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Practice Guide – Understanding Therapy Supports

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Purpose ………………………………………………………………………………………………………. 3
To be used by ………………………………………………………………………………………………. 3
Scope ………………………………………………………………………………………………………….. 3 3.1 Early Childhood Early Intervention (ECEI) ……………………………………………………… 4 3.2 Multidisciplinary teams ………………………………………………………………………………… 4 3.3 Assessments …………………………………………………………………………………………….. 4 3.4 Progress Reports. ………………………………………………………………………………………. 5
Allied Health Practitioners ………………………………………………………………………………. 6 4.1 Allied Health Assistants ………………………………………………………………………………. 7 4.2 Dietitian …………………………………………………………………………………………………….. 7 4.3 Exercise Physiologist ………………………………………………………………………………….. 8 4.4 Maintenance Therapy …………………………………………………………………………………. 8 4.5 Music Therapy …………………………………………………………………………………………… 9 4.6 Occupational Therapist ……………………………………………………………………………….. 9 4.7 Orientation and Mobility Specialist ………………………………………………………………. 12 4.8 Orthoptist ………………………………………………………………………………………………… 13 4.9 Physiotherapist ………………………………………………………………………………………… 15 4.10 Podiatrist ……………………………………………………………………………………………… 15 4.11 Prosthetist or Orthotist ……………………………………………………………………………. 16 4.12 Psychologist …………………………………………………………………………………………. 17 4.13 Speech Pathologist ……………………………………………………………………………….. 18
Pre-planning……………………………………………………………………………………………….. 19 5.1 Planning conversations about therapy supports ……………………………………………. 19
Planning …………………………………………………………………………………………………….. 21 6.1 Capacity Building - Daily Activity supports ……………………………………………………. 21 6.2 Case example - Multidisciplinary team using music therapy ……………………………. 24
Supporting material ……………………………………………………………………………………… 27
Feedback …………………………………………………………………………………………………… 29
Version change control ………………………………………………………………………………… 29

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1. Purpose

The content of this document is OFFICIAL. This Practice Guide provides guidance on what to consider when including therapy supports in the participant’s plan. It contains information to guide conversations about how therapy supports may help participants to achieve their goals. The areas covered include:

roles of allied health professionals and how they can assist participants to build independence
reports
assessments
planning conversation considerations
justifying decisions.

2. To be used by

Plan Developers – Planners and NDIS Partners in the Community (Early Childhood Partners and Local Area Coordinators [LACs]).

3. Scope

Therapeutic supports assist participants to develop skills to build independence in the home, community, place of education and work. Allied health professionals (AHPs) develop therapeutic supports in their specialist area. They may also prescribe assistive technology. AHPs develop strategies to improve outcomes for participants in areas including:

mobility
movement
personal and social well-being
managing diets and nutrition
organisation
communication
self-care
cognitive capacity
social skills
moods and emotion
modifying the environment to make it more accessible.

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This Practice Guide provides you with considerations for making a reasonable and necessary decision on the therapeutic supports to include in the participant’s plan.

3.1 Early Childhood Early Intervention (ECEI)

Refer to Early Childhood Services Branch resources if you are using an Early Childhood Early Intervention approach to develop a plan for the participant aged under seven.

3.2 Multidisciplinary teams

A multidisciplinary team is a team of professionals who work with one another and share the job of evaluating, planning and providing therapy services to the participant. Individuals may be treated by one or more AHPs from different specialisations at the same time to optimise benefits and outcomes of therapy.

3.3 Assessments

You can ask the participant to have an assessment when you need further information to make a decision on supports. This can help you determine if the request for therapeutic supports meets the reasonable and necessary criteria.

When the participant first requests therapy supports it is important that you have the information you need to demonstrate that the support is best practice, value for money and will assist the participant to meet their goals. You will also need guidance from a suitably qualified allied health professional on the amount of support that the participant will need to achieve their goals. You can get this information through an assessment.

Before asking the participant to have an assessment you need to:

review all existing information and determine that additional information is needed
consider the costs and benefits of the request
consider how it will assist you to decide whether to approve funded supports
determine the type of assessment that is likely to produce the information you need
specify the information to be provided in the assessment
make sure the request aligns with the objects and general principles in the NDIS Act.

When you request an assessment for therapeutic supports, make sure you include funding for the assessment. See 6.1 Capacity Building supports.

Requests should clearly specify:

The functional area to be assessed. Some examples are communication, activities of daily living, balance and mobility, orthotics.
The information you need in the assessment. For example:

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How the therapeutic support will build the participant’s independence.
How the participant’s informal, community and mainstream supports will help them to achieve their goals.
How the gains or outcomes will be measured.
The expected time the participant will need to achieve the outcome.
The NDIS contact person to forward the information to.

If this is not the participant’s first plan have a discussion with your team leader to consider if an auto-extension of the participant’s current plan would be appropriate and reschedule the plan review to a time suitable for the participant.

3.3.1 Assistive Technology or Home Modification Assessments

When including Assistive Technology (AT) or Home Modification (HM) support in a plan an assessment may be required that considers the participant’s environment, skill building, selection of support and ongoing support. Templates to help participants and assessors provide the information required are located on the Providing assistive technology page of the NDIS website.

Detailed information on the ATHM process can be found in:

Our Guidelines – Assistive Technology
ATHM guidance on the Planning resources Intranet page

3.3.2 Housing

Participants who identify a housing goal will need to undergo relevant assessments by AHPs to determine their most suitable housing solution and support needs. These will be used to assist with determining whether the participant’s housing and support needs are reasonable and necessary. Detailed information on housing supports is in the Practice Guide – Identifying Housing Solutions.

3.4 Progress Reports

As the goal of therapy supports is to build or maintain the participant’s independence, requests for future therapy support will generally reduce over time. There may be instances where supports remain the same or increase. Some examples include:

the participant has not progressed as expected
a change in circumstance
the participant had difficulty attending sessions.

If the report does not have enough information to justify continued support at the same level or an increase in support you should talk to the participant during the planning conversation

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to gather further information. Refer to 5.1 Planning conversations about therapy supports and 6.1.2 What if I decide not to include all of the AHP recommendations?

Progress reports should also include information on how the proposed supports will further increase independence and the risks or impacts on other supports.

A progress report should include:

a summary of the supports provided
how the support has helped the participant achieve or work towards their goals
the measurable gains the participant has made since receiving therapeutic supports
how the participant has been linked to additional informal, community or mainstream supports to help them achieve their goals
any barriers encountered and how these have been resolved
any risks to the participant or others.

4. Allied Health Practitioners

AHPs hold a university qualification, specialise in different areas and work directly with the person requiring support. AHPs are not part of the medical, dental or nursing professions. AHPs may be, but are not limited to; occupational therapists, psychologists, speech pathologists, physiotherapists, exercise physiologists, prosthetist or orthotists, podiatrists, dieticians or respiratory therapists. They assess, prevent, diagnose and treat a range of conditions and illnesses to help people:

develop skills and abilities to manage their disabilities
become more independent
become healthier and more active
increase function to build capacity.

The information below will give you a snapshot of information for each AHP including:

their role
how they support people
tasks and approaches they use and the benefits of these
where to go for further information.

Note: Not all activities listed in this section will meet the reasonable and necessary criteria. For guidance on the responsibility of other government services or broader systems of support refer to Mainstream Interfaces intranet page.

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Talk about the bigger picture. How are all of the participant’s supports working together to reinforce strategies?
Are people working together to help the participant achieve their goals? For example, if they have strategies to help them increase their gross motor skills and attend school, is the school helping them to implement these strategies throughout the day?
What people in the participant’s life can help them to apply the strategies? It is important to acknowledge that informal supports are not therapy assistants or support workers. They may however be able to reinforce suggestions by allied health professionals and create consistency. For example, if the participant is learning to communicate through exchanging pictures, family members can learn the right way to exchange pictures with them to communicate what they need or want.
If the participant has support workers to assist with activities of daily living and an occupational therapist has provided some strategies to build their independence in this area, are support workers assisting them to build their independence by encouraging them to use these strategies?
If the participant has not progressed towards their goals as expected and is requesting a similar amount of support, have a discussion about any barriers they may have experienced:
- Are the providers meeting their expectations?
- Were there barriers to attend sessions? If yes, how were or will these be addressed?
- How will this support assist them to do more things on their own?
- What differences do they expect following the supports? Describe how this looks in day-to-day life.
- Do the important people in their life know how to support them to build independence?
- If they will continue to require support how will this allow them to build independence?
Where an allied health professional has/will develop recommendations and strategies for the participant:
- How will the participant be supported to implement the strategies?
- Are there things that can be done in other environments to support the participant to build these skills? For example, where the participant is building independence in communicating, are there strategies that others at their place of employment can implement?

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How can people where they live support them to improve their independence at home?

5.1.3 Following the meeting

Compare the information provided in the planning conversation.

Does it match the information in the allied health report?
Does it match information from other reports such as other allied health professionals, support workers, family, the accommodation they live in, school, other services?

If you notice a difference talk, to the participant to determine the support that they want.

6. Planning

Refer to Our Guideline – Reasonable and Necessary Supports.

6.1 Capacity Building - Daily Activity supports

The frequency of therapy will depend on the participant’s individual circumstances. When making a reasonable and necessary decision about the therapeutic supports to include in the participants plan use the following information:

the participant’s knowledge and experience with how therapeutic supports interact with their condition
assessments
reports
published information about the therapeutic supports such as the TAT digest or research journal articles.

All information is important in determining if the support meets the reasonable and necessary criteria for the participant. Where information from all four information sources do not match talk to your line manager. If you are still uncertain refer to the Technical Advisory Branch (TAB).

6.1.1 Value for money

Value for money considers:

whether a support will represent value for money over time
the cost of other available supports that can help the participant reach the same goal.

When determining if therapeutic supports are value for money, consider:

If investing in therapeutic supports early is likely to have the long-term benefit of significantly improving life stage outcomes for the participant or reducing their

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support needs. For example, is it likely that the use of therapeutic supports for early intervention will increase the participant’s independence and decrease reliance on supports throughout life?

If investing in therapeutic supports is likely to reduce the participant’s support needs in the short and medium term. For example, will increasing the participant’s independence in self-care reduce the amount support worker hours needed each day.
If investing in the support will delay the need, or avoid reliance, on additional supports. For example, will maintenance therapy delay the functional impact of a degenerative condition allowing participants to maintain independence for longer?
Whether there are similar supports that would have the same outcome at a lower cost.

6.1.2 What if I decide not to include all of the AHP recommendations?

The AHP providing the assessment or report is a qualified professional who has met and worked with the participant.

There may be times when you do not believe the supports the AHP recommends meet the reasonable and necessary criteria. Some reasons may include:

the information conflicts with other reports or information you collect in the course of the planning conversation
the support hours requested are higher than expected
the supports requested may not be considered best practice
the supports requested may not seem value for money

When this happens, you need to:

review all reports and supporting information
review your planning conversation with the participant
speak to the AHP to get further information and discuss any differences
seek advice from your team leader

When this is not the participant’s first plan and you still require more information you should have a discussion with your team leader to consider if an auto-extension of the participants current plan is appropriate to allow the participant to submit the required information. You will then be able to develop a plan that includes the reasonable and necessary therapeutic supports, reducing delays and the need for an unscheduled plan review.

When you make a decision to include supports in the participant’s plan that are different to the AHP’s recommendations you must:

write a clear justification detailing:

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the reason the supports recommended do not meet the reasonable and necessary criteria
evidence to support this decision (for example, consultation with your team leader or TAB advice)
what other lower cost/alternative supports were considered
Speak to the participant and clearly communicate:
- the funding that was included in the plan
- a justification for any decision that is different from the AHP’s recommendation. For example, rather than the participant receiving weekly physiotherapy from an AHP it is considered best practice that the participant build their capacity to complete self-managed physiotherapy exercises at home with the program regularly reviewed by the physiotherapist. Provide information on where you sourced this information.

You need to make sure you are open and transparent with your decision making to avoid confusion for the participant and unnecessary plan reviews.

6.1.3 Comments

The comments printed on the plan should provide information the participant needs to understand the purpose of therapeutic supports. You must include:

the purpose of the funding
the goals the therapy is supporting the participant to achieve. For example, communication, activities of daily living, assistive technology, identifying housing needs.
the amount of funding. Including an amount of funding in the plan instead of support hours enables the participant to negotiate supports with their provider. If the participant would like more information on working with providers, show them the Making a service agreement page on the NDIS website.
any expectations of the AHP to submit a progress report or assessment. For example, ‘$900 of funding for a speech pathologist to assess and provide strategies to increase your expressive communication skills. Assessments and reports tracking your progress must be submitted to the NDIS 6 weeks before your plan review.’

6.1.4 Justifications

Your justification for therapeutic assessments and supports will include:

how the supports will assist the participant to achieve their goals
the amount of support included
the information you have used to come to this decision

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how this will help the participant join in social and/or economic activities
how the support will build independence and reduce reliance on supports
how this support is required in addition to support received from families, carers, informal networks and the community

For example:

<The participant> has a goal to improve their expressive communication as they currently use one or two words to communicate and become frustrated when not understood. <The participant’s> workplace have reported that this frustration is impacting their ability to maintain friendships and is reducing the independence <the participant> previously had at work. An OT assessment in the previous plan period recommended that <participant> works towards improving their communication skills to reduce frustration. Information indicates that the last communication assessment was conducted when <participant> was in high school, 12 years ago.
15 hours of therapeutic support has been included for a speech therapist to assess, provide recommendations and develop resources for <participant> to develop expressive communication skills. The assessment is to include strategies for <participant> and their family and carers to increase verbal communication. The expected outcome of the communication strategies is to increase <participant’s> independence, reduce their frustration, improve interpersonal relationships and improve independence in the workplace.
The participant will be supported to implement these strategies at home by family members, supported by employees at their workplace, and supported by informal and formal supports in the community to use identified strategies when they are having difficulty communicating.

6.2 Case example - Multidisciplinary team using music therapy

Arnold is a 10 year old boy who lives at home with his parents and two older siblings. He has a diagnosis of Down Syndrome and is experiencing difficulty with communication, social skills and mobility. He attends a mainstream school where he receives support from a teacher’s aid. During the previous plan, Arnold had difficulties building rapport with his therapists due to negative behaviours and difficulty travelling to, and waiting in, the therapist’s office. This resulted in intermittent engagement and Arnold not using all of his capacity building supports.

Assessments from the previous plan period have recommended using a multidisciplinary approach of music, occupational, and speech therapy focused on skill building in Arnold’s natural environments to assist him to achieve his goals.

6.2.1 Assessment recommendations:

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16 hours Occupational Therapy to work towards Arnold’s goal of “To join in playground games with friends.”
- Develop strategies to assist Arnold to increase motor control.
- Develop strategies to assist Arnold to increase social skills.
- Provide guidance to important people in Arnold’s life on ways he can be supported to join in games and the types of exercises and games he can do to build his endurance and muscle control.
- Expected Outcomes: Arnold will participate in a structured climbing activity or game with two peers with minimal adult support.
12 hours of speech therapy to work towards Arnold’s goal of: “Be able to tell people what I want or need.”
- Communicate using 1-2 word phrases.
- Support communication through picture exchange while developing speech.
- Provide guidance to the important people in Arnold’s life on techniques specific to Arnold to assist with communication.
- Expected outcomes: Arnold will use 1-2 word picture exchange to request a motivating item or a need.
7 hours of music therapy to develop strategies to motivate Arnold to engage with other therapists by:
- Writing a song to motivate Arnold to participate in 1-2 word phrases.
- Use rhythmic and motivational elements of music to encourage Arnold to engage and participate in gross and fine motor activities.
- Outcomes - Arnold will engage with the occupational therapist, speech pathologist and music therapist to develop his communication and motor skills.
$300 of Low cost AT to develop communication supports. Picture exchange
Travel associated with delivery of supports in Arnold’s natural environments
10 hours of report writing

6.2.2 Planning conversation

During the planning conversation, Arnold and his family discussed with the planner how they and other people in Arnold’s life can assist him to develop his skills and become more independent. The strategies they discussed included:

AHPs will meet at the start and mid-way through Arnold’s plan to discuss strategies and how these will complement each other.

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Each AHP will develop strategies to assist Arnold to work towards his goals and guide the people in Arnold’s life on building his skills and independence.
The school is using picture exchange with other students and will support Arnold to use picture exchange if he is unable to verbalise his wants or needs.
Arnold’s siblings are close to him and enjoy playing games. They can find it difficult when he gets upset. Arnold’s parents and siblings have shown enthusiasm with structuring some group activities/games with the family to help him develop his social skills.
Arnold attends Scouts on a Thursday night. He has a support worker to assist him to attend and participate in activities. The support worker can implement strategies to assist Arnold to be more independent in interactions with peers.

6.2.3 Justifications

Core – Consumables

$300 of Low Cost assistive technology has been included for the development of individualised picture exchange cards as recommended by the speech pathologist. These cards will support Arnold to communicate which will develop independence and increase participation in social, school and community activities. This will reduce reliance on supports in the future. Funding has been included in Capacity Building – Daily Activities for Arnold’s supports to receive training on implementing communication strategies.

Capacity Building – Daily Activities

45 hours of support has been included in for a multidisciplinary team to build Arnold’s capacity in communication, mobility and social skills. The multidisciplinary team will meet at the start and mid-way through the plan period to create consistency in their approach.

Arnold has difficulties in the last plan period engaging with therapists and is highly motivated by music. A report from allied health professionals has recommended a music therapist be engaged to develop strategies that will motivate Arnold to engage with other therapists to develop his skills. This will increase participation in school, home and community life and is likely to result in a reduced need of supports in the future.

Arnold will be assisted to implement communication, mobility and social skills strategies by his family at home, teacher’s aide at school and support worker during Scouts.

Funding has been included for:

16 hours Occupational Therapy to work with Arnold to achieve his goal of joining in playground games with friends. The OT will provide training to informal and formal supports on how to implement these strategies.
12 hours of speech therapy to work with Arnold to achieve his goal of telling people what he wants or needs. The speech therapist will work with Arnold to develop strategies to communicate using picture exchange while he develops 1-2 word

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phrases in speech. The speech therapist will provide training to informal and formal supports on how to implement these strategies.
7 hours of music therapy to develop strategies to motivate Arnold to engage with other therapists.
10 hours of report writing to understand the benefits and gains achieved by Arnold across the plan period.

Funding has been included for travel of the allied health professionals to deliver supports in Arnold’s natural environments.

6.2.4 Outcomes

This information provides enough evidence for the planner to make a reasonable and necessary decision to include the recommended therapeutic support hours in Arnold’s next plan. This included information from the planning conversation on the participant’s lived experience and information in the allied health reports.

7. Supporting material

Our Guideline - Disability-related health supports
Early Childhood Services Branch resources
Practice Guide – Assistive Technology
Practice Guide – Identifying Housing Solutions
Our Guideline - Nutrition supports including meal preparation
Our Guideline – Dysphagia supports
Our Guideline – Reasonable and Necessary Supports
Speech Pathology Australia (external)
Australian Psychological Society (external)
Australian Orthotic Prosthetic Association (external)
Australian Podiatry Association (external)
Australian Physiotherapy Association (external)
Occupational Therapy Australia (external)
Australian Music Therapy Association (external)
Exercise and Sports Science Australia (external)
Dietitians Association of Australia (external)
Mainstream Interfaces intranet page

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Objects and general principles in the NDIS Act 2013
Our Guidelines – Planning - Appendix 1 - Table of guidance on whether a support is most appropriately funded by the NDIS | NDIS
Our Guidelines – Requesting further information or reports to inform a participant’s plan
Our Guidelines – Assistive Technology

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Contents

1. Purpose

2. To be used by

3. Scope

3.1 Early Childhood Early Intervention (ECEI)

3.2 Multidisciplinary teams

3.3 Assessments

3.3.1 Assistive Technology or Home Modification Assessments

3.3.2 Housing

3.4 Progress Reports

4. Allied Health Practitioners

5.1.3 Following the meeting

6. Planning

6.1 Capacity Building - Daily Activity supports

6.1.1 Value for money

6.1.2 What if I decide not to include all of the AHP recommendations?

6.1.3 Comments

6.1.4 Justifications

6.2 Case example - Multidisciplinary team using music therapy

6.2.1 Assessment recommendations:

6.2.2 Planning conversation

6.2.3 Justifications

Core – Consumables

Capacity Building – Daily Activities

6.2.4 Outcomes

7. Supporting material