A new national survey of informal supporters of people with disability who have received NDIS-funded behaviour support services has found that families are often asked to choose behaviour support practitioners without enough information to judge their qualifications, experience or approach.
The study identified wide variation in the confidence supporters have in practitioners' knowledge and skills, pointing to a need for greater transparency about practitioner expertise and stronger, more consistent, rights-based behaviour support across the NDIS.
The research focuses specifically on supporters' experiences of engaging with NDIS behaviour support practitioners, the information they need when selecting a practitioner, and their perceptions of practitioners' knowledge, skills and practice approaches.
Behaviour support has become an important area of disability policy and practice in Australia, including in national discussions about safeguarding the rights of people with disability and reducing the use of restrictive practices.
Positive behaviour support (PBS) is intended to be person-centred and rights-based. It aims to understand and address the unmet needs and environmental barriers that may contribute to behaviours of concern, promote quality of life, and reduce the use of restrictive practices. Meaningful involvement of the person with disability is central to this approach, alongside engagement with the people who know them well - including their everyday preferences, goals and contexts.
The survey of 123 informal supporters, conducted by researchers from Flinders University, Monash University and the University of Melbourne, found substantial variation in supporters' confidence in the knowledge, skills and practice of NDIS behaviour support practitioners.
Almost two-thirds of respondents reported being confident or very confident that they understood the practitioner role, yet many described limited information and support when trying to identify a suitable practitioner. Respondents described limited local availability and long waitlists as constraining choice, particularly for people in regional, rural and remote areas.
These findings reflect supporters' perceptions and experiences; they are not direct measures of practitioner competence or participant outcomes.
Supporters' ratings of practitioners varied across areas of practice. Almost one-third of respondents rated their overall confidence in practitioners' knowledge and skills as moderate. Supporters' ratings indicated lower confidence in several areas, including the involvement of NDIS participants in developing positive behaviour support goals, ensuring plans reflect a participant's values and preferences, supporting the implementation of plans, and developing plans to reduce restrictive practices over time.
Respondents identified communication, empathy, collaboration and accessible explanations as strengths when these were present. They also described concerns about limited involvement of participants and supporters, a perceived emphasis on compliance processes rather than meaningful outcomes, limited disability-specific knowledge, and insufficient practical support to implement plans.
"This study highlights that meaningful choice depends on more than simply having a provider listed or available," says Dr Alinka Fisher from Flinders University.
"Participants and informal supporters need clear information about a practitioner's qualifications, experience, areas of expertise and approach to behaviour support, as well as opportunities to determine whether the practitioner is a good fit.
"The findings reinforce the importance of behaviour support that is rights-based, person-centred and practical. That means participants' own views, will and preferences must remain central, while informal supporters are meaningfully included as important stakeholders in planning and implementation."
Based on the survey findings, the authors propose a series of recommendations to strengthen transparency, informed choice and person-centred practice in NDIS behaviour support. These include:
- Making information about individual practitioners' qualifications, professional background, relevant experience, areas of specialisation and practice frameworks easier for NDIS participants and informal supporters to access.
- Giving NDIS participants and informal supporters an opportunity to meet prospective practitioners before formal engagement, where possible, to discuss needs, experience and suitability.
- Strengthening processes that support the meaningful inclusion of people with disability and informal supporters in behaviour support planning, review and implementation.
- Ensuring practitioners have positive behaviour support knowledge and disability-specific expertise, while recognising the value of relevant lived experience.
- Supporting workforce quality through adequate funding arrangements, supervision and quality assurance measures.
The predominantly female sample also draws attention to the gendered nature of unpaid support and advocacy work involved in navigating disability services.
The authors note the need for policy settings that do not rely on this often invisible and unevenly distributed family labour.
"Overall, the study highlights the need for more transparent, person-centred and equitable behaviour support systems," says Dr Fisher.
The research - "A National Survey of Informal Supporters' Experiences and Views of Behaviour Support Practitioners in the National Disability Insurance Scheme", by Alinka Fisher, David Nicoll, Irene Belperio, Maverick Clissold, Aiden Osborne, Russ Fox, Erin Leif and Keith McVilly - has been published in the Australian Journal of Social Issues. DOI: 10.1002/ajs4.70135
