Include Support Coordination in a plan

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Standard Operating Procedure Planning OFFICIAL For internal use only

Include Support Coordination in a plan

Previous Step: Pre-planning tasks are completed in the National Disability Insurance

Scheme (NDIS) business system (System)

Next Step: Complete the Determine Plan Management task in the System

1. Purpose

The content of this document is OFFICIAL. This Standard Operating Procedure (SOP) will

support you to consider and include reasonable and necessary support coordination in a

participant’s plan and should be used alongside the Standard Operating Procedure –

Complete the Determine Funded Supports task.

2. Index

• 6.1 Navigate to the support calculator • 6.2 Include Support Connection in a plan • 6.3 Include Coordination of Supports (support coordination) in a plan • 6.4 Include Specialist Support Coordination in a plan • 6.5 Training in planning and plan management • 6.6 Next steps • 7. Supporting material

3. To be used by

• Plan Developers:

• Planners

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

Coordinators [LACs]) • NDIA plan delegates.

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Standard Operating Procedure Planning OFFICIAL For internal use only 4. Scope

Support coordination is a broad term used to describe the three levels of support (support

connection, coordination of supports and specialist support coordination). This support can be

included in the participant’s plan to support them to connect with services whilst strengthening

their ability to achieve their goals and aspirations. The provision of support coordination will

also help the participant understand how the NDIS operates within a broader ecosystem of

supports including disability organisations and mainstream and community supports.

To provide a high quality service to participants, planners and partners are reminded

successful planning is centred on the following principles:

• Valuing and respecting the goals and aspirations of the participant. • Understanding the importance, role and opportunity that may be afforded to the

participant by connecting with mainstream, community and informal supports. • Applying reasonable and necessary judgements in developing and determining the

funded supports to assist the participant to achieve their stated goals. • Determining and assessing the suitability of funded supports against the generated

Typical Support Package (TSP). • Quality interactions which demonstrate empathy and understanding of the

participant’s disability and needs.

4.1 Levels of support coordination

There are three levels of support coordination which may be included in the plan in the support

coordination budget. Use your reasonable and necessary decision making and take into

account the goals and aspirations of the participant. Streaming is an important factor to

determine the level of support coordination a participant needs. However, it’s important that

plan developers also take into account a participant’s individual circumstances. When you

determine the type, level and number of hours to be included in the plan, consider existing

informal supports, any additional complexity factors as well as the participant’s streaming

outcome.

The generated TSP will also guide you in determining the funded supports. The following is

provided for guidance only and is not intended to be used as a rule.

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Standard Operating Procedure Planning OFFICIAL For internal use only If the TSP is exceeded by more than 10% because of a reasonable and necessary decision,

clear evidence from a relevant professional must be attached as an inbound document in the

NDIS Business System (System). Justification for any changes, in line with the attached

evidence, must be recorded in the Review and Submit Plan for Approval task.

You must ensure any increases to the TSP above 10% are reviewed by an executive level

delegate prior to plan approval. Record the information for this review using the Plan submitted

for executive level review of changes to the TSP interaction template. Make sure you also

record the review information in any justifications for changes to the TSP. You will then follow

the usual plan approval process.

Note: If support coordination is included in the plan, discuss with the participant if they have

any preferred providers for this support and gain their consent for the NDIA to make a referral

on their behalf. This information will be required for plan implementation. For further

information refer to the Standard Operating Procedure – Request for Service – Make a

request.

4.1.1 Support Connection

Support connection is typically delivered by a participant’s Local Area Coordinator (LAC) or

Early Childhood Partner. Support connection is a time-limited assistance to strengthen the

participant’s ability to connect with mainstream and community supports, and establish service

agreements and bookings with support providers. The aim is to increase the participant’s

capacity and ability to maintain relationships, negotiate with service providers and respond to

minor service delivery issues.

Participants who reside in an area that is supported by an LAC or Early Childhood Partner,

should generally not require additional funding to be included in their plan as this is the primary

role of the partner. This is, however, dependent on the level of support the participant needs to

implement their plan. You will need to consider all information available to you to make this

decision as each participant’s circumstances are different.

For participants streamed General or Supported:

• If supported by an LAC Partner, you can remove the funding generated in the

Support Coordination budget. In doing so, you should assess if the participant

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Standard Operating Procedure Planning OFFICIAL For internal use only requires referral to a specific support connector, such as a CALD organisation or a

preferred Aboriginal and Torres Strait Islander provider.

If not supported by a LAC partner, amend the generated Support Coordination budget to

reflect your reasonable and necessary consideration. As a guide, this would typically be an

hour a month (around 12 hours for a 12 month plan) of support connection.

4.1.2 Coordination of Support (formerly support coordination)

Coordination of support is delivered by a support coordinator. Consider including coordination

of support in a participant’s plan to assist in strengthening the participant’s capabilities to

connect to and coordinate informal, mainstream and funded supports in a complex service

delivery environment. Participants requiring this level of support will have usually been

streamed at the Intensive level. This may include resolving points of concern, unexpected

service delivery issues, developing capacity and resilience in a participant’s network and

coordinating supports from a range of suppliers or providers.

The support coordinator should focus on addressing barriers and reducing complexity in the

support environment, while ensuring that the participant is supported to connect with, and build

their capacity and resilience. It may also involve development of an intervention plan which will

be delivered by disability support workers.

There may not be enough funding in the generated TSP to meet the participant’s coordination

of support needs. You may need to adjust the coordination of support funding to enable the

participant to receive the right level and type of support to implement their plan and address

any complexities in their life.

Note: When a support coordinator is providing capacity building supports, immediately moving

to a partner - LAC or Early Childhood may disadvantage the participant. In this case you can

include 3 months of coordination of support in the new plan, with a request that the support

coordinator completes a ‘warm handover’ to the partner at the end of those 3 months.

The below provides some guidance for including funds for coordination of support in the plan

however you will need to consider all information available to you when making your

reasonable and necessary decision.

• Low (1-2 hours a month/approx. 24 hours per year) for example, this could be

considered when the participant:

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Standard Operating Procedure Planning OFFICIAL For internal use only

• has elderly parents who are needing to explore and establish a range of

supports including housing options and future planning issues for their

son/daughter

• lives in a group home or large residential facilities and has a strong informal

support network with no identified risks

• is adjusting to vision, hearing and other sensory loss type conditions. • Medium (3-6 hours a month/approx. 48-72 hours per year) for example, for

participants who:

• have a managed psychosocial diagnosis and are well connected to clinical

supports. For example, may be accessing treatment options to understand their

condition, trial medications and create a recovery plan.

• have a support network that may be at risk

• are at mid stages of a degenerative condition

• may require assistance to transition to alternative living arrangements. • High (approximately 7-9 hours a month) for example, participants who:

• are experiencing an unstable psychosocial disability and have a history of long-

term hospitalisation and/or history of tenancy instability

• have limited family and social networks

• have very low levels of community participation

• in the absence of support, have difficulty living in the community and are at high

risk of hospitalisation or homelessness

• identify as Aboriginal or Torres Strait Islander and may be living in remote

communities

• are involved with other services such as child protection or justice

• are living with a diagnosis of a degenerative condition such as; younger onset

dementia, Huntington’s disease, multiple sclerosis (MS), muscular dystrophy or

motor neurone disease (MND). As a result they require support to engage with

specialist support organisations to assist with understanding their condition and

connecting with available supports. Required where multiple providers are

involved.

• mild to moderate levels of intellectual disability or acquired brain injury and are

residing alone and need to ensure proactive supports are in place. They may

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Standard Operating Procedure Planning OFFICIAL For internal use only require assistance to access and maintain community activities, budgeting,

shopping, or similar activities ensuring successful maintenance of their

independence.

Important Note: For all levels, these are examples only and you must use your reasonable

and necessary decision making when including supports in a plan.

4.1.3 Specialist Support Coordination (typically up to 100 hours for a 12 month plan)

Participants who have been streamed as Super Intensive may require specialist support

coordination as they may have multiple complexities in their circumstances, multi-jurisdictional

involvement and limited support networks. This could involve a specialised and/or intensive

response within a specialist framework if the participant has high risks in their life situation

and/or environment. These could include:

• risk of homelessness due to their behaviours of concern • interface with justice, housing and/or other complexities • children living outside the family home under formal voluntary out of home care

arrangements as acknowledged by the relevant state or territory authority and the

NDIA. Refer to Practice Guide – Children Living in a Formal Voluntary Arrangement

Outside their Family Home.

This approach is expected to:

• address barriers and reduce complexity in the participant’s environment • assist to connect the participant with multiple complex supports • assist to build the participant’s capacity and resilience.

You will need to use your reasonable and necessary decision making to determine how many

hours will need to be included for specialist support coordination and consider the guidance

under the heading of Specialist Support Coordination above if needed. When deciding how

many hours, ensure there is enough funding to support the participant as well as to allow the

support coordinator to fulfil their reporting requirements.

4.1.4 Referral for Complex Support Needs

When determining the level of support coordination you may identify the participant has

complex support needs that require referral into the Complex Support Needs (CSN) Pathway.

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Standard Operating Procedure Planning OFFICIAL For internal use only The CSN Pathway aims to provide specialised support for people with disability who

experience personal and situational factors that are beyond the scope of the typical NDIS

Pathway. To refer a participant for assessment by the CSN branch, refer to Standard

Operating Procedure – Referral for Complex Support Needs. For more information on the CSN

Pathway refer to Practice Guide – Complex Support Needs Pathway.

4.2 Support Coordination Roles

The role of the LAC, Early Childhood Partner (support connection) or support coordinator is to

assist the participant to implement their plan. They will ensure the participant can exercise

choice and control to, link with the right providers, meet and achieve their goals and locate and

coordinate a range of supports. Generally, this will include mainstream, community and funded

supports while building on informal networks. They will provide participants with strategies for

how to use their support budgets to achieve their goals. Support coordination activities can

include supports to build participant resilience in their own network and community.

A support coordinator will need to complete implementation and progress reports as part of

their role in supporting the participant. Plan developers should make sure that additional hours

are included in the support budget to allow for this to be completed. You will need to use

reasonable and necessary decision making to ensure all required inclusions are in the

participant’s plan.

4.3 Psychosocial Recovery Coach

From 1 July 2020, a new support called psychosocial recovery coach (recovery coach) will be

available for NDIS participants and is included in the NDIS Pricing Arrangements and Price

Limits.

Generally, if a participant’s primary disability is psychosocial disability then you should

consider including the support of a recovery coach. Recovery coach support should be

included if, in your discussions with the participant, you identify that they require support to link

to and maintain engagement with informal, community, mainstream and funded supports; and

to build capacity, including strengths and resilience. A recovery coach is available to

participants across all streams – General, Supported, Intensive and Super Intensive.

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Standard Operating Procedure Planning OFFICIAL For internal use only Generally, the participant should not have funding for both recovery coach support and support

coordination included in their plan. Support coordination may be considered reasonable and

necessary in addition to funding a recovery coach in limited circumstances. For example,

funding for a specialist support coordinator may be considered reasonable and necessary if

the participant identifies a goal of finding suitable housing.

If the participant had funding for support coordination in their previous plan, discuss the

supports a recovery coach can provide. Explain that a recovery coach will be able to provide

targeted support for the participant in relation to their psychosocial disability and can support

them in their recovery journey.

If the participant is already linked with a support coordinator they can exercise their own choice

and control to decide if they want to use their recovery coach funding to continue receiving

support from their support coordinator, or they may wish to change to support provided by a

recovery coach.

Note: As this is a new support the market may be limited to provide this service. Until the

market matures there may not be any recovery coach providers available in the participant’s

local area. If this is the case and the participant has support coordination included in their plan

they can continue to be provided with support through their LAC or support coordinator.

If recovery coach support is included in the plan you must complete the Request for Service

System task during plan implementation. See Standard Operating Procedure – Request for

Service – Make a request.

For further information refer to the Practice Guide – Psychosocial Disability, Standard

Operating Procedure – Psychosocial Recovery Coach Support.

4.4 Children 15 and Under

As of 15 September 2017, the System no longer auto-generates funding for support

coordination for participants aged 15 years or under, even if it has been indicated as required

in the Guided Planning Questionnaire. Apply reasonable and necessary decision making when

determining if funding for support coordination is required. Consider the participant’s

circumstances and context (including their informal support networks and parental

responsibility) and if the support meets reasonable and necessary criteria. Record adequate

justification to support and document the decision.

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Standard Operating Procedure Planning OFFICIAL For internal use only 5. Prerequisites

• You have had a planning conversation with the participant to understand and identify

their current and potential Assistive Technology (AT) support needs, as well as

identifying any preferences for specific providers to provide support coordination

services. • You have completed all relevant pre-planning tasks in the System. • You have read the Standard Operating Procedure – Complete the Determine Funded Supports task.

6. Procedure

Please note: Data in screenshots is fictional and intended for instructional purposes only.

6.1 Navigate to the support calculator

1. From the Home screen select My NDIS.

2. Search for and select the Participant. For more information, see the Standard Operating Procedure - Search the NDIS Business System.

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Standard Operating Procedure Planning OFFICIAL For internal use only 3. From the pathway tab, select the In Progress Application.

4. Select Planning.

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Standard Operating Procedure Planning OFFICIAL For internal use only 5. The Planning page displays. Select Determine the Funded Supports.

6. The Determine the Support Needs screen opens.

7. Complete the Determine the Funded Supports task for the plan as per the guidance in the Standard Operating Procedure – Complete the Determine Funded Supports task.

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Standard Operating Procedure Planning OFFICIAL For internal use only 8. Once the plan’s funded supports have been completed, select the Save button.

9. Select the Capacity Building support type.

10. The two Capacity Building sub types are displayed.

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Standard Operating Procedure Planning OFFICIAL For internal use only 11. Manually remove any funding auto-generated for Support Coordination.

12. Select the expand icon in the Support Coordination price field.

13. The Support Calculator will open. Select anywhere in the Product field.

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Standard Operating Procedure Planning OFFICIAL For internal use only 14. The Select a Product screen will open.

15. Continue to add support connection, coordination of supports (support coordination), specialist support coordination or training in planning and plan management using the guidance below.

6.2 Include Support Connection in a plan

1. In the support calculator, select Support Connection.

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Standard Operating Procedure Planning OFFICIAL For internal use only 2. Use reasonable and necessary decision making to adjust the Quantity as guided

above.

• At How Often select Per Year. • Select Done.

3. In the Comment field record the following: XX hours of support connection to help me

connect with my chosen service providers.

4. Select Submit when completed.

5. When the form has been submitted, a success message appears. The success

message will ask Are the funded supports correctly aligned to the goals listed in

the Participant Statement?

• If you select No, you will be taken directly to the Participant Statement to review

the goals section and make sure the correct support type boxes have been ticked.

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Standard Operating Procedure Planning OFFICIAL For internal use only • If you select Yes, you will continue as usual.

6. If the TSP has been increased by more than 10%, select Save and assign a Plan

submitted for executive level review of changes to the TSP interaction to an executive

level delegate to review the funded supports.

6.3 Include Coordination of Supports (formerly support coordination) in a plan

Note: In the System support coordination is referred to as coordination of supports.

1. In the support calculator, select Coordination of Supports.

2. Use reasonable and necessary decision making to adjust the Quantity as guided above.

• At How Often select Per Year. • At Item Type select Stated. • Select Done.

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Standard Operating Procedure Planning OFFICIAL For internal use only 3. In the Comment field enter the following text: XX hours of Support coordination to

support me to connect to, engage with and coordinate my chosen service providers.

4. Include any other reasonable and necessary supports within the TSP using the Support

Calculator.

5. If the TSP has been increased by more than 10%, select Save and assign a Plan

submitted for executive level review of changes to the TSP interaction to an executive

level delegate to review the funded supports.

6. When you are satisfied that all supports in the plan are reasonable and necessary and

any required executive level reviews are complete, select Submit.

6.4 Include Specialist Support Coordination in a plan

1. Navigate to the support calculator, select Specialist Support Coordination.

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Standard Operating Procedure Planning OFFICIAL For internal use only 2. Use reasonable and necessary decision making to adjust the Quantity as guided above.

• At How Often select Per Year. • At Item Type select Stated. • Select Done.

3. In the Comment field record the following: XX hours of Specialist support coordination

to support me to connect to, engage with and coordinate my chosen service providers.

4. Include any other reasonable and necessary supports within theTSP using the Support

Calculator.

5. If the TSP has been increased by more than 10%, select Save and assign a Plan

submitted for executive level review of changes to the TSP interaction to an executive

level delegate to review the funded supports.

6. When you are satisfied that all supports in the plan are reasonable and necessary and

any required executive level reviews are complete, select Submit.

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Standard Operating Procedure Planning OFFICIAL For internal use only 6.5 Training in planning and plan management

You can include supports in the participant’s plan aimed at building their capacity to self-

manage their NDIS funded supports. The line item Training in Planning and Plan

Management sits in the Support Coordination support category and can be included on a

time limited basis if considered reasonable and necessary.

This support does not have to be provided by a support coordinator, however the provider

must be registered for this category.

Plan and financial capacity building support may also be provided by a plan manager where

there is no coordination of supports funded in the participant’s plan. Refer to Standard

Operating Procedure – Plan Management and Financial Administration Support Items.

6.6 Next steps

6.6.1 Determine Plan Management

Complete the Standard Operating Procedure – Complete the determine plan management

task task before finalising and approving the plan.

6.6.2 Finalise and approve the plan

Complete the Standard Operating Procedure – Review and Submit a Plan for Approval OR the

Standard Operating Procedure – Finalise and Approve a Plan task. You will need to include

justification for including coordination of supports in the plan.

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Standard Operating Procedure Planning OFFICIAL For internal use only 7. Supporting material

e National Disability Insurance Scheme Act 2013 (section 34) e National Disability Insurance Scheme (Supports for Participants) Rules 2013

e Practice Guide — Intensive and Super Intensive Participants

e Standard Operating Procedure — Complete the Determine Funded Supports task e Planning Operational Guideline

8. Process owner and approver

General Manager, Participant Experience Design.

9. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our Feedback form.

10. Version control

Version Amended Brief Description of Change Status

by

5.0 MBO056 | Class 2 approved. APPROVED | 2020-06-18

Included reference to Practice Guide — Complex Support Needs Pathway and Standard Operating Procedure — Referral for Complex Support needs.

Included new section on psychosocial recovery coach role.

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Standard Operating Procedure Planning OFFICIAL For internal use only

Version Amended Brief Description of Change

by

6.0 EMN960 | Updated recovery coach guidance to clarify: APPROVED | 2020-07-27

e when a support coordinator may be considered reasonable and necessary

in addition to a recovery coach

e aparticipant can continue with their current support coordinator using their recovery coach funding if they choose

to.

7.0 CS0074 | Class 1 Approval APPROVED | 2021-01-18

Updated links relating to the NDIS Business System.

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