Danger! Danger! Danger! There Is A Therapist In The Room!!!

that’s a bit dramatic as we all know that some therapists are fantastic But....

there is a problem when there are so many people, NDIS included, seem to want us to think “therapy” is a magic word. Or that all therapists are equal and bring the same level of quality to their work; they don’t. Some are absolutely fantastic, some are good and some are pretty useless and a waste of money, and these ones seem to be increasing in numbers.

So when you are buying therapy support, just like anything else you need to look for the best value.

What we think:

a good therapist can make a great difference for your son or daughter and if you need therapists you should definitely be using them.
the NDIS, while it has created some fantastic opportunities for people and it should be recognised for that, has also created lots of situations where money earned is the main focus rather than the quality of services given.
this focus on money is resulting in a shift in quality and it is hurting people who we care about; and some Therapy companies, seem to be very keen to make money rather than providing great support.
there is absolutely no need to panic about this as you are in control and can manage things so that you can get the best supports possible.
If you have a good therapist of any type, hang on to them and refer them to others who you know. If you are referring on a therapist, we always encourage you to pass on the name of a person rather than just a company name .

I am sharing some of our recent experiences in reference to therapy that may highlight the need for all of us to be very vigilant so you are sure to select one of the good ones and not one of the duds.

BSP Incompetence

The NDIS conducted research into Behaviour Practitioners in the last couple of years. Their own research (attached) showed that over 80 percent of the plans created by Behaviour Practitioners were weak or underdevelop and would not make a difference for the individual the plans were designed for. We wrote to Bill Shorten along with the CEO of the NDIS to ask some questions about this, like, what are you doing to make this better and what are you doing to tell families to be wary and to tell them how to connect to the Therapists doing good work. We received a two page response telling us that they were going to offer better training. That is a good thing but it is a long term solution and doesn’t say much about quality and means that there is a good chance that the Behaviour Practitioner who is working with you now may be struggling to make the difference that you want them to.

Inexperienced therapists

One of our families told me about a young person who has been providing direct support to their child. This staff member recently finished a Degree in psychology. This of course doesn’t make them a proper Psych. There is post degree education and a whole range of practice and supervision factors that take years to complete. As soon as this staffs basic degree was complete they were offered a full time job as a behaviour practitioner. It didn’t matter to the company (a large not for profit charity) that even after they started the staff member still had no idea what a behaviour plan was or how they are developed. He was offered no training and was put in a room with a bunch of referrals and told to start seeing the people and developing plans; that he knew nothing about. He was not provided with proper supervision and what supervision was provided was about how to write a report that made the NDIS happy, not how to contribute more to a person’s life. This, tossing people in at the deep end, is something that we are seeing more and more of across all of the therapy types. Inexperienced practitioners being sent out to do complex work that they are not ready for.

Putting people at risk

We are a bit sensitive about meal time profiles (MTP). That’s because I have been in the room when someone died because a profile was not followed correctly (not at Milparinka). A MTP is a set of specifc directions deveopled by a qualified Speech Pathologist, that instructs on how to support someone, who has problems with swallowing etc, to be supported to eat a meal safely. Any meal time profile that is used on our sites is vetted to ensure the instructions are clear and cannot be misinterpreted. When we have a choice we only work with highly experienced and skilled therapists, or younger less experienced ones, as long as we know that they have a very strong supervision structure, so, most times when we see MTP we are just saying thank you, that’s great we can understand what you want us to do. But.. we come across Speech Pathologists, who have no relevant experience, who have jumped into this field because of the chance to work, who design the Meal time profiles and send in absolute rubbish that is not even recognisable as a MTP. Recently we needed to send a MTP back 6 times before we could accept it as usable by our staff to support someone to have a meal.

Not all therapists are equal or have the same experience, and an increasing number, like this one that we recently dealt with, are inexperienced, ineffective and they often don’t know it themselves, so it is your place, or the place of people you trust, to judge. Remember you are paying the same amount for poor practice as you are paying for the absolute best.

Is it a Disaster

It doesn’t need to be, but it can be a wasted opportunity. We can all contribute to being sure we are getting good therapy support by exercising the choice and control that the NDIS encourages. Instead of just accepting a therapy referral from your support coordinator, or much worse than that, from an NDIS planner, ask some questions, and think about the answers that you want to hear, so that you can decide for yourself, and, if you are not happy, say thanks but no thanks and get someone else.

The view that any therapist can do any job that you need done is completely wrong.

What Can We Do About This

Ask people you know if they have had good support from a therapist. Ask what made them good so you can see if they match your needs.
If you are a member of a support group or information sharing organisation ask them.

Ask questions before you sign a service agreement and hire someone. Here are some ideas and things that we may ask therapists if we are seeking them out for someone. You don’t need to ask them all. Ask the ones that give you enough information to feel comfortable with their practice and experience.

What is your experience in undertaking the task that we are asking you to do?
What is your experience in working with people who have intellectual disabilities, and how many years have you been doing this work for?
What are your qualifications and what was the last training that you have done? Many therapists have areas of specialisation so you may want to know that they are focused on the type of support you are after.
What is your supervision structure, who will supervise your work with my child and how often does this occur? This is really important if you are sent a young therapist. Young therapists can be great and enthusiastic, but you do want to know that they are checking their work with a wiser more experienced head.
Can you provide references or put me in contact with other people you have supported?
Ask about how they deal with reports that they are writing. Will they send through draft versions of their reports to ‘check-in’ with you and give feedback before finalising them, or there is a conversation that takes place early on in the working relationship where this is discussed that feedback is considered welcome. Will you receive regular case notes, if you want these, following appointments You will want them to have the report ready before the end of plan so that you, and people you trust, can review and comment on these.
Make sure you feel comfortable with them. If they seem overly pushy and are not listening to you in the first few sessions then think about a change, because they are not likely to get any better.
Before you tell them how much money you have to spend, be sure to ask them what their approach will be, what is the work they will be doing and how many hours will they expect it to take. You are the purchaser, you shouldn’t tell them about the money first, they should be telling you what they are going to do for you and how they are going to do it.
Ask them what are the things you will be charged for that is not direct work related to your child. It is very reasonable for a therapist to charge for non-contact time to write reports and follow up issues on your behalf, but you will want to know if they are charging for other bits and pieces – which does happen.
Ask them about their history and interest in liaising and working collaboratively with other allied health professionals, sharing reports, assessment and progress in a cooperative team environment.
Can you modify your approach or times to allow for our unique circumstances?
Don’t get sucked in by NICE. I have a lot of conversations with families who are disappointed with Therapists who say things like, but they were really nice and likeable so I thought they were good. We want people to be nice and likeable, it’s a great starting point but it isn’t enough. Therapy is a complex and multifaceted process and it involves a lot of skills and competencies, including assessment, diagnosis, treatment planning, interventions, communication, empathy, active listening, and knowledge of therapeutic techniques and theories. Being nice does not show you that the therapist has these skills or experiences, so ask some questions to be sure. There are lots therapists who are nice as well as skilled – but don’t presume that is everyone.

Milparinka has a long history of working in collaboration with therapists, not just in our work with individuals, but also in our organisational planning and development, and in our training of staff. And we will keep doing that because they have helped to make us better at what we do. But it is different now. We have to be much more thoughtful about who we invite to take these roles with us, because the range in experience and abilities is becoming more extreme. We can pay nearly $200 for someone who is worth every cent of that, they will be experienced, focused and add value, or, we can pay the same $200 for someone who isn’t able to do the work to the required level. Just like you we need to find a way to make sure we are getting the impact we are seeking from a specialised intervention.

Therapy isn’t alone. It would be naive to imagine that there isn’t one part of the service system, including ourselves, that has got everything right. There is going to be problems and issues that need to be addressed across the whole range of areas. But Therapy supports, funded by the NDIS has some very visible problems at the moment that we need to do something about.