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NexttGet More Out of Life - The Journey Home

April 2020

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Background & context

● In October 2018, DHHS approached Nextt to support the transition of 22 SIL clients with ASD and

Intellectual Disability. Their provider was a “provider of last resort” to clients with complex needs.

● In November, DHHS and Nextt engaged Lancaster Consulting to perform an independent clinical

review of each client to assess key risks, optimal service levels and to evidence support needs.

● In late January Nextt transitioned all staff and clients across after a 6-week project, whilst

maintaining existing service levels.

● Over the next 12 months we worked with clients and families to renew all SIL plans with the NDIS,

and make a number of practice improvements based on the Lancaster Reports.

This presentation summarises our mistakes and successes along the journey, what we learned from it

and how we improved our clients quality of life. We recognise that we still have much further to go!

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What we learned (i)1. Independent review before transition provided an invaluable starting point

○ The review of each client’s needs provided an independent baseline of client capacity and needs, including

behaviours of concern, and what was needed to improve quality of life. This also provided an environmental

review of the homes, and assessment of client compatibility within each home.

○ What we learned: we learned the value of a structured clinical review, and established our own clinical Quality &

Risk Panel comprised of Allied Health Practitioners and specialists. This Panel conducts an independent

assessment as part of our onboarding process for all SIL clients. This year we supported another 20 individuals

with complex needs to successfully transition to their tailored SIL option with Nextt.

2. We underestimated administration, funding and compliance requirements

○ Clients with complex needs have complicated NDIS plans and a wide range of stakeholders to engage. The time

and effort to manage this was much more than we expected. For example, the work to update, roster and renew

SIL plans, required a dedicated team working over 12 months - we had planned for 3 months!

○ What we learned: We have centralised our SIL rostering and quoting processes, to ensure our clients have

sufficient funding for sustainable, quality service delivery. This also frees up our front line managers and staff to

focus more on quality service and practice improvements, rather than administration.

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What we learned (ii)3. Staff culture is critical for quality service delivery

○ Our staff were loyal and dedicated to supporting the clients, but were delivering more “passive care” within the

homes, and were reluctant to report non-critical incidents and issues.

○ What we learned: we recognised that culture permeated from operational leadership, so we reviewed /changed

this team to ensure strong advocacy for evidence based and person-centred practice. We are also investing

heavily in a new Learning & Development Platform to deliver all support staff training in foundational skills, person-

centred active supports, positive behaviour support, and a culture of open reporting and celebrating success.

4. We were missing an important function to translate therapy recommendations into practice

○ On transition, we found that each of our clients had a pile of therapist reports which were gathering dust and not

being translated into their daily supports because staff did not understand them or know how to action them.

○ What we learned: we recognised the need for a new Practice Leader role, tasked with translating therapist

recommendations into clear and simple instructions for support staff, as well as providing structured coaching

and reflective practice sessions for House Leaders and teams to ensure accountable and evidence based

supports. This has become one of the central tenants of our SIL quality model.

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ResultsGrowing participation with active supportRicardo is a young man who had previously been know as someone

who ‘liked to sit and watch others’ and would often decline to

participate in the more physical activities with his housemates.

His support team worked closely with external therapists to think

more broadly about his interest and goals and how to engage him in

active supports.

Staff supported him to try new things he had never done before. Turns

out Ricardo is an amazing artist and he is now creating paintings to

share with his family and decorate around his home!

Ricardo is now participating more actively and staff are supporting

him to look at other interests. He has been learning to bake and is now

also in charge of feeding the chickens in the garden.Please note: we have changed names and altered photos to protect our client’s privacy

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ResultsEngagement through tailored skill buildingPatrick was living with 4 others, whom he had not chosen to live with and who all

presented with behaviour of concern. He had high levels of anxiety, was

reluctant to engage, and kept to himself.

His support team worked with him to provide more choice, control and

consistency in his daily routine – such as choosing his own meals, knowing

which staff would be supporting him and choosing his own social activities.

They also supported him to develop a functional method of communication,

using symbols, pictures and software on his iPad.

Patrick recently moved into a new home with just one housemate. His

engagement in daily activities has increased significantly. He is speaking more

and using his iPad to communicate, cooking his own meals and taking up

woodwork. Restrictive practices that were in place have been removed.Please note: we have changed names and altered photos to protect our client’s privacy

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ResultsMore choice and control for clients

Adriano reported that most days he did “not have much going

on” because he was very anxious and also because he “didn’t

know what to do”.

So, with support from our Practice Leader and support staff,

Adriano developed his own daily timetable, skill building goals

and calming strategies.

He and staff have been trialling them and it has given him a

greater degree of ownership for his supports and involvement

in his daily activities.

Please note: we have changed names and altered photos to protect our client’s privacy

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ResultsWe asked our SIL clients and families how we are doing a year in - here’s what they said

How would you rate the quality of your services?

How likely is it that you would recommend

Nextt to a friend or colleague?

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ResultsRestrictive practices decreased 33% as we improved quality

Quality improvements in behaviour support

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ResultsAn increase in both the quality and quantity of reported data allows us to respond better to client needs

Incident report frequency

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To deliver tangible outcomes to all our clients, we translated our learnings into a national SIL quality model with clear service commitments.

Our service commitments> define how we work with our clients,> to deliver measurable improvements in their quality of life,> and form the basis for the processes, training and KPIs of our staff.

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4. Improve:

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Our SIL service commitments

3. Review

2. Measure

1. Team ✓A dedicated support team comprising House Leader and Support Staff trained in foundational skills, active supports and client disabilities

✓Our Quality & Risk Panel ensures all new clients have clear goals, activities to achieve them and baseline measures at onboarding

✓Our Practice Leader ensures tracking of individual goals and reviews of progress every 6 months

✓The Practice Leader works with House Leaders and Support Staff to learn, implement change and track improvements

we provide each client with >

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Thank you

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https://www.nextt.com.au/our-clients/#

Email: helloSIL@nextt.com.au

Website: www.nextt.com.au

Call: 1300 657 915 and ask for the SIL team.