National Disability Insurance Scheme

Outcomes Framework

Short Form Questionnaires

Participants from 0 to before starting school

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Participants from 0 to before starting school

Introduction

Thank you for participating in our survey. The purpose of these questions is to find out how NDIS participants and their families and carers are going in different areas of their lives. The questions are an important part of pre-planning, and will help us to develop a plan that provides the right supports. Because we ask the questions again at plan review, we will also be able to see what progress has been made, and whether any adjustments to plans are needed. Information from the questions will also be important for tracking the progress of the NDIS, and will help to improve the Scheme.

Participant information

Question	Options
1. Please enter the child’s NDIS ID number	Free text (check for valid number of characters?)
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. 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
5. Is compensation being sought, or has compensation previously been sought, in relation to the child’s disability?	☐ Yes ☐ No

Please answer the following questions about the participant

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Domain 1: Daily living

Question number	Question	Answer options
1	Do you have any concerns about your child’s development in the following areas?

• Gross motor skills (e.g. crawling, standing, walking, catching a ball) Yes No
• Fine motor skills (e.g. drawing, stacking blocks, pincer grasp) Yes No
• Self-care (e.g. washing or eating) Yes No
• Eating/ Feeding (e.g. chewing, swallowing, transitioning to table foods) Yes No
• Social interaction (e.g. playing with peers, interacting with others, separating from parents, behaviours such as biting, hitting, frequent tantrums) Yes No
• Language/Communication (e.g. following directions, speaking, expressing themselves, participating in conversations) Yes No
• Cognitive development (e.g. understanding concepts, problem solving) Yes No
• Sensory processing (e.g. concentration, responses to changes in routine or certain textures, dislikes bath or grooming activities) Yes No | Please specify any other areas of concern: | Free text | | 2 | My child uses specialist services (e.g. speech pathology, occupational therapy) that assist their learning and development | Yes (go to 3) No (go to 5) | | 3 | These services help my child gain the skills she/he needs to participate in everyday life (e.g. go to preschool) | Yes No | | 4 | These services support me to assist my child | Yes No | | 5 | Has the NDIS improved your child’s development? | It’s my first plan Yes No | | 6 | Has the NDIS improved your child’s access to specialist services? | It’s my first plan Yes No |

Domain 2: Choice and Control

Question number	Question	Answer options
1	My child is able to tell me what he/she wants	☐ Yes, without assistance ☐ Yes, with assistance ☐ No
2	Has the NDIS helped increase your child’s ability to communicate what they want?	☐ It’s my first plan ☐ Yes ☐ No

Domain 3: Relationships

Question number	Question	Answer options
1	My child gets along 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	My child joins me when I complete tasks at home	☐ Often ☐ Sometimes ☐ Never
4	My child joins me when I complete tasks outside the home (e.g. shopping, sport)	☐ Often ☐ Sometimes ☐ Never
5	My child fits in with the everyday life of the family	☐ Yes ☐ No
6	Has the NDIS improved how your child fits into family life?	☐ It’s my first plan ☐ Yes ☐ No

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Domain 4: Social, community and civic participation

Question number	Question	Answer options
1	Do you use any form of childcare?	☐ Yes (go to 2) ☐ No (go to 3)
2	Please specify which of the following types of childcare you use, and whether you use them when you and/or your partner are at work, or when you are not at work (you may select both situations, or leave blank if you do not use that form of childcare) Use while we’re at work Use while we’re not at work	- The child’s brother or sister - Another relative who lives with you (paid or unpaid) - Another relative who doesn’t live with you (paid or unpaid) - A friend or neighbour (caring for the child either at your home or in their home; paid or unpaid) - A nanny or babysitter who is paid to come to your home - A nanny or babysitter who is paid to care for your child in their home - Family day care, long day care, any other care at a Child Care Centre - The child goes to your (or your partner’s) work
3	My child has friends that he/she enjoys playing with	☐ Yes (go to 4) ☐ No (go to 5)
4	These friends are at (choose all that apply)	- Preschool - Playgroup - Social or family gatherings (e.g. children of friends or extended family) - Other community activities - Other (please specify):
5	My child participates in age appropriate community, cultural or religious activities	- A few times a week - About once a week - Once every two weeks - About once a month - Less than once a month - Never (go to 7)
6	At these activities, I think my child is	Choose one option

CONFIDENTIAL AND NOT FOR FURTHER DISTRIBUTION

Question number	Question	Answer options
	Welcomed Actively included Mostly an observer Tolerated Made to feel unwelcome Is present but not really a part of the group	☐ Welcomed ☐ Actively included ☐ Mostly an observer ☐ Tolerated ☐ Made to feel unwelcome ☐ Is present but not really a part
7	I would like my child to be more involved in community activities	☐ Yes (go to 8) ☐ No (go to 9)
8	The barriers to my child being involved in community activities 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):
9	Has the NDIS improved how your child fits into community life?	☐ It’s my first plan ☐ Yes ☐ No

Thank you for completing the participant questions. Please tell us who completed the questionnaire. You may also provide a comment if you wish. Who responded to the questions? | ☐ The participant’s mother
☐ The participant’s father
☐ Other, please specify: | | Any comments? | |

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