National Disability Insurance Scheme

Outcomes Framework

Short Form Questionnaires

Family Questions for participants aged 25 and over

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Family Questions for participants aged 25 and over

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.

Family member/carer information

1. Please enter the participant’s NDIS ID number	Free text (check for valid number of characters?)
2. What is your relationship to the participant?	Mother Father Grandmother Grandfather Sister Brother Spouse/partner Other family member Carer Other (please specify):

Are you currently working in a paid job?
Yes
No (go to 7)
Is it permanent or casual?
Permanent
Casual
What is the industry of employment? | Free text |
What are the typical hours per week worked (range)?
0 hours
More than 0 but less than 8 hours
8 hours to less than 15 hours
15 hours to less than 30 hours
30 or more hours
What is your annual income, before tax and other deductions? Include all sources (e.g. wages, investments and Government pensions and benefits)
$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+ |

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CONFIDENTIAL AND NOT FOR FURTHER DISTRIBUTION

CL Not disclosed

before tax and other deductions? Include all sources (e.g. wages, investments and Government pensions and benefits)

What is the annual income of your household,

LX $0-$9,999

$10,000-$19,999

LC) $20,000-$29,999

$30,000-$39,999 CL $40,000-$59,999 LJ $60,000-$79,999 1 $80,000-$99,999
$100,000-$149,999
$150,000-$199,999
$200,000+

L] Not disclosed

Please specify whether you currently receive any government benefits:

	Yes	No
Carer payment	O	O
Carer allowance	Oj	O
Other (please specify):	Free text

Are you currently studying? LI Yes, full time LI Yes, part time

Please answer the following questions about the family member/ carer

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Domain 1: Families know their rights and advocate effectively for

their family member with disability

Question Number	Statement/Question	Response options
1	I am able to identify the needs of my family member with disability and my family and know how to access available services and supports to meet those needs	a) Yes b) I have some difficulty c) I have a great deal of difficulty
2	I am able to advocate (stand up) for my family member: I am able to speak up if we have issues or problems with accessing supports	a) Yes b) I have some difficulty c) I have a great deal of difficulty
3	Has the NDIS helped you to know your rights and advocate effectively?	c) It’s our first plan a) Yes b) No

Domain 2: Families have the support they need to care

Question Number	Statement/Question	Response options
1	I have friends and family that I see as often as I like	a) Yes b) No
2	I have people who I can ask for practical help as often as I need	a) Yes b) No
3	I have people who I can ask to support my family member with disability as often as I need	a) Yes b) No
4	I have people who I can ask for emotional support as often as I need	a) Yes b) No
5	I get the services and supports I need to care for my family member with disability	a) Yes b) I would like more support c) I would like different support d) I would like support at different times
6	Has the NDIS improved the level of support for your family?	a) It’s our first plan b) Yes c) No

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Domain 3: Families are able to gain access to desired services, programs, and activities in their community

Question Number	Statement/Question	Response options
1	I feel that the services my family member with disability and my family use listen to me	a) Yes b) Not very much c) Not at all
2	I feel in control in selecting services and supports that meet the needs of my family member with disability and my family	a) Yes b) I have some difficulty c) I have a great deal of difficulty
3	The services my family member with disability and my family receive meet our needs	a) Yes b) No
4	Has the NDIS helped you to access services, programs and activities in the community?	a) It’s our first plan b) Yes c) No

Domain 4: Families have succession plans

Question Number	Statement/Question	Response options
1	Have you made plans for when you are no longer able to care for your family member with disability?	a) Yes b) I have begun c) No (go to 3)

Have you asked for assistance from any of the following?

Siblings of the person with disability
Your extended family
Your friends
The friends of your family member
Service providers
Professionals
Support workers
Other (please specify):

Has the NDIS helped you with preparing for the future support of your family member? a) It’s our first plan
b) Yes
c) No |

Domain 5 Families enjoy health and wellbeing

Question number	Question/Statement	Answer options
1	In general, my health is	a) Excellent b) Very good c) Good d) Fair e) Poor
2	I feel that my family member gets the support he/she needs	a) Strongly agree b) Agree c) Neutral d) Disagree e) Strongly disagree
3	Family who provide informal care to my family member with disability are able to work as much as they want	a) Yes (go to 5) b) No, they would like to work more
4	The barriers to working more are	Choose one or more of: a) Situation of family member with disability b) Availability of jobs c) Available jobs do not have sufficient flexibility (e.g. of hours) d) Other (please specify)
5	Has the NDIS improved your health and wellbeing?	a) It’s my first plan b) Yes c) No

Thank you for completing the family member/carer questions. If you have any further comments, please enter them below. Any comments?