Full Community Inclusion

and a Fully Inclusive Community:

Why Rehabilitation Counselling has a valuable role to play
in supporting homelessness resolution in Australia
Erin M Fearn‑Smith, Faculty of Health Sciences, The University of Sydney and NSW SHS Projects,
Mission Australia and Dr Evelyne Tadros, State Leader, NSW Metro, Mission Australia
Published earlier this year, the 2016 Rehabilitation Counselling is Although in Australia the profession
Census of Population and Housing an allied health and human has been increasingly concentrated
demonstrated a 20.4 per cent increase services profession, which is in the insurance‑based return
in rough sleeping and a 13.7 per cent developing a regional identity to work industry, a case can be
overall increase in population around Community‑Based made for utilising Rehabilitation
homelessness in Australia, compared Rehabilitation (CBR),6 supporting Counselling in homelessness
to 2011 Census data.1 Recently, people to achieve social resolution, as there is alignment
Specialist Homelessness Services inclusion, and communities between the World Health
(SHS) in New South Wales (NSW) to be inclusive. Practitioners Organisation’s (WHO) model of CBR
have responded to this growing support people experiencing and SHS service delivery practice,
problem in a number of ways: disability, illness, injury and and between the core competencies
• An increased focus on early social disadvantage to identify of Rehabilitation Counsellors and
intervention and Housing First strengths and build capacity.7 SHS workforce requirements. The
approaches;2 traditional vocational
• The establishment rehabilitation focus
of an Industry in rehabilitation
Partnership counselling also
project, offers value to
‘SHS Sector SHS, both through
Development’, enhancing program
to align service performance in a
quality, resource policy environment
access and with increasing
workforce focus on education
development and employment
across SHS;3 social inclusion
• A redesign of measures,8, 9 and
the future NSW through the potential
Department for facilitating
of Family and meaningful poverty
Community reduction.
Services Outcomes
Measurement Community
framework;4 Based
• The development Rehabilitation:
of a community In Rehabilitation
and industry Counselling
housing campaign, and in SHS
‘Everybody’s SHS can be
Home’.5 mapped to the
WHO model of
In addition to these CBR. Designed
focused strategies, initially to enhance
however, there is an quality of life
argument for bringing for people with
a well‑aligned disabilities through
profession into increasing access
the pursuit to end to rehabilitation
homelessness services,
— Rehabilitation CBR describes
Counselling. Artwork by Rodney Crombie work that seeks to

47
 WORLD HEALTH ORGANISATION CBR MATRIX

Health Education Livelihood Social Empowerment

Skills Personal Advocacy and

Promotion Early childhood development assistance communication

Relationships,
marriage and Community
Prevention Primary Self‑employment
family mobilisation

Secondary Wage Political

Medical care Culture and arts
and higher employment participation

Recreation,
Rehabilitation Non‑formal Financial services Self‑help groups
leisure and sports

Disabled
Assistive devices Lifelong learning Social protection Justice people’s
organisations

Figure 1: CBR Matrix (WHO, 2010) (21)

promote social inclusion, fight HIV‑AIDS (1.5 per cent), requires a complex skillset

disadvantage and disrupt
the cycle of poverty, and is
approached through individuals,
their families and communities,
and health, education,
vocational, social and other
government and non‑government
community services.10
People experiencing homelessness
experience significant poverty and
disadvantage impacting health,
education and employment.11, 12
The Australian Institute for Health
and Welfare (AIHW) reported that of
the people who were experiencing
homelessness or at risk of becoming
or returning to homelessness who
were supported by SHS during
2016–17,13 10 per cent had a core
activity limitation (self‑care, mobility
or communication), 27 per cent had
a mental health issue, and 9 per cent
had problems with substance use.
Other sources, such as the VI‑SPDAT
interview data generated across
Australian cities from 2010–2017,14
found evidence of potentially much
higher incidence of mental illness
and disability, as well as high rates
of significant medical conditions,
such as brain injury (29.2 per cent),
cancer (7.6 per cent),
Hepatitis C (21.9 per cent),
heart disease (18.7 per cent),
liver disease (15.8 per cent),
kidney disease (6.9 per cent),
emphysema (10.2 per cent),
and asthma (32.9 per cent),
amongst others.
Rehabilitation Counsellors also
work in applied CBR. Along with
the International Classification of
Functioning, Disability and Health
(ICF),15 and the UN Convention
on the Rights of Persons with
Disabilities (UNCRPD),16 the WHO
model of CBR,17 has had a growing
influence on the evolving local
tertiary Rehabilitation Counselling
curriculum at the University of
Sydney.18, 19 Representing this model,
the CBR Matrix (figure 1, overleaf)
comprises five key components,
‘Health’, ‘Education’, ‘Livelihood’,
‘Social’, and ‘Empowerment’, each
containing five related elements.
The WHO CBR model not only
provides a solid platform from
which to approach the drivers
of homelessness, but also maps
directly to the life domains that
inform the development of case
management goals and service
delivery in local SHS practice.20
Applying Rehabilitation
Counselling
Competencies to SHS
Challenging drivers of
homelessness and supporting
people who have experienced
trauma, stigma and disadvantage
involving personal, social and
political sensitivity, assessment,
evaluation and planning, adaptive
communication, interpersonal
and multi‑sectoral collaboration,
knowledge of resource availability
and access pathways, compassion,
resilience, and perseverance.
The Rehabilitation Counselling
Association of Australasia’s (RCAA)
Rehabilitation Core Knowledge and
Competencies 22 emerged from
practitioner research conducted
in Australia in 2010,23 and not
only reflects the competencies of
tertiary‑qualified Rehabilitation
Counsellors and accreditation
requirements of rehabilitation
education providers, but also
closely aligns with workforce
requirements for SHS 24 and
provides a strong foundation for
supporting vulnerable people
towards sustainable outcomes.
The Core Competencies are closely
aligned with organisational practices
in SHS, including frameworks such
as Mission Australia’s Partnership
Framework,25 Recovery Oriented
Practice Framework,26 and National
Case Management Approach.27
Similarly, a review of a group of SHS
Position Descriptions 28 (excluding
explicit requirements for periods of
prior experience and certifications)
found all key tasks, competencies,

48
WHS requirements and purpose
and values to map against the
Competencies of Rehabilitation
Counselling. The workplace‑specific
Rehabilitation Counselling
competencies also offer a
currently‑untapped, additional
opportunity to support
people towards greater
community inclusion.
Rehabilitation Counselling:
Reducing Poverty and
Enhancing Social Inclusion
The traditional vocational outcomes
orientation of Rehabilitation
Counsellors applied to SHS
program delivery aligns well with
the 2017 National Homelessness
Strategy 29 towards achieving
sustainable housing outcomes. Of
the 288,273 people supported by
SHS during 2016–17,30 62 per cent
were experiencing housing
affordability stress, demonstrating
the relationship between
inadequate access to financial
resources and homelessness.
Across Greater Sydney in June
2018, the median costs of bedsitter
accommodation was $330 to $403
per week.31 For single people
who are unemployed and in
receipt of Centrelink Newstart
payments of just $302.30 weekly,
including energy supplement,32
securing appropriate housing is a
challenge. With the 2018 Anglicare
Rental Affordability Snapshot 33
finding only three affordable
and appropriate properties for a
single person receiving Newstart
in March 2018, homelessness for
this group becomes a significant
risk, which is reflected in the
2016–17 AIHW SHS data,34 with
48 per cent of the client population
reported as unemployed.
Alongside advocating for
improved payment rates and
housing affordability, including
supporting campaigns ‘Raise the
Rate’ 35 and ‘Everybody’s Home’,36
improving employment outcomes
amongst people experiencing
or at risk of homelessness would
enhance economic capacity in this
group, and offer greater protection
from housing affordability stress.
In addition to meaningful social
impact, improving vocational
participation would also add value
to contract delivery performance.
Partnerships offer exceptional
strength in the community
services sector, and have paved
the way for enhanced responses
to homelessness locally both in
practice and in collective social
advocacy. In SHS, Rehabilitation
Counselling could offer a
new ally, and potential tertiary
pathway, in the pursuit to end
homelessness and achieve
full community inclusion.
Endnotes
1. Australian Bureau of Statistics 2018, Census
reveals a rise in the rate of homelessness
in Australia. 2049.0 — Census of
Population and Housing: Estimating
Homelessness, 2016. http://www.abs.gov.
au/ausstats/abs@.nsf/lookup/2049.0Media
per cent20Release12016
2. NSW Department of Family and
Community Services (FACS) 2014,
Specialist Homelessness Services —
Practice Guidelines. pp.2, 31. http://
www.housing.nsw.gov.au/__data/
assets/pdf_file/0009/327996/
GHSHPracticeGuidelines.pdf
3. SHS Development Project, The Industry
Partnership. https://www.shssectordev.
org.au/about/industry-partnership
4. NSW Department of Family and Community
Services, 2018, Webinar — Strategic
updates for the SHS Sector, 22 May 2018.
5. Everybody’s Home, 2018, Everybody’s
Home: Our Campaign. http://
everybodyshome.com.au/our-campaign/
6. Millington, M., 2017, University of
Sydney — New Curriculum: Evidence,
Excellence, and Partnership. International
Partnership in Community Based
Rehabilitation Education. Asia Pacific
Rehabilitation Counselling Community of
Practice Workshop, 30 October 2017.
7. Rehabilitation Counselling Association
of Australasia (RCAA), ND, Accreditation
Manual for Rehabilitation Counselling
Education Programs, pp.6–16. https://
www.rcaa.org.au/assets/frontend/pages/
accreditaion per cent20manual/RCAA per
cent20Accreditation per cent20Manual.pdf
8. FACS 2014, op cit. p. iv.
9. Homelessness Australia 2017, A National
Homelessness Strategy: why we need
it — Strengthening the service response
to people who are homeless or at risk
of homelessness, April 2017. https://
www.homelessnessaustralia.org.au/
sites/homelessnessaus/files/2017-10/
HA per cent20Position per cent20Paper
per cent20- per cent20FINAL_0.pdf
10. World Health Organisation (WHO) 2010,
Community-based rehabilitation: CBR
guidelines. WHO Press, Geneva. https://
www.ncbi.nlm.nih.gov/books/NBK310940/
11. Australian Institute of Health and Welfare
(AIHW) 2018, Specialist Homelessness
Services Annual Report 2016–17. https://
www.aihw.gov.au/reports/homelessness-
services/specialist-homelessness-
services-2016-17/contents/contents
12. Flatau P, Tyson K, Callis Z., Seivwright
A, Box E, Rouhani L, Ng S, Lester
N and Firth D 2018, The State of
Homelessness in Australia’s Cities: A
Health and Social Cost Too High. http://
www.csi.edu.au/media/STATE_OF_
HOMELESSNESS_REPORT_FINAL.pdf
13. AIHW 2018, op cit.
14. Flatau P et al 2018, op cit.
15. The World Health Organisation 2001,
International Classification of Functioning,
Disability and Health (ICF), Geneva. http://
www.who.int/classifications/icf/en/
16. United Nations 2006, Convention on
the Rights of Persons with Disabilities.
NY: United Nations. www​.un.org/esa/
socdev​/enable/rights/convtexte.htm
17. WHO 2010, op cit.
18. Millington M 2017, op cit.
19. The University of Sydney 2018, What You’ll
Study, Master of Rehabilitation Counselling.
https://sydney.edu.au/courses/courses/pc/
master-of-rehabilitation-counselling.html
20. Mission Australia 2018, Mission
Australia Client Service Information
Management System (MACSIMS).
21. World Health Organisation 2010, CBR
Matrix, Community-based rehabilitation:
CBR guidelines. http://www.who.int/
disabilities/cbr/cbr_matrix_11.10.pdf?ua=1
22. RCAA, ND, op cit.
23. Matthews L R, Buys N, Randall C,
Biggs H and Hazelwood Z 2010,
Evolution of vocational rehabilitation
competencies in Australia.
International Journal of Rehabilitation
Research, vol. 33, pp. 124–133.
24. Mission Australia 2018, Selection
of NSW SHS Position Descriptions.
http://careers.missionaustralia.
com.au/caw/en/filter/?search-
keyword=&category=community
per cent20services&job-mail-
subscribe-privacy=agree
25. Mission Australia 2016,
Partnership Framework.
26. Mission Australia 2016, Recovery
Oriented Practice Framework.
27. Mission Australia 2017, National
Case Management Approach.
28. Mission Australia 2018, op cit.
29. Homelessness Australia 2017, op cit.
30. AIHW 2018, op cit.
31. Family and Community Services (FACS),
2018, Issue 124 (2018) — Rent Tables
June Quarter 2018. https://www.facs.
nsw.gov.au/download?file=631795
32. Department of Human Services 2018,
Centrelink: Payment and Service Finder.
https://www.centrelink.gov.au/custsite_pfe/
pymtfinderest/pfResultsPage.jsf?prg_id
=2ded77cc429943d3886f0ff0614076
b3&wec-appid=pymtfinderest&page
=1A7D146D3FAE4D7AAF031036D7
8DBF15&wec-locale=en_US#stay
33. Anglicare Australia 2018, 2018 Rental
Affordability Snapshot. http://www.
anglicare.asn.au/docs/default-source/
default-document-library/final---rental-
affordability-snapshotb811d9309d696
2baacc1ff0000899bca.pdf?sfvrsn=4
34. AIHW 2018, op cit.
35. Australian Council of Social Service
(ACOSS) 2018, Raise the Rate. https://
www.acoss.org.au/raisetherate/
36. Everybody’s Home, 2018, op cit.
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