” The Lowitja Institute Aboriginal and Torres Strait Islander Health CRC (Lowitja Institute CRC) is seeking applications for research projects under the theme of ‘Understanding disability through the lens of Aboriginal and Torres Strait Islander people – challenges and opportunities’.
The research questions identified for funding are part of the Institute’s Community Capability and Social Determinants of Health program, and build on its current work. The work includes the positive impacts of cultural determinants, gender, and relationships on the health and wellbeing of Aboriginal and Torres Strait Islander peoples (for further details see www.lowitja.org.au/research-programs).”
Please note that applications may only be submitted by Lowitja Institute CRC Participant Organisations. Applications close 27 November 2017
Regional and remote communities background added by NACCHO for discussion
” We argue that two schemes may emerge under the NDIS “one in urban areas with robust markets, and a second (lesser) scheme subsidised by government in rural and remote areas that continues to offer little choice.”
Attention should be focused on the way that the NDIS works in remote and regional areas, and how to ensure that government subsidised care (which may prevent people with disability from being forced to relocate) remains of good quality and continues to offer choice and control to people with disability in remote and regional areas, many of whom are Aboriginal and Torres Straight Islander people.”
Eleanor Malbon and Gemma Carey write in The Mandarin see Part 2 Below:
Funding
While other institutions may partner in the research team, if successful, the Research Activity Funding must be administered by a Participant Organisation (the Administering Institution).
The Lowitja Institute recently held a workshop comprising of Aboriginal and Torres Strait Islander people with lived experience of disability, as well as policymakers, disability organisations, researchers, and advocates.
Background and literature scan
Aboriginal and Torres Strait Islander disability was identified as a high priority at a meeting of the combined Lowitja Institute Program Committees in December 2016. This priority covers all research program areas of the Institute, aligning closely with the social determinants of health program, particularly in the realm of agency and control at all levels for Aboriginal and Torres Strait Islander peoples.
Aboriginal and Torres Strait Islander people with disability are often further disadvantaged by experiences of systemic and ongoing racism and ableism. Current government policies, particularly the implementation of the National Disability Insurance Scheme (NDIS), are driving significant change by re-defining interactions and relationships between services and clients. This climate adds to the uncertainty and complexity of an already challenging reality for many Aboriginal and Torres Strait Islander people with a disability.
Below is a summary of themes and issues that are particular to Aboriginal and/or Torres Strait Islander people with a disability:
Five research questions were identified as key research priorities for Aboriginal and Torres Strait Islander peoples with a disability. More information is available in the overview document below.
Question 1
How are disability services and supports delivered to Aboriginal and Torres Strait Islander people with a disability?
– What type of supports are available (formal or informal)?
– What is the composition of the workforce (Aboriginal and/or Torres Strait Islander staff /non-Indigenous staff)?
– What is the value in Aboriginal and Torres Strait Islander organisations delivering disability services? What lessons can be taken from these to mainstream services?
Question 2
What are the lessons that can be learned from past and/or current supports and services that have attempted to shape the lives of Aboriginal and/or Torres Strait Islander people with a disability?
– What were their outcomes?
– What impact has this had on self-agency and individual control over one’s life?
Question 3
How do we support the agency and leadership of Aboriginal and Torres Strait Islander people with a disability?
– What are past and current cases of Aboriginal and Torres Strait Islander people with a disability that demonstrate agency and leadership?
– What external factors have shaped their contribution or roles?
– How can these stories be shared?
Question 4
What are the concepts of health and wellbeing for Aboriginal and Torres Strait Islander people with a disability?
Understanding disability through the lens of Aboriginal and Torres Strait Islander people – challenges and opportunities Call for research funding – October 2017 10
– What are their expectations, aspirations and definitions of success?
Question 5
How can Aboriginal and Torres Strait Islander peoples’ values and knowledges be optimised and inform a policy system for people with a disability?
Research aim
To understand how disability intersects with broader health and wellbeing for Aboriginal and Torres Strait Islander peoples.
Objective
Understanding the enablers and barriers that exist for Aboriginal and Torres Strait Islander people with a disability.
Please note that applications may only be submitted by Lowitja Institute CRC Participant Organisations.
While other institutions may partner in the research team, if successful, the Research Activity Funding must be administered by a Participant Organisation (the Administering Institution).
Resources
Eleanor Malbon and Gemma Carey write:
The NDIS has the potential to secure gains in health and wellbeing for thousands of Australians living with disability, but this can only be achieved with careful attention to the inequities that arise in the scheme. The NDIS has been beset with implementation issues due to a rushed implementation that has been noted by the Productivity Commission, amongst others.
New research, supported by the NHMRC Centre for Excellence in Disability and Health, shows that the use of the NDIS market to enable choice and control for people in the NDIS is vulnerable to unequal distribution. As the NDIS is structured, choice and control is reliant on the ability for participants to have new and better service providers to choose from. However the rushed implementation means that the danger of ‘thin markets’ – areas with only one or two providers of a disability service – is acute.
The NDIS is not one market, but rather a set of markets in different geographic locations, meaning that the health of markets in regional and remote areas is not reliant on market performance in cities. Markets in remote and regional communities are most at risk of becoming thin markets:
“Thin markets are also susceptible to market failure, where no new providers enter the market place due to high costs of entry or lack of business prospects, and existing providers are challenged by being paid retrospectively for business, gaining the necessary breadth and depth of expertise and business costs running higher than the funds collected via individuals.” (Carey et al., 2017).
The Productivity Commission’s position paper on costs in the NDIS also discusses the dangers of poor implementation for market failures. The Productivity Commission lists the groups that are mostly likely to experience persistently thin markets as people:
- living in outer regional, remote and very remote areas
- with complex, specialised or high intensity needs, or very challenging behaviours
- from culturally and linguistically diverse backgrounds
- who are Aboriginal and Torres Strait Islander Australians
- who have an acute and immediate need (crisis care and accommodation).
These are the people for whom the NDIS will not enable equitable access to choice and control of services.
Indigenous people may have to relocate from their homelands
Alarmingly, by analysing past documents the new research found that the original blueprint for the NDIS by the Productivity Commission (written in 2011) explicitly states that Indigenous people with complex needs will have to relocate from their communities – and geographical connections to kin and country – in order to receive care in metropolitan areas where the service market is stronger:
“…the diversity and level of care and support available in major cities cannot be replicated in very remote areas. In some cases, Indigenous Australians with complex needs will have to move to regional centres or major cities to receive appropriate care and support (as is also the case with non-Indigenous Australians)”
For the design of the NDIS to call for the relocation of Aboriginal and Torres Strait Islander people with disabilities from their country and communities is unacceptable in terms of health equity and fairness.
If the goal of the NDIS is to offer empowerment to Australians with disability through increased choice and control there must be a recognition that not all individuals will have access to robust or well functioning markets.
Our research notes that there is the suggestion that the federal government may provide continued block funding, contracts, or be a provider of last resort in areas that are facing thin markets or market failure.
We argue that two schemes may emerge under the NDIS “one in urban areas with robust markets, and a second (lesser) scheme subsidised by government in rural and remote areas that continues to offer little choice.”
Attention should be focused on the way that the NDIS works in remote and regional areas, and how to ensure that government subsidised care (which may prevent people with disability from being forced to relocate) remains of good quality and continues to offer choice and control to people with disability in remote and regional areas, many of whom are Aboriginal and Torres Straight Islander people.
*Eleanor Malbon is a faculty member at UNSW Canberra in the Public Service Research Group. On Twitter @Ellie_Malbon Dr Gemma Carey is an National Health and Medical Research Council Fellow and Senior Lecturer at UNSW Canberra in the Public Service Research Group. On Twitter @gemcarey
This article was first published on November 8, 2017, at The Mandarin
*Eleanor Malbon is a faculty member at UNSW Canberra in the Public Service Research Group. On Twitter @Ellie_Malbon Dr Gemma Carey is an National Health and Medical Research Council Fellow and Senior Lecturer at UNSW Canberra in the Public Service Research Group. On Twitter @gemcarey
This article was first published on November 8, 2017, at The Mandarin
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