National Disability Insurance Scheme

Outcomes Framework

Short Form Questionnaires

Participant from starting school to age 14

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Participants from starting school to age 14

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

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. Does the child currently have a job? (including a part time job outside school hours) | ☐ Yes
☐ No (go to 8) |

| 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 |

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CONFIDENTIAL AND NOT FOR FURTHER DISTRIBUTION

	☐ $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

Please answer the following questions about the participant

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Domain 1: Daily living

Question Number	Statement/Question	Response options
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 (go to 7)
6	When our child spends time away from us, he/she spends time with (please answer Yes or No for each option):	Extended family
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?	☐ It’s my first plan ☐ Yes ☐ No

Domain 2: Lifelong learning

Question Statement/Question Response options Number 1 My child attends school ☐ Yes (go to 2) ☐ No (go to 8) 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? Yes No In school plays/ concerts ☐ ☐ In school clubs ☐ ☐ In sporting teams ☐ ☐ As a prefect ☐ ☐ As a member of the student representative council As a buddy or mentor to other students Other (please specify):

Domain 3: Relationships

Question Number	Statement/Question	Response options
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 options you use ☐ 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 (go to 8) ☐ No (go to 9)
8	The friends are	Choose all that apply ☐ At school ☐ Outside school ☐ Online
9	Has the NDIS improved your child’s relationships with family and friends?	☐ It’s my first plan ☐ Yes ☐ No

Domain 4: Social, community and civic participation

Question Number	Statement/Question	Response options
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 (go to 5) | | 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 (go to 6)
  ☐ No (go to 7) | | 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): |

CONFIDENTIAL AND NOT FOR FURTHER DISTRIBUTION

Question Number	Statement/Question	Response options
7	Has the NDIS improved your child’s social and recreational 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 on their own
☐ The participant with assistance from another person (e.g. family member, friend)
☐ The participant’s mother
☐ The participant’s father
☐ Other, please specify: Any comments?

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