficulties and a range of issues
related to the cultural contexts of family life, education, and values about
child behaviour. Adolescents and young adults from diverse backgrounds
may experience heightened uncertainty related to cultural identity,
discrimination, peer relations, cultural views on sexuality and sexual
identity, work and family demands. This would appear to be the same for
adults arriving in a new country.
Therefore cultural tolerance and understanding is an important quality in
support workers who work with people living with a disability and their
carers. The following resources relate to developing these qualities.
Earley and Ang, 2003 introduced the concept of Cultural Intelligence in
their book of the same name. Cultural Intelligence is important for
disability workers to understand when working with people from CaLD
backgrounds.
‘Those with high cultural intelligence are attuned to the values, beliefs,
attitudes, and body language of people from different cultures; and they
use this knowledge to interact with empathy and understanding.’
(Cultural Intelligence, Earley and Ang, 2003)
People with high cultural intelligence are not experts in every culture;
rather, they use observation, empathy, and intelligence to read people and
situations, and to make informed decisions about why others are acting as
they are.
They also use cultural intelligence to monitor their own actions. Instead of
making quick judgments or relying on stereotypes, they observe what is
happening, and they adapt their own behaviour accordingly.
Anyone can improve their cultural intelligence. According to Dr David
Livermore, an expert on cultural intelligence and author of the 2011 book
The Cultural Intelligence Difference, there are four things that contribute
to it:
1.
2.
3.
4.
Drive.
Knowledge.
Strategy.
Action.
According to Livermore, you must develop each of these to be culturally
intelligent.
1. Drive
Drive is your motivation to learn about and adapt to a different culture.
People who aren't interested in what shapes a particular culture are unlikely
to adapt well to it.
But think of what happens when you make an effort to learn about this new
culture. Your mind is open, and, instead of seeing difference as a difficulty,
you see it as something that you want to learn about.
2. Knowledge
Cultural knowledge isn't about learning a new culture inside out. Rather, it
means learning about how culture in general shapes someone's behaviours,
values, and beliefs.
3. Strategy
The "strategy" component of cultural intelligence describes the (often
instinctive) planning that you do as a result of being culturally aware. It
involves taking what you have learned from being aware of cultural
differences, and making robust, culturally sensitive plans as a result.
4. Action
The last part of cultural intelligence relates to how you behave, and, in
particular, how well you adapt when things don't go according to plan.
Cross-cultural interactions won't always go smoothly, so it's helpful to be
able to think on your feet and to stay in control of your emotions.
(Sourced from www.mindtools.com )
Emotional intelligence is also a desirable quality for support workers, of
which empathy is a basic necessity. Empathy is the ability to identify with
and understand the wants, needs, and viewpoints of those around you.
People with empathy are good at recognizing the feelings of others, even
when those feelings may not be obvious. As a result, empathetic people are
usually excellent at managing relationships, listening, and relating to
others. They avoid stereotyping and judging too quickly, and they live their
lives in a very open, honest way. Empathy is an essential quality in support
workers who work with people living with disability and their carers, not to
be confused with sympathy which does not enable the worker to provide
the necessary supports.
According to Segal & Smith 2013, ‘emotional intelligence (EQ) is the ability
to identify, use, understand, and manage emotions in positive ways to
relieve stress, communicate effectively, empathize with others, overcome
challenges, and defuse conflict. Emotional intelligence impacts many
different aspects of your daily life, such as the way you behave and the way
you interact with others.
If you have a high emotional intelligence you are able to recognize your
own emotional state and the emotional states of others and engage with
people in a way that draws them to you. You can use this understanding of
emotions to relate better to other people, form healthier relationships,
achieve greater success at work, and lead a more fulfilling life.
Emotional intelligence consists of four attributes:



Self-awareness – You recognize your own emotions and how they affect
your thoughts and behaviour, know your strengths and weaknesses, and
have self-confidence.
Self-management – You’re able to control impulsive feelings and
behaviours, manage your emotions in healthy ways, take initiative, follow
through on commitments, and adapt to changing circumstances.
Social awareness – You can understand the emotions, needs, and concerns
of other people, pick up on emotional cues, feel comfortable socially, and
recognize the power dynamics in a group or organization.

Relationship management – You know how to develop and maintain good
relationships, communicate clearly, inspire and influence others, work well
in a team, and manage conflict.’
The authors also provide the Bringing Your Life Into Balance Toolkit which
has five sections to develop emotional intelligence and a section to help
workers apply the kit to help others.
(Downloaded from www.helpguide.org )
This would be a useful tool in training for support workers to develop their
own emotional intelligence, with possible application to assist the people
they work with. It becomes particularly important to recognise emotions in
other people when working with people from different cultures because
their reactions may be quite different from our culture.
The Disability Services Commission released a DVD resource in February,
2010 entitled Our Voices, Our Journeys which offers information for
people with disability and their carers from Cald backgrounds. The DVD
can be viewed in eight different languages and gives people information
about what services are available and where to find them.
If people from CaLD backgrounds need interpreter services these are
available by contacting the national Translating and Interpreter Service (TIS)
by telephone 131 450. Other contact details are available on
www.immi.gov.au under the help with English menu.
‘It is important that professional interpreters should be used wherever
there is a communication problem. Choosing an interpreter from the correct
language group, cultural identity, and gender is important. In
long-term work it is important to negotiate with TIS to have the same
interpreter each time, where possible, as it does make an impact on the
work.’
(Asetts Working with People From Other Cultures op cit)
In rural and regional areas people from CaLD not only experience the loss of
their own community, they also experience the added burden of travelling
long distances to access specialised services, increased cost of travel and
limited choice in local services. It will be important under the NDIS for all
services to be open and welcoming to people from CaLD by understanding
who is in their neighbourhood and using the resources available to train
staff accordingly.
Services where there is a high representation of a particular nationality
in their neighbourhood would be best to try engaging that particular
group by offering culturally appropriate supports and using volunteers
from the same nationality. Employment of staff from the cultural
background of a specific group could also encourage more use of service
by the same group.
Support groups built around particular cultures would encourage
volunteerism and benefit people with disability by giving a contact point
where support staff could be employed. Linking in to existing groups such
as the Men’s Shed project which has many branches, would provide a level
of support to someone interested in mixing with others who enjoy making
things. People interested in similar leisure activities often relate to each
other through the activity and tend to ignore or accept personal differences.
A normative approach to working with people with disability is essential to
encourage development of meaningful lifestyle patterns. Support workers
need to believe a person can participate and be included in community life
in order for them to support appropriately.
When working with people from CaLD backgrounds it is important to
include the whole family wherever possible. This will ensure that goals and
activities are culturally appropriate and acceptable to the family otherwise,
success will be impossible.
Building Community Capacity
Whilst not the focus of this work, it would be unrealistic to talk about the
role of people with disability, community and support services without
considering the role of the broader community. The need to build local
communities in a way that supports participation and inclusion of people
living with disability is inherent in the NDIS, otherwise people will remain
recipients of government funding and their lifestyles are unlikely to
improve.
The concept of building communities has been around for decades and
would be particularly useful in this instance. For example, the work of John
Kretzmann and John McKnight (1993) in their foundation publication
Building Communities from the Inside Out: A Path Toward Finding and
Mobilizing a Community’s Assets, is still well respected in the field and has
produced exciting results. They also have an extremely useful training
video: Kretzmann, John & McKnight, John, 1996, Mobilizing Community
Assets, The Video Training Program for Building
Communities from the Inside Out, produced by Civic Network Television,
distributed by ACTA Publications, 4848N. Clark Street, Chicago, Illinois,
60640.
Information about their publications and resources (including how to
order materials) can be found online at:
http://www.nwu.edu/IPR/abcd.html
Of particular interest to this project is the resource produced by the Latrobe
City and Monash University in Melbourne entitled Shifting focus:
alternative pathways for communities and economies.
(Sourced from www.abcdinstitute.org )
This comprehensive kit guides the reader through the structure of
community development based on the work of Kretzmann and McKnight
and gives real community examples of applications that have improved the
lives of disadvantaged people in several communities.
The following example gives a local perspective of one of the successful
projects achieved:
‘Beginnings
CERES (Centre for Education and Research into Environmental Strategies)
started in the late 1970s when a small group of volunteers were given
access to a disused seven-hectare tip site on the banks of the Merri Creek in
inner city Melbourne. The group started off by developing community
gardens with a no-dig garden method.
Community Activities
CERES now provides a range of activities and facilities that appeal to diverse
groups in the surrounding community. The original community gardens are
largely used by migrants from southern Europe. People interested in urban
sustainability participate in composting, recycling and permaculture.
School children are involved with the animal farm and educational centre.
Local residents care for the free-range chooks. People are encouraged to
build connections with each other and develop their own community
initiatives. The community gardeners, for example, have established their
own bocci court, while another group is building a sauna.
Economic Activities
CERES is a non-profit incorporated association characterised by diverse
economic practices. Commercial activities include a café, nursery
(specialising in permaculture and bush food) and educational programs.
These activities generate around 60 per cent of the $1.6 million annual
budget. Other funds come from government grants and sponsorship.
There are also non-commercial activities. The residents who tend the
chooks, for example, are “paid” in free-range eggs. Manure from the
chickens is used on the community gardens where people grow their own
food. People involved in the apiary make their own honey. CERES currently
employs fifteen people on a full-time basis and another 55 part-time.
Future Directions
CERES is continuing to develop the site for sustainable community and
economic activities. It has recently been selected as a demonstration
project by Australia’s Greenhouse Office.
Further Information
www.ceres.vic.edu.au 8 Lee Street, Brunswick, Victoria, 3057, Australia
Phone: 61 3 9387 4472 or 61 3 9387 2609
From a disused tip site to a $1.6 million community economic initiative
with a strong environmental commitment, this project is one example of
how a small beginning can lead to enormous benefit for people who were
considered disadvantaged. The purpose of including this example is to
highlight the need to think broadly of how people with disability, their
carers and friends could enhance their lifestyles in an inclusive
development.
A further resource to guide community development particularly in rural
and remote areas is The Organization of Hope: A Workbook for Rural
Asset-Based Community Development by Luther Snow (2001).
This workbook explores these questions: How do you build your rural
community from the inside out? How do you find and mobilize the assets of
your small town and rural area? It tells inspiring stories of rural
communities from across the countryside and covers points for getting
started, strategies for turning assets and hope into action and new
relationships, and practical examples of appropriate projects and methods
to consider in a rural community.
www.abcdinstitute.org
One method of developing local communities to be more inclusive in
Australia would be the involvement of local government authorities. The
closest level of government to the people, local government has already
shown a commitment to making buildings and their own services more
accessible to people with disability. Several state governments require local
government to design and report on Disability Access Plans which has
improved physical access considerably, it would be a simple process to
include social inclusion in these plans and encourage innovative responses.
To encourage and assist with this development, disability service providers
would need to develop sound relationships with their local government
authority and be prepared to share their knowledge and skills with local
government employees and the community at large.
Working groups including local government personnel and Councillors,
disability service providers, people from Aboriginal and CaLD backgrounds
could plan and instigate inclusive practices in their local area and publish
successful projects like the previous example to encourage others to take
up the challenge.
In Western Australia, the Disability Services Commission (DSC) provides
small grants to local government authorities (up to $50,000) to improve
inclusive practices and opportunities in their area.
‘Twenty local government authorities (LGAs) recently received funding of
up to $50,000 to implement initiatives to enhance inclusion and
participation for people with disability in their local communities over a
two-year period.
By following a four-stage partnership process, people with disability, their
families and carers will work closely with LGAs and the Disability Services
Commission to develop and implement their chosen initiative.
There are four stages:




Stage 1: reflecting on and assessing existing priority areas for connecting
people with disability in local contexts.
Stage 2: developing strong partnerships with key stakeholders, people with
disability and their carers to plan and develop a project.
Stage 3: the implementation stage of the project and the development of a
detailed project plan.
Stage 4: will provide LGAs and their partners an opportunity to showcase
key achievements and promote their initiative in the community.’
(Sourced from www.dsc.wa.gov.au )
This approach encourages development at the local level where people are
most likely to participate in their community. A similar approach within
the NDIS would allow people living with disability and their carers to have
more say in their local area.
Issues for Rural and Remote Areas
Transport
All managers interviewed for the project identified transport costs as a
major restriction in rural and remote areas as did people with disability and
carers.
One young lady living in supported accommodation, wished to pursue her
education and training towards a career in youth work. In order to achieve
her goal, the initial certificate she needed could be undertaken in Busselton.
However, for training in mental health (her particular interest) she needed
to travel to Bunbury a round trip of 106 kilometres. She then needed to
travel to Perth to complete training in Drug and Alcohol addiction a round
trip of 450 kilometres. This was an unrealistic journey for her given her
own disability and the lack of public transport available at the times she
needed to travel.
Given that this young lady wished to work and improve her own lifestyle,
support to study would need to be included in her package under the
NDIS and creative ways of supporting her sought. Temporary supported
accommodation for the term of her study in the relevant cities or
boarding with a host family would allow her access to the required study.
Service providers identified several issues involving transport, as did
people with disability and carers, these were:

The higher cost of petrol in country areas;





The need to travel to capital cities for specialist services;
The particularly high cost of running modified vehicles;
The cost of purchasing and maintaining vehicles;
The need to replace vehicles regularly when they were often used to travel
on unsealed roads;
The cost of Chief Executive Officers and managers attending meetings and
information sessions in capital cities (particularly government meetings).
Carers found it particularly difficult to travel to Perth for information
sessions and consultations held by governments, both state and federal.
One carer indicated her dissatisfaction by saying “we are fed up with the
same old meetings and consultations, when will the data and information
collection end and our voices be heard?” ”It is time governments got on with
the job and acted out the rhetoric”. This person was impressed with the
content of the NDIS but felt it was sad that Western Australia couldn’t be
involved from the start. She felt that there were so many positive examples
from the Local Area Co-Ordination model it was time they were used
elsewhere.
Overcoming the issue of transport in rural and remote areas requires a
financial commitment such as improved public transport, roads and rail
services.
The fuel card offers some relief to families who are eligible but $500 per
year does little to assist if regular visits to capital cities are needed. The
fuel card could also be provided to service providers to ease the cost of
transport where it is used to provide direct individual service.
Service providers need some assurance that their workers will have access
to vehicles to provide support. ”It is unrealistic to expect support workers to
use their own vehicles on unsealed roads and to carry wheelchairs which can
cause irreparable damage”. (disability service provider in Busselton, 2013)
An innovative Western Australian program used to overcome transport
difficulties was ‘Get Around’. The program was set up as an incorporated
body to provide people with disability with vehicles which were purchased
at fleet discount and free of sales tax. This gave the person with a disability
a vehicle which suited their individual needs at a reduced cost. The vehicle
could then be used by carers and support workers to transport the person if
they were unable to drive. The program no longer exists for two reasons,
firstly GST was introduced and sales tax was removed from vehicles. Under
the GST system the organisation was unable to claim the tax back so the
price of vehicles rose by 10%. Secondly, public servants in the disability
area objected to people being provided with their own vehicle without
paying the tax.
Allowing people with disability to purchase their own vehicle through an
organisation would reduce the cost of the vehicle by allowing the
organisation to pass on the benefits of fleet discount and refunding the
GST.
One of the carers interviewed expressed the view that her son was only able
to participate in local activities (which he did five days a week), because a
local disability service was able to pick him up and support him. This carer
was particularly interested in the NDIS because her son currently received
funding under My Way and was able to purchase support under a shared
management scheme through a local disability service provider. The family
had a life plan for her son to move to the Northern Territory to live with
one of his brothers if either parent passed away or they were not able to
continue with their support. The father had dementia and the mother
provided care for him and their son. The appeal of the NDIS was the
transportability in the event of the parents no longer being able to provide
support.
Technology offers solutions also with video broadcasting of meetings and
information sessions. Webinars are another useful tool for training.
However, in Busselton there are still issues with drop out on the internet
and power cuts are a frequent occurrence.
The tyranny of distance could also be overcome by training existing
services such as Silver Chain, hospitals, schools and higher education
facilities to provide more specialised services suitable for people with
disability in their region.
Lack of Services
Most participants in the project identified the lack of services to choose
from in rural and remote areas, particularly specialist services. Although
this situation has improved in the medical field with specialist doctors
visiting the region from Perth; “therapy and mental health services were still
thin on the ground”, according to participants.
Carers pointed to the lack of opportunities for respite from their caring role
and the need to ‘take time out’ to keep going.
Local government should be more engaged to examine their own areas and
assess their ability to provide more assistance to people with disability and
carers. Local committees (as previously discussed) could provide
meaningful input to how to change services to make them more inclusive.
Local community development could overcome many issues for people in
rural and remote areas.
Partnerships with existing disability service providers offer a two way
benefit and enhance the service provided to the person with a disability or
carer. When partnerships are fostered successfully a transfer of learning
will occur naturally between staff from both organisations.
Disability service providers need to engage with local committees and
encourage their service users to become involved in local activities rather
than having to travel long distances.
State and Federal Governments need to acknowledge the cost of
transportation and realise the difference for rural and regional based
services, people with disability and carers is an additional barrier.
The Limitation of Time
Western Australia and Queensland in particular constantly need to be aware
of time differences. In summer there can be as much time difference as
three hours between states, this needs to be taken into account whenever
information is being sought from other states. Funding bodies often do not
recognise this limitation.
For people living in rural and remote areas, to undertake something as
simple as going to the doctor or visiting a therapist can be unrealistically
time consuming. Particularly when services are developed regionally and
do not provide outreach to other cities and towns in the region.
Lack of Choices in Community Opportunities
Limited choice often restricted inclusion in community activities. A person
interviewed in the project who lived in Dunsborough expressed her
frustration with needing to swim to improve her physical activity.
Recommended by her doctor, swimming was seen as necessary to improve
her fitness and maintain flexibility. However, the nearest swimming pool
was 24 kilometres away in Busselton. Bus services only ran twice a day and
the walk from the bus stop to the swimming pool was beyond her ability.
Resistance to including people with disability was also seen as a limitation
by three people interviewed. This was particularly experienced in
community art classes and yoga.
Inclusion WA offers education to sporting clubs wishing to include people
with disability as do many other organisations in other states.
Supporting this work and increasing the spread of inclusive practice
promotion could enhance the opportunities in rural and remote areas.
Community education was seen as a solution to this aspect of limitation.
The NDIS was seen as an ideal opportunity to publicise inclusion and
promote more welcoming communities.
A mother who raised her son who had an intellectual disability in a rural
area stressed the importance of socialisation in the teen years and related
that she could not get any support in those years to employ support
workers. She saw a real benefit in the NDIS to support these developmental
years and encourage socialisation with peers. Her son who is now in his
fifties enjoys participating in daily activities through a local disability
support service funded by an individual budget from My Way.
Discussing the future and the NDIS this person expressed the view that “if
it’s not broken don’t try to fix it”. She was happy with individual funding
through My Way and felt that she would want to maintain the same services
she already had when the NDIS began in this state.
Fewer opportunities for part time work exist in rural areas for someone who
uses a wheelchair.
Another interviewee who was a single parent with a seven year old boy had
recently been told by Centrelink that her benefits would be reduced by $60
per week when her son turned eight. She could not see any possibilities for
working with her disability and was deeply concerned about the loss of
income.
Support workers play an important part in developing community
connections for people with disability. It is not enough to take people
along to visit community activities it is important to support meaningful
connections.
An important skill for support workers is the ability to introduce people
to community activities to enable the opportunity for a broad array of
people to make connections and be involved in the lives of people with
disability, including through casual acquaintance and mentoring.
Local community connecting should be a part of every support workers
job description.
Mentoring can be a useful tool usually based around a particular interest or
activity. For example, a wood turners club will happily include someone
with a disability if they are interested in learning or have previously be
involved with woodwork. It just needs someone to ask and to assure the
club that the person wants to be included.
Planned Individual Networks Inc. (PIN) provides a service to parents who
wish to secure the future of their offspring with disabilities. The
organisation provides a facilitator at $35 per hour for 4-6 hours per month
to build and maintain a network of support around the person with
disabilities.
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Australian Bureau of Statistics (ABS) 2012b Census of Population and
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Australian Bureau of Statistics, Cultural Diversity in Australia: Reflecting a
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Bay of Isles Community Outreach (BOICO) 2013 Creating your own Wellness
Recovery Action Plan (WRAP) unpublished.
Department of Human Services Victoria 2011, Enabling choice for Aboriginal
people living with disability: Promoting access and inclusion, Government of
Victoria.
Department of Human Services Victoria 2012, Supporting Decision Making A
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Disability Services Commission 2011/2012 Annual Report, Western
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Disability Services Commission, Disability Health Check, 2007 Disability
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Earley, C.P. and Ang, S 2003, Cultural Intelligence, Individual Interaction
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Etmanski, A et al 2008, Safe & Secure Six Steps to Creating a Good Life for
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Appendix A
Categories of Care for People with Mental Illness
Living in The
Community
Access and ability to build
and maintain meaningful
relationships in community
Identified formal and informal
supports
Capacity to maintain existing
living skills and develop new
skills
Ability to sustain daily
activities for day to day living
Individual
characteristics
Current mental health
status
Impact of mental illness on
individuals functionality
Commitment to engage
support:
Decision making capacity
Risk to self / others or
environment
General Health Issues
Medication/treatments
Clinical specialist supports
Independence level of
individual
Low support
 Access to general community with
no or limited assistance. Can and
will use public transport and has
well developed communication
skills.
 Ability to make new acquaintances
and maintain established
friendships. Able to resolve issues
as they arise with minimal support.
 Will requires access to small
amounts of support , both direct
(person to person) and indirect
(telephone contact or email).
 Can require support at specific
times.
 Individual already has the
necessary skills for living in the
community. Capacity to develop
new skills with limited instruction or
support .
 Able to live independently at home,
engage with community with a high
degree of autonomy provided that
limited supports and assistance are
available if required.
 Individual has ability to live
independently, requiring some
prompts to assist with everyday
living activities such as, cooking,
cleaning, budgets,
relationships/friendship circles,
education, work and self-care.
 Mental health stable or improving.
Sound recovery focus
 Mental illness has a low impact on
the person’s functioning
 Desire to engage in support.
 Capacity to make all or most
personal judgements or decisions.
Has control of all or most decisions
around lifestyle and finances
 Minimal risk to self or others.
 General health is adequate with
minimal identified significant health
 Compliant with medications and
treatments
 Diagnosed mental illness requires
limited and/or intermittent support
from clinical specialist services.
 Individual has high levels of
personal independence either all/or
most of the time.
Medium support
 Will access the community but, experiences varying
levels of discomfort in unfamiliar environments.
 Requires some support with developing and
maintaining day to day connections in their local
community.
 No public transport available.
 At times of heightened difficulty will require access to
personal assistant or other supports with limited/short
notice. This may include telephone contact and/or
one-on-one personal contact.
 Times and duration of support can vary over a 24 hour
period.
 Some existing informal/formal supports
 Requires regular motivation and encouragement to
engage in day to day activities. Support to assist with
new activities and to develop new skills.
 Identified areas of support with structuring majority of
tasks such as personal care, budgets, home care,
community connections, relationships, hobbies and
club/group attendances, holidays and education
 Requires varying levels of support, prompting and
motivation to engage in some or all every day
activities.

Mental health stable or improving.



Mental illness of the individual has
moderate levels of functional impact.
Able to engage with supports with assistance.

Capacity to make some major personal judgements
and decisions.


intermittent but predictable risk minimal to self or
others
Minimal or reduced significant health issues.

Low level adherence issues.

Requires some ongoing input from clinical specialist
support services.

High to moderate levels of personal independence
most of the time.
Living in The
community
cess and ability to build
and maintain meaningful
relationships in
community
Identified formal and
informal supports
Capacity to maintain
existing living skills and
develop new skills
Ability to sustain daily
activities for day to day
living
High support
Very High support
 Unlikely to use or comprehend public
transport services, requires some
transport assistance.
 Requires assistance to build and maintain
community connections and relationships.
 Requires ongoing support to access
opportunities for personal assistance.
Including telephone contact with the added
opportunity for personal attendance by a
Recovery support worker on a regular
basis
 Support may need to be available to assist
or intervene at short notice or as required.
 Limited current / previous, or potential
informal and/or formal supports – could
have burnt bridges.
 Requires significant support and
mentoring to attempt new things as well
as to maintain previously developed skills.
 Supports provided spend significant part of
each day interacting with the individual
around specific activities. Such as,
ensuring their living environment is
maintained and access to general
community resources and activities are
provided.
 Poorly developed daily living skills.
 High likelihood of needing assistance with transport to
access community activities.
 Likely to need significant support and assistance to
participate in community due to challenging and
complex needs.
 Likely to require extensive personal assistance and
highly structured regular and frequent support.
 A controlled environment or structured intervention
may be required at times.
 May have existing informal and/or formal supports but
requires assistance to maintain positive relationships.
 Likely to have no/few current informal or formal
supports – may have previously burnt bridges
Individual characteristics
Current mental health  Fluctuating periods of stable mental
health.
status
 Moderate to significant impact from mental
Impact of mental
illness on the individuals capacity to
illness on individuals
function well on a daily basis
functionality
Commitment to
engage support:
Decision making
capacity
Risk to self / others or
environment
General Health
Issues
Medication/treatments
Clinical specialist
supports
Independence level
of individual
 Commitment to engage with support and
assistance varies
 Reduced capacity to input and make major
decisions on daily activities, events and
needs.
 May have some history of risk to self or
others.
 Identified some ongoing health issues.
 May have some medication adherence
issues. May not understand significance of
medication compliancy.
 Episodic nature of mental illness likely to
require regular engagement with clinical
specialist supports/services.
 Individual has some levels of personal
independence
 Will require significant support to attempt new things
as well as to maintain previously developed skills
 Likely to need assistance in addressing personal
needs, day to day activities
 Complexity of behavior may require additional support
specifically tailored to the individual.
 Will require assistance to develop and maintain daily
living skills.
 Poorly developed daily living skills.
 Regular/increasing periods of unstable mental health.
 High levels of psychiatric disability impacting on
individuals capacity to function well on a daily basis
 Lacks insight and ability to engaging in support. High
levels of assistance required to maintain any
engagement.
 Limited/absent functioning capacity for
judgment/decision making.
 History of aggression/violence/harm to self or others.
 Identified high level of ongoing health issues.
 Lack of compliance, insight and ability to maintain
medication adherence.
 Significant contact and ongoing clinical support
required. Individual requires complex care support
 Levels of personal independence limited, requiring
ongoing community support
Appendix B
Acknowledgements
We would like to thank the following people for their opinions and honest
input to this project:
Management and staff of Lamp Inc.
Management and staff of Enable Inc.
Management and staff of InteWork Inc.
WA Individualised Services Inc.
Planned Individual Networks Inc.
Vincent Care Inc.
Bay of Isles Community Outreach Inc.
Management and staff of Community First Inc.
GP Down South
Inclusion WA Inc.
My Place
Perth Home Care Services
South West Aboriginal Mental Health Services
Busselton Local Area Co-Ordinators
Those people with disability and carers who agreed to be interviewed but
preferred not to be named.
The many support workers who made time in their busy working days.
Those people who diligently reviewed the paper and added their many
years of experience.