National Disability Insurance Scheme Outcomes Framework Short Form Questionnaires Participant from starting school to age 14 v3.0

DOCUMENT 5

National Disability Insurance Scheme

Outcomes Framework

Short Form Questionnaires

Participant from starting school to age 14

v3.0

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Participants from starting school to age 14 In this first section, I will ask you some background questions.

Participant information

Question	Answer
1. NDIS Participant ID number	Pre-populated NDIS participant number
2. Who does the child currently live with?	☐ With parents ☐ With other family members ☐ With people not related to participant (e.g. foster carers) ☐ Other, please specify:
3. What type of housing does the child currently live in?	☐ Private home: owned by family/carers ☐ Private home: rented from private landlord ☐ Private home: rented from public authority ☐ Other, please specify:
4. Does the child currently have a job? (including a part time job outside school hours)	☐ Yes ☐ No
5. Please describe the type of work (e.g. serving in a restaurant, newspaper round, office administration, babysitting)	Free text
6. What is the usual number of hours worked per week?	☐ 0 hours ☐ More than 0 but less than 8 hours ☐ 8 hours to less than 15 hours ☐ 15 or more hours
7. What is the usual weekly income (before tax and other deductions)?	☐ $0 ☐ $0-$49 per week ☐ $50-$99 per week ☐ $100 or more per week ☐ Not disclosed
8. What is the annual income of the child’s household, before tax and other deductions? (Don’t include the income of people the participant only shares accommodation with, e.g. in a group home)	☐ $0-$9,999 ☐ $10,000-$19,999 ☐ $20,000-$29,999 ☐ $30,000-$39,999 ☐ $40,000-$59,999 ☐ $60,000-$79,999 ☐ $80,000-$99,999 ☐ $100,000-$149,999 ☐ $150,000-$199,999 ☐ $200,000+ ☐ Not disclosed
9. Is compensation being sought, or has compensation previously been sought, in relation to the child’s disability?	☐ Yes ☐ No

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These next set of questions relate to the child’s development and level of autonomy.

Domain 1: Daily living

#	Statement/Question	Answer
1	My child is developing functional, learning and coping skills that are appropriate to his/her ability and circumstances	☐ Not very well ☐ Pretty well ☐ Very well
2	Most of the time my child manages his/her emotions	☐ Not very well ☐ Pretty well ☐ Very well
3	Most of the time my child is able to do tasks at home, at school and in the community that a child of the same age would be expected to be able to do	☐ Not very well ☐ Pretty well ☐ Very well
4	My child is becoming more independent	☐ Yes ☐ No
5	My child spends time away from us (his parents) other than at school	☐ Yes ☐ No
6	When our child spends time away from us, he/she spends time with (please answer Yes or No for each option):	Yes
	Extended family	☐
	Family friends	☐
	Child’s friends	☐
	In group activities with local peers	☐
	In activities with other children with disability	☐
	In a respite house	☐
	Other (please specify):
7	My child spends time with friends without an adult present	☐ Frequently ☐ Occasionally ☐ On one occasion ☐ Never
8	My child has a genuine say in decisions about him/her	☐ Yes, most decisions ☐ Some decisions ☐ No
9	Has the NDIS helped your child to become more independent?	☐ Yes, a lot ☐ Yes, a bit ☐ No, not at all ☐ N/A (did not need help in this area)

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I would now like to understand a little bit about your child’s learning and education experience.

Domain 2: Lifelong learning

#	Statement/Question	Answer
1	My child attends school (includes home schooling)	☐ Yes ☐ No
2	My child’s current (or most recently completed) school year is:	☒ Kindergarten or equivalent ☐ Year 1 ☐ Year 2 ☐ Year 3 ☐ Year 4 ☐ Year 5 ☐ Year 6 ☐ Year 7 ☐ Year 8 ☐ Year 9 ☐ Year 10 ☐ Year 11 or above
3	My child is enrolled in	☐ A mainstream class ☐ A support class ☐ A special school ☐ A school/class for gifted/talented children ☐ Home schooling
4	I think that my child is learning at school	☐ Almost always ☐ Usually ☐ Sometimes ☐ Not usually ☐ Almost never
5	I think that my child is happy at school	☐ Almost always ☐ Usually ☐ Sometimes ☐ Not usually ☐ Almost never
6	Has your child been involved in the following co-curricular activities at school? Please answer Yes or No for each activity.	Yes
	In school plays/ concerts	☐
	In school clubs	☐
	In sporting teams	☐
	As a prefect	☐
	As a member of the student representative council	☐

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#	Statement/Question	Answer
	As a buddy or mentor to other students	☐
	Other (please specify):
7	Has your child ever been suspended from school?	☐ Yes ☐ No
8	Has the NDIS improved your child’s access to education?	☐ Yes, a lot ☐ Yes, a bit ☐ No, not at all ☐ N/A (did not need help in this area)

These next questions and statements centre on relationships, including friendships and the family dynamic.

Domain 3: Relationships

#	Statement/Question	Answer
1	My child gets along well with his/her brother(s)/sister(s)	☐ Yes ☐ No ☐ No brothers or sisters
2	My child can make friends with people outside the family	☐ Yes ☐ With some people ☐ No
3	There is enough time each week for all members of my family to get their needs met	☐ Yes ☐ No
4	My child fits well into the everyday life of the family	☐ Often ☐ Sometimes ☐ Never
5	When you need to go out, which of the following options do you use to look after your child? Choose all that apply:	☐ Siblings ☐ Extended family ☐ Friends ☐ He/she is able to stay alone ☐ Privately recruited babysitter ☐ NDIS individualised support ☐ Respite centre ☐ We never go out without our child
6	Are you happy with that arrangement?	☐ Yes ☐ No
7	My child has friends that he/she enjoys spending time with	☐ Yes ☐ No
8	These friends are	Choose all that apply ☐ At school

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#	Statement/Question	Answer
		☐ Outside school ☐ Online ☐ Other, please specify
9	Has the NDIS improved your child’s relationships with family and friends?	☐ Yes, a lot ☐ Yes, a bit ☐ No, not at all ☐ N/A (did not need help in this area)

Finally, I would like to understand a little more about your child’s social and community involvement.

#	Statement/Question	Answer
1	During school holidays I use the following holiday care (choose all that apply):	☐ Parents provide care ☐ Mainstream school holiday program ☐ School holiday program for children with disability ☐ NDIS funded support ☐ Grandparents ☐ Other family ☐ Friends ☐ Able to stay by themselves ☐ Other (please specify):
2	My child is happy with this choice/ these choices	☐ Most of the time ☐ Some of the time ☐ Rarely ☐ Never
3	After school and on the weekend my child (choose all that apply):	☐ Gets together with friends ☐ Is involved in mainstream sport, clubs, or other group activities ☐ Is involved in sport, clubs, or other group activities with children with disability ☐ None of the above
4	In these activities, I feel my child is:	☐ Welcomed ☐ Actively included ☐ Mostly an observer ☐ Tolerated ☐ Made to feel unwelcome ☐ Present but is not really part of the group
5	I would like my child to have more opportunity to be involved in activities with other children	☐ Yes ☐ No

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#	Statement/Question	Answer
6	The barriers to my child being more involved with other children are (choose all that apply):	☐ My child’s disability (e.g. ability to communicate) ☐ Other children are not welcoming ☐ Other families are not welcoming ☐ I am too busy ☐ Transport ☐ Cost ☐ Other (please specify):
7	Has the NDIS improved your child’s social and recreational life?	☐ Yes, a lot ☐ Yes, a bit ☐ No, not at all ☐ N/A (did not need help in this area)

Conclusion

Thank you for answering these questions. To close this out I just need to record (confirm) who completed the questionnaire. You may also provide some comments if you wish.

Question	Answer options
Who responded to the questions?	☐ The participant on their own ☐ The participant with assistance from another person (e.g. family member, friend) ☐ The participant’s mother ☐ The participant’s father ☐ The participant’s grandmother ☐ The participant’s grandfather ☐ Other, please specify:
Any comments?

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