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. 
This chapter focuses mainly on services covered by the third Commonwealth State/Territory Disability Agreement (CSTDA), which applies to the period 1 July 2002 to 30 June 2007. The CSTDA forms the basis for the provision and funding of services for people with a disability, where the person’s disability manifests before the age of 65 years and for which they require ongoing or long term episodic support. Specialist psychiatric disability services are excluded from the chapter to improve data comparability across jurisdictions. 
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. This Report 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) and Commonwealth Rehabilitation Services (CRS) Australia. Performance information on the HACC program is provided in the ‘Aged care services’ chapter (see chapter 12). CRS Australia’s services are not covered in this Report.
Some mainstream services provided to the community as a whole are covered elsewhere in this Report — for example, school education (see chapter 3), vocational education and training (VET) (see chapter 4), public hospital care (see chapter 9), specialised mental health services (see chapter 11) and public housing (see chapter 16). 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. 
Significant improvements in the reporting of Indigenous data related to services for people with a disability in this year’s Report are the inclusion of:
•	data on disability prevalence rates among Indigenous people 
•	data reported against the ‘service use by severity of disability’ and ‘service use by special needs groups — Indigenous people’ indicators for community support and respite services.
Profile of specialist disability services
The CSTDA defines ‘specialist disability services’ as ‘services or initiatives specially designed from time to time to meet the needs of people with disabilities’ (CSTDA 2003, p. 10). A definition of disability is provided in box 13.1.

Box 13.1	Definition of disability	
The International Classification of Functioning, Disability and Health defines disability as being an experience for the person involved that may include the impairment of their body structure and function, limitation of their activity and restriction of their participation in life areas. The International Classification of Functioning, Disability and Health also recognises the role of physical and social environmental factors in affecting disability (WHO 2001).
The Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers (SDAC) 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.	
(Continued on next page)	

Box 13.1	(Continued) 	
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 (2004b); WHO (2001); CSTDA (2003); 2007 Report, box 13.1, pp. 13.2-3.	
	
	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 2007 (2007 Report) contains the following data items on Indigenous people:
•	proportions of age groups who have a profound or severe core activity limitation
•	users per 1000 people in 2004-05 of the following services:
–	accommodation support 
–	employment 
–	community access 
–	community support 
–	respite 
•	labour force participation and employment rates of people with a profound or severe core activity limitation, 2005.
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 2007 Report, the compendium also notes where the original table, figure or text in the 2007 Report can be found. For example, where the compendium refers to ‘2007 Report, p. 13.15’ this is page 15 of chapter 13 of the 2007 Report, and ‘2007 Report, table 13A.2’ is attachment table 2 of attachment 13A of the 2007 Report.
Disability prevalence among Aboriginal and Torres Strait Islander people 
Indigenous people have significantly higher rates of profound or severe core activity limitation than non-Indigenous people. The Australian Institute of Health and Welfare (AIHW) estimated that the proportion of Indigenous people aged over 18 years who had a profound or severe core activity limitation was approximately 2.4 times that of non-Indigenous people in 2002 (AIHW 2006). This estimate is based on data from the ABS’s General Social Survey (GSS) and National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and takes into account differences in the:
•	age structure of the Indigenous and non-Indigenous populations
•	method that was applied in remote areas for the two surveys (for further details on the difference in method see AIHW 2006).
The difference (in rate ratio terms) between the populations is most marked for people aged 50–54 years and those aged 30–34 years (figure 13.1).

Figure 13.1	Proportions of age groups who have a profound or severe core activity limitation, by Indigenous status, 2002a 
	
a For the NATSISS, there were a number of differences in the ‘screening’ questions used to establish disability status and disability type for persons living in remote and non-remote areas. While a ‘common’ set of questions was asked in both remote and non-remote areas, some additional questions were asked in non‑remote areas only. The expanded set of screening questions asked in non-remote areas is referred to as the ‘broader criteria’, the smaller set is referred to as the ‘common criteria’. For the reported proportions, the relative impact of the broader criteria on the Indigenous estimate in non-remote areas was calculated and applied as a weight to the estimate for remote areas. The non-Indigenous estimates from the GSS are based on the broader criteria only (AIHW 2006). 
Source: AIHW (2006); 2007 Report, figure 13.2, p. 13.8.
Framework of performance indicators
Data for Indigenous people are reported for a subset of the performance indicators for specialist disability services in the 2007 Report. It is important to interpret these data in the context of the broader performance indicator framework outlined in figure 13.2. The performance indicator framework shows which data are comparable in the 2007 Report. For data that are not considered directly comparable, the text includes relevant caveats and supporting commentary. 
Figure 13.2	Performance indicators for services for people with a disability
	
Source: 2007 Report, figure 13.5, p. 13.12.
The performance indicator results reported in this chapter generally relate to CSTDA funded services. This Report includes service user data for 2004-05. These data were sourced from the CSTDA National Minimum Data Set (NMDS) collection, which is coordinated by the AIHW.
When considering the indicator results derived using service user data, comparisons between jurisdictions and between the 2003-04 and 2004-05 data (see attachment) should be undertaken with care. While the implementation of the CSTDA NMDS continues to improve data quality, quality is still affected by a number of factors. 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 and between 2003-04 and 2004-05. 
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). 

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 identified as Indigenous. 
This indicator compares the proportion of service users per 1000 people from a particular special needs group with the proportion of service users per 1000 people outside the special needs group. The disability service types reported are accommodation support, employment, community access, community support and respite services. For accommodation support, community access, community support and respite services, people aged under 65 years are included in the population counts for both the special needs groups and the 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 service users per 1000 people outside the special needs group. 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 13.2	(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 into account differences in:
•	the prevalence of disability between people in the special needs group and people outside the special needs groups — this may be a significant issue when comparing Indigenous and non-Indigenous populations’ access to services
•	the level of informal assistance that is available for people in special needs groups and outside the 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 may be more readily 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.	
	
	Nationally, the proportion of the Indigenous population who used CSTDA funded accommodation support services in 2004-05 (2.1 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the non-Indigenous population who used these services (1.5 service users per 1000 non-Indigenous people aged under 65 years) (figure 13.3). Comparisons between Indigenous and non-Indigenous populations’ access to services need to be undertaken with care as the prevalence of disability is significantly different for these two populations (figure 13.1).
Figure 13.3	Users of CSTDA funded accommodation support services per 1000 people, by Indigenous status, 2004-05a, b, c, d, e, f, g, h, i
	
a Users per 1000 people were derived by dividing the number of service users by the number of people 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 2436 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 Individuals might have accessed services from more than one State or Territory during 2004-05. f Data quality continues to improve following the implementation of the CSTDA NMDS. However, this indicator needs to be interpreted with care due to a number of factors impacting on data quality. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. g Comparisons of the Indigenous and non‑Indigenous populations’ access to services should be undertaken with care. The need for services is likely to be greater for Indigenous people than non-Indigenous people due to the higher prevalence of disability. The AIHW estimated that the proportion of Indigenous people aged over 18 years who had a profound or severe core activity limitation is approximately 2.4 times that of non-Indigenous people. 
h NSW experienced low data response rates. This led to the significant underreporting of service user numbers. 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 (2004a, 2004c); AIHW (unpublished); table 13A.1; 2007 Report, figure 13.18, p. 13.31.
Nationally, the proportion of the Indigenous population who used CSTDA funded employment services in 2004-05 (6.0 Indigenous service users per 1000 Indigenous people aged 15–64 years) was higher than the proportion of the non-Indigenous population who used these services (4.6 service users per 1000 non-Indigenous people aged 15–64 years) (figure 13.4).
Figure 13.4	Users of CSTDA funded employment services per 1000 people, by Indigenous status, 2004-05a, b, c, d, e
	
a Users per 1000 people were derived by dividing the number of service users by the number of people aged 15-64 years, multiplied by 1000. b Data for all service users exclude 2665 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. c Individuals might have accessed services from more than one State or Territory during 2004-05. 
d Data quality continues to improve following the implementation of the CSTDA NMDS. However, this indicator needs to be interpreted with care due to a number of factors impacting on data quality. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. e Comparisons of the Indigenous and non-Indigenous populations’ access to services should be undertaken with care. The need for services is likely to be greater for Indigenous people than non‑Indigenous people due to the higher prevalence of disability. The AIHW estimated that the proportion of Indigenous people aged over 18 years who had a profound or severe core activity limitation is approximately 2.4 times that of non-Indigenous people. 
Source: ABS (2004a, 2004c); AIHW (unpublished); table 13A.2; 2007 Report, figure 13.19, p. 13.32.
Nationally, the proportion of the Indigenous population who used CSTDA funded community access services in 2004-05 (2.3 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the non-Indigenous population who used these services (1.8 service users per 1000 people aged under 65 years) (figure 13.5).
Figure 13.5	Users of CSTDA funded community access services per 1000 people, by Indigenous status, 2004-05a, b, c, d, e, f, g, h, i, j
	
a Data for users per 1000 people were derived by dividing the number of service users by the number of people 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 5222 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 Individuals might have accessed services from more than one State or Territory during 2004-05. g Data quality continues to improve following the implementation of the CSTDA NMDS. However, this indicator needs to be interpreted with care due to a number of factors impacting on data quality. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. h Comparisons of the Indigenous and non-Indigenous populations’ access to services should be undertaken with care. The need for services is likely to be greater for Indigenous people than non‑Indigenous people due to the higher prevalence of disability. The AIHW estimated that the proportion of Indigenous people aged over 18 years who had a profound or severe core activity limitation is approximately 2.4 times that of non-Indigenous people. i NSW experienced low data response rates. This led to the significant underreporting of service user numbers. j 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 (2004a, 2004c); AIHW (unpublished); table 13A.3; 2007 Report, figure 13.20, p. 13.33.
Nationally, the proportion of the Indigenous population who used CSTDA funded community support services in 2004-05 (7.6 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the non-Indigenous population who used these services (3.6 service users per 1000 people aged under 65 years) (figure 13.6).
Figure 13.6	Users of CSTDA funded community support services per 1000 people, by Indigenous status, 2004-05a, b, c, d, e, f, g, h
	
a Data for users per 1000 people were derived by dividing the number of service users by the number of people 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 27 356 service users whose Indigenous status was not reported, so community 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 community support services exclude specialist psychiatric disability services specifically identified by the jurisdiction. e Individuals might have accessed services from more than one State or Territory during 2004-05. f Data quality continues to improve following the implementation of the CSTDA NMDS. However, this indicator needs to be interpreted with care due to a number of factors impacting on data quality. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. g Comparisons of the Indigenous and non-Indigenous populations’ access to services should be undertaken with care. The need for services is likely to be greater for Indigenous people than non‑Indigenous people due to the higher prevalence of disability. The AIHW estimated that the proportion of Indigenous people aged over 18 years who had a profound or severe core activity limitation is approximately 2.4 times that of non-Indigenous people. h NSW experienced low data response rates. This led to the significant underreporting of service user numbers.
Source: ABS (2004a, 2004c); AIHW (unpublished); table 13A.4; 2007 Report, figure 13.21, p. 13.34.
Nationally, the proportion of the Indigenous population who used CSTDA funded respite services in 2004-05 (1.9 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the non-Indigenous population who used these services (1.0 service users per 1000 people aged under 65 years) (figure 13.7).
Figure 13.7	Users of CSTDA funded respite services per 1000 people, by Indigenous status, 2004-05a, b, c, d, e, f, g, h, i
	
a Data for users per 1000 people were derived by dividing the number of service users by the number of people 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 3667 service users whose Indigenous status was not reported, so respite 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 respite services exclude specialist psychiatric disability services specifically identified by the jurisdiction. e Individuals might have accessed services from more than one State or Territory during 2004-05. f Data quality continues to improve following the implementation of the CSTDA NMDS. However, this indicator needs to be interpreted with care due to a number of factors impacting on data quality. Differences in service type outlet response rates between jurisdictions, for example, should be considered when comparing jurisdictional data. 
g Comparisons of the Indigenous and non-Indigenous populations’ access to services should be undertaken with care. The need for services is likely to be greater for Indigenous people than non-Indigenous people due to the higher prevalence of disability. The AIHW estimated that the proportion of Indigenous people aged over 18 years who had a profound or severe core activity limitation is approximately 2.4 times that of non‑Indigenous people. h NSW experienced low data response rates. This led to the significant underreporting of service user numbers. i Tasmanian and 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 (2004a, 2004c); AIHW (unpublished); table 13A.5; 2007 Report, figure 13.22, p. 13.35.
Outcomes
Labour force participation
Nationally, the estimated labour force participation rate of people aged 15–64 years with a profound or severe core activity limitation in 2005 (32.7 ± 3.3 per cent) was below the rate for other people with a disability, excluding those with a profound or severe core activity limitation (65.0 ± 1.4 per cent) and the rate for people without a disability (81.4 ± 0.5 per cent). 
The labour force participation rates of people aged 15–64 years with a profound or severe core activity limitation by geographic location, country of birth and Indigenous status, in 2005 are reported in table 13A.6. Nationally, the estimated labour force participation rate of people with a profound or severe core activity limitation was 23.0 ± 16.5 per cent for Indigenous people, no different to the rate for non‑Indigenous people (33.0 ± 3.4 per cent) (table 13A.6).
Employment
Nationally, the estimated employment rate of people aged 15–64 years with a profound or severe core activity limitation in 2005 (86.7 ± 4.4 per cent) was below the rate for other people with a disability, excluding those with a profound or severe core activity limitation (92.5 ± 0.7 per cent) and below the proportion for people without a disability (95.9 ± 0.2 per cent).
The employment rates of people aged 15–64 years with a profound or severe core activity limitation by geographic location, country of birth and Indigenous status, in 2005 are reported in table 13A.6. Nationally, the estimated employment rate of people with a profound or severe core activity limitation was 96.0 ± 9.0 per cent for Indigenous people, no different to the rate for non‑Indigenous people (86.5 ± 4.7 per cent) (table 13A.6).

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      	
Table 13A.4	Users of CSTDA community support services, per 1000 people, by Indigenous status      	
Table 13A.5	Users of CSTDA respite services, per 1000 people, by Indigenous status      	
Table 13A.6	Labour force participation and employment of people with a profound or severe core activity limitation, by special needs groups, 2005 (per cent)     	
References 
ABS (Australian Bureau of Statistics) 2004a, Australian Demographic Statistics, Cat. no. 3101.0, Canberra.
—— 2004b, Disability, Ageing and Carers Australia: Summary of Findings 2003, Cat. no. 4430.0, Canberra. 
—— 2004c, Experimental Projections of the Aboriginal and Torres Strait Islander Population, 30 June 2001 to 30 June 2009, Cat. no. 3238.0, Canberra.
AIHW (Australian Institute of Health and Welfare) 2006, ‘Potential Population’ — Updating the Indigenous Factor in Disability Services Performance Indicator Denominators, Welfare Working Paper Series Number 50, Cat. no. DIS 45, 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.