Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697643944006.pdf (Australia)
Australian Senate Community Affairs References Committee: Violence, abuse and neglect against people with disability in institutional and residential settings, including the gender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people with disability, and culturally and linguistically diverse people with disability NDS welcomes the opportunity to comment on the Committee’s inquiry into violence, abuse and neglect of people with disability in institutional and residential settings.
We acknowledge and support the Committee’s additional emphasis on gender, age and the indigenous and/or culturally and linguistically diverse status of people with a disability as factors that can play a part in a person’s experience of abuse.

Violence and abuse towards people with disability are crimes which contravene a person’s human rights.
NDS condemns any such actions and supports approaches which build awareness of and seek to prevent abuse and which facilitate timely responses to serious incidents.

This Inquiry takes place at a critical juncture as the disability sector and governments consider the most appropriate and robust safeguards to support the delivery of the National Disability Insurance Scheme (NDIS).
We have a unique opportunity to assess the effectiveness of existing systems, strategies and approaches and address areas that require attention.

Momentum for this Inquiry comes from a series of national and state and territory-specific reports about the abuse and neglect of people with disability in a range of environments and settings.

This is consistent with the definition of ‘institutional and residential settings’ offered in the terms of reference which are very broad.
NDS believes this reflects a community problem where the rights of people with disability are not fully acknowledged or respected.

This Inquiry provides an opportunity for the Australian community to engage with people’s experiences and to understand and acknowledge that people with disability are overrepresented as victims of abuse in all walks of life, from early education to aged care service settings.
NDS has been active in supporting disability service providers to meet their specific duty of care responsibilities to safeguard the rights of people with disability who use their services, in accordance with United Nations Convention on the Rights of Persons with Disability and the National Disability Strategy (2010 - 2020).
Key initiatives include development of the Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 Online Human Rights Training Program1, NDS NSW’s The Rights Stuff regional support worker conferences, NDS Western Australia’s Applied Human Rights Training and Safer Services project and NDS’s national Zero Tolerance initiative.2 Zero Tolerance aims to provide an evidence-based, nationally applicable and contemporary approach to preventing and responding to abuse which can impact on organisational cultures, improve practice and influence the development of safeguarding mechanisms emerging from the NDIS.
The initiative is producing a series of practice advice sheets to help organisations improve safeguards for the people they support.

Each sheet focuses on a specific element of preventing and responding to abuse and neglect.

NDS actively supports the disability services sector to implement and build on preventative and developmental approaches which empower and build the capacity of service users, increase choice and control and lift service quality.
This focus is supported by feedback from service users consulted in the development of Zero Tolerance who made a clear connection between the quality of supports received and how safe people feel when using them.3 NDS comments and specific recommendations are informed by this engagement with industry and consumers.

Detailed comment with regard to specific items in the Terms of Reference is offered in Appendix A.
Our overall recommendation to the Committee is that prioritisation of investment in developmental and preventative strategies that promote positive ‘rights based’ organisational cultures and broader community development is the most effective way to tackle violence, abuse and neglect against people with disability.

Recommendations 1.
Recommendations 1.

Governments should invest in prevention and early intervention As outlined in the Department of Social Services’ draft consultation paper on the quality and safeguarding framework, effective strategies must address developmental, preventative and corrective actions.

To date there has been an emphasis on remediation of serious allegations of abuse and corrective actions.

This focus is unlikely to achieve better outcomes for people with disability.
NDS strongly supports investment in developmental strategies which empower people with disability, their families and carers.

This should be accessible to all, strategic and ongoing.

In the disability services sector prevention should focus on improved guidance for staff, related training and monitoring, and broader cultural change to change societal attitudes and service cultures.

This also requires sustained and consistent effort.
1 http://www.carecareers.com.au/page/human-rights-course 2 http://www.nds.org.au/projects/article/194 3 NDS Speaking up about Safety (2014) ibid Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 Building on the wealth of contemporary evidence about abuse prevention and trauma informed responses, development of NDS’s Zero Tolerance framework drew on a national panel of experts, feedback from national sector consultations and focus groups with service users across Australia.
It sets out a prevention-focussed education and action curriculum for providers, outlining responsibilities for frontline workers, managers, CEOs and boards.

NDS is seeking to further develop and make available these resources for the disability sector.
The cost of prevention also needs to be reflected in pricing that allows for adequate training and workforce development, especially as new workers come into the sector at the rapid rate of growth required to meet the workforce demands of NDIS implementation.

2.
2.

Australia must embrace a crucial opportunity to better understand prevalence and nature of the problem The limited availability of data about abuse and violence experienced by people with disability is a significant barrier to fully understanding the prevalence and nature of abuse.

Lack of data can be largely attributed to the many barriers people with disability face in reporting abuse.
This includes fear of reprisal or loss of service, lack of communications support; unclear pathways and lack of advocacy to make complaints or report abuse, lack of access to the criminal justice system and perceived issues of witness credibility.

As long as people do not or cannot speak up, abuse will continue to be under-reported.

An additional factor is that existing data is not made widely available.
For example data collected by the Department of Social Services through the National Disability Abuse and Neglect Hotline is not reported or published.

Such data could help inform understanding of risk for people in different settings or for people with specific disability support needs.

Preliminary investigations by NDS into developing a more comprehensive view on national data revealed a number of systemic barriers.
These include:  multiple data custodians and their willingness to share data;  differing approaches to management of data requests;   timeframes between abuse occurring and being reported; inconsistency on definitions of abuse and neglect amongst different sectors and jurisdictions; and  differing methods of data recording - some focussing on victims, others on perpetrators Investment in research to respond to these issues would contribute to better understanding of prevalence of abuse, violence and neglect of people with disability.
A nationally consistent approach to reporting serious incidents through the new quality and safeguards regulatory framework will also assist.

Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 3.
The Inquiry should reinforce the critical link between quality and safety An effective safeguarding approach must recognise and respond to complaints, feedback and poor quality services as well as more serious incidents and crimes.

Responding to quality concerns is a form of early intervention critical to reducing risk of neglect, abuse and violence.
Our consultation with service users (published as Speaking up about Safety4) showed that when people using disability services felt able to speak up and be listened to, make choices about where and when their supports were delivered and who delivered them, they felt more empowered and safer.
NDS asserts that the current low price of one-to-one in-home and community participation support under the NDIS (which constitutes 69 percent of all NDIS funded support) increases risks that staff skills and training will atrophy.

The current price does not support investment in developing the capacity of staff across a range of key areas that can affect quality and risk.
The price also risks accelerating the casualisation of an already fragmented workforce, and sanctions unacceptably low levels of supervision.

Minimum quality standards must be maintained wherever NDIS participants are negotiating on price.

4.

Improved understanding of responses to abuse is required Whilst investment in prevention is the key to cultural change required regarding abuse and violence, improvements are urgently required in responding to serious incidents.
For victims this means greater access to trauma-informed responses with improved understanding of how to support the varied needs of people with disability by staff of mainstream and specialist support services.
Improvements are also required to facilitate access to the criminal justice system, as evidenced through the Australian Human Rights Commission’s Access to Justice report and Beyond Doubt, the Victorian Equal Opportunity and Human Rights Commission’s review of the experiences of people with disability reporting crime.

Supports for people using augmented and alternative communication are a clear and critical gap in this area.
In the disability services sector, further research is required to understand whether existing government policies and practice are adequate.

The offices of the NSW and Victorian Ombudsman have recently examined this issue with NSW strengthening reporting requirements with regard to reportable incidents, with positive results.

NDS has been working with disability complaints bodies and the police to improve approaches to investigations.
This is a complex issue requiring understanding of topics such as legal obligations and preservation of evidence to maximise opportunity for successful prosecution of perpetrators.

Service providers need to know how to work collaboratively with authorities.

Capacity building is also needed with regard to best practice in conducting disciplinary investigations into staff behaviours.
4 Speaking up About Safety, NDS 2014 http://www.nds.org.au/projects/article/194 Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 5.
Engage with the existing evidence and fund research gaps There is a significant body of work on which to base the Inquiry’s recommendations.

NDS has drawn from many such pieces of work including the Victorian Disability Commissioner’s Safeguarding People’s Right to be Free from Abuse; Access to Justice; the Nucleus Group’s Abuse Prevention Strategies in Specialist Disability Services; Queensland Government’s Preventing and responding to abuse, neglect and exploitation Resource Kit; and Beyond Doubt.
With regard to the Inquiry’s focus on gender and age, extensive and excellent work has been undertaken regarding abuse and violence towards women and children with disability.

This includes Women with Disability Australia’s Stop the Violence initiative; Children with Disability Australia’s Enabling and Protecting report; and the 2014 series of Voices Against Violence reports led by the Victorian Public Advocate and Women with Disability Victoria.
The Royal Commission on Institutional Child Sexual Abuse is also highlighting lessons about specific risks for children with disability as part of their work.
However, more evidence is required to understand specific risks for some groups including people with intellectual disability; those with complex communication support needs; people from or living in indigenous communities; people with disability from CALD backgrounds; people with acquired brain injury; and people with few informal supports and/or friendships.

The gender and age dimensions of all these groups must also be considered.
NDS supports funding of research-into-practice approaches to address risk in the range of settings identified in the Terms of Reference.

Particular attention should be placed on understanding risk in accommodation settings.

NDS supports the ongoing closure of institutions and moves to increase accommodation options for people to live in.
Beyond research there remains a challenge in embedding what is known through translation into the knowledge, skills and attitudes of frontline workers, organisations and the community.

This is a primary objective for the Zero Tolerance Initiative which seeks to develop flexible, engaging and accessible evidence-based training for frontline workers.
Active monitoring of potential new risks associated with the introduction of the NDIS is also required including risk of financial abuse and exploitation, and the different risk profiles for the potential influx of people moving away from centre-based environments to more community oriented support.

6.
6.

Consistent national approaches are required The current array of initiatives and structures across the different jurisdictions do not form a comprehensive framework for safeguarding, however many jurisdictions remain wedded to their own approaches, statutory bodies and legislation.

There are key areas where nationally consistent approaches would be beneficial.
Examples highlighted in recent NDS policy papers include: Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111  pre-employment screening  a worker exclusion scheme with a legislative basis,  consistent definitions and reporting of critical incidents; Other areas which would benefit from a national approach include a complaint and monitoring system that is independent of government, systemic investment in self advocacy, advocacy and awareness of human rights; and independent monitoring of use of restrictive practices.
Whilst a federated safeguarding system may satisfy existing stakeholders, purpose-developed national approaches will be more effective in preventing and responding to abuse in some cases.

In the coming months it will be important for all jurisdictions to identify what works and what doesn’t amongst the different state and territory approaches to safeguarding.
Any relevant evidence obtained through this Inquiry and other related investigations should be shared to help inform the development of the quality and safeguarding framework.

7.

Disability service providers must be active and vigilant The new quality and safeguarding framework is a critical step to increase safety for people with disability using funded specialist disability supports.
It is appropriate that the approach to design the future system has been extensive and consultative, with the views of people with disability and those who support them actively sought.

Transition to implement the framework should be well supported and at a pace that does not compromise people’s safety.

However, the framework should not be seen as the only way for ameliorating the problem.
Work undertaken in the development of Zero Tolerance highlights many areas for improvement in the practice, approaches and cultures of organisations which can and should be done now, and that will complement and ultimately support the implementation of the framework.
These include: o Adopt rights based approaches for people with disability – disability services have a responsibility to understand and develop practice that reflects Australia’s commitment under the UN Convention on the Rights of Persons with Disability.

These are reinforced in the National Disability Strategy’s focus to ‘increase awareness and acceptance of the rights of people with disability.’ Staff at all levels, frontline workers to boards, should be trained about rights and how to support them.
State government investment has supported NDS to develop targeted human rights initiatives for frontline workers in Western Australia and NSW5 and the Online Human Rights Training program is currently available in four states with plans to nationalise the program into 2016. o Create positive complaints and feedback cultures – organisations must create cultures that maximise opportunity for open discussion of issues, are receptive to feedback (including complaints) and can support people in case of disclosure or allegation.
5 http://www.nds.org.au/projects/article/159 Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 Contributors to Speaking up about Safety placed the highest value on ‘being listened to’.

Organisations must reflect this as their priority too.
Feedback processes - for people with disability and staff – must be clear, accessible and widely known.

Organisations should promote that they welcome, respect and act on any feedback and that they will manage any risk of negative impacts for those who speak up.
o Recruit workers based on values but with thorough background checks – providers should take every precaution to ensure the suitability of workers they recruit such as the approaches articulated in NDS’s abuse prevention recruitment practice advice.

Providers must also work together where possible – through prompt reporting, provision of reference checks and sharing of information - to reduce risk of potential perpetrators being able to work in the sector.
o Train workers to understand, recognise and act on signs of abuse – frontline disability workers have ‘unique access to a person, their home environment, physical and emotional space and possessions’.6 Evidence shows that risk of abuse and violence is reduced where workers understand and recognise signs of abuse.

This should cover the range of personal and systemic risks people with disability face, including education on elimination of restrictive practices.
Staff must be trained and encouraged act positively to ensure people receive safe and quality supports and actions are taken where concerns exist.

Such training should be part of induction for new employees and revisited for existing workers.

NDS has presented related content at support worker conferences with positive feedback demonstrating an appetite for more information and targeted training opportunities.
o Support empowerment of people with disability – service providers can play a key role in supporting people with disability to be empowered, especially those with minimal or no support networks.

Actions can include providing information and training on rights and self-advocacy; ensuring access to abuse prevention education; promoting positive relationships and sexuality courses; building peoples’ connections outside the service and engaging families and advocates in service design and implementation.

8.
8.

Governments must continue to invest in safeguarding in the interim Work on the national quality and safeguarding framework should not put other much needed safeguarding actions from governments on hold.
o Collective leadership is required – governments must actively engage with and resource disability advocates and the disability service sector to empower people with disability through peer support and advocacy, building capacity of the sector through investment in prevention oriented approaches and building community awareness of risk for people with disability.
6 Prevention of abuse and safeguarding mechanisms in Ageing, Disability and Home Care, KPMG 2012 Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 o Support external complaints bodies – submissions on the quality and safeguarding framework indicate a growing consensus on the need for a national authority that is independent of government to manage complaints about disability services.
Where complaints bodies currently exist governments should commit to supporting continuity of their work through an appropriate transition to the new system, once agreed.

Consideration should be given to how states where such bodies are limited or do not exist (for example Tasmania) can strengthen existing complaints mechanisms.
o Provide support for victims – mainstream supports for victims of abuse are not currently sufficiently resourced and staff not adequately trained to meet the needs of people with a disability.
Improving access to specialist support services (includes sexual assault services and ongoing counselling) and justice (as per Beyond Doubt and Access to Justice report) should be a priority area for governments as per the purpose of the National Disability Strategy (to ‘drive improved performance of mainstream services in delivering outcomes for people with disability).
o Be clear on the importance of advocacy and support it systemically – advocacy plays a significant role in empowering people to have choice and control, and in living safer lives.

It can provide a vital support for people and families, and governments should be clear on the need for advocacy o Ensure a fair price for NDIS supports – Creating safe services requires investment in people, processes and practices.
Ensuring services have capacity to train staff, educate and change cultures is critical and must be reflected in pricing under the NDIS.
Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 Appendix 1 Specific commentary relating to Violence, abuse and neglect against people with disability in institutional and residential settings, including:   the gender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people with disability, and culturally and linguistically diverse people with disability.
NDS supports approaches which identify risks for specific groups of people with disability.

Zero Tolerance identifies gender, age, CALD and indigenous status as additional factors for people with disability in how they might live safely.

In developing the Speaking up about Safety report NDS identified the need for specific focus groups for women, remote indigenous communities and people with complex communication support needs to better understand their specific experiences.
From these experiences NDS advocates for greater investigation of how risk is managed for these cohorts.

We also note that risk for people with cognitive disability – including people born with an intellectual disability or who have an acquired brain injury - is different than that for other people with disability.
a) the experiences of people directly or indirectly affected by violence, abuse and neglect perpetrated against people with disability in institutional and residential contexts; NDS recognises this Inquiry as a unique opportunity to bear witness to the abuse and violence experienced by Australians with a disability.
The breadth of the definition of institutional and residential proposed by the Inquiry makes it challenging to address all causes of abuse but it does recognise that people with disability are over-represented as victims of abuse in all walks of life, from school to specialist services to aged care.
b) the impact of violence, abuse and neglect on people with disability, their families, advocates, support persons, current and former staff and Australian society as a whole; Findings from the Royal Commission into Institutional Child Sexual Abuse have increased public understanding of the significant lifelong impact of abuse on victims.

These include recurrent trauma, mental health issues, difficulty in maintaining personal relationships, ongoing issues of trust and lack of confidence in authority.
Whilst there is insufficient data to fully understand the impact of violence on people with disability there are issues which compound the experience of violence and abuse.

These include reliance on others for support for daily activities and – in the case of people with a cognitive disability or people with complex communication needs– limited ability to express trauma.
Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 c) incidence and prevalence of all forms of violence, abuse and neglect perpetrated against people with disability in institutional and residential settings; please refer to Recommendation 2 in main document d) the responses to violence, abuse and neglect against people with disability, as well as to whistleblowers, by every organisational level of institutions and residential settings, including governance, risk management and reporting practices; The issue of appropriate response to violence, abuse and neglect is a significant topic currently being addressed by a number of initiatives including the quality and safeguarding framework consultation and the Victorian Ombudsman’s investigation into abuse reporting amongst others.
Zero Tolerance highlights the need for providers to understand their local legal and statutory obligations with regard to abuse and violence including the need to work collaboratively with the police when crimes occur.
e) the different legal, regulatory, policy, governance and data collection frameworks and practices across the Commonwealth, states and territories to address and prevent violence, abuse and neglect against people with disability; There is little doubt that the differing jurisdictional approaches to disability have had a significant impact on the quality and quantity of supports that people with disability experience.
This informs at least part of the rationale for the NDIS, which seeks to ensure people’s support needs are met regardless of where they live.

Differing priorities and approaches to legal, regulatory, policy, governance, risk management, and reporting practices mean that some states are better prepared than others for the transition to a national scheme; for example those that have prioritised rights-based approaches and those that have introduced individualised funding and support.
In terms of consistency around safeguarding, a clear challenge is to understand the effectiveness of approaches.

It should not be assumed that the presence of a mechanism, policy or body will automatically deliver better outcomes.

People need to understand what they do, how to use them, have confidence in them and see outcomes being delivered.

Preliminary work by NDS about prevalence of abuse reveals inconsistent approaches to data collection and monitoring.
This is a significant barrier to understanding abuse at local and national levels.

NDS advocates greater consistency and transparency about abuse and reporting requirements.

f) Australia’s compliance with its international obligations as they apply to the rights of people with disability; NDS recognises and is committed to Australia’s obligations as signatory to the UN CRPD.
We acknowledge the September 2013 report to the Committee on the Rights of Persons with Disabilities in Geneva on the implementation of the Convention in Australia which Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 highlighted the National Disability Strategy as Australia’s key mechanism for implementing the UNCRPD.
We believe there is great merit in the Strategy which sets out a bipartisan and clear pathway to improve the lives of people with disability in all walks of life – including rights and freedom from harm.

NDS would like to see more investment to ensure its implementation and monitoring, including regular reports on progress to parliament(s) to create external and cross government accountability and ongoing bi-partisan commitment.
We also support the Committee’s views on the Australian Law Reform Commission report on the review of equal recognition before the law and legal capacity for people with disability.

This report proposes guiding principles on supported decision making to inform legislative amendments across all Australian jurisdictions.

These principles if fully implemented would ensure all people with disability have their rights recognised by the law and the support they need to speak up and make independent decisions.
This is fundamental to reducing and addressing the incidence of abuse and neglect.

NDS notes the Committee’s recommendations around Article 16 and the proposal to investigate abuse of women and children in institutions.

NDS agrees that there needs to be increased understanding of the unique experiences of women and children.

This should be in parallel with research to ensure the safety of other at risk groups – especially people with complex communication needs.
NDS strongly supports the views on closure of institutions as expressed in Article 19 and believes that people should be able to live independently in the community.

Whilst this is occurring in degrees in some states and territories many people still have restricted housing choices and are limited to inappropriate accommodation options.
g) role and challenges of formal and informal disability advocacy in preventing and responding to violence, abuse and neglect against people with disability; Advocacy can play a vital role in the lives of people with disability receiving funded services, helping them to navigate systems and make choices.

People with disability cannot always understand and manage risk alone, especially those without family or other supports.
Even people who have networks, may find understanding risk and developing ways to stay safe challenging.

For some people risk is associated with family or friendship networks so independent assistance can be vital.

People with disability should have access to independent advocacy.

This should be easy to understand and access and adequately funded.

This includes initiatives that build a person’s capacity to self-advocate.
h) what should be done to eliminate barriers for responding to violence, abuse and neglect perpetrated against people with disability in institutional and residential settings, including addressing failures in, and barriers to, reporting, investigating Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 and responding to allegations and incidents of violence and abuse; please refer to Recommendation 4 in main document i) what needs to be done to protect people with disability from violence, abuse and neglect in institutional and residential settings in the future, including best practice in regards to prevention, effective reporting and responses; please refer to range of responses in main document j) identifying the systemic workforce issues contributing to the violence, abuse and neglect of people with disability and how these can be addressed; Across the country NDS is leading a range of projects and initiatives to build the capacity of frontline workers to deliver quality supports.
This includes training sessions, forums and educational resources on the links between workforce issues and risk of abuse and violence towards people who use funded disability services.

Focus areas include: o quality of supervision and management – managers and supervisors play a critical role in setting expectations and monitoring practice.

They need to have both the skills and time to do this effectively.

Sector-wide investment in practice leadership would support this.
induction and setting expectations – quality of induction and training is critical in setting the organisational culture and promoting best practice.

o o staff training and competence – staff should receive the right amount of training to be able to do their job without creating risk for clients or themselves.
Areas for specific attention include personal care, management of behaviours of concern in a way consistent with the reduction and elimination of restrictive practices and supporting people who use augmented and alternative forms of communication.

o need for effective staff deployment and support – staff to person ratios must be appropriate to the level of support required.

Where funding does not allow for sufficient staff, it can place people at risk, creating worker burnout and stress adds to.
o reducing staff turnover – pay and conditions should be commensurate with skills, experience, training and work environment.

o staff attitudes and behaviours and boundaries – services must give clear messages about personal and professional boundaries for staff, including prioritising their values over those of the people they support.
o need for more flexible accommodation options – limited funding for accommodation options have led to continuation of outdated and inflexible models of service in some parts of the country which prioritise staff routines and efficiency over service user preferences and choice and control.
k) the role of the Commonwealth, states and territories in preventing violence and abuse against people with disability; see Recommendation 8 in main document feedback and (m) below regarding the new quality and safeguarding framework Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 l) the challenges that arise from moving towards an individualised funding arrangement, like the National Disability Insurance Scheme, including the capacity of service providers to identify, respond to and prevent instances of violence, abuse and neglect against people with disability; NDS fully supports allocation of funds to people with disability to increase individual choice and control.
The NDIS brings great opportunities but also new challenges.

There must be ongoing investment in both the development of people with disability and the sector development to ensure the capacity of providers to meet these challenges.

Allocation of individualised funding needs to be balanced with ensuring continuation of vital services and ensuring there is not a loss of capacity in the sector that might increase risk for service users.
NDS has outlined some of these risks in our policy paper The Case for Block Funding in the NDIS.7 As more people choose to receive services in their own homes, the community and in less supervised environments there will be new challenges of supervision and ensuring the safety of people with disability.

Further, as more people self-manage their funding, protections will be required to limit risk of financial exploitation.
Zero Tolerance is one example of a clear, cost effective educational strategy to build service provider capacity through flexible, accessible e-learning for disability service providers across all jurisdictions.

Ongoing investment by governments into this and other similar targeted initiatives would deliver long term outcomes across the sector.
m) elements required in a national quality framework that can safeguard people with disability from violence, abuse and neglect in institutional and residential settings: We refer you to NDS’s response to the Department of Social Services in May 2015.8 NDS’s broad position on quality and safeguarding recognises that:  regulation has a minority role in promoting quality and safeguards  choice is a necessary but not a sufficient driver of quality  all disability providers should comply with a code of conduct based on the National Standards for Disability Service  compliance monitoring should be proportionate to risk, assessed in relation to the risk profile of the organisation and the risk profile of the participant  some risk can be managed through individual planning  co-regulation recognises a shared responsibility for standards  restrictive interventions require independent legal authorisation 7 http://www.nds.org.au/publications/page/4?s=NAT&c 8 http://nds.org.au/asset/view_document/979324511 Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111  there is strategic funding of independent advocacy to ensure adequate coverage  disability safeguards should enhance – not replicate universal systems  ensure quality and safety throughout the transition to a mature market NDS proposals include that:  organisations that provide support to NDIA participants (including those who self- manage their plans) be required to register with the NDIA and adhere to a provider code of conduct  a mandatory, national and cross sector approach to staff and volunteer screening is established that includes a properly resourced and empowered barred worker scheme  NDIA prices recognise the costs for providers of implementing mandatory safeguards, such as robust
 staff screening and supervision, complaints systems and incident monitoring  a national disability industry regulator is established to monitor the provider code of conduct and to provide a external complaints system amongst other things  an independent and statutory oversight body ensures the industry body fulfils its responsibilities and undertakes own motion investigations  all registered providers report regularly with evidence of self-assessed compliance with the provider code of conduct ,independent inspections are undertaken by an industry regulatory body where specific risks are identified, independent quality evaluation with a focus on outcomes is required (and funded through higher prices) in higher-risk support situations and the results should be publically available to improve informed choice  where a service is already subject to professional registration requirements (such as therapy services), or where a provider has third-party quality accreditation, this would reduce or eliminate the need for other auditing or quality evaluation to avoid duplication, there should be cross-recognition of quality systems across human services   there needs to investment in sector development to support quality and a positive complaints culture in disability organisations especially during the transition to the full NDIS.
a.
‘institutional and residential settings’ is broadly defined to include the types of institutions that people with disability often experience, including, but not restricted to: residential institutions; boarding houses; group homes; workplaces; respite care services; day centres; recreation programs; mental health facilities; hostels; supported accommodation; prisons; schools; out-of-home care; special schools; boarding schools; school buses; hospitals; juvenile justice facilities; disability services; and aged care facilities; and People with disability are over-represented as victims of abuse in all areas of society.
We recognise that the definition of ‘institutional and residential settings’ offered is a reflection of this and an attempt to place attention on all areas where people with disability might be at risk of harm.
Our response to the Committee is clear that violence and abuse of people with Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 disability is not acceptable in ANY environment and the disability services sector across Australia is committed to the prevention of violence, abuse and neglect and working towards improving responses.
NDS shares the view of many in the disability sector that there are unique and pressing risks associated with provision of accommodation services that must be addressed urgently.
These include:  Shortage of flexible accommodation options and vacancies  Poor and inappropriate building stock with minimal effort to include people with disability in design considerations and planning  Ongoing operation of institutions in many states and territories  Insufficient pre-planning ahead of moves, including time for people with disability and organisations to prepare leading to poor or rushed transition processes Inappropriate grouping together of people with disability creating risk of violence and abuse   Grouping of people with challenging behaviours in congregate care without sufficient behaviour intervention support  Staff suitability including appropriate skills and training, inconsistency (meaning people with disability being regularly supported by strangers) and reliance on casuals  Lack of flexibility and choice around routine, meals and personal freedoms  Lack of freedom for people to explore personal – including healthy sexual - relationships  Reliance on staff for personal care   Insufficient opportunities for community participation and inclusion Insufficient availability of temporary accommodation for people who are experiencing abuse and violence, in particular women with disability and their children.
Whilst some of these issues are being addressed and progressed to different degrees across the states and territories, there is a huge degree of inconsistency resulting in poor outcomes, reduced service quality and increased risk of harm for people with disability.

b.
b.

‘violence, abuse and neglect’ is broadly understood to include, but is not limited to: domestic, family and interpersonal violence; physical and sexual violence and abuse; psychological or emotional harm and abuse; constraints and restrictive practices; forced treatments and interventions; humiliation and harassment; financial abuse; violations of privacy; systemic abuse; physical and emotional neglect; passive neglect; and wilful deprivation.

NDS supports the definitions provided.


We would also draw the Committee’s attention to the feedback from service users who participated in consultations for the Speaking up about Safety report.

Respondents were clear that their feelings of safety were directly related to their experience of good and bad service.
This makes a powerful link between service quality and safety and reinforces that abuse prevention strategies should be built from a human rights perspective which starts from a perspective of empowerment of people with disabilities.

Where human rights are not recognised or maximised there is a risk of more serious abuse.
Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111 Appendix 2: NDS’s Zero Tolerance Framework Zero Tolerance is a project led by NDS in partnership with the disability sector.
It aims to assist disability service providers to understand, implement and improve practices which safeguard the rights of people they support.

The approach is built around a national evidence-based framework with specific strategies for service providers to improve prevention, early intervention and responses to abuse, neglect and violence experienced by people with disability.

This prevention focussed framework informs the range of tools and resources for the disability sector.
Promoting and Applying Human Rights - applying the UN Convention on the Rights of Persons with Disabilities (UNCRPD) - abuse as a violation of human rights - right to justice 1.

Understanding Abuse Education and training to understand abuse - understanding abuse, neglect, exploitation, violence in disability services - recognising lived experience - power and gender - abuse as a crime 2.
Practices and Safeguards which can help prevent abuse Risk factors and Signals of Abuse - recognise when abuse is happening - prevalence of abuse - individual and service risk factors - trauma informed approaches Primary Prevention Implementing policy and practice that protect people’s rights - committing to person centred approaches - strong leadership, policy and guidelines - staff training, deployment and supervision - training on communications preferences - encouraging bystander action Empowering people with disability - providing information and training on rights, self-advocacy and speaking up - abuse prevention education and training - relationships and sexuality training - building connections outside the service - engaging family and advocates Create the right organisational cultures - safer recruitment and screening practices - establishing cultures of respect - attitudes, behaviour and boundaries - creating positive feedback cultures - addressing barriers to disclosure - openness to external mechanisms - clearly documented whistleblower protections 3.
Risk factors for specific groups and service settings Targeted Prevention Targeted approaches for disability groups at increased risk of abuse - people with intellectual disability and ABI - women and children with disability - people with communication support needs - indigenous and CALD communities - people isolated from family and community - people at risk of familial abuse Understand and address service features and settings that increase risk - abuse in accommodation settings - personal care - unpacking systemic abuse - remote and unsupervised service provision Understanding Behaviours of Concern - Identifying causes of behaviours - Using positive behaviour support - Reducing and eliminating the use of restrictive practices Early intervention and response - intervening early: guidelines on responding to early indicators of abuse and trauma - clear expectations, policies and procedures for responding to disclosures and allegations - timely reporting to maximise victims recall - evidence gathering and record keeping Maintaining and Analysing Records - rigorous quality monitoring - meeting incident reporting requirements - review and analysis of individual incidents - maintaining records on alleged staff to client abuse 4.
Responding to Abuse Secondary Prevention Supporting the person - ensuring safety of victims through trauma informed key support person - response informed by victim’s experience - engaging family, carers and significant others - linking to specialist support services, complaints bodies, police and advocacy - addressing barriers to justice - ongoing person-centred healing strategies 5.
Analysis, Learning and Improvement Tertiary Prevention Continuous Improvement Approach - review staff knowledge and competencies - using data to inform improvements to abuse prevention and response processes - exploring systemic safeguarding gaps - addressing organisational impact of abuse Meet organisational requirements - Acknowledgement, Actions, Answers, Apology - rigorous approaches to investigations - clear disciplinary processes that protect victims - approaches meet needs of whole organisation including other clients, families and staff - communication of actions and outcomes - meeting legislative and external body obligations Supporting initiatives to reduce abuse - using referee checks to identify people of concern in the sector - working collaboratively with mainstream, specialist support services and advocacy - contributing to cross-sector approaches Violence, abuse and neglect against people with disability in institutional and residential settings, including thegender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people withdisability, and culturally and linguistically diverse people with disabilitySubmission 111