OFFICIAL DOCUMENT 4

Justification Workbook

The contents of this document are OFFICIAL.

This document contains various activities for new starters to understand and practice writing justifications. New starters should receive guidance from their team leaders to review completed activities.

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Contents

Justification Workbook 1

Best Practice Justifications 4 Example 1 — Capacity Building Supports: CB Daily Activity 4 Example 2 — Capacity Building Supports: CB Relationships 4 Example 3 — Core Supports: Transport 5 Example 4 — Core Supports: Social Community & Civic Participation 5 Activity 1: Justification breakdown 8 Activity 2: Justification breakdown 9 Activity 3: Justification breakdown and building 10 Activity 4: Justification breakdown and building 10

Declined justifications 11 Declined supports example 1 11 Declined supports example 2 11 Declined supports example 3 12 Declined supports example 4 12 Declined supports example 5 12 Declined supports example 6 13 Declined supports example 7 13 Declined supports example 8 13 Declined supports example 9 14 Declined supports example 10 14 Declined supports example 11 15 Declined supports example 12 15 Declined supports example 13 15 Declined supports activity 1: Mobile phone 17 Declined supports activity 2: Social group 17 Declined supports activity 3: 1:1 Support worker 17 Declined supports activity 4: Pre-prepared meals 18

Declined supports activity 5: Vehicle purchase

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Declined supports activity 6: Therapy supports 19

Scenario 1 – Joseph 19

NDIS Assistive Technology Letter of Support 19 Discuss: 24 Activity: 24

Scenario 2 – Andrew 24

NDIS Functional Capacity Assessment (FCA) Report 24 Activity: 34

Scenario 3 – James 34

NDIS Specialist Disability Accommodation (SDA) Report 34 Activity: 55

Scenario 4 – Sam 55

NDIS Supported Independent Living (SIL) Report 55 Discuss: 69 Activity: 69

Version Control 70

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Best Practice Justifications

Why do we record justifications?

The National Disability Insurance Agency (NDIA) requires you to complete reasons for your decision. Legislation amendments which came into place in 2024, requires the Agency to give a reason when making a reviewable decision.

We need to make sure we are making good, evidence-based decisions. Being clear about the reasons for our decisions:

• Reflects the principles outlined in the Service charter | NDIS, particularly the principle of transparency.
• Delivers the ‘communicating with us’ promises in the NDIS Participant Service Improvement Plan 2020-21.
• Is a requirement of the legislation.

Best practice justifications

A streamlined justification should clearly explain the rationale for the funded supports, including what is being funded, the reasons for the funding decision, supporting evidence, and any key information that the reader needs to understand the plan. All information should be presented concisely and clearly.

A best practice justification will have the following information:

Why: does the participant require funding for the support? What barrier, resulting from their disability, necessitates the direct need for this support? You could include information here about:

• What disabilities the participant has met access for.
• What is the plan context eg: Is this a s48/s47a, first plan, scheduled reassessment?
• How the support relates to the disability that the participant has met access for.

What: what is being funded? What are the details of the funded support? how did you calculate the amount you have funded? You could include information here about:

• the details of the funded support ie what is being funded?
• Details about how you calculated the amount that you have funded?

Critical information: are there any critical pieces within the decision-making process that would be relevant to explain to the participant and useful for the next planner to know? You could include information here about:

• Changes to previous plan including the:
• removal of…
• inclusion of…
• increase of…
• decrease of…

Where is the Evidence: Where is the location of the evidence/ guidance considered?

• For example: OT report xxx by xx dated xxx located in PACE.

Example 1 – Stated Budget: Improved Daily Living Skills

Lucy has a primary disability of bipolar disorder and a secondary disability of vision impairment. Lucy wants to pursue her goal to do more things for herself at home. Her first step in working towards this goal is to be able to prepare a basic meal for her family.

Lucy has difficulty reading a recipe, following instructions, and using kitchen appliances. She currently relies on her parents to complete all meal preparation tasks. As per professional recommendations, funding is included (15 hours) for Lucy to work with an occupational therapist to assess her capacity to complete household tasks independently. The therapist can recommend capacity building strategies in a skill development plan and recommend Assistive Technology (AT) to help Lucy pursue her goal.

Example 2 – Stated Budget: Behaviour Support

Michael has complex behaviours of concern. He has a current behaviour support plan (refer to “Behaviour Support Plan 2025” uploaded to the Documents tab in PACE). Funding for ongoing monitoring and review of the behaviour support plan (45 hours) will help Michael to build capacity in managing his emotions, develop relationships with others, enhance his communication skills, and develop, implement, and review strategies to engage appropriately with others at home and when out in the community.

These strategies will support Michael to work towards his goal of accessing the community. It will also help him build stable relationships with his support network. It is anticipated this support will reduce his need for intensive 1:1 funded supports over the next 12 months. The support represents value for money in the long term.

Example 3 – Flexible Budget: Recurring Transport

Sally has autism and can’t use public transport independently. Currently, she does not know how to hail a bus, or which stop to get off at. She also experiences anxiety in crowds and public places. Sally would like to work towards her goal to join a sports class which is 20 minutes away from home. She won’t need support while she is at the class.

As per professional recommendation from Sally’s occupational therapist, Level 1 transport funding has been included to allow Sally to use taxis to attend the class and other social activities. Sally is not currently working or studying but she is looking to increase her community access. The funding in the Capacity Building Daily Activity support category will help her to build her skills in using public transport independently. She may not need transport support in future plans.

Example 4 – Flexible Budget: Assistance with Social, Economic and Community Participation

Helen is 35 years old with a moderate intellectual disability who lives with her parents. Helen requires assistance to access the community and participate in individual and group activities.

Flexible Funding is included for Helen to attend her current group day program three days per week for 6 hours per day at a ratio of 1:3 (This equates to a total of 18 hours per week). This program provides Helen with structured opportunities to engage in social and recreational activities in a supportive environment.

Additional funding has been included for 1:1 support for five hours per week, for Helen to do her weekly grocery shopping and to attend medical appointments. This individualised support is crucial for full and safe participation in the community, and support Helen to participate in the community independently.

These supports are directly aligned with Helen’s goal of maintaining friendships and engaging in social activities. By attending the day program, Helen can interact with peers, fostering social connections and enhancing a sense of belonging.

The provided supports meet the reasonable and necessary criteria as they are directly related to Helen’s disability, aim to increase social participation, and are based on recommendations from Helen’s Occupational Therapist (refer to Occupational Therapy report 01/2025). Helen’s parents will continue to support her at home, including overnight and on weekends.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity 1: Justification breakdown

Rachael is 48 years old with a primary disability of Parkinson’s disease, which significantly impacts her cognitive and motor skills.

Rachael requires ongoing support of 3 hours per day for self-care supports and 2 hours per day for domestic assistance. This funding will help Rachael maintain her independence at home and achieve her goal of keeping her house clean and tidy.

These supports will enable her to meet her hygiene needs, assist with her morning bathroom routine and ensure her home is ready for the day.

Rachels OT has submitted a functional capacity assessment dated 01.11.2024. It is located in PACE.

Activity:

1. Use the information regarding Rachael to complete the information below.

Please note: Off-system justification tools should not be used, as they do not reflect current agency processes.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity 2: Justification breakdown

Rob is 42 years old and has a diagnosis of Acquired Brain Injury as a result of a car accident in 2010. Rob is unable to drive due to his left sided weakness. Rob is also unable to use public transport, as he struggles to navigate and feels overwhelmed.

As recommended by Rob’s Occupational Therapist, Transport funding (level 1) is included to assist Rob to access the community. This support directly aligns with Rob’s goal to access the community independently. By accessing the community, Rob will be able to explore social and leisure opportunities of his choosing. Rob’s elderly parents will continue to provide occasional transportation assistance when required.

Robs psychologist has submitted a letter of support dated 11.12.2024. It is located in PACE.

Activity:

1. Use the information regarding Rob to complete the information below. Please note: Off-system justification tools should not be used, as they do not reflect current agency processes.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity 3: Justification breakdown and building

Daniel is 30 years old and has a primary disability of multiple sclerosis. Funding has been included for 26 hours of physiotherapy as per the recommendation from Physio4you on 14 April 2024. Funding will support Daniel with his mobility and balance, muscle mass and core body strength.

redacted: s47E(d) - certain operations of agencies

Activity 4: Justification breakdown and building

John is 35 years old and has a diagnosis of Major Depression. Due to his disability, he has difficulties completing domestic tasks. Funding has been included for 8 hours per week of domestic assistance. This funding will support John to maintain his living environment.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Declined justifications

For a support to be considered reasonable and necessary, it must meet all of the reasonable and necessary criteria outlined in Section 34 of the NDIS Act 2013, NDIS (Supports for Participants) Rules 2013, and the (NDIS Supports) Transitional Rules 2024.

Sometimes, requested supports may not meet the NDIS reasonable and necessary criteria and must be declined. By examining examples of declined justifications, we can gain a better understanding of how to meet the required criteria for each requested support.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Declined supports activity 1: Mobile phone

Scenario: Rebecca doesn’t have a telephone or internet service connected to her home. She asks us to fund a mobile phone so she can access the internet to book appointments with her service provider. Rebecca also wants to use the mobile phone to stay in contact with her support coordinator.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity: Write a decline justification for your decision

Declined supports activity 2: Social group

Scenario: Sophie is 8 years old, in grade 3, with a primary disability of autism. One of Sophie’s goals is to be able to effectively communicate with others. Evidence has been submitted by her speech pathologist, indicating that Sophie would benefit from being in social situations to practice her speech. Sophie’s mum has requested funding for 2 hours per week on a Saturday, for Sophie to attend a social group so she can practice communicating with children her own age.

redacted: s47E(d) - certain operations of agencies

Activity: Write a justification for your decision

Declined supports activity 3: 1:1 Support worker

Scenario: Dale has a psychosocial disability. He has been found guilty of a crime and his lawyer has asked the magistrate to let him stay in the community due to his

disability. The magistrate has agreed on the condition that Dale has 24 hour 1 to 1 supervision to reduce the risk of him reoffending.

To help him obey the community supervision order, Dale asks us to fund 24 hour 1 to 1 support from a support worker in his plan.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity: Write a justification for your decision

Declined supports activity 4: Pre-prepared meals

Scenario: Casey is 20 years old and lives with his parents and two teenage brothers in the family home. He has multiple sclerosis and has limited mobility and hand function because of his disability. This makes it unsafe for him to prepare his own meals without assistance and he can’t go to the shops on his own. Casey would like the NDIS to pay for pre prepared meals that are delivered to his home every day.

redacted: s47E(d) - certain operations of agencies

Activity: Write a justification for your decision

Declined supports activity 5: Vehicle purchase

Scenario: Sean lives with paraplegia and uses a wheelchair for mobility. He has been taking driving lessons in a modified vehicle using hand controls to operate the accelerator and brakes. Sean recently passed his driving test.

Sean has been looking for a job. One of his goals is to re-join the workforce and he feels his employment chances would increase if he had his own vehicle. Looking online Sean sees a second-hand car within his price range. He feels it could probably be modified to support his disability needs. He asks us to fund the cost of the vehicle.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity: Write a justification for your decision

Declined supports activity 6: Therapy supports

Scenario: Simon, a 20-year-old with a primary disability of autism, has requested funding for weekly speech therapy sessions in addition to his fortnightly occupational therapy sessions. His speech pathologist has recommended these high intensity sessions to help Simon engage and contribute to conversations and build confidence to participate in activities. This evidence highlights the importance of targeted speech therapy in achieving Simon’s communication goals. Additionally, Simon is currently working with an occupational therapist to build confidence and enhance his participation in activities.

Activity: Discuss the supports you are unlikely to fund, then write a justification for your decision.

Scenario 1 – Joseph

NDIS Assistive Technology Letter of Support

Re: Letter of support for purchase of a recliner lift chair

I am Joseph’s Community Occupational Therapist, and I am writing this letter informing that I have completed an assessment of his assistive technology needs. It has been determined that the provision of a sit to stand recliner will assist to increase Joseph’s transfers independently and safely in his home environment.

Background and goals

Joseph suffered from a stroke on the 15th of February 2023. He spent approximately three months in hospital before being discharged back home. Joseph does not have any other medical conditions; however, his father did suffer from a stroke when he was in his 60’s, indicating there is a history of strokes in his family.

Joseph has the following goals listed in his NDIS plan:

1. I would like to maximise my independence with attending to my daily living tasks.
2. I would like to improve my physical and mental wellbeing.
3. I would like to improve my social communication and community participation.
4. I would like to get back to running my own canteen.
5. I would like to increase my knowledge and maximise use of my plan.

Current symptoms:

Joseph has reported to experience the following symptoms as a direct result of suffering a stroke:

• Reduced function in left side of body
• Decreased mobility
• Frustration due to loss of independence
• Low mood due to loss of independence and severity of the disability
• Limited range of motion in left arm and hand

• Cramps and pain in left hand when attempting to work on hand therapy exercises
• Deteriorating eyesight
• Unable to open left hand after clenching motion
• Experienced a few falls when attempting to get up from the couch
• Swelling of left hand
• Difficulty with transfers, especially toilet, chairs, and couch.

Since experiencing his stroke, Joseph has experienced weakness in the left side of his body. This includes his upper and lower limbs, as well as his core strength which has been impacting Joseph’s balance and coordination. The weakness throughout his body has resulted in him experiencing difficulties with completing transfers from different surfaces, such as the couch. Joseph’s current couch is not suitable for his decreased physical function, as he is unable to get off the couch independently. He requires assistance from his wife or sons to complete a sit to stand transfer. This increases the carer stress that Joseph’s wife currently experiences.

Additionally, Joseph has also reported that he has experienced several falls from the couch as he has attempted to stand up independently. As he does not have the adequate strength to stand up without pushing off the couch, he is at a high risk of experiencing a fall and sustaining an injury. Joseph reported that he does not feel safe completing transfers from the couch and that he worries each day that he will fall. This causes Joseph a significant level of anxiety as he does not want to fall or return back to hospital as this will not only deteriorate his physical health, but also his mental health. Joseph often will have to remain seated in the couch and wait for a family member to physically assist him to stand up from his seated position. This can cause Joseph to feel frustrated and upset that he is reliant on his family to complete tasks that he was independent in less than 12 months ago. Additionally, the level of physical assistance Joseph’s family members are required to provide to assist him in completing the sit to stand transfer from the couch is inappropriate, as it is a high level of manual handling which may cause the family members injury or harm.

It is recommended that Joseph be provided with a sit to stand recliner which allows him to use the mechanics of the recliner to move into an almost standing position, reducing the physical effort required to stand up from his current couch. This will

reduce the likelihood of falls, allow Joseph to be independent with transfers and reduce the level of manual handling his family currently engage in, overall, reducing the level of carer stress they currently experience.

The recommended recliner is fitted with four motors, allowing Joseph to isolate the leg elevation, back recline, head rest and lumbar support features. This will allow Joseph to create multiple positions to promote comfort and lumbar support.

The recommended item is suitable for Joseph to continue to use into the future regardless of any change in functional status. The leather material of the recliner will also allow for easier maintenance of the exterior surface.

There is research to suggest that individuals who have suffered a stroke have impairments in their ability to rise from a chair to reach a standing position. Studies have found that when completing sit to stand transfers, individuals will often present with a lateral deviation of their trunk towards their unaffected side and have difficulty with weight bearing. Thus, this further highlights the need for interventions such as sit to stand recliners to assist individuals such as Joseph to be able to complete the transfers safely, with reducing the risk of falls or loss of balance and coordination due to the physical deficits they live with as a result of their stroke.

The recommended recliner was trialled by Joseph on March 5th at the Independent Living Essentials showroom. Joseph was observed sitting comfortably in the recliner and using the remote to adjust the four aspects of the recliner that move separately from each other to customise his sitting position for maximum comfort. Joseph was able to use the mechanics of the recliner to move it from a sitting position to a standing position. Joseph was able to move independently to complete the sit to stand transfer safely and confidently.

He reported that he felt secure and did not experience any pain with the assistance of the recliner moving into a standing position. He also advised that he did not feel unstable or that he would lose his balance as he normally feels with his couch at home. Joseph was very pleased with the functionality of the recliner and its features, advising that he felt that he would be able to regain some of his independence back, improving his quality of life.

Recommendations

Cost benefit analysis

The provision of the recommended lift chair will increase Joseph’s safety during transfers, enhancing his independence as well as reducing the need for his family members to assist him with sit to stand (and vice versa) transfers from the couch/chair. This will reduce the carer burden on his family, as well as limit the level of manual handling they are currently engaging in to assist Joseph with transfers. The provision of the lift chair will also reduce the likelihood of falls and injury, thus also reducing the need for future care support, ultimately providing a value for money alternative.

Implications of non-provision

Joseph’s current couch is not suitable for his decreased physical function, and Joseph does not have access to another suitable item. Therefore, should Joseph not be provided with the recommended lift chair, there is significant likelihood of the following:

• Increased risk of falls and further deterioration to physical and mental health

• Increased level of assistance from wife and sons with transfers and manual handling
• Reduced quality of life due to not being able to sit with his family and be forced to lay in bed alone due to not having an appropriate seating option
• Increased cost of supports if Joseph experiences a deterioration in physical health due to a fall or injury.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Activity:

Write an approve or decline justification for the recliner lift chair.

Scenario 2 – Andrew

NDIS Functional Capacity Assessment (FCA) Report

Reason for Referral:

Andrew’s parents and Support Coordinator requested a functional capacity assessment to be submitted as professional evidence with Andrew’s change in situation application. The reporting therapist has supported Andrew for over two years at the time of this report.

Andrew has experienced the following changes in his circumstances:

• Reduced availability and capacity of informal family support
• Changes in functional impact of Andrew’s disability that requires more support.

Background Information:

Andrew is an 11-year-old male who lives with his parents in a rental property in Geelong, Victoria. Andrew’s parents have both recently experienced periods of acute psychiatric care. Andrew attends primary school and is in Year 6. Andrew will transition to Year 7 in 2024. Andrew enjoys spending time exploring nature and Star Wars.

Diagnosis:

Andrew was diagnosed with Autism Spectrum Disorder by his Psychologist and Speech Pathologist. This impacts his daily life in the following ways:

• Difficulty initiating conversations outside of areas of interest
• Difficulty with back-and-forth conversation
• Experiencing Autistic burnout as a result of social masking

• Difficulty understanding non-verbal social cues
• Difficulty initiating, developing, and maintaining friendships
• Difficulty with shared play or group interactions
• Difficulty with context shifting in relationships, i.e. difficulty identifying relationship boundaries as per the context
• Difficulty with expected changes
• Highly restricted, fixated interests that are abnormal in intensity or focus.

Medication:

Morning medications:

• 25mg Sertraline
• Intuniv
• Dexamphetamine

Night medications:

• Melatonin
• Catapres

Current Supports:

• redacted, Psychologist at redacted
• redacted, Paediatrician at redacted
• redacted, Classroom Teacher at redacted
• redacted, Support Coordinator at redacted
• redacted, Occupational Therapist at redacted

Strengths:

• Andrew likes to create and build, taking care and putting effort into the things he makes.
• Andrew has a keen interest in music, both the piano and the guitar.

Change in Situation:

Andrew’s parents are responsible for providing all informal support for Andrew. Andrew’s parents each have life-long complex mental illnesses. Despite being dedicated parents; their disabilities significantly impact their functioning and reduce

their ability to provide the capacity-building support their son requires. Both parents are also NDIS participants.

Both parents have recently experienced episodes of mental illness that required admittance to an acute psychiatric inpatient unit. Andrew’s elderly grandparents moved into the family home to provide care during this time. Currently, the informal support Andrew’s parents provide remains lower than before their admission. Andrew’s grandparents live 2 hours away and cannot provide regular day-to-day support.

Andrew’s informal support network is likely to remain impacted and potentially unavailable whilst he navigates significant changes in his life, including puberty, transitioning to high school, and more complex social relationships. Andrew requires care and support that is beyond what is reasonable to expect of available informal supports.

NDIS goals:

As outlined in their NDIS plan dated 08/2024 – 08/2025:

1. During this plan, Andrew’s parents would like to see Andrew become more socially connected
2. During this plan, Andrew’s parents would like to see Andrew work on his sensory and emotional regulation and reduce frequency of feeling overwhelmed
3. During this plan, Andrew’s parents would like for Andrew to have improved mood and reduced anxiety.

Suggested goals:

1. Andrew to receive support to develop his fine motor skills, including writing, using cutlery, and gross motor skills for typical games played with his age group
2. Andrew to receive support to develop his daily living skills including those relating to safety such as crossing the road safely and exercising caution in the kitchen
3. Andrew to receive support to increase his executive functioning skills relating to organisation and maintaining an ordered and hygienic room.

Personal Activities of Daily Living:

• Dressing: Andrew is insistent on wearing a small selection of clothes. Andrew insists on wearing his school uniform during school and on the weekends. This includes his school hat, which he wears both inside and outside. Andrew has difficulty with unexpected changes, and it is likely that he will find having to change from his primary to high-school uniform distressing. Andrew’s parents will verbally prompt Andrew to change his clothes after explaining the weather and how they’re inappropriate for the day.
• Grooming: Andrew requires his parents to verbally prompt him to brush his teeth and hair. Andrew has not habituated to these being a part of his morning and afternoon routine.
• Eating: Andrew experiences his medication side effect of reduced appetite. Andrew’s parents and teachers monitor if Andrew has eaten and how much to ensure his nutritional needs are met.
• Sleep: Andrew requires parental support to establish and maintain sleep patterns that support his health. Andrew has difficulties sustaining his sleep.
• Showering/Bathing: Independent
• Toileting: Independent
• Medication Management: Andrew’s parents are responsible for administrating his medications. This is difficult for his parents to sustain during periods of mental illness.
• Routine: Andrew can manage positive change when he is prepared and given advanced warning of the change, for example having preferred house guests stay. If change occurs unexpectedly Andrew finds this stressful. Andrew’s parents verbally prompt him to stay on track with his getting ready for school morning routine. Andrew has difficulty regulating his attention and gets distracted by his special interests.

Domestic Activities of Daily Living:

• Meal Preparation: Andrew is insistent on sameness and prefers that his parents prepare his breakfast, lunch, and dinner so that there is no variation with the end result. For example, Andrew won’t butter his own toast because he is dissatisfied with the outcome and wants it to be how it is when his

parents prepare it. Andrew will independently get his own snack if it is pre-packaged or requires no preparation.

• Grocery Shopping: Andrew requires a gluten-free diet, and his parents are responsible for ensuring he doesn’t consume gluten.
• Laundry tasks: Andrew when asked is able to put away the laundry that is clean and folded on the kitchen table. He cannot operate the washing machine.
• House cleaning: The family requires support worker assistance to maintain a clean and organised home. The support worker helps Andrew to clean his room intermittently and he is expected to maintain this. Due to challenges in executive functioning, Andrew has difficulties doing this independently, but when given explicit instructions he is able to. Andrew is unable to operate the dishwasher, nor does he wash the dishes by hand. Andrew’s participation in domestic occupations is not age appropriate.

Emotional Regulation:

• Behaviour: Andrew has difficulty regulating his emotions in a goal-specific way. Andrew has a history of suicidal ideation and self-harm. He talks about the idea that it would be easier to not be here. During periods of dysregulation, Andrew may abscond from either home or school. Recently, Andrew has reported experiencing high levels of stress and anxiety relating to his impending high school transition. As a result, Andrew started to abscond from class as he rationalised that if he were to get into enough trouble he would be kept down and would not need to transition.
• Sensory: Andrew’s atypical sensory profile impacts his occupational performance across a number of activities of daily living. The way that Andrew actively or passively responds to sensory input means that he requires the task or the environment to be adapted to facilitate and enable his participation in meaningful activities (for example: Andrew needs to be supervised and monitored so that he is not taking excessive risks when seeking sensory experiences like climbing trees).
• Play/Social Interaction: Andrew has limited opportunities to play with same-aged peers outside of school. Andrew’s two friends from school are not

transitioning to the same high school as him. These two friends do not regularly visit for play dates. Andrew is direct in social interactions which is sometimes perceived as rude. When asked, Andrew reports that he is not very interested in what others say or having a conversation about topics that they are interested in. Andrew has difficulty with back-and-forth conversation and does not recognise facial expressions and other non-verbal cues. He often dominates the conversation with his own special interests, then apologies and expresses negative self-talk for having dominated the conversation.

• Developing relationships: Andrew has developed relationships with formal supports including support workers. Andrew reports feeling anxious that everyone is looking at him. He refuses to join in sporting teams for fear of being judged. He also avoids other group activities such as school holiday programs.
• Online Communication: Andrew’s parents provide controlled access to the internet via Andrew’s iPad. Andrew’s parents report to their knowledge that Andrew uses the internet safely.

Cognition:

• Attention: Andrew has difficulty regulating his attention. Andrew requires structured activities and environments to support him to sustain his attention, particularly when he is engaging in non-preferred activities.
• Planning and sequencing: Andrew has difficulty thinking through and considering likely situations or action outcomes. Andrew does not plan ahead to connect with peers and often waits for others to suggest ideas to him. Andrew relies on familiar adults to suggest to him what sequence he should complete tasks in.
• Problem solving/Executive functioning: Andrew requires the support of familiar others to support his problem solving or return to and persist with solving problems.

Community Access:

• Car/Public Transport/Road Safety: Andrew isn’t able to cross the road safely and still holds his parent’s hand across busy roads when walking to

school. Andrew is allowed to walk around the block independently, however, his parents hold concerns that he doesn’t always check for cars coming out of driveways.

• Shopping/Money Management: Andrew with support can purchase something from the shop. Andrew’s parent’s help Andrew to get the right amount and check if he has the right change.
• Personal Safety: Andrew is aware of obvious risks to his personal safety, e.g. hot ovens in the kitchen. Andrew extends this awareness to others if he observes them engaging in potentially risky situations. When risks are more discrete or their likelihood fluctuates, i.e. crossing a busy road, Andrew requires the assistance of his parents.

Communication:

• Expressive Communication: Andrew expressive communication largely depends on his communication partner’s familiarity and understanding of how to facilitate his participation. Andrew can be restricted or fixated on his thoughts or opinions in conversations when others hold views that are different. This can dysregulate Andrew who may become irritable or down and disengage from the conversation.
• Receptive Communication: Andew can decode and read words. Andrew has challenges regulating his attention in conversations, particularly if the subject is not of interest to him. Andrew is observed to not enjoy the reciprocal nature of the conversation and appears frustrated at times when others are speaking.

Leisure:

• Interests/Hobbies: Andrew has a number of leisure-based occupations that he is objectively skilled in, including swimming, riding his bike, playing music and gaming. Andrew’s subjective experience of these occupations is a barrier to his engagement. If Andrew perceives he has failed or not completed activities to a satisfactory standard he will quickly disengage, refusing to return even with prompted. Andrew also requires significant support to participate in group-based interests and often reports that he has heightened anxiety regarding what people might think of him.

• Group Programs/Memberships/Links to organisations: Andrew does not participate in group activities with same aged peers outside of the school environment. Andrew attends Church with his family, however, refuses to go to the children’s Church group. Andrew requires increased access to group activities that give him to opportunity to develop a shared interest with Neurodivergent peers.
• Employment/School: Andrew has had a challenging past few months at school. Mostly Andrew’s difficulties are attributed to anxiety regarding high school. Andrew has frequently absconded from class multiple times a week, experienced social difficulties, and at times, refused to complete school work. School staff including well-being, leadership, and Andrew’s classroom teacher, have all supported Andrew to remain engaged in his learning. High school environments have increased social, academic, and organisational skill expectations. Andrew’s disability means that he will have a challenging time navigating those expectations without formal support.

Recommendations: Capacity Building

Occupational Therapy (45 hours per year)

• 33 hours for approximately fortnightly home-based Occupational Therapy sessions to support Andrew (15 minutes travel = 30 minutes in travel per session)
• Fortnightly home-based sessions to focus on the development of social skills, emotional regulation skills, road safety and community safety skills, sensory processing strategies, executive functioning skills, and fine motor skills
• 4 hours for quarterly care team meetings to ensure best practices and a multi-disciplinary approach
• 2 hours for communication between therapist, support worker, and peer mentor to ensure that strategies are implemented and transferred
• 6 hours for end-of-plan assessment and review report.

Occupational Therapy – Therapy Assistant (OT TA) Level 2 (104 hours per year)

• Fortnightly OT TA 2-hour sessions to support Andrew and his family to implement therapy strategies outside of scheduled therapy sessions. This

would include developing independence in the morning routine and organisation skills.

Psychology/Counselling: As recommended by treating Psychologist

Speech Pathology (38 hours per year)

• 26 hours of fortnightly speech pathology sessions, including travel, preparation and note taking to support Andrew in developing his social skills, and capacity to develop and maintain relationships.
• 4 hours of receptive and expressive language skill assessment
• 4 hours of quarterly care team meetings to ensure best practice and a multidisciplinary approach
• 4 hours for end-of-plan assessment, report writing, and recommendations.

Equine and Animal Assisted Therapy (40 hours per year)

• Andrew requires equine therapy to help improve his mental, emotional, social, and physical wellbeing. The reporting therapist has worked with participants similar to Andrew and has seen their self-esteem and self-awareness benefit after participating in equine therapy. Equine therapy helps to reduce anxiety and improve participants ability to interact with others.

Support Coordinator - Level 2 (20 hours per year)

• Andrew requires support coordination to support him and his family to continue to engage in therapy and seek additional support to maximise Andrew’s NDIS plan and help him work towards his goals. Andrew’s parents experience challenges with their own mental health and do not have the functional capacity to engage and coordinate the services Andrew requires.

Recommendations: Core

Support Worker/Peer Mentor (156 hours per year)

• Support worker assistance 3 hours Saturday to support Andrew to access the community and increase social and independent living skills. Including support to participate in meaningful skill building activities after school
• Assistance of a support worker will allow him to manage anxiety, stress, and frustration within new environments and effectively increase the number of currently limited opportunities Andrew has to access community activities and social environments outside of school.

Respite (18 days per year)

• Assistance to build Andrew’s capacity in social and domestic activities of daily living and to be able to maintain the integrity and longevity of Andrew’s informal supports.

Group Programs (2 hours per week across 32 weeks - 1 x group per school term)

• Leisure-based occupations and groups are evidence-based practices that have a positive impact on improving mental health and well-being. Andrew’s participation will allow him to engage with peers in a supported environment and in activities he would otherwise not be able to access. Andrew is at risk of social isolation, ongoing difficulty in building social relationships and heightened anxiety without support to access the programs described above.

School Holiday Program (3 days per week -during school holidays)

• Andrew would benefit from access to school holiday programs 3 days per week of school holidays to ensure that his parents do not experience carers burnout and ensure that Andrew is provided with a supported environment to try new things while also engaging with peers. Without this support, Andrew’s parents are at risk of carers burnout and Andrew is at risk of social isolation and not achieving his NDIS goals.

Transport (3 days per week - during school holidays)

• Three days per each week of the school holiday program (approx. 12 weeks in total) of Specialised Transport service for Andrew to attend school holiday programs. This support will help maintain the capacity of informal support.

Consumables/Assistive Technology ($1,500)

• $1,500 for low cost off the shelf consumables is recommended to support Andrew in working towards their goals. This may include visual schedules, timers, alarm clock, storage options to support maintaining organisation, regulation tools, noise cancelling headphones, and other tools to manage anxiety.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Scenario 3 – James

NDIS Specialist Disability Accommodation (SDA) Report

Executive Summary:

James is a 63-year-old man who presents with extreme functional impairments and very high need for person to person supports as a result of cerebral vascular accident (CVA/Stroke). As per the discharge documentation from Austin Health, James has been diagnosed as having an anterior cerebral artery stroke.

The ACA supplies the frontal, prefrontal, and supplementary cortex, as well as parts of the primary motor and primary sensory cortex. Functionally, James presents with dysarthria, aphasia, hemiparesis of right side and urinary incontinence. James has previously suffered a Middle Cerebral artery stroke (date unknown) and has diabetes (requires dialysis treatment three times per week). James has extreme functional impairments consistent with his diagnosis of stroke affecting mobility, self-care, and self-management activities. James requires a modified environment to maintain safety and improve independence, and requires assistance with all transfers, self-care, all home, and self-management activities.

James was discharged to supported residential services (SRS) in July 2022, as his care needs were determined to be too high to manage safely at home nor in a Fully Accessible SDA, for which he has current approval. James would like to live an ordinary live and be more independent. He would like to live in an environment where he feels more connected to his housemates.

James needs cannot be met in mainstream accommodation, and he requires an environment with specialised design features to support his needs and build independence. High Physical Support SDA would allow James to live with a greater

level of independence and would provide him with greater choice and control over his day-to-day activities. A High Physical Support needs house, in conjunction with SIL supports, would provide James with a safe environment to meet his NDIS goals and maximise his ability to live an ordinary life with potential for everyday activity engagement.

Purpose of Assessment:

James’s support needs, functional abilities, and risks associated with his current living situation were assessed to contribute to planning for his long-term housing and support needs. This assessment forms part of James’s housing needs assessment currently being completed for NDIS.

James’s goals, as per his NDIS plan, relevant to this assessment and report are:

• I would like access to improve my functional capacity to increase my mobility and communication with others.
• I would like to explore suitable alternative accommodation with SDA and be supported to remain in my home while this occurs.
• I would like to increase my community access and participate in social and recreational activities of my choice and interest.
• I would like to improve my health and wellbeing.
• I would like to re-ignite my interest in music and IT and explore and identify new interests.

Contributors to the assessment:

Information to the assessment was provided by:

• Support workers rostered on the day of the assessment.
• James’s brother.
• James’s sister.
• Manager of the SRS.

Background Information:

James is a 63-year-old man who presents with extreme functional impairments and a very high need to person to person supports as a result of a cerebral vascular

accident (CVA/Stroke). As per James’s discharge documentation, James has been diagnosed as having an Anterior Cerebral Artery (ACA) stroke. The ACA supplies the frontal, pre frontal, and supplementary cortex, as well as parts of the primary motor and primary sensory cortex. Functionally, James presents with dysarthria, aphasia, hemiparesis of right side and urinary incontinence. James has previously suffered a Middle Cerebral artery stroke (date unknown) and has diabetes (requires dialysis treatment three times per week).

Prior to his most recent stroke, James was living at home with his elderly mother. He has been approved for SDA accommodation, however, this most recent stroke resulted in James experiencing extreme physical impairment and his support needs were no longer able to be met in accommodation of Fully Accessible classification.

Current Living Situation:

James’s current accommodation is not meeting his needs. James has limited scope to work on pursuing and achieving his goals, objectives, and aspirations in the current accommodation. James’s goals relevant to this report including exploring suitable alternative accommodation with SDA. James is mismatched with the other co-residents, and the environment is noisy, busy, and his own needs and routine must fit around multiple other residents, staff breaks, and availability. James has not been able to choose his own support workers and is frequently under supported due to staff availability, placing him at risk of reduced opportunities for engagement in everyday activities.

Functional Capacity

Risks

and his incapacity to

alter his own position

within the bed or

wheelchair.

Consequence of

Occurrence:

Moderate/Major

(Moderate to serious

injury or complication)

Loss of Roles Likelihood of Occupational roles and how

                        Occurrence: Probable     James is supported to fulfill

Loss of engagement in these or have these unfulfilled meaningful occupations • James is very can impact upon his vulnerable to chronic subjective quality of life. and worsening of his Studies have shown that there mental health, is a positive relationship deterioration of between life satisfaction and relationships with number of roles performed providers, family, and and level of involvement in friends. meaningful roles.

Consequence of To support James to Occurrence: participate in meaningful Moderate/Major occupations, his basic ADL’s, (Moderate to serious positioning, nutrition, injury or complication) hydration, and pain

                                       management needs all must

                                         be met. Receiving 2:1 support

                                              ensures this.

Manual Handling Likelihood of Ensuring immediately

                        Occurrence: Possible     available, active 2:1 supports

                                                 are rostered for James’s

The outcome of the personal care needs (am and assessment of his pm) ensures his needs are transfers and assistive met safely and adhering to

technology needs best practice guidelines and

strongly recommends       legislative requirements as

 that 2 persons must be     established by his treating

present for all transfers. allied health team.

This is consistent with Ongoing capacity building OHS legislative funding and allocation of requirements for worker funded hours for support safety. workers to participate in

James is only able to regular carer training must

provide minimal physical   also be factored into reducing

assistance with transfers   the risk of `redacted`

  or mobility. There are       injuries.

   multiple transfers

completed per day. This

          is in addition to transfers

    to support James as part

    of his evening care

    routine.

Given the high intensity

and physicality of

 supports required to

    assist James meet his

everyday support needs,

                             it would be very difficult

        for injured supports to

     participate in a

graduated return to work

program.

Consequence of

Occurrence:

  Moderate/Major

  (Moderate to serious

          injury or complication)

Recommendations

Eligibility to receive support for SDA

On the basis of evidence from standardised assessment and clinical observation

during the assessment process, the OT believes James meets the eligibility criteria

as addressed below:

Referring to Eligibility to Receive Support for Specialist Disability Accommodation,

Division 2, Section 12(b) subsection (1a), it is the Occupational Therapist’s clinical

opinion that James meets the Extreme Functional Impairment due to:

 o  him needing maximum physical assistance with all functional transfers

       (mobility) and regular repositioning.

 o  him needing maximum physical assistance with all self-care, including

    meal assistance, drinking, bathing, dressing, and toileting.

Even with assistance of assistive technology, equipment, and home modifications,

James has a very high need for person to person supports in undertaking these

activities provided in a 2:1 and 1:1 ratio.

For the purpose of assessing whether James has extreme physical impairment, due

to the functional impact and impairment associated with his diagnosis of stroke, the

following assessments have been conducted detailing the daily support requirements

and need for person-to-person supports:

FIM Functional Independent Measure

Scores of 15/56 for self-care, 6/35 for mobility and 16/35 for cognition with a total

FIM score of 37/126 indicating extreme functional impairment in self-care, mobility,

and cognitive (including communication) abilities.

WHODAS 2.0 World Health Organisation Disability Assessment Schedule 2.0

WHODAS score of 93%, which represents a severe functional impairment across

domains including: getting around, self-care, life activities, and community

participation.

Care and Needs Scale Assessment (CANS)

Overall score on the CANS was 7, indicating that he requires support 24/7, and

cannot be left alone for any period of time.

Thus, supporting the clinical opinion, derived from assessment and observations,

and interview with James, that he does meet the requirement for Extreme Functional

Impairment.

Support Needs

James requires access to supports constantly available because of his high level of

support needs attributable to his diagnosis. He requires practical and physical

assistance due to his high support needs. James requires intensive levels of 1:1 and

at times 2:1 support to meet his self-care needs, however shared supports (1:3)

would meet his requirement for assistance with domestic activities of daily living and

overnight supports, James is unable to be left alone for periods of time throughout

the day and requires someone to be constantly available. In a group home with three

SDA participants, this type of support can be shared with other participants which

represents better value for money than other support models.

The following tables identify the amount of support time required to assist James to

complete his Activities of Daily Living (ADLs) on a typical day.

Personal Care Activities

Domestic Activities

Community Activities

Need for Responsive Services nearby and immediately

James is unable to be left alone at any time during the day, as indicated above with

nil gaps in supports, he requires support 24 hours per day (including immediately

available plus on-site overnight assistance) due to his high support needs.

Assessment regarding benefit of Capacity Building Activities

James currently has had significantly restricted opportunity to build capacity in

meaningful activities, as articulated in his goals. This is largely due to limitations

within the built environment whilst residing in residential aged care. In group

accommodation, High Physical Support house SDA, James would be provided with

opportunities to increase autonomy and independence. Assessment and prescription

of technologies compatible with smart home features will build James’s capacity to

control his home environment, he will be able to be more engaged in meal planning

and preparation. Furthermore, he will have opportunity to have a greater

occupational performance in other activities in and around the home. James will

have greater role participation and attainment of his goals.

Recommendations, Housing Preferences and Consideration of other

Housing options

SDA Design Category

Division 3, Section 17 of the National Disability Insurance Specialist Disability

Accommodation Rules 2020, state that for the purpose of determining under

subsection 15(1) the SDA design category that is appropriate to support an eligible

participant, the CEO must have regard to the specific needs of the eligible

participant.

It is the Occupational Therapist recommendation based upon assessments

undertaken that James’s goals and support needs would be best met by housing that

falls within the SDA category of High Physical Support. The recommendation is

made for James to reside in a Group Home (3 resident) High Physical Support

House SDA with active overnight assistance. James presents with extreme

functional impairment because of his disability, affecting his functional capacity

impacting his ability to undertake self-care, domestic activities of daily living, and

self-management, and due to his impairments consistent with living with stroke.

The following design features, consistent with High Physical Support Design are not

only reasonable and necessary but critical to giving James the opportunity to live

independently, safely, and with dignity in the community.

Access

James uses a manual wheelchair for all functional mobility, he sits in a tilt space in

position to optimise his positioning. This 25-degree tilt in space increases the overall

occupied footprint of the wheelchair and therefore entry and egressing property must

be level access, with minimal clear doorway opening of 950mm and level landing of

1500x1500. The capacity to automate the doors at building entry and exit points is

recommended.

Layout

Compliance with the design standard is necessary to enable level access, sufficient

space within rooms and space through doorways and corridors to comply with

circulations spaces as per AS1428.1.

Bathroom

James requires maximum assistance with showering, having a level access shower

with shower curtain and a hob less shower recess of a minimum 1160 x 1100mm is

compatible with the occupied space of James’s recommended tilt in space shower

commode and enables physical assistance to be provided to James when

showering, with reference to a safe working environment for the support workers

assisting him.

Kitchen

James currently has limited engagement with meal preparation tasks. Having greater

access to the kitchen so that he can be actively involved in meal planning,

preparation, etc. Having at least 1550mm clearance in front of fixed bench and

appliances will enable greater involvement with meal preparation.

Bedroom

James uses an adjustable bed. A pressure mattress is being considered as part of

future assistive technology needs. There must be sufficient power outlets located on

the wall where the head of the bed is likely to be and at least one GPO on the wall

opposite where the head of the bed is likely to be.

It is recommended that James use a ceiling hoist to facilitate transfers. His bedroom

must have provision for power and inbuilt structure, capable of installation of a

constant charge ceiling hoist. A room covering system is necessary (i.e. where it is

capable of going across the bed and down the bed) to ensure optimum positioning

and placement when transferring between bed, commode, and wheelchair.

Housing Preference and Location of SDA

Division 3, Section 18 of the National Disability Insurance Scheme Specialist

Disability Accommodation Rules 2020, state that for the purposes of determining

under subsection 15(1) the area in which the SDA for an eligible participant is to be

located, the CEO must have regard to the following matters:

James’s preference has been established and supplied to the NDIS in the form of his

NDIS goals. James has the goal to “explore suitable alternative accommodation with

SDA”. Not living in residential aged care is a lifestyle preference consistent with

someone of James’s age and social status. SDA funding for High Physical Support

group home with combined onsite and planned supports will enable James to live in

housing that aligns with his statement of goals and aspirations.

Choice and control would be achieved by respecting James’s decision to move out

of home and be supported to maximise his functional capacity and increase his

social and community participation. James needs to live in Specialised Disability

Accommodation, with a combination of 1:1 and 2:1 supports is evidenced by his

scores in the FIM and WHODAS indicating extreme functional impairment. Without

this funding, James is at risk of harm, neglect, and exploitation.

Building Type

Division 3, Section 16 of the National Disability Insurance Scheme Specialist

Disability Accommodation Rules 2020 SDA Building Type considers the following:

• James’s preferences have been established and discussed above. It is in

     alignment with his statement of goals and aspirations. SDA funding for
  
     group home with onsite overnight assistance, will support James to live in
  

housing that aligns with his preferences, as well as assisting him to

     achieve his goals under his NDIS plan (Rule 16a)

• Living with others in a house, where James has planned support hours

    and access to onsite support, is the most appropriate support model for
  
    James to meet his needs. This will support James to live as independently
  
     as possible and have access to immediate on-site assistance for the
  
     unplanned times he requires 2:1 support (Rule 1b)
  

• James is requiring support 24/7, as discussed. Living with others in a

     group home, where he has planned supports and access to onsite
  
      supports, is the most appropriate model of support for James (Rule 16c).
  
    The model of supports ensures that James has the right supports at the
  
        right time and mitigates risks associated with inappropriate models of care
  
     (Rule 16d)
  

• Living in a group home will reduce cost of other supports that James

     needs, as he will be sharing onsite support with a total of 3 residents, thus
  
      representing greater value for money, in comparison to sharing onsite
  
     support with one other resident in a two-person home or alternative rental
  
      housing.
  

• Living with others facilitates social and economic participation, he can

       build capacity with his socialisation skills and participate in community
  
        activities (Rule 16f)
  

• James currently resides in residential aged care. For optimal

     independence and capacity building, careful consideration of the dynamic
  
       of the household needs to be factored into the recommendation for James
  
       to live with others and have access to trained and consistent support
  
     workers
  

• Residing with others in an SD group home reduces risks associated with

     reduced dignity, safety, response to environmental threats, and neglect
  

• A planned transition to SDA will provide him with the platform and

     environment to undertake intensive capacity building and further develop
  
       his independent living skills.
  

Consideration of other Housing Options

• Continued residency in residential aged care is not in alignment with his

        goals and does not align with the Younger People in Residential Aged
  
       Care Strategy 2020 – 2025
  

• James is unable to live with family due to his extreme functional

        impairment and very high need so therefore it is not possible to live in the
  
          family home
  

• James requires person to person supports 24/7, private rental properties

       would require supports to be provided 2:1, which does not represent value
  
           for money in comparison to SDA
  

• Similarly, residing in public or social housing, given his requirement for

        high person to person supports, this housing situation would require 2:1
  
        supports and there is no capacity to share supports
  

• James has a limited fixed income of the Disability Support Pension; he

       does not have the means to acquire his own home.
  

  Summary

  It is the Occupational Therapist’s opinion that, based upon all evidence detailed in

  this report, James requires a specialised environment to compensate for his very

  high need for person to person supports. A Group Home, High Physical Support

  SDA with planned supports and immediately available onsite support model would

  provide the level of support and housing design required to support James’s goals

  and functional capacity. The recommended supports relate directly to the functional

  impairments as a result of James’s disability.

redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

Scenario 4 – Sam

NDIS Supported Independent Living (SIL) Report

Reason for Referral:

Sam was referred for an occupational therapy (OT) assessment including support

independent living assessment (SIL). The aim of this assessment is to holistically

consider and define the comprehensive needs and goals of Sam with regard to any

necessary support required for maintaining independent living in shared

accommodation.

Report overview:

The provider acknowledges the content of this report may be considered deficit

focused and, as a result, could be confronting to participants and their carers. The

aim of this report is to outline areas where support is needed in order to justify

access to the necessary funding.

Participant information

Background Information:

Sam is a 17-year-old male residing in Fairy-town, VIC. He is living in out of home

care, with foster parents Jane and Austin and their daughter. Sam has had 4

placements in Jane and Austin’s care since 2016. Sam was attending Sage

Specialist School three days per week however recently he chose to withdraw from

education this year.

Sam’s biological mother, Ida, resides in Melbourne, with two of her daughters and a

grandchild. Sam has six other siblings of varying ages. He enjoys visiting his family

each month and during school holidays. As stated above, Sam was removed from

the living arrangement with his mother in 2016 and has had 4 placements with Jane

and Austin. It was reported that there is historical family violence within the family,

including intervention orders. When OT initially met with Sam, he reported a goal that

once he turns 18 years old in January 2025, he would like to relocate to Melbourne

to live with his mother. Sam’s care team and mother have expressed concern over

this, related to Sam’s independence and the sustainability of the proposed situation.

Ida’s home is owned by the Department of Families, Fairness and Housing, and is

three bedrooms; if Sam were to move in, he would not have his own bedroom or

space and the house would be extremely cramped. Additionally, the care team are

concerned regarding Ida’s capacity to provide Sam with the daily supports he

requires to function as an adult due to her own health and cognitive limitations. It

would not be appropriate to introduce drop-in supports into the current home due to

social and environmental risks. Sam’s care team have proposed the idea of SIL,

where he could live with other people his own age as Sam cannot be left alone

without support due to his disability – Sam and Ida have been enthusiastic about this

idea.

Supports of Sam have indicated concern over his current NDIS plan including that is

insufficient funding to support him as an adult. Once Sam turns 18, he will not be

eligible to receive funding or support from Child Protection Services (CPS), including

Anglicare. Currently, Sam has no secure plan of activities after turning 18. He has

voiced a desire not to return to schooling and complete his year 12. Sam would like

to get a job and earn money in order to buy items he likes. He is also interested in

obtaining his driver’s license.

Primary Disability

Sam’s primary disability recognised by NDIS is intellectual disability. There was no

diagnostic information available to review at time of writing.

Main difficulties that impact daily life:

• Rigidity in thought pattern, for example Sam’s present with a concrete thinking

  style

• Behaviours of concern, including poor understanding of personal space,

  manipulation, vulnerability, and inability to keep himself safe (risk of exploitation),

  argumentative and demanding

• Limitations with communication skills including expressive and receptive. This in

  turn impacts his social skills

• Cognitive deficits including limitations with attention/concentration and problem

  solving

• Limited life skills including public transport use, banking, paperwork skills.

Sam’s disability is permanent, and he is likely to require a level of support throughout

his life. Sam’s functional impact as a result of disability impair his ability to participate

in daily living activities include personal care, instrumental and community tasks.

Barriers to engagement with services

Sam lacks insight into his disability and associated impairments. Due to this, he

struggles to recognize when, how or why he would require support. If SIL funding

and accommodation is not arranged once Sam is 18, there is a risk he will move into

his mother’s accommodation, where he will not have space. Sam has been given the

option of remaining with Jane and Austin until appropriate accommodation is

sourced.

Participant goals

NDIS goals as per plan

1. To learn how to manage and regulate my emotions.

2. To be supported with my communication, social and interpersonal skills and

   strategies around my behaviours of concern.

3. To support me to maintain my current living arrangement with my foster

   parents.
   

   4. I would like to develop my relationship with my mother and learn safe

   boundaries to keep myself safe.

Goals identified during assessment:

1. When I turn 18, I would like to live in Melbourne in a safe, secure and

  supported housing, with other people my age.

2.   I would like to obtain my driver’s license.

3.   I would like to obtain employment.

Child protection services and Anglicare have requested a Home and Living

Assessment be completed by occupational therapy services.

Factors Impacting Functional Capacity

Cognition

• Concentration and attention: Sam struggles with attention during each

  assessment. He was easily distracted by his surroundings and had limited
  
  focus on OT, including questions and activities. The WHODAS reflects that
  

  Sam has mild difficulty concentrating for ten minutes.

• Memory: Jane reported that Sam was good at remembering appointments.

  He was able to recall the days he would attend school and would challenge

  the information provided by others if incorrect.
  

• Impulsivity: Sam often jokes around with hot food/cooking items such as

  saucepans or toasters and engages in “risky” behaviours in the kitchen. Due
  
   to this he requires supervision and monitoring at all times for safety.
  

• Executive functioning: During each task of making toast and laundry, Sam

   required monitoring and redirection to ensure he remained on task.
  

• Decision making: as Sam is under 18, his current guardian and decision

  maker is CPS. Once 18, all decision making will be returned to him. Sam’s

  care team have explored and discussed guardianship, with consideration
  
   continuing. Sam is highly vulnerable to financial, emotional and other forms of
  
  abuse due to his cognitive impairment. Sam would benefit from formal support
  

in decision making and financial management due to current reduced capacity

    in decision making. This would mitigate risks of exploitation and ensure that

    bills/rent is paid on time to further secure his housing. It is foreseeable that in

 a SIL accommodation, Sam would be able to be supported in making daily

   decisions. OT predicts that Sam will require support in providing options while

 he develops this skill and his routine further.

• Safety management: it is OT’s opinion that Sam requires support in safety

  and emergency management. He was able to recognize 000 as an

  emergency contact number but could not discuss how to contact them or what

  was considered an emergency.

Sam would benefit from ongoing OT input and low-cost aids such as whiteboards,

routine charts/boards and clocks to support routine development and engagement.

Psychological

• Mental Health History: no formal mental health diagnosis. Sam reported that

  he understood feeling sad, as he experienced this when a pet lizard passed

  away. Jane was told that he had a diagnosis of ADHD.
  

• Mood: Sam was consistently happy during each assessment. He may get

  upset if visits with his mother get changed, as he may not understand why this
  
   occurs.
  

• Motivation: as per his age, if Sam has interest in an activity or item, he will

  be very motivated. His limitations with motivation are exacerbated by

    disability. Sam’s motivation could be perceived as transitional, whereby he
  
  needs to get something out of an activity or interaction or he may not engage,
  
    for example engaging in chores if no reward is offered.
  

• Emotional Regulation: when he is heightened such as being excited or

   stressed, he struggles to regulate his emotions. This can cause others to get
  
  upset which can in turn trigger him to become upset. Sam has substantially
  
  reduced capacity with emotion regulation and coping due to disability. Sam
  
  would benefit from psychology and ongoing positive behaviour support to
  
  increase capacity in mood, motivation, emotional regulation and coping with
  
   stress.
  

Communication and social interaction skills

• Speech and language: Sam is verbal in communication and can express his

  basic needs including pain, hunger, and thirst. He does not require alternative
  
   or augmentative communication strategies.
  

• Receptive skills: Sam struggles to engage in a two-way conversation; OT

  notes he was distracted by his environment and needed regular redirection to
  
  engage.
  

• Expressive skills: Sam struggles to express complex ideas and sharing his

  own thoughts/opinions. He is mostly agreeable in conversation with others,

  which demonstrated difficulties with understanding and articulating complex
  
   ideas. This is likely to increase the risk of his vulnerability as he may not grasp
  
  consequences or exploitation. He can express basic emotions, such as
  
   explaining he felt sad when his lizard died but struggles beyond this.
  

• Social skills: as a result of impairments with expressive and receptive skills,

  Sam has impaired social skills. Sam often interrupts and talks over others. He

  does so when he is excited to talk, but has limited understanding of
  
   implications (e.g., perceived as rude).
  

• Relationships: as noted above, Sam has no friendships or intimate

   relationships. Jane reported that regarding sexual activities he can be “fairly
  
  immature” but shows no interest.
  

Sam would benefit from support from speech pathology services to develop his

communication, social and relationship skills.

Mobility

The WHODAS indicated nil functional impact.

Home modifications and assistive technology

Sam does not currently use any assistive technology or have any home

modifications in place. Sam would benefit from funding within his consumable budget

to support purchase of low cost visual and cognitive aids to enhance routine

development and capacity building.

Behaviours of concern

A behaviour support plan (BSP) completed in 2022 (by Everyday Inc) was provided

to OT to review.

The behaviours Sam displays listed in this report include:

• Verbal aggression: Jane reported that this behaviour is current. This is

  demonstrated by shouting when heightened. Sam may accuse others of lying
  
   or disagree with a point. Due to his rigidity in thinking, Sam often believes
  
  what he is told as fact, so when this is challenged it is difficult for Sam to
  
  understand. Sam may become verbally aggressive or defiant if he believes his
  
  needs are not met, being told no or perceives he is being challenged.
  

• Physical aggression: Jane denied this as a current behaviour. The BSP has

   limited information expanding on this, the report states “Sam has shown
  
   incidents of physical aggression in the past against others and against
  
   objects. Sam has not displayed physical aggression towards others in the
  
  past 12 months.”
  

• Perseverative/repetitive behaviours: Jane reported this is a current

  behaviour. Sam may repeatedly ask questions to others in order to obtain
  
    their attention, make noise, jokes or gestures. He also intrudes others
  
  personal space and needs to be instructed to step back. Sam struggles to
  
  understand why this is inappropriate and crosses boundaries for people.
  

  At the time of writing, Sam is engaged with Everyday Inc for ongoing behaviour

  support intervention.

  Activities of daily living

  Personal Activities of Daily Living – self-care

  The WHODAS reflected a moderate functional impact in self-care. He has

  lowered motivation and impaired executive functioning resulting in limitations in

  personal care tasks.

• Eating: Jane reported that Sam will remember to eat regular meals but will

   make poor food choices without support. For example, if hungry he may
  

snack on high caloric, low nutrient foods such as lollies or chips rather

     than having something sustaining.

      Direct support required. 1:3 support recommended.

• Showering: Jane reported that Sam requires “constant” prompting to

     shower. He will not engage in this task without encouragement or
  
      prompting. He must be reminded to use soap and shampoo. Sam scored
  
     severe in “washing his whole body” on the WHODAS.
  
      Direct support required. 1:1 support recommended.
  

• Toileting: Sam is typically continent through the day but occasionally wets

      the bed overnight which occurs a few nights per week. Jane reported that
  
    he can manage clean up by himself overnight as required but is likely to
  
    wake up Jane to inform her of the incident. He has had previous support
  
       via Royal Children’s Hospital to investigation into incontinence.
  
      Direct support required. 1:3 support recommended.
  

• Grooming and personal hygiene: Sam struggles to engage

     independently in brushing teeth, nail trimming and hair management. He
  
      requires prompting and encouragement to engage. Sam would struggle
  
      with prioritising time to complete grooming and hygiene tasks prior to
  
      leaving the house.
  
      Direct support required. 1:1 support recommended.
  

• Dressing: Jane reported that post shower Sam will put dirty clothes back

      on. He also struggles to dress appropriately to weather. Sam needs
  
      supervision for a quality check of clothing and prompting to ensure clothing
  
     choices are appropriate to weather.
  
      Direct support required. 1:3 support recommended.
  

• Sleep: Jane reported that Sam will often get up often overnight to talk with

     her and will require prompting to go to bed. Sam also has difficulties with
  
      wetting the bed overnight but is able to change his own sheets if that
  
      occurs. Sam would benefit from further support and education regarding
  
     sleep hygiene to promote healthy sleep habits.
  
      Direct support required (inactive/passive). 1:3 support recommended.
  

• Medication management: nil known medications.

• Health management: Sam can articulate if he feels sick or pain but may

      struggle with more specific detail. He requires ongoing support to manage
  
      health and appointments for heath.
  
      Direct support required. 1:1 support recommended.
  

Domestic activities of daily living (household activities)

The WHODAS reflected a moderate functional impact in domestic tasks. Sam is

physically able, but struggles with motivation, planning and initiation to engage in

these tasks independently hence requires support.

• Cooking/meal preparation: Sam struggled to identify meals and the

   ingredients required in each meal. Overall demonstrating that while he has
  

  some skill in cooking, he cannot independently manage meal preparation and

   appropriate food choices there requires in person supports. Direct support
  
   required. 1:3 support recommended.
  

• Cleaning: During interview, Sam struggled to articulate what tasks need to be

  completed to maintain a household and the frequency of said tasks. Direct
  
  support required. 1:3 support recommended.
  

• Laundry: While Sam has learnt to complete laundry tasks, he does not have

  the ability to complete complex washing or problem solve if a change were to
  
   occur. Sam reported that he does not hang washing out as he uses the dryer.
  

  Sam noted that he does not separate his washing into colours/materials,

  however Jane clarified this was a requirement with completing laundry.
  
   Direct support required. 1:3 support recommended.
  

• Technology use: Sam reported nil issue with technology use. Sam has his

  own phone, television and Xbox. Jane also reported nil issue with use, outside

   of overuse which is age normative.
  
   Indirect support required. 1:3 support recommended.
  

• Garden/maintenance: Jane and Sam reported that he loves gardening and

  being outdoors. However, he often requires support to remain on task and
  
  complete tasks correctly otherwise he will likely rush.
  
   Direct support required. 1:3 support recommended.
  

• Pet care: Sam has three pet lizards. Sam demonstrated significant

  knowledge about lizards during assessment and was able to inform OT facts
  
  about lizards and how to care for them.
  
   Direct support required. 1:3 support recommended.
  

Productivity - Work and learning activities

At time of initial assessment, Sam was enrolled in Sage Specialist School and

attended three days per week. Engagement in school was hard for Sam, and he

often expressed that he did not like going. During the interview with his teacher, it

was reported that he was engaged in a VET horticulture course. Sam was engaged

in kitchen activity which is part of the school program – Kelly (teacher), reported that

Sam appeared to enjoy this and would participate well. Unfortunately, despite

encouragement from his family and care team, Sam ceased attending school and is

refusing to return. Sam does not have a job, however, has expressed interest in

obtaining employment. He reported that he would like to work at McDonalds or for a

gardening service. Sam would benefit from engaging with School Leavers

Employment Services (SLES) to support him in finding employment opportunities

that are suitable for him. Sam is likely to require direct support at his job initially,

while building his skills and routine.

Direct support required. 1:3 support recommended.

Leisure activities

Sam’s hobbies include playing Xbox, caring for his pet lizards and riding motorbikes

with supervision at his home. Sam can engage in these tasks directly but benefits

from supervision and monitoring for safety.

Direct support required. 1:3 support recommended.

Community access – participation in society

• Driving: Sam cannot drive. He does not have a learners permit or own a car.

  Sam has a goal of working toward obtaining his driver’s license. Sam will

   require a driving assessment by specialist OT due to observed deficits in
  
   attention, executive functioning and safety management.
  

• Public transport: Sam only uses public transport with his mother; he is not

  independent in this task. As Ida cannot drive, she uses public transport and
  
  supports Sam to do so also. Sam will require further capacity building to use
  
   public transport independently.
  
   Direct support required. 1:1 support recommended.
  

• Community activities/social groups: Sam’s community access is currently

    limited. There is funding for community funding and options for him to go out
  
   with Jane, however Sam often declines to do this. He will, however, access
  
  the community when visiting his mother. Sam cannot access the community
  
   without support due to his risk of exploitation. Sam’s cognitive and
  
  communication impairments hinder his ability to recognise and process
  
  safe/unsafe interactions and situations as well as seeking further support,
  
  hence he will require further support determine further activities to complete in
  
  community following transition to SIL.
  
   Direct support required. 1:1 support recommended.
  

• Shopping: Sam demonstrated that he has significant difficulties with planning

  meals and with creating a shopping list. Sam requires support with shopping
  
    in the form of prompting and guidance to develop skills in this area.
  
   Direct support required. 1:1 support recommended.
  

• Attending appointments: Sam relies on Jane and Anglicare supports to

  organize and manage his appointments for him. Sam has limited capacity to
  
  recognize health needs or if an appointment is required. Sam demonstrated
  
   limited knowledge into first aid and when to seek assistance. Direct support
  
   required. 1:1 support recommended.
  

• Maintaining tenancy: Sam has not lived out of home without his mother, Ida

   or out of home carers, Jane and Austin. Based on OT observations, interview
  

  and standardized assessment, Sam does not have the skills or capacity to

  maintain tenancy, without formal support.
  
   Direct support required – SIL funding with support indirectly.
  

Finances/ Money Management

Sam does not have an income stream. Currently, Sam will “work for money” by

completing chores at Jane and Austin’s. It is evident that Sam does not understand

budgeting, banking financial management or bill paying. Additionally, during

discussions about finances, Sam would reference his wishes to buy Lamborghinis,

Ferraris, numerous pet lizards, various Xbox models and name brand appliances for

his home. When asked on how to pay for it, he reported he would work part time at

McDonalds to acquire these items, with no regard for cost of these items, pay rate of

part time employment, savings, or daily living costs. Sam recently opened his first

bank account and has a bank card. It is recommended that Sam obtain direct

support in this area once 18 to ensure that rent and utilities are paid on time; support

in this area could be provided by State Trustee’s. In conjunction with this support,

Sam requires capacity building in this area. Sam has expressed interest in obtaining

employment but will need support in this area. OT recommends that Sam trial

supported employment prior to trialling mainstream employment, such as

McDonalds, so that he can receive appropriate support, training and capacity

building in being employed and job responsibilities to set him up for success long

term. OT recommends that Sam be supported to explore income via the Disability

Support Pension (DSP) to ensure he receives an income once 18 and can pay for

tenancy costs. At the same time, it is hoped that Sam can be supported by SLES to

source employment.

Summary and Recommendations

Sam is a 17-year-old male, living with his out of home carers in Fairy-town. His

primary disability recognized by NDIS includes intellectual disability. Sam is due to

turn 18 on 30 February 2025; he is currently receiving substantial support through

CPS and Anglicare, all of which will cease once turning 18. Sam has been referred

to OT for a home and living assessment, to explore disability housing options. It is

the OT’s opinion that Sam is eligible for SIL based on NDIS operational guidelines

for SIL, as well as Sam’s presentation and disability related needs. The main

functional impairments impacting Sam’s day to day life include concrete thinking

style and reduced flexibility in thought, behaviours of concern as listed earlier in the

report, limitations with communication skills including expressive, receptive, social

and relationship skills, impaired attention/concentration and problem solving and

difficulties with mood, motivation and emotional regulation. As a result of this, Sam

has substantially reduced functional capacity with social interaction and

communication skills, self-management skills, self-care activities, domestic activities

and community access and social participation.

Sam requires SIL funding including:

• Standard level of SIL including of 24/7 support and inactive overnight support

• In person, onsite support

• Ratio: 1:3 with periods of 1:1 (8 hours Monday to Friday AND 4 hours Saturday

  and Sunday)

• Management of occasional behaviours of concern

• Location: Melbourne.

Sam requires this level of SIL as a direct result of their disability, which is NDIS

recognized.

Recommendations for occupational therapy: OT HOURS/ TIMEFRAME

• Therapy sessions: 40 hours are required.

• Once Sam transitions to SIL in Melbourne a period of intensive capacity building

  is recommended to rapidly upskill daily living activities to increase independence.

  It is recommended that occupational therapy sessions occur WEEKLY for 12

  WEEKS (20 hours)

• 12 hours for sessions

• 6 hours for travel

• 2 hours for resource development

• After intensive period, occupational therapist can support monthly visits for

  intervention and capacity building. (20 hours)

• 9 hours for sessions

• 9 hours for travel

• 2 hours for resource development This is to occur over the 12-month planning

  period

• Care team meetings: 12 hours – allows for 1-hour monthly meetings over 12

  months

• Progress report: 3 hours for progress report writing as per NDIS guidelines

  throughout plan.

  TOTAL OT HOURS = 57 hours.

Based on OT clinical assessment the following is recommended:

Core Supports:

24/7 SIL funding is recommended for Sam commencing January. Home and Living

Report to follow. Recommendations are inclusive of shared supports during the day

(1:3), periods of 1:1 for community access and capacity building as well as shared

(1:3) inactive overnight supports.

Support funding (prior to 18th birthday, i.e., September to January):

• Personal care: 1.5 hours, three days per week to support with morning routine

  and transport to school. TOTAL 4.5 hours per week

• Domestic Tasks: 10 hours per week in the home support for capacity building.

  (five nights per week) TOTAL 10 hours per week

• Community Access: 10 hours per week, including a weekend shift (6 hours).

TOTAL 10 hours per week

Finding and keeping a job: Sam would benefit from funding for a School Leavers

Employment Service (SLES) to support transition from schooling to employment.

Transport: level 3 transportation funding.

Consumables: Sam would benefit from visual schedules to support his routine.

While currently in schooling, his routine is well structured but following leaving school

his routine will change and Sam will need support to manage this.

Capacity Building:

Occupational therapy: 57 hours as stipulated earlier in this report.

• OT driving assessor: 15 hours ADDITIONAL TO 57 HOURS. OT TOTAL 72

  HOURS

Speech pathology: ongoing; to develop communication skills. Hours as stipulated

by provider.

Support coordination: ongoing; as Sam cannot organize supports and referrals.

Hours as stipulated by provider.

Improved relationships - Positive behaviour support services: ongoing funding as

per PBS recommendations.

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