How appropriate are independent allied health providers in conducting the proposed independent NDIS assessments? Not very, writes Claire Salter Parry.
The federal government recently announced it has put a pause on its controversial proposal for independent assessments under the NDIS , but the question remains fraught.
Independent assessment can ethically compromise clinicians and result in prospective or current NDIS clients not having their full needs addressed.
A holistic and person-centred approach to allied health service delivery requires a complete understanding of the clients’ needs, history, environment, support network, in order to effectively and genuinely support a client and empower them with the tools, support, and services they need to lead fulfilling lives. to live their lives. This simply is not achievable when the original assessment process itself is ineffective.
The proposed changes will lead to a narrow and skewed view of clients’ needs.
The pilot phase of independent assessments saw single allied health professionals responsible for the full assessment of a client. For example, a speech pathologist could have been charged with not only looking at the communication and swallowing abilities and limitations of a client, but also their mobility, capacity to do self care tasks, and mental health.
Concerningly, the latter aspects are outside the scope of a speech pathologist’s role and field of expertise.
Consequently, to put speech pathologists in a position where they would need to do assessments under these conditions, would go against the Speech Pathology Australia’s code of ethics, which states that speech pathologists:
- Recognise our competence (scope of our education, training, and experience) and do not practice beyond these limits
- Represent our professional qualifications, experience, and standards accurately and fairly
- Exercise independent professional judgment when we provide professional service
By having allied health professionals assess someone’s capacity in facets that are not their area of expertise, they are likely not able to give more than a layperson’s perspective of that aspect of functioning.
Simply put, a speech pathologist is not going to be able to determine whether a client’s toileting habits and routines are typical or of concern any more than an accountant.
While this is merely an example of one profession, the proposed changes mean every assessment and NDIS client will be exposed to the same level of risk in inaccuracy and incompletion of a proper assessment of their broad needs.
We need approaches based on both professional advice and people with lived experiences with disability
It is not unreasonable to have qualified and appropriately experienced allied health professionals conducting assessments for the NDIS, but a multi-disciplinary approach is required to conduct a fair and thorough assessment by people with the appropriate range of skills.
The current assessment tool being touted, although developed for both clinical and policy contexts, was not developed with the aim of determining a comprehensive picture of a person’s abilities, nor with the purpose of calculating the amount of support for which a person should be eligible.
As the NDIA continues to iterate and look for ways to improve the efficiency of how the NDIS is made available across the country, regular consultation with both allied health professionals, the disability community, and people with lived experiences with disability are critical to ensuring further billions of dollars are not wasted through excessive under-utilisation of the NDIS while, most importantly, clients receive the full care they need.
Current approaches to fairness and equity are only the tip of the iceberg. We need to aim higher
Whilst the payment of assessments by the NDIS is commendable, if this decision is based on fairness and equity, the assessment process itself must also be fair and equitable and not put allied health professionals in a position where they feel compromised or that they are acting against the codes of conduct upheld by their professional associations.
Clients need to be front and centre of how services are designed and made accessible across the country. This includes consulting with experts and clients based in rural and remote regions, from different cultural and religious backgrounds, from First Nations Indigenous communities, and from various socioeconomic circumstances.
There cannot be a ‘one-size-fits-all’ approach to addressing the needs of people with disability, and having blanket rules for time limits on assessments, who can and cannot conduct an assessment, and the format in which questions are asked will only lead to significant portions of Australians being left behind.
Claire Salter Parry is Clinical Services Manager at Umbo