CI Connect – Severity Tools

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CI Connect – Severity Tools

CI Connect – Severity Tools
- 3
CI Connect – Severity Tools Knowledge Check
- 10 Appendix

14 Video Transcript
14

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CI Connect – Severity Tools

Accessibility Options

Lesson 1 of 6

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Severity Indicator - Setting the Scene

Lesson 2 of 6

Pre-planning

Pre-planning is where you gather information from a participant or their carers and nominees. Your conversations are integral to deliver a positive participant experience. Your conversations help you to get the right information about the way a participant lives their day-to-day life, what they can do, their goals and supports.

You are all aware of the five Engagement Principles from our Participant Service Charter. They are:

Transparent
Responsive
Respectful
Empowering
Connected

Two are particularly important in the application of the content of this CI Connect module.

Responsive – We will respond to individual needs and circumstances Respectful – We will recognise your individual experience and acknowledge you are an expert in your own life

When applying the “must dos” of Pre-Planning, it is very important to remember our Engagement Principles and that you deliver a quality, strengths based, participant-

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The Update the Severity Tools task is one of two Pre-Planning tasks that contribute to the generation of the Typical Support Package (TSP). These two tasks are:

Update Severity Tools
Update the Guided Planning Questions

The primary disability is the disability with the greatest functional impact. The primary disability also contributes to the generation of the TSP. It is important at the Pre-Planning stage to confirm that the primary disability is correct and that evidence is available to confirm the primary and any secondary disability.

Correct severity tool choice, correct scoring and recording, correct responses to the Guided Planning Questions and a correct primary disability, ensures the integrity of the participant’s Typical Support Package and plan. Data from quality checking of recently approved plans demonstrates that when this information is correct and evidence based, the funding decisions are more likely to meet all criteria in Section 34.1 of the NDIS Act 2013.

Note that for children 7 years and under the Guided Planning Questions are used to guide decision-making, not generate a TSP.

Does the TSP matter?

You may recall that the first principle Fair for everyone, both today and for future generations from the document “Principles we follow to create your plan” discusses the Typical Support Package. The information below is written for participants, however, it is a reminder for plan developers that the two Pre-Planning tasks that generate a Typical Support Package do matter and must be correct.

“The Typical Support Package gives us an indication of what supports we’d usually expect to include in your plan based on the participant’s situation and disability support needs.

Each support in a plan must be reasonable and necessary, but they also need to be reasonable and necessary as a package of supports. We approve your whole plan, not the individual supports in a plan in isolation. The Typical Support Package helps guide this validation process.

The Typical Support Package also helps to guide the consistency of our decision making process. We use these to check the overall plan to make sure that all the supports make sense together, and that the support types and amounts will complement each other to help participant’s fulfil “an ordinary life.”

The Problem - What does the data show?

Lesson 3 of 6

What does the data tell us?

The graph below shows the June 2021 result for KPI 5a - % of plans where Section 34.1 of the NDIS Act is satisfied. Good, better and best ranges are represented by colours. This graph was used in all the previous CI Connect modules. We are in the good range at 82% nationally for Reasonable and Necessary decision-making.

Severity Tools and WHODAS - Percentage of compliance

The graph below shows the results from 500 - 600 approved plans from January to June 2021 for three Pre-Planning tasks, as well as for whether the primary disability is correct.

The vertical axis shows percentages.

The horizontal axis shows the different months from January to June 2021.

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The four colours represent four questions, and also where they are situated in the good, better, best range (as shown by the KPI 5a graph above). Orange means not yet in that range while green means they have achieved a good or better range.

The bar graphs below represent the results of quality checks for each question from January to June 2021.

Percentage of Compliance by Month 2021
January
Question 1

The four questions are as follows:

Question 1 – Have the Guided Planning Questions been fully completed and do these responses appropriately reflect available information?

The pale orange bar graph shows the percentage of compliance with this question from January to June 2021. That is guided planning questions are fully completed and reflect the information on the participant record. The bar graphs show that we are achieving about 70%.

These results have not quite reached the good range of 75 to 85%.

Question 2 – If there has been a change in guided planning, is there sufficient evidence to justify this change?

The light green bar graph shows the percentage compliance where guided planning questions are changed and whether there is sufficient evidence on the participant record to justify the change. The bar graphs show that we have crept up to 80% over

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the last few months. This tells us that for about 20 of 100 approved plans, the evidence available in the participant record does not support the change to the guided planning questions.

These results have reached the good range of 75 to 85%.

Question 3 – Is the participant’s level of function supported by appropriate evidence?

The dark orange bar graph shows whether the participant’s level of function is supported by appropriate evidence. These bar graphs directly relate to the Update the WHODAS and the Update Severity Tools task – that the severity tool chosen is correct, the score is recorded correctly and information in the severity tool is consistent across the participant record. The results show about 60% compliance, meaning that about 40 out of 100 plans for participants 7 years and older have a level of function recorded that is not supported by appropriate evidence.

These results have not reached the good range of 75 to 85%.

Question 4 – Has the primary disability been recorded correctly based on available evidence?

The dark green bar graph shows whether the primary disability is recorded correctly based on the available evidence. In the last CI Connect module about sustainability, we mentioned this result in relation to Rules for Participants 5.1b – supports are related to the participant’s disability. The graphs show that we are consistently at about 90% compliance, indicating that about 10 of every 100 plans does not have a correct primary disability recorded.

This result is in the better range of 85 to 95%. There is opportunity for improvement to reach the best range for this question.

Further analysis of June data

Further analysis of the June data to explore whether compliance with the Update the WHODAS and Update Severity Tools task (Question 3) influenced KPI 5a - the % of plans where Section 34.1 of the NDIS Act is satisfied, demonstrated that:

Correct completion of the Update the WHODAS or Update the Severity Tool task resulted in funding decisions that met Section 34.1 in 87% of plans – 5% above the national result for KPI 5a.
Incorrect completion of the Update the WHODAS or Update the Severity Tool task resulted in funding decisions that met Section 34.1 only 74% of the time, well below the national result of 82% for KPI 5a in June 2021.

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What does it mean?

It means that there is an opportunity to improve the Update the WHODAS and Update the Severity Tools task by:

Paying closer attention to the chosen severity tool
Carefully considering evidence
Scoring and recording the tool correctly
Substantiating and justifying all changes in an interaction - General - Update Severity Tools.

The data tells us that correct evidence based scoring in the Update Severity Tool task (and the WHODAS when appropriate) and the Update the Guided Planning Questions task results in better Reasonable and Necessary decision-making.

Better decision-making ensures a sustainable scheme now and into the future.

Severity Indicator – Video Transcript

See Appendix

Lesson 4 of 6

Overview - Video

A short introduction and overview of the use of the Severity Tools and their importance to the participant’s journey and the planning process.

https://youtu.be/oZQfOzTwMsw

Resources - Things to read before the discussion

Lesson 5 of 6

Resources

The following resources examine the Severity tools in more detail and include SOPs and documents. of interest.

Complete the Update Severity Tools task
Complete the WHODAS
Complete the Guided Planning Questions

Tools

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Cerebral Palsy Severity Tool: Gross Motor Functional Classification
Hearing Severity Tool:Functional Impact of Hearing Loss
Multiple Sclerosis Severity Tool:Patient Determined Disease Steps
Stroke Severity Tool:Modified Rankin Scale
Hearing Severity Tool:Functional Impact of Hearing Loss
Vision Severity Tool:Functional Impact of Vision Loss
Conversation Style Guide

Interaction Template

Interaction templates - General - Severity indicator updated, Request to change primary disability and Primary disability change complete.

Discussion and Examples

Lesson 6 of 6

Discussion Starter

Solution based questions for your team engagement session Use any or all of the questions below to help facilitate the Severity Tool task Team Facilitation session. You may decide to choose questions that you consider are more relevant to your team/State or Region. You can choose to discuss questions as a whole group, in small groups, in partners or individually depending on the size of your team. Similarly, you can choose to use the same questions or designate different questions to groups to promote further discussion. Remember this session is an hour in duration and you need to allow time for a debrief.

Severity Indicator Discussion Questions.docx

Debrief and Next Steps

Debrief meetings allow you to formally conclude a discussion, identify key learnings and talk about next steps. In concluding the team facilitation session, cover off expectations for weeks 2 - 4 as part of the CI Connect Program.

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CI Connect – Severity Tools Knowledge Check

Accessibility Options

Lesson 1 of 5

Accessibility options

To navigate through the course simply use the previous or next buttons at the bottom of each screen. For screen reader keyboard navigation instructions please follow this link.
All videos will use closed captions
All hyperlinks will open in a new browser

What You Will Need

Lesson 2 of 5

Before you begin

Take your time to answer the questions and refer to all available material via Intranet.
The knowledge check is found in the next block. They are presented as true or false, multi choice, multi answer questions and match responses.
You are required to correctly answer all questions to complete the module. You will be provided with a statement that your answer is either correct or incorrect. You must get a correct feedback statement on each question to proceed to the next question.
Where you receive any incorrect feedback you will have the option to either review the module section or to take the question again. You can undertake the question as many times as you need until you get a correct feedback statement.

Knowledge Check - Severity Tools

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Lesson 3 of 5

https://forms.office.com/Pages/ResponsePage.aspx?id=ZYt3zS11SkWHz7mZD-WJk3-inbY1Qx1Iti3MIgjtkndUQ01QREo5VjBST1JVRVo1SlJSWlZJVkRMRy4u

Click the button to go to a survey form. When you are finished return here to complete the rest of the knowledge check.

Knowledge Check

According to this module, which two of the five engagement principles are particularly important in the application of the content in this module?

Transparent & Respectful
Empowering & Connected
Respectful & Empowering
Responsive & Respectful SUBMIT

TAKE AGAIN

According to this module, the Update the Severity Tools task is one of two Pre-Planning tasks that contribute to the generation of the Typical Support Package (TSP). The other task is…

Update the Guided Planning Questions
Update the WHODAS
Update the Typical Support Package
Update the Percentage of Compliance SUBMIT

TAKE AGAIN

Look at the following image

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Percentage of Compliance by Month 2021
January
Question 1

Which of these results have consistently reached the good range (ie. not the better or best range)

Question 1
Question 2
Question 3
Question 4

SUBMIT

TAKE AGAIN

The Standard Operating Procedure - Update the Severity Tools Task contains information about when plan developers are required to complete the Update the Severity Tools task. Here are some of the circumstances.

Which one of these is not one of the circumstances listed in the module?

The participant provides you with an updated functional capacity assessment
You are completing a plan review for a participant who is 0-6 years of age
The participant has a physical disability which has consistent outcomes over a period of time.

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General Survey

Lesson 4 of 5

Before you begin

Below is a general Survey about CI Connect.

Take your time to answer the questions and think about your responses.
The questions are multi choice, multi answer questions and free text responses. If you wish to change your responses then do so before clicking submit.
There are no incorrect answers. Please be honest. The survey is anonymous.

Survey Link

Survey Click this link to go to the survey

General Survey

Exit

Lesson 5 of 5

Course Completed.

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Appendix

Video Transcript

The Update the Severity Tools task or Update the WHODAS task is one of the essential building blocks of planning and supports the integrity of funding decisions. Understanding the functional impact of disability and a participant’s individual circumstances are integral to the way the NDIA approaches planning. The severity tool choice and scoring represents a participant’s level of function. The scoring must be evidence based as it contributes to the Typical Support Package, guides decision-making and is the basis of the justification of funded supports included in a participant’s plan.

For most participants the Update Severity Tools task is informed entirely by standardised functional assessments, scores and reports completed externally by a participant’s treating health professional/s. They are submitted to the NDIA and attached to the participant’s record.

These assessments constitute evidence for the planning process. The scores demonstrate the level of impact a participant’s disability has on their everyday activities. Your conversation with a participant builds from these scores so that you fully understand what a participant can do and how they live their life.

When do you need to complete the Pre-Planning task Update Severity Tools?

There is a change in the participant’s functional capacity
The participant provides you with an updated functional capacity assessment
You are completing a plan review for an adult or child who has met access based on disability or early intervention
You are completing a plan review for a participant who is 0-6 years of age
The participant has a degenerative disability such as motor neurone disease or an fluctuating disability like psychosocial disability where functional capacity may change

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A severity score was not entered as part of the access process.

Twelve of the most common disabilities and the NDIA preferred Severity Tool and a second or third option if the first severity tool option is not available is explained in the SOP - Update the Severity Tools task. It explains when to use the WHODAS and it outlines how to enter the score correctly in the NDIA Business System.

What is evidence?

Information taken from an external or internal assessment and recorded in the Update the Severity Tools task constitutes evidence. Severity Indicator information comes from three sources. In order of preference for plan development purposes these are:

Disability specific assessments
Internal disability specific Severity Tools
Assessments not specific to a disability type.

Disability specific assessments:

Treating health professionals complete these assessments
Partner or NDIA staff cannot complete these assessments

Includes the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) for Intellectual Disability and Autism

Internal disability specific severity tools:

Partner and Agency staff can complete these assessments

Includes the Gross Motor Function Classification Scale (GMFCS) for Cerebral Palsy, Modified Rankin Scale (mRS) for Stroke, Disease Steps for Multiple Sclerosis, Hearing and Vision tools

Assessments not specific to a disability type:

Partner and Agency staff can complete these assessments

Includes the PEDI-CAT – Paediatric Evaluation of Disability Inventory Computer Adaptive Test and WHODAS 2.0 World Health Organisation Disability Assessment Schedule

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When collecting functional capacity assessment information, the score of an external assessment needs to be provided by the participant, their nominee, their child representative or their treating health professional.

Plan developers must:

• Sight a copy of the assessment report before the score is entered into the Update Severity Tools section of the NDIS Business System

• Attach the evidence in the NDIA Business System

Plan developers can complete the WHODAS assessment if an external functional capacity assessment is not available in the participant’s record or if there is no other preferred NDIA severity tool.

What are the evidence requirements if there is no preferred external assessment tool and plan developers apply or change an internal disability specific severity tool? (This can include the WHODAS, PEDI-CAT, Gross Motor Function Classification Scale (GMFCS) for cerebral palsy, the Modified Rankin Scale for stroke, the Disease Steps for multiple sclerosis and hearing and vision tools)

There are four points for plan developers to note:

• You must sight evidence of the impact of a participant’s disability or sight evidence of a change in function.

• Changes to severity scores must be justified in an Interaction General – Severity indicator updated

• Scoring information must be consistent across the participant record, including provider reports, Guided Planning Questions and the Planning Conversation Tool

• All evidence of function must be attached to the participant’s record.

Evidence can be supplied in the form of a signed letter or a letter on formal letterhead from the participant’s treating health professional. Evidence of the severity of the disability should include:

      • type of disability

      • date disability diagnosed

      • how long the disability will last

      • available treatments

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how the disability impacts the participant’s everyday life. For example, mobility/movement skills, communication, social interaction, learning, self-care, self-management.

When competing the Update Severity Tools task or the Update the WHODAS task in Pre-Planning plan developers can ask themselves: Is the participant’s level of function recorded in the severity tool supported by appropriate evidence? That is:

Is the chosen severity tool correct?

Is the score recorded correctly?

Is the information in in the severity tool consistent with other information in the participant record such as the Planning Conversation Tool, Guided Planning Questions, the Participant Statement or provider reports?

In addition, check that the primary disability is correct, that there is evidence attached to the participant record that confirms the primary disability (and secondary disability), that responses to the Guided Planning Questions are correct and that all information is consistent across the participant’s record.

Pre-Planning tasks require careful attention to scores, evidence and participant information. They are the foundation of plan development. It is equally important that your information gathering conversation with a participant, their carer or nominee is dynamic and strength-based, uses open-ended and probing questions to focus on what the participant can do and how they live their day-to-day life.

This is quality Pre-Planning and leads to sound and sustainable funding decisions and a good participant experience.

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