Supporting choice during NDIS change: an OT’s perspective

In the same way an excited child can send a flock of birds into the air, a bird’s eye view over Queensland right now would probably show a flurry of activity brought on by the announcement of the first NDIS transition sites. In the flurry, professionals have shifted their sights, some have reshuffled to different perches, and organisation dynamics and structures have shifted, creating new-looking terrain to navigate.

I perceive, though, that the experience looks a little different from the perspective of our clients (now called ‘customers’ to reflect the shift in their standpoint). As an allied health professional I have managers and other people higher up providing informed guidance and direction to navigate the change well. For our customers there have been letters and workshop invitations and new service plan formats, yet it’s really in the face-to-face contact that I feel the cogs of change turning most effectively. It’s in the therapeutic relationships established through journeying together to tackle the challenges of disability, that awareness of the coming change can be discussed with user-specific relevance.

Entering into the change is a bit like building a mechanised wheel using an arrangement of differently sized cogs, without actually knowing what the finished wheeled device will look like. So it’s taking a while to piece together. A few of my customers are not personalities who naturally speak up when they have a need because they “don’t like to bother” anyone unless they have to. These are people with whom we (my team) are having sincere conversations about the implications of that approach when they need to outline their needs to an NDIA planner.

Then there are those customers whose lives have simply taken on that additional level of chaos because of the challenges of living with disability, and siblings, and growing children, and transport issues, and school, and hospital appointments, and ….and… negotiating change as an additional challenge is …well, an additional challenge. Still other customers are simply content with the status quo, and so it’s difficult to work with change that seems unnecessary. In my role, highlighting the useful part of change is probably where I can oil the cogs to turn more easily in the NDIS direction.

“I’m tired of having the ball in my court,” is one of the reactions I recently had from a father in response to establishing therapy goals for his child at school. So there’s another angle. Having choice and control is a prized outcome of the NDIS, but should not be at the expense of the scaffolding that other key players can provide for making those choices and taking that control. ‘Self direction’ should not be ‘lonely direction’.

If the ancient Greek philosopher, Heraclitus, is still right after all these years, then ‘there is nothing permanent except change’. So best we get comfortable with the discomfort of change. I still have change to undergo amidst the NDIS flurry. There is a lot of science behind change and how to do it well, and those knowledgeable in the field are being kept quite busy right now with it. I’m not a Change Manager, yet that does not exclude me from being an agent of change.

For me, change is going to mean stepping out of the parameters of the current framework’s box, and exploring the new world with customers of what their picture of choice and control could look like. For now, while our customers are ‘our’ customers under the old structure, I can do that together with them, facilitating and preparing them for the changes ahead. In future, when I may not be the person providing the scaffolding for big picture planning, it will be about being open to exploring the diversity of solutions beyond the current ‘Approved List’. It will be about empowering customers to find their identified solutions in the part of the NDIS journey where our paths cross.