Referral for Complex Support Needs

FOI 21/22 - 0030 DOCUMENT 2

Referral for Complex Support Needs

Previous Step: The participant is identified as having complex support needs or has experienced a crisis situation and is referred by the Exceptionally Complex Support Needs Program.

Next Step: The participant either enters the Complex Support Needs Pathway for planning or is referred back to National Delivery for planning as they do not meet the criteria.

1. Purpose

This Standard Operating Procedure (SOP) will guide you to:

 consider if the circumstances of the participant require the Complex Support Needs (CSN) Pathway

 refer the participant to the CSN Branch

 understand the participant will be assessed by the CSN Branch and either enter the CSN Pathway or remain in the General Pathway.

Note: Enhancements to the CSN Pathway processes are underway. It will be important to check back for updated guidance in the future.

2. Index

 6.1 Refer the participant to the CSN Pathway  6.2 CSN Branch assess the participant and advise outcome  6.3 The participant exits the CSN Pathway and is referred to National Delivery for

planning  7.1 Appendix 1 - Workflow diagram  7.2 Appendix 2 – Workflow diagram alternative text  8 Supporting material

Page 9 of 19

FOI 21/22 - 0030

3. To be used by

 National Access Workload Management Branch Delegates  Plan Developers

• Planners

• Partners in the Community (Early Childhood Partners and Local Area

Coordinators [LACs])  National Delivery Directors and Assistant Directors  Complex Support Needs Planners and Business Support Officers  Exceptionally Complex Support Needs Program.

4. Scope

During the planning process you may identify the participant has complex support needs. Complex support needs are where the participant has extraordinary support needs requiring a greater need for coordination of multiple services to assist the participant in the development and implementation of their plan. Table 1 lists the factors which may contribute to the participant requiring this more tailored approach.

The decision to refer the participant to the CSN Branch can be made by:

 the National Access Workload Management Branch (NAWMB)  National Delivery  the Exceptionally Complex Support Needs Program (ECSNP).

As with any streaming decision, Partners in the Community will need to make a request for the CSN Pathway via National Delivery.

The decision to move a participant in, or out of, the CSN Pathway is made by the CSN Branch. Only CSN authorised officers can complete the CSN Suitability Checker assessment and update the participant’s stream to Complex. For more information regarding streaming, refer to the Standard Operating Procedure – Participant Streaming.

5. Prerequisites

 Generally, National Delivery will have determined the participant’s streaming as

Super Intensive in the NDIS Business System (System).  There is sufficient documented evidence attached to the participant record indicating

the need for referral to the CSN Pathway.

Page 10 of 19

FOI 21/22 - 0030

 The participant is identified as requiring referral to the CSN Pathway by the ECSNP

team after experiencing an unexpected crisis due to a sudden change in

circumstances.

6. Procedure

6.1 Refer the participant to the CSN Pathway

1. Consider the participant circumstances and the factors in Table 1. To refer to the CSN

Branch there should be one or more situational or personal factors. In addition, a

significant level of intensity or impact must be demonstrated in relation to each factor,

which results in the participant requiring an extraordinary level of support and liaison

across mainstream interfaces for them to be able to achieve their outcomes.

6.1.1 Table 1: Situational and personal factors indicating complex support needs s47E(d) - certain operations of agencies

Page 11 of 19

FOI 21/22 - 0030

s47E(d) - certain operations of agencies

Page 12 of 19

FOI 21/22 - 0030

2. When referring to the CSN Pathway, consider the CSN Checklist below. You must be

satisfied of the following:

 The situation cannot be handled through changes such as a new provider or plan review.

 The participant cannot be adequately supported by an experienced LAC or planner in conjunction with an appropriate support coordinator.

 It is not in the best interests of the participant to stay with the current planning team.

 An active Section 48 or Section 100 review is not currently underway by the National Review Team or Internal Review Team. This is because it may be in the best interests of the participant to continue with a particular process, or staff member, to complete a review process. However, if during the process of a Section 48 or Section 100 review you identify circumstances that critically require the CSN Pathway, speak to a National Delivery Director or Assistant Director (AD) regarding the appropriateness of a referral.

 There is not an active Administrative Appeals Tribunal (AAT) case underway.

 Agreement to refer to determine suitability has been provided from a National Delivery Director or AD.

 Participant has exceptionally complex support needs if referred via the ECSNP.

 Referrals to the CSN Pathway should be submitted at the Assistant Director or Director level, so it is clear that there is endorsement for the referral.

3. Create an open Interaction in the System, using the category - CSN Assessment

Required and assign to the CSN inbox CR SDP Return to CSN. Refer to Interactions

Template – Planning for how to complete the interaction. Set the interaction status to

Open. Include the login ID of the referrer so advice on the outcome can be returned to

the right person.

Note: If the open Interaction remains in your inbox, go to Internal Use and reassign it

from Open Activities.

4. The participant remains with National Delivery until the CSN Branch makes the

decision.

6.2 CSN Branch assess the participant and advise outcome

1. The CSN Branch receives the referral via an Interaction.

2. The CSN Suitability Checker assessment is completed within five business days of the

Page 13 of 19

FOI 21/22 - 0030

referral interaction.

3. The CSN Suitability Checker assessment to be completed within two hours of the

referral interaction if a crisis referral has been undertaken for the participant

(categorised as Extreme under the Escalation Prioritisation Matrix).

4. The CSN Suitability Checker is uploaded to Inbound Documents in the System.

5. A new Interaction is created and assigned to the referrer with the category Outcome

of CSN Assessment.

6. If the outcome is the participant does not meet the CSN Suitability Assessment,

planning will continue with National Delivery.

7. If the participant is suitable for the CSN Pathway, the CSN Branch will update the

participant’s stream to Complex and organise a warm handover with the staff familiar

with the participant’s circumstances. The CSN Branch will take over the planning

process where there is CSN planner capacity. Note: The streaming value Complex is

only for use by the CSN Branch and the decision to give a participant the streaming

value of Complex can only be made by the CSN Branch.

8. If the participant enters the CSN Pathway resulting from a crisis referral, the CSN

Branch may organise a warm handover with the staff familiar with the participant’s

circumstances. The CSN Branch will take over the planning process; and undertake a

plan review the same day of the referral interaction.

6.3 The participant exits the CSN Pathway and is referred to National Delivery for planning

The referral and warm handover to National Delivery will occur when the participant is already receiving support in the CSN Pathway and their circumstances change to the extent they are determined to no longer require this Pathway.

1. The CSN Branch will complete the Suitability Checker Assessment prior to each

participant plan review. When the participant is assessed as no longer requiring the

CSN Pathway, the participant’s stream will be updated and they will be referred back to

National Delivery for planning.

2. The CSN Branch will discuss the referral with a National Delivery AD in the geographic

area of the participant. The AD will facilitate the identification of an appropriate plan

Page 14 of 19

FOI 21/22 - 0030

developer to plan with the participant.

3. The CSN Branch will create an open Interaction in the System with the category of

CSN handover to SD&P for planning and assign to the nominated plan developer.

Refer to Interaction Templates – Planning for how to complete the interaction.

4. The CSN Branch will conduct a warm handover with the plan developer in National

Delivery, and identify outstanding or ongoing matters to consider during the planning

process.

5. The plan developer in National Delivery will support the participant in the NDIS

Pathway.

Page 15 of 19

FOI 21/22 - 0030

7. Appendices

7.1 Appendix 1 – Workflow diagram

For alternative text to the diagram, go to Appendix 2.

Page 16 of 19

FOI 21/22 - 0030

7.2 Appendix 2 – Workflow diagram alternative text

7.2.1 Steps for National Access Workload Management Branch (NAWMB)

 Start.

 NAWMB delegate identified participant has sufficient evidence of complexity.

 Approval required from NAWMB AD.

 If No, follow standard process. End process.

 If Yes, NAWMB AD will use the CSN Checklist found in the Standard Operating Procedure - Referral for CSN.

 If No, follow standard process. End Process.

 If Yes, NAWMB AD creates interaction and assigns to CSN inbox - CR SDP Return to CSN. Flow on to Steps for CSN Branch.

7.2.2 Steps for Service Delivery

 Start.

 Plan developer identified participant needs indicate CSN Pathway.

 Approval required from National Delivery AD.

 If No, follow standard process. End Process.

 If Yes, National Delivery AD will use the CSN Checklist found in the SOP - Referral for CSN.

 If No, follow standard process. End Process.

 If Yes, National Delivery AD creates interaction and assigns to CSN inbox- CR SDP Return to CSN. Flow on to Steps for CSN Branch.

7.2.3 Steps for CSN Branch

 CSN inbox (CR SDP Return to CSN) receives interaction.

 Complete CSN Suitability Checker and determine suitability for Pathway within 5 business days.

 Complete CSN Suitability Checker assessment within 2 hours of the referral interaction

if a crisis referral has been undertaken for the participant (categorized as Extreme

under the Escalation Prioritisation Matrix).

 BSO allocates participant to planner within the CSN Pathway, to occur within 2 hours of

the referral interaction, if the participant has undergone a crisis referral via the ECSNP.

Page 17 of 19

FOI 21/22 - 0030

 Referrer advised of outcome.

 If Not Suitable, referrer will follow standard process. End Process.

 If Yes, CSN reach agreement with referred on appropriate handover process and participant is reassigned to CSN. End Process.

 Warm handover of participant between National Delivery and CSN Pathway to occur

the same day; if the participant has undergone a crisis referral via the ECSNP.

7.2.4 Steps for Exceptionally Complex Support Needs team – not in workflow diagram.

 Receipt of crisis referral assessment report by 9am each morning.  ECSNP team create interaction into CRM.  ECSNP assign interaction to inbox in the system; either National Delivery or CSN

branch (according to the participant’s current plan).  Participant’s individual needs will be considered for CSN Pathway, example crisis

referral interaction recorded, and a sudden severe change in circumstance.  Flow on to Steps for National Delivery/Complex Team according to participant’s

current plan.

8. Supporting material

 National Disability Insurance Scheme Act 2013  Practice Guide - Complex Support Needs Pathway

9. Process owner and approver

Process Owner – CSN Branch.

Approver – General Manager Participant Experience Design.

10. Feedback

If you have any feedback about this Standard Operating Procedure, please email Service Guidance and Practice. In your email, remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

Page 18 of 19

FOI 21/22 - 0030

11. Version control

Version Amended Brief Description of Change Status Date by

7.0 KN0014 Class 1 Approval APPROVED 2020-03-25 Inclusion of complex streaming process and information. Replaced Service Delivery with National Delivery.

8.0 CRG 656 Class 1 Approval APPROVED 2020-07-23 Guidance updated to highlight that young people at risk of entry into an aged care facility should be referred to Complex Support Needs Pathway and that children in voluntary or statutory out of home care, and children at risk of requiring accommodation outside the family home should be referred to CSN.

Page 19 of 19