A case study approach to understanding the pathway to individualised funded supports under the National Disability Insurance Scheme for community-dwelling individuals with acquired brain injury

Michael Skinner; Ray Quinn; Judith Nance; Suzanne Wright; Melissa Kendall

doi:10.1071/IB23040

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 24(3)

A case study approach to understanding the pathway to individualised funded supports under the National Disability Insurance Scheme for community-dwelling individuals with acquired brain injury

Michael Skinner ^A , Ray Quinn ^A , Judith Nance ^A , Suzanne Wright ^B and Melissa Kendall

^A ^C ^*

+ Author Affiliations

- Author Affiliations

^A Acquired Brain Injury Outreach Service (ABIOS), Division of Rehabilitation, Metro South Health, Brisbane, Australia

^B Skills to Enable People and Communities Program (STEPS), Division of Rehabilitation, Metro South Health, Brisbane, Australia

^C The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

^* Correspondence to: Melissa.kendall@health.qld.gov.au

Brain Impairment 24(3) 489-507 https://doi.org/10.1017/BrImp.2022.21

Submitted: 23 June 2021 Accepted: 18 August 2022 Published: 7 September 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

The National Disability Insurance Scheme (NDIS) offers opportunity against a historical background of underfunded and fragmented services for people with disability. For people with acquired brain injury (ABI), concerns have been raised about how they access NDIS individualised funded supports. The aim of this research was to explore how community-dwelling individuals with ABI in Queensland navigate the NDIS participant pathway to individualised funded supports.

Methods:

This study used a multiple case study design within a policy implementation framework. Twelve people with ABI, nine family members and eight NDIS funded and mainstream service providers participated. Data was collected from relevant NDIS documentation, health records and semi-structured interviews with individuals with ABI, family members, and service providers.

Results:

The current study highlighted the complexity of navigating the NDIS participant pathway of access, planning, implementation and review for people with ABI, their family and service providers. The NDIS pathway was impacted by the insurance and market based NDIS model itself, time, communication, and the requirement for external supports. Equally, the process was affected by environmental factors, individual person and injury factors as well as service providers, with a range of outcomes evident at the individual, family and system level.

Conclusions:

Findings suggest that the NDIS has struggled to make specific allowance for people with ABI and the complexity of their disabilities. Providing people with ABI access to the NDIS Complex Support Needs Pathway may redress many of the difficulties people with ABI experience accessing and using NDIS funded supports.

Keywords: Disability services, acquired brain injury, policy implementation, case study.

References

Australian Institute of Health and Welfare (2007). Disability in Australia: Acquired brain injury. Canberra: AIHW.

Australian Institute of Health and Welfare (2014). National Community Services Data Dictionary, version 8, 2014. Canberra: AIHW.

Bailey, C., Plath, D., Sharma, A. (2021) Purchasing power and self-determination: Social worker perspectives. The British Journal of Social Work 52(2), 624-642.
| Crossref | Google Scholar |

Barrett, S., & Fudge, C. (1981). Policy and action: Essays on the implementation of public policy. London: Methuen.

Beach, D., & Pedersen, R. B. (2019). Process-tracing methods: Foundations and guidelines. Ann Arbor, MI: University of Michigan Press.

Bigby, C. (2013) A National Disability Insurance Scheme—challenges for social work. Australian Social Work 66(1), 1-6.
| Crossref | Google Scholar |

Blaxland, M., Fisher, K. R., Purcal, C., Robinson, S., Quan Farrant, F., Pearson Gotting, M., & Kayess, R. (2020). National Disability Insurance Scheme: People who self manage their NDIS plan. Sydney: Social Policy Research Centre, UNSW Sydney. doi:10.26190/5f56b3c1d3c0d

Carey, G., Malbon, E., Blackwell, J. (2021) Administering inequality? The National Disability Insurance Scheme and administrative burdens on individuals. Australian Journal of Public Administration 80(4), 854-872.
| Crossref | Google Scholar |

Cations, M., Day, S., Laver, K., Withall, A., Draper, B. (2021) Post-diagnosis young-onset dementia care in the National Disability Insurance Scheme. Australian & New Zealand Journal of Psychiatry 56(3), 270-280.
| Crossref | Google Scholar |

Collier, D., Brady, H. E., & Seawright, J. (2010). Sources of leverage in causal inference: Towards an alternative view of methodology. In H. E. Brady & D. Collier (Eds.), Rethinking social inquiry: Diverse tools, shared standards (pp. 161–199). Lanham: Rowman and Littlefield.

Cortese, C., Truscott, F., Nikidehaghani, M., Chapple, S. (2021) Hard-to-reach: The NDIS, disability and socio-economic disadvantage. Disability & Society 36(6), 883-903.
| Crossref | Google Scholar |

Earle, T., Boucher, N. (2021) Disability policy and active citizenship: The case of Australia’s National Disability Insurance Scheme. Journal of Disability Policy Studies 32(1), 3-12.
| Crossref | Google Scholar |

Esterman, A., Thompson, F., Fitts, M., Gilroy, J., Fleming, J., Maruff, P., Clough, A. (2018) Incidence of emergency department presentations for traumatic brain injury in Indigenous and non-Indigenous residents aged 15-64 over the 9-year period 2007-2015 in North Queensland, Australia. Injury Epidemiology 5(1), 1-7.
| Crossref | Google Scholar |

Farrer, T. J., Hedges, D. W. (2011) Prevalence of traumatic brain injury in incarcerated groups compared to the general population: A meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry 35(2), 390-394.
| Crossref | Google Scholar |

Fawcett, B., Plath, D. (2014) A National Disability Insurance Scheme: What social work has to offer. British Journal of Social Work 44(3), 747-762.
| Crossref | Google Scholar |

Foster, M., Henman, P., Fleming, J., Tilse, C., Harrington, R. (2012) The politics of entitlement and personalisation: Perspectives on a proposed national disability long-term care and support scheme in Australia. Social Policy and Society 11(3), 331-343.
| Crossref | Google Scholar |

Foster, M., Henman, P., Tilse, C., Fleming, J., Allen, S., Harrington, R. (2016) Reasonable and necessary’ care: The challenge of operationalising the NDIS policy principle in allocating disability care in Australia. Australian Journal of Social Issues 51(1), 27-46.
| Crossref | Google Scholar |

Foster, M., Hummell, E., Fisher, K., Borg, S. J., Needham, C., Venning, A. (2021) Organisations adapting to dual aspirations of individualisation and collaboration in the National Disability Insurance Scheme (NDIS) market. Australian Journal of Public Administration 81(1), 1-18.
| Crossref | Google Scholar |

Henderson, S. (2018, November 16). Improved NDIS planning for people with complex support needs. NDIS. Retrieved from https://www.ndis.gov.au/news/1002-improved-ndis-planning-people-complex-support-needs

Hough, A. (2021) Regulating disability services: The case of Australia’s National Disability Insurance Scheme quality and safeguarding system. Research and Practice in Intellectual and Developmental Disabilities 8(2), 99-110.
| Crossref | Google Scholar |

Houston, V., Foster, M., Borg, D. N., Nolan, M., Seymour-Jones, A. (2020) From hospital to home with NDIS funded support: Examining participant pathway timeframes against discharge expectations. Australian Social Work 73(2), 175-190.
| Crossref | Google Scholar |

Hurley, J., Hutchinson, M. (2021) Carers’ experiences of the National Disability Insurance Scheme workforce: A qualitative study informing workforce development. Australian Journal of Social Issues 57(2), 458-471.
| Crossref | Google Scholar |

Kendrick, M., Ward, M., Chenoweth, L. (2017) Australias national disability insurance scheme: Looking back to shape the future. Disability & Society 32(9), 1333-1350.
| Crossref | Google Scholar |

Lakhani, A., McDonald, D., Zeeman, H. (2018) Perspectives of the National Disability Insurance Scheme: Participants’ knowledge and expectations of the scheme. Disability & Society 33(5), 783-803.
| Crossref | Google Scholar |

Lloyd, J., Moni, K., Cuskelly, M., Jobling, A. (2021) The National Disability Insurance Scheme: Voices of adults with intellectual disability. Research and Practice in Intellectual and Developmental Disabilities 9(1), 5-13.
| Crossref | Google Scholar |

Loadsman, J. J., Donelly, M. (2021) Exploring the wellbeing of Australian families engaging with the National Disability Insurance Scheme in rural and regional areas. Disability & Society 36(9), 1449-1468.
| Crossref | Google Scholar |

Mahoney, J. (2012) The logic of process tracing tests in the social sciences. Sociological Methods & Research 41(4), 570-597.
| Crossref | Google Scholar |

Mavromaras, K. G., Moskos, M., & Mahuteau, S. (2016). Evaluation of the NDIS: Intermediate report. Adelaide: Flinders University.

Mavromaras, K. G., Moskos, M., Mahuteau, S., Isherwood, L., Goode, A., Walton, H., …Flavel, J. (2018). Evaluation of the NDIS: Final report. Adelaide: Flinders University.

McClure, J. (2011) The role of causal attributions in public misconceptions about brain injury. Rehabilitation Psychology 56(2), 85-93.
| Crossref | Google Scholar |

Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks: Sage Publications.

National Disability Insurance Agency (2019). Building a better NDIS: Pathways Program. Canberra: Commonwealth of Australia.

National Disability Insurance Agency (2021–2022). NDIS Quarterly Report Q1. Canberra: Commonwealth of Australia.

National Disability Insurance Scheme Act (2013). www.legislation.gov.au/Details/C2013A00020

National Statement on Ethical Conduct in Human Research 2007 (2018). The national health and medical research council, the Australian research council and universities Australia. Canberra: Commonwealth of Australia.

NDIS Quality and Safeguards Commission (2020). Activity report July 2019-June 2020. Canberra: Commonwealth of Australia.

Productivity Commission (2011). Disability care and support. Productivity Commission Inquiry Report, 1(54). Melbourne: Productivity Commission.

Quilliam, C., Bourke, L. (2020) Rural Victorian service provider responses to the National Disability Insurance Scheme. Australian Journal of Social Issues 55(4), 439-455.
| Crossref | Google Scholar |

Schofield, J. (2004) A model of learned implementation. Public Administration 82(2), 283-308.
| Crossref | Google Scholar |

Soldatic, K., van Toorn, G., Dowse, L., Muir, K. (2014) Intellectual disability and complex intersections: Marginalisation under the National Disability Insurance Scheme. Research and Practice in Intellectual and Developmental Disabilities 1(1), 6-16.
| Crossref | Google Scholar |

Stephens, A., Cullen, J., Massey, L., Bohanna, I. (2014) Will the National Disability Insurance Scheme improve the lives of those most in need? Effective service delivery for people with acquired brain injuries and other disabilities in remote Aboriginal and Torres Strait Islander communities. Australian Journal of Public Administration 73(2), 260-270.
| Crossref | Google Scholar |

Stubbs, J. L., Thornton, A. E., Sevick, J. M., Silverberg, N. D., Barr, A. M., Honer, W. G., Panenka, W. J. (2020) Traumatic brain injury in homeless and marginally housed individuals: A systematic review and meta-analysis. Lancet Public Health 5(1), e19-e32.
| Crossref | Google Scholar |

Townsend, C., McIntyre, M., Lakhani, A., Wright, C., White, P., Bishara, J., Cullen, J. (2018) Inclusion of marginalised Aboriginal and Torres Strait Islander Peoples with neurocognitive disability in the National Disability Insurance Scheme (NDIS). Disability and the Global South 5(2), 1531-1552.
| Google Scholar |

Tune, D. (2019). Review of the National Disability Insurance Scheme Act 2013: Removing red tape and implementing the NDIS participant service guarantee. Canberra: Commonwealth of Australia.

Van Velzen, J. M., van Bennekom, C. A. M., Edelaar, M. J. A., Sluiter, J. K., Frings-Dresen, M. H. W. (2009) How many people return to work after acquired brain injury? A systematic review. Brain Injury 23(6), 473-488.
| Crossref | Google Scholar |

Venning, A., Hummell, E., Foster, M., Burns, K., Rimmer, S. H. (2021) Adjudicating reasonable and necessary funded supports in the National Disability Insurance Scheme: A critical review of the values and priorities indicated in the decisions of the Administrative Appeals Tribunal. Australian Journal of Public Administration 80(1), 97-113.
| Crossref | Google Scholar |

Warr, D., Dickinson, H., Olney, S., Hargrave, J., Karanikolas, A., Kasidis, V., …Wilcox, M. (2017). Choice, control and the NDIS: Service users’ perspectives on having choice and control in the new National Disability Insurance Scheme. Melbourne: Melbourne Equity Institute.

White, C. S., Spry, E., Griffiths, E., Carlin, E. (2021) Equity in access: A mixed methods exploration of the National Disability Insurance Scheme Access Program for the Kimberley region, Western Australia. International Journal of Environmental Research and Public Health 18(17), 8907.
| Crossref | Google Scholar |

Wilson, E., Campain, R., Pollock, S., Brophy, L., Stratford, A. (2021) Exploring the personal, programmatic and market barriers to choice in the NDIS for people with psychosocial disability. Australian Journal of Social Issues 57(1), 164-184.
| Crossref | Google Scholar |

Xiong, C., Hanafy, S., Chan, V., Hu, Z., Sutton, M., Escobar, M., Mollayeva, T. (2019) Comorbidity in adults with traumatic brain injury and all-cause mortality: A systematic review. BMJ Open 9(11), e029072.
| Crossref | Google Scholar |

Yin, R. K. (1994). Case study research: Design and methods. California: Sage Publications.

Yin, R. K. (2003). Case study research: Design and methods (3rd ed.). California: Sage Publications.

Zasler, N. D., Ameis, A., Riddick-Grisham, S. N. (2013) Life care planning after traumatic brain injury. Physical Medicine Rehabilitation Clinics of North America 24(3), 445-465.
| Crossref | Google Scholar |