Man in wheelchair playing with his daughter

Co-designing Victoria’s disability services - Participant report

To support EOI evaluation, and shape a potential transfer process, additional co-design was conducted

EOI evaluation

Government released an Expression of Interest (EOI) to measure the interest of non-government service providers in taking on four disability services.

In May 2017, the government released an Expression of Interest (EOI) to measure the interest of non-government providers taking on four government disability services, and to test whether strict government conditions and evaluation criteria could be met under that scenario.

The four disability services are: Behavioural Intervention Services (BIS), Early Childhood Intervention Services (ECIS), Short-Term Assisted Accommodation (STAA), and Supported Independent Living (SIL).

In July 2016 and March 2017, the government undertook two rounds of co-design with more than 50 people that would be affected by a conditional transfer, including people with disability, their families and workers. This engagement sought to understand participants’ lived and ideal experience, with a focus on quality, safety and trust.

Findings from the co-design directly shaped government’s strict transfer conditions and the EOI evaluation criteria.

The government is continuing to consider the feasibility of a potential conditional transfer

The government has now undertaken a further co-design engagement to continue to build on knowledge and insight gained in previous phases. This is to ensure people with disability, families, and workers have greater input, ownership, and confidence in outcomes from a potential transfer of services.

Findings from this new round of co-design will inform decisions relating to EOI evaluation, the potential transfer process, an† communication recommendations to update people with disability, families, and workers.

Additional co-design activities may be conducted in the future to continue to inform any conditional transfer process.

In-depth research with  participants, families and workers was conducted

In-depth interviews were used to immerse in the experiences, needs and emotions of participants, families and workers.

Research focused on:

  • Testing and building upon insights from Phase 1 and 2
  • Deepening learning from EOI submissions
  • Understanding service attributes and levels of performance that support quality outcomes
  • Developing an initial understanding of transition needs

Evaluating quality outcomes

We heard that quality outcomes are individualised and safe; and are enabled by trusted  workers and ongoing communication.



Participants want support and services to be tailored to their individual needs and goals.

Families also want services to consider their needs and offer support and flexibility where possible.

Participants’ and families’ needs are fulfilled when their preferences are recognised and acted on, and when workers and providers are driven by the participant’s agenda rather than their own.


Safety is one of people’s primary concerns.

Participants need to feel safe with other participants and with workers.

Families need to know the participant is safe, and feel they can speak up about concerns without fear of repercussions for the participant. Consistency and stability of workers assists in perceptions of safety.

Workers also need a physically safe and emotionally supportive environment to deliver the greatest impact for participants.


Trusted workers

Workers are at the centre of how participants and families perceive and experience disability services.

Trusted workers develop relationships with participants and families over time, based on rapport, respect, and expertise.

Trusted workers take responsibility, and are responsive to participant and family needs.

Ongoing communication

Families want to be informed of important events or incidents that impact the participant.

Ongoing and meaningful communication between participants, families, and workers creates confidence in the quality of support, and relieves concerns regarding safety.

Two  further attributes  form the foundations for enabling quality outcomes: Comfortable participant environments and Proven provider values


Comfortable participant environments

Comfortable participant environments are ‘homely’ and safe. They create a secure space for participants that reflects their individuality.

Considered layouts contribute to practical freedom, where participants and families can engage in a variety of home-based activities that align with their personal preferences.

Proven provider values

The governing values and demonstrable practices of service providers are strongly linked to their perceived performance. Providers guided by values including empathy and human dignity deliver superior outcomes for participants, families and workers alike.

Family and workers have clear parameters for judging high and low performance, irrespective of provider.

Trusted workers are in partnership with participants and families, rather than focusing on  process driven tasks

Trusted workers advocate for and collaborate with participants and families, identifying and coordinating funding and support

Trusted workers:

  • Are driven to improve quality of life for participants. They leverage a network of disability and health service providers to design holistic solutions
  • Demonstrate ?exibility in approach and scheduling. Families appreciate coaching on speci?c support practices and workers who make themselves available for participant appointments, if required
  • Engage with co-workers, and share knowledge and expertise with other practitioners to deliver superior participant and family outcomes
  • Empathise with emotional and practical pressures affecting participants and families, and are most effective, particularly when issues such as substance abuse, domestic violence, unemployment and/or unstable housing are factors
  • Use individualised strategies to actively and patiently support participants and families transitioning into or out of services, for example ECIS workers remaining a point of contact post school age, and children exploring STAA by ?rst just visiting for dinner and then returning home. This is essential to maintaining continuity of support especially transitioning from ECIS to school based services, and from high school to adult programs

Low performing workers are perceived by participants and families as displaying limited empathy, with a focus on process tasks

It’s perceived that low performing workers rarely:

  • Undertake their role beyond principally focusing the basics, such as cleaning
  • Connect with the broader disability sector; for example between disability and mainstream services and how to facilitate this relationship
  • Be ?exible in their approach to (and scheduling of) support, or adapt to participant and family needs
  • Engage with other workers and practitioners, or actively share participant and support speci?c knowledge and experience
  • Be empathic and sensitive to deal with issues with participants and families that are experiencing challenging situations

A trusted worker creates a positive experience with disability  services

Lisa’s* story, mother of Amelia*, accessing ECIS

'When you’re first accessing ECIS you’re stressing out about your kid ... you’re not used to it, you don’t know what’s going on.

You’re kind of reeling from a diagnosis ... you don’t know the right questions to ask. I don’t know about the different pots of money available, and whether we’re eligible to access them.

Our current worker is great, she talks a lot about what we can do and what we can get going and what pots of funding we can access…she initiates conversations about things I haven’t thought of...makes suggestions about things I could consider for Amelia*.

[Our key worker] is proactive; we’re already looking at wheelchairs for Amelia*, and starting the application process even though she won’t need it for a while. The process takes ages so we want to be ready...if you’re slow to identify a need there’s a big lag.

What’s important is that you gel with the person. You see them a lot and you need to feel open and communicative and get along...With [our key worker] I feel like we have a team, we have a collaborative ongoing  dialogue.'

*NOTE: Names have been changed for privacy

Effective communication invites the participation of all parties; poor communication is infrequent and transactional

Effective communication is proactive and engaging, adopting a sensitive and mature approach

  • Participants and families feel most secure and satis?ed when they are engaged in regular two-way communication with support workers to discuss issues, share knowledge and develop collaborative plans
  • Proactive and ongoing communication between support workers and other practitioners to understand participant needs facilitate the most effective model of support
  • New migrants to Australia, and those for whom English is a second language, require additional communication support. Workers and providers that are able to recognise and respond to this can be critical to these participants and families

Poor communication is evidenced by limited, sporadic interaction that fails to articulate understanding of participant needs

  • Irregular communication with limited detail or evidence of speci?c participant understanding, or having to chase information, leaves participants and their families feeling anxious about the quality of support
  • Participant outcomes are negatively impacted when the communication approach limits the opportunity to share knowledge or develop collaborative support plans with other workers, practitioners and family
  • Limited ability to access language support services, and/or help participants and families navigate the system and complete documentation, can result in reduced access to services and funding for participants and families

Communication between all parties who support a participant has clear benefits

Brad* and Liz’s* story, parents of Hannah*, accessing STAA

'With [the STAA facility], all we had was an initial chat with the person at the house at the start, you don’t have regular meetings, and you get no communication unless something goes wrong.

I think in some ways they don’t want to bother you with how they’ve behaved ... but if I ask specifically, they can tell me what behaviours are happening. With Hannah*, we have to ring up and ask [the STAA facility] if we need info, like if she’s not sleeping.

At [the activities service provider], they send us photos and we get reports and updates about what’s going on. At [the STAA facility], their process for communication isn’t very good, but we just really needed the service, and she’s happy to go, so we just go with it.

What we want is for them to be prepared to sit and listen to what we’re trying to implement, the behaviours we’re working on with Hannah*, so it’s linked up and we’re all collaborating together.

Everything’s fragmented, nothing’s connected. I find a lot the communication really poor, they don’t keep you in the loop about when people are leaving or moving on. I just want communication regarding what’s happening, so I know what to expect.'

*NOTE: Names have been changed for participant privacy

Comfortable participant environments create positive well being; unsatisfactory environments are sterile and rigid

Comfortable participant environments feel like a safe and cared for home, and reflect the participants’ individuality  and  preferences

  • Participant and families prefer environments that are homely and comfortable, where the house and bedrooms are furnished with participants’ personal items, artwork and photos
  • Environments that are relatively clean, tidy, well maintained and cared for, avoiding furnishings that feel clinical or institutional, are most desirable
  • Superior environments offer various options for residents, allowing for participants to be housed according to how they match with other participants and the level of security they require
  • Access to Wi-Fi, and the ability to charge and manage personal devices (e.g. iPads), is highly valuable to a number of participants and families
  • The availability of transport services makes a significant difference to the quality of support and range of activities that can be offered

Unsatisfactory participant environments feel clinical, inflexible, and limit socialisation

  • Participants and families identify environments with limited personal possessions as institutional, as there is no linkage to the individuality of the participant
  • Families feel distressed by environments that appear overly clean and tidy, relating them more to hospital wards than homes. Conversely, environments that are dirty and disordered feel neglected and sub-standard
  • Environments that have limited capacity for security customisation can result in poor participant matches and consequent behavior challenges
  • Locations with limited public transport, and no or infrequent private transport solutions, isolate participants and restrict their capacity to engage in activities

Workers need to first understand participant needs, then adapt the environment to suit them

Thomas’* story, father of Greg*, accessing SIL

'l remember two young went in the place they were running and they had refrigerator boxes with curtains hanging over them. He said ‘some of the kids like privacy, there’s no privacy in this place’, so  he got these boxes and put little curtains on them and he’d play with residents and they’d hide in there, and then some of them stay in there because they like the private space. He identified the needs of those kids and provided for it.

At Greg’s there’s three wings in it; there’s two large living areas. If people get sick of one living area they can wander up to the other one...there’s nice outdoor areas as well because Greg loves to get outside and get a handful of dirt or grass.

He’s been at a few different units there...they tend to change them around if there was somebody that was a bit rough.

There’s another young fellow with special needs.

They actually created a little granny flat in one of the major units for him. He’s pretty well isolated but that’s what he likes. So I suppose generally what they try to do is to identify what the needs are and within the limitations of the resources they have, they try and respond to the needs.'

*NOTE: Names have been changed for participant  privacy

Proven providers create a culture of dignity and respect, poor quality providers are satisfied with meeting minimum standards

Proven providers have robust and demonstrable participant-centred values that govern their daily operations and practices

  • Reputable providers have a set of clearly articulated values (specific to the disability sector) that are intrinsic to their support approach, practices and processes. These values also play a significant role in worker recruitment, induction and training
  • Within the context of organisational values, proven providers actively manage the performance of their workforce, so as to increase the retention of quality workers and reduce the prevalence of under-performance or misconduct
  • Participants and families embrace providers that offer increased flexibility of worker rostering, to allow for participant activities outside of ‘normal’ working hours, such as evening outings or cultural activities
  • Providers that leverage efficient systems for management of participant information and administration dedicate more time to direct participant support, and therefore offer better outcomes overall

Poor quality providers do not establish and adhere to disability specific principles, practices are developed to primarily serve operational imperatives

  • Providers with no governing values or principles deliver inferior support services for people living with disability and their families
  • Providers that recruit with no focus on disability related values and character indicators are less likely to build a workforce that adequately meets the diverse needs of participants and families
  • Providers that apply performance management with limited efficacy or alignment to values and principles have a higher turnover of quality workers and retention of low performing teams
  • Rigid approaches to rostering and scheduling limit the scope and flexibility of activities available to participants and families
  • Inefficient systems that don’t effectively capture and manage participant information negatively impact on provider ability to support both participant planning, and worker and family collaboration

The right staff and the right practices need to work together, in an environment of respect

Kathleen’s* story, SIL worker

'The role of staff should be more about enhancing the quality of people’s life and engaging them.

I’m very particular with the casuals I get working with me, I look for certain qualities ... that they’re nice, I can’t overstate how important it is for staff to be nice, it sounds so simple, because if people come in with a sense that people with disability need to be controlled or managed, then they’re not nice. If they’re thinking they’re there to support and assist, they’re going to be nice ... you can’t really quantify it but it’s the nice factor ...

Within the department, there’s so many processes and intricate ways to deliver the services, there’s so much  to know, you need a lot of knowledge. I’m lucky enough to have a really supportive, switched on manager, she’s really good ... my conversations with her are always constructive, something tangible always comes out of our discussion, we come up with some sort of plan on how to problem solve.

I have the right systems up and running, it provides staff with structure and clarity. ...when you have the right systems, that’s when things get done, that’s when it happens.'

*NOTE: Names and photographs have been changed to protect participant  privacy

Hopes and concerns for a potential  transfer

When considering the impact of a transfer of services, participants, families and workers have distinct hopes and concerns

The concept of transfer evokes mixed feelings. Currently, participants, their families and workers have little understanding of what transfer means and how it might impact them.


There is hope that a transfer might enable greater creativity, innovation and ?exibility for participants, families and workers.

Clear aspirations exist for a future where the tenants of ?exibility, access, protection and excellence are central to the design and delivery of disability support services.


There are concerns that transfer could result in services being compromised, reduced in quality or eventually cut, creating negative impacts on participants and families.

Concerns are driven by the uncertainty of future accountability and governance, and confusion as to the different responsibilities of NDIA and state government.

Hopes focus on the potential for greater creativity, innovation and flexibility for participants, families and workers

Families hope for greater creativity and innovation including enhanced accommodation and support models

  • Participants and their families hope for increased creativity and innovation from service providers to go beyond minimum standards when designing individualised support and activities
  • Participants and their families hope for greater ?exibility in accommodation and support models from service providers including resident matches, shared support models, better home support models and part time SIL accommodation. These models are currently not available or very limited availability

'It’s good to have a market with other players. Think it’s likely to bring more creativity, innovation and lateral thinking but it’s not like other marketplaces because the consumers are so vulnerable.' SIL family

'I’d love to have younger staff who aren;y frightened of technology to help with my son, it takes less than one minute to add new communication messages to his tablet, but there is a reluctance to learn.' SIL family

Workers hope for simplification  of systems, less administration and maintenance of strong governance

  • Workers hope for decreased administration driven by less policy and bureaucracy
  • Workers desire the simpli?cation of accessing disability services for clients and families
  • Workers hope to maintain the strength of governance currently in place which seeks to assure protection for people with disability

'The good thing … could be less paperwork. You look at the paperwork in the non govvy services already and they don’t have it.' SIL worker

'There was something about the bureaucracy that was really reassuring – the structure, guidelines, and process were in place, and I know the reasons behind them … sometimes you can be frustrated by the bureaucracy but the ultimate goal is protect the people we support.' SIL worker

Participants, families and workers have clear, positive aspirations for the future of disability support services

Participants, families and workers hope for a future where the tenants of flexibility, access, protection and excellence are central to the design and delivery of disability support services.

Flexibility and choice

More providers with a broader range of support offerings and delivery models, creating new choice and flexibility in disability support services

Protection and assurance

A regulatory environment which provides the framework for high quality support and the systems and controls to ensure it is adhered to

Ease and clarity of access

A simpler, more streamlined disability support system where families have one trusted point of contact and can view all options, compare and choose providers and apply for support through a single, integrated channel

Culture of excellence

A workforce in which high performance is recognised and rewarded; where exceptional performers are celebrated and stories of success are circulated for others to emulate

Reputable service providers

A values-based approach where providers articulate and adhere to disability specific principles focusing on quality of life for the participants and families they serve

360 degree communication

Systems and practices that ensure all participants in the support ecosystem have input and access to the information they need to design and deliver quality support

Concerns centre on the potential for services to be compromised, reduced in quality or eventually cut after the transfer

There are concerns that provider behaviours may result in a decline in service availability, and staff retention

  • There is concern about potential provider motivation to pro?t from a vulnerable population
  • There is a concern providers might cut services, fold if not pro?table, or decide to not provide access for people with complex needs that cost more to service
  • There is concern that consistency, quality and training of staff will diminish due to an increased focus on the bottom line

'You have to have enough big players that you aren’t going to have those services fall over, and the disruption to people’s lives that would happen then.' SIL family

'Anyone within reason can provide for those that are easy to provide for. The greater the disability, the greater the amount of attention and services and funding that needs to be applied to the situation.' SIL family

Workers are concerned service quality may decline through reduced accountability, collaboration and job stability

  • Workers are concerned providers bring in new values and practices and the impact this will have on service delivery and the worker environment
  • There are concerns of overall decline in service quality due to poor provider practices and their inability to create a quality service. Workers fear employment with substandard providers
  • Workers are concerned they will be put on rolling contracts with no stability and reduced compensation
  • ECIS have concerns the transdisciplinary model will be dissolved, resulting in siloed services and the loss of the key worker model

'It’s the culture of DHS. I think the culture leads to greater accountability … it’s the culture that worries me … there are NGOs out there that clearly articulate their values and they tend to do better.' SIL worker

'Fear the model being jeopardised and silos occurring and losing a lot of the collaboration that we do as part of our job – unless there’s an allowance for it. They (families) might get more service but not necessarily the outcomes.' SIL worker

Concerns are driven by the uncertainty of future accountability and governance

There is concern that providers will take advantage of an already vulnerable population

  • There is fear that transferring services to non-government providers may lead to a situation similar to the VET sector where a number of providers exploited students by delivering sub-standard education at in?ated prices. If this were to occur, the negative impact would be considerably more dramatic given the vulnerability of those accessing disability support services
  • Participants, their families and workers want government to provide the regulatory framework for safety and quality, including duty of care and a provider of last resort to provide assurance of access to services for people with complex needs
  • They also want an independent and trusted watchdog to regularly and rigorously monitor service providers to ensure adherence to regulations

'Risk for those with serious behaviour issues – who’s going to provide accommodation for them – it’s the accommodation of last resort and the oversight of how the house is going, the accountability of safety and quality framework. And that line of oversight.' SIL family

'Of particular concern is a watch dog or a monitor…with the advent of going to the private sector, whether it’s for profit or not for profit, there still needs to be an independent organisation that’s charged with the responsibility of watching on a routine basis.' SIL family

'There is a capacity, or right, within the service provider, and also that same right applies to the person that owns the house and they can say well I’m sorry, their line of behaviour we can’t handle. We could if you give us a lot more money, but if not they have to leave. In the past, one way or another there has been the government to provide a safety net.' SIL family

'You’d want it to be strictly regulated … there’s been trouble with registered training boards and the poor quality and dodginess of those.' FBR family