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URGENT

Ms Louise Sole
Manager, Information, Referral and Intake
Ageing Disability and Home Care
Metro South Regional Office
Level 3, 56 Railway Parade
BURWOOD NSW 2134

13 September, 2010

Dear Ms Sole,

Re: Neil John MacDonald DOB: 23.09.1966
       Request for Internal Review regarding Eligibility for Services

The Intellectual Disability Rights Service (IDRS) requests a review of the decision regarding Mr Neil MacDonald's ineligibility for ADHC services. Mr MacDonald is a current client of IDRS. He has criminal matters next before Burwood Local Court on 4 October 2010. We would be pleased if you could determine this application as a matter of urgency.

Mr MacDonald was referred for ADHC services by IDRS and the referral was considered by the Regional Intake Panel on 9 February 2010. The Regional Intake Panel determined that Mr MacDonald was ineligible for ADHC Direct Disability Services on the basis that he does not have an intellectual disability. However, the Regional Intake Panel did acknowledge that Mr MacDonald had a high need for support and suggested a number of alternative referral options. Referral was made to those services but the level of service provision that is available is insufficient to meet Mr MacDonald' needs.

IDRS has undertaken further background enquiries regarding Mr MacDonald and as a result has evidence consistent with a finding that Mr MacDonald meets the clinical definition of being a person with an intellectual disability required to receive ADHC Direct Disability Services.
That is:

• Has an intellectual disability, two or more standard deviations below the mean;
• Significant deficits in at least two areas of adaptive functioning; and
• Onset prior to the age of 18yrs

Criteria One: Intellectual Disability

IDRS has copies of two psychological reports detailing the results of psychometric assessment for Mr MacDonald undertaken by Susan Sontag in 2004 and 2009. These reports were previously supplied to you at the time of our initial application for ADHC services on Mr MacDonald's behalf.

In 2004, Mr MacDonald was assessed by Susan Sontag using the Kaufman Brief Intelligence Test (K-BIT). The assessment reported that Mr MacDonald was functioning in the range of mild intellectual disability, with a Performance IQ of 70, Verbal IQ of 69 and Full Scale IQ of 66 (attached).

In 2009, Mr MacDonald was again assessed by Susan Sontag using the K-BIT. The assessment reported that Mr MacDonald was functioning in the lower range of borderline intellectual disability, with a Performance IQ of 75, Verbal IQ of 73 and Full Scale IQ of 72 (attached).

Although the results of the 2009 psychometric assessment were slightly elevated, there is no significant difference between the scores for Performance IQ and Verbal IQ, and the Full Scale IQ falls within the standard error of measurement.

We note that all standard intelligence tests have a margin of error, with the usual practice to apply plus or minus 5. As such, on the basis of testing by Ms Sontag, Mr MacDonald falls within criteria one.

Criteria Two: Significant Deficits in at least Two Areas of Adaptive Functioning

Mr MacDonald's adaptive functioning was assessed by Susan Sontag in 2009 using the Vineland Adaptive Behaviour Scales-II. The assessment reported that Mr MacDonald has significant deficits in three of the adaptive functioning domains (Communication, Daily Living Skills and Socialisation) and that his adaptive behaviour skills are in the range of moderate intellectual disability.

Medical reports obtained by IDRS from Centrelink (attached), undertaken at the time of Mr Macdonald's application for the Disability Support Pension support the assessment undertaken by Susan Sontag. The examining medical officer, Dr M Chapelle, in 1995, reports that Mr MacDonald has very limited personal care skills, often neglecting to wash himself or change his clothes for a number of days. In addition, Mr MacDonald demonstrates significant limitations in daily living skills as he is unable to budget his money, undertake shopping independently, cook or clean for himself and he has difficulties with independent travel as he often gets lost when using the public transport system.

Mr MacDonald has informed IDRS that due to his difficulties in managing his own money, Mr MacDonald “hocks” his bicycle each fortnight for $200 and then when his Centrelink benefits comes through pays $240 to retrieve it, only to have to hock his bike again later in the fortnight. In addition, Mr MacDonald's Centrelink benefit is being garnished for two separate debts and he is in rental arrears on his Housing NSW property.

Criteria Three: Onset Prior to the age of 18

As Mr MacDonald is a forty-three year old man, it has been difficult to obtain documentary evidence regarding his intellectual functioning prior to the age of 18 despite the best efforts of this service and of other service providers. In addition, Mr MacDonald is a poor historian and has on occasion given conflicting accounts of his history.

IDRS was able to build a social history profile for Mr MacDonald based on information obtained from his maternal Aunt, Mrs Suzie Coleman, and his brother, Mr John MacDonald. Letters from both Mr John MacDonald (Brother) and Mrs Coleman (Aunt) are attached.

Mr MacDonald is the eldest of three children born of his parents' marriage. Mr MacDonald Snr is reported to be an alcoholic who physically assaulted his wife and children. Mr MacDonald's mother developed significant mental health issues and was unable to remain with her family.

Mr MacDonald was born prematurely following an assault on his mother when she was seven or eight months pregnant. Both his aunt and brother reported that Mr MacDonald was diagnosed as having an intellectual disability as a child and was placed in OA classes as a result of the disability and not due to any behavioural or emotional problems. Despite Mr MacDonald' self-report that he left school at the age of 15 or 16, Mrs Coleman and Mr MacDonald state that Mr MacDonald left school when he was in year seven or year eight i.e. between the ages of 12 to 14.

IDRS also received information from Mr MacDonald Snr in the form of a short letter to the effect of “he was pretty backward as a child (attached).

Current Level of Need

Following notification that Mr MacDonald was not eligible for ADHC Direct Disability Services, he was referred to Care Connect for Specialist Case Management by the Court Referral of Eligible Defendant's into Treatment (CREDIT) Coordinator at Burwood Local Court. Although Mr MacDonald was accepted by that service and has been receiving case management from that service, the level of service that can be provided to Mr MacDonald is not sufficient to meet his needs and he has again been referred back to the CREDIT program at Burwood Local Court.

Mr MacDonald requires comprehensive and intensive service provision in order to address his wide ranging needs, including:

• Assistance with budgeting his finances and/or undertaking education to learn how to budget his money in an attempt to avoid a financial management order;
• Education to develop independent living skills;
• Drop in support until such time as Mr MacDonald is able to live independently with only case management support;
• Counselling to address childhood trauma and strategies for controlling anger when he comes into contact with the police;
• Counselling to address childhood trauma and strategies for controlling anger when he comes into contact with the police;
• Address his offending behaviour through counselling and other appropriate supports

Mr MacDonald is currently in stable accommodation through Housing NSW, however due to his arrears on the property it is a possibility that this accommodation will not remain stable if these financial difficulties continue.

While there has been some progress in Mr MacDonald's case management, the resources available are not sufficient to meet Mr MacDonald's needs, particularly in light of his repeat offending and current offences before the court. While Mr MacDonald's current matters are not of the most serious category of offending behaviour, the cumulative effect of his criminal history places him at risk of further incarceration.

Mr MacDonald only has one family member that is able to provide any level of support, his brother Mr John MacDonald. However Mr John MacDonald does not live in the Sydney Metropolitan area and can only provide limited support to Mr MacDonald.

IDRS has gone to some considerable length to source documentary evidence about Mr MacDonald's disability. The passage of time has made this a near impossible task. Accordingly, we have resorted to constructing a social history on the basis of information supplied by Mr MacDonald's family members who have contemporaneous memories of his functioning prior to the age of 18 years. This appears to be the only evidence available and clearly points to an intellectual disability prior to the age of 18 years. It is submitted that the information presented is consistent with ADHC eligibility criteria and accordingly request that services be offered to Mr MacDonald.

Given the passage of time and the difficulties in obtaining records, it is submitted that unless ADHC can positively demonstrate that Mr MacDonald does not fall within ADHC eligibility criteria, then Mr MacDonald should, in all the circumstances, be deemed to be eligible.

In the event that this application for services on Mr MacDonald' behalf is to be denied by ADHC, in the interests of procedural fairness and transparency, we request full and detailed reasons for any such denial of services.

We look forward to receiving your positive determination in this matter. In the event of a positive determination of this matter, it is further submitted that it is appropriate that Mr MacDonald be assessed for CJP entry because of his ongoing offending behaviour and time in custody as a matter of urgency. His matters are next before Burwood Local Court on 4 October 2010. Full details are available on request.

Please do not hesitate to contact the writer should you require any further information.

Yours faithfully

Encl.

• Letter of Julie Rowles, dated 11 March 2010;
• Report of Susan Sontag, Psychologist, dated 19 November 2004 and 18 October, 2009; and
• Assessment by Dr Chapelle, dated 2 February 1995