Accepting referrals in the NDIS

By March 4, 2020Blog

In this blog we’re looking at the process of accepting new participants into your support coordination service. The support coordination market is growing up. More than ever, participants should expect providers to have the skills, experience and confidence to provide relevant and value for money support coordination.

Service providers are starting to show increased sophistication in how they consider taking on new participant business. Below we will look at where we’ve been and where we are going.

Where we started: Providers taking on all referrals

As the NDIS started to transition into each new region across the country, many support coordination service providers accepted all referrals, regardless of the participant’s circumstances or the number of hours funded to provide the service.

This was largely due to:

“Start-up” realities

  • As newly established services, support coordination providers needed to put staff on the ground and needed to rapidly increase revenue in order to minimise upfront overheads. As a result, service providers were not selective about which participants they took on.

Funding uncertainty & inconsistency

  • Limited information about how much demand there would be for support coordination services. Support coordination was inconsistently funded around the country, in terms of hours and frequency on a participant’s plan.
  • In addition, the NDIA seemed reluctant or unable to frame the size of the long term market beyond signalling that support coordination was not an “ongoing service”.
  • These factors made service providers reluctant to invest in and plan for the long term, and made short term gains a priority.

Lack of insight regarding the nature of Support Coordination

  • As a new service type, little was known about support coordination as the NDIA was not clear about their expectations, especially around managing risk and crisis situations.
  • Many service providers were yet to know their unique strengths in the market, and differentiation between providers was limited.
  • In new NDIA Regions the early leaders in support coordination were those who were quick to the market and had capacity. The ability to take on participants was seen as a key indicator of support coordination quality.

Limited information was shared about the person seeking Support Coordination

  • Support Coordination providers often had extremely limited information about participants seeking support, because the NDIA’s Request for Service process was inconsistently followed.
  • It was difficult to understand the nature of the request, and easy for providers to assume they had the capacity and skill to work with the participant only to later realise the situation was way more complex.

Increasing specialisation among SC providers

Let’s move forward several years to the present day. Most support coordination service providers now have significant experience on the ground and more confidence about the ongoing demand for their service.  They can also clearly see the impact different referrals have had on their organisations, and the risks involved with accepting a referral which has not been adequately funded and limits them from providing a quality service.

This has resulted in increased specialisation among support coordination service providers.

Specialisation may be focused around:

  • participants with specific disabilities e.g. participants with psychosocial disability, intellectual disability, spinal cord injury
  • service-related specialisation e.g. Supported Independent Living (SIL), Specialist Disability Accommodation (SDA), or Assistive Technology
  • outcome focus e.g. getting a job, leaving hospital or nursing care, collaboration with specific mainstream providers such as corrections or child protection
  • age demographics e.g. early childhood, transition from school, ageing
  • a specific cultural and/or linguistic group
  • willingness and expertise to work in complex and high-risk circumstances e.g. complex behaviour support, corrections/justice, complex mental health support, trauma, high medical support needs

Increased specialisation allows for a concentration of expertise and strengths that are better tailored to each participant’s specific circumstances. In theory, this should increase the overall quality of support coordination services and in practice so far, this is likely to have occurred.

However, there are natural limits to how far specialisation is likely to progress across the market. Participants have diverse goals, characteristics and social circumstances that change over time. Most participants are likely to want providers who can offer flexible services that can evolve over time and are not too tightly constrained by excessive specialisation.

To accept or to not accept a request for service

There are a number of processes which you can put in place to support better decision making about when to accept requests for service:

Clearly define your “need to know” information

  • Develop a checklist of the minimum information set you need in a Request for Service to ensure you can accurately assess suitability. This will ensure that you know when to request additional detail from the NDIA and/or the participant.

Map your strengths and your target market

  • You need to be sure you have the skills to deliver the requested service. Clearly map the specific services you can offer and who you can confidently work with and have a process for assessing new requests to ensure good fit with your strengths.

Clarify what you consider acceptable and unacceptable risk

  • Service providers need to consider many components of risk from multiple perspectives. As a starting point, you need to consider risk to the client, risk if complex work is delivered by people without the required skills, support risk when funded support coordination hours are inadequate, and risk of harm to staff. Be explicit about what risks you are equipped to effectively manage and be prepared to only provide a service within these parameters.

Establish a procedure for assessing whether hours on the plan are adequate

  • Taking on participants with inadequate hours funded for the support they need can present high risks for both them and you. Considering whether you can achieve outcomes effectively needs to be part of the process of assessing each request.
  • If hours are inadequate you might refuse the request or provide evidence to the NDIA about why additional support coordination hours are required, based on the high level of complexity and situational context of the request.

Define your service footprint and process for assessing new business from scheduling and efficiency perspectives

  • The location of the participant is a key consideration for a Support Coordinator’s productivity and ability to provide value for money around travel charges. Do you already see other participants in this locality? Is it an area you want to source more work in?

Be clear about your cultural awareness and skills

  • Recognise that providing culturally relevant support is essential and have a clear understanding of the strengths of your support coordinators. Undertake relevant training and research if you need to expand your skills to support people effectively and respectfully.

Implement an effective caseload and capacity rating process to understand your organisational capacity

  • You need to continually understand the capacity of each support coordinator to take on new participants. Caseload numbers alone are not effective because the hours needed by each participant are different and fluctuate across the year.
  • It can be useful to rate intensity/complexity for each participant in a support coordinator’s caseload (e.g. 1 – for low, 2 – for medium and 3 – for high intensity) to determine the time a support coordinator needs per week to provide a high-quality service to a participant.
  • This can be rated for the current week and predicted for the next 4 or 6 weeks
  • This can provide a system for understanding how many hours a support coordinator has available over coming weeks for new participants, not just how many participants they are working with.

As you can see, there are numerous factors that sophisticated providers consider when making a decision of when to accept or not to accept a request.  Having clear processes in place ensures support coordination service providers only accept referrals when they can confidently offer a high-quality service that aligns with their business priorities.  Having these processes in place can only lead to better outcomes for service providers and NDIS participants.

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