Quality over growth… yet the team expands

It has been a long time between updates. A lot has happened in the past year in Veritable.

Veritable has been slowing building up its practitioner team, valuing quality services over growth. This is a very important guiding principle for us. In the end, we want to be seen as a company that promotes the best work for our clients. We have to grow in a careful and managed way to ensure we do not compromise quality services. In fact, we want to innovate and inspire as we go.

For this reason, our focus in 2021 has been on slow and managed expansion. Expansion with a strategic focus on seeking to provide the best remote behaviour support services in Australia, informed by a social work practice framework.

Fiona joined the team as a Behaviour Support Practitioner in May 2021. It is a delight to have such a skilled, competent and caring social worker with us.

Around the same time, we added Clare to the team operations, as Quality and Business Manager. Clare has helped us manage the challenges of growth (including endless rounds of service agreements) while keeping quality front and centre of what we do.

In June 2021, Chris left to pursue other opportunities. We wish him all the best on his own social work business journey, and we know his heart for great work will shine wherever he lands.

Reflecting that evidence-based behaviour support is at the core of what we do, when we learned of Joel’s skills in data analysis and reporting, we jumped at the chance to have him join our team. In August 2021, Joel joined Veritable and is also cutting a path for the provision of ‘Remote PBS’ (working even more remote from us here in Alice Springs!). When you find the right person with the right skill turns up, in remote Australia, you have to adapt to make it work.

Then, in October 2021, we were delighted to have Suzanne to join our team as a Behaviour Support Practitioner. Her passion for social justice, and her sense of humour, is unparalleled. Like our Managing Director, Suz has lived and worked in remote communities for many years and came to social work as a career and a calling later in life. In fact, Sophie and Suz first met in the Ngaanyatjarra Lands about 10 years ago.

Klara continues in the team, with her focus now shifting increasingly to the development of visual resources. We are incredibly lucky to have an ‘in house artist’ who says she has found her calling in our work. The use of visual tools across all facets of our work, and the creativity and insight Klara brings to her artworks, never ceases to amaze us.

Thank you to all who have supported us this past year, and since we established nearly 3 years ago. We are committed to bringing the best of remote behaviour support and social work to Central Australia, and defining innovate practice along the way.

Stay tuned for some photos of the team… including the many dogs of the team that each bring us joy when we down tools and go home to fill our cup.

More posts to follow… with a commitment from Sophie to update you all more often than once a year.

Quality and growth

There is a constant tension in the challenge of owning a NDIS-based business between growing (such that you can offer your services to a larger number of people) and losing touch with what you do and why.

Part of the reason we chose to establish Veritable, stepping out into the unknown, was to set the bar for quality services in Central Australia. The way in which the NDIS is designed, due in part to its deep and important commitment to choice and control, is ripe for potential exploitation of already marginalised and vulnerable populations.

In the mainstream, capitalist ‘achievement-focused’ world that many Westerners operate in, it is often assumed that we started the business in order to be in business. To create an income stream. To grow and expand. To be ‘successful’.

Our definition of successful is altogether different. Success is relationship. Trust. Connection. A genuine interest in and concern for the whole messy and wonderful lives of the people we support. Being open and attentive to what we don’t know, as much as what we might bring.

Success is also knowing that you did something useful, however small, for that person and their family. Knowing that you helped reduce the use of restrictive practice. That you listened slowly and deeply, and mapped a path together that could lead to positive change. That you saw your flaws for what they are, and took steps to improve. That you were humble enough to say you were wrong, to apologise and to commit to doing better next time.

With growth, comes the risk that these important qualities for the best work with people is lost. That the business becomes about key performance indicators, recruitment, business management, new office locations, and brand management. That the business becomes about the business itself. About sustaining itself, rather than the people within it and the people for whom it serves.

There does come a point when the next step forward into growth happens. Certainly, the NDIS is a positive game changer for Central Australia, in the support it can enable for many people. The drive to step into that space for growth (and all the risks it brings of losing touch with what we’re doing and why) is that, if done well, more people’s lives can be touched.

The challenge then is how to grow well, so that this genuine connectedness to the purpose of the work infuses all of the business. To grow in a values-driven way, so that all the people in the business understand what they are creating together. With people, and for people.

More than just a business

Social responsibility is part of corporate responsibility, values and ethics. It’s impossible to be in business in disability or human services and operate on standard ‘for profit’ lines.

The inequities and injustices that the people we serve, who enable our business to exist and succeed, are part of our responsibility to address as business owners. These injustices need to drive not just a commitment to individual quality service, but also service that seeks to address the systemic barriers faced by our clients.

Veritable has been advocating in a range of different areas, from ‘fee free interpreting’ for Aboriginal NDIS participants to new line items in the NDIS schedule of supports to enable culturally safe practice. The list of potential areas for systemic advocacy is long.

In the end, however, it is the individual injustices that strike the hardest. The small decisions that make the biggest impact on a person, their relationships, families and connectedness to the world they live in. From being denied access to their own funds for a much sought after item, to being isolated from their peers in their ‘best interests’.

While many people making such individual decisions do so from a space of genuine care and concern for the person, the overall impact on the person’s individual quality of life must be the yardstick. For these small decisions together make a life. A life engaged in the community, connected to family and country, filled with joy and laughter.

This is where we work – at the intersection of such lives and the systems that support or constrain them. And as a business, all of us providing ‘for profit’ services to NDIS participants must be more than providers. We must be enablers of lives that are rich with meaning and purpose.

Beyond just setting the bar for behaviour support

I have been preoccupied of late with what it means to be a behaviour support practitioner.

Last weekend, I settled down with a cup of tea to take in the new NDIS Quality and Safeguards Commission ‘competency framework’. Surely this eagerly anticipated guide would fuel my thinking, I pondered to myself.

And it was … interesting. It was somewhat reassuring. As a sole practitioner with a business mostly focussed on behaviour support, I need to make sure I’m meeting the requirements for registration.

At another level, however, it was also unsettling.

Unsettling because supporting people to better understand and address behaviours of concern is important work. Someone’s behaviour may mean that carers or staff are reluctant to leave the house with them. Anxious or unsure about how to support them in the community. Afraid they will hurt themselves.

In real terms, what this can mean for the person with a disability is that they end up leading an incredibly isolated life.  A life that gives little opportunity to learn new skills, have new experiences, to have fun, or to anticipate the day with pleasure.

If carers feel uncertain, worried or frustrated, this is not a positive support environment. We are all human. We react under stress, and make mistakes. We all will retreat to familiar (but often unhelpful) ways of responding. Ways that are usually more informed by a parent-child dynamic than one which recognises and responds to the person’s disability.

At worst, it can mean a revolving door of support for a person. For someone who needs carers that know them. For someone who needs to know their carers in order to feel safe in their environment.

Quality behaviour support provides a pathway out. It is proven way to reduce behaviours of concern. But what does quality support ‘look’ like?

To my mind, in order to deliver, the practitioner has to be highly skilled in engagement and observation. Skilled at analysing and building data systems. Able to develop robust hypotheses in new situations. Expert at identifying the right evidence-based strategies. Able to effectively meet the individual needs of carers. Adept at modifying systems and identifying areas to change and improve. Most importantly, they have to be deeply attuned to the fundamental human rights values that define the work.

They sound somewhat superhuman! I don’t claim to be all of those things I just listed. I do have my strengths. I do certainly aspire to improve. And an important part of that is recognising where I need to focus my development and seeing that through.

While each of the above skills are covered in the different competencies of the NDIS Commission’s framework, the level at which a practitioner needs to meet these standards is not set high. While I can understand that the market of practitioners needs to develop and grow in Australia, at the same time there is an incredible imperative for change.

The imperative is people who need the support. Who need a quality service at a level higher than that set in the NDIS Commission’s framework. In order to achieve change in that person’s life, the rubber has to hit the road at each point of the service.

A practitioner may be particularly skilled in analysis, but struggle to communicate their vision to others. Another practitioner may have the capacity to connect exceptionally well with support staff, but not lift their gaze above the information before them. Another person may be strong across many areas, but fail to see that the person’s quality of life has become worse.

Do we really imagine that one practitioner has all these skills? With the bar at ‘core’ competency set (somewhat) low in the NDIS Commission framework, can we take the risk with the outcome being no or poor change?

We may need to start thinking more creatively across the framework, and across the field of behaviour support. To identify levels of competency in skill sets, as well as base skills. To identify pathways towards core competency set at a higher standard, while still giving practitioners the opportunity to use their skills and develop further.

This might include building different skills sets into registration requirements. Perhaps identifying different categories of behaviour support practitioners (behaviour analyst, behaviour trainer, behaviour data clinician). Possibly create new fields of support in the NDIS price guide (‘behaviour assistants’).

These are just some late night, cup of tea musings. What drives me, however, is the knowledge of what is required to see that person out in the community, laughing, having fun.

If what it takes is that we need to expect more, and design our systems to ensure that a high standard can be met across multiple skill sets (including by different practitioners), then that’s what we need to do.

The business of quoting

Quoting in the world of NDIS, it’s a tricky business but one that needs attention.

There is a subtle interplay between what you can deliver and what the person has available in their plan.

There is, after all, no point quoting for 40 hours of (what you might regard as necessary work) if the person has 12 hours in their plan.

The discussion needs a ballpark.  Something to frame what a service provider can do, and what’s available to the person in their plan. Without this, neither party can really assess what is right for plan implementation.

What is a risk, however, is that the provider shapes their support only to what has been conceived and enabled in the plan. While this may be pragmatic, it doesn’t serve the participant. It also doesn’t help NDIS planners to really understand what is needed for participants in the scheme.

One way in which I have sought to address this is to be attentive to this ethical dilemma. My own internal ethical compass has to become part of the quoting process itself. After all, the quote is not just a piece of paper – it represents the beginning of a relationship.

In the end, if there are insufficient hours to deliver a quality service, this has to be stated up front. The quote has to be specific and focused on identifying needs only.

The bulk of the work might need to be directed into a report. While this is not immediately helpful to addressing systemic or sometimes pressing needs, it gives the participant a platform on which the person can stand at their next NDIS meeting. Giving all parties, including the NDIS planner, a clearer picture on what is needed to help.

A quote is never just a quote. It’s the opportunity to start a conversation and, potentially, a relationship of support that will extend well beyond the work itself.