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The following is a response to the
draft Department of Ageing, Disability, and Home Care
(DADHC) document 'Future Directions 2004'. This response has
been written by the Ethnic Communities Council of NSW (ECC)
and Multicultural Disability Advocacy Association of NSW
(MDAA) and is endorsed by the following agencies:
- ACROD NSW
- Carers NSW
- Ethnic Child Care Family and
Community Services Co-op
- Mental Health Coordinating
Council
- NSW Council of Social
Services
- NSW Council of Intellectual
Disability
- NSW Meals on Wheels
Association
- Physical Disability Council of
NSW
INTRODUCTION
We welcome the opportunity to
respond to DADHC's 'Future Directions 2004' draft
document. By doing so, we hope to contribute to
developing the framework outlined in the document so it
can more effectively address current inequities.
This response is based on two
assumptions:
- that the NSW Government through
DADHC is committed to redress the current inequities
experienced by people with disability, older people,
and their carers from culturally and linguistically
diverse (CALD) backgrounds; and
- that there is awareness among
government and its bureaucracy that continuing with
the same strategies and approaches - which often
simply means doing nothing - will not advance equity
and in real terms will further discriminate against
and marginalize people from a CALD
background.
RECOMMENDATIONS
Recommendation 1:
Commitment to stated values
That DADHC commits to the following
actions to implement its stated values :
- Advance equity.
- Invest in longer term outcomes
and build the capacity of communities
- Enhance the cultural competence
of the services sectors
- Develop new service
options.
Recommendation 2:
Targets
That DADHC establish broad
performance targets in collaboration with stakeholders
which increase incrementally to achieve equity over the
next 10 years. In practice, we recommend that regional
DADHC offices (see Recommendation 4: established
partnerships), assist agencies to develop targets to
ensure that, over time, the agencies' consumers reflect
the cultural diversity of the community the agency
serves.
Recommendation 3: Sector
Capacity Building
That DADHC build the cultural
competence of the sector based on sound research and
development, and evaluation of past and present
programmes and services.
Recommendation 4: Community
Capacity Building
That DADHC build the capacity of
communities to inform and guide future decision making
based on the five recommended action areas outlined in
this section.
Actions to achieve this
are:
- Creating active, sustainable,
and ongoing partnerships between local communities,
DADHC regional offices, and local service providers;
and
- Providing regular culturally
appropriate information sessions and advocacy training
to local communities.
- DADHC referring to inclusive
communities rather than community;
- DADHC clarifying the shift to
participation in community life / inclusive
communities;
- DADHC accompanying this
clarification with an explicit policy shift to a
community development model in addition to the current
service development model.
Recommendation 5: Immediate
Initiatives
Recommendations about the immediate
initiatives DADHC identified in its draft future
directions are:
5.1 Service Access
System (SAS):
That the stated aim of better
targeting include targeting people in specific ethnic
communities. For 2004-2005 this should include
information about SAS being made available and
distributed in 10 community languages.
5.2 Transition from
education:
That the current priority target
remain in place until equity is achieved in the ATLAS
program. We also recommend that this strategy be
evaluated in 2004.
5.3 Support for children:
That in 2004-2005 DADHC initiate
work with health services, particularly GPs (including
bi- lingual GPs), to ensure better co-ordination of
support for children from a CALD background with a
disability.
5.4 Boarding houses:
That by December 2004 DADHC has
ascertained the ethnic background of all the people
currently supported in Boarding Houses and developed
culturally appropriate strategies for each of these
people.
5.5 Closure of large
residentials:
That DADHC undertake an audit in
2004 of the cultural and linguistic backgrounds of all
residents and their families in all large residential
facilities.
5.6 Respite extension and
improvements:
That by December 2004 DADHC
undertake an evaluation of whether the growth funds in
respite have been used to advance equity in line with
the EOIs submitted. In addition, we recommend a focus
on people from a CALD background in all work
undertaken in relation to ageing carers.
5.7 Personal care services:
That DADHC require from all
service providers a commitment to deliver equitable
services with clearly spelt out service targets at the
commencement of the projects.
5.8 Improving service for
indigenous people and those from CALD backgrounds:
That for the CALD population,
DADHC ensure that the current joint Action Plan is
implemented and evaluated and is immediately followed
by another action plan when the current plan runs out
in July 2004.
5.9 Intake and assessment:
That DADHC engage in regular
discussions with ethnic community agencies about
intake and assessment procedures; DADHC develop a
promotion strategy for the intake and assessment
procedures which includes ethnic communities; DADHC
evaluate the procedures after 6 months to ascertain
the level of use by ethnic communities; and DADHC draw
up a promotion plan based on that evaluation to target
communities which do not access the service at an
equitable rate.
5.10 Prevention and early
intervention:
That by 2005 all current and new
prevention and early intervention strategies,
activities and initiatives are accessible to people
from CALD backgrounds. In addition, we recommend that
specific prevention and early intervention issues are
designed with and targeted for 5 different ethnic
communities.
5.11 Stabilizing grants
program:
That DADHC train all staff
involved in service support and monitoring in cultural
competence and develop guidelines on how to support
services to achieve the set targets.
5.12 Improving DADHC
service:
That DADHC disability services
and Home Care develop an action plan with set targets
by December 2004.
Recommendation 6: Medium and
Long Term Strategies:
That DADHC state its commitment to
'Research and Evaluation' as part of the development of
strong policy and management responses within medium to
long term strategies.
Recommendation 7: The best way
forward:
That DADHC make a long term
financial and policy commitment to CALD issues as part of
the organisation's core business, and work in ongoing
partnerships with peak bodies, service providers,
communities and individuals to achieve this.
BACKGROUND:
A general lack of awareness and
understanding of the impact of culture, language and
ethnicity on the lives of older people, people with
disability, and carers from CALD backgrounds currently
hampers efforts to achieve an accessible, responsive,
sustainable and equitable system of services and supports
for these people. The current perception is that ageing,
disability and caring are more important than, and
therefore separate from, the impact of culture, language
or ethnicity on the well-being and functioning of
individuals within communities. This misunderstanding of
the place of culture has led DADHC to include culture,
language and ethnicity either as appendages to perceived
core issues, or not to include them at all.
However, culture, language and
ethnicity are of vital importance to the lives of people
with disability, people who are ageing, or who are
carers, and the broader communities within which they
live and participate. Numerous studies carried out both
in Australia and overseas have shown that:
- culture and ethnicity influence
experiences of health and well-being, including what
it is to lead, and to be aided in leading, a healthy
life;
- culture, language and ethnicity
influence perceptions of, access to, and use of
services by clients, their families and broader
communities;
- culture influences attitudes
towards, and understanding of, the functions of
services and service providers by clients, their
families and communities; and
- people from culturally,
linguistically and ethnically diverse backgrounds must
overcome personal experiences of biases within
services and systems.
It follows that for a fully
accessible, responsive, equitable and sustainable system
of services and supports, culture, language and ethnicity
cannot simply be ignored or added on. As outlined in the
social justice frameworks of multiculturalism and access
and equity, they must be included as an active ingredient
in what it means to be a person with disability, to be
ageing, to be a carer, and to access and use services
that are often perceived as in place only for
Anglo-Australians.
DETAILED RESPONSE
1. The current situation
Positive
Initiatives:
The formation of the CALD policy
unit has been a strong positive initiative by DADHC. This
unit is to be applauded for its continued work, both
within the department and with the community sector, in
moving towards increasing equity for CALD communities and
the accessibility and responsiveness of services. The
fact that this unit is comprised solely of two
individuals should also be noted.
The development of a CALD joint
action plan for HACC and disability services is also a
strong positive initiative. However, the limited lifespan
of this plan (until June 2004), with no ongoing
commitment to a long-term plan, raises questions about
DADHC's ongoing commitment to increase accessibility and
responsiveness of services.
Low-Service
Use:
People from a CALD background do
not use services, including specialist disability, ageing
or carer services, at a rate anywhere near their
proportion in the population. The latest available HACC
MDS data shows that 13 % of HACC clients in NSW were born
in a non-English speaking country, whereas the benchmark
figure was 20.7 % .
The most recent publicly available
disability statistic is quoted in 'Making it Happen', the
final report of the Standing Committee on Social Issues.
In May 2002 Robert Griew, the then DADHC Deputy Director,
reported that 3% of disability services users were of
CALD background.
Strategic development vs
crisis management:
A commitment to addressing the
needs of people from CALD backgrounds ought to be
embedded in DADHC's corporate goals. This would place
these needs where the demographics require them to be: at
the forefront of DADHC's continuing strategic development
and planning. For example, DADHC's focus on enhanced
outcomes for people from a CALD background is important,
but should be positioned throughout as short, medium and
long term strategies.
DADHC's current emphasis on crisis
management is exacerbating difficulties both at present
and in the future for people from CALD
backgrounds:
Firstly, short-term crisis
management allows the development of a service system
that responds solely to those who articulate their needs
best. In this situation the 'add-ons' of culture and
ethnicity are invariably diminished in importance, and
often shifted to one side. For example, while known
service use rates are at crisis levels, and despite
DADHC's pledges to the contrary, DADHC continues to
direct funds and dedicate priorities to other areas
considered more immediately in need.
Secondly, focussing on crisis
management can compromise the allocation of resources to
prevention and early intervention programmes, which, as
DADHC notes in the discussion paper, can 'minimise crisis
responses and reduce the need to draw on higher cost
services.' (p.6)
2. Lessons from the past /
strategies for the future
It is important to understand
better the impact of initiatives, policies and approaches
in achieving greater programme and service access and
responsiveness for people from CALD backgrounds. To
achieve this the following comments briefly outline some
past efforts that in our view have yielded little success
and several strategies that we believe can improve access
and responsiveness in a sustainable manner.
Initiatives that have
yielded little success:
Some common initiatives that have
yielded little success in delivering outcomes to people
from a CALD background are:
- 'Piecemeal' single target
initiatives and one dimensional approaches, such as
making available money for translations with no
dissemination strategy and no additional training
about the information that was translated.
- One-off programs, such as end
of year 'under-spent funds' projects, and one or two
year projects with no evaluation framework built in,
and thus no way of gauging success or failure. In
addition where projects are deemed successful, there
is no guarantee of ongoing funding.
- Making services responsible for
a new policy without providing the necessary support,
such as including budget lines for interpreters with
no guidelines on how to arrive at an amount that is
reasonable and considered.
- EAPS planning which occurs in
isolation from other corporate planning and is
perceived as just another layer of reporting, with
little evidence of a flow-on to create culturally
competent services.
Unfortunately, it appears that
instead of learning from the past DADHC continues to
expend funds on initiatives and projects with little
understanding of their effectiveness.
Initiatives that have proved
or are highly likely to prove
successful:
While overall there has been little
research and evaluative work undertaken, we believe the
following initiatives may prove more successful and
sustainable in improving access and
responsiveness:
- Targeted approaches to make
CALD needs a priority for regional planning and
funding. These would allow regional projects to grow
from need, in an environment where potential advocates
for CALD needs do not have to compete with
others
- Ethnic community specific
approaches, such as ethno-specific and multicultural
CACP packages, or ethno-specific disability and carer
programs, which are developed and delivered in close
cooperation with the target group; and
- Small local initiatives with
broad ownership and a shared commitment to achieving
outcomes. A commitment to ensuring the viability and
sustainability of these initiatives, where they are
evaluated to be successful, is essential.
3. Commitment to DADHC values of
Client focus, Equity, Integrity, Performance and Valuing
people
In relation to people from a
CALD background, we believe that the initiatives
currently undertaken by DADHC will remain single,
isolated, unconnected and contribute little to achieving
DADHC's stated vision, unless DADHC commits to the
following actions:
1. Advance equity. This
commitment needs to stand in an environment where demand
is already greater than supply. This requires not only
that all new funds be spent equitably, but a review over
time of all grants, to ensure that they service the needs
of the growing diversity in the community.
2. Invest in longer term
outcomes and build the capacity of the communities
instead of the focus on responding to crisis. This
requires a clear shift in the development of any
initiatives towards an understanding that ethnic
communities may have difficulty articulating their unmet
need for services. A capacity building approach to
working with those communities would lead to the
articulation of new ideas and approaches, adding to the
responsiveness of the existing system. This would
increase demand on services, which needs to be
recognised.
3. Enhance the cultural
competence of the services sectors. This requires a
clear understanding that cultural competence will improve
service quality for everyone, not just for people from
CALD backgrounds.
4. Develop new service options.
This includes evaluation and knowledge of key
contributions offered by ethnic communities in dealing
with ageing, disability and carer needs.
Recommendation 1: Commitment to
stated values
That DADHC commits to the
following actions to implement its stated
values:
- Advance equity.
- Invest in longer term
outcomes and build the capacity of the
communities
- Enhance the cultural
competence of the services sectors
- Develop new service
options.
4. Initiatives that need to be
implemented
To advance the capacity of
the community and services, to build on successful
initiatives and to translate the above commitments into
practice, a range of initiatives must be implemented.
These are based on targets, sector capacity building and
community capacity building, including an informed
understanding of social capital.
Targets
The creation of planning and
funding allocation benchmarks and targets, both for
existing programmes and new services, is an essential
initiative to improve access to services for CALD
communities. This was recommendation 1 in the recent
Standing Committee on Social Issues 'Making it Happen'
final report on disability services: 'The Department of
Ageing, Disability and Home Care should, in consultation
with representative groups, establish Departmental
targets for equitable service access. Targets should be
established…performance against targets should be
monitored and reported upon…an implementation plan
should be developed…' (p.10).
Recommendation 2:
Targets
That DADHC establish broad
performance targets in collaboration with stakeholders
which increase incrementally to achieve equity over
the next 10 years. In practice, we recommend that
regional DADHC offices (see Recommendation 4:
established partnerships),assist agencies to develop
targets to ensure that, over time, the agencies'
consumers reflect the cultural diversity of the
community the agency serves.
Sector capacity
building
Targets alone will not improve
outcomes. A significant part of enhancing equity requires
investment in skills and knowledge of the service sector.
Cultural competence needs to become a core competence of
workers for non-government and government providers and
DADHC.
Cultural competence is increasingly
being seen both overseas and in Australia as a means of
achieving good quality outcomes for all people, not only
people from culturally diverse backgrounds. Cultural
competence, based on sound research, development and
evaluation of past and present programmes and services,
improves the capacity of services to be more inclusive
and responsive. Evaluation of current programmes and
services is important so that future services can learn
from the successes and failures of the past, and
incorporate the successes into their service
provision.
Recommendation 3: Sector
Capacity Building
That DADHC build the
cultural competence of the sector based on sound
research and development, and evaluation of past and
present programmes and services.
Community Capacity
Building
Targets and sector capacity
building will go a long way towards achieving equity, but
without developing and building the capacity of ethnic
communities themselves, equity cannot be achieved.
Empowerment of communities to take control of decisions
that affect their lives should be an important stated
goal of any government Department. This is even more
important where structures and beliefs in particular
communities may differ from that of the mainstream
society and systems.
We welcome DADHC's emphasis on
'working together' to inform and guide future
decision-making and to improve the focus and design of
priority initiatives. However, greater emphasis on
engaging with ethnic communities, both established and
emerging, should be central to a holistic - a life course
and continuum of care approach - framework of improved
responsiveness. This enables clients from CALD
backgrounds and CALD communities to articulate their
needs while enabling services to respond effectively to
them. Through these mechanisms the framework should
emphasise working towards an informed understanding of
the link between service outputs and CALD client
outcomes.
Recommended action areas to
achieve this are:
- Creating active, sustainable,
and ongoing partnerships between local communities,
DADHC regional offices, and local service providers;
and
- Providing regular culturally
appropriate information sessions and advocacy training
to local communities.
Both the DADHC framework and model
refer to the importance of a welcoming and inclusive
community and to services (both mainstream and
specialist) working together to enable participation in
community life. These outer layers of DADHC's proposed
model are the least understood, yet potentially the most
rewarding both for the community and
government.
However there are two issues that
DADHC should address within this framework and outer
layer of the model. Firstly it is important that DADHC
refer to inclusive communities within this outer layer of
the proposed model; reference to one inclusive community
with no reference to the diversity that makes up
Australia smacks of a policy of assimilation rather than
multiculturalism.
Secondly DADHC's continued emphasis
on 'Participation in community life' must be based on a
sound understanding of the concept of social capital as
it exists within and affects CALD communities, families
and individuals. Currently there is little knowledge or
use of skills and networks that are currently employed
within CALD background communities and families to
respond to ageing, disability and caring. There is also
little understanding about what community life, and
participation within it, means for these people. Greater
understanding of how differing levels of social capital
or participation in community life can improve the lives
of people within CALD communities must place these
communities, families and individuals at the centre of
'working together'.
Greater clarity on DADHC's shift in
emphasis to participation in community life / inclusive
communties should spell out that this is not a cost
shifting exercise, which has the potential to further
restrict access, particularly to those at most risk of
isolation. Rather DADHC should highlight that the move
will be supported actively through the mechanisms
outlined above. In addition, greater clarity about this
change in emphasis should be supported by an explicit
policy shift to a community development model in addition
to the current service development model. An emphasis on
empowering communities will directly contribute to the
service sector's capacity to respond to community
diversity.
Recommended action area:
- DADHC referring to inclusive
communities rather than community;
- DADHC clarifying the shift to
participation in community life / inclusive
communities;
- DADHC accompanying this
clarification with an explicit policy shift to a
community development model in addition to the current
service development model.
Recommendation 4: Community
Capacity Building
That DADHC build the capacity of
communities to inform and guide future decision making
based on the five recommended action areas outlined
above.
5. Immediate initiatives
identified by DADHC
See Appendix 1
6. Medium to Long Term
Strategies
We welcome the future
development of strong policy and management responses in
the medium to long term, and acknowledge that each
strategy outlined in the draft paper is an important step
towards these responses. However, simply stating a
commitment to 'development' is insufficient. Given the
level of future demand and unmet need looming over the
horizon for DADHC, additional emphasis on a research and
evaluation strategy would be a timely addition to this
section of the document. Currently there is limited
evidence on whether services are providing responsive
services to clients from CALD backgrounds. A strong
research and evaluation strategy can identify both
positive policies and gaps for the Department to base
future policy and management responses on.
Recommendation 6: Medium and
Long Term Strategies:
That DADHC state its commitment to
'Research and Evaluation' as part of the development of
strong policy and management responses within medium to
long term strategies.
7. The best way
forward
We believe the best way
forward for an increasingly important service sector to
an increasingly diverse community is through active
participation by the communities and individuals for whom
DADHC provides and purchases services. By making a
long-term commitment and with strategies to meet CALD
needs as part of DADHC's core business, and by directly
working with peak bodies, service providers, communities
and individuals to achieve this, we believe that the
services delivered by DADHC can be more accessible,
responsive, sustainable, and equitable for CALD
communities and individuals in NSW.
Recommendation 7: The best
way forward
That DADHC make a long-term
financial and policy commitment to CALD issues within the
organisation's core business, and work in ongoing
partnerships with peak bodies, service providers,
communities and individuals to achieve this.
APPENDIX 1
DADHC's draft future
directions document appears to have disability as its
main focus. MDAA takes this opportunity to focus on
specific issues relating to disability outlined in the
DADHC draft as 'Immediate Initiatives'. The ECC and the
above mentioned organisations endorse this appendix as
recommendations needed for people from a CALD background
with disability and their families in the areas DADHC
identified.
Immediate initiatives DADHC
identified
Service Access System (SAS)
For people from a CALD background, DADHC needs to
acknowledge that the SAS does not deliver to those in
greatest need, but to those who are best able to
articulate their need.
We recommend:
That the stated aim of better targeting include targeting
people in specific ethnic communities. For 2004-2005 this
should include information about SAS being made available
and distributed in 10 community languages.
Transition from education
The current ATLAS round included people from a CALD
background as a priority. From early discussions we
understand that this has meant a significant increase in
the participation of people from a CALD background in the
ATLAS program.
We recommend:
That the current priority target remain in place until
equity is achieved in the ATLAS program. We also
recommend that this strategy be evaluated in 2004.
Support for children
It appears that CALD service use rates are the
highest among children with disability from a CALD
background who are born in Australia. It also appears
that this is largely based on referrals from health
services to disability services. We are concerned about
the children who currently miss out and do not access the
service system at equitable rates, particularly children
whose parents are from a CALD background who acquire a
disability after birth, and children who come to this
country from a non-English speaking country, whether with
a disability or who acquire a disability here.
We recommend:
That in 2004-2005 DADHC initiate work with health
services, particularly GPs (including bi- lingual GPs),
to ensure better co-ordination of support for children
from a CALD background with a disability.
Boarding houses
Many people who live in boarding houses are from a
CALD background. Often these people do not have any
families or any connections to their community. In fact,
quite frequently, they are in a particular boarding house
because the proprietor or manager is from their ethnic
community. Little or no work has been done to develop
culturally appropriate accommodation support options for
people from a CALD background leaving boarding
houses.
We recommend:
That by December 2004 DADHC has ascertained the ethnic
background of all the people currently supported in
Boarding Houses and developed culturally appropriate
strategies for each of these people.
Closure of large
residentials
As with boarding houses, large residential centres
were often services of last resort and we understand that
there are significant numbers of people from a CALD
background residing in large residential
centres.
We are concerned about the lack of
any reference to the closure of large residential centres
past stage 1 of the devolution process.
In 2001-2002 MDAA undertook a
communication project for DADHC with families and
residents from Arabic backgrounds. MDAA's final report to
DADHC stated 'Overall, the lack of knowledge about the
residents and their families' cultural background in the
large residential centres is very disturbing. We are
unsure how any communication ever happens if there is not
even the knowledge in what language that communication
needs to occur. We have serious concerns about issues
relating to informed choice, consent, etc.'
We recommend:
That DADHC undertake an audit in 2004 of the cultural and
linguistic backgrounds of all residents and their
families in all large residential facilities.
Respite extension and
improvements
We welcome the expansion of the respite program and
commend organisations that are making significant efforts
to achieve equity in those programs. However, so far as
we can ascertain, there is little monitoring even though
the additional respite funding EOI clearly required
organisations to identify steps they would undertake to
achieve equity.
We are also concerned that there is
little comprehension of the high numbers of ageing carers
from a CALD background who will need services and whose
'children' now in their 50s have not had any support or
any intervention. We are concerned that many of these
people with disability have extremely low skills and will
require intervention when their parents are no longer
able to support them at much greater intensity than their
Anglo-Australian counterparts.
We recommend:
That by December 2004 DADHC undertake an evaluation of
whether the growth funds in respite have been used to
advance equity in line with the EOIs
submitted.
In addition, we recommend a
focus on people from a CALD background in all work
undertaken in relation to ageing carers.
Personal care services
We look forward to the equitable allocation of the
100 Attendant Care places.
We also look forward to a more
effective and equitable delivery of the Home Care High
Needs Pool and the joint projects with the
MAA.
We recommend:
That DADHC require from all service providers a
commitment to deliver equitable services with clearly
spelt out service targets at the commencement of the
projects.
Improving service for indigenous
people and those from CALD backgrounds backgrounds.
We congratulate DADHC for making Aboriginal and
Torres Strait Islander and CALD issues an immediate
priority.
We recommend:
That for the CALD population, DADHC ensure that the
current joint Action Plan is implemented and evaluated
and is immediately followed by another action plan when
the current plan runs out in July 2004.
Intake and assessment
We look forward to an intake and assessment procedure
which is culturally competent in responding to requests
for support and links from CALD families.
We recommend:
That DADHC engage in regular discussions with ethnic
community agencies about intake and assessment
procedures;
DADHC develop a promotion
strategy for the intake and assessment procedures which
includes ethnic communities;
DADHC evaluate the procedures
after 6 months to ascertain the level of use by ethnic
communities; and
DADHC draw up a promotion plan
based on that evaluation to target communities which do
not access the service at an equitable
rate.
Prevention and early
intervention
Prevention and early intervention are laudable
strategies to decrease pressure on the service system.
However such initiatives only work and are sustainable
when there is considerable active involvement and a sense
of ownership by local communities.
We recommend:
That by 2005 all current and new prevention and early
intervention strategies, activities and initiatives are
accessible to people from CALD backgrounds. In addition,
we recommend that specific prevention and early
intervention issues are designed with and targeted for 5
different ethnic communities.
Stabilizing grants program
We welcome DADHC's renewed commitment to stabilise
the grants program and we certainly recommend that DADHC
develop a monitor and support function to achieve
outcomes for people from a CALD background.
We recommend:
That DADHC train all staff involved in service support
and monitoring in cultural competence and develop
guidelines on how to support services to achieve the set
targets.
Improving DADHC service
While there is no recent data available we are
certain that rates of using DADHC services, that is DADHC
disability services and Home Care, are little different
from the service use rates in non-government
services.
We recommend
That DADHC disability services and Home Care develop an
action plan with set targets by December
2004.
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