1. Research findings from the early intervention review in the Nepean Blue Mountains / Hunter Trial sites
Ariella Meltzer, Karen Fisher, Lorraine Heywood & Margie O’Tarpey

2. Presentation overview
Research context - ECIA NSW/ACT
Project focus and methods
Findings:
Changes in services
Changes in collaboration
Changes in funding and business models
Implications for good practice
ECIA NSW/ACT comments on sector implications
Good afternoon. Today we’re going to talk about our research on how the ECI sector is transitioning to the NDIS in the Nepean Blue Mountains and Hunter trial sites.
Presentation overview:
Research context: Lorraine Heywood.
Project focus and methods
Findings:
Changes in services
Changes in collaboration
Changes in funding and business models
Implications for good practice
ECIA comments on sector implications: Lorraine Heywood
I’m going to start by handing over to Lorraine to talk about the research context.

3. Research context Commissioned by ECIA NSW/ACT - DSS funded
State funded ECI services contracted out - 68 NGOs
Intake and referral undertaken by NGO services
NDIS sites – Hunter (Trial) & Nepean Blue Mountains (Early roll out)
20% of ECI NGOs transitioning to NDIS (during time of research)
Additional 30% of ECI NGOs transitioning from 1 July 2016
State 0-8 Strategy – large increase in funding to the sector between

4. Project focus
Research that focused on the provision of ECI in the Nepean Blue Mountains and Hunter NDIS trial sites.
It aimed to develop an understanding of:
how ECI practice is currently changing in each site
what opportunities exist for implementing ECIA’s Best Practice Guidelines under the NDIS
how ECI good practice has developed under, and has been influenced by, the NDIS roll out
The research focused on the provision of ECI in the Nepean Blue Mountains and Hunter NDIS trial sites and how the ECI sector is transitioning to the NDIS in these sites.
The research aimed to develop an understanding of:
how ECI practice is currently changing in each site
what opportunities exist for implementing ECIA’s Best Practice Guidelines under the NDIS
how ECI good practice has developed under, and has been influenced by, the NDIS roll out

5. Project methods Partnership with ECIA NSW/ACT Literature review
Advice from a reference group (facilitated by ECIA NSW/ACT)
Change leaders’ forum
Telephone interviews (n=13)
Sector engagement forum
Literature review
Focus on service transition and integration in ECI - Looked at past integration with other new service models/changes, particularly individualised service models
Advice from a reference group facilitated by ECIA
Membership from the staff and Board of ECIA, NDIA and change leaders in ECI from NBM and Hunter region
The role of the reference group was to advise on how to best target and conduct the project and interpret its findings, including by providing local, sector and policy context
Change leaders’ forum
6 change leaders from NBM and Hunter: ECI providers and other related roles in education, health and allied health
The purpose was for them to talk about new ideas for sector development and inform the focus and content of the rest of the data collection
Telephone interviews
13 interviews, including NGO and private ECI providers, paediatricians and education, health and allied health from NBM and Hunter
Sector engagement forum
Broader group of ECI managers from across NSW who discussed the implications of and helped interpret the preliminary findings
Based on these methods, I will now talk about some of the findings from the research

6. Changes in services (1)
ECI services have expanded and become more diverse. Providers were concerned about inequities between packages and recognised the need to work with parents and planners on adapting children’s plans.
“It seems to me that the ones that get the best access to the NDIS and to early intervention services are still the ones that are the most motivated and where the parents are the best advocates for their children” (private provider).
The first area of findings was that providers in the research spoke about a number of changes in the services they were now providing under the NDIS and about the implications of these changes for the way they worked.
Firstly, in line with increased choice and control, ECI services have expanded and become more diverse under the NDIS – more children are receiving a greater variety of services.
In this context, providers were concerned about inequities between families with NDIS packages, observing that some packages addressed the child’s needs better than others. This often appeared to depend on the skills and confidence of parents in forming their child’s plan. One private provider observed:
“It seems to me that the ones that get the best access to the NDIS and to early intervention services are still the ones that are the most motivated and where the parents are the best advocates for their children” (private provider).
In response, ECI providers recognised the need to work with parents and planners on adapting children’s plans and building parents’ capacity and skills for planning.

7. Changes in services (2)
Children’s inclusion in mainstream settings and home-based support placed time and travel demands on providers and increased demands on schools. Providers were learning how to navigate these issues.
“This family was quite secluded in their home, wouldn't leave their home because it was difficult for their child to get out in the community because of their disability. The physio then supported the family to go to places like the beach… the physio and the child [were] at the beach with the parents looking in rock pools, which is something they've never done. That was just wonderful to hear that physiotherapy could happen at the beach.” (Direct funded worker)
Secondly, children’s inclusion in mainstream settings and home-based support has also become more frequent with the NDIS.
This is beneficial for children’s life experiences and inclusion, as this quote from a direct funded worker [about a child going to the beach] demonstrates:
“This family was quite secluded in their home, wouldn't leave their home because it was difficult for their child to get out in the community because of their disability. The physio then supported the family to go to places like the beach… the physio and the child [were] at the beach with the parents looking in rock pools, which is something they've never done. That was just wonderful to hear that physiotherapy could happen at the beach.” (Direct funded worker)
The increased incidence of including children in mainstream settings and providing home-based support also however placed time and travel demands on ECI providers and increased demands on schools to accommodate therapists coming in. Providers were learning how to navigate these issues, for example, by experimenting with different ways to fund travel costs (through a child’s package, through service planning to minimise travel costs) or by working out schedules between schools and therapists.

8. Changes in collaboration (1)
ECI providers were working through challenges in collaborating under the individualised, market model of the NDIS.
“These days, there’s a little bit more competition, because they’re all clients and we all want to survive” (direct funded worker).
“[Collaboration] takes a lot of to-ing and fro-ing and that’s tricky because if you’re working with a number of services in the package, then you need to communicate with them. That communication costs … time costs money” (direct funded worker).
There were also changes, and some challenges, in providers’ collaboration under the NDIS and its individualised, market model.
The market model initially prompted some providers to see each other as competitors, which made collaboration hard, as one person observed:
“These days, there’s a little bit more competition, because they’re all clients and we all want to survive” (direct funded worker).
They were however learning to collaborate again in this new model.
In the market model, collaboration also cost money. This is in the second quote on the slide:
“[Collaboration] takes a lot of to-ing and fro-ing and that’s tricky because if you’re working with a number of services in the package, then you need to communicate with them. That communication costs … time costs money” (direct funded worker).
It was not clear to all providers when they were and were not able to bill children and families for time spent on collaboration; but they were learning and developing confidence in when to charge families for this time and when to invest unfunded time.

9. Changes in collaboration (2)
The trans-disciplinary model was valued by ECI providers, but was difficult for some non-ECI providers, as trans-disciplinary work was not best practice in their own discipline.
“I think the whole concept of working in a trans-disciplinary model has always confused families … They will go to an ECI provider and get allocated a key worker who doesn't know the answers to the questions that they have and then they need to go and find a physiotherapist anyway” (direct funded worker)
Also on the collaboration front, the trans-disciplinary model encouraged by the NDIS was valued by ECI providers, but was sometimes difficult for some of the people they worked closely with. Some non-ECI providers who worked closely with ECI and would be included in their trans-disciplinary practice, said that trans-disciplinary work was not actually best practice in their own discipline and they worried whether it would confuse families and whether children would properly receive their expertise in a trans-disciplinary model.
The quote on the slide speaks to some of those concerns:
“I think the whole concept of working in a trans-disciplinary model has always confused families … They will go to an ECI provider and get allocated a key worker who doesn't know the answers to the questions that they have and then they need to go and find a physiotherapist anyway” (direct funded worker)
Different ECI and non-ECI providers were still thinking about how to manage the interconnections between the best practice standards from different disciplines. It was an area that was as yet unresolved.

10. Changes in funding and business models (1)
Many ECI providers were concerned about how to fund work with children for whom it was not appropriate to have an individualised package, who did not have a diagnosis or did not meet the residency requirements for the NDIS. In response, they drew on ECEI and other funding sources.
“We’ve also got that other funding from the NDIS – the ECEI funding that we have that still allows us to see children and do assessments on kids that don’t have a diagnosis and that may end up not getting a plan, which we see is really important” (Direct funded worker)
The changed funding and business model was also commented on in the research.
Many ECI providers were concerned about how to fund work with children for whom it was not appropriate to have an individualised NDIS package, who did not have a diagnosis or did not meet the residency requirements for the NDIS.
In NBM where the NDIS Early Childhood Early Intervention (ECEI) approach had been trialled, many providers valued this approach for allowing them to continue working with these children.
“We’ve also got that other funding from the NDIS – the ECEI funding that we have that still allows us to see children and do assessments on kids that don’t have a diagnosis and that may end up not getting a plan, which we see is really important” (Direct funded worker)
This approach was not however yet available in the Hunter and there providers were more concerned.
In both sites, however, providers had also found the solution of drawing on a range of other health system initiatives to fund this work. This included funding from Medicare plans, Enhance Primary Health Care plans, Mental Health Care plans and the Close the Gap initiative

11. Changes in funding and business models (2)
Providers were navigating the move to individualised, billable hours. They were learning how to discuss money with families; find other funding sources; and how to be transparent and flexible about what they were billing and about how they were sharing hours.
“It’s also having these conversations about money … in these [kinds of helping] roles we don’t talk about money … it’s just something so different that we haven’t done before … I suppose we’ll … just have to work out having conversations with families about money and just have to do it – we’re going to have to do it, it’s just it feels weird” (Direct funded worker).
Providers were also navigating the move to individualised, billable hours. They sometimes had difficulty knowing how to fund travel costs, unanticipated time spent on their work and servicing families with complex needs (where helping the child was by helping the family).
In response, they were learning how to discuss funding and money with families; find other funding sources; and how to be transparent and flexible about what they were billing and about how they were sharing hours between the trans-disciplinary team. For example, one person spoke about learning how to talk with families about money:
“It’s also having these conversations about money … in these [kinds of helping] roles we don’t talk about money … it’s just something so different that we haven’t done before … I suppose we’ll … just have to work out having conversations with families about money and just have to do it – we’re going to have to do it, it’s just it feels weird” (Direct funded worker).

12. Implications for good practice (1) ECIA Best Practice Guidelines
Quality area 1: Family
Quality area 1 focuses on family-centred and strengths-based practice and culturally responsive practice.
Support families to make informed choices about their child’s support
Maintain soft-entry pathways and funding to support the complex needs of disadvantaged families
Improve equity of access to the NDIS and ECI services by supporting families throughout the NDIS Access Request and maintaining an approach like ECEI for families not receiving a NDIS package
Ensure culturally sensitive service provision
The project also highlighted the implications of these findings for good practice. These are based on the ECIA’s Best Practice Guidelines, which cover: (1) family, (2) inclusion, (3) teamwork and (4) universal principles.
Based on the findings I’ve just spoken about and others that appear in the report, the project highlighted a number of implications for good practice in these areas.
Quality area 1: Family
Quality area 1 focuses on family-centred and strengths-based practice and culturally responsive practice.
Support families to make informed choices about their child’s support
Maintain soft-entry pathways and funding to support the complex needs of disadvantaged families
Improve equity of access to the NDIS and ECI services by supporting families throughout the NDIS Access Request processes and by maintaining an approach like ECEI for families not receiving a NDIS package
Ensure culturally sensitive service provision
These implications clearly respond to some of the findings of the report about working with families to fix inequities between NDIS packages and about concerns about how to service families with complex needs and for whom it was not appropriate to have an individualised package. These are areas where further best practice should still be developed.

13. Implications for good practice (2) ECIA Best Practice Guidelines
Quality area 2: Inclusion
Quality area 2 focuses on inclusive and participatory practice, and engaging the child in natural environments.
Resource mainstream settings to support inclusion
Include travel allowances in NDIS plans
Quality area 2: Inclusion
Quality area 2 focuses on inclusive and participatory practice, and engaging the child in natural environments.
Resource mainstream settings to support inclusion
Include travel allowances in NDIS plans
These implications respond to the findings about the difficulty of knowing how to support and fund inclusion, including some of the travel costs involved and the need to resource some settings and players to support inclusion, including cultivating the collaborative skills necessary.

14. Implications for good practice (3) ECIA Best Practice Guidelines
Quality area 3: Teamwork
Quality area 3 focuses on collaborative teamwork practice and capacity building practice.
Provide funding and accountability measures to ensure collaboration
Support collaboration with key external partners such as schools, pre-schools and medical/health services
Address concerns about how the key worker model and trans- disciplinary approach fit with other best practice standards from outside the ECI sector
Quality area 3: Teamwork
Quality area 3 focuses on collaborative teamwork practice and capacity building practice.
Provide funding and accountability measures to ensure collaboration [collaboration wasn’t going to happen if it wasn’t built into the procedures to follow]
Support collaboration with key external partners such as schools, pre-schools and medical/health services [some were less experienced in collaborating for ECI service provision than others and needed more support]
Address concerns about how the key worker model and trans-disciplinary approach fit with other best practice standards from outside the ECI sector
These implications apply to the renewed emphasis in the NDIS on collaboration between different ECI providers and others providing services to children with disability. They show the areas that need to be further developed if collaboration is to flow effectively and apply to resolving some of the early challenges in collaboration found in this research.

15. Implications for good practice (4) ECIA Best Practice Guidelines
Quality area 4: Universal principles
Quality area 4 focuses on the evidence base, standards, accountability and practice and an outcomes based approach.
Facilitate discussions with families about good practice
Require quality assurance standards for all providers of ECI
Guide how to apply outcomes based approaches, such as by releasing data about recipients and contents of plans, goals, reviews and packages to inform good practice.
Quality area 4: Universal principles
Quality area 4 focuses on the evidence base, standards, accountability and practice and an outcomes based approach.
Facilitate discussions with families about good practice
Require quality assurance standards for all providers of ECI
Guide how to apply outcomes based approaches, such as by releasing data about recipients and contents of plans, goals, reviews and packages to inform good practice.
These implications apply less to the areas of research findings I’ve spoken about today, but further information is provided in the report. They tap into some of the evidence and outcomes areas that can be developed to ensure good practice for children and families.
I’m now going to hand over to Lorraine again, who is going to end the presentation by talking about some of the sector implications of the research.

16. ECIA NSW/ACT comments on sector implications
Changes anticipated – ECEI Approach
Policy issues being taken forward (i.e. travel)
Future service models
Practice implications

17. Resources and contacts
Project report Contact SPRC ECIA NSW/ACT Dr Ariella Meltzer Ms Lorraine Heywood (02) (02)