Australian Indigenous

A review of the literature on disability services for Aboriginal and Torres Strait Islander peoples

This review is also available as a downloadable PDF using Adobe Acrobat.

• Abbreviations
• Appendix
  • The nature and assessment of disability
  • Concepts of disability
  • The nature of disability
  • Defining disability
  • Disability support services
    • The Australian context of disability support services

Abbreviations

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Appendix

The nature and assessment of disability

Concepts of disability

Concepts of disability are complex and have changed over time [37]. There are historical, social, legal, and philosophical influences on the perception of disability, and further complexities in spiritual interpretations. The experience of disability is unique to each person, but there are common elements. The identification of these elements is essential for providing support, enhancing community understanding, and minimising marginalisation. There are obvious needs:

• to address the factors contributing to disability;
• to make interventions where appropriate;
• to overcome barriers to participation in all areas; and
• to improve access to disability support and other relevant services.

Various conceptual models have been used to direct services for disability—medical, psychological, and sociological models of disability, all of which have been criticised to some degree [91]. The labelling of people, in medical and rehabilitation models, as people with a disability can have negative consequences: they may feel ashamed of their condition and may be stigmatised and looked down upon by their community. In sociological models, disability is viewed within a wider social context and people with a disability may be considered to be a minority group—with the associated possibility of being oppressed. Recognition of oppression has led to an independent living model, through which people with a disability have demanded independence and responsibility.

Generally, social models of disability have proven to be the most valuable, but many still rely on a distinction between what is 'normal' and what is 'not normal'. As this distinction is itself socially defined, models relying on it are open to criticism, and it has been argued that a universal approach is preferable [82]. Universalism decreases limitations for people with disabilities and opens their scope of opportunities, allowing them to live as ‘normal’ a life as possible. It has been argued that universalism serves people with disabilities more effectively than a civil rights or a 'minority group' approach [82].

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The nature of disability

There are generally five broad categories that are currently used to define the type of disability that a person has. These categories are, however, multi-dimensional, and include people with varying degrees and severities of a particular condition/s.

Physical disabilities are those that result in restricted activity due to decreased mobility and manipulation, and can include conditions of the brain, spinal cord, muscular, nervous and respiratory systems [71].

Intellectual disabilities refer to conditions caused either by genetic disorders or infections, and can result in limitations and slowness primarily in general learning ability as well as communication and information retention [71].

Psychiatric disabilities are the most varied in terms of their scope and effects. They usually include people with underlying medical conditions such as schizophrenia, manic depression, phobias, and neuroses [71].

Blind or vision-impaired disabilities can affect visibility to varying degrees, from a total absence of vision, to useable vision [71].

Deaf or hearing-impaired disabilities account for those who have varying degrees of hearing impairment. In the strictest sense, individuals usually have no useable hearing and communicate through Auslan (Australian Sign Language). Individuals with less acute forms of hearing impairment usually communicate through oral [71].

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Defining disability

Although there are difficulties in conceptualising disability, there is a need for an agreed definition of ‘disability’ for ‘the collection and analysis of meaningful data on people needing services, the services they receive and the outcomes from services, and for ensuring that these data are in some way comparable for different population groups’ [83]. To that end, the Disability Data Reference and Advisory Group was established in 1996 to advise the Australian Institute of Health and Welfare (AIHW) on how generally to improve, harmonise, and standardise data collections (see Box) [83]. The Group also acted as an advisor and consultant in its role as an Australian reference group for the development of the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF), a revision of the International Classification of Impairments, Disability and Handicaps (ICIDH). The process of redevelopment and testing took several years and involved the WHO and its Collaborating Centres, which included the AIHW [26]. As part of the testing in Australia, the AIHW sponsored a test of ICF concepts in two Indigenous communities in the Northern Territory [13].

The ICF uses the concept of ‘participation restriction’ instead of ‘handicap’. The neutral terms, which include all people, not only those with a disability may therefore be seen as an improvement on the terms used previously. The revised classification system focuses on inclusiveness and reflects the universal approach discussed by Bickenbach and colleagues [82].

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Disability support services

It is generally accepted in Australian society that people with disabilities may need assistance from others to continue participating in all aspects of community life. Different types and varying levels of disability require different levels of care and the use of different types of services. Daily activities are categorised according to self-care (bathing, dressing, eating); mobility (movement, public transport); and communication (understanding, speaking, etc) [84].

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The Australian context of disability support services

The planning, policy setting, and management of disability support services in Australia is undertaken within the framework of the Commonwealth State/Territory Disability Agreement (CSTDA) [85]. The current CSTDA, which covers the period 2002-2007, is the third such agreement (the previous agreements were known Commonwealth State Disability Agreements (CSDAs)).

The CSTDA agreement, which is binding between the Commonwealth and State and Territory governments, outlines the roles and responsibilities of each in their jurisdictions [85]. The agreement provides both a national framework for disability services enabling the contribution of funds by Commonwealth, State and Territory governments, and a bilateral agreement that provides for strategic activity between the Commonwealth and individual States and Territories.

In acknowledging the principles and aims of the Commonwealth Disability Services Act 1986, the Disability Discrimination Act, and complementary state and territory legislation,^xxv the agreement prioritises access to generic services by people with a disability; the development of across-government linkages;^xxvi strengthening the capacity of individuals, their families and carers; improving accountability, performance reporting and quality; and putting in place long-term strategies that respond to, and manage the demand for, specialist disability services [85].

The CSTDA is aimed primarily at people aged less than 65 years, with people older than that age only being eligible for services if their disability had been manifest before they turned 65 years [86].^xxvii

The specialist disability services covered by the CSTDA comprise accommodation support, community support, community access, respite, employment, advocacy, information and print disability [85]. The agreement does not cover services provided as veterans’ entitlements or those with a specialist clinical focus. Responsibility for advocacy, information and print disability services is shared by the Commonwealth and the States and Territories, as is research and development (the Commonwealth is expected to provide ‘national leadership and coordination’ in this area). The Commonwealth has responsibility for specialist disability employment services, and the States and Territories for the specialist disability services in the areas of accommodation support, community support, community access, and respite.

Accommodation support provides accommodation and housing in the form of institutions, residential, hostels, group homes, attendant care, outreach support, and alternative family placement. It is the largest support service accessed by all people with a disability [87].

Community support and access services are equally accessed and in some areas there appears to be some overlap in the services that each provides. Community support however, can be viewed largely as being based on a therapeutic and holistic approach. It provides early childhood intervention, recreation, holiday programs, therapy, case management, behaviour interventions, counselling, brokerage, self-help, and resources [87]. Community access on the other hand, provides services to continue education, post-school options, training, independent living, day programs, and social events [87].

Respite services provide care for those profoundly restricted by their disability on a temporary basis in that their carers may be given a break. Respite services can be in the form of own home, centre, host, peer, and flexible or combination respite support [87]. It is the least accessed of all support services, as many individuals with a profound level of disability are usually institutionalised (as represented in accommodation support figures) [87].

As well as the specialist disability employment services provided by the Commonwealth, individuals seeking supported employment and sheltered employment options are assisted by the employment sector of state employment agencies [87, 88].

Apart from generic community services, other important services for people with a disability include income support and rehabilitation, neither of which is covered by the CSTDA. Income support for people with a disability is provided by the Commonwealth, mainly in the form of Disability Support Pensions. Rehabilitation services are provided through a number of mechanisms, including CRS Australia (known previously as the Commonwealth Rehabilitation Service) and a variety of State and Territory agencies.^xxviii

Performance reporting will be based mainly on data from the CSTDA National Minimum Data Set (developed by the National Disability Administrators in partnership with the AIHW) [85]. This will form the foundation for a publicly available account demonstrating achievements ‘in the delivery of specialist disability services and national progress in implementing agreed national policy priorities’ [1].

Consumer-focussed, government and non-government service providers represent people with a disability in the direction and implementation of disability policy in Australia, and the Commonwealth, State and Territory governments share responsibilities for funding advocacy, information and research services [85].

The National Disability Advisory Council (NDAC), appointed by the Commonwealth Minister for Family and Community Services, acts on Ministerial referrals about matters pertaining to people with a disability [89]. The Council gives relevant advice and information, promotes opportunities for consultation and discussion between the Commonwealth and clients, their carers and service providers, and advances matters that it thinks warrant further investigation.

Under the terms of the CSTDA, the Commonwealth also provides financial support for State and Territory advisory bodies [85]. The national, state and territory advisory bodies are expected to consider issues such as the CSTDA, deinstitutionalisation (and the subsequent need for community housing); employment opportunities and income support; appropriate health care; associations between ageing and disability; and access to education and training.

In 2001, the Commonwealth decided to support the establishment of an Australian Federation of Disability Organisations to become an advisory voice for people with a disability across Australia [90]. In addressing its task of setting up this new organisation, the eight leading disability organisations set up a Federation Working Party, which included a representative from the Interim National Indigenous Disability Network (INIDN). It is anticipated that the first meeting of the Federation’s Board will take place in 2004.

In relation to information about disability, the Australian Bureau of Statistics (ABS) is piloting a question on disability for the 2006 population census. It is anticipated that this should improve the quality of information about relatively small groups of people in smaller geographical regions (such as Indigenous people living in remote areas).^xxix

In an effort to promote a consistent and constructive approach in service provision to people with a disability the Australian Institute for Health and Welfare (AIHW) has developed an Australian ICF User Guide, and has included ICF concepts in the CSTDA national minimum data sets (NMDS) [26]. The incorporation of the ICF definitions and concepts in national data collections is seen to advantage both providers and clients by increasing understandings about roles and responsibilities. For instance, the redeveloped CSTDA NMDS recognises the importance of primary carers, especially those who are ageing, and the mutual support evident among people with a disability.

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Last updated: 23 February, 2005