Skills for Living: Introducing a Social Skills Programinto the National Disability Insurance Scheme(NDIS)

Sharidan Shimmin 1

Presentation Outline

• Illustration of where I work and who I work with

• Outline of the Brightwater Social Skills Program that began 5 years ago

• A demonstration of how the program has been delivered

• Show how the program has been effective through a case study – you’ll get to know

Mr Pink

• Explain how the model is being introduced under the NDIS

• But first…….

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I don’t have all the answers

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Brightwater Oats Street

• Slow stream rehabilitation facility for people

living with a neurological impairment

• Funded by Health Department of WA (HDWA)

and client fees

• 39 Rehabilitation places (includes onsite beds &

community places)

• 15 long stay beds

• 3 private places

• Social Skills Program funded by Home and

Community Care (HACC)

• NDIS program – Skills for Living Program

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Oats St - A Different Approach

• Real life living in houses with 4/5 bedrooms, graduated stages to achieve independence in

every day and community-based activities

• Targeted, interdisciplinary, individualised approach for residential & community-based

clients

• A continuum of support - full assistance with the whole task, part of the task, physical

prompt, direct prompt, indirect prompt - offered by all staff

• All daily activities are potentially ‘rehab’ rather than just going to specific therapy sessions

• Length of stay determined by progress

• Allied Health intervention according to need

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• On-site Living – 8 houses providing individual rooms some with ensuites

• Learning Hub – A purpose designed rehabilitation centre

• Education Centre – A dedicated centre for staff, students and other visiting health care professionals

• Independent Living Units –8 independent living units with street frontage

The HACC Social Skills Program

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Aim

• Focuses on a person’s abilities rather than their disability by supporting them to

maintain current skills, regain lost skills and learn new skills

• Provides clients with the means, knowledge, opportunity and strength to achieve

personal contentment

• Supporting individuals to develop social integration skills over a 12-month period

• Some may not reach an independent level but improve their skills enough for

support by standard HACC provider (improved communication, meeting

behavioural challenges)

• Breaking goals into smaller, achievable objectives to gradually improve individuals’

skill levels (Goal Tree)

• Allied Health Professionals complete assessment and Disability Support Workers

deliver support plans

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To assess the extent the program helps maintain and enhance functionality, wellness and

quality of life for its clients

Background• Operating for 5 years - funded through HACC and

developed by HDWA

• Aims to support 20-30 clients aged 18-65 from the

Perth metro area

• Hours of support are distributed by need rather

than by week

• Hours should reduce over time as skills increase

• Referrals directed through a Regional

Assessment Service

• Client eligibility includes their motivation to

achieve specific goals related to social integration

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Who Operates the Program:

•Trial and embed new interventions

•Provide relevant feedback to the team including support workers

•Provide ongoing intervention in accordance with agreed plan

•Operate in the community on a daily level

•Communicate with AH regularly

•Clinical and functional assessment

•Goal setting

•Care planning

•Individual problem solving

•Ongoing review

•Accepts referrals

•Organises assessments

•Supervises and coordinates staff

•Coordinates allied health

Rehabilitation Coordinator

Allied Health (OT, PT, SP,

SW)

Allied Health Assistant

Disability Support Workers

Goal Setting

• Goals are established from the outset of the program

• Geared toward reducing social isolation by breaking down barriers

“If that’s what you want to do then what’s stopping you from doing that now”

• The goal is broken down into smaller objectives to promote achievable progress

• This information is captured on each client’s Goal Tree

• Copies are given to the client and all team members

• Goals reviewed every three months and measured using the Goal Attainment Scale

• Each client’s ability is measured using the Mayo Portland Adaptability Inventory Scale

(MPAI-4) every three months

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Measuring Outcomes - Goal Attainment Scale (n=82)

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46%

16%

38%

Expected level of performance

Reflects performance above the expected level

Reflects performance below the expected level

Mayo-Portland Adaptability Inventory (n=22)

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43

44

45

46

47

48

49

50

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Admission 3 Months 6 Months 9 Months

MPA

I-4

Sco

re

Ability

Adjustment

Participation

Total

Case Study: Mr Pink and Social Support

• Initial Allied Health assessment

• Weekly Disability Support Worker

visits

• Mr Pink has improved static and

dynamic balance, and endurance

• Accessing community-based activities

more independently

• Independently gardens in his own

home

• Wife reports reduced anxiety

• Mr Pink continues to receive support

to attend his local gym

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0

1

2

3

4

A01_MobilityA02_UseOfHands

A03_Vision

A04_Audition

A05_Dizziness

A06_MotorSpeech

A07A_Verbal

A08_Attention

A09_Memory

A10_FundOfInfo

A11_NovelProblem

A12_Visuospatial

B13_AnxietyB14_Depression

B15_IrritabilityB16_PainB17_Fatigue

B18_Sensitivity

B19_SocialInteraction

B20_SelfAwareness

B21_Relationships

C22_Initiation

C23_SocialContact

C24_Recreational

C25_SelfCare

C26_Residence

C27_Transportation

C28_EmploymentC29_ManagingMoney

Jan-14

Dec-12

HACC Social Skills VS NDIS Skills for Living

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What is the NDIS Skills for Living Program

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• The Skills for Living Program offers participants an opportunity to develop and work

towards goals relevant to their NDIS plan

• Aims to promote participants’ functional capacity and reduce the need for support

• Uses an early intervention approach

• Works toward all aspects of capacity building for people living with disability - more than

just social inclusion as explained in the Social Skills Program

• Being tested outside the scope of Acquired Brain Injury

• Modelled on the discrete Social Skills Program

• Continues to measure outcomes of participants’ plans

Similarities

• Goal-setting

• Enablement focused

• Directed at social impact

• Goals/plans are time-limited and reviewed

• Use of Goal Tree and the GAS

• Choice and control

• Functional approach based on evidence-informed

practice

• Staffing model - Allied Health and Disability Support

Workers

• Working with other service providers and mainstream

supports (education)

• Face-to-face time and time-limited approach KPIs

• Inclusive of social participation

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Differences

• Funding sources - block vs individual (pay on receipt of service)

• Social versus full range of services

• Price of services - price guide

• Billing methods

• Goal development versus complete participant plans

• Funded supports

• Working with other service providers – multiple supports for 1 goal

• The outcomes we are looking to measure

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Challenges

• Enterprise agreements for staff

• IT systems

• The need to test the program’s effectiveness for

individuals and the program itself

• Trial versus roll-out

• MyWay or NDIA in WA

• Are the outcomes that we want to measure

different?

• Is the model transferrable to other disabilities?

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Strategies

• Transferring the plan into the Goal Tree

• Scoring the goals with the participant every three months

• Working with the planners on recommendations if the planned objectives do not fit

the goal

• Completing a satisfaction survey with the participant and significant other to ensure

the service is meeting its need from their perspective

• Providing education to other organisations that we are working with

• Providing education to the planners we are working with

• Development of a sound concise report writing template

• Enabling our staff to maintain the ethos of how we work with our participants under

the NDIS framework

• Building a culture that nurtures the opportunity our participants have under the NDIS

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Now

• Await State Government decision on

choice of scheme – nearly there

• Continue to monitor Skills for Living

Program outcomes

• Research the benefits for those with

other disabilities

• Investigate potential for the model to

also function under tier two of the

NDIS

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Questions?

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