Peter Wilson understands what it’s like to live with a life-changing disability. He also knows about the power of having fun when you have a disability.
Peter conceptualised Determined2 as a way of getting people with disability underwater… and watched in amazement as their enjoyment turned into major health benefits and improvements in their day-to-day lives.
He talks about the power of water and his non-negotiables that put people with disability at the very centre of Determined2.
In 2007, when I was 27 years old, I was involved in a serious workplace accident. Witnesses on the scene thought I was dead. When I arrived at the emergency room and they were prepping me for surgery, they told my wife to say goodbye to me.
When I survived, I was in critical care for about two weeks with only a 20 per cent chance of survival, and I still had people visiting to say goodbye. Our son was five and our daughter was 18 months old, and they came in to say goodbye.
But then, when I didn’t die, they said I wouldn’t walk again, or I’d be permanently disabled. All up it was three months that I couldn’t move, I had to lie flat while my pelvis and spine healed. I transitioned to rehab and then to home with support from the Royal District Nursing Service and my amazing wife. It took about a year to get back to standing up.
Mine is a workplace injury, so I continue to be supported by ReturnToWorkSA (formerly WorkCover) and now claims like mine, which are catastrophic in nature, are managed through a team called Enable. My supports now are very similar to an NDIS participant. But it wasn’t always like it is now.
I thought I’d be able to go back to work, but returning to the motor industry didn’t go that well. By 2015 I was in a severe, depressed state. My biggest challenges were mental. With WorkCover, I had no choice and control, all the power sat with the insurer. I was in a pretty dark place, and that was the turning point for me.
I’d started scuba diving after my accident and it was difficult for me to get involved in, specifically around the medical requirements. But I found it beneficial in a bunch of ways and I wondered if I could use it to help people with injuries like me. There was no one else doing it, which meant I didn’t need a uni degree to do it – I left school in Year 9. Then ReturnToWorkSA was able to support me as I went about setting up Determined2.
We found people injured at work weren’t that interested in accessing the program, but people with disability were. And I’d never met someone with disability – even though I am a person with a disability! We were doing callouts and I rang my Occupational Therapist (OT), who connected me with people. I asked for someone who had significant disabilities, someone who would challenge our program, the doctors and our design, because if we can make it work for them, we can make it work for anyone.
And that’s how we met Ben. The same day I’d called my OT, he’d rolled up to one of the staff in the Hampstead Rehabilitation Centre and said: “Do you know anyone who could help get me back in the water?”.
Ben changed my whole world. I’d lived in this bubble of workers’ compensation, and I felt so sorry for myself. Ben was this kid who was 20 years old, a quadriplegic, who would go on to live in his own home, no partner, no kids… and he was so happy. So bright. His footy club had done fundraising for him to get a wheelchair. This was 2015 – he inspired me to look at my own situation.
It took us three months to get there, to get the insurance in place and the doctors in place. Initially, no pool would let us in, but we found one that would let us use it when everyone else had gone home.
The night we first tried what would become immersion therapy was Ben’s 21st birthday. When Ben got out, he was glowing. There were 20 people in the room, all crying. I said: “This is what I’ve got to do.”. It’s why I survived.
And from there we got to work, and then very quickly won the National Disability Award from the Commonwealth Government. One second this was a scribble in a book, then six months later we were in Canberra with the Prime Minister at an awards night… and we won. That opened the door and people started enquiring – people with more challenges than Ben.
It will always be about having fun. I don’t believe therapy has to be boring or vanilla!
In the beginning we had people around us, including doctors with underwater medicine specialities overseeing the medical part of what we were doing. The people in the pool were dive instructors or professional divers. Everyone was safe. Everyone was having fun. Participants were talking about a sense of freedom and confidence. And then people started getting better. More mobility, increased flexibility, happier and healthier – all things that any health service should be doing.
That’s when we first asked the question: “Could this actually be a therapy?”.
One of our team members came up with the name immersion therapy. He was the second person to go in the pool, Paralympic gold medallist Tim Maloney OAM. He’s now on our advisory committee.
Anyway, we were always careful not to position ourselves as therapists – while we had underwater medicine doctors involved, we weren’t therapists.
We had to investigate our hunch, whether immersion therapy could actually be a therapy. We were pretty sure it was – that’s what our participants were telling us.
Of course, research needs funding dollars, so along with ReturnToWorkSA, we also had the Lifetime Support Authority (LSA) as one of the first funding bodies to endorse and fund our service. The LSA supports people who’ve been seriously injured in road accidents.
Through the LSA we applied for a research grant and our doctors connected the University of South Australia (UniSA) and an exercise physiologist, Karlee, looking to do her Masters by research and she investigated: “Could this be therapy?”. You can find her thesis here.
Parallel to that, there was a qualitative study, which included about 60 participants and their support workers and families. I really liked the idea of this research because I always believed what was missing in my recovery was my voice, and so hearing from the participants about what they thought immersion therapy was really gave the whole picture of what was going on underwater.
The qualitative research was really cool, because the researchers thought the biggest benefit of immersion therapy would be the physically obvious – the ability to move underwater, for people who find it difficult to move on land. But the largest consistent theme was an improvement in their mental health and self confidence. Their physical improvement was, in most cases, a pleasant byproduct of doing something they enjoyed.
Now, as part of our seven-year relationship with UniSA, we’re entering the next phase of research with clinical trials. We continue to put forward Honours research projects each year and we currently have five underway, which is awesome because we get to include students in our work and, in return, they bring fresh eyes and ideas to the table to make what we do even better!
Where we’ve evolved to is incredible, and I am very proud of where the service is today.
Once we realised the potential, we knew that we couldn’t deliver it any more – as divers. Instead, we recruited allied health professionals with no scuba experience, and trained them under the expertise of diving doctors, along with the model and standards we had developed during the previous four years to deliver the service.
We had to check – did therapists suck the psychosocial fun out of the activity and turn it clinical? I honestly thought they would, it was one of my greatest fears taking this step.
But we found no, not only could you retain the fun, but we could dramatically increase the physical outputs for participants, now that the people delivering the program were allied health professionals who understood how to maximise those physical benefits.
The mounting evidence is pointing towards immersion therapy being a truly evidenced-based biopsychosocial therapy that nearly anyone can do. It can support your body, your mind, and how you see yourself – it's truly holistic. It doesn’t matter if you live with a profound disability or a back injury, you can do immersion therapy.
We’re all equal under the surface of the water.
People that have restrictions with mobility talk about how under the water they are free. There’s no worry about falling over because the whole body is supported – unlike hydrotherapy, which is partial support. With immersion therapy you have an air supply, so you don’t need to know how to swim.
People with communication challenges find under the water it’s just calm. People with Tourette’s and tics find they disappear under the water. People with chronic pain are pain-free under the water.
Immersion therapy is like the fourth dimension. It’s a totally new environment.
The first is people think it’s just scuba diving in a pool – that’s false. We use some common scuba equipment, as well as modified equipment we’ve developed with our doctors, so people have access to air while being fully immersed.
The other misconception is people think they couldn’t do it, it’s beyond their capabilities, you need to be wild and adventurous. Not true. We have people who need support 24/7 and we can support them in the water. We have people who are petrified of water – including a man who nearly drowned when he was 10 and had to be resuscitated, so he never went in the water again. He acquired a disability and, after a long time, he tried immersion therapy and now he’s gone to snorkelling independently and he’s going to Fiji.
Our participants include children with autism, right through to elderly people post-stroke, a broad spectrum of people.
We had to build a business model that was trainable, scalable, and repeatable, assessed to be appropriate and backed by research. We know the service is life changing and we wanted the most efficient way to get it to people.
Since 2015 we have had one simple vision – immersion therapy for all – and that vision is about to become a reality.
About three years ago we started conversations with potential partners and their first question was always about the return on investment and commercial terms. These conversations didn’t last long.
Dr Jeff Walkley from Belgravia Leisure had a different question: “How does immersion therapy help people?”. We know they’ll be an organisation that can rise to the occasion and meet our values, and they have the resources and capability to deliver. We are excited to see where they can take immersion therapy.
Put lived experience at the centre. Make sure you have people with disability in your company. There’s the great saying ‘nothing about us without us’. That’s not about getting a bunch of people with disability, taking their advice and not paying them, because that’s not co-design. Include people with disability, not just in the advice, but in the company in key roles.
Make sure you are being safe. Make sure you have insurance for what you are doing. Make sure you have the qualifications – or bring qualified people in. Doing something like this takes a lot of resources and commitment, so be ready for the long haul. It takes hard work and a bit of luck, and I think we have had the right combination of both.
If you are a person with disability, look into supports like micro-enterprise, there are lots of new and excellent way to support people with lived experience to set up and run their own gig. Don’t stress about the things you might not be good at or find hard to do, it is about having the right people around you to bring your vision and passion to life.
Ask for the person’s qualifications, registration, and insurance – then look at the testimony. Do it in that order. “How long have you been doing this?”. “What are your qualifications?”. “What is your insurance?”. “How have you helped other people?”. If you are happy with the answers, go and have a look and don’t be afraid to go slowly.
We have some people in our service who take nine sessions before they get in the water for the first time. It’s about your choice and your control.
Yes, I’d encourage you to push yourself, but you should feel the provider has the flexibility to hear you, see you, understand you, and know your limits and not take you beyond them.
We can adapt our service to meet almost any goal. You’re the expert and we’ll work it out with you. If you have funding for Improved Daily Living, or any allied health, you can choose to do our service. We are also registered with ReturnToWorkSA, LSA, and the Department of Veterans’ Affairs. We’ve even had people access our services under their aged care package, and we also support people without funding through a pro bono program.
We also provide land-based exercise physiology and hydrotherapy programs for people who feel going underwater might be a step too far out of their comfort zone. And we are based in a community aquatic centre, so it can be a really easy transition to mainstream programs for our participants looking to make that transition.
For immersion therapy, the process is booking a meet and greet online, calling, or shooting us an email – you can leave your bathers at home for this! Come and have a chat and a look, then get checked over by one of our doctors. There are a few medical exclusions, but not many. And if you’re safe and happy, we can start. Anyone can take that journey with us.
I can’t choose, there are too many. We’ve delivered 10,000 sessions of immersion therapy, and in partnership with Belgravia Leisure, we’re going to deliver 36,000 sessions a year in five years.
The thing I love most, hands down, about Determined2 is our sense of community. It’s my most favourite, no matter what else is going on.
We’ve been so fortunate to have been supported by a huge community of people – too many to name – but our staff, the students who do placements with us, our team of expert doctors, the research team at UniSA, and my own family, my personal mentors, coaches and supporters. And, of course, the hundreds of participants who have gone underwater with us.
I feel truly blessed to be part of something this special.
Have you thought about how you can best support the social and emotional wellbeing of children with disability?
National not for profit organisation, Emerging Minds, has a suite of free online courses and resources designed to help foster positive mental health for children aged up to 12 years.
Developed in partnership with children with disability and their families, the resources are perfect for anyone who works with children, including disability support workers, allied health professionals and general practitioners.
Emerging Minds’ Practice Development Manager, Dr Daniel Moss, said it was vital that mental health support was considered as part of a holistic approach to children’s care.
“Studies show that from the age of three years, a child with intellectual disability is already significantly more likely to develop mental health difficulties. But with the right support, professionals can prevent these challenges from developing and continuing into adulthood,” said Dr Moss.
“As professionals, we need to keep in mind the different factors that can influence the mental health and wellbeing of children with disability. Incorporating child-centred, family-centred and communication-focused skills and interventions into our everyday practice will help us to better support both children and families.”
Learn more about Emerging Minds’ suite of disability resources and sign up for free.
Understanding clients is key to providing better service. That’s why My Plan Manager recently interviewed Emma, Managing Director of One Tribe Australia, to find out what questions clients are asking – and why.
Fifteen years after establishing One Tribe Australia – a multidisciplinary provider offering everything from support coordination and social work to disability support work and coaching – and several years spent working as a support coordinator herself, Emma tells us these are the Frequently Asked Questions (FAQs) she most often hears.
Clients want to know that their support coordinator has the right skills and experience to provide a great service. This is important because there are a wide variety of areas that a support coordinator can specialise in.
Whenever a client asks this question I:
If I feel like our team isn’t the right fit for a client, I will always point them towards a better match – like a support coordinator who has specialist skills in a specific physical disability such as a spinal cord injury or cerebral palsy. I will never take work that doesn’t fit my team’s experience, because it is important that the client is able to access supports from people who are highly skilled and knowledgeable about their unique situation. Our role is to assist people to maximise their plan so they can live their best life and to do this well, we need to have a strong understanding of the barriers they may face so we can identify creative ways to support them to achieve their goals. This additional knowledge only comes from experience.
Everyone’s needs evolve over time, especially when it comes to allied health services. Clients want to know that they can change supports if and when they need to.
Whenever a client asks this question, the answer is ‘Yes, of course’. We look at their goals and the funds in their plan, and then we work with our client to find another provider to use those funds up. This shows the National Disability Insurance Agency that the client’s level of funding is appropriate, and they’ll have less chance of losing it at their next plan review.
This is a common concern, because a lot of clients depend on their funding to do everyday tasks – like getting out of bed, preparing meals and getting to and from appointments.
Whenever a client asks this question, my team of support coordinators and I reassure them that we will gather all the evidence and data they need to support the continuation of their funding, or to establish the case for a funding increase – depending on their circumstances. I may also talk about my experience in allied health to reassure them that I won’t miss a thing during the process.
If a client has a funding change, increase or decrease, we will talk about the next steps – whether that’s helping them to review their National Disability Insurance Scheme (NDIS) plan or lodge a change of circumstance to get their plan adjusted. We’ll then look at what’s required to do that – whether it’s more assessments, more support letters, or better summaries from allied health providers to demonstrate their needs.
The reality is, you can provide all the evidence in the world, and the NDIS may still come back and say they’re not going to fund a particular support. You have to be persistent and not just accept it, but say ‘Ok, what else do we need to get this over the line?’.
This is a common concern because a lot of clients depend on their funding and don’t want to see it dry up. Whenever a client asks this question, we look at:
Sometimes, it can be challenging to get this information from the NDIS, which is where My Plan Manager’s client portal is really useful. It shows a client’s budget in a snapshot to easily see what funding they have, where they can spend it, and how long it will last. A lot of plan managers don’t have this technology, which means we have to fill out consent forms for the NDIS (forms we often have to chase up and resend) in order to access the information we need to review our clients’ funding. Having great technology that lets you access client information quickly and conveniently is incredibly important.
Clients want help working out what they can do with the funding they have. Within a Core Supports budget, there are certain services or items that a client can purchase, like support work, assistive technology, cleaning, or gardening. Unlike a Capacity Building Supports budget, a Core Supports budget can be used flexibly, meaning a client isn’t locked into spending a set amount of funding on each service or item.
Whenever a client asks this question, we’ll find out what supports they want to access, and what bucket of funding these would come out of, and we then support them to choose which options they want. For instance, a client may choose to engage a support worker for six hours a week or they may want a support worker for four hours a week, plus a cleaner for two hours, and with the right planning and budgeting both options are achievable.
We plug this information into spreadsheets that pop out the cost of each support across the duration of their plan. This means we can work with our clients to plan for the future and give them greater choice and control, which is really empowering.
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Support coordination is a capacity building support that assists participants to:
Unlike local area coordination, a free-of-charge service, support coordination is NDIS funded, and not every participant has the relevant funding included in their plan.
My Plan Manager recently interviewed Emma, Managing Director of One Tribe Australia, a multidisciplinary provider offering everything from support coordination to social work, disability support work to complex coaching. We asked Emma to walk us through a day in the life of a support coordinator.
Emma: A support coordinator assists participants with NDIS funding to help them implement their plans and build their capacity. They help people set goals and connect them to the right service providers to achieve them.
They will check that people are receiving quality services and have continuity of care and help them prepare for plan reviews by gathering evidence to show what their needs are.
Support coordinators often work with people with complex disabilities who may experience crisis situations. A support coordinator can help them through a crisis and check they have the supports they need to be able to do that.
Emma: My background is in vocational rehabilitation - I used to help people get back to work after an injury. When I had my own work injury and was unable to work, I decided to pivot my career and become a dog trainer.
A man I knew whose son has autism and obsessive compulsive disorder asked me to train his dog, and when I got there, I saw they had absolutely no support. I'd never worked in disability before, but I did have the right qualifications and transferable skills, so I offered to become his support worker. I was able to help him do things he’d never done before, like walk on a treadmill. It sounds very simple, but it took months and a lot of courage to get to that point.
We worked together for 18 months, and during that time I started doing support coordination for Mind Australia. After a six month hiatus to finish my Masters degree in social work, they asked me to be his support coordinator too. That’s a nutshell version of how it started.
Emma: A Local Area Coordinator (LAC) is a starting point for people who want to request access to the NDIS. They help people to gather information that the NDIS will turn into a plan. A LAC can then help a participant to understand and implement their plan - however, if they require extra support, that’s when a participant may turn to a support coordinator.
A LAC is free, whereas a support coordinator is funded in a plan and has a stronger focus on capacity building.
Emma: The funding provided in each plan is based on the planner’s assessment of what is reasonable and necessary for a participant to pursue their goals. When making this decision, the planner will also consider informal supports, such as family, friends and other relevant services. If there are factors that hinder a participant from engaging with support services, such as limited informal supports, a mental health condition or difficulties with cognitive processing etc, the planner can provide additional funding for a support coordinator.
A really good planner will automatically identify this need when the plan is being developed, but sometimes participants need to request this service to ensure they receive the most appropriate supports. It is important to have a good understanding of the available options and gather as much supporting evidence as possible prior to commencing the planning process.
Emma: A typical day could look like making phone calls, sending emails and meeting service providers to discuss a participant’s plan, their supports and capacity. It might involve sourcing providers to connect participants to, writing letters and reports to demonstrate a participant’s needs for a plan review, home visits to run through a participant's plan goals and helping them to develop strategies to achieve them, or checking service agreements to make sure participants can afford the services they want to access.
Emma: It depends on the participant and their plan. It’s really important not to burn through a participant’s NDIS funds for the sake of it, so if we can provide a good service and achieve their goals without having to see them regularly in person, we are happy to do that. During a first meeting with a participant, we will look at what’s covered in their plan in detail and ask them how they would like to work with us.
Emma: Yes. If a participant wants help to find a provider, we may give them a shortlist of three to 10 options, depending on what services are available. We are constantly looking for new service providers to give clients greater choice and control with their NDIS funds.
Emma: A lot of referrals that come through to us are for participants who already have plan management – however, it depends on how new their plan is. If it's an older plan, they may already have a plan manager and we will talk with them about that to make sure they are getting the support they need. If they want to switch, then we will assist them to find different options and explain the pros and cons of each provider.
Every NDIS participant has the right to exercise choice and control over the supports, services and providers in their life – and if they aren’t working for you, you have every right to change. The great news is, you can switch to My Plan Manager at any time, at no out-of-pocket cost to you. Click here to find out more.
Emma: You can work super hard and gather every piece of evidence, and a plan may still come back with less funding than expected. There may be a lot of to-ing and fro-ing with the NDIS to get a plan reviewed and supporting the participant to demonstrate what their needs are. This is where it’s really crucial for a participant to have experience in their corner.
Emma: Yes, if it’s within 90 days of getting a decision, we can help them to seek a review. If it’s after 90 days, we’d look at a change of circumstances, which is a different route, but a similar process.
Often people come to us with a plan that a LAC has helped them put together and the first thing we do is check it covers what they need. If it doesn’t, we may need to help them gather additional evidence, like reports from allied health professionals, that will assist them to have it reviewed or changed.
Emma: Someone close to me had a significant mental health condition, and I saw the impacts of that during my childhood - but at the time, there was little understanding or support for people facing mental health challenges. It was brushed under the carpet and nobody spoke about it as it was such a taboo subject. Unfortunately, this meant that my loved one didn’t get the help they needed and they lived an unhappy life until they passed away. If adequate support had been available, this beautiful and talented person, who had so much potential, may still be with us. Instead, they were incredibly let down by the system.
I therefore have a very strong sense of social justice and feel that everyone should get a fair go. I find it frustrating when I see people constantly hitting barriers that stop them from doing, often simple things. I will go above and beyond to support someone to achieve a better quality of life because I know exactly what they are going through and I seek team members who are on the same page. Everyone in our team have lived experience but they also have really solid case management and clinical skills, so not only can they genuinely empathise with people they support, but they can also take action and help put strategies in place to facilitate real change.
The motivation that underpins everything is found in the little wins - those moments when something we have done has made a tangible difference to someone. I may not have been able to help my loved one, but if I can help other people, then their experiences haven’t been in vain.
For more information visit onetribeaustralia.com.au.
We know that success starts with small daily habits. That's why a therapy provider called Everyday Independence is helping its clients to build their confidence, achieve their goals and improve their lives through a support called a ‘habit coach’.
A habit coach is an allied health assistant and part of a client’s therapy team. They work with a client and their supports to cement new skills they've learned in their therapy by implementing daily habits and routines.
This in turn helps them reach their daily and longer terms goals, live with greater independence, and participate more in everyday life.
Nathan Nute from Everyday Independence said this evidence-based approach can help clients reach their goals faster compared to working with a single therapist and make a real difference to the lives of people living with a disability.
“A therapist will set up a client’s plan, but then the therapist can recommend that the client engages a habit coach, or the client can request the services of a habit coach {themselves} to help get them into a routine,” he said.
The habit coach will follow the action plan with the participant to practice the new skills they’ve learned in their therapy session.”
“That could look like a child that needs to get into a routine before school to make sure they get to class on time, with everything they need to enjoy a normal day.
“A habit coach can instil that routine to empower them to get on with their day, get out in their community and live their everyday life.
“Or, a habit coach could come in after school to setup homework and bed-time routines to make sure they’re ready for school the next day and getting plenty of sleep. That could happen once, twice or several times a week – it really depends on their National Disability Insurance Scheme (NDIS) plan.”
Using a habit coach can also conserve plan spend to maximise a client’s NDIS funding.
"This ensures that therapists are working within their scope of practice so a client isn’t paying a higher rate for an occupational therapist to support them with routine building activities that can be more cost effectively supported by a habit coach,” said Nathan
Nathan said habit coaches are suited to clients that would benefit from developing daily routines and activities. For example a child or adult may benefit from an exercise routine, morning/evening routine and routines that help them get to school or work.
He said he sees clients achieve their goals at an accelerated rate when they have the extra support of a habit coach, however even if a habit coach is a good fit, it’s ultimately up to the client whether they take up this service.
"We put our clients, their families and support networks at the centre of everything we do,” said Nathan.
“{Their therapy} is built on their capacity and what they are willing to do to reach it.”
Habit coaches are an innovative role that are unique to Everyday Independence, however the concept of implementing habits and routines to ingrain new skills learned in therapy is growing across the disability sector.
Clients can access habit coach services through Everyday Independence using the ‘Improved Daily Living Skills’ budget category. An Everyday Independence therapist can build habit coaching in as part of a therapy plan.
Alternatively, you can ask your providers if they offer any kind of habit coaching as part of their services to cement new skills you or someone you care for has learnt in therapy. They may have Allied Health Assistants available to work on your habits with you, which might be more cost effective than having an occupational therapist support you with routine building.
If you don’t have an ‘Improved Daily Living Skills’ budget category included in your NDIS plan to access a support like this, you may want to request it in your next plan review.
My Plan Manager can help clients find information about different providers to make their own decisions that we explain here.
