Opportunities to enhance relational wellbeing through the National Disability Insurance Scheme: Implications from research on relationships and a content analysis of NDIS documentation

Interpersonal relationships are critically important to ensuring that people with disability can access the benefits of individual funding models such as the National Disability Insurance Scheme (NDIS). The NDIS aims to enhance participants’ self‐determination of supports and social and economic participation, but the emerging evidence indicates that achieving these policy outcomes requires stronger recognition of participants’ relational context, even in a system focused on individual choice and control. This paper reports on a content analysis of the NDIS Act, NDIS Rules, Operational Guidelines, and Price Guide to examine the extent to which the scheme's conceptual foundations and funded supports in individual plans enable it to support relationships. Implications are drawn from this analysis and theory and evidence about the importance of relationships for disability policy and practice. The paper outlines three areas where the approach of the NDIS to relationships is limited and can be improved: first, by conceptualizing relationships as relationships rather than simply sources of informal support; second, through provisions to actively support relationships; and third, by considering the relational appropriateness of support provided by family, carers, and friends. It concludes with suggestions for how relational considerations can be enhanced, including implications for government in administering the scheme.     

Will the National Disability Insurance Scheme Improve the Lives of those Most in Need? Effective Service Delivery for People with Acquired Brain Injury and other Disabilities in Remote Aboriginal and Torres Strait Islander Communities

The aims of National Disability Insurance Scheme (NDIS) are to provide long‐term, person‐centred care and support to all Australians with a significant and ongoing disability, including individuals with an acquired brain injury (ABI). The scheme has significant potential to provide equitable opportunity of access to health and disability services. Historically, however, service provision in remote and outer regional areas of Australia lags behind more densely populated centres. Aboriginal and Torres Strait Islanders living with disability are already significantly marginalised. Further to this, people with an ABI are very often misunderstood and overlooked by disability services, health professionals and governments, and frequently fall victim to the criminal justice system. This paper provides an overview of the state of ABI disability for Aboriginal and Torres Strait Islanders in remote and outer regional settings, and the present sets of barriers they face to obtaining quality care and effective interventions. A significant opportunity has emerged with the advent of the NDIS but equitable benefit can only be achieved if additional and specialised measures are devised and implemented to appropriately screen for, and assess, incidence of ABI; disability services are appropriately resourced to overcome the pre‐existing disadvantage, and education, training and recruitment of Aboriginal and Torres Strait Islanders with the NDIS is undertaken to lead attitudinal changes in community to disability and health services. This paper concludes with recommendations for the NDIS to meet its laudable objectives.     

Disability and support relationships: What role does policy play?

Very little is known about how relationships between people with disabilities and their paid support workers are positioned in policy. With the policy shift toward choice of provider, individualised approaches, person centredness and self‐directed funding, the nature of their relationship assumes a more prominent role in the quality of support practice. The policy analysis in this article explores the extent to which current disability policy acknowledges, promotes, or diminishes the relationships between people with disabilities and workers, in their organisational context. It uses Honneth's conditions for recognition—love (cared for), rights (respected) and solidarity or social esteem (valued)—to understand how policy positions mutuality in the relationship. The policy review applied a three‐stage process: categorisation of policies, textual analysis and content analysis to policy documents at four levels—international, Australian federal, state and organisational in two case studies. The analysis revealed that while a rights framework is explicit in most policies, the emphases on the conditions for recognition within a relationship between people with disabilities and workers are compromised in instructional policies that attempt to manage the tension between choice and risk, particularly at the organisational level.     

Adjudicating reasonable and necessary funded supports in the National Disability Insurance Scheme: A critical review of the values and priorities indicated in the decisions of the Administrative Appeals Tribunal

Beyond the initial euphoria of the National Disability Insurance Scheme (NDIS), tough choices will be needed for sustainability. Although the spirit of the NDIS is to deliver choice and control, the Australian government's objective is to ensure that rights and aspirations are proportionate to expectations of best practice, aptness of mainstream services and cost effectiveness. The position in this paper is that this test of ‘reasonable and necessary’ when determining funded supports, raises value dilemmas for government and citizens. The objective is to demonstrate this through a critical scrutiny of the reviews and decisions regarding reasonable and necessary funded supports of the Administrative Appeals Tribunal (AAT). In this paper, a synthesis and critique of 35 appeals to the AAT and one Federal Court Appeal are used to make explicit the decisional ambiguities and contestations in the scheme and the values and priorities that are currently dominant in the allocation of reasonable and necessary support. This in turn is used as a basis for a discussion about the operation of rights in the scheme and what counts as legitimate support. The benefit is for scheme transparency and fairness but also broader debate about core principles and values to inform decisions about scarce resources in society.     

Accountability in Public Service Quasi‐markets: The Case of the Australian National Disability Insurance Scheme

Australia's National Disability Insurance Scheme (NDIS) represents the latest in a worldwide shift towards individualised funding models for the delivery of care services. However, market‐based models for care deliveries bring new considerations and dilemmas for accountability. Drawing on previous work by Dickinson et al. (2014), we examine a range of accountability dilemmas developing within the early implementation of the NDIS. These relate to accountability for the following: care outcomes, the spending of public money, care workers, and advocacy and market function. Examining these accountability dilemmas reveals differences in underpinning assumptions within the design and on‐going implementation of the NDIS, suggesting a plurality of logics within the scheme, which are in tension with one another. The contribution of this paper is to set out the accountability dilemmas, analyse them according to their underpinning logics, and present the NDIS as having potential to be a hybrid institution (Skelcher and Smith 2015). How these dilemmas will be settled is crucial to the implementation and ultimate operation of the scheme.     

The implementation of complex social policy: Institutional layering and unintended consequences in the National Disability Insurance Scheme

In this article, we identify the unfolding unintended consequences which flow from one instance of policy layering in Australia's National Disability Insurance Scheme (NDIS). We show how use of a causal diagram, which highlights feedback loops and emergent properties, to map complex chains of causal factors can assist policy scholars and policy practitioners to understand the likely direction of change and possible responses. In the case of Australia's National Disability Insurance Scheme, our analysis suggests that the likely direction of change will work against two of the fundamental design features of the NDIS: providing participants with more choice and control, and ensuring all eligible Australians are able to access appropriate services and supports regardless of where they live. Our analysis points to the use of price regulation as the site of potential intervention because of the role it plays in subsequent feedback loops and the development of the two, unwelcome, emergent properties.     

澳大利亚强制年金管理模式分析

对澳大利亚强制年金的管理模式进行了系统而深入的分析,得出了一些重要结论:澳大利亚的受托人制度虽然有其优势,但由于需要一些外部条件,也许并不适合许多发展中国家;有收益率做保证加上合理的业绩评估方法有利于基金的长期增长,但无法避免一些人收入大幅度下降;高度分散化的管理模式特别是业务外包也许会提高管理成本;而扩大成员在投资领域的发言权更值得反思。     

International Power and Local Action – Implications for the Intersectionality of the Rights of Women with Disability

The recent United Nations Convention on the Rights of Persons with Disabilities (CRPD) reframes how policy responds to disability, difference, interdependence and rights. We examine how Australian disability activists used the CRPD to advocate for the intersectional rights of women with disability. We applied a framework from Zwingel's conceptualisation of mutually constituting global norms to analyse the intersectionality of rights represented in three stages of the CRPD process – during the drafting, the wording in the Convention, and the periodic review. We found that disability activists were able to shape the gendering of disability through their targeted representation as people with lived experience. This expertise filled a knowledge gap in the policy process valued by the actors at other policy levels. Extending Zwingel's concept of global discourse translation, it also suggests that the dynamic contribution continues in the international interpretation of the CRPD itself.     

The Lure of New Jobs: How Framing Impacts Perceptions of Local Subsidies for Sports Teams

Municipalities often use public funds to support private projects in pursuit of economic growth or improved quality of life. How does the framing of municipal subsidies impact public support for such funding? We examine the case of government-funded minor league baseball stadiums to address this question. Using nationally representative survey data, we find respondents are much more likely to support funding for stadiums when told that baseball will bring jobs and improve the local economy, compared to other frames. Local governments may therefore rely on positive, economic frames to gain public support, despite a lack of evidence that sports stadiums deliver net economic benefits.     

Measuring the Effectiveness of New Approaches to Housing Support Policy for Persons with Disabilities

Housing support policy for persons with disabilities who require access to 24‐hour formal or informal support is changing throughout Australia. This is consistent with international trends including: independent living in generic housing; facilitating choices about where and with whom people live; individualised home‐based support; and community integration. Are these trends leading to policies that are effective in the Australian context? This article presents a framework for analysing the effectiveness of new approaches to housing support using a rights perspective. The framework consists of four domains: client outcomes; administrative systems; service viability; and coordination between formal and informal carers. Applying the framework to six case studies found that they all aim to foster independence, while providing effective individualised, holistic housing support.     

Structurally Excluded? Structural Embeddedness and Civil Society Competition for Funding

ABSTRACT

The debate about the funding and support of civil society by government bodies has become a central and politicized issue in many countries. European states in particular have sought to make use of civil society to deliver key supra-national policy aims of addressing economic and social disadvantage, as well as delivering national and territorial outcomes. To this end European structural funding has been used at a regional level to develop and engage organizations and their beneficiaries. One of the key considerations in such activity is the ability of civil society organizations to engage with the funding available, and whether structural barriers exist that potentially prevent organizations with relevant expertise participating. In order to illustrate this, this article investigates how civil society organizations fared in gaining funds from the 2007–2013 European Social Fund (ESF) programmes in Wales, what, if any, barriers were found to exist in acquiring those funds and what this means for the sector in Wales in the context of future funding. The wider significance of this work is in revealing how the structural embeddedness of organizations plays a significant role in determining organizational success in gaining ESF funds, and how this contributes to a cleavage in the sector as a whole. Thus, this article concludes that it is organizations that are structurally embedded that will be most successful in gaining ESF funds, due to their organizational characteristics and their institutionalized relationships with, and receipts from, the state. Other organizations, conversely, are shown to become structurally excluded.     

The Future of Social Policy in Scotland: Will Further Devolved Powers Lead to Better Social Policies for Disabled People?

Scotland has laid claim to being ‘different’ from the rest of the UK with regards to disability policy. This article examines the evidence for that with regard to long‐term and social care, and discusses the possibilities opened up by the devolution of disability benefits. It asks whether Scotland will demonstrate policy divergence from the rest of the UK, and whether that is likely to be beneficial for disabled people. It argues that Scotland has the potential to create better social policies for disabled people, but faces significant challenges in doing so.     

The politics of fund raising through grantsmanship in the human services

Funds for human service programs and services are declining, and selection criteria for funds are becoming more objective. These conditions are creating an imbalance in the system which will result in a significant change in human service funding and delivery. The climate is ripe for increased competition among those who obtain funds for human services. This article attempts to define how that competition will ultimately generate a spirit of cooperation among the survivors. To reach that point, however, grantsmen/providers, to be competitive, will need to sharpen their technical writing skills and their political skills, that is, they need to become more shrewd, prudent, and diplomatic. This article suggests some methods for improving technical grant-writing skills and developing political skills among grant writers.     

Short‐Term Emergency or Recurring Climatic Extreme: A Rural Town Perspective on Drought Policy and Programs

Drought is most often encountered as a long‐running and recurring climatic extreme; one that can have devastating environmental, social and economic impacts. While drought is a routine feature of the Australian climate, the politics of drought are often highly reactive, and drought support programs are notoriously ad hoc and ineffective. In the context of emergent global recognition of climate change, drought has received renewed political attention that presents significant opportunities for change. In this paper, we review the context of drought policy in Australia. Yet we seek to provide a unique contribution to current debates by considering the perspectives of those people at the forefront of drought; in particular, those people living and working in small rural towns in drought‐affected areas. The aim of the paper is to use a case study to present an account of drought policies and programs from those who are the targets of such interventions.     

Explaining Contextual Effects on Vote Choice

How are individual voters influenced by their social surroundings? Though numerous studies establish that voting behavior can be influenced by the social context, we lack a full understanding of how the actions of individual voters can be influenced by the composition of their social environment. In this paper, I develop and test a micro-level model of the operation of contextual influences on political behavior. The model specifies the effects of both personal contact and individual perception of the partisan nature of the local environment. The data show little support for personal contact as a mechanism of contextual influence, but reveal that perception of partisan dominance markedly enhances the impact of partisan identification on vote choice.     

Innovation and Implementation in the Public Sector: An Examination of Public Entrepreneurship

This article develops an empirical measure of public entrepreneurship and uses it to discover the correlates that distinguish between those participants in a policy domain who are seen as more or less important in the entrepreneurial process. Looking at two rural regions dealing with telemedicine technologies, the authors examine the role of personal attributes and situational attributes in predicting who will emerge as the most mentioned public entrepreneurs on these issues in their community. Status in the local community, membership in the health professions, and strong local focus and ties are the most instrumental variables in distinguishing between those in a policy domain who are more likely to be identified as entrepreneurial. The authors provide an empirical test that can, for the first time, identify in a comparative context the traits that distinguish more entrepreneurial individuals from less entrepreneurial ones (or nonentrepreneurial ones) participating in the same policy domain.     

Empirical investigation of party preferences and economic voting in Turkey

Abstract.  This article examines the factors that shape party preferences in Turkey by estimating an individual vote intention function that includes both economic and non-economic factors. The economic variables can be used to test the familiar hypotheses of economic voting theory – whether individuals vote retrospectively and/or prospectively, and whether they are sociotropic and/or egotropic. The non-economic factors include sociodemographic characteristics as well as identity and issue variables likely to be good predictors of party choice. The analysis focuses on comparing the characteristics of those who intend to vote for the ruling Justice and Development Party (AKP) with those of other parties. According to multinomial logit estimates, young people, especially males, constitute the electoral base for the AKP. Those who have been affected adversely by recent economic developments, as well as those who are against Turkey's accession to the European Union are also more likely to vote for the AKP. The empirical work also provides evidence in support of economic voting hypotheses.     

Death with "dignity": the wedge that divides the disability rights movement from the right to die movement

Much of the American debate over physician assisted death (PAD) is framed as an ideological split between conservatives and liberals, pro life and pro choice advocates, and those who emphasize morality versus personal autonomy. Less examined, but no less relevant, is a split within the ranks of progressives--one that divides those supporting a right to die in the name of human rights from disability rights activists who invoke human rights to vehemently oppose euthanasia. This paper reviews how "dignity" serves both as a divisive wedge in this debate but also as a value that can span the divide between groups and open the way to productive discourse. Supporters of legalized euthanasia use "dignity" to express their position that some deaths might indeed be accelerated. At the same time, opponents adopt the concept to argue that physician assisted suicide stigmatizes life with a disability. To bridge this divide, the worldviews of two groups, Compassion & Choices and Not Dead Yet, are studied. The analysis concludes that the two organizations are more parallel than contrary--a finding that offers opportunities for dialogue and perhaps even advances in public policy.     

Changing the Culture of Health: One Public Health Misstep at a Time

In this article, I argue that public health regulations are a necessary component of changing the culture of health in the US. After considering libertarian critiques of public health interventions, I maintain that many of the interventions critiqued are not in fact coercive. Looking forward, I do not envision an either/or between the nanny state vs. a libertarian polity. Instead, a middle ground will emerge that respects individual choice and personal responsibility while accepting that government has a legitimate interest in securing the population’s health. Better health helps people make better choices and enjoy freedom; being free from poor health status is as important to liberty as free choice.     

Still a poster child for social investment? Changing regulatory dynamics of early childhood education and care in Denmark and Sweden

This paper investigates the regulation of publicly organized early childhood education and care (ECEC) in Denmark and Sweden, through the regulatory welfare state (RWS) framework. The analysis focuses on how alterations in funding and quality of care are shaped by governmental and nongovernmental actors at national and local levels of government. Through focused structured analysis, we examine how various actors have shaped the funding and quality of childcare in Denmark and Sweden, from the early 2000s to 2020, with special attention to the period during and after the 2008 financial crisis. In the aftermath of the financial crisis, concerns about quality in care were raised on the political agenda by various actors in both countries, leading to decisions to improve the quality of care. Yet, the regulatory dynamics differ: In Denmark, the debate led to a decision in 2019, to implement a minimum statutory requirement of regulatory quality standards. From an RWS perspective, this outcome can be qualified as “double expansion,” because regulatory quality standards, and public funding for childcare increased. In Sweden, the debates about quality of ECEC led, in 2016, to political guidelines about quality standard, but with no additional national funds, and no mandatory regulatory quality requirements. Analytically, this can be qualified as “regulatory-led expansion,” that is requirements for quality standards, although the lack of additional national funds suggests that it will be difficult to improve ECEC quality substantially. The RWS perspective, which focuses on national and municipal levels of governance, also gives insights into hidden inequalities between municipalities regarding funding and quality of ECEC, which are more pronounced in Sweden than in Denmark.