People living with disabilities

Key Points

  • In recent years there has been an increase in the number of people from refugee backgrounds settling in Australia who are living with a disability
  • Rapid specialised assessments and advocacy may be needed to promote early referral and access to disability services.
  • Cost of specialised assessments should be minimised given the financial constraints faced by recently arrived people from refugee backgrounds.
  • For eligibility and planning of NDIS services, assessments must include detailed information on the person’s functionality, not just a diagnosis.
  • Cultural considerations may mean that families are less accepting of outside help, including respite care. They are unlikely to be aware of available support services and concepts of care, and of the notions of rights for people who are living with a disability.

Overview

Since 2012, a streamlining of health waiver provisions for offshore Humanitarian entrants has seen an increase in people of refugee background living with a disability settling in Australia.  Clinical assessment, service access and access to aids and equipment can be complex for recently arrived refugee children, adolescents and adults with disability.

The concurrent rollout of the National Disability Insurance Scheme (NDIS) has increased this complexity. The National Disability Insurance Scheme (NDIS) is administered by the National Disability Insurance Agency (NDIA). The NDIS provides support to people with disability and to their families and carers. Support is goal-oriented, with a focus on community participation and accessing mainstream supports. The process of applying for and accessing the NDIS should be explained to the patient/patient’s family.  

Approach to care

The approach to care will be dependent on age and type of disability.

  • In the case of children, a good perinatal and developmental history, as well as history of any severe illness and current nutritional status, can be very informative.
  • In some cases, parental consanguinity may be relevant to enquire about; however, this needs to be done with great sensitivity, due to negative attitudes that families may have already faced here.
  • A thorough physical, developmental and mental state examination <link to health assessment> <link to paed developmental assessment>, with a focus on the person’s ability to function in day to day tasks and in general, such as work ability, will be important for completing the NDIS referral form, and will assist other health providers with their assessments.
  • Specialised assessments will be needed to promote early access to disability services. This may include referral to a dedicated adult or paediatric disability doctor or team, psychometric testing, an occupational therapist assessment and/or other needs depending on age and type of disability. The clinician may need to advocate with the disability team to ensure that assessment and access to required services is timely.
  • Individuals with disabilities may have never had a formal diagnosis. Specific tests may be needed to define the condition, and in some cases to inform parents of a need for genetic counselling regarding future children. These tests may need to be guided by seeking advice from experts such as developmental paediatricians or an adult disability team.
  • Case management is available for newly arrived refugees/families with complex needs. See: Department of Social Services Complex Case Support (CCS) Programme 
  • Refugee Health Nurses and Refugee Health Services will be able to recommend relevant referral pathways and low-cost services
  • Specific information can be gained from relevant disability agencies, depending on the type of disability. Examples include services for people with autism, Down syndrome, hearing impairment and visual impairment. There may also be specific disability services to assist those from certain Culturally & Linguistically Diverse backgrounds.
  • Diagnosis and assessment are supported via Medicare through the Better Start for children with disability initiative – MBS item 137 (specialist) and MBS item139 (GP) to determine eligibility for the Better Start program (translated information). However these initiatives are superseded when an application for NDIS access is submitted. A pathway via NDIS is the Early Childhood Early Intervention Approach (ECEI)

Considerations

Centrelink and the NDIA will not accept overseas medical reports at this time, although they may be included as supplementary documentation.

Equipment needs may be urgent, with temporary options (e.g. though NGO/charities and some settlement services) needing to be found before the NDIS or other disability services commence. In some states, community health centres may provide equipment loans.

Access to interpreters for the assessment process and preparing a plan for NDIS support is not free currently. TIS National is however available free for participants to access funded supports in their NDIS plan.


Links

A range of useful resources can be found here:  Royal Children’s Hospital Melbourne – Immigrant Health Clinic

Australian Hearing

Australian Government Hearing Services Program (if over 65)  

Vision Australia 

NDIS resources


References

Hotton, P., Raman S, Brown T. Developmental disability in refugee children and youth in South Western Sydney: double jeopardy. Journal of Paediatrics and Child Health, 2015. 51: p. 7

Refugee Council of Australia. Supporting humanitarian entrants with disabilities – National Settlement Policy Network Teleconference 2014. Available at: https://www.refugeecouncil.org.au/r/spn/140508-SPN.pdf

Diversitat Disability Findings Report 2016. Available at: www.pavetheway.org.au/sites/pavetheway.org.au/files/documents/CALD%20in%20NDIS%20launch%20site%20Diversitat_Disability_Report.pdf 

Produced by

in consultation with

                  Refugee Health Network of Australia

Endorsed by

Funded by

The Australian Refugee Health Practice Guide was produced with funds from the Australian Government Department of Health.

Disclaimer

The information set out in the Australian Refugee Health Practice Guide (“the Guide”) is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is the Guide exhaustive of the subject matter. Persons implementing any recommendations contained in the Guide must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. The statements or opinions that are expressed in the Guide reflect the views of the contributing authors and do not necessarily represent the views of the editors or Foundation House. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Whilst the information is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices.

Accordingly, Foundation House and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in the Guide for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in the Guide and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Although every effort has been made to ensure that drug doses and other information are presented accurately in the Guide, the ultimate responsibility rests with the prescribing clinician. For detailed prescribing information or instructions on the use of any product described herein, please consult the prescribing information issued by the manufacturer.