13	Services for people with a disability
The Australian, State and Territory governments aim to maximise opportunities for people with a disability to participate actively in the community, by providing services and support for people with a disability, their families and carers. A definition of disability is provided in box 13.1.
The Commonwealth State/Territory Disability Agreement (CSTDA), which applies to the period 1 July 2002 to 30 June 2007, forms the basis for the provision and funding of specialist services for people with a disability who require ongoing or long term episodic support. 
This chapter focuses on services covered by the CSTDA, examining the performance of the Australian, State and Territory governments in providing services and supports for people with a disability where the disability manifests before the age of 65 years. Specialist psychiatric disability services are excluded to improve data comparability.
Services for people with a disability can be grouped into income support, disability support services and relevant generic services provided to the community as a whole. The Review of Government Service Provision generally does not report information on income support. Disability support services are primarily delivered under the CSTDA, as well as through programs such as Home and Community Care (HACC). The HACC program aims to prevent inappropriate or premature admission to residential care by providing basic maintenance and support services to frail older people, younger people with a disability, and their carers. An estimated 68.2 per cent of HACC clients in 2004-05 were aged 70 years or over, while 31.8 per cent were aged under 70 years (table 12A.7). Performance information on the HACC program is provided in the ‘Aged care services’ chapter (chapter 12). 

Box 13.1	Definition of disability 	
Disability is conceptualised as being a multidimensional experience for the person involved, relating to body functions and structures, activities, and the life areas in which the person participates (WHO 2001). The International Classification of Functioning, Disability and Health also recognises the role of physical and social environmental factors in affecting disability.
The Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers was conducted in 1981, 1988, 1993, 1998 and 2003, and was based on the International Classification of Functioning, Disability and Health and its predecessor. The 2003 survey defined a disability as a limitation, restriction or impairment that has lasted, or is likely to last, for at least six months and restricts everyday activities.
Self‑care, mobility and communication are defined as core activities. The ABS defines levels of core activity limitation as follows:
•	mild — where a person does not need assistance and has no difficulty with self‑care, mobility and/or communication, but uses aids or equipment
•	moderate — where a person does not need assistance, but has difficulty with self‑care, mobility and/or communication
•	severe — where a person sometimes needs assistance with self‑care, mobility and/or communication tasks; has difficulty understanding or being understood by family or friends; or can communicate more easily using sign language or other non‑spoken forms of communication 
•	profound — where a person is unable, or always needs assistance, to perform self‑care, mobility and/or communication tasks.
The CSTDA (2003, p. 9) defines people with disabilities who are eligible for CSTDA funded services:
People with disabilities attributable to an intellectual, psychiatric, sensory, physical or neurological impairment or acquired brain injury (or some combination of these) which is likely to be permanent and results in substantially reduced capacity in at least one of the following:
•	self-care/management
•	mobility
•	communication
requiring significant ongoing and/or long term episodic support and which manifests itself before the age of 65. 	
Source: ABS (2004a); WHO (2001); CSTDA (2003); 2006 Report, p. 13.2, box 13.1.	

Some mainstream services provided to the community as a whole — for example, vocational education and training (VET), school education, public hospital care, specialised mental health services and public housing — are covered elsewhere in this Report. Other mainstream services provided to people with a disability — such as transport and utility services at concessional rates — are outside the scope of this Report. 
Indigenous data in the services for people with a disability chapter
The services for people with a disability chapter in the Report on Government Services 2006 (2006 Report) contains the following data items on Indigenous people:
•	users of accommodation support services per 1000 people, 2003-04
•	users of employment services per 1000 people, 2003-04
•	users of community access services per 1000 people, 2003-04.
Supporting tables
Supporting tables for data within the services for people with a disability chapter of this compendium are contained in attachment 13A of the compendium. These tables are identified in references throughout this chapter by an ‘A’ suffix (for example, table 13A.3 is table 3 in the services for people with a disability attachment). As the data are directly sourced from the 2006 Report, the compendium also notes where the original table, figure or text in the 2006 Report can be found. For example, where the compendium refers to ‘2006 Report, p. 13.15’ this is page 15 of chapter 13 of the 2006 Report, and ‘2006 Report, table 13A.2’ is attachment table 2 of attachment 13 of the 2006 Report.
Framework of performance indicators
Data for Indigenous people are reported for a subset of the performance indicators for specialist disability services in the 2006 Report. It is important to interpret these data in the context of the broader performance indicator framework outlined in figure 13.1. The performance indicator framework shows which data are comparable in the 2006 Report. For data that are not considered directly comparable, the text includes relevant caveats and supporting commentary. 
Figure 13.1	Performance indicators for specialist disability services
	
Source: 2006 Report, p. 13.11, figure 13.3.
When considering the indicator results derived using service user data, comparisons between jurisdictions should be undertaken with care because the implementation of the CSTDA National Minimum Data Set (NMDS) has led to some data quality issues. In particular, the proportion of service users and service outlets that provided data (response rates) and the ‘not stated’ rates of particular data items vary across jurisdictions. 
Service use by special needs groups — Indigenous people
One indicator of access is the comparison between the representation of all people with a disability who use CSTDA funded services and the representation of people with a disability from special needs groups (box 13.2). 
Nationally, the proportion of the Indigenous population who used accommodation support services in 2003-04 (2.2 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the total population who used these services (1.6 service users per 1000 people aged under 65 years in the total population) (figure 13.2).

Box 13.2	Service use by special needs groups 	
The proportion of people from special needs groups accessing CSTDA funded services is an output (access) indicator of governments’ objective that access to appropriate services should be equitable for all members of the community. The special needs group reported here is:
•	people who have an Indigenous background. 
This indicator compares the proportion of service users per 1000 people from the particular special needs group with the proportion of all service users per 1000 people in the Australian population or with the proportion of service users per 1000 people outside the special needs group. The disability service types reported are accommodation support, employment and community access services. For accommodation support and community access services, people aged under 65 years are included in the population counts for both the special needs groups and the Australian population/people outside the special needs groups. For employment, only people aged 15–64 years are included in these population counts.
Holding other factors constant, the proportion of service users per 1000 people from a special needs group should not vary significantly from the proportion of all service users per 1000 people in the Australian population. While a markedly lower proportion may represent reduced access for a special needs group, it may also represent strong alternative support networks (and thus a lower level of need), or the individual choice of people with a disability not to access CSTDA funded services. Similarly, while a higher proportion may suggest poor service targeting or the lack of alternate support networks, it may also reflect the special needs group having a greater prevalence of disability. 	
(Continued on next page) 	

Box 13.3	(Continued)	
The CSTDA funded services are provided on the basis of need and available resources. This indicator does not provide information on whether the services are appropriate for the needs of the people receiving them, or correctly targeted to those most in need. The indicator also does not take account of informal assistance that may be significant for special needs groups. Results for outer regional and remote/very remote users of accommodation support services, for example, need to be considered with care because alternatives to government funded accommodation support services are available in these areas. Specifically, accommodation support services in outer regional and remote/very remote areas are largely provided informally, making use of local area coordinators and local community resources.	
	
	Figure 13.2	Users of accommodation support services per 1000 people, by Indigenous status, 2003-04a, b, c, d, e, f, g, h
	
a Data for Indigenous users per 1000 people were derived by dividing the number of Indigenous service users by the number of Indigenous Australians aged under 65 years, multiplied by 1000. b Where Indigenous status was inconsistently recorded for the same user, the user was counted as an Indigenous Australian. c Data for all service users exclude 954 service users whose Indigenous status was not reported, so accommodation support service users per 1000 total population aged under 65 years may differ from other figures. Due to the relatively high rate of missing data, care should be taken when interpreting this indicator. d Data for users of CSTDA funded accommodation support services exclude specialist psychiatric disability services identified by the jurisdiction. e Service user data are estimates after a statistical linkage key is used to account for individuals who received services from more than one service type outlet in 2003-04. Individuals might have accessed services from more than one State or Territory during that period. f Data used for this indicator have quality issues related to the development of the new CSTDA NMDS. This indicator thus needs to be interpreted with care. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. g The number of NSW service users is underreported because of low response rates. h ACT data for service users per 1000 Indigenous people are not published as they are based on a small number of service users.
Source: ABS (2003, 2004b); AIHW (unpublished); table 13A.1; 2006 Report, p. 13.28, figure 13.12. 
Nationally, the proportion of the Indigenous population who used employment services in 2003-04 (6.0 Indigenous service users per 1000 Indigenous people aged 15–64 years) was higher than the proportion of the total population who used these services (4.5 service users per 1000 people aged 15–64 years) (figure 13.3).
Figure 13.3	Users of employment services per 1000 people, by Indigenous status, 2003-04a, b, c, d
	
a Data for Indigenous users per 1000 people were derived by dividing the number of Indigenous service users by the number of Indigenous Australians aged 15–64 years, multiplied by 1000. b Where Indigenous status was inconsistently recorded for the same user, the user was counted as an Indigenous Australian. c Data for all service users exclude 4498 service users whose Indigenous status was not reported, so employment service users per 1000 total population aged 15–64 years may differ from other figures. Due to the relatively high rate of missing data, care should be taken when interpreting this indicator. d Service user data are estimates after a statistical linkage key is used to account for individuals who received services from more than one service type outlet in 2003-04. Individuals might have accessed services from more than one State or Territory during that period. 
Source: ABS (2003, 2004b); AIHW (unpublished); table 13A.2; 2006 Report, p. 13.29, figure 13.13. 
Nationally, the proportion of the Indigenous population who used community access services in 2003-04 (2.6 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the total population who used these services (2.0 service users per 1000 people aged under 65 years) (figure 13.4).
Figure 13.4	Users of community access services per 1000 people, by Indigenous status, 2003-04a, b, c, d, e, f, g, h, i
	
a Data for Indigenous users per 1000 people were derived by dividing the number of Indigenous service users by the number of Indigenous Australians aged under 65 years, multiplied by 1000. b Where Indigenous status was inconsistently recorded for the same user, the user was counted as an Indigenous Australian. c Data for all service users exclude 7283 service users whose Indigenous status was not reported, so community access service users per 1000 total population aged under 65 years may differ from other figures. Due to the relatively high rate of missing data, care should be taken when interpreting this indicator. d Service users who accessed the service type ‘recreation/holiday programs’ (service type 3.02) were not required to complete the item on Indigenous status; however, those who did provide a response are included in the data. e Data for users of CSTDA funded community access services exclude specialist psychiatric disability services specifically identified by the jurisdiction. f Service user data are estimates after a statistical linkage key is used to account for individuals who received services from more than one service type outlet in 2003‑04. Individuals might have accessed services from more than one State or Territory during that period. g Data used for this indicator have quality issues related to the development of the new CSTDA NMDS. This indicator thus needs to be interpreted with care. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. h The number of NSW service users is underreported because of low response rates. i ACT data for service users per 1000 Indigenous people are not published as they are based on a small number of service users.
Source: ABS (2003, 2004b); AIHW (unpublished); table 13A.3; 2006 Report, p. 13.30, figure 13.14. 
Future directions in performance reporting
There is scope for further improvements in reporting against the current framework. The Steering Committee intends to address limitations over time by reporting additional indicators on services for Indigenous people with a disability where possible.

Supporting tables
Supporting tables for data within this chapter are contained in the attachment to the compendium. These tables are identified in references throughout this chapter by an ‘A’ suffix (for example, table 13A.3 is table 3 in the services for people with a disability attachment). The tables included in the attachment are listed below. 

Table 13A.1	Users of CSTDA accommodation support services, per 1000 people, by Indigenous status      	
Table 13A.2	Users of CSTDA employment services, per 1000 people, by Indigenous status    	
Table 13A.3	Users of CSTDA community access services, per 1000 people, by Indigenous status       	

References 
ABS (Australian Bureau of Statistics) 2003, Australian Demographic Statistics, Cat. no. 3101.0, Canberra.
—— 2004a, Disability, Ageing and Carers Australia: Summary of Findings 2003, Cat. no. 4430.0, Canberra. 
—— 2004b, Experimental Projections of the Aboriginal and Torres Strait Islander Population, 30 June 2001 to 30 June 2009, Cat. no. 3238.0, Canberra.
CSTDA (Commonwealth State/Territory Disability Agreement) 2003, Agreement between the Commonwealth of Australia and the States and Territories of Australia in Relation to Disability Services, Australian Government Department of Family and Community Services, Canberra.
WHO (World Health Organisation) 2001, International Classification of Functioning, Disability and Health (ICF), Geneva.