Disability and working effectively in the NDIS (with Dr Katherine Elliston)

[00:00:00] Bronwyn: Hey, mental workers. You're listening to the Mental Work podcast, your companion to early career psychology, I'm your host, doctor Bronwyn Milkins.

[00:00:13] Have you ever thought about working in the NDIS, or do you currently work within the NDIS system or with NDIS participants? Is it a struggle, do you really love it?

[00:00:23] Do you not know what I'm talking about when I say the letters NDIS? Well, here to help unpack the NDIS, which is the National Disability Insurance Scheme, and how to work with NDIS participants is our guest today which is Dr Katharine Elliston.

[00:00:39] Katherine: Thanks for having me.

[00:00:40] Bronwyn: My pleasure. Thank you So much for coming on the podcast. So, Katherine, can you just tell listeners who you are and what your non psychology passion is?

[00:00:50] Katherine: Sure. So my name is Catherine. I am a psychologist living in Hobart in Tasmania. I grew up in Tas, so this is where all my study and work life has been based, um, which is a bit of a unique perspective in and of itself. Uh, non work passion. I am quite into gardening. I'm building my skills, let's say, um, but my dream is to become self efficient or as close to self sufficient as I can be eventually. Fingers crossed I kill all the veggies.

[00:01:24] Bronwyn: What are you currently growing?

[00:01:27] Katherine: Oh, a a range of different things, but my biggest success at the moment is strawberries. We get an insane amount each day, so quite fun.

[00:01:34] Bronwyn: That's amazing and also very tasty.

[00:01:37] Katherine: Yes. Definitely.

[00:01:38] Bronwyn: Yeah. We're, um, I'm growing lettuce at the moment and we've got lots of lettuce, but I'm definitely not eating enough salad. I'm like, do I need to just eat salad like Breakfast, lunch, and dinner?

[00:01:48] Katherine: Maybe you need to adjust your diet just what you've got available.

[00:01:51] Bronwyn: I know. But with strawberries, I feel like you can just eat them every meal.

[00:01:57] Katherine: Pretty much. It's quite

[00:01:58] Bronwyn: Yeah. No. What a great passion. Gardening is so relaxing as well.

[00:02:03] Katherine: Yeah. Absolutely.

[00:02:05] Bronwyn: So, listeners, today, we're going to cover what the NDIS is. We're also interested in how and came into contact with this topic. Because I hope you don't mind, Katherine, I I just wanted to mention as well that you're involved in a lot of advocacy and advisory roles in the disability sector. So You're the Tasmanian representative on the Australian Disability Advisory Council and the deputy community chair of the Premier's Disability Advisory Council and a member of the supported accommodation governance team for an SDA property in Tasmania. Wow. That's a lot.

[00:02:38] Katherine: Yeah. It's a bit to juggle, but I do love it. It's obviously something that I'm very passionate about the disability space, so very active. Yep.

[00:02:47] Bronwyn: So we're interested in how you came into contact with the disability sector. And then Katherine works in the disability sector with NDIS participants, and she has been for the past few years. She's going to share with us some tips and tricks on working well with NDIS participants and just a little bit about the system as well. So hopefully, by the end of this episode, you'll come away with more knowledge about what NDIS is and how to work well within it. Does that sound good, Catherine?

[00:03:13] Katherine: Yeah, absolutely.

[00:03:15] Bronwyn: Let's go for it. Okay. So what drew you to the disability sector?

[00:03:20] Katherine: Well, I have a younger brother with an intellectual disability. So growing up I saw that he was really engaged in a whole range of allied health supports, had a lot of early intervention. He initially was very late to start talking, communicating with others. And I think from that really young age, I then stepped in to help, kind of communicate or translate almost between my brother and other people and I think that was what really started my interest in disability around well, he can talk. He can communicate. Why aren't you guys listening?

[00:03:58] And I I recall being a young child being very frustrated that, he wasn't always able to get his needs met by other people, and I think that's what really sparked my interest in advocacy work in the importance of just slowing down and listening to people and in all things disability, and it just kind of grew from there.

[00:04:17] Bronwyn: So with the disability sector, is this always a place you thought you would be in as a psychologist? Were you like, I'm gonna be a psychologist. Okay. Yep.

[00:04:27] Katherine: Yep, pretty much. I don't think I thought about anything else. It was always, uh, always disability sector, absolutely.

[00:04:34] Bronwyn: Yeah. it sounds like you really wanted to make a difference in this sector, so you really wanted people the listen with folks with disabilities.

[00:04:41] Is there anything else that from your own personal experience you were like, I really wanna address that as a psychologist.

[00:04:47] Katherine: Oh, it was mostly just taking the time to listen into people, I think. When I my experiences growing up, it was all state based and now it's federal based under the NDIS. So I don't think I really had that, you know, understanding of how the systems were changing, and they were changing very rapidly and continue to do so. so I don't think that there was, Yeah. I didn't come in with a specific goal to change something in particular. It was more just, hey, let's just listen to these people better and, basically, that's it.

[00:05:21] Bronwyn: Yeah. I think that's wonderful aim to listen to better.

[00:05:24] You mentioned that disability services before the NDIS, we're all state based and I guess I'll say to listeners as well because it's coming up for me, it's like, my brother has a disability as well, and he'll be on the podcast in a few episodes or maybe next episode. But I remember when it was all state based as well because we had to choose multiple service providers and organized multiple things independently. And, yeah, there was a lot of services in Allied Health that my brother was going to as well. So when the NDIS came in, it came in about is it about 10 years ago now?

[00:05:56] Katherine: Each state and territory had different rollout dates, and they were for different ages at different times, so it was not uh, 1 day and then the entire country had the same system. It was lot mix match for a while.

[00:06:08] Bronwyn: Yeah. I remember, like, even in WA where I live, it was being rolled out, like, south of the river, north of the river. So it was being rolled out over a number of years, and we're waiting for the NDIS to come in. So could you just summarize for us? I know it's a big question, but what is the NDIS?

[00:06:27] Katherine: So the NDIS stands for the National Disability Insurance Scheme, and it's this it's an Insurance game first and foremost. So it's there to help connect individuals with disability with relevant services to their needs, and, um, our taxes go towards funding this service, and there's very complicated kind of arrangements in place with how people get matched to funding allocations and then get matched to services, but it's basically set up there so that people with disability can access relevant services.

[00:07:01] Bronwyn: Yeah. And meet their needs.

[00:07:03] Katherine: Absolutely. To meet their needs. Yes.

[00:07:05] Bronwyn: Yeah, so the NDIS, like, the national part of it is that it replaced these state based systems.

[00:07:12] Katherine: Mhmm.

[00:07:13] Bronwyn: Yep. And lot of psychologists I've been working within the NDIS over the past few years. So could you tell us a bit about the roles that you've had working within the NDIS?

[00:07:25] Katherine: Sure, so I've I've, um, had a couple of roles within the NDIS now. I started my first role in the NDIS is working as a disability support worker and then, I began doing my 4 plus 2 where I worked as a provisional psychologist and behavior support practitioner. So I've done that for a few years and now have my full registration as well. So a couple of different, spaces where I've worked under the NDIS framework I suppose, but terms of psychology in particular, it's with the goal of what we call capacity building, which is about improving individuals daily living skills, their day to day functioning, increasing their independence and increasing their participation in the community in whatever capacity that looks like for the individual.

[00:08:17] Bronwyn: So it's not like in under the Medicare system, like, we deliver psychological therapies. And so the goal is to, I guess, alleviate mental distress to improve their functioning and quality of life, but it's through delivering the psychological therapies. Whereas for NDIS, I guess it it comes with its own glossary. Like, you have to learn a lot of language to really understand NDIS, and capacity building is, like, the key term for psychologists. Right?

[00:08:46] Katherine: Mhmm. Yeah. That's where the funding comes from under capacity building supports. That's the sort of language that we're using and things like increasing functional capacity. It's requires some really specific terminology, um, that the NDIS is looking for.

[00:09:04] Bronwyn: And I I think 1 of the other domains is improved relationships and daily living. Is that another domain?

[00:09:09] Katherine: Yeah. Yep. That's

[00:09:11] Bronwyn: Yep. Yep. Because I've worked a few NDIS participants, but it was a few years ago. So I just remember, like, this language coming up and I was like, oh, yeah. Like, I had to write reports that were, like about improved relationships and daily living.

[00:09:22] Katherine: That's all feels under capacity building as an brand, but yeah absolutely those are the sort of terminology that comes up a lot.

[00:09:31] Bronwyn: So if we're talking about capacity building, what are we actually doing with participants?

[00:09:36] Katherine: I guess I could probably provide some examples of what I've been doing with my participants to give you a bit of context. It's um, abstract otherwise. Um, I mostly work with children and adolescents under the NDIS. Um, most of my caseload are autistic individuals, and we look stuff like, uh, social skills, so around improving, um, participants communication. So how can they have back and forth conversation with others? How can they join in, play groups with their peers? Um, how and likewise, how their supports can effectively communicate to them as well. Sometimes that's using assistive technology as well.

[00:10:20] So it's really practical, behavior focused work under the NDIS, um, very very applied. I think when I think about psychology under the mental health system, um, in my mind at least, it's a little bit more cognitive base, I guess, uh, under the NDIS, it's very it's very applied. You can see very clearly the impact it's having on that day to day basis for these participants.

[00:10:48] Bronwyn: So, yeah, I guess under Medicare, it's like we'd be focusing on people's thoughts, um, and feelings, and maybe having a look at how helpful or unhelpful the way people thinking are and how that contributes to their view of situation and then affects how they cope with stressful things. With NDIS and people living with a disability, we're really looking at how can we set them up to communicate with others, help them out with shopping or planning or organizing, that kind of stuff?

[00:11:19] Katherine: Yeah. That's exactly it. Very practical cool things. So it's a lot of, um, mapping out with visuals around routines, a lot of planning around what's your day going to look like? What's your week going to look like? Around mostly the if we think about CBT, it's the b in the CBT. It would be the focus. Yeah.

[00:11:40] Bronwyn: Yeah. Do you do any work on emotions with NDIS participants? Like, how to regulate emotions?

[00:11:47] Katherine: Yeah. Absolutely. Um, that's a really key component here as well, but it's thinking about how to regulate those emotions and how to safely express them, the difference between safe versus unsafe or expected versus an unexpected behaviors. then it's linking more back to behaviors as well. So yes, the emotions and emotion regulation certainly come into it, but It's less about, the underlying cognitions there.

[00:12:16] Bronwyn: Okay. And with the emotions as well, I'm just curious. Do you work 1 on 1 with people or do you work within their system, like, with their parents or their carers, how does that what does that look like?

[00:12:29] Katherine: It's for me personally, it's very rarely been 1 on 1 with just the NDIS participant. suppose it depends on the NDIS participant's support needs and their level of functioning and independence. But for the participants I've worked with, you're certainly working with their support team. So often that's their parents, it's often the school as well, um, their support workers, everybody around them that is connecting with the participants on a day to day basis.

[00:13:02] Of course, there's 1 on 1 work as well , we certainly don't want to leave the NDIS participant out of the conversation, that's never the goal here, but it is working certainly within a broader system.

[00:13:13] Bronwyn: I guess I wanted to highlight that as well because I think 1 thing that people might not be aware of is, like for example, so for me, I work in private practice. I work a lot with Medicare clients.

[00:13:25] Um, the most interaction I have is sometimes with my clients' partners, sometimes with, the The client's GPs wanna interact and communicate with them, but it's usually through written communication, so letters. And I'm thinking that a key difference between Medicare and NDIS is that I reckon you would have a lot of meetings with external folks. Is that right?

[00:13:47] Katherine: Yes. Definitely. We call it care tea meetings, and, yes, certainly, that's a lot, a large part of my week is around meetings with external providers.

[00:13:58] Bronwyn: And I think 1 thing is, like so for me in private practice, I might see 4, 5, or 6 clients a day. How many clients are you seeing a day?

[00:14:08] Katherine: Um, it can fluctuate. A really, really, really busy day without a lunch break would be 4 clients per

[00:14:15] Bronwyn: Okay. Sure. that's really busy.

[00:14:17] Katherine: that's that's no for a proper break kind of level Yeah.

[00:14:22] Bronwyn: Yep. And so Because 1 of the things I talk about on the podcast a lot is case loads.

[00:14:26] And, like, I've said it before on the podcast, but for NDIS, like I've said, is that 4 clients is super, super busy. What would be a comfy day for you? Like, how many clients?

[00:14:36] Katherine: 2 to 3. 2 to 3. depends. there's a lot of report writing to do under the NDIS as well.

[00:14:44] So it depends, you know, if you've got report writing. Sometimes I have just days where all I'm doing is report writing and not seeing any clients. But 3 would be the amount that I aim for.

[00:14:56] Bronwyn: Yeah. So I think I've jumped the gun a bit. So let's go back and be like, okay.

[00:14:59] What are what are your work roles? Because I think you mentioned to me off air that you actually have 2. There's 1 which is psychology and there's 1 which is behavior support. So I listeners would be interested in what's the difference, Um, and then we could talk about the kind of tasks that you might do in both.

[00:15:15] Katherine: Sure. Absolutely. I actually have 3 roles. I behavior support

[00:15:19] Bronwyn: Okay. Sure.

[00:15:20] Katherine: So I know. Just to add another thing. So we've talked a little bit about the psychology aspect there.

[00:15:29] Bronwyn: Yeah.

[00:15:30] Katherine: behavior support is a little bit different. So a lot of, um, I've noticed in particular a lot of early career, clinicians tend to do a dual role where they're working as a psychologist and in behavior support, which is certainly where I started but what I've also continued to do as well. think, look, the reason being for that would be more financial for the business. Um, behavior support brings in a higher hourly rate than, uh, provisional psychology or counseling under the NDIS.

[00:16:02] For behavior support, uh we're looking at what's called restrictive practices, so things that may be in place to the idea is that they're in place to safeguard an NDIS participant, but in doing so it restricts either their access to or movement within the community. Um, so behavior support would be around identifying the use of restrictive practices and working very hard to fade them out over time. We don't want our NDIS participants to be subjected to lots of, um, restrictions in their life, that is a really key part of that work, and the reason why we don't is an infringement on their human rights.

[00:16:51] So we want our NDIS participants, yeah, just like everybody else, to have as much access to the world as I possibly can. Um, that's really the focus of behavior support is about reducing and eliminating those practices.

[00:17:06] Bronwyn: Yep. NDIS does have a huge like, it's a human rights framework. So the principles of NDIS symbols of NDIS are choice, control, autonomy, helping them live as much of their life independently as they can, not these restrictive practices as much as we can. Right?

[00:17:21] Katherine: Mhmm. Absolutely. And behavior support is around looking at what we call behaviors of concern are going on. So what sort of behaviors might be occurring for that individual, that might be a result of them trying to communicate with other people or manage internal distress. So that can be things like verbal aggression or physical aggression, property damage, breaking things, etc.

[00:17:48] And behaviour support is focused around managing those behaviors whilst working to reduce and eliminate the use of restrictive practices. So I think a fairly different focus to what psychologists under the NDIS do, um, which is around increasing individuals participation into the community. So similar, but different kind of overarching focuses there.

[00:18:17] Bronwyn: And can you walk us through what you do when you assess behaviors of concern? Because I think a big focus for behavior support practitioners is this, um, functional behavior analysis. Is that right?

[00:18:28] Katherine: Yeah. Absolutely.

[00:18:30] Bronwyn: Again, big topic, but could you just walk us what the hell is a functional behavior analysis?

[00:18:36] Katherine: Sure. So functional behavior assessment is understanding the function of the behavior, so the the why people are doing it, essentially, we need to work out why they're doing it so that we can work out safer, more appropriate replacement behaviors to introduce as an alternative strategy there.

[00:18:55] How we generate that, it's a lot of clinical interviews with key stakeholders, so that might be with group home team team leaders, might be with disability support workers, um day support Program managers, families, of course, the NDIS participant as well, uh, would be involving, um, observation of the NDIS participants and their supports in a range of different settings. So you can work out all this this sort of support or this way of communicating works really well here. Let's try and replicate it over here, etcetera. Um, and there's some formalized assessment tools that we can use as well to help inform that impression. It's quite a lengthy process to complete a functional behavior assessment.

[00:19:44] Bronwyn: it's a lot of hypothesis testing, isn't it? It's like, Okay. What is prompting the person to engage in this behavior? What setting does it occur in? How frequent? What's the intensity? Uh, who are they doing it with, what triggers might be in their environment. So it's really taking a view that, like, okay. This person isn't trying to be a real shithead when they're doing stuff. Like, there's something that they're communicating and there's a need there that they are trying to get met, and then the people are viewing it as challenging, but they're viewing it as, like, I'm just trying to get my need met.

[00:20:15] Katherine: Absolutely. Absolutely. And, you know, I think under the NDIS, uh, a lot, not every, but a lot of the NDIS participants do have troubles with communicating their needs to others. So naturally that oftentimes results in behavioral outbursts or behavioral difficulty, but I think people just trying to do the best they can with what they've given.

[00:20:39] Bronwyn: Yeah. Yeah. Absolutely. So it really takes a really understanding and compassionate view towards humans. I guess it, you know, just comes within the human rights framework again.

[00:20:49] Katherine: Yeah, yeah absolutely.

[00:20:51] Bronwyn: And is that something that you enjoy doing, or is it challenging for you?

[00:20:54] Katherine: I love it. It's, I I feel like it's a little bit more straightforward than the work in psychology. There's a finite number of functions for the behavior. So once you can at that, it's relatively straightforward process in working out replacement behaviors and then a lot of skill building around those.

[00:21:17] But I really like going in there and doing observations and talking to many different people, um, consulting with a range of key stakeholders. I think that's fascinating. I do also, um, supervise other behavior support practitioners that are new to the NDIS are new to this role, um, and guide them through that sort of process of Understanding the behaviors and writing the very lengthy reports that the NDIS requires too.

[00:21:48] Bronwyn: It does sound very rewarding as well because if you can identify the function of a behavior and then come up with a replacement behavior that you then train the system to use and you help build the skills and the participant to use, it sounds like that could be really rewarding to see.

[00:22:03] Katherine: Yeah. Absolutely. I've had some massive wins where I've had clients that were real targeting behaviors such as running out towards highways ways that now know safer ways to express their needs and that's completely eliminated. Alongside that, there's no need to lock doors anymore and You know, they get more access to the environment, so it has such potential to have a really big impact on participants' lives and that is so rewarding when you can get to that point, it's amazing to be part of.

[00:22:38] Bronwyn: That's wonderful. So, Katherine, when we're talking about psychology and behavior support. You did mention lengthy reports of the behavior support Um, could you just tell us a bit about maybe the tasks you do in either role?

[00:22:56] Katherine: In psychology, um, my work is around a lot of emotion regulation work and a lot of social skill training type work. Under psychology, I would usually write a progress report, which would be identifying their participants NDIS goals and how our therapy goals are working towards their NDIS goals, where they're and recommending additional supports in future or a reduction in supports in future if we've met those goals.

[00:23:31] Under behavior support, it's around identifying the use of restrictive practice, identifying their behaviors of concern, working to reduce both aspects there, write functional behavior assessment reports, write behavior support plans, train, key stakeholders like NDIS support workers, families around the behavior support plan, and then and teach the NDIS participants the replacement behaviors and the skills to use alternative ways of communicating their needs.

[00:24:07] Bronwyn: Cool. So there's a variety of tasks that you undertake. And 1 thing I'm interested in is, do you write reports where you are asking the NDIS for more funding or different funding?

[00:24:21] Katherine: Yes. All the time.

[00:24:23] Bronwyn: Yeah.

[00:24:25] Katherine: So often, um, NDIS participants have a 1 year NDIS plan, and at the end of that 1 year, we would be writing, as allied health professionals, we'd be writing a report to recommend supports in future, and That's where a lot of advocacy comes in to try and match, allied health supports to the NDIS participants' current needs and work out where they need to be linked to.

[00:24:53] Bronwyn: And so is it difficult to get the funding that you feel that the NDIS participant needs?

[00:24:59] Katherine: To be honest, yeah, it can be really challenging. At the moment, I'm finding it quite challenging to get psychology through under the NDIS. The NDIS certainly does fund psychology. Um, it has not outlined any, intention to cut that out of the NDIS, but I have noticed just anecdotally there is a bit of a misconception that the NDIS won't fund psychology and that NDIS participants should go get a mental health care plan and get their mental health support or psychological support elsewhere. So that's quite tricky to navigate.

[00:25:38] Um, there are, you know, certain terms that we can use to try and get the funding there and it's really again speaking to that functional need. What's what we're we're hoping to achieve, what tangible difference that's going to make to the participant, and what would be the consequence should they not be funded to get that? What would happen? Would they have more, you know, an increased need for more formal supports in future? Would they have a decreased capacity to engage in their regular routine. So it's really highlighting those aspects as well that I found works best but it is a challenging space at the moment.

[00:26:17] Bronwyn: Yeah. Like, is there a misconception maybe amongst people who fund NDIS plans that people with disabilities can't benefit from psychology?

[00:26:28] Katherine: Look. Possibly. Um, I'm not sure where it stems from exactly. It's very hard to pinpoint, but it's certainly a topic of conversation at the moment, and it's absolutely something that I've noticed working in the area. It does seem to be more and more challenging to get that funding through.

[00:26:47] Bronwyn: It does seem a shame. But I guess it's good for listeners to know that it it can be difficult to obtain that funding for psychology in particular.

[00:26:57] Katherine: Yeah. I think if listeners are experiencing that, they're they're certainly not alone. And to perhaps go back to the NDIS guidelines and look at, how they term what psychology services should be used for and matching those terms accordingly.

[00:27:12] Bronwyn: So, yeah, you can get guidance from, like your workplace and, I guess, supervisors. Like, this is something that you'd probably discuss with supervisees as well?

[00:27:20] Katherine: Yeah, absolutely.

[00:27:22] Bronwyn: Yep. So, Katherine, is there anything else that you wanted to say about your role in the NDIS specifically?

[00:27:30] Katherine: Oh, I guess I probably I haven't made maybe clear enough, but Under psychology, under the NDIS, we need to really highlight how it rate relates to their disability.

[00:27:42] Bronwyn: Oh,

[00:27:42] Katherine: So it's it seems very obvious and I that's why I left it out, we're bringing everything back to the disability. Otherwise, perhaps they could seek support from elsewhere. So I think that's probably another really crucial thing that I should have said earlier.

[00:28:00] Bronwyn: Yeah. No no worries. Because you've been working in this sector for a few years with NDIS participants, I wondered if you had any tips on working well with people who live with disabilities for listeners? do's and don'ts?

[00:28:14] Katherine: Yeah. Okay.

[00:28:15] So let's create some do's and don'ts. I guess My don't would be assuming that everybody with disability is the same. Even if it's the same type of disability, it's not necessarily going to be the same presentation and you would still need to adjust your approach, to the individual that's in front of you. So it is very individualized... I suppose that's, you know, across the mental health spectrum, but if you get if you meet 1 person with anxiety, that's just 1 person that's experiencing anxiety. There's so many different types that fall under that and we would adjust our intervention and our work with clients accordingly. It's the same under the NDIS, um, everybody's very different, So let's just start by assuming that and working with who you're who's across from you.

[00:29:07] Bronwyn: Awesome. Yes. I think that's very important. Like, yeah, there's no 1 size fits all approach.

[00:29:12] Katherine: Absolutely. Um, another don't would be If somebody has a physical disability, that doesn't mean that they necessarily have an intellectual impairment or a cognitive impairment. Don't talk down to them and assume that there's some cognitive difficulties going on there. There may be, There may not be, it's very insulting to go in with that assumption.

[00:29:37] And if we do work with people with intellectual disability or any cognitive deficits there. We'll need to adjust the pace of our therapy and, you know, work quite differently with our approach. It would be less abstract reasoning, more concrete examples, a lot of visuals, pictures, social stories, video communication, that sort of thing would work best.

[00:30:02] Katherine: And adjusting the length of the sessions as well. Um sometimes People's attention spans don't last the 50 minutes and that's not appropriate, so we need to work out what the individual in front of us can manage and adjust our approach accordingly.

[00:30:20] Bronwyn: So how do you find that out? Do you get feedback from the participants, or are you like, was this session too long for you today? Or yeah. How do you work out how to adjusts your approach to the person in front of you.

[00:30:34] Katherine: Sometimes, um, when I first get a referral, the first thing I do is speak to their nominee and their nominee is an informal support that helps the NDIS participant. Oftentimes that's family members, it might be their parents or grandparents, aunt or something and get a bit of background information from from them around the participant and what their needs are, you know... would they prefer us to come into their home? Would they prefer to meet at a clinic somewhere else? Where would be comfortable? What's their preferred communication style? Anything else that is relevant? Asking How else can we support their needs? And asking those questions upfront, I think, is helpful, But it's good to check-in with the NDIS participant as well around is there anything else that I can do for you.

[00:31:25] With my case load with kids and adolescents, it's pretty bloody obvious when you're doing something well versus when you miss the mark a bit there. They'll tell you and you just do better next time.

[00:31:38] Bronwyn: Is not hard to come by.

[00:31:39] Katherine: It is written all over their bodies.

[00:31:42] Absolutely.

[00:31:43] Bronwyn: Yeah. And I just wanted to circle back to your point of not speaking down to people with disabilities, like, as a sibling of someone with a disability, and and you might have experienced something similar with your sibling, but it annoys me to no end when people come up to my sibling and they just, like, speak to them like they're a baby, and I'm, like, don't start off with that. Just treat them like a normal human, and then if you need to adjust after that then do that, but don't start off with the very patronizing and and speaking down, you know, tone.

[00:32:14] Katherine: Absolutely, and it happens all the time which Blows my mind that

[00:32:19] Bronwyn: I know.

[00:32:20] Katherine: It's so inappropriate.

[00:32:22] Bronwyn: know. Yeah. It is. It's super inappropriate. And I've had it with friends who use wheelchairs as well. People will assume that They can't talk and they'll talk to me. And it's like, no, no, no. Don't assume that. they can talk. Talk to them. Don't talk to me.

[00:32:37] Katherine: Yeah. Absolutely. And I guess that's that's a good, um, point that I should raise here too. When I'm meeting with the NDIS participant, often they'll have a support person with them. Maybe that's a formal support worker. Maybe it's a family member or a friend.

[00:32:53] I wouldn't be looking at the the friend or the formal support or the informal support in the room. It's about the NDIS participant, And they will defer when they need to defer, but my default isn't to go to everybody else. Absolutely

[00:33:08] Bronwyn: No. Yes. Yeah. It's It's really centered on them. They're the participant. They're the they're the person. They're your client. Like, you speak to them. Yeah.

[00:33:17] Katherine: I'll name that I get there too. I'll name that up and say, hey. Just so you know, I am going to face Johnny today and look at him and I'm not ignoring you, but he's the star of the show, and I wanna hear about his experience and how I can work with him. And if we've got questions we can come back that to that later.

[00:33:39] And I guess it's also about being aware of, you know, when you're bringing up sensitive information or things that might be embarrassing or uncomfortable to disclose, to choose your moments or sorry. Not to disclose, to ask about, to pick your moments. Is this appropriate to be asking when our participant is sitting right across from us, or is this a conversation that we should go back to later on.

[00:34:03] Bronwyn: Yeah. That's really appropriate.

[00:34:06] Are there any other do's and don'ts for folks with disabilities when we're working with them.

[00:34:10] Katherine: I suppose when you're making reports or recommendations about the participant, Involve the participant. It sounds very simple, um, but I do think it it can be often overlooked. Um, so when I'm writing a report I will go through it with the participant and I'll adjust my language, based on their capacity. But I'll always go through that report. And when I talk about what I recommend, I check-in. Does that seem to match with your expectations? Is there something that I've forgotten? Is there something else that you would like support with? And then if there is and it's appropriate, I'll add it in. And if it's way left of field, which oftentimes it is, I will then educate onto, uh, great idea, but The NDIS can't find an ice cream truck out the front of your house or, you know, something like that.

[00:35:04] Bronwyn: I would love for you to have an ice truck. It's just, know, something out of out of the capacity.

[00:35:09] Katherine: It sounds fun, but not really what is for.

[00:35:14] Bronwyn: Yeah. No. I think that's great, and I love doing that as well. And I think that comes back to our human rights model. It's like everyone the right to make choices about their life, and that includes people with disabilities. What kind of supports do they want? What services do they want?

[00:35:30] How do they wanna live their life? If they want ice cream track therapy and even if it's not possible with NDIS, like, just because I might think it's a bad idea, which I don't, Like, if they want it, then that's that's their choice.

[00:35:45] Katherine: Yeah absolutely and yeah I think, our disability community, a lot of the times these people are really really vulnerable. They're left out of the conversation. People speak over them. They ignore their opinions, and we've got to be really conscious of that, when working with these participants as well and consciously not do that ourselves.

[00:36:11] Bronwyn: Yeah. And, I mean, that's something that I wanted to come to, which is that people with disabilities are quite vulnerable and we don't wanna do them harm as psychologists. And 1 way we can do that is really by upholding their dignity, their respect that we have for every other human and them included. And that might require challenging our own conceptions that we have about people with disabilities or if we haven't socialized much with people with disabilities, educating and upskilling in that area.

[00:36:37] Katherine: Yeah absolutely, and it it is very different and you know sometimes it can be confronting and I understand, I understand that for me personally I'm quite comfortable around the disability community, it's what I grew up with and it's totally fine, it's no biggie, I don't really even think about it.

[00:36:56] But I know that that isn't the norm and a lot of people may be coming into this area not working with people with disability before not having any interaction with people with disability before, and people can look different, they can speak differently. They can understand really different. There is nothing wrong with that. It's just around challenging our own with how we um, recognize and respond to that.

[00:37:25] Bronwyn: Absolutely. And I think that's what supervision is really good for as well, like, being able to discuss our biases in a safe place. So, um, for instance, like my brother who has an intellectual disability, I know that I may need to talk about something in multiple different ways or show something in multiple different ways for my brother to understand, um, what I'm trying to get cross, and I'm not impatient with that. I just know from being the sibling that that's what I need to do. And He's not trying to be annoying or or, um, I don't know, anything else. It's just that's that's the way I need to do things.

[00:38:05] But perhaps there's somebody else who hasn't been raised in that kind of environment, they may be like, uh, why do I have to explain this again and again? I explained that to them last time. Like, why do I need to repeat this. And that can be something that's really good to bring up in supervision.

[00:38:19] Katherine: Yeah absolutely, I agree.

[00:38:21] Bronwyn: Cool.

[00:38:22] So at the top of the podcast, I said I mentioned your advisory and advocacy roles. And I wondered if you wanted to share with listeners what you're doing in those roles and what that involves for you.

[00:38:33] Katherine: Sure I'll start by the governance group. I'm a committee member, uh, as part of a governance team that oversees the runnings of a specialist disability accommodation site. Um, so we do things like look at the tenancy, the service provider, ensure that their participants or the residents' needs are met through the provider, needs are met through the provider, look towards redeveloping, upgrading, um, the physical infrastructure, and of course that changes over time as the resident's needs change over time, which can occur at quite a different rate for participants with disability. So that's what that role entails.

[00:39:14] For the Premier's Disability Advisory Council in Tasmania, I am a Community Deputy Chair and we are working on, the Accessible Island Framework which is Tasmania's framework for the inclusion of people with disability. So we communicate with all state government entities around disability inclusion, and that can be things like physical infrastructure, so looking at wheelchair accessibility across public spaces, parks, beaches etc. It can be around, uh, looking at staffing arrangements, how disability is included at all levels of government and in the community as well.

[00:40:07] Transportation is another big 1, so looking at how people with disability can travel. So that's either, you know, by car, bus, e scooters come up a lot as well, that can be challenging in this space, um Spirit of Tasmania and airlines as well, so looking at that it's quite broad and it's around really ensuring that people with disability have a say and can access and participate in the community, like anybody Um, and we know that if we make things Accessible, it's accessible to everybody, whether you have a disability or not, whether you're a parent with a pram for example or just the average person. If we make things accessible they are accessible to all. So that's the goal All there, um and the other 1 through that role I am part of the Australian Disability Strategy Advisory Council, so that's looking at the national strategy around the inclusion of people with disability.

[00:41:16] A lot of the conversation at the moment is around the response to the Disability Royal Commission and the NDIS review which were recently released this year as well. So mapping out whose responsibility it is to follow, discuss, and act on the recommendations of these reviews and what that would look like for people with disability.

[00:41:39] Bronwyn: Amazing. So, Katherine, why is it important to you to be involved on committees, like, why not just sit back and relax and be like, whatevs? what does it give you?

[00:41:54] Katherine: Well, I'm just not somebody to sit back and watch things, okay? Um, but it it is it is something that I do struggle with. I am not somebody that lives with disability myself, um, and sometimes that feels really uncomfortable. I don't... I'm very conscious not to speak over the voices of the peep of people with disability, and it's something that I am very conscious of and do my very best to listen and advocate in an informed way by talking to a range of people within our disability community.

[00:42:30] I think I'm in a good position to make recommendations and be part of the discussion with these councils because I have personal experience through my family member, I work in the area and I'm just super duper passionate about making things fairer for the lives of people with disability. Um, I want to see Australia be a more inclusive place, I think it's it's pretty good. Um, there's, Yeah. Certainly, uh, a lot of other countries that don't have the level of disability inclusion that we do in Australia, but I think there's room to grow and we're only going to know that by listening to the voices of others and I'm in a position to be able to do that, to take it forward and get, um, momentum on that conversation. And I feel like It's because I can. It's almost my responsibility to do that, and I'd be doing a disservice, um, if I just ignore that and sat back.

[00:43:36] Bronwyn: Yeah. No. It it feels really amazing to hear you speak about that, actually. It's it's a privilege to be in a position where we are educated and we can make a contribution to this discussion. So what I'm hearing from you, it's almost like, yeah, like, I've got an imperative to do this. I can do something, so I will do something.

[00:43:54] Katherine: Yeah. Yeah. Pretty much.

[00:43:57] Bronwyn: Yeah. No. And it sounds like you're making a really big difference, which I think is fantastic and is a great way to use our roles as psychologists to really be leaders in in spaces that are important.

[00:44:07] Katherine: Being a psychologist in this space has taught me the skills to communicate with a range of different people, to get those needs communicated across. Um, obviously, with academic writing, report writing, advocacy stuff. I think we're in such a unique position to have that be almost that middleman and get the message moved across. Um, so So I feel like it's a really, yeah, privileged, very unique, special position to be in, and I'm so glad that I get to be part of that.

[00:44:40] Bronwyn: Yeah. That's awesome. I'm really keen on being an active member of the community and being involved in in passions that way you can make a difference, um, as a psychologist and also using your lived experience. And so, yeah, I would encourage anybody who also wants to get involved in the disability space to to do that, I think. Are guys looking for new members?

[00:45:02] Katherine: I'm sure all the time there is Always well, look I can I can speak a bit to Tasmania in particular, but I'm pretty sure nationally there's a shortage of psychologists at work with NDIS participants, um, yeah, there's such a need there? So Absolutely. Get on get on

[00:45:22] Bronwyn: Cool. And when we're talking about inclusion, tell us what the future holds to you because I know that that's a passionate, uh, area that you want into your work moving forward. Is that right?

[00:45:34] Katherine: Absolutely. So at the moment, I am about to transition to a role as a school psychologist, um, and through that role, I really want to work towards the inclusion of people with disability in mainstream education settings, um, working out what supports are needed, how we can make that happen and how we can have schools have their education and disability awareness so that future generations are growing up with more inclusion around them.

[00:46:09] Bronwyn: I think that's amazing. the number of people who I've met who's who's, like, the schools can't accommodate what their children need, say, and then they've needed only alternative they've had is to homeschool their children, has been has been too many. In my own personal experiences growing up watching my brother trying to struggle to be included at a mainstream school, it's a shame that it's still such a struggle.

[00:46:33] Katherine: Yeah. And it it is. It really is. Um, I think things are improving. That's, you know, a changing space that's rapidly evolving. There's been a lot of recommendations come out recently about how to advance this space. We've come a long way, um, but I think there's just so much potential to improve things even further to have that longer term impact on people.

[00:46:56] Bronwyn: Absolutely. Yeah. 100 percent. And, yeah, I wish you the very best with your school psych position. I hope it goes really well. What an exciting future.

[00:47:05] Katherine: Thank you. I'm very excited for the opportunity. Yeah. We'll see how things unfold. Um, I don't think that, uh, there's a special place in my heart for disability work, so, um, we've just got to work out how to mesh all of the interests and passions together, I thInk.

[00:47:22] Bronwyn: Well, Katherine, is there anything that we haven't touched on which you really want to share with listeners?

[00:47:27] Katherine: I guess if people are listening to this and wondering If it's an area that, is going to work for them, I think give it a try. Um, Be open to learning and, you know, learning from your peers, your supervisor, and learning from people with disability would be my main takeaway. I think there's so much potential there.

[00:47:49] Bronwyn: Katherine, if listeners wanna learn more about you or get in touch, where can they find you?

[00:47:55] Katherine: Um, I am on LinkedIn at Kat Elliston. Um, not super but active on other areas of social media, so I think that's probably the best way.

[00:48:05] Bronwyn: No worries. Well, Katherine, thank you so much for coming on. I really appreciate it. It's been such an enlightening conversation about NDIS working with people with abilities, and just a really good insight and overview about this system and the roles that psychologists can have. So thank you so much.

[00:48:22] Katherine: Oh, thank you for having me. It's been, um, such a great opportunity to have these conversations. Could talk about disability work all day, I feel just so happy that somebody wanted to listen to

[00:48:33] Bronwyn: Yeah. No worries. And I'm sure a lot of listeners have benefited. So listeners as well, thank you so much for listening. Have a good 1 and catch you next time.