Effectiveness of Individual Funding Approaches for Disability Support (original) (raw)

2010, SSRN Electronic Journal

This report, by the Social Policy Research Centre (SPRC), examined the effectiveness of individual funding of disability support and aimed to inform policy to improve the provision of disability support. The study was commissioned by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA). The research methodology included a literature review; secondary data analysis of the Commonwealth State Territory Disability Agreement (CSTDA) National Minimum Data Set (NMDS); interviews with policy officials from all states and territories; case studies with 10 disability service providers, involving interviews with people with disabilities and staff; and questionnaires for people with disabilities and service providers. Use of individual funding Individual funding is defined in this report as a portable package of funds allocated for a particular person that facilitates control over how they purchase their disability support needs. The way individual funding is organised varies in relation to who holds the funds, which parts of it are portable and what disability support types it can be spent on from which parts of the market. The profiles from the CSTDA and surveys show that individual funding is more likely to be used by people of working age with low support needs, by male and non-Indigenous service users, by people with one disability and by people without informal care networks. This applies across disability types and disability support services. Although disability employment service users are classified as receiving individualised funding in CSTDA data, the type of individualised funding for disability employment services does not fall within the scope of the definition used for this research. 1 This should be taken into account when viewing the results of the CSTDA NMDS analysis. Individual funding in the states and territories Australian government disability agencies demonstrate a growing policy interest in individual funding and self-directed approaches. They are developing policies and guidelines, extending pilots, introducing and refining models and conducting evaluations to better understand consumer outcomes. The dominant approach to individual funding in Australia is a portable individual funding package held by a service provider, except in Western Australia (WA), which has a longer history of individual funding and use of direct funding. Jurisdictions are aiming to offer a continuum of individual funding approaches, with varying levels of control and choice for the person. Such a mix of approaches requires a diversified, viable disability support sector to offer support options that include informal, formal, specialised, general and professional support, with a range of consumer control. Managing effective approaches to individual funding Person-centred disability support Policy officials, service providers, people with disabilities and their family members agreed that, overall, individual funding in Australia facilitates control and choice in support provision. Mechanisms for facilitating consumer preferences include individual needs assessments, planning and goal setting processes, as well as flexibility in how funds are spent. These mechanisms are often successfully employed. Achieving flexibility, choice and control depends to some extent on the type of individual funding. Packages that are managed by the person with a disability, their family or a facilitator and that can be spent in the EFFECTIvENESS OF INdIvIdUAL FUNdINg AppROAChES FOR dISAbILITy SUppORT vi Occasional paper No. 29 open market, can generally be tailored more easily towards the consumer's preferences than more restrictive packages or those that must be spent through a single service provider. Opportunities to support people with significant cognitive disabilities to exercise their preferences are often more limited. Most commonly, family members, friends or informal carers (if they are available) assist with interpreting their needs. The level of funding provided through individual packages is generally not sufficient for these people to live independently. Support according to capacity and vulnerability Government and advocacy organisations are the main providers of information about individual funding options. Service providers give ongoing information to existing individual funding clients through planning and reviews. Service providers support choice and decision making by involving family and friends in support planning. Some people with disabilities and their families who manage individual funding in the open market reported that they do not have sufficient information to help them manage their individual funding. Administrative systems to support management responsibilities Government and service providers assist people and families to manage the funds, through mechanisms such as providing information and training to people with disabilities and WA's Local Area Coordination. Some people with disabilities receiving direct payments said they lack sufficient administrative support. EFFECTIvENESS OF INdIvIdUAL FUNdINg AppROAChES FOR dISAbILITy SUppORT viii Occasional paper No. 29 Outcomes of individual funding The outcomes data compared people's experiences before and while using individual funding; outcomes for people with disabilities who have individual funding with the outcomes for people whose disability support is organised in other ways; and an Australian population norm for personal wellbeing. Most people using individual funding experienced personal wellbeing, and physical and mental health at levels similar to both the Australian population norm and the Victorian norm of people with intellectual disabilities. In the interviews, they attributed these positive results to the better control they have over the way they organise their disability support. Using a standard measure of personal wellbeing, scores on all domains (standard of living, achievement in life, personal relationships, personal safety, community connectedness) were similar or higher than the scores for the broader Australian population, except for personal health and future security. The scores of people using individual funding were also higher than normative data for Victorians with intellectual disabilities in the domains of personal health, achievement in life and personal safety, but lower in personal relationships, community connectedness and future security. People with disabilities and their families also commented on how changing to individual funding had improved the wellbeing of family members because they could share the responsibilities. They were worried about what would happen in the future when the family members could not help manage the individual funding. Most people were happy with their social relationships and community participation. Service providers attributed this to the whole-of-life approach they can take providing support for people with disabilities who have individual funding compared to disability support clients who have other arrangements. The type and amount of individual funding used by people with disabilities sometimes limited the contribution individual funding could make to their social participation. For example, if it was support restricted to economic activity, the person could not use support workers to attend social events. All respondents said that individual funding had improved their control, choice, independence and self-determination in their lives. possible limitations of the primary data Possible limitations to the primary data collection were addressed using mixed methods, including validated scales in the instruments, and incorporating advice from people with disabilities, families and providers through piloting and draft versions. The survey response rates from people with disabilities and service providers were approximately 50 per cent. While the response rate and sample sizes are acceptable for this analysis, the sample sizes may decrease the generalisability of the conclusions. Using proxy interviews and questionnaire completion with family members instead of people with disabilities where cognitive impairment presented a problem to communication enabled contribution of information about these people's experiences. The proxy views might compromise the validity of the data collected. Using simplified scales in the easy English survey for people with disabilities enabled participation by people for whom the full scale might have been too complex. A possible limitation is that scales with fewer points can have lower sensitivity compared with full point scales. Comparison data about the experiences of outcomes and risks of people with disabilities who do not use individual funding was available from two sources: asking service providers to compare support they provide to people organised through individual funding with support organised in other ways; and asking the people with disabilities to compare their current individual funding support service experience to their support service experience prior to individual funding. A control group was not included. Conclusions drawn from comparing people receiving support organised through individual funding to people receiving support organised in other ways should be read with this analysis framework in mind.