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Practice Guide – Early childhood- supports for children who are deaf or hard of hearing

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Contents

Practice Guide – ………………………………………………………………………………………………………….. 1

Early childhood- supports for children who are deaf or hard of hearing ……………………………… 1

1. Purpose ………………………………………………………………………………………………………….. 3
2. To be used by………………………………………………………………………………………………….. 3
3. Scope …………………………………………………………………………………………………………….. 3
4. Hearing loss ……………………………………………………………………………………………………. 3
5. Early childhood intervention………………………………………………………………………………. 4 5.1 Communication Approaches ………………………………………………………………………….. 5
6. Hearing Services Program ………………………………………………………………………………… 7
7. Applying ………………………………………………………………………………………………………….. 7 7.1 Early Intervention requirements ……………………………………………………………………… 7
8. The NDIS Pathway Hearing Stream (hearing stream)………………………………………….. 8 8.1 Overview of the hearing stream ……………………………………………………………………… 8 8.2 Summary of the hearing stream ……………………………………………………………………… 8 8.3 Determining eligibility for the hearing stream………………………………………………….. 10 8.4 Having the planning conversation …………………………………………………………………. 10 8.5 Pre-planning tasks ………………………………………………………………………………………. 10 8.6 Planning …………………………………………………………………………………………………….. 12 8.7 Justification for reasonable and necessary supports ………………………………………. 14 8.8 Finalise and Approve a Plan ………………………………………………………………………… 14
9. Plan changes…………………………………………………………………………………………………. 15 9.1 Plan reassessment - CEO-initiated ……………………………………………………………….. 15 9.2 Requesting a CEO-initiated plan reassessment ……………………………………………… 15 9.3 Determining capacity building supports …………………………………………………………. 17 9.4 Determining supports in Core budget ……………………………………………………………. 18 9.5 Determining support in the Capital budget …………………………………………………….. 20
10. Supporting material ………………………………………………………………………………………… 21
11. Process owner and approver …………………………………………………………………………… 22
12. Feedback ………………………………………………………………………………………………………. 22

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13. Version change control …………………………………………………………………………………… 23

1. Purpose

This practice guide will help you understand the NDIS Pathway Hearing Stream (hearing stream) and how to determine reasonable and necessary funded supports for participants younger than 7, newly diagnosed with a permanent hearing loss. It will also help you determine funded supports for participants at plan reassessment and for new participants with existing hearing loss.

2. To be used by

Plan Developers – National Disability Insurance Agency (NDIA) planners, plan delegates and early childhood partners. Plan delegates includes Hearing Stream Lead (HSL) delegates.

3. Scope

This practice guide will support you to understand the priority hearing stream and how to develop and approve NDIS plans (plan) for participants younger than 7, newly diagnosed with a permanent hearing loss. These participants are eligible to access the Scheme via the hearing stream, where they are prioritised to access timely NDIS funding and early intervention supports.

From 1 July 2023, the age of children supported under the early childhood approach will progressively change to include children younger than 9. However, there is no change to the age of participants accessing the hearing stream, it remains for participants younger than 7, newly diagnosed with a permanent hearing loss.

This guidance will assist you to determine reasonable and necessary funded supports in accordance with section 34 of the National Disability Insurance Agency Act 2013 and the NDIS Rules 2013, 2014 and 2016. For further information go to Practice Guide – Early childhood planning, Our Guidelines - early childhood approach, Our Guidelines – Creating your plan and Our Guideline – Reasonable and necessary supports.

Note: Most often the child representative will be the participant’s parent or carer. In this practice guide reference to the participant’s parents, family or carer also includes any other child representative.

Note: For further information regarding the Agency’s language and terminology, refer to Deafness and Hearing Impairment Snapshot. To learn more go to the Practice Guide - Assisting Communications.

4. Hearing loss

Hearing loss presents in many forms and varies according to type, amount and range.

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Hearing loss can be described as:

• congenital - present at birth or soon after birth or
• acquired - occurs or develops during a person’s life but was not present at birth.

A hearing loss can be described as unilateral (only one ear is affected) or bilateral (the hearing loss is in both ears).

Types of hearing loss:

• Sensorineural hearing loss is considered permanent affecting the inner ear (cochlear).
• Conductive hearing loss is typically considered a temporary condition that is associated with middle ear pathology (for example an ear infection). A conductive hearing can sometimes be permanent. Permanent conductive hearing loss is less common and often associated with a malformed ear (for example microtia or atresia).
• Mixed hearing loss is a combination of a sensorineural (permanent) hearing loss with a conductive overlay.
• Auditory Neuropathy Spectrum Disorder (ANSD) is sometimes called auditory neuropathy or auditory dys-synchrony. It is a condition which impacts on the ability of the hearing (auditory) nerve to send sounds from the inner ear (cochlear) to the brain. This type of hearing disorder is considered complex. It is not possible to predict the functional impact auditory neuropathy has on a child’s ability to hear or prognosis for the child’s speech and language development.

The degree of a person’s hearing loss describes how much they can or cannot hear on their own. The terms used are mild, moderate, severe and profound. To learn more about hearing loss go to Hearing Australia’s Choices guide.

Table one: Classification of hearing loss

Degree of hearing loss	Decibel Range
Normal hearing	0 – 20dBHL
Mild	21 – 40dBHL
Moderate	41 – 60dBHL
Severe	61 – 90dBHL
Profound	>90dBHL

5. Early childhood intervention

The National guidelines best practice in early childhood intervention and our guideline on the early childhood approach highlight the importance of a child’s early years. Early intervention starts soon after a child has been diagnosed with hearing loss. The primary goal of early

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intervention is to help families communicate with their child and encourage their development. The earlier there is language (spoken and/or signed) in their environment, the sooner their communication can develop. Early childhood supports are needed for young infants as their brain development benefits from early stimulation and parents or carers benefit from the support early intervention provides.

Research shows that the earlier intervention services begin, the better the outcomes for children, so early intervention often starts when a child is first diagnosed with hearing loss. Australia has a world class system including the early detection of hearing loss supported by the Universal Newborn Hearing Screening (UNHS) program, and timely access to early intervention supports.

Advances in technology and the introduction of the newborn hearing screening program have provided children with improved access to the sounds of speech at the earliest possible age. A growing body of evidence demonstrates the positive impact this has on children’s language outcomes later in life.

Early intervention supports for children who are deaf or hard of hearing focus on supporting:

• development of the neural pathways involved in speech, listening and communication
• development of age-appropriate language, using chosen communication modality
• development of age-appropriate social and emotional skills
• families with the acceptance of the hearing loss and teaching them to be effective language role models
• optimal use of Assistive Technology (AT)

5.1 Communication Approaches

In 2007, a systematic review of the literature on early intervention for children with a permanent hearing loss suggested there is a lack of high level, quality research on the effectiveness of one particular communication approach over another. There is widespread recognition that no single option is ideal for all children with hearing loss at all stages of their development. Some families feel under pressure when making choices about communication. It is important that families understand that they do not have to make a choice for life. They may wish to change their approach as they learn more about their child’s needs and preferences. The right choice is the one that works best for the child and their family.

The choice of communication approach is the family’s decision. There are various communication approaches, and there is no one communication approach that fits every family’s needs. You will need to take this into account when determining reasonable and necessary supports to adequately support the child’s language development and minimise the risk of language deprivation.

To learn more about communication approaches go to Hearing Australia’s Choices eBook. This resource can be shared with families if they do not already have it.

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5.1.1 Table Two: Different communication approaches

Communication approach	Description
Auditory-verbal/ oral-aural	- Focuses on using residual hearing to listen, understand spoken language and communicate through speech. - In the oral-aural approach they also use lipreading. - Emphasises consistent use of optimally fitted hearing devices to make the best use of residual hearing.
Bilingual/bicultural	- Focuses on the child learning Auslan and English, to foster language, communication and literacy skills. Typically, the child will start accessing both modalities at around the same time. - Children may learn about Deaf community, its history, language and culture as well as learning about the hearing community.
Total communication	- Focuses on using a range of communication methods including speech, listening, signing and finger spelling, either on their own or in combinations. - The idea is to communicate and teach vocabulary and language in the way that works best for the child.

5.1.2 Auslan

Auslan (Australian Sign Language) is a native language of the Australian Deaf community. Auslan has its own syntax, grammar and uses a combination of handshapes, movements and facial expression.

Note: It is written ‘Auslan’ rather than ‘AUSLAN’.

It is common to confuse Auslan with Key Word Sign (previously known as Makaton), however they are very different. Key Word Sign (Makaton) is the use of Auslan signs and natural gesture to support communication. Unlike Auslan, Key Word Sign is not a language. It does not contain structure and grammar but follows the same grammatical structure as spoken English. Along with speech, it uses symbols or signs to highlight the core vocabulary. Key Word Sign is commonly used to support individuals with communication difficulties and language delays.

Go to the Auslan related supports section in this guide or the Practice Guide - Assisting Communications to learn more.

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6. Hearing Services Program

The Hearing Services Program (HSP) provides government funded hearing services and devices to eligible people. Young Australians who are under 26 years of age and are a citizen or permanent resident are eligible for the Community Service Obligation (CSO) component of the HSP.

Hearing Australia is the sole provider of the CSO Program. The services and supports they provide to children who are deaf or hard of hearing includes:

• fully government subsidised hearing devices (for example hearing aids and remote microphone systems) and ongoing audiological services
• upgraded and replacement speech processors for cochlear implantable devices
• repairs and maintenance for devices
• ongoing services and support

Funding for hearing services and devices should not be included in a child’s NDIS plan. Only include NDIS funding for additional reasonable and necessary supports that are not available through Hearing Australia. For example, funding for early childhood intervention, Auslan related supports, and low cost assistive technology such as alerting systems.

Go to Hearing Australia’s policy to learn more about the technology that is provided at no cost to children.

Hearing Australia have developed Choices. Choices is a free resource for families of children who are newly diagnosed with hearing loss from birth to 12 years of age. This resource provides valuable information to help families confidently make the right choices for their child throughout their hearing journey.

Choices was developed in consultation with a range of different stakeholders including families and aims to make it easier for families to understand and find information about the range of hearing technology, communication and supports services that are available to help them.

7. Applying

7.1 Early Intervention requirements

The NDIS will be satisfied a person meets the early intervention requirements if they are aged between 0 and 25; and have auditory neuropathy or a hearing loss at least 25 decibels in either ear at 2 or more adjacent frequencies. The evidence must show the hearing loss is likely to be permanent.

For further information regarding the early intervention requirements go to Our guidelines - Applying.

Note: For all children younger than 7 (except children diagnosed with a condition on List A, with a permanent hearing loss greater than 90 decibels in the better ear) the NDIA will first

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consider whether the child meets the early intervention requirements before considering the disability requirements.

8. The NDIS Pathway Hearing Stream (hearing stream)

8.1 Overview of the hearing stream

The priority hearing stream is for infants and children, younger than 7, newly diagnosed with a permanent hearing loss. Refer to the Standard Operating Procedure - NDIS Pathway Hearing Stream for children younger than 7 for further information.

8.2 Summary of the hearing stream

The hearing stream supports infants and children newly diagnosed with hearing loss to receive priority and streamlined access (within 2 days) to the NDIS. The initial plan will be approved within 10 business days. The plan includes NDIS funded supports so the child and their family can access timely early childhood support, to assist their child’s language and communication development.

The Hearing Stream Lead (HSL) delegate is a role specific to the hearing stream, they will develop and approve the initial plan. HSL delegates are skill tagged National Delivery delegates who have completed all relevant training requirements, as set out by the Early Childhood Services (ECS) branch.

8.2.1 Diagnosis of confirmed hearing loss, referral to Hearing Australia

In Australia, under the universal newborn hearing screening program, hearing loss may be detected in an infant when they are only days old. If a hearing loss is suspected in an infant or a child of any age, they will be referred to a paediatric audiologist for a full diagnostic assessment. If a permanent hearing loss is confirmed, the paediatric audiologist will arrange a priority referral to Hearing Australia (with consent from the family).

8.2.2 Making a priority access request under the hearing stream

Once the hearing loss is confirmed, Hearing Australia will assist the family to submit a priority access request to the NDIA. This will generally occur at the child’s first appointment but may happen later if requested by the family.

With permission, Hearing Australia will submit:

• all documentation including an audiological assessment report with an audiogram and
• the specific Evidence of Disability (EOD) form to the National Access and Reassessment Branch, marked as a high priority.

The EOD form has been specifically designed for use by Hearing Australia under the hearing stream. Once a completed access request has been submitted the access decision will be made by the delegate within 2 business days.

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Note: If it is identified that the child has additional needs or other areas of concern, Hearing Australia may support the family to also make early contact with their early childhood partner.

An early childhood partner can also support the child’s family with early connections, and if required can submit a priority access request under the hearing stream. For example, the child has a newly diagnosed hearing loss which is likely to meet the eligibility criteria, however the family have chosen not to receive services from Hearing Australia. In this case, the early childhood partner will email the access request and supporting evidence to:

• redacted: s47E(d)@ndis.gov.au
• with the email subject header: Priority Access Level 1 early childhood partner - Hearing Australia – Urgent – Access Request for <Insert Person’s first and last name>

8.2.3 Developing the initial plan under the hearing stream

Once access is met, the participant will be triaged to the hearing stream. The HSL delegate will contact the participant’s child representative to develop the plan.

The plan will:

• be developed over the phone or via video link
• have a generic goal as agreed to by the family or carer
• have an initial funding amount primarily based on the degree of the participant’s hearing loss.

Note: Should the child’s family or carer wish to include additional goals in their child’s plan they can be encouraged to do so. To learn more go to Appendix 1 of the Practice Guide - Early childhood planning and Our Guideline – Creating your plan.

8.2.4 Plan approval

The plan will then be developed and approved within 10 business days of the access decision date. The HSL delegate will inform the family or carer once the plan is approved and connect them with their local early childhood partner to support plan implementation.

8.2.5 Plan implementation and connection to local community and mainstream supports

Following the approval of the plan, the early childhood partner will then become the family’s key contact, supporting plan implementation and linkages to mainstream and community supports.

8.2.6 Plan reassessment

If it is identified during the initial planning conversation that the participant has additional support needs which are unmet in the plan, the early childhood partner will meet with the child’s family to undertake a family-centred, evidence-based assessment of the child and family’s needs. This may result in a plan reassessment being recommended, this will require delegate approval.

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Refer to the Plan reassessment – CEO-initiated section of this practice guide for further information.

8.3 Determining eligibility for the hearing stream

Once priority access is met, the participant will be assigned in the NDIS Business System (System) to the HSL Coordinator managed via the Early Childhood Services Branch.

A new participant is likely to be eligible for the hearing stream if they:

• have a new diagnosis of a confirmed, permanent hearing loss and they have been referred by Hearing Australia
• have a new diagnosis of a confirmed, permanent hearing loss and they have been referred by the early childhood partner
• are identified with high risk of auditory / language deprivation related to a significantly delayed diagnosis of a permanent hearing loss, which requires immediate early intervention support.

A child is not eligible for the hearing stream if they are a new participant with an existing diagnosis of a confirmed hearing loss. This is because they are likely to have already been connected to early intervention supports.

8.4 Having the planning conversation

The NDIA must ensure that assistance is provided to the participant’s child representative to support their communication with the Agency. For further information refer to Practice Guidance – Assisting Communications.

The child representative’s preferred method of communication needs to be established before the planning conversation. Where necessary alternative face to face (for example via video link or in person) arrangements can be made to ensure they are able to fully participate in the planning conversation.

If a child’s representative has alternative communication needs:

• confirm if the planning conversation can take place over the phone or via video link
• understand and respect communication barriers for example, the child representative may require an interpreter (Auslan or LOTE) or live captioning.

HSL delegates will engage with the participant’s child representative in a conversational manner, reflecting a family-centred focus to avoid information gathering in an interview style. Refer to Appendix 2 of the Standard Operating Procedure - NDIS Pathway Hearing Stream for children younger than 7 for the recommended script.

8.5 Pre-planning tasks

When developing plans under the hearing stream, the HSL delegate should complete the following pre-planning tasks in the System:

• review participant streaming

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• update consent and proof of identity

• update the severity tools (including the PEDI-CAT)

• check participant’s disabilities

• complete early childhood planning note pad (optional off system tool)

• complete participant statement

• complete informal and community mainstream supports (for example listing Hearing Australia as a mainstream support)

• update Outcomes and Family Questionnaire

• complete risk assessment

• complete share plan information

• update the relevant guided planning questions (saved but not submitted)

• read and tick the reasonable and necessary supports statement in the planning conversation tool (PCT)

• update My NDIS Contact

Go to the pre-planning tasks section of the [Practice Guide - Early childhood planning](/foi-library/releases/7408eb842277-22-23-0633-documents-disclosure-log/document-018__practice-guide-early-childhood/) for further information. The information below highlights the pre-planning tasks where there are slight differences under the hearing stream.

8.5.1 Hearing Australia - Evidence of disability (EOD) form

The EOD form is unique to the hearing stream and is completed exclusively by Hearing Australia’s audiologists.

In preparation for the planning conversation the HSL delegate should review the:

• evidence including the EOD form • audiological assessment report • audiogram to confirm which funding level best aligns to the severity of the participant’s hearing loss and its likely functional impact.

8.5.2 Completing the participant statement

The HSL delegate may assist the participant’s child representative to prepare their statement and with agreement, inclusion of the recommended plan goal. Under the hearing stream the recommended plan goal focuses mainly on the child’s language and communication.

Recommended NDIS Plan Goal: would like <child’s name> to be able to understand and communicate effectively with those around them.

Note: This example goal is optional, the HSL delegate can support the family to further individualise the goals if the family wish to do so. Should the child representative wish to include additional goals in their child’s plan refer to Appendix 1 Practice Guide - Early childhood planning.

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8.5.3 Informal, community and mainstream supports

The supports and services provided by Hearing Australia, including details of the participant’s devices, would be considered a mainstream service for children who are deaf or hard of hearing.

Existing community and mainstream supports, like Hearing Australia, should be listed in the System as well as any supports the participant will engage with during the plan period. For further information refer to Our Guidelines – Mainstream and community supports overview and the Standard Operating Procedure – Record informal, community and mainstream supports.

8.5.4 Complete the risk assessment

Plans developed under the hearing stream will have a recommended plan duration of 12 months. For further information refer to the Standard Operating Procedure – Complete the determine plan management task.

8.6 Planning

8.6.1 Support budgets

Funded supports in a participant’s plan are included in one or more budgets based on the purpose of the support: Core, Capacity Building and Capital. Under the hearing stream, funding is included in the Core and Capacity Building budgets.

8.6.2 Core supports

For plans developed under the hearing stream consider including funding for low cost assistive technology (AT).

Under the HSP, the participant can enter into a maintenance agreement to receive batteries and maintenance (including repairs and spare parts) for their hearing device. Under the maintenance agreement, the participant is required to make a small co-payment towards the annual maintenance fee.

Include low cost AT for Hearing Related AT Core – Consumables to cover the cost of this annual maintenance co-contribution fee in the initial plan. For further information refer to the Standard Operating Procedure - NDIS Pathway Hearing Stream for children younger than 7, the Fact Sheet -AT- Guide for low cost support funding or Standard Operating Procedure - Add low cost assistive technology supports in a plan.

8.6.3 Capacity Building (CB) supports

Based on the planning conversation and upon reviewing available evidence the HSL delegate can determine the most appropriate level of funding to include in the initial plan. The hours of Early Childhood Supports– Early Childhood Professional to include in the initial plan is selected from the four levels outlined in Table three.

For initial plans developed under the hearing stream the funding level for capacity building supports is primarily based on the child’s average hearing loss, typically the four-frequency average hearing loss (4FAHL), in their poorer ear.

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For further information on how to calculate the four frequency average hearing loss (4FAHL) refer to the Standard Operating Procedure - NDIS Pathway Hearing Stream for children younger than 7.

8.6.4 Table three: Recommended levels of CB support to be included in the initial 12-month plan

Level	CB Supports	Description
Level 1	redacted: s47E(d) - certain operations	Unilateral hearing loss (Mild/Moderate) in affected ear
Level 2	redacted: s47E(d) - certain operations	Unilateral hearing loss (Severe/Profound/ANSD) in affected ear Mild hearing loss in both ears
Level 3	redacted: s47E(d) - certain operations	Hearing loss in both ears, with a Moderate hearing loss in the poorer ear
Level 4	redacted: s47E(d) - certain operations	Hearing loss in both ears, with a Severe/Profound/ANSD hearing loss in the poorer ear

Note: The funding levels in table three should only be used by HSL delegates developing an initial plan for a participant younger than 7, eligible for the hearing stream. For participants younger than 7 who are not eligible for the hearing stream please refer to the determining capacity building supports for participants with hearing loss section in this guide and the Practice Guide - Early childhood planning. For a child with a bilateral hearing loss, where the evidence indicates they are at significant risk of auditory and language deprivation, consider increasing the funding level to the next level (capped at level 4). For example, the diagnosis of a child’s hearing loss was delayed by more than six months.

8.6.5 Case Study: Olive – evidence of a delayed diagnosed

Olive’s family reported she did not pass her initial hearing screen as a newborn. Follow up diagnostic assessments were not pursued as Olive’s family were not concerned at the time and noticed she was responding to sounds around the home. Olive’s family took her to see a speech pathologist when she was 3 years old as they had some concerns around the development of her speech sounds. The speech pathologist referred Olive to a paediatric audiologist where she was diagnosed with a mild, sensorineural hearing loss in both ears. Olive was immediately referred to Hearing Australia. Hearing Australia fitted Olive with hearing aids in each ear and supported her to access the NDIS under the priority hearing stream.

Given Olive did not pass her newborn hearing screen, Olive’s audiologist and ear specialist reported her hearing loss was likely to be congenital and the diagnosis of Olive’s hearing loss was considered significantly delayed. With reference to table three, under the hearing stream she would normally be allocated level 2 funding, however given the evidence of the delayed diagnosis it would be appropriate to increase the amount of funding to level 3. Olive now receives regular specialist early childhood intervention to support the development of her listening skills, speech and language development.

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8.6.6 Capital supports

Under the hearing stream, assistive technology including hearing devices, remote microphone systems and cochlear implant speech processors are provided by Hearing Australia, funded under the Hearing Services Program. To learn more, go to Determining supports in the Capital budget.

8.7 Justification for reasonable and necessary supports

Justification comments must be recorded before the plan can be submitted for approval. HSL delegates are responsible for providing adequate justifications, including recording that the plan was developed under the hearing stream.

It is best practice to include the following information in justification comments:

• succinct summary of the child context and impact of disability • description of the support and reasons for including it in the plan • how the proposed support enables the participant to pursue goals • how the proposed support meets the reasonable and necessary criteria • any relevant supporting evidence to support the inclusion of proposed supports

For more information refer to the Standard Operating Procedure - Review and submit a plan for approval and the Interaction template - planning.

8.8 Finalise and Approve a Plan

This task is completed by the HSL delegate and involves determining if the proposed plan meets the reasonable and necessary criteria under s.34 of the NDIS Act.

For more information refer to Our Guidelines – Creating your plan and Our Guidelines – Reasonable and necessary supports. Further information is also available in the Practice Guide – Early childhood planning and Standard Operating Procedure - Finalise and Approve a Plan.

Once a plan is approved, the NDIA must provide a copy of the plan to the participant’s child representative within 7 days of the plan coming into effect.

A participant’s approved plan can be provided in alternate accessible formats as per the Practice Guide - Assisting Communication. This provision is satisfied by the plan being sent to the participant’s child representative or by being able to view it in the participant portal.

If the participant’s child representative has not received the portal activation code, provide this and information on accessing the myGov portal.

Once the plan is approved, the HSL delegate will assign the participant to their identified early childhood partner using the interaction template Early childhood - Plan approved and ready for implementation – Hearing stream for participants younger than 7 (along with an email where possible) to advise the early childhood partner that the plan has been approved. Advise the participant’s family who their local early childhood partner is, clarifying they will

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support plan implementation and be the family’s ongoing point of contact with the Agency. Make sure the family understand that they can now start using their NDIS funding.

Note: Assign participant to designated early childhood partner inbox in participant’s region as an open interaction.

For further information refer to the Standard Operating Procedure - NDIS Pathway Hearing Stream for children younger than 7.

9. Plan changes

9.1 Plan reassessment - CEO-initiated

Participants younger than 7 who have newly diagnosed hearing loss and additional disabilities, or other areas of need identified will be offered an initial plan under the hearing stream. Once the plan is approved the early childhood partner should then engage with the family to undertake a family-centred, evidence-based assessment of the child and family’s needs. Ideally, this will be conducted within four weeks of the approval of the initial plan. This may include linkages to mainstream or community services and other supports. It may result in a plan reassessment.

If additional funded supports are required, the Agency may need to initiate a plan reassessment.

9.2 Requesting a CEO-initiated plan reassessment

Contact the HSL delegate who approved the initial plan via email (provide justification and attach any supporting evidence) and an open interaction to request a plan reassessment.

Create an Open Interaction using the Interaction template – NDIS staff: pre-check and booking.

The HSL delegate will review the evidence to decide whether to conduct a plan reassessment.

If a plan reassessment is approved the HSL delegate will:

• initiate the reassessment • reassign the application back to the early childhood partner.

The early childhood partner will then complete pre-planning and planning tasks and will assign the application to the HSL delegate for approval.

Note: Do not ‘Review and Submit Plan for Approval’ if using Work Load Manager as it will not be assigned to the appropriate HSL delegate.

If a plan reassessment is declined the HSL delegate will discuss this with the early childhood partner and create an interaction detailing the decision.

Go to Our Guidelines – Your Plan, Our Guidelines -Changing your plan and Standard Operating Procedure – Initiate an Agency-initiated plan review more than 100 days of plan review date.

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For further information related to participant requested plan reassessments, where the participant’s circumstances have changed or their current plan no longer meets their needs (see case study below) go to the Standard Operating Procedure - Create a plan reassessment (or variation) request (PRR) and Standard Operating Procedure – Support tool to determine CEO-initiated plan reassessment type within 100 days of plan reassessment date.

9.2.1 Determining additional funded supports

Continue to use the recommended level of supports funded under the hearing stream, Table three. This level of capacity building supports, is predominantly based on the degree of the child’s hearing loss (and likely functional impact) and is expected to support the child’s:

• language and communication development • social development • emotional development.

If the child has additional support needs (high or medium-low) identified, for example, related to their physical development, (go to the Guide Appendix 2) consider these in addition to the capacity building funding originally allocated under the hearing stream.

Include your reasonable and necessary justification for these supports as a justification comment in the System also including this in the Interaction Early childhood – Plan Submitted for Approval – First Plan or Plan Reassessment (full) within 100 days of plan reassessment date.

Refer to the Practice Guide - Early childhood planning for further information.

9.2.2 Case Study - Zoe, infant requiring a plan reassessment (CEO-initiated)

After Zoe’s newborn hearing screening tests, she was immediately referred to an audiologist for a full diagnostic audiological assessment. Results confirmed Zoe had a severe, sensorineural hearing loss in both ears. Zoe was referred to Hearing Australia and she proceeded to have hearing aids fitted. At their appointment, the family informed their audiologist that they had significant concerns regarding Zoe’s physical development, and that she was undergoing paediatric neurology investigations.

Hearing Australia supported Zoe’s family to submit a priority access request to the NDIA via the hearing stream. The audiologist noted on the EOD form that Zoe was undergoing paediatric neurology investigations due to other identified areas of concern.

Zoe quickly became a NDIS participant and was contacted by a HSL delegate to develop her initial plan. The approved plan included redacted: s47E(d) - ce hours (level 4) of Early Childhood Supports – Early Childhood Professional. As it was identified that Zoe had other areas of concern, a priority appointment with their early childhood partner was arranged.

The early childhood partner met with the family and identified that Zoe had one other area of concern which related to her physical development. A plan reassessment was initiated and approved. Zoe’s initial plan was reassessed to include new goals and additional funding to address Zoe’s physical development, which was identified as a ‘high’ area of need. In this

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example, redacted: s47E(d) - ce hours plus redacted: s47E(d) additional hours, a total of redacted: s47E(d) - ce hours of Early Childhood Supports – Early Childhood Professional was included in the new plan.

9.2.3 Case Study - Zayden infant, plan reassessment – participant requested

Zayden is a 7-month-old, his family have requested a reassessment due to a change in circumstance.

Zayden was diagnosed with a unilateral hearing loss at 2 months of age. He was referred to Hearing Australia and was fitted with a hearing aid in the affected ear. Hearing Australia assisted Zayden to access the priority hearing stream. Under the hearing stream Zayden received a level 1 plan which included redacted: s47E(d) hours of ‘Early Childhood Supports – Early Childhood Professional’. At the time the initial plan was developed, hearing was the only reported area of need.

Five months later, Zayden’s family contacted their early childhood partner to report that Zayden’s paediatrician recently confirmed several other delays in his development including his fine and gross motor skills, cognition and a visual impairment. Based on this new evidence Zayden’s family require additional funding to access other early childhood intervention supports. In view of the change in circumstance and new evidence, the early childhood partner supports the family with a plan reassessment request. The decision to conduct the plan reassessment was referred to the National reassessment team.

9.3 Determining capacity building supports

Note: This guidance will help you develop plans for participants younger than 7 who are deaf or hard of hearing. Whether it be for their plan reassessment or for a new participant with an existing hearing loss, who has not accessed the Scheme via the priority hearing stream. Use the early childhood approach outlined in the Practice Guide - Early childhood planning Our Guidelines - early childhood approach, and Our Guideline – Changing your plan when developing these plans.

More information can also be found in Guides for understanding supports - children who are deaf of hard of hearing.

The early childhood approach will assist you to determine a level of reasonable and necessary funded supports to include in plans. The plans should be built based on the family and carers’ goals for the participant, the functional impact of the participant’s disability on daily life, and the level of support required. For participants younger than 7, Capacity Building budgets are determined based on the participant’s number of high and medium to low areas of need. Section 5.2 of the Practice Guide – Early childhood planning unpacks what we mean by high and medium to low areas of need. You will need to have a clear understanding of this when planning for children younger than 7.

During the planning conversation with the participant’s family or carer, it is important to understand current plan utilisation and future recommendations. If the child’s first plan was, for example, developed under the hearing stream, then discuss plan utilisation. Where the plan was underutilised, the reasons for this should be understood. For example, the family may have needed time to come to terms with the diagnosis of their child’s hearing loss.

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For participants younger than 7, the Guide for calculating early childhood capacity building supports (the Guide), outlined in Appendix 2 of the Practice Guide – Early childhood planning should be used to develop these plans. The Guide will typically provide a level of Capacity Building supports based the number of identified high and medium to low areas of need. You should use the ‘intensive capacity building supports in early childhood form’ (Intensive form) when considering requests for intensive supports for participants younger than 7.

The newborn hearing screening program targets children with moderate or above hearing loss in both ears. This is because evidence shows that communication outcomes are significantly improved when the hearing loss is identified early, and intervention commences soon after. Hearing should always be identified as a high area of need for children who have this degree of hearing loss.

The impact of mild and unilateral hearing loss varies amongst individuals, as does the benefit of early intervention including amplification. These children may be at risk, however to date, research has been inconclusive. Given there are no clear recommendations of best management approaches, it is recommended that the outcomes of hearing related functional assessments (documented in provider reports) are also taken into consideration when determining whether hearing is identified as a high or medium to low area of need.

Include your justification for reasonable and necessary supports in the justification comments. All information related to the functional impact of the participant’s needs and calculations of supports must be documented in the justification comments, refer to Standard Operating Procedure – Review and submit plan for approval for further information.

9.4 Determining supports in Core budget

9.4.1 Consumable – Low cost assistive technology

Hearing devices for children are provided by Hearing Australia, funded under the HSP. Families can enter into a maintenance agreement, receiving batteries and maintenance for their child’s hearing device. This includes repairs and spare parts for their hearing device and/or speech processor. Under the maintenance agreement the participant’s family makes a small co-payment towards the annual maintenance fee. This can be funded as low cost AT.

Go to the Fact Sheet - AT - Guide for low cost support funding, Assistive Technology, Home Modification and Consumables Code Guide or Standard Operating Procedure - Add low cost assistive technology supports in a plan for further information.

The following low cost AT items are commonly requested and may be funded if there is sufficient evidence to demonstrate that they meet the reasonable and necessary criteria:

• specialised alarm systems such as a flashing doorbell and other alerting systems. • cochlear Implant waterproof accessories such as the Aqua + which is the compatible option for the Nucleus 7 speech processor.

Speech processors (including their replacement parts), remote microphone or wireless communication devices are funded under the HSP and are generally not funded under the NDIS.

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9.4.2 Auslan related supports

Auslan related supports should be considered on an individual basis and funded under the NDIS where the support meets the reasonable and necessary criteria. The choice of communication approach is the family’s decision. There are various communication approaches, and there is no one communication approach that fits every family’s needs. The NDIA will need to take this into account when determining reasonable and necessary supports to ensure the capacity of families is increased, so they can support their child’s language development. Auslan related supports are considered reasonable and necessary and need to be considered on an individual basis.

A participant’s age and level of hearing loss are some of the factors to consider when determining the level of support an individual may need in their everyday life. Other factors to consider include:

• the child’s family and social networks • the child’s access to early intervention supports • access to mainstream service, for example, education • provider reports which include the child’s progress towards goals, outcomes achieved and provider recommendation • other disabilities, geographic location and cultural backgrounds also influence the type and severity of barriers which a child who is deaf may experience.

The level of support that a participant might require will vary depending on their language development, literacy skills and preferred method of communication.

For further information related to Auslan related supports go to the Practice Guide - Assisting Communications and Would We fund it resources related to Auslan.

• Auslan language development supports

 This support type is typically delivered in children's natural, everyday settings, such as home and childcare. Auslan language development supports aim to build the capacity of the child, family, and other important people in the child's life to ensure that they can meaningfully and effectively communicate.
 
 Auslan language development support may include, but is not limited to teaching Auslan, provision of strategies to support communication and interaction between the child and informal supports, education around Deaf culture, recommendations and the development of resources.
 
 Learning Auslan is not a short-term activity, it requires long-term support to ensure the child and their family fully immerse in learning Auslan to maximise language acquisition. Families should be encouraged to use quality Auslan trainers who are fluent and extensively experienced with teaching Auslan to children and families. It is important that families have opportunities to practice Auslan skills with other fluent Auslan users.

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Case Study: Jeff – Auslan development supports

Jeff is a deaf child; he was born with a profound hearing loss in both ears. Jeff wears hearing aids and uses Auslan to communicate. He attends a mainstream bilingual early intervention program twice a week. Jeff’s family is invested in supporting him to be bilingual and is learning Auslan to maximise the development of Jeff’s communication and language development. Jeff’s family have also made some connection to deaf community groups such as Deaf 4WD Social Group and Parents Mentor support group.

During the planning meeting, Jeff’s family expressed interest in increasing their Auslan skills and submitted a provider report recommending a high level of Auslan language development supports including ‘Auslan in the home’ for Jeff and his family.

Based on the evidence, funding for the Auslan language development supports was deemed to be reasonable and necessary.

• Auslan training

 This is typically delivered at settings in the child’s community, like their local sports club or church. They may include but are not limited to Deaf Awareness Training (DAT), provision of targeted strategies to promote inclusion and communication and education of specific Auslan signs. The availability and appropriateness of mainstream options for general Auslan training through, for example, the education system or the community should be explored alongside NDIS funded supports.

• Auslan interpreting

 This is an important consideration to ensure Deaf children can access services. It is recommended that funding for interpreting services be included where it is considered appropriate and meets the reasonable and necessary criteria. It is important to give children access to incidental learnings and positively increasing their social and community participation, supporting their social and emotional development. For further information related to interpreting and translation supports go to the [Practice Guide - Assisting Communications](/foi-library/releases/079ffed7fb07-foi-2324-0814-disclosure-log/document-001__practice-guide-assisting-communication/).

9.5 Determining support in the Capital budget

Funding for hearing services and devices should not be included in a child’s NDIS plan. Fully government subsidised hearing devices are provided to children at no cost under the HSP. Hearing Australia is responsible for managing this program, including the provision of hearing devices and speech processors. Go to Hearing Australia’s policy to learn more about the technology that is provided at no cost to children.

Eligible young Australians under 26 years of age can obtain speech processors to replace those that are lost or damaged beyond repair. Upgraded technology can be provided to young people who meet certain clinical criteria. For further information go to Hearing Australia’s Cochlear Implant Speech Processor Upgrade and Replacement Program.

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10. Supporting material

• NDIS Act 2013 and NDIS Rules 2013, 2014 and 2016 • Our Guidelines – Mainstream and community supports overview • Our Guidelines – Creating your plan • Our Guidelines – Reasonable and necessary supports. • Our Guidelines – Assistive technology • Our Guidelines – Early childhood approach • Our Guidelines - Early connections • Our Guidelines -Changing your plan • Cochlear Implant Speech Processor Upgrade and Replacement Program • Hearing Australia’s policy • Choices eBook • Assistive Technology, Home Modification and Consumables Code Guide • Systematic review of the literature on early intervention for children with a permanent hearing loss • National Guidelines Best Practice in Early Childhood Intervention • Deafness and Hearing Impairment Snapshot • Fact Sheet - AT - Guide for low cost support funding • Practice Guide - Assisting Communications • Practice Guide - Early childhood planning • Standard Operating Procedure - NDIS Pathway Hearing Stream for children younger than 7 • Standard Operating Procedure – Record informal, community and mainstream supports • Standard Operating Procedure - Complete the determine plan management task • Standard Operating Procedure - Add low cost assistive technology supports in a plan • Standard Operating Procedure - Review and submit a plan for approval • Standard Operating Procedure - Finalise and Approve a Plan • Standard Operating Procedure – Initiate an Agency-initiated plan review more than 100 days of plan review date • Intensive capacity building supports in early childhood form (Intensive form)

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• Interaction templates – Pre-planning • Interaction Template - Planning • Would We fund it

11. Process owner and approver

Branch Manager Early Childhood Services.

12. Feedback

If you have any feedback about this Practice Guide please submit your feedback by completing and submitting this Early Childhood feedback email form. Alternatively, you can use this accessible feedback form. First save it to your computer, then complete the form and send it to Early Childhood inbox

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13. Version change control

Version No	Amended by	Brief Description of Change	Status	Date
1.0	CM0032	Minor feedback to enhance ECI wording; accessibility check	APPROVED	2019-09-16
2.0	LNL387	Class 3 approval	APPROVED	2020-05-28
3.0	CM0032	Updated to include new eligibility criteria, updated links to OGs and removal of reference to CBSN	APPROVED	2022-05-23
4.0	FC0007	Class 1 approval	APPROVED	2022-12-20
4.1	MM0095	Age range change updates	DRAFT	2023-04-06
4.2	FC0007	Class 1 approval	APPROVED	2023-04-11
4.3	DHO937	Accessibility check	APPROVED	2023-04-11

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OFFICIAL DOCUMENT 10

Standard Operating Procedure

For Internal Use Only

The contents of this document are OFFICIAL.

NDIS Pathway hearing stream for children younger than 7

This Standard Operating Procedure (SOP) will assist you to complete the following in the NDIS Business System (System):

• Complete the pre-planning and planning tasks for participants younger than 7, newly diagnosed with a permanent hearing loss and eligible to receive a NDIS plan under the NDIS Pathway hearing stream (hearing stream). • Determine the reasonable and necessary level of funding for Capacity Building and Core supports for an initial plan under the hearing stream.

From 1 July 2023, the age of children supported under the early childhood approach will progressively change to include children younger than 9. However, there is no change to the age of participants accessing the hearing stream, it remains for participants younger than 7, newly diagnosed with a permanent hearing loss.

Note: The funding levels in Table 2 should only be used by Hearing Stream Lead (HSL) delegates developing an initial plan for participants younger than 7, who are eligible for the hearing stream. For participants younger than 7 not eligible for the hearing stream, follow the Practice Guide – Early childhood planning using the Guide for calculating capacity building supports for early childhood. Plans developed under the hearing stream are generally approved within 10 business days from the date the access met decision was made. They will have a recommended duration of 12 months.

1. Recent updates

Date	What’s changed
July 2023	The following update has been made: • Age range change to younger than 9 for the early childhood approach, however hearing stream remains for participants younger than 7.

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Standard Operating Procedure

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Date	What’s changed
November 2022	The following update has been made to section 3.7 – Enter Capacity Building funding: • Updated comment recorded on the child’s plan (section 3.7 step 9).
May 2022	The following updates have been made: • Updated to align with updated Practice Guide – Early Childhood – Supports for children who are deaf or hard of hearing. • Name changed from SOP – NDIS Pathway Hearing Stream for children aged under seven years to SOP – NDIS Pathway Hearing Stream for children younger than 7. • Transitioned to current Standard Operating Procedure template.

2. Checklist

Topic	Checklist
Pre-requisites	You have: ☐ read Practice Guide – Early Childhood – Supports for children who are deaf or hard of hearing ☐ read and are familiar with Practice Guide – Early childhood planning, Our Guideline – Early childhood approach, Our Guideline – Creating your plan and Our Guideline – Reasonable and necessary supports. ☐ made sure the primary disability and streaming have been correctly recorded in the System and the participant is eligible for the hearing stream. ☐ access to PEDI-CAT to complete the Update Severity Tools task.
Actions	☐ 3.1 Prepare for the planning conversation ☐ 3.2 Conduct the planning conversation ☐ 3.3 Complete pre-planning tasks

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Standard Operating Procedure

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Topic	Checklist
	☐ 3.4 Add a Capacity Building goal ☐ 3.5 Complete planning tasks ☐ 3.6 Enter Core funding ☐ 3.7 Enter Capacity Building funding ☐ 3.8 Capital ☐ 3.9 Save and submit funding ☐ 3.10 Determine plan management ☐ 3.11 Review and submit plan for approval ☐ 3.12 Finalise and approve plan ☐ 3.13 Implementation

3. Procedure

3.1 Prepare for the planning conversation

When developing plans under the hearing stream, the HSL delegate will complete the following pre-planning tasks in the System:

• review participant streaming • update consent and proof of identity • update the severity tools (including the PEDI-CAT) • check the participant’s disabilities • complete the participant statement • update the Outcomes and Family Questionnaire • complete share plan information • update the relevant guided planning questions (saved but not submitted) • read and tick the reasonable and necessary supports statement in the planning conversation tool (PCT) • update My NDIS Contact.

There may be relevant information in the System from the participant’s family or carers to help you understand the participant’s circumstances. Check this information to avoid asking for information already provided. Go to the pre-planning tasks section of the Practice Guide – Early childhood planning for further information.

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Standard Operating Procedure

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The following pre-planning tasks are specific to the hearing stream:

• Review the evidence including the Hearing Australia Evidence of Disability (EOD) form. • Review the audiological assessment report. • Review the audiogram to determine which funding level best aligns to the degree of the participant’s hearing loss and its likely functional impact. Refer to section 4.1. • Review information gathered by the early childhood partner where early connections have been provided (if applicable). • Review other relevant information available within the participant’s record, including any Alerts and information for staff. • Review information recorded in Interactions. • Complete Risk Assessment. Plans developed under the hearing stream will have a recommended plan duration of 12 months. For further information refer to the Standard Operating Procedure – Complete the Risk Assessment task. • Complete informal community and mainstream supports. The supports and services provided by Hearing Australia, including details of the participant’s devices, are considered a mainstream service for children who are deaf or hard of hearing. For more information refer to Our Guideline – Mainstream and community supports overview and the Standard Operating Procedure – Record informal, community and mainstream supports.

3.2 Conducting the planning conversation

The planning conversation is conducted by the HSL. The HSL is a nominated delegate who has received training to develop plans under the hearing stream. The HSL delegate will guide the development of the plan, considering the participant’s goals, strengths and abilities, and support needs. To ensure the planning conversation is a positive experience, the HSL delegate will engage with the participant’s child representative in a conversational manner, reflecting a family-centred focus. For recommended scripting to assist with planning conversations refer to section 4.2.

We must make sure that the child representative is supported to communicate with the Agency. For further information refer to Practice Guidance – Assisting Communications.

If a child representative has alternative communication needs:

• confirm if the planning conversation can take place over the phone or via video link • understand and respect communication barriers for example, the child representative may require an interpreter (Auslan or LOTE) or live captioning.

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Standard Operating Procedure

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Note: If an interpreter is unavailable within the 2-week timeframe, create an interaction to explain why the approval of the plan will be more than 10 business days from the access met decision.

When conducting your conversation, confirm that you are speaking with the participant’s child representative. The child representative has authority to act on the participant’s behalf. Refer to:

• Our Guideline – Child representatives • Standard operating procedure – Record and verify identity for an individual • Standard operating procedure – Verify identity for a third party organisation

Note: If you are unable to contact the child representative on 5 occasions refer to Standard Operating Procedure – Unable to contact the participant. Advise the ECS Branch Hearing stream coordinator via email once this process has been completed.

Face-to-Face planning appointment required (priority)

Where a planning conversation over the phone or via video link is not appropriate, a face-to-face planning conversation with the early childhood partner will be arranged as a high priority. Where possible, the HSL delegate can join this appointment by video/teleconference or in person. The HSL delegate will be responsible for developing and approving the initial plan.

3.3 Complete pre-planning tasks

1. From the NDIS account, select Pathway.
2. Select the relevant Application.
3. Select Pre-Planning.

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Standard Operating Procedure

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4. Complete Pre-Planning tasks. The Practice Guide – Early childhood planning outlines the approach to develop plans for participants younger than 7.
5. To add a goal go to 3.3.1 Add a Capacity building goal.
6. Make sure all Pre-Planning tasks are submitted except for the Guided Planning Questions which you must answer and save. Do not submit. Go to the Standard Operating Procedure – Complete the Guided Planning Questions for further information.
7. The Pre-Planning tasks will display a green tick when complete.
8. Confirm the preferred method of contact with the child representative. Advise the child representative of the timeframe when the plan will be approved. Once approved, advise the child representative.

3.4 Add a Capacity Building goal

Within Complete Participant Statement, the HSL delegate may assist the participant’s child representative to prepare their statement and, with agreement, include the recommended plan goal. Under the hearing stream the recommended plan goal focuses on the child’s language and communication.

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Standard Operating Procedure

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1. At My Plan Goals add a goal. Recommended NDIS plan goal: would like <child’s name> to be able to understand and communicate effectively with those around them.

   Note: This example goal is optional, the HSL delegate can support the family to further individualise the goals if the family wish to do so. To include additional goals in their child’s plan refer to Appendix 1 Practice Guide – Early childhood planning.

2. Select Daily Life.

3. Select Capacity Building.

4. At How I will achieve this goal enter: <child’s name> will be able to develop communication skills to strengthen relationships with <his/her/their> family and the community. At How will I be supported enter: <child’s name> will be supported by <his/her/their> locally identified early childhood intervention (key worker model) provider working closely with <child’s name> using evidence based practice to assist <child’s name> to reach <his/her/their> goal focusing on their communication support needs.

3.5 Complete planning tasks

5. From the Participant Account screen select Pathway.
6. Select the relevant Application.

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Standard Operating Procedure

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7. Select Planning.
8. The Planning page displays. Select Determine the Funded Supports.
9. The Determine the Support Needs form opens. There is the option for 3 Support Types in the plan budget Core, Capacity Building and Capital. Under the hearing stream, funding is included in the Core and Capacity Building budgets.

Note: Do not click on Generate Support Plan. For early childhood plans a TSP is not generated. Plans developed under the hearing stream are first plans, the values displayed will all be zero and there will be no prepopulated funds.

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Standard Operating Procedure

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3.6 Enter Core funding

10. Include funding for low-cost AT. Select the Support Type Core.
11. The support categories are displayed. Select the support calculator category at Consumables by clicking on the Expander (2 overlapping boxes).
12. Select the Product field.

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13. In the product field, search for Low Cost AT and select the line item Low Cost AT For Hearing Related AT.
14. The Support Calculator opens.

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Standard Operating Procedure

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At Quantity enter one hundred quantities ($100) of Low Cost AT units using the guidance in the:

• At Quantity enter the number of units (1 unit = $1) • At How Often, select Per Year from the drop down box • Select Done

Note: If a child is using hearing devices, you must enter one hundred quantities ($100) of low cost AT to make sure the family can access funding for the co-contribution fee for the annual maintenance agreement under the Hearing Services Program (HSP).

For further information refer to Practice Guide – Early Childhood – Supports for children who are deaf or hard of hearing or Standard Operating Procedure-Add low cost assistive technology support in a plan.

15. Remove the automatically generated support item comment in the Consumables field and replace with the comment below.

<Funding for assistive technology: <$insert budget amount> is allocated for the purchase of low cost assistive technology to support you to pursue your goals and outcomes for . This funding may be used flexibly to cover the annual maintenance and batteries contribution related to the services your child receives from the Hearing Services Program>.

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Standard Operating Procedure

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Note: Only include additional quantities of Low Cost AT For Hearing Related AT if this is reasonable and necessary.

16. Select Support Type to return to the main Determine Support Needs screen.

3.7 Enter Capacity Building funding

1. From the Support Type screen select Capacity Building. The support categories Capacity Building and Support Coordination are displayed.
2. Select the support category Capacity Building. All of the Capacity Building supports will be displayed.
3. Open the support calculator from the CB Daily Activity category by selecting the Expander (2 overlapping boxes).

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Standard Operating Procedure

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4. The Support Calculator opens. Select the Expander (2 overlapping boxes) in the Product field.
5. Select Early Childhood Supports – Early Childhood Professional. The search field can also be used to find the item.

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Standard Operating Procedure

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6. Enter the Quantity determined in pre-planning.

   • Level 1 quantity redacted: s47E(d) (hours) • Level 2 quantity redacted: s47E(d) (hours) • Level 3 quantity redacted: s47E(d) (hours) • Level 4 quantity redacted: s47E(d) - ce (hours)

   • At Quantity select the relevant amount • At How Often select per year.

7. Select Done.

8. Delete the auto-generated Comment.

9. In the Comment section of the Determine the Support Needs screen add the following comment:

   • Insert the next 3 paragraphs.

This funding is for capacity building - early childhood supports. To achieve the best outcomes it is important that these supports are delivered within the home and

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Standard Operating Procedure

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community, by early childhood professionals. These professionals should have a Bachelor’s degree or higher and have registration or membership with relevant professional bodies, such as an occupational therapist, speech pathologist, physiotherapist, psychologist, social worker, early childhood teacher and developmental educator.

Professionals should use a best practice model, all working together as a team with your family to pursue your goals for and preferably using a key worker model. It is expected the supports are delivered in line with the NDIS Commission’s NDIS Practice Standards and Quality Indicators for Early Childhood Supports, the NDIS Code of Conduct and the NDIS Pricing Arrangement and Price Limits.

This funding includes time for professionals to build the capacity of those supporting , at home, childcare, preschool and/or school and support the effective use of hearing devices . It is expected that an annual progress report on <participant’s name> outcomes will take approximately <include between redacted: s47E(d) - c hours as per the Guide - Appendix 2> per year shared between your providers and it is strongly recommended they collaborate to use the NDIS early childhood provider report form. This funding also includes for Assistive Technology (AT) assessment .Note: Any comments recorded will print on the participant’s plan. The comments should include any information the family may need to describe and understand this support.

10. Link the funding in the Support Category to the participant’s Associated Goal using the drop down box next to the comment.
11. Return to the Support Category section of the System and enter any additional reasonable and necessary support items. Record any relevant comments.

Note: For more information on adding supports, such as plan management, refer to Standard Operating Procedure – Include plan management support items.

3.8 Capital

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Funding for hearing services and devices should not be included in a child’s NDIS plan. Fully government subsidised hearing devices are provided to children at no cost under the HSP. Hearing Australia is responsible for managing this program, including providing hearing devices and speech processors. Go to Hearing Australia’s policy to learn more about the technology that is provided to children at no cost.

Eligible young Australians under 26 years of age can get speech processors to replace those that are lost or damaged beyond repair. Upgraded technology can be provided to young people who meet certain clinical criteria. For more information go to Hearing Australia’s Cochlear Implant Speech Processor Upgrade and Replacement Program.

In general, we will not fund supports that are available to participants through mainstream supports like the HSP. For more information refer to the Practice Guide – Hearing Supports and Our Guideline – Reasonable and necessary supports.

3.9 Save and submit funding

1. Once all supports have been included in the plan you can return to the Determine the Funded Supports screen by selecting Support Type.

   Note: you can select Save at any time and return to complete it later.

2. When the form is complete, select Submit.

3. A confirmation message appears. This confirmation message will ask Are the funded supports correctly aligned to the goals listed in the Participant Statement?

   • If you select No, you will be taken to the Create-NDIS Participant Statement page to review the goals section and make sure the correct support type boxes have been ticked. • If you select Yes, you will continue as usual.

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4. The Planning – Staff Tasks page displays. Determine the Funded Supports has a green tick to show it is now complete.

3.10 Determine plan management

1. Select Determine Plan Management and refer to the guidance in Standard Operating Procedure – Complete the Determine Plan Management task.
2. For low cost AT make sure the Core-Consumable funding is either Plan Managed or Self Managed, where possible. Refer to Our Guideline – Assistive technology.

3.11 Review and submit plan for approval

Refer to Standard Operating Procedure – Review and submit plan for approval to complete the next step in the pathway.

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3.12 Finalise and approve plan

Prior to approving the plan, it is important you are satisfied there is sufficient evidence on the participant record to justify and support the reasonable and necessary decision making. This information should be recorded within Pre-Planning and Planning tasks, referencing that the plan was developed under the NDIS pathway hearing stream.

The HSL delegate will determine if the proposed plan meets the reasonable and necessary criteria. The HSL delegate will then approve the plan.

For more information refer to:

• Our Guideline – Creating your plan • Our Guideline – Reasonable and necessary supports • Practice Guide – Early childhood planning • Standard Operating Procedure – Finalise and approve a plan.

3.13 Implementation

When a plan is approved, a copy of the plan is automatically sent to the participant’s child representative within 7 days. A participant’s approved plan can be provided in alternate accessible formats. Refer to the Practice Guide – Assisting Communication for more information.

If the child representative has not received a my place portal activation code, make contact to provide them with this. Refer to Standard Operating Procedure – Generate an activation code.

If needed, provide the family with a link to the Hearing Supports page on the NDIS website.

After the call is complete use Interaction templates – General to create an open Interaction to the identified early childhood partner.

4. Appendices

4.1 Appendix 1 – Determining Capacity Building funding under the hearing stream

Under the priority hearing stream, the level of Capacity Building supports funded in the first plan is primarily based on the child’s average hearing loss (based on the four frequency average hearing loss (4FAHL) in their poorer ear (highest 4FAHL). The 4FAHL is an average of hearing thresholds at 500, 1000, 2000 and 4000Hz. If the audiogram is incomplete, then the HSL delegate will use available hearing thresholds to estimate the most appropriate initial funding level.

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Note: Refer to the poorer ear to determine the initial plan funding levels.

4.1.1 Table one: Classification of hearing loss

Degree of hearing loss	Decibel Range
Normal hearing	0 – 20dBHL
Mild	21 – 40dBHL
Moderate	41 – 60dBHL
Severe	61 – 90dBHL
Profound	>90dBHL

4.1.2 Table 2: Determining level of funding for NDIS plan for Capacity Building Supports for Early Childhood Professional

Level	CB Supports	Description
Level 1	redacted: s47E(d) hours	Unilateral hearing loss (Mild/Moderate) in affected ear
Level 2	redacted: s47E(d) hours	Unilateral hearing loss (Severe/Profound/ANSD) in affected ear Mild hearing loss in both ears
Level 3	redacted: s47E(d) hours	Hearing loss in both ears, with a Moderate hearing loss in the poorer ear
Level 4	redacted: s47E(d) - ce hours	Hearing loss in both ears, with a Severe/Profound/ANSD hearing loss in the poorer ear

4.1.3 Table 3: Example of how to calculate the four frequency average hearing loss (4FAHL)

	Left Ear	Right Ear
500Hz	20	55
1000Hz	30	65
2000Hz	35	70
4000Hz	35	70
4FAHL	20 + 30 + 35 + 35 = 120 ÷ 4	55 + 65 + 70 + 70 = 260 ÷ 4

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	Left Ear	Right Ear
Degree of hearing loss	30 (mild)	65 (severe)
Recommended funding level		Level 4

4.2 Appendix 2 – Recommended hearing stream script

This script is recommended for use when developing the initial plan under the hearing stream.

4.2.1 Task 1 Initiate call

Step 1: Make Outbound call

If call answered: go to Step 2

If call not answered:

• Record an Interaction Using Interaction templates – Pre-planning - Unable to complete Pre-planning and record the contact attempt. • Refer back to Standard Operating Procedure – Unable to contact the participant. • END.

Step 2: Introduction

• Hi, my name is . I’m calling from the National Disability Insurance Agency. • Is <child representative’s name> available please?

Yes – child representative available: go to Step 3

No, person identifies as a person not listed as primary contact.

If the person does not identify themselves as an authorised contact of the participant (their child representative) do not proceed with the call.

• Record an Interaction using Interaction templates – Pre-planning - Unable to complete Pre-planning. As per Chapter 3: Australian Privacy Principle (APP) 3 – Collection of solicited personal information (external) the name of the person who answered the phone should only be recorded if this information is needed to support contact with the child representative or authorised contact. • END.

Step 3: Checking identity and authority

Before proceeding, verify the identity of the participant’s child representative. Refer to Standard Operating Procedure – Record and verify identity for an individual.

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If identity is verified, proceed to Task 2.

If identity is unable to be verified:

• Do not proceed with the call. • Record an Interaction using Interaction Templates – Pre-planning - Unable to complete Pre-planning. As per the Australian Privacy Principle 3 (external) the name of the person who answered the phone should only be recorded if this information is needed to support contact with the child representative. • END.

4.2.2 Task 2 Provide information about the purpose of the call

• I understand <child’s name> has recently met access to the NDIS and we would like to develop a plan to assist <child’s name> have access early intervention supports as soon as possible. • If you agree we can develop this plan together now, would you like to proceed? • Do you have time to talk to me now, so I can develop <child’s name> plan today? • It will take about 45 minutes. Alternatively, we can make a start and finish at another time or arrange another time to speak over the phone?

Yes, child representative wants to develop plan now: go to Step 4

No, child representative would like an appointment over the phone at a later date

• When would it suit to have a planning conversation with me over the phone? Do you have any question or is there any information you require in the meantime?

• Book an appointment providing your name and contact details. • END

No, I want to meet with the early childhood partner in my local area

I will refer you back to where you will go on their waiting list. will contact you to arrange a planning appointment at a later stage. Refer the participant and their child representative to the early childhood partner.

Add Interaction Note: Document the date and details of the conversation as an open interaction to early childhood partner nominated person in the System. ‘ has declined the offer of an initial plan under the NDIS pathway hearing stream and would prefer to wait for a planning appointment. The early childhood partner organisation has been informed and will contact the family.’

If the child has additional disabilities or other developmental areas of need:

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• It is indicated that there are needs related to <other developmental areas / or other diagnosed disabilities>. We can continue over the phone today to develop a NDIS plan now, and this plan will primarily focus on supporting <child’s name’s> communication needs so you can immediately access early intervention supports. Once this plan is approved your early childhood partner will then be able to meet with you to better understand all areas of <child’s name> development. If needed, this may result in <child’s name> plan being reviewed. Alternatively, I can arrange for you to meet directly with over the coming weeks. They will then help you develop <child’s name> a NDIS plan that will address all developmental areas of need. How would you like to proceed?

Yes, child representative wants to develop plan now: go to Step 4

No, I would prefer to meet with the early childhood partner in my local area.

I will refer you back to . will contact you to arrange a planning appointment as soon as possible.

If child representative prefers to wait to have their planning appointment with their early childhood partner.

• Refer the participant and their child representative to the early childhood partner. • Add Interaction Note: Document the date and details of the conversation as an open interaction to early childhood partner nominated person in the System. has declined the offer of an initial plan under the NDIS pathway hearing stream and would prefer to wait for a planning appointment as <child’s name > has . The early childhood partner organisation has been informed and will contact the family. • END

Step 4: Planning Conversation

Yes, I have time to develop the initial plan now

Today I would like to gather some information in relation to <child’s name> to better understand <his/her/their> everyday activities, people in <his/her/their> life and current supports received. We will discuss your plan goals for <child’s name> and discuss the NDIS funded support to be included in this 12-month plan. I can give you an example of a goal you might like to use for this plan. <Optional talking point-recommended goal for plan: “ would like <child’s name> to be able to understand and communicate effectively with those around them.

Would you like to include any additional goals for <child’s name>?

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At the end of our conversation, I will be able to approve the plan and a copy of <child’s name’s> plan will be available to access on the myplace portal and will be mailed to you within seven days.

Step 5: Reasonable and necessay supports explanation

• Explain the definition to the child representative and select the checkbox in the PCT to indicate this has been completed.

The NDIS provides reasonable and necessary supports that aim to assist people to live a good life through building and maintaining independence and through participation in community, work and social activities. There must be evidence that funded supports are likely to be effective and beneficial (good practice) and represent a reasonable cost in comparison to alternative support. Importantly, funded supports must relate to a person’s disability and have a clear link to their goals. The NDIS does not fund supports that are seen as day-to-day living costs, that is, costs that everyone would incur regardless of whether they have a disability. Before the NDIS can determine what is reasonable and necessary to fund, we must first explore what can be provided by informal and other support systems. This is because the NDIS does not want to replace the positive natural supports a person has in their life (such as those supports provided by family, carers and friends); and because the NDIS is not responsible for funding supports that are already available through existing services, community groups or government departments (such as Medicare or the education system).

Step 6: Approved NDIS funded supports

<child’s name’s> plan will include for the provision of early childhood intervention supports to work together within the home and community settings, utilising relevant disciplines within a key worker model to support the development of <child’s name’s> communication skills. Hearing supports and services will continue to be provided by Hearing Australia funded under the Hearing Services Program. There is the inclusion of <$0.00> for low cost equipment <optional: to pay for the cost of your annual maintenance fee for Hearing Australia>.

Step 7: Plan approved

<child’s name’s> plan will be approved by <expected timeframe within the next 24 hours>. A copy of the plan will be available on the NDIS portal, a copy of the plan will also be automatically sent to you in the mail. Are you aware of the early childhood intervention providers in your local area? Your audiologist at Hearing Australia may have provided you information about this.

Yes, I am aware of early childhood intervention providers in my local area, and I feel confident in contacting them to deliver early intervention supports for my child.

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Great, you can get started. If you have any difficulties implementing your child’s plan, can assist you to engage with an early childhood intervention provider. The early childhood partner can also link you to other government and community services who may assist you and <child’s name> as needed. will be your ongoing point of contact with the NDIA and will also conduct future plan reviews with you and your child.

• Optional: If <child’s name> has support needs in addition to their hearing loss, < early childhood partner name > may meet with you sooner to discuss this.

No, I do not know of any early childhood providers and would like assistance so <child’s name > can start accessing early intervention supports

The early childhood partner organisation will contact you as soon as possible to help you if you are having difficulty engaging with an early childhood provider. They can also connect you to other government and community services who may assist you and <child’s name> as needed. will be your ongoing point of contact with the NDIA and will also conduct future plan reviews with you and your child. You can also find service providers on the NDIS website and further information about the NDIS.

• Optional: If <child’s name> has support needs in addition to their hearing loss, < early childhood partner name> may meet with you sooner to discuss this.

Step 8: Activation code to access NDIS portal

I will now give you an activation code (valid for 10 days) and information about how to access <child’s Name> NDIS portal via myGov. Further information is also available on the NDIS website.

• END

5. Related procedures or resources

• Our Guideline – Reasonable and necessary supports • Our Guideline – Assistive technology • Practice Guide – Early childhood planning • Standard Operation Procedure – Update participant streaming • Standard Operation Procedure – Record and verify identity for an individual • Standard Operation Procedure – Verify identity for a third party organisation • Standard Operation Procedure – Complete the update the severity tools task

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• Standard Operating Procedure – Complete the participant statement • Standard Operating Procedure – Record informal, community and mainstream supports • Standard Operating Procedure – Complete the update the outcomes questionnaire task • Standard Operating Procedure – Complete the risk assessment task • Standard Operating Procedure – Complete the guided planning questions • Standard Operating Procedure – Add, check or change a My NDIS contact • Standard Operating Procedure-Add low cost assistive technology support in a plan • Standard Operating Procedure – Complete the determine plan management task • Standard Operating Procedure – Include plan management support items • Standard Operating Procedure – Navigate the participant record in the NDIS business system • Standard Operating Procedure – Update participant details • Standard Operating Procedure – Add or change disability • Standard Operating Procedure – Review and submit plan for approval • Practice Guide – Hearing supports • Practice Guide – Early Childhood – Supports for children who are deaf or hard of hearing

6. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our feedback form.

7. Version control

Version	Amended by	Brief Description of Change	Status	Date
1.0	LCN545	Remove Draft and upgrade version	FINAL	2018-09-06
2.0	LNL387	Class 3 Approval	APPROVED	2020-05-28

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Version	Amended by	Brief Description of Change	Status	Date
3.0	CM0032	Class 3 Approval	APPROVED	2020-09-13
4.0	CM0032	Class 3 Approval of changes including transfer to new template and updating content in line with updates to PG-Early childhood- Supports for children who are deaf or hard of hearing	APPROVED	2022-05-23
5.0	LKM022	Class 2 Approval	APPROVED	2022-11-21
6.0	FC0007	Class 1 Approval	APPROVED	2023-04-11

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