Community Based Respite 
Community Support Teams
Day Programs
Home and Community Care Program (HACC)
What is the purpose of Respite
- To provide planned short-term and time-limited breaks for families and other unpaid care givers of children with a developmental delay and adults with an intellectual disability in order to support and maintain the primary care-giving relationship
- To provide a positive experience for the person with an intellectual disability
Description of activity of Respite
There are four types of respite activity: -
1. Centre-based (General and Specialist)
2. Home based
3. Host Family
4. Community-based
1. Centre-based Respite - where a person stays for a day stay, overnight or longer in a General respite centre providing respite services for people with an intellectual disability. Day stays should only be provided when all other flexible respite options have been explored thoroughly by the Case Manager eg Carers Respite Centres and other non government respite providers.
Centre based respite may have a specialised focus or may dedicate periods of time for a specialist focus. For example:
- a respite centre may dedicate particular periods of time for the exclusive use of the centre by women only or men only, or other client characteristics, depending on the needs of the client group.
- a respite centre may specialise in the school age or adult age groups. A generalist centre may also dedicate particular periods for the use of a single age group.
- Centre based respite in a general respite centre is not provided to children from 0 to 6 years of age.
Specialist Centre-based respite - we operate one such centre for medically frail children 0 – 6 years of age. This centre provides intensive support by staff trained in meeting these clients’ specific needs.
2. Home Based: - where respite is provided in a client’s home.
3. Host Family: - where a client receives planned, short term respite from a designated (host) family. Host family or families are matched to the age, interests and background of the individual and their carers.
4. Community-based Respite:- where a person with an intellectual disability is provided with the opportunity to participate in a positive experience in the community whilst their usual carer has a break. Community-based respite activities may include:
- Group activities: where a group of people is supported to access common activities such as a teenagers group.
- Camps/holidays/weekends away.
Periods of client stays in respite
Wherever possible respite should be planned and allocated as equitably as possible based on assessed client need (please see section below titled Who is eligible).
The typical or ideal stay is of 4 – 7 days in the school aged (6 – 18) and adult groups (over 18). Alternative lengths of stay include planned extended respite of 2 – 6 weeks or a single day to accommodate carer needs such as a holiday or medical issues or client needs such as monitoring changes in medication or behaviour changes.
For children using respite services that involve separation from their usual caregiver/s especially children in the 0- 6 age group who are accessing specialist centre-based respite, an assessment must be made that the length of respite is in line with their needs, age, and development. The impact on the child of separation from their primary caregiver must also be assessed. The need to provide opportunities for the child to have ongoing contact with their family during a stay in respite must also be assessed.
Under the Children and Young Persons (Care and Protection) Act 1998 some respite provided to children (0-16 years of age) and young people (16 – 18 years of age) may also be defined as ‘voluntary out of home care’. Out of home care is defined as a period of time in excess of 21 consecutive days or 28 days in any period of 12 months at a place other than the usual home of the child or young person.
When the period of time is exceeded services are required to develop restoration or care plans and notify the Children’s Guardian.
6In some instances respite is an appropriate service option although not planned. Emergency Short Term Respite is an immediate, time-limited break for families and carers who are unable to provide care due to an unforeseen crisis. Emergency respite is provided on the assumption that the usual care-giver will assume their role in the near future. Emergency respite is usually provided for 96 hours where issues of high support, risk or urgency have been identified although this may be extended in some circumstances and is subject to review.
Maximum stays
Children and young people (0-18years) should not be in respite for 21 consecutive days or 28 days in any period of 12 months without a restoration or care plan being submitted to the Children’s Guardian.
Clients should not exceed the length of the agreed time stipulated in their respite plan
Clients entering emergency respite should not exceed 96 hours without an extension granted through a review.
If an adult client exceeds 63 days per financial year in one of more centre based respite service it may indicate that the individual requires more than respite support. If care reaches or exceeds the 63 day period, an assessment of the client/carer needs must be conducted and a plan developed to meet those needs.
What is Centre Based Respite
Where respite occurs in a centre, it occurs in a dwelling for at least 4 to 6 people that is, wherever possible, located in a residential neighbourhood, or in an area zoned residential by the local government authority. The location should be accessible to services and supports as maybe required to meet client needs, including, transport, commercial services, medical, and recreational facilities.
Basic Physical requirements:
- 4 to 6 bedrooms, to allow adults to have individual bedrooms unless they choose to share a bedroom or their support person consents to the client sharing a room. Children may share a bedroom.
- There will be adequate space for clients, staff (including some office capacity) and provision for visitors.
- The provision of sufficient out door recreational and leisure space is essential.
- A cyclic program of repair and maintenance is undertaken. Urgent repairs are organised locally and within an appropriate time frame.
The property should conform to or exceed the minimum standards as defined in the Departmental "outline brief for homes in the community."
Accommodation is fire safe, conforming to fire standards and departmental guidelines and have conformity with State Environmental Planning Policy No.9 – Group Homes.
A policy manual for respite is currently in development. When completed, these service descriptions are to read in conjunction with the policy manual.
Service Capacity
In determining the capacity of a centre based respite service there are two areas to consider:
1. Physical capacity of centre based services. This is the number of beds in bedrooms in the centre. The minimum number of beds in an adult centre based respite service is five.
2. Resourced beds. This is the number of clients who can be accommodated in the centre at one time given the total staff establishment of the centre. The factors which determine the number of resourced beds a centre can provide are:
- the level of staff support required to meet the needs of individual clients
- the level of staff support required to meet the collective needs of a group of clients who are using the service at the same time.
Currently the capacity of a respite centre is determined by the respite allocation committee based on the client needs assessments. The Manager, Respite is responsible for approving the resourced bed numbers. The Disability Services Directorate is developing a point score methodology to assess capacity.
The vacancy rate of a respite centre is expressed as:
Vacancy rate = The number of beds available minus the number of resourced beds occupied
Who is eligible.
The target group is:
- Persons with an intellectual disability with moderate to high support needs
- Person must have a needs assessment to guide service prioritisation and must be reviewed through the central intake system.
- Our Primary clients are those people over the age of 6 who have an intellectual disability or multiple disabilities where an intellectual disability is also present. We define intellectual disability using the international definition as:
- an IQ of two standard deviations below the mean
- with significant deficits in adaptive behaviour skills
- as manifest in the developmental period prior to 18 years.
- For our clients under the age of 6 years, we determine their eligibility on the basis of their developmental delay. To continue as a client accessing DADHC Disability Services past their sixth birthday we require a reassessment to determine if the child has an intellectual disability.
Who has priority of access
- Persons living with a sole carer.
- Persons living with an aged carer.
- Persons with fragile health and complex multiple support needs.
- Persons with assessed complex challenging/assaultive behaviour.
- Persons with forensic issues.
- Persons who have no or limited access to other services.
Respite is not
- Long term accommodation
- Crisis accommodation
What are the outcomes for clients
- Positive experience including the opportunity to mix with other people with an intellectual disability and carers.
- Return to their regular care arrangement that has been replenished due to the break
- Maintenance of regular caring arrangement
- Security and safe care for the client
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What is the purpose of Community Support Teams
- To provide access to the necessary supports such as case management, behaviour intervention, therapy and skill development to maintain children with a developmental delay and adults with an intellectual disability in their families and communities.
- To work cooperatively with other service providers to increase capacity to meet the identified needs of our clients.
- To provide access to therapeutic interventions aimed at developing and maintaining the skills and functions of people with an intellectual disability who have high and complex needs.
What is a Community Support Team (CST)
A CST is a multi disciplinary team generally comprised of professionals who provide a range of support services to clients, families and carers. Support services include both direct intervention and the planning and coordination of services provided to a client and his/her family or carer. Services include assessment, case planning and management, counselling, referral, therapy, family support, early intervention and behaviour management.
The Teams are structured to provide services on either a geographical (all ages within a defined geographic; area eg LGA) or client age (Early Intervention, School Aged and Adult) basis. Geographically based teams are usually rural and age based teams are usually metropolitan.
A policy manual for Community Support Teams is currently being developed. When completed, these service descriptions are to be read in conjunction with the policy manual.
Who is eligible.
The target group is:
- Persons with an intellectual disability with moderate to high support needs
- Person must have a needs assessment to guide service prioritisation.
- Our Primary clients are those people over the age of 6 who have an intellectual disability or multiple disabilities where an intellectual disability is also present. We define intellectual disability using the international definition as:
- an IQ of two standard deviations below the mean
- with significant deficits in adaptive behaviour skills
- as manifest in the developmental period prior to 18 years.
- For our clients under the age of 6 years, we determine their eligibility on the basis of their developmental delay. To continue as a clients accessing DADHC Disability Services past their sixth birthday we require a reassessment to determine if the child has an intellectual disability.
Who has priority of access
- Persons with complex multiple needs.
- Persons with assessed complex challenging behaviour.
- Persons with forensic issues.
- Persons who are at risk of entering a more restrictive option and/or whose carer is likely to be at risk unless entry into the service is facilitated.
- Persons who are homeless or who are at risk of becoming homeless.
- Persons whose carer requires assistance to develop skills and interventions to assist the person with a disability to remain in their home.
Description of activity of Community Support Teams
CST services are provided through three main activities; intake, case management and direct intervention.
Intake involves providing information and advice, referral to other services and also assessment for eligibility for Disability Services Division services.
Case management is defined as a collaborative and individualised approach to service delivery which is based on systematic assessment, planning, coordination of services and the Individual Plan, monitoring and evaluation of services ensuring that a quality service is provided which is timely, responsive and cost effective. The Individual Plan may include a range of agreed, documented specific intervention plans.
Direct intervention is the provision of identified services that arise out of the case management process and are part of the person’s Individual Plan. Intervention can occur with the client, their family or carer to achieve the outcomes.
What services do CST staff provide
CSTs provide the following services in the activity areas:
Intake
- Information/Advice
- Referral
- Eligibility Assessment
Case Management
Based on the outcomes of the Intake process, the following services are delivered as part of case management activity. Not every client who receives a case management service will receive every service listed below.
Planning
- Needs Assessment
- Development of Individual Plan
- Monitoring and Review of IP
Intervention
- Referral (may be to another service provider or a Disability Services Division provider on the CST. A list of the services provided as part of the Direct Intervention activity are listed below)
- Service Coordination
Community Development
- Enhancing generic agencies’ abilities to provide services to the clients
- Liaison with other service providers
Exit
The following services may also occur as part of case management in the current funding environment:
- Managing Funding Applications
- Costing and Brokering Service Packages
Direct Intervention
This group of services are interventions for individual clients and are delivered in accordance with the agreed Individual Plan. Interventions are time limited, data based and regularly reviewed.
- Diagnostic Assessment
- Behaviour intervention and Support
- Counselling & family support
- Skills development
- Movement and mobility
- Seating and positioning
- Dysphagia
- Communication
- Self Care
- Learning and Applying Knowledge
- Community and Social Participation
- Money and Budgeting
- Interpersonal Skills
Services CSTs do not provide
Although CST staff can assist clients to access the following services, they do not provide them directly:
What are the outcomes for clients
- Client has intervention need identified
- Client receives the intervention to meet the need
What is a unit of service?
For the Intake activity the unit of service is one hour of service.
For the Case Management activity the unit of service is one hour of service.
For all services listed in the Direct Intervention activity units of service are defined as:
Intervention (Short Term)
This involves providing direct services to a client. An intervention would usually include a comprehensive assessment, intervention plan, direct intervention and regular monitoring. Where clients are seen in a group, intervention should be recorded against each client.
Duration: Up to six months
Invention (Long Term)
This involves providing direct services to a client. An intervention would usually include a comprehensive assessment, intervention/treatment plan, direct intervention and regular monitoring. Where clients are seen in a group, direct intervention should be recorded against each client.
Duration: Greater than six months.
Consultation (Secondary)
This involves discussion between a specialist and other staff, family members or carer to develop strategies to meet a specific client's needs. It may include limited direct contact with the client.
Consultation (Brief)
A Secondary Consultation of a short duration.
Duration: Up to 3 hours over 4-6 weeks.
Tertiary Consultation
This involves providing advice or information to a service provider with the aim of improving outcomes for clients who come in to contact with that provider. Focus is on the system for the delivery of services rather than an individual client. The consultation is specific to the particular environment. This may include involvement in service review, agency/regional planning workshops etc.
Education and Training
This involves providing advice or information to a broad audience with the aim of improving outcomes for client. It may be to families, staff from a range of agencies etc and is not environment specific.
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What is the purpose of Day Programs
To provide meaningful ie purposeful day activities that are valued by clients and community members, that are based on a person’s Individual Plan and that promote learning, skill development and enable access, participation and integration in their local community.
Description of activity of Day Programs
There are four areas of activity in Day Programs:
1. Skills Development
2. Community Access
3. Adult Education
4. Leisure and Recreation
In some limited circumstances, it may be appropriate for Day Programs to offer vocational activities and therapy. However this will only occur where these activities are not available elsewhere.
Transport– Some Day Programs currently provided transport both to and from Day Programs. It is recognised that providing this form of transport does create difficulties in terms of consistency and equity across services. A review of transport will be undertaken to resolve these issues.
Transport during programs eg from one venue to another remains part of the Day Program.
What is a Day Program
Day Programs are opened to clients 48 weeks of the year from Monday to Friday. Services are closed between Christmas and New Year and have between 6 – 12 (including Christmas closure) client free days per year. These days are used for planning and staff development.
Day Program services are offered on a long term basis – where clients attend the Day Program for a minimum of 0.5 days per week for an extended, predictable length of time.
Day Programs have either a Centre as a primary base (although services may be offered in a range of other settings) or provide services across a range of settings. Day Programs occur primarily in group settings.
Day Programs may provide supervision, behaviour intervention and support and personal care as part of the service.
A policy manual for Day Programs is currently being developed. When completed, these service descriptions are to be read in conjunction with the policy manual.
Who is eligible.
The target group is:
- Persons with an intellectual disability with moderate to high support needs from 18 – 65 years of age.
- Our Primary clients are those people who have an intellectual disability or multiple disabilities where an intellectual disability is also present. We define intellectual disability using the international definition as:
- an IQ of two standard deviations below the mean
- with significant deficits in adaptive behaviour skills
- as manifest in the developmental period prior to 18 years.
- People with an intellectual disability between the ages of 16 to 18 may attend a Day Program only after negotiation and with the endorsement of the Director, Disability Services.
- People over the age of 65 may attend a Day Program if it has been identified as meeting their individual needs.
- Person must have an independent assessment, which has determined their level of support needs.
Who has priority of access
- Persons with high and complex multiple needs.
- Persons with assessed complex challenging behaviour.
- Persons who are at risk of entering a more restrictive option and/or whose carer is likely to be at risk unless entry into the service is facilitated.
- Persons who are currently in a government accommodation service
- Persons living with an aged or sole carer who are not accessing other support services
- Persons who have no or limited access to other services for reasons of social isolation, geographic location and lack of peer support networks.
What services do Day Programs provide
Day Programs provide the following services in the following activity areas:
Skills Development
- Daily living
- Social skills
- Independent living Development
- Pre vocational
Community Access & participation & Integration
- Peer support
- Participation in the community and its activities
Adult Education
Leisure and Recreation
- Creative expression
- Passive recreation
- Retirement
- Vacation – Holiday program
- Music
- Massage
Services Day Programs do not provide
- Service for ill clients
- Weekend programs
- Evening programs
- Holidays
- Respite without an educative element
What are the outcomes for clients
- Access to programs that provide an opportunity to develop skills and interests
- Break from families and carers
- Social interaction with a range of people
- Access to their local community
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The HACC Program is a joint Commonwealth/State program that provides support to frail aged people, younger people with disabilities and their carers to allow them to remain at home and to prevent inappropriate or premature admission to residential care. This group of people comprise the target population for the HACC Program.
HACC MDS
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