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Ability Therapy Specialists Pty Ltd

Individuals, Couples, Families, Children ~ NDIS Registered Provider of Behaviour Support, Counselling Therapies with Creative Arts, Rehabilitation, Employment Job Readiness, Paediatric Early Childhood Intervention ~ Serving Armidale, New England, NSW, Australia and Online

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Restrictive Practices Update in Light of NDIA Commission Developments

The NDIS Commission launched 1 July 2018 with new standards for behaviour support. In NSW we have entered into a joint agreement that fits our standards within the umbrella determined by the Commission. This means a few changes to NSW Policy and Practice. To read more and learn about the changes, click on the links.

These vital and important developments are not without their growth pains. However we need to keep a view to the big picture – that emerging requirements will aim towards eventually strengthening the review of restrictive practices. This is important for individual’s rights to adequate treatment under legal, ethical, and professional standards. The hope is that legal, ethical, and professional standards will be upheld among some of Australia’s most vulnerable population.

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Australian standards for Restrictive Practices is vital towards protection of the human rights of people with disabilities.

On the ground people who come forward for behaviour support reviews are somewhat surprised by the administrative burdens of 1. setting up a service generally under the NDIS and 2. processing issues around cases with restrictive practices.

After 1 July 2018 in many cases existing funding allocations may not be adequate to address the complexities of NDIS Commission requirements. This means that participants may face NDIS Plan reviews that can often take a great deal of time, leading to delays in situations where risks tend to be high.

Lengthy NDIS template forms for behaviour support and equally extensive NSW authorisation processes go in tandem with behaviour support reviews by practitioners. It appears that NDIS requirements may easily double if not triple the time it once took to provide clinical reviews, in large part due to compliance measures for data collection by the Commission.

While the new requirements may lead towards greater compliance and standardisation of services across the sector, there are always inherent risks when a government department takes oversight of clinical and professional roles. Whether discussing the historical track record in the UK or in other countries, in relation to Australian core disability service standards we are next in line for major adjustments and growth pains across the disability sector.

Implementing providers such as those managing day programs or home based supports are required to undertake NSW state level restrictive practice authorisation reviews. This process requests a great deal of information and forms, and in some cases appears to double up what is required by the Commission. The time it takes to process information appears so far to be without funding allocated for these complex mandatory requirements. It is unclear how vulnerable people with disabilities will fair in the midst of these contradictory set of circumstances. But like all things NDIS, there are positives and negatives as the Scheme rolls out across the country.

In the bigger picture, the NDIS Commission is charged with a large and important undertaking, and as things roll along the goals of monitoring and safeguarding will invariably be shared with the states. The proposed role of NSW for example is quite vital for the purposes of reviewing restrictive practices, how they are managed, and in what ways they can be reduced or eliminated over time. External senior clinical review appears to part of the NSW proposed authorisation model, which makes absolute sense. The state is taking on the burden of cost for maintaining a list of qualified external reviewers who will sit on review panels alongside the organisations presenting the restrictive practices review request.

Even though the NDIS has been trundling along for a few years already, and the safety net that once existed for people with disabilities has vastly expanded to include many more people within funded supports, the NDIS Commission role for people with more profound disabilities and behaviours of concern who require restrictive practices review is extremely necessary and entirely reasonable. How they go about this vital task is another matter, which Australians may not entirely comprehend for some time to come.

At the end of the day, it is important to see one thing clearly. The NDIS Commission and the NSW Restrictive Practices Authorisation under Family and Community Services are undertaking one of the most core and vital responsibilities of the disability services sector. In many ways this should have been the first undertaking of the NDIS. But we welcome the leadership of the Commission and the NSW FACS and we look forward to the ways that disability standards in Australia will grow and evolve from this point onwards.

 

Finding Your Path in Life

One of the amazing parts of counselling psychotherapy is when a person is seeking where they belong. We feel lost, afraid, alone, stressed out, and even desperate. But only one sleep can change all that. We honestly never know what is around the corner. Life is actually a massive adventure, and we have no idea where we might end up.

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For some of us, not knowing is stressful. Do you think the bee knows exactly where her next bunch of flowers might be found? Surely I can imagine, a bee flying around not sure where the flowers might be growing and blooming. Even whatever sensors they have probably leave them with not knowing, maybe a sense of intuitive instinct. Why should human beings be all that different?

When I was a young man, several really close friendships fell apart leaving me pretty much all alone in the world for the first time in my life. The crisis lasted for a few years because there was no clue inside me of how to cope. Towards the end of this searching someone flatly told me to “go see Redge Craig.” He was a senior counsellor in our region of Canada.

After sitting down with Redge, and sharing the ending of those friendships that still made me feel lower than low, he leaned forward and said something that I cannot easily forget. He said, “How deeply you really cared for each of your friends, and that love you have for them is just as strong now, inside of you.” For some reason, his saying this was like light bulbs going off inside my body. For the first time, it dawned on me that instead of feeling defeated by loss, I could actually feel good about my capacity to care for others. This was a huge turn around that led me toward a new path in life.

Counselling can be like this for many people. It never ceases to mystify me how people come to therapy on the cusp of healing, change, and new pathwork.

Mental Health 101

So many people talk about “mental health” nowadays… but the simple truth is that dealing with the illness side of mental health can be extremely challenging.

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Therapists and clinicians, doctors and nurses, psychologists and counsellors, also deal with mental health and illness in their personal lives. I remember as a young Counsellor in training one of the first times a senior Minister visited my practice. It surprised me to realise how everyone carries challenges, sometimes hidden, other times not as well concealed.

Ministers, priests, doctors, psychologists, disability support workers, managers, and all sorts of helpers over the years have sat down with me. They have shared stories of deeply personal battles through depression, anxiety, suicidal thoughts, relationship break ups, workplace stress, and conflicts that deeply impacted their lives.

Interesting enough, the vast majority of helpers we’ve seen over the years have carried what I have come to recognise as a deep seated fatigue, something kin to existential depression, often appearing like a pragmatic and even realistic loss of hope and wonder in the mystery of life. This strikes me as quite powerful, and endemic to our era that is so focused on logic, critical theory, analysis, and science. While focusing on evidence and measuring everything in life, even our emotions, we have lost a sense of childlike innocence in just exploring, and staying curious about life.

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Within the journey of psychotherapy and counselling, helpers are seriously among the hardest people to help. We helpers throw up every self-defence mechanism known to humanity. Being well trained in communication, we can spin circles around any sentence and interpret about a dozen different meanings in half a minute flat. As the words cascade from a helper’s lips, they are often immediately internally sabotaging their heart and body by avoiding, superimposing, dissociating, and confusing meanings.

Yet working with helpers has been one of the most rewarding aspects of my career. For over two decades my focus was training therapists, and mentoring counsellors. The most valuable lessons included the fact that we are all so very human.

We cannot go it alone. In fact, everyone needs someone else to help them sort the harder parts of life. And as older and wider as you get, this fact never changes.

Psychometric and Educational Assessments

ATS offers a range of psychometric and educational assessments upon request. This post is dated and will not be revised in future. To see a more up to date list visit the page on this topic found via a link on the site menu.

The following tests and assessments we may be able to provide. This list may change without notice, and may depend on third party availability of testing materials. This being said, please contact us to discuss your needs. If an assessment tool is not listed here, send us a note via the Contact page to inquire whether we can provide the test you are seeking.

  1. Adaptive Behaviour Assessment System Edition 3 (ABAS 3). The Adaptive Behavior Assessment System Third Edition (ABAS-3) is used to assist assessment, diagnosis, intervention planning, and progress monitoring with Autism Spectrum Disorder, Intellectual Disability, Developmental Delays, Learning Disabilities, Neuropsychological Disorders, and Sensory or Physical Impairments.
  2. Brief Infant Toddler Social and Emotional Assessment Screening for Issues (BITSEA), 12 to 36 months.
  3. Autism Spectrum Rating Scales (ASRS).
  4. Independent Living Scales (ILS).
  5. School Functional Assessment.
  6. Vineland 3 – Adaptive Behaviour Scales. To assist toward diagnosis of Intellectual Disabilities and Developmental Disabilities.
  7. Adolescent and Adult Sensory Profile.
  8. Quality of Life Inventory (QLI).
  9. Quality of Life Questionnaire (QLQ).
  10. Behavioural Assessment of Dysexecutive Syndrome (Adults).
  11. Brief Cognitive States Exam.

Restrictive Practices and NDIS Part 2

Essentially, when the states hand over certain controls of the disability sector to the #NDIS, existing standards for safety, dignity, and human rights once covered by state policies will translate to national standards. For example, the NSW Behaviour Support Policy and Practice Guide.

The assumption is that existing standards will actually remain if not become subject to increasing quality assurance measures. Over time standards may also raise and in ways this is already happening. No one would suggest standards may fall or become less.

If anything the NDIS vision indicates a rather comprehensive overhaul of disability service standards quite unlike anything Australia has seen in past.

This development may be combined with other changes across the sector, and influenced by external forces like legal and community expectations, leading to higher standards of care and professionalism among disability service organizations.

The role of the Disability Support Worker is due for reappraisal. We often consider the DSW role as defined so far by common sense as quite inadequate to the tasks and demands of the job. We see a new role emerging in practice where staff gain greater skills across a range of areas particularly within mental health support. Something we have called a Disability Support Clinician.

In similar ways we are seeing the disability sector slowly shifting away from one stop shops, orgs offering everything under one umbrella, toward a greater emphasis on multi-professional input and collaboration. Naturally no one org can do nor specialise in everything and often by trying to do too much orgs become top heavy and inflexible. In these settings behaviour support and access to counselling and other therapeutic services often become overlooked if not avoided for the simple fact that therapeutic work often involves question of the status quo.

Not at all beside the point, we are well into this discussion and we have not even defined key terms like #restrictivepractices and behaviour support. The reason I have not looked at the practical details yet is that our current situation in Australia demands seeing the big picture within the transition to full NDIS jurisdiction. Dispelling a few key myths. And setting the stage for clearly looking at standards for behaviour support.

As you might guess this article is turned into a mini series… a bit of a drama really… but a discussion that actually often involves extremely important values. For example?

Health. Safety. Individual and staff rights. Human rights more broadly but often in cases where maintenance and oversight of these rights becomes critically important. Dignity and duty. Freedom and responsibility. Ethics and standards of care… and these are only a few of the values applied in #behavioursupport and the closely related field of #mentalhealth.

Restrictive Practices and NDIS

Behaviour support in Australia has evolved in significant ways over the past five years. The NDIS has created a new social, political, and legal environment. One of the areas of most significant change is around restrictive practices.

On one hand, the disbanding of state based systems in some states like NSW has left some with the illusion of deregulation and less oversight of complex cases and restrictive practices. Orgs that used to engage state resources to cover governance of restrictive practice panels and annual review no longer have this support.

On the other hand, many factors are converging to encourage higher standards for disability support and around restrictive practices. These factors include greater legal recognition, the emergence of a national scheme, international standards, professionalisation of the disability sector, and changing community and social expectations.

Insidious Travel Distance, NDIS Behaviour Support, and Regional Australia

Access, choice, and control in regional Australia and across northern NSW relies on stronger travel policies that take large distances into account.

For example, in the New England North West of NSW it is extremely common to rely on services by travelling from one regional centre to another – especially to see a specialist service.

Case in point, it is common for Inverell people to shop in Armidale, 1.5 hrs away, and to go to Tamworth, 2.5 hrs drive, for other essential services not available in Inverell. Armidale people go to Inverell as well. In fact people rely on neighboring regional centres such that they form part of local identities much like residents of large bush estates rely on neighbours who may live far away. But then again distance is rated differently in the bush.

Many services are sought across regional centres but health and allied health services commonly require a great deal of travel.

It is also more common for professionals and specialists to travel in regional Australia. Of course we think of the flying doctors. Nurses also travel extensively. But this is very true for mental health and disability specialist therapists. The latter is all the more relevant for people with disabilities because therapists often prefer to see these clients in their own environment where there is greater chance to observe natural functioning without the added stress for the client that comes from travel to a foreign or clinical setting.

Over the past many years behaviour specialists have travelled across northern NSW under state government funded initiatives because that policy acknowledged the incidious nature of regional travel as a vital life line for regional Australian’s access to specialist disability supports. The policy also followed best practice in evidence based outcomes. Visiting people with disabilities in their own homes or community generally attaches better outcomes.

Many feel the NDIS has not yet generated an adequate funding policy for regional Australia, which does not fall into the remote policy definitions.

What exists so far may not reflect the reasonable and necessary needs of regional Australians. Naturally for the new Scheme existing policy arises from an urban centered model, and applies notions from the urban-based health sector, without acknowledging the critical and historical differences the disability and regional sectors present that either make service provision viable or fall flat on its face.

To reduce if not eliminate this layer of travel and service quality support to regional Australia is to effectively reduce access to specialist behaviour support and other therapies.

Such services may not ever exist in smaller regional centres. Travel will always be an issue.

It is simply not viable to set up a clinical service in most areas of northern NSW. This is unlikely to change in the near future.

This means travel across region to access specialists or for practitioners to visit clients will likely remain the norm.

In the same light, certain NDIS services will not likely expand with the market due to certain geographic, regional, and economic reasons, and will require policy initiatives to support regional access. Other methods will need to be employed to maintain the limited number of viable independent specialist services the region can sustain as a market niche.

Add to this discussion the fact that the former state model saw three tiered services with local practitioners, specialist behaviour support supplied regionally, and an added statewide senior specialist backup system, networked across levels. The current reality in NSW is by no means matching pre Scheme measures.

People who need a service are often encouraged to go back to their Support Coordinator, NDIS Planner or Local Area Coordinator and put up a change of circumstances review.

Sad as this is for a family in need, it is the only way the Scheme will register these needs, and eventually come up with better ways to measure allocations for behaviour support or other therapies.

Having said all of this, in our opinion the NDIS is an impressive vision and historic accomplishment. We are only on the cusp of NSW formal transfer this July, and yet so much progress is evidenced already.

As vital as this remains for so many, progress so far has a way to go before the sector can actually sustain services for regional Australians and for high needs complex cases. Even for those others who require periodic specialist supports the current system is falling short.

But we live in hope.

From Behaviour Support to Trauma Counselling

ATS are NDIS Registered Providers, and we do private work with a wide range of clients.

The NDIS allows participants of the Scheme to access our services under the guidelines of funding. We have developed a number of tailored solutions for people with disabilities and mental health concerns. As specialists in this area our work adapts counselling, psychotherapy, psychology, education, and other methods to individual needs and capacity.

Assessment and offering suggestions for treatment and support planning have become central to our work, and helps to inform many client’s NDIS planning. Addressing complex needs is often part of this work.

We have taken on many psychometric and educational tools for assessment like the ABAS 3. These may assist with diagnostic observations and in some cases may inform funding programs that request assessments.

Clients across these areas from Scheme to private interests access counselling, psychotherapy, trauma therapy, grief and loss counselling, couple counselling, and other specialist methods like clinical hypnotherapy.

Contact us via our contact page form with questions.

Australian Counselling and Psychotherapy

People from around the world ask me whether there is a distinct form of Australian counselling and psychotherapy. My response is immediately, yes!

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Over the past three decades my work has brought me to many conferences. Over time presenting and doing keynotes has given me a unique perspective. Teaching counselling training at universities, and maintaining interest in the field long after leaving full time academic work, has given me many strengths in understanding Australian approaches to psychotherapy and counselling.

For one, Australian Aboriginal culture is unique around the world. Nothing exists like Aboriginal ways arising from the Dreamtime, deeply connected with Country as Sacred Place, and the many quite profound ways this translates into familial values, community identity, and as time goes on influences within mainstream Australian culture that are often overlooked by people who grow up in this country.

Secondly, Australia is completely unique in its very landmass, and how this holds a great deal of influence, meaning, and inspiration for Australian music, art, science, and culture. Australians have an existential basis in this place we call home, our country, our land and sea. Australians unconsciously and often in full awareness gravitate and hover around the Centre, the desert as heartland, the place of unconscious, that tends to dominate our consciousness. This forms a rich compost layer within the Australian psyche. A hinterland for dreams, vision, and mysticism. A source of enormous power in creativity and problem solving.

Thirdly, Australian counselling and psychotherapy has its own unique professional traditions within the fields of education, public health, and ironically as an offspring of the psychology professional body’s decision to become highly exclusive and begin shutting down their grandfather clause during the late 1990s. Besides, the profession of counselling in Australia grew very quickly to be extremely diverse due in large part to a great deal of healthy competition between factions. This resulted in hundreds of smaller professional and specialist bodies being formed – something that is still sorting itself out as the next couple of generations of therapists cope with the confusion and mess handed down to them by their senior founders.

Finally, Australian counselling and psychotherapy are often places of advanced innovative research and advancements in our understanding of qualitative issues. We can think of a dozen studies that match this criteria, across the areas of child sexual abuse, abuse recovery, trauma and healing, Aboriginal cultural methods in therapy, sexuality and identity, sexual health counselling, ageing and community practice, couple and relationship issues, depression and anxiety, just to name a few. Perhaps in contrast, as a professional body psychology tends toward advancements in quantitative research outcomes.

Unlike psychology perhaps worldwide, counselling in Australia is unique because as a profession counsellors and psychotherapists are not as interested in “rats and stats” as the focus is on human relationships, understanding the dynamics of healing and change outcomes, and actual practice based outcomes that advance our knowledge of evidenced based therapeutic strategies.

These are just a few of the ways that Australian counselling and psychotherapy are unique around the world. There is much to be thankful for in Australia. And most Australians are not aware of the incredible resources we have in our communities and across our nation in the form of counsellors, whose work is often hidden and unassuming, but whose efforts form part of the social fabric of our community.

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