Acknowledgement of Country

DOCUMENT 1

ndis

Section 24(1)(a)

Facilitator notes:

Say

Welcome to your first session of the Disability criteria. This morning we are looking at Section 24(1)(a).

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Acknowledgement of Country

Before we begin, I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea, and community. I pay my respects to their Elders, past and present.

I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples here today.

Facilitator notes:

[Show or hide this slide as needed.]

Say

Before we begin, I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea, and community. I pay my respects to their Elders, past and present.

I acknowledge that I am facilitating this training from the lands of the [insert name] people.

I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples

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here today.

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OFFICIAL

Learning outcomes

This session has been designed to help you:

• explain the difference between disability and impairment
• understand that Section 24(1)(a) is made up of two components
• navigate to and use resources to support decision making
• begin building your knowledge on how to determine if an impairment is intellectual, cognitive, neurological, sensory or physical impairments; or to attributable to a psychiatric condition.

Facilitator notes:

Here are our learning outcomes for this session.

This session has been designed to help you:

• explain the difference between disability and impairment
• understand that Section 24(1)(a) is made up of two components
• navigate to and use resources to support decision making
• begin building your knowledge on how to determine if an impairment is intellectual, cognitive, neurological, sensory or physical impairments; or to attributable to a psychiatric condition.

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Please feel free to ask questions throughout the session. Let’s get started.

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List A & B conditions

Facilitator notes:

Say

Before we take a closer look at the individual Disability legislative criteria, let’s look at some of the streamlined access processes relevant to Disability.

These include conditions that are listed on List A or List B.

As you know, a condition on List A will likely meet the Section 24 Disability criteria.

List B also contains conditions that are likely to meet Section 24(1)(a) — and Section 24(1)(b). Where an applicant has been diagnosed with a condition (or conditions) on List B the NDIA will be satisfied that the person has a disability attributable to one or more impairments that is, or is likely to be, permanent, without further assessment. This

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means you only need to assess Section 24(1)(c) onwards.

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OFFICIAL

NDIS Act — Section 24(1)(a)

Is your disability caused by an impairment?

The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition

Facilitator notes:

Say

As you know, Section 24(1)(a) is the first criteria of the disability criteria in the NDIS Act. To meet this criteria the person must have a disability attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments; or to one or more impairments attributable to a psychiatric condition.

Our Guidelines provides us with the definitions that the NDIA has adopted for disability and impairment. When looking at 24(1)(a), remember that the definitions we use for disability and impairment may be different to others you are used to using, or what health professionals use.

There are two components to consider when assessing s24(1)(a) — disability and impairment.

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We’ll look at each component in a minute.

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OFFICIAL

Group discussion

Key Terms — Disability & Impairment

What is the difference between the two?

Facilitator notes:

Say

As we just mentioned, Our Guidelines provide us with the definitions that the NDIA have adopted for the terms disability and impairment.

Does anyone remember what these terms mean? Or, what the difference between the two are?

Pause

[Provide opportunity for learners to consider question. Prompt learners to navigate to the Our Guidelines to find the answer.]

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[Allow time for group discussion of the definitions, and difference between Disability & Impairment. Answers will be discussed on the next slides.]

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Disability & impairment

Disability:

any reduction or loss in your ability to do things, across all life domains

Impairment:

a loss or significant change in at least one of:

• your body’s functions
• your body structure
• how you think and learn

Facilitator notes:

Let’s take a look at the definitions on the screen here.

We can see that disability is defined as any reduction or loss in your ability to do things, across all life domains.

We consider an impairment to be a loss or significant change in at least one of your body’s functions, structure, or in how you think and learn.

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OFFICIAL

Impairment

Facilitator notes:

Say

The NDIS Act states that a person must have a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments; or to one or more impairments attributable to a psychiatric condition.

We will now take a look at each of the impairments.

Click [for animation]

Intellectual — this relates to how a person speaks and listens, reads and writes, solves problems, and

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processes and remembers information

Click [for animation]

Cognitive — how a person thinks, learns new things, uses judgment to make decisions, and pays attention

Click [for animation]

Neurological — how a person’s body functions

Click [for animation]

• Sensory — how a person sees or hears

Click [for animation]

• Physical — the ability to move parts of their body.

Click [for animation]

A person may also be eligible for the NDIS if they have a psychosocial disability. This means they have reduced capacity to do daily life activities and tasks due to their mental health.

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Assessing impairments

Facilitator notes:

Say

We need to assess whether an applicant’s disability is caused by at least one of the listed impairment categories.

We record the impairment category in PACE for access met decisions.

It’s important that you record the impairments correctly as in future this information will be used to develop a person’s plan and ensure they receive the right supports.

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Guide. We will look at the Guide in the next slide.

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OFFICIAL

Impairment Categories Guide

Facilitator notes:

Say

The Impairment Categories Guide is a simple table that gives you clear and precise information about which category a disability falls under.

There is a snip of the Guide on the slide.

Use pointer to show relevant column as you talk about each one

The first column shows the condition.

The second column lists the ICD-10-CM Diagnosis Code.

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The third column identifies the required impairment category.

The fourth column lists optional impairment categories.

Delegates will refer to this guide to help them determine the appropriate category for each condition.

As mentioned earlier, we will input in the System the most relevant impairment for each condition that meets access.

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OFFICIAL

Recording impairments: previous legislation

Facilitator notes:

Say

The impairment categories section of an access decision case will not display if you are assessing an application under previous legislation.

This is because it is not a requirement to record the impairment categories under previous legislation.

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OFFICIAL

Activity

Facilitator notes:

Say

Now, to apply the definitions we have learnt, to what we might see in an application for the NDIS. I’ll read out a sentence, and then you may use the “hand up” function or write in the chat if you are able identify which is the disability and which is the impairment.

Click [for animation]

The person has a broken leg and is unable to walk without crutches.

Which is the disability and which is the impairment?

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Pause [for answers]

Click twice [for 2 animations]

In this example the broken leg is the physical impairment because there is a significant change to a physical function – i.e. a broken bone. The disability (i.e. the reduction or loss of an ability to do things) is being unable to walk unaided.

Okay, next sentence.

Click [for animation]

The person has difficulty speaking after having a stroke.

Pause [for answers]

Click twice [for 2 animations]

In this example the disability is the person having difficulty speaking, this is caused by a neurological impairment, stroke. This is because a stroke causes brain cells to die and therefore there is loss and/or significant change to a mental function.

Final sentence.

Click [for animation]

The person has bilateral knee osteoarthritis and is unable to bend their legs properly.

Pause [for answers]

Click twice [for 2 animations]

In this example bilateral knee osteoarthritis is a physical impairment because there is loss to a physical function because the arthritis is causing joint inflammation. The disability is being unable to bend their legs.

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OFFICIAL

Multiple Sclerosis

Facilitator notes:

Say

We will now have a more in depth look at how we determine if an impairment meets the criteria for Section 24.1.a.

We will first have a look at Multiple Sclerosis.

MS is defined as “a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. In MS, the body’s own immune system mistakenly attacks and damages the fatty material — called myelin — around the nerves. As the myelin breaks down during a MS attack — a process called demyelination — patches of nerves become exposed and then scarred.”

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These scars occur within the central nervous system and depending on where they develop, manifest into various symptoms.

As demonstrated in the image, a healthy brain does not have lesions, however a brain with MS has neurological differences.

MS is a neurological impairment because it impacts the central nervous system.

It then follows that the impacts, or disability of MS, is of a neurological nature. People with MS may experience difficulties with coordination and problems with controlling the body, pins and needles, loss of sensation or changes in memory.

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OFFICIAL

Chronic Obstructive Pulmonary Disease (COPD)

Facilitator notes:

Say

Chronic Obstructive Pulmonary Disease, or COPD, is considered a physical impairment.

As defined by the Lung Foundation (Australia), COPD causes narrowing of the bronchial tubes in the lung making it difficult to breathe. As demonstrated in the image, a healthy bronchial tube compared to one with COPD is physically different.

In this case, COPD has caused a significant change to a physical function. Someone with COPD can find it hard to physically complete tasks and activities such as walking due to the damage to their lungs, therefore COPD can be considered a physical impairment.

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OFFICIAL

Auditory Processing Disorder (APD)

Facilitator notes:

Say

We will now have a look at an impairment that is unlikely to be an impairment that is intellectual, cognitive, neurological, sensory or physical in nature; or attributable to a psychiatric condition; - Auditory Processing Disorder.

As defined by the Raising Children Network (Australia), Auditory Processing Disorder is “a problem with the way the ears and brain work together to understand sound”. People with APD have “normal hearing, but difficulty interpreting the sounds they hear”.

APD by itself is not considered a sensory impairment as someone with APD does not have damage to their

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hearing.

Although the brain has difficulty interpreting the sounds there is no loss of, or significant change to the functions of the brain, we cannot assume that APD is a neurological or cognitive impairment. We require specific neurological or cognitive testing to confirm this.

In most cases, it is likely that APD will not meet Section 24(1)(a) as the disability cannot be attributed to an impairment. There may be instances where the person has undertaken testing and it can be linked to a specific impairment.

Click [to go to next slide.]

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OFFICIAL

Resources available

Facilitator notes:

Say

When you are assessing applications, it is important to remember that you have many resources available to support you.

This includes utilising the Access Decision Tree, the Access Assessor OneNote and Our Guidelines.

We will now practice applying Section 24(1)(a) to different scenarios, and it is important to use these tools to support your knowledge.

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OFFICIAL

True and false

Facilitator notes:

[This slide contains an activity where learners will refer to available resources to answers questions.]

Say

Before we head into some case studies, we will go onto a couple of True or False questions. For this one I will provide you with 10 minutes to review the questions on the screen, and to use the resources available to you to answer the question. When you return, I will ask the question and then everyone that thinks the answer is true, put your hand up.

[Provide learners approximately 10 minutes (longer if required) to review the questions. Prompt learners to Our Guidelines, OneNote etc if required.]

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A person living with Huntington’s Disease that has not started showing symptoms meets Section 24(1)(a).

If you think the answer is true, raise your hand now.

Pause [for answers]

Click [for animation]

The answer is true. Although the person does not yet have a disability, Huntington’s Disease is a List B condition. As per Is your impairment likely to be permanent? of Our Guidelines, if someone has a List B condition, they will meet Section 24(1)(a) and (b).

Okay, next question.

You have received an application for a 7 year old child with a Speech Delay. Their GP has advised that their speech is developing slower than their peers. No evidence of any assessments have been provided with their application. The applicant does not meet Section 24(1)(a) as the delay cannot be attributed to one of the impairments.

If you think the answer is true, raise your hand now.

Pause [for answers]

Click [for animation]

The answer is true. You would need to have intellectual, cognitive or neurological testing to show that the delay can be attributed to one of these impairments (cognitive, neurological, or intellectual). Typically, this is quite often hard to determine unless comorbid with another impairment (such as Intellectual Disability or Down Syndrome).

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OFFICIAL

Break time

Facilitator notes:

Say

Let’s take a 10-minute break.

[Tell learners what time to be back in front of their computers. Leave this slide showing during the break.]

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OFFICIAL

Case study 1

Facilitator notes:

[This slide contains an activity where learners will complete a case study and you will paste questions into the chat. When pasting the questions, right click and select ‘Paste as plain text’. The case study PDFs are located in the same location as this presentation.]

Say

The following 3 case studies are de-identified case studies of real cases that delegates have made a decision on. For the purposes of this training, all the evidence of disability (EOD) is recent. It is acknowledged that for some of these cases you will not see these regularly when assessing applications. The idea of a case study is to help further explain the criteria, but not to create a blanket rule. If you have the underlying understanding of the criteria, you are able to apply it to more complex cases when you break

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down the evidence.

For a brief summary of this case study:

Annie is 8 years old and applying with a primary disability of Specific Learning Disorder

The psychologist who completed the supporting documentation has written a sentence for each legislative criteria as to how Annie meets it

The psychologist has also provided a copy of the testing completed and Annie’s results

I will now paste the case study evidence (pdf) and some questions into the chat. You will have 15 minutes to review the evidence and answer the questions.

Does anyone have any questions before we begin?

Paste in chat

Does Annie have a disability as defined in Is your disability related to an impairment? of Our Guidelines? If so, can it this be attributed to one or more impairments? Does Annie meet Section 24(1)(a)? Should further information be sought?

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OFFICIAL

Activities — Our Guidelines

Facilitator notes:

[Facilitator to demonstrate navigating to the correct area of the OGs noting that the website may have undergone changes.]

Say

Now we’re going to do some activities. In these activities, you will need to navigate to Our Guidelines. I will remind you how to do this now.

[Share your screen and follow the steps below whilst explaining the steps to the learners.]

• Go to the Access page on the intranet by opening a new tab on your browser, hovering over ‘Service Delivery’ and selecting ‘Access’.
• Scroll down slightly and select ‘NDIS Operational Guidelines (external)’.

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• Scroll down and select ‘Applying to the NDIS’.
• Scroll down. Select the document titled ‘Applying to the NDIS’.

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OFFICIAL

Case study 1 Q & A

Facilitator notes:

Say

We will now go through a few questions, please use the hand up function or use the chat if you would like to answer.

Click [for animation]

Does Annie have a disability as defined in Is your disability related to an impairment? of Our Guidelines?

Pause [for answers]

Click [for animation]

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Advise if correct/incorrect - Yes, based on the evidence provided Annie does have a reduction or loss of an ability to do things, across all life domains, because of an impairment. This is demonstrated in the evidence as a reduction in her ability to learn.

Click [for animation]

If so, can it this be attributed to one or more impairments?

Pause [for answers]

Click [for animation]

Advise if correct/incorrect - No, although the “Access Request Support Documentation” states that Annie’s disability is attributable to cognitive and neurological impairments when you read the “Psychological Report” the test results show that the majority of her test scores, including her FSIQ is in the average range and therefore would not be considered a “loss of, or significant change in your body’s functions, structure or how you think and learn”. There is also no neurological testing provided to attribute the disability to a neurological impairment. This would not be considered a sensory impairment as there is no loss or significant change to how she sees or hears.

Click [to go to next slide]

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Case study 1 - Q & A continued

Q: Does Annie meet Section 24(1)(a) (external)?

A: No, although Annie has a disability, as stated above it cannot be attributed to an impairment and therefore Section 24(1)(a) is not met.

Q: Should further information be sought?

A: No — there are no red flags to indicate that Annie would meet all criterion if further information was sought. The current evidence demonstrates that the impairment is not permanent or likely permanent, as the health professionals have recommended treatment options. Therefore, even if the delegate was to get information that attributes the disability to an impairment, it would not be considered likely permanent in line with Section 5.6 of the NDIS (Becoming a Participant) Rules 2016 (external).

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OFFICIAL

Facilitator notes:

Click [for animation]

Say

Does Annie meet Section 24(1)(a)?

Pause [for answers]

Click [for animation]

Advise if correct/incorrect - No, although Annie has a disability, as stated above it cannot be attributed to an impairment and therefore Section 24(1)(a) is not met.

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Click [for animation]

Should further information be sought?

Pause [for answers]

Click [for animation]

Advise if correct/incorrect - No – there are no red flags to indicate that Annie would meet all information was sought. The current evidence demonstrates that the impairment is not permanent or likely permanent, as the health professionals have recommended treatment options. Therefore, even if the delegate was to get information that attributes the disability to an impairment, it would not be considered likely permanent in line with Section 5.6 of the NDIS (Becoming a Participant) Rules 2016.

Before we move onto the next case study, did anyone have any questions about this first case study?

Click [to go to next slide]

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OFFICIAL

Case study 2

• Name: James* (*For training purposes only)
• Age: 32 years old
• Diagnosis: Schizoaffective Disorder
• Evidence:
  • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent.

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Facilitator notes:

[Learners will complete a second case study and you will paste questions into the chat.]

Say

This next case study is for a 32 year old living with Schizoaffective Disorder. The psychiatrist has completed the Supporting Evidence Form and indicated that James was diagnosed 13 years ago when he was 19 years old and previously on a Community Treatment Order (CTO). The psychiatrist has selected “No” in all the domains and advised in social interaction “would benefit from transport to activities” and in self-management “would benefit from someone to mow his lawn on a regular basis”.

I will now paste some the case study evidence (pdf) and questions into the chat. You will have 15 minutes to review the evidence and answer the questions.

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Does anyone have any questions before we begin?

Paste in chat

[Does James have a disability as defined in Is your disability caused by an impairment? of Our Guidelines? Does James currently meet Section 24(1)(a)?]

Click [to go to next slide]

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Case study 2 - Q & A

Q: Does James have a disability as defined in ‘Is your disability related to an impairment?’ of Our Guidelines?

A: No — although we commonly associate someone living with Schizoaffective Disorder as having a disability, based on the evidence on file, James does not have a disability. The Supporting Evidence Form (SEF) states that he would benefit from transport to activities and someone to mow his lawn; however we do not know why he needs this support.

Q: Does James currently meet Section 24(1)(a) (external)?

A: No — as the current information shows that James does not have a disability.

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OFFICIAL

Facilitator notes:

Say

First question for this case study.

Click [for animation]

Does James have a disability as defined in Is your disability related to an impairment? of Our Guidelines?

Pause [for answers]

Click [for animation]

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Advise if correct/incorrect - No — although we commonly associate someone living with Schizoaffective Disorder as having a disability, based on the evidence on file, James does not have a disability. The Supporting Evidence Form states that he would benefit from transport to activities and someone to mow his lawn, however we do not know why he needs this support.

Click [for animation]

Does James currently meet Section 24(1)(a)?

Pause [for answers]

Click [for animation]

Advise if correct/incorrect - No — as the current information shows that James does not have a disability.

Does anyone have any ideas on how you would proceed with this application?

Pause [for answers]

[In this situation, both an Access Not Met Decision and a Phone Call/s26 are appropriate ways to proceed. This example highlights to learners that as the delegate it is their decision and judgement.]

[Discuss the following as a group with learners.]

Both an Access Not Met and a Further Information Request may both be appropriate courses of action in this situation. As we’ve discussed, James is not currently meeting Section 24(1)(a), so making an Access Not Met decision would be legislatively correct.

Alternatively, you as the delegate may decide to make a phone call before proceeding to a decision. One of the reasons you may do this is because a psychiatrist does not necessarily focus on functional impact, they mainly focus on the

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clinical aspect of the disability. They also may not be aware of the day to day functional impacts, possibly seeing the person only a few times a year. As we do not know what sort of assistance is required in social interaction and self-management, a phone call is a tool that you can use as an Access Assessor to discover this information.

If during the call it is deemed that he does not have a substantial reduction in functional capacity then an Access Not Met decision should be made. If you determine that there is a substantial reduction in function, you would need to send a Further Information Request (s26) letter because this would be new information and would need to be confirmed in writing.

Alternatively, if you are making the phone call to the treating health professional you may be able to email them a summary of your conversation and ask them to reply confirming they agree with the summary.

This is a decision that you need to make as a delegate, it is not part of the process to make this call, and making a decision straight away based on this information would be legislatively correct. However, looking at the application holistically and putting the applicant first, a quick clarification phone call attempt may be beneficial.

Does anyone have any questions about this case study?

Click [to go to next slide]

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Key points

• Section 24(1)(a) is a 2-part question

Does the person have a disability? And is the disability attributable to an impairment that is intellectual, cognitive, neurological, sensory or physical; or an impairment attributable to a psychiatric condition

• List B impairments are likely to meet 24(1)(a) and (b)

• The definition used for disability and impairment used in determining access may be different to what you are used to using and also what health professionals use.

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Facilitator notes:

Now for the Key Points:

Section 24(1)(a) is a 2 part question — Does the person have a disability? And is the disability attributable to an impairment that is intellectual, cognitive, neurological, sensory or physical; or

an impairment attributable to a psychiatric condition. We must consider the evidence to identify the disability and impairment in order to confirm that s24(1)(a) is met.

When looking at 24(1)(a), remember that the definition used for disability and impairment used within the Agency for the purposes of determining access to the Scheme may be different to what you are used to

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using and also what health professionals use.

List B impairments are likely to meet Section 24(1)(a) and (b). Remember to check if the applicant’s impairment is on List B!

Click [to go to next slide]

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Useful resources

AA OneNote (external)

Access and ER decision tree (external)

Knowledge Article - Check eligibility - DIS - disability caused by an impairment (external)

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Facilitator notes:

Say

Here are links to some resources that you might find useful for making an access decision. I will give a minute to open these links before moving on.

[Give learners 1 minute.]

Click [to go to next slide]

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Questions

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Facilitator notes:

Say

That brings us to the end of the 24(1)(a) training. Before we move on, does anyone have any questions?

Click [to go to next slide]

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Version control

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Hidden Slide — Version Control

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DOCUMENT 2

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Slide 1

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National Access QDO & AA — Technical Meetings

Section 24(1)(a)

redacted: s47E(d) - certain operations of agencies@NDIS.GOV.AU

ndis

OFFICIAL

The first legislative criteria we will be going through is Section 24(1)(a)

CLICK FOR NEXT SLIDE

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Slide 2

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Overview

• Explanation of Section 24(1)(a)
• Explanation of impairments listed in Section 24(1)(a)
• Advice from Technical Advisory Branch
• Case Study 1 — Specific Learning Disorder
• Case Study 2 — Schizoaffective Disorder
• Case Study 3 — Multiple Sclerosis
• Test your knowledge — True or False
• Key Points
• Questions

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OFFICIAL

Today we will be going through:

• CLICK Explanation of Section 24(1)(a)
• CLICK Explanation of Impairments listed in Section 24(1)(a)
• CLICK Advice from the Technical Advisory Branch
• CLICK Case Study on Specific Learning Disorder
• CLICK Case Study on Schizoaffective Disorder
• CLICK Case Study on Multiple Sclerosis
• CLICK An opportunity to test your knowledge
• CLICK Key Points
• CLICK And we will finish with questions

CLICK FOR NEXT SLIDE

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Slide 3

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Section 24(1)(a)

As defined in the NDIS Act 2013, Section 24(1)(a) states:

“The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition“

Is your disability caused by an impairment? defines the terms disability and impairment as:

• Disability — any reduction or loss in your ability to do things, across all life domains, is because of an impairment.
• Impairment — a loss or significant change in at least one of your body’s functions, structure, how you think and learn.

Therefore to meet this criteria the evidence must demonstrate the person has a reduction or loss of an ability to do things that can be attributed to the loss of, or significant change in, your body’s functions, structure, how you think and learn.

You may also be eligible for the NDIS if you have a psychosocial disability. This means you have reduced capacity to do daily life activities and tasks due to your mental health.

ndis

OFFICIAL

As you know, Section 24(1)(a) is the first criteria of the disability criteria in the NDIS Act. To meet this criteria the person must have a disability attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments; or to one or more impairments attributable to a psychiatric condition.

CLICK FOR NEXT PARAGRAPH

Is your disability caused by an impairment? of Our Guidelines provides us with the definition that the NDIA have adopted for disability and impairment. Disability being any reduction or loss in your ability to do things, across all life domains, is because of an impairment, and impairment being the loss or significant change in at least one of your body’s functions, structure, how you think and learn.

CLICK FOR NEXT PARAGRAPH

This therefore makes Section 24(1)(a) a 2 part question — first we need to determine that the person has a reduction or loss of an ability to do things (disability), and then we need evidence that your disability is caused by at least one of the impairments.

CLICK FOR NEXT SLIDE

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Slide 4

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Section 24(1)(a)

From the below examples, which is the disability and which is the impairment?

• The person has a broken leg and is unable to walk without crutches
• The person has difficulty speaking after having a stroke
• The person has bilateral knee osteoarthritis and is unable to bend their legs properly

ndis

OFFICIAL

Now, to apply those definitions to what we might see in an application for the NDIS. I’ll read out a sentence, and then use the “hand up” function if you are able identify which is the disability and which is the impairment.

CLICK - will show sentence — the person has a broken leg and is unable to walk Give people time to put hands up, call one someone to answer

CLICK - will show “physical impairment”

CLICK - will show “disability”

Advise if correct/incorrect — in this sentence the broken leg is the physical impairment because there is a significant change to a physical function — i.e. a broken bone. The disability (i.e. the reduction or loss of an ability to do things) is being unable to walk.

Okay, next sentence

CLICK - will show sentence — The person has difficulty speaking after having a stroke Give people time to put hands up, call one someone to answer

CLICK - will show “disability”

CLICK - will show “neurological impairment”

Advise if correct/incorrect — in this sentence the disability is the person having difficulty speaking, this is caused by a neurological impairment because of the stroke. This is because a stroke causes brain cells to die and therefore there is loss and/or significant change to a mental function.

Final sentence

CLICK - will show sentence — The person has bilateral knee osteoarthritis and is unable to bend their legs properly

Give people time to put hands up, call one someone to answer

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CLICK - will show “physical impairment”

CLICK - will show “disability”

Advise if correct/incorrect – in this sentence bilateral knee osteoarthritis is a physical impairment because there is loss to a physical function because the arthritis is causing joint inflammation. The disability is being unable to bend their legs.

Thanks everyone

CLICK FOR NEXT SLIDE

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Slide 5

OFFICIAL

Section 24(1)(a)

It is important not to associate certain diagnoses with not meeting Section 24(1)(a) as there are no lists which have conditions that do not meet Section 24(1)(a). Regardless of the name of the diagnosis, if the evidence demonstrates the person has a disability attributable to an impairment then this criterion will be met. The only blanket rule when it comes to conditions that meet Section 24(1)(a) is if they are listed on List A or List B.

This is as per Do you meet the disability requirements? | NDIS and Is your impairment likely to be permanent? of Our Guidelines:

• List A Conditions

Where an applicant has been diagnosed with a condition on List A the NDIA will be satisfied that the person meets the disability requirements without further assessment. A person does not need to have a condition on List A to become a participant in the NDIS.

• List B Conditions

Where an applicant has been diagnosed with a condition on List B the NDIA will be satisfied that the person has a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment. This therefore means the delegate only needs to assess from Section 24(1)(c) onwards.

ndis

OFFICIAL

As usual it is important that we do not blanket rule conditions for not meeting this criteria. There are definitely conditions that are not likely to meet, however as there is no List or legislative criteria stating certain conditions do not meet 24(1)(a), we must assess each case individually.

Whilst there isn’t a policy excluding conditions, there is a policy which states that conditions on List A and B will automatically meet Section 24(1)(a).

CLICK FOR NEXT PARAGRAPH

As we know, a condition on List A will meet the Section 24 Disability criteria. This is as per Do you meet the disability requirements of Our Guidelines.

CLICK FOR NEXT PARAGRAPH

The other conditions that will automatically meet Section 24(1)(a) are those on List B. This is as per Is your impairment likely to be permanent? of Our Guidelines. Therefore, if the person has a condition on List B, the confirmation of this condition is enough to meet Section 24(1)(a) and (b) and you only need to assess the remainder of the criteria.

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Slide 6

OFFICIAL

Explanation of Impairments

listed in Section 24(1)(a)

• Intellectual — how you speak and listen, read and write, solve problems, and process and remember information
• Cognitive — how you think, learn new things, use judgment to make decisions, and pay attention
• Neurological — how your body functions
• Sensory — how you see or hear
• Physical — the ability to move parts of your body.

NB: You may also be eligible for the NDIS if you have a psychosocial disability. This means you have reduced capacity to do daily life activities and tasks due to your mental health.

ndis

OFFICIAL

There are many different types of impairments, however to meet the criteria in Section 24(1)(a), the evidence must demonstrate that the person has a disability that is attributable to one of more of the below impairments

CLICK Intellectual — how you speak and listen, read and write, solve problems, and process and remember information

CLICK Cognitive — how you think, learn new things, use judgment to make decisions, and pay attention

CLICK Neurological — how your body functions

CLICK Sensory — how you see or hear

CLICK Physical — the ability to move parts of your body.

CLICK You may also be eligible for the NDIS if you have a psychosocial disability. This means you have reduced capacity to do daily life activities and tasks due to your mental health.

CLICK FOR NEXT SLIDE

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Slide 7

OFFICIAL

Physical and Neurological

Impairments

The following pages will explain the conditions of Multiple Sclerosis, Chronic Obstructive Pulmonary Disease (COPD) and Auditory Processing Disorder related to the term “impairment”.

These examples have been provided to assist in a practical application of the term “impairment”. As a delegate, all information should be taken into consideration when making a decision.

ndis

OFFICIAL

On paper, physical and neurological impairments can present similarly. The following pages will explain the conditions of Multiple Sclerosis, Chronic Obstructive Pulmonary Disease (COPD) and Auditory Processing Disorder related to the term “impairment”.

These examples have been provided to assist in a practical application of the term “impairment”. As a delegate, all information should be taken into consideration when making a decision.

CLICK FOR NEXT SLIDE

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Slide 8

OFFICIAL

Multiple Sclerosis

• As defined by the MS Society, “Multiple Sclerosis is a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. It is characterised by sclerosis a Greek word meaning scars. These scars occur within the central nervous system and depending on where they develop, manifest into various symptoms
• As demonstrated in the image, a healthy brain does not have lesions, however a brain with MS has neurological differences. Therefore, MS is considered a neurological impairment, not a physical impairment. This is because the impacts of Multiple Sclerosis are neurological in nature — coordination, problems with controlling the body, pins and needles, loss of sensation, changes in memory.

ndis

OFFICIAL

Multiple Sclerosis is a List B condition and as defined by the MS Society it’s a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. It is characterised by sclerosis a Greek word meaning scars. These scars occur within the central nervous system and depending on where they develop, manifest into various symptoms

CLICK TO SHOW PICTURE

Taking a look at this image, there are 2 brain scans. The one on the left hand side is that of a healthy brain and the one on the right hand side is a brain scan of someone living with MS. You can see that the right scan has lesions (also known as scars). This is therefore damage to a mental function. These lesions are what causes the person’s disability, and their level of disability.

CLICK TO SHOW NEXT PARAGRAPH

Although some people may think that MS is a physical impairment, it is actually neurological. This is because the impacts are neurological in nature — the lesions on the brain cause a number of disabilities such as changes to coordination, problems with controlling the body, pins and needles, loss of sensation and changes in memory

CLICK FOR NEXT SLIDE

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Slide 9

OFFICIAL

Chronic Obstructive Pulmonary Disease

(COPD)

• As defined by the Lung Foundation (Australia), Chronic Obstructive Pulmonary Disease (COPD) causes narrowing of the bronchial tubes in the lung making it difficult to breathe
• As demonstrated in the image, a healthy bronchial tube compared to one with COPD is physically different. In this case, COPD has caused a significant change to a physical function. Someone with COPD can find it hard to physically complete tasks and activities such as walking due to the damage to their lungs, therefore COPD can be considered a physical impairment.

ndis

OFFICIAL

Chronic Obstructive Pulmonary Disease (COPD) is another condition that we regularly come across, some practice guidance has recently been provided around how to assess COPD and if you think the evidence demonstrates an access met decision, TAB advice is required due to it being a chronic health condition. As defined by the Australian Lung Foundation, COPD causes narrowing of the bronchial tubes in the lung making it hard to breathe.

CLICK TO SHOW PICTURE

Taking a look at this image, there are two bronchial tubes. The one on the left hand side is that of a healthy tube and the one on the right hand side is someone living with COPD. The end of the right bronchial tube is red indicating a narrowed tube. As a result less air can pass through, which increases difficulty in breathing.

CLICK TO SHOW NEXT PARAGRAPH

The narrowing of the tubes causes a physical impairment as someone living with COPD can find it hard to physically complete tasks and activities such as walking.

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Slide 10

OFFICIAL

Auditory Processing Disorder (APD)

• As defined by the Raising Children Network (Australia), Auditory Processing Disorder is “a problem with the way the ears and brain work together to understand sound”. People with APD have “normal hearing, but difficulty interpreting the sounds they hear”.
• Therefore, APD by itself is not considered a sensory impairment as someone with APD does not have damage to their hearing.
• Although the brain has difficulty interpreting the sounds there is no loss of, or significant change to the functions of the brain. Therefore, unless there has been specific neurological testing to confirm otherwise, APD is not considered a neurological impairment.
• In most cases, it is likely that APD will not meet Section 24(1)(a) as the disability cannot be attributed to an impairment. There may be instances where the person has undertaken testing and it can be linked to a specific impairment.

ndis

OFFICIAL

Auditory Processing Disorder is a condition that you may come across where the health professionals write strong evidence as to how the person meets the criteria, however when you break the evidence down into each criteria, this is not always the case.

CLICK TO SHOW PARAGRAPH

As defined by the Raising Children Network (Australia), Auditory Processing Disorder is “a problem with the way the ears and brain work together to understand sound”. People with APD have “normal hearing, but difficulty interpreting the sounds they hear”.

CLICK TO SHOW PARAGRAPH

Therefore, APD by itself is not considered a sensory impairment as someone with APD does not have damage to a sensory function.

CLICK TO SHOW PARAGRAPH

Although the brain has difficulty interpreting the sounds there is no loss of, or damage to the functions of the brain. Therefore, unless there has been specific neurological testing to confirm otherwise, APD is not considered a neurological impairment.

CLICK TO SHOW PARAGRAPH

In most cases, it is likely that APD will not meet Section 24(1)(a) as the disability cannot be attributable to an impairment. There may be instances where the person has undertaken testing and it can be linked to a specific impairment.

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Slide 11

OFFICIAL

Advice from the Technical

Advisory Branch (TAB)

There is nothing in the Section 24(1)(a) that requires the applicant to have a substantial reduction in functional capacity.

The delegate must be satisfied that the applicant has:

1. An intellectual, cognitive, neurological, sensory or physical impairment or an impairment attributable to a psychiatric condition, that results in;
2. A disability

ndis

OFFICIAL

The Technical Advisory Branch have provided some advice in relation to Section 24(1)(a), this is similar to what we are going through today and is available on the Access Assessor One Note.

CLICK FOR NEXT SLIDE

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Slide 12

OFFICIAL

Section 24(1)(a) — Case Studies

Navigate to:

• Access Assessor OneNote
• Technical Meetings and Training
• Section 24(1)(a)
• Read through the case studies

ndis

OFFICIAL

We’ll now give you some time to read through the case studies for Section 24(1)(a). These are found in the Access Assessor OneNote.

Provide approximately 30 minutes to read through the slide — can move on earlier if everyone is ready.

CLICK FOR NEXT SLIDE

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Slide 13

OFFICIAL

Case Study 1

• Name: Annie* (*For training purposes only)
• Age: 8 years old
• Diagnosis: Specific Learning Disorder
• Evidence:
  • ARF Support Documentation
  • Psychological Report

Note: This is a de-identified case. For the purposes of the case study, the dates of the EOD are recent.

ndis

OFFICIAL

The following 3 case studies are de-identified case studies of real cases that delegates have made a decision on. For the purposes of this training, all the evidence of disability (EOD) is recent. It is acknowledged that for some of these cases you will not see these regularly when assessing applications. The idea of a case study is to help further explain the criteria, but not to create a blanket rule. If you have the underlying understanding of the criteria, you are able to apply it to more complex cases when you break down the evidence.

Everyone should have read the case studies prior to the training. For a brief summary of this case study:

• Annie is 8 years old and applying with a primary disability of Specific Learning Disorder
• The psychologist who completed the supporting documentation has written a sentence for each legislative criteria as to how Annie meets it
• The psychologist has also provided a copy of the testing completed and Annie’s results

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Slide 14

OFFICIAL

Case Study 1 — Q&A

Q: Does Annie have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

A: Yes, based on the evidence provided Annie does have a reduction or loss of an ability to do things, across all life domains, because of an impairment. This is demonstrated in the evidence as a reduction in her ability to learn.

Q: If so, can it this be attributed to one or more impairments?

A: No, although the “Access Request Support Documentation” states that Annie’s disability is attributable to cognitive and neurological impairments when you read the “Psychological Report” the test results show that the majority of her test scores, including her FSIQ is in the average range and therefore would not be considered a “loss of, or significant change in your body’s functions, structure or how you think and learn”. There is also no neurological testing provided to attribute the disability to a neurological impairment. This would not be considered a sensory impairment as there is no loss or significant change to how she sees or hears.

ndis

OFFICIAL

We will now go through a few questions, please use the hand up function if you would like to answer.

CLICK TO SHOW QUESTION Does Annie have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

CLICK TO SHOW ANSWER Correct/Incorrect - Yes, based on the evidence provided Annie does have a reduction or loss of an ability to do things, across all life domains, because of an impairment. This is demonstrated in the evidence as a reduction in her ability to learn.

CLICK TO SHOW QUESTION If so, can it this be attributed to one or more impairments?

CLICK TO SHOW ANSWER Correct/Incorrect - No, although the “Access Request Support Documentation” states that Annie’s disability is attributable to cognitive and neurological impairments when you read the “Psychological Report” the test results show that the majority of her test scores, including her FSIQ is in the average range and therefore would not be considered a “loss of, or significant change in your body’s functions, structure or how you think and learn”. There is also no neurological testing provided to attribute the disability to a neurological impairment. This would not be considered a sensory impairment as there is no loss or significant change to how she sees or hears.

CLICK FOR NEXT SLIDE

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Slide 15

OFFICIAL

Case Study 1 — Q&A

Q: Does Annie meet Section 24(1)(a)?

A: No, although Annie has a disability, as stated above it cannot be attributed to an impairment and therefore Section 24(1)(a) is not met.

Q: Should further information be sought?

A: No — there are no red flags to indicate that Annie would meet all criterion if further information was sought. The current evidence demonstrates that the impairment is not permanent or likely permanent, as the health professionals have recommended treatment options. Therefore, even if the delegate was to get information that attributes the disability to an impairment, it would not be considered likely permanent in line with Section 5.6 of the NDIS (Becoming a Participant) Rules 2016.

ndis

OFFICIAL

CLICK TO SHOW QUESTION Does Annie meet Section 24(1)(a)?

CLICK TO SHOW ANSWER Correct/Incorrect - No, although Annie has a disability, as stated above it cannot be attributed to an impairment and therefore Section 24(1)(a) is not met.

CLICK TO SHOW QUESTION Should further information be sought?

CLICK TO SHOW ANSWER Correct/Incorrect - No — there are no red flags to indicate that Annie would meet all criterion if further information was sought. The current evidence demonstrates that the impairment is not permanent or likely permanent, as the health professionals have recommended treatment options. Therefore, even if the delegate was to get information that attributes the disability to an impairment, it would not be considered likely permanent in line with Section 5.6 of the NDIS (Becoming a Participant) Rules 2016.

Before we move onto the next case study, did anyone have any questions about this first case study?

• Answer questions if required

CLICK FOR NEXT SLIDE

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Slide 16

OFFICIAL

Case Study 2

• Name: James* (*For training purposes only)
• Age: 32 years old
• Diagnosis: Schizoaffective Disorder
• Evidence:
  • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent.

ndis

OFFICIAL

This next case study is for a 32 year old living with Schizoaffective Disorder. The psychiatrist has completed the Supporting Evidence Form and indicated that James was diagnosed 13 years ago when he was 19 years old and previously on a Community Treatment Order (CTO). The psychiatrist has selected “No” in all the domains and advised in social interaction “would benefit from transport to activities” and in self-management “would benefit from someone to mow his lawn on a regular basis”.

CLICK FOR NEXR SLIDE

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Slide 17

OFFICIAL

Case Study 2 — Q&A

Q: Does James have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

A: No — although we commonly associate someone living with Schizoaffective Disorder as having a disability, based on the evidence on file, James does not have a disability. The Supporting Evidence Form (SEF) states that he would benefit from transport to activities and someone to mow his lawn; however we do not know why he needs this support.

Q: Does James currently meet Section 24(1)(a)?

A: No — as the current information shows that James does not have a disability.

Q: Should further information be sought?

A: Yes — A psychiatrist does not necessarily focus on functional impact, they mainly focus on the clinical aspect of the disability. They also may not be aware of the day to day functional impacts, possibly seeing the person only a few times a year. A phone call is recommended as we do not know what sort of assistance is required in social interaction and self-management. Following this, if required, a Request for Further Information (s26) letter can be sent.

ndis

OFFICIAL

First question for this case study

CLICK TO SHOW QUESTION Does James have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

CLICK TO SHOW ANSWER Correct/Incorrect - No — although we commonly associate someone living with Schizoaffective Disorder as having a disability, based on the evidence on file, James does not have a disability. The Supporting Evidence Form states that he would benefit from transport to activities and someone to mow his lawn, however we do not know why he needs this support.

CLICK TO SHOW QUESTION Does James currently meet Section 24(1)(a)?

CLICK TO SHOW ANSWER Correct/Incorrect - No — as the current information shows that James does not have a disability.

CLICK TO SHOW QUESTION Should further information be sought?

CLICK TO SHOW ANSWER Correct/Incorrect - Yes — A psychiatrist does not necessarily focus on functional impact, they mainly focus on the clinical aspect of the disability. They also may not be aware of the day to

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day functional impacts, possibly seeing the person only a few times a year. A phone call is recommended as we do not know what sort of assistance is required in social interaction and self-management.

If during the call it is deemed that he does not have a substantial reduction in functional capacity then an Access Not Met decision should be made. If you determine that there is a substantial reduction in function, you would need to send a Further Information Request (s26) letter because this would be new information and would need to be confirmed in writing.

Alternatively, if you are making the phone call to the treating health professional you may be able to email them a summary of your conversation and ask them to reply confirming they agree with the summary. If you have made all required attempts and contact is unsuccessful, please proceed with sending a s26 letter as per SOP-Progress NDIS Application in the System.

CLICK FOR NEXT SLIDE

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Slide 18

OFFICIAL

Case Study 3

• Age: 45 years old
• Evidence:
  • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent

ndis

OFFICIAL

The final case study is for Lilly, a 45 year old living with Multiple Sclerosis. The Supporting Evidence Form confirms the diagnosis, however the health professional has selected “No” in each of the domains and has not written any comments.

CLICK FOR NEXT SLIDE

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Slide 19

OFFICIAL

Case Study 3 — Q&A

Q: Does Lilly have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

A: No — based on the evidence provided, Lilly does not have a disability. The GP has ticked “no” in all the domains and has not provided any comments on functional impact. Therefore we cannot determine if Lilly has a “reduction or loss of an ability to do things, across all life domains, because of an impairment”.

Q: Does Lilly have an intellectual, cognitive, neurological, sensory or physical impairment, or one or more impairments attributable to a psychiatric condition?

A: Yes — Multiple Sclerosis is a neurological impairment as someone living with Multiple Sclerosis has lesions on their brain and/or spinal cord. Therefore they have “loss of, or significant change to their body’s functions, structure or how they think and learn”.

ndis

OFFICIAL

First question for this case study

CLICK TO SHOW QUESTION Does Lilly have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

CLICK TO SHOW ANSWER Correct/Incorrect - No — based on the evidence provided, Lilly does not have a disability. The GP has ticked “no” in all the domains and has not provided any comments on functional impact. Therefore we cannot determine if Lilly “reduction or loss of an ability to do things, across all life domains, because of an impairment”.

CLICK TO SHOW QUESTION Does Lilly have an intellectual, cognitive, neurological, sensory or physical impairment, or one or more impairments attributable to a psychiatric condition?

CLICK TO SHOW ANSWER Correct/Incorrect - Yes — As previously discussed, Multiple Sclerosis is a neurological impairment as someone living with Multiple Sclerosis has lesions on their brain and/or spine. Therefore they have “loss of, or significant change to their body’s functions, structure or how they think and learn”.

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Slide 20

OFFICIAL

Case Study 3 — Q&A

Q: Does Lilly currently meet Section 24(1)(a)?

A: Yes — Although Lilly does not have a disability (based on current evidence), Multiple Sclerosis is a List B impairment. Therefore in line with Is your impairment likely to be permanent? of Our Guidelines, a person with a List B condition will meet Section 24(1)(a) and (b).

Q: Should a clarification call be made?

A: Yes — It would be beneficial to make a clarification phone call attempt and if required then send an S26 letter. This is because generally people apply for the NDIS because they need assistance. The health professional may have misinterpreted the Supporting Evidence Form, or, the person may not yet have impacts. It is not a requirement to make the call however it is important to make the clarification call for a positive applicant experience.

ndis

OFFICIAL

CLICK TO SHOW QUESTION Does Lilly currently meet Section 24(1)(a)?

CLICK TO SHOW ANSWER Correct/Incorrect - Yes — Although Lilly does not have a disability (based on current evidence), Multiple Sclerosis is a List B impairment. Therefore in line with Is your impairment likely to be permanent? of Our Guidelines, a person with a List B condition will meet Section 24(1)(a) and (b).

CLICK TO SHOW QUESTION Should a clarification call be made?

CLICK TO SHOW ANSWER Correct/Incorrect - Yes — Similar to Case Study 2, it would be beneficial to make a clarification phone call attempt and if required then send an S26 letter. This is because generally people apply for the NDIS because they need assistance. The health professional may have misinterpreted the Supporting Evidence Form, or, the person may not yet have impacts. It is not a requirement to make the call however it is important to make the clarification call for a positive applicant experience.

This is a decision that you need to make as a delegate, it is not part of the process to make this clarification call, and making a decision straight away based on this information would be legislatively correct. However, looking at the application holistically and putting the applicant first, a quick clarification phone call attempt is beneficial.

If making this call, ensure you record it in CRM to show it is a clarification call and not a further information phone call.

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If the interaction is interpreted as a further information phone call, it may appear the delegate does not think there was sufficient information to make a decision.

CLICK TO GO TO NEXT SLIDE

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Slide 21

OFFICIAL

Test your Knowledge —

True or False

A diagnosis of ADHD does not meet Section 24(1)(a)

False — As a delegate you need to consider the evidence on file. If this shows the applicant has a disability attributable to an impairment, then this criterion is met.

A person living with Huntington’s Disease that has not started showing symptoms (i.e. no disability) meets Section 24(1)(a)

True — although the person does not yet have a disability, Huntington’s Disease is a List B condition. As per Is your impairment likely to be permanent? of Our Guidelines, if someone has a List B condition they will meet Section 24(1)(a) and (b).

ndis

OFFICIAL

That’s all of our case studies, so we will now go onto a couple of True or False questions. For this one I will ask the question and then everyone that thinks the answer is true, put your hand up.

CLICK TO SHOW QUESTION First question — A diagnosis of ADHD does not meet Section 24(1)(a)

If you think the answer is true, raise your hand now wait for people to raise their hands

CLICK TO SHOW ANSWER The answer is false - As a delegate you need to consider the evidence on file. If this shows the applicant has a disability attributable to an impairment, then this criterion is met.

Okay, next question

CLICK TO SHOW QUESTION A person living with Huntington’s Disease that has not started showing symptoms (i.e. no disability) meets Section 24(1)(a)

If you think the answer is true, raise your hand now wait for people to raise their hands

CLICK TO SHOW ANSWER The answer is true — this is the same as the third case study. Although the person does not yet have a disability, Huntington’s Disease is a List B condition. As per Is your impairment likely to be permanent? of Our Guidelines, if someone has a List B condition they will meet Section 24(1)(a) and (b).

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Slide 22

OFFICIAL

Key Points

• Apart from conditions on List A and B, there are no blanket rules to what does and doesn’t meet Section 24(1)(a) — when making the decision ensure it is all evidence based and not based on past knowledge of that condition, previous cases or lived experience.
• Regardless of the name of the diagnosis, if the evidence shows the person has a disability that is attributable to one of the listed impairments then it will meet 24(1)(a) — this is because you do not need to have a diagnosis to meet access, we assess on the impairment, not the diagnosis.
  • NB: A diagnosis does make it easier to meet the criteria, as we can then determine if there is any treatment available for Section 24(1)(b), but we cannot ask someone to provide a diagnosis.
  • There are some cases that we think should meet 24(1)(a) based on the name of the diagnosis, but the health professional has ticked “no” to everything and there are no red flags to show that require follow up. On the other hand, there are times where the health professional will tick “no” to everything, but due to red flags we need to follow up (i.e. Schizophrenia, not compliant with medication, regular hospitalisation but the health professional has ticked “no” to all the domains)
• List B impairments always meet 24(1)(a) and (b), even if the evidence doesn’t show the person is impacted (i.e. if it wasn’t on List B we would rule out on Section 24(1)(a). This is as per Is your impairment likely to be permanent? of Our Guidelines which states “If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent”.

ndis

OFFICIAL

Now for the Key Points:

CLICK FOR PARAGRAPH

Apart from conditions on List A and B, there are no blanket rules to what does and doesn’t meet Section 24(1)(a) — when making the decision ensure it is all evidence based and not based on past knowledge of that condition, previous cases or lived experience.

CLICK FOR PARAGRAPH

Regardless of the name of the diagnosis, if the evidence shows the person has a disability that is attributable to one of the listed impairments then it will meet 24(1)(a) — this is because you do not need to have a diagnosis to meet access, we assess on the impairment, not the diagnosis

NB: A diagnosis does make it easier to meet the criteria, as we can then determine if there is any treatment available for Section 24(1)(b), but we cannot ask someone to provide a diagnosis.

There are some cases that we think should meet 24(1)(a) based on the name of the diagnosis, but the health professional has ticked “no” to everything and there are no red flags to show that require follow up. On the other hand, there are times where the health professional will tick “no” to everything, but due to red flags we need to follow up (i.e. Schizophrenia, not compliant with medication, regular hospitalisation but the health professional has ticked “no” to all the domains)

CLICK FOR PARAGRAPH

List B impairments always meet 24(1)(a) and (b), even if the evidence doesn’t show the person is impacted (i.e. if it wasn’t on List B we would rule out on Section 24(1)(a). This is as

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per Is your impairment likely to be permanent? of Our Guidelines which states “If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent”.

That brings us to the end of the 24(1)(a) training. Before we go to afternoon tea does anyone have any questions?

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Section 24(1)(a)

The content of this document is OFFICIAL

Feedback Survey | Please email redacted: s47E(d) - certain operations of agencies@ndis.gov.au if you have any feedback | | Key Points | • Apart from conditions on List A and B, there are no blanket rules to what does and doesn’t meet Section 24(1)(a) — when making the decision ensure it is all evidence based and not based on past knowledge of that condition, previous cases or lived experience.
• Regardless of the name of the diagnosis, if the evidence shows the person has a disability that is attributable to one of the listed impairments then it will meet 24(1)(a) — this is because you do not need to have a diagnosis to meet access, we assess on the impairment, not the diagnosis
    • NB: A diagnosis does make it easier to meet the criteria, as we can determine if there is any treatment available for Section 24(1)(b), but we cannot ask someone to provide a diagnosis
• There are some cases that we think should meet 24(1)(a) based on the name of the diagnosis, but the health professional has ticked “no” to everything and there are no red flags to show that require follow up. On the other hand, there are times where the health professional will tick “no” to everything but due to red flags we need to follow up (i.e. Schizophrenia, not compliant with medication, regular hospitalisation but the health professional has ticked “no” to all the domains) |

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• List B impairments always meet 24(1)(a) and (b), even if the evidence doesn’t show the person is impacted (i.e. if it wasn’t on List B we would rule out on Section 24(1)(a). This is as per Is your impairment likely to be permanent? of Our Guidelines which states “If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent”.

How can someone without a diagnosis meet 24(1)(a)?

It is important to remember that we are not assessing the diagnosis, we are assessing whether the person has a disability that can be attributable to an impairment. This can be difficult with our previous knowledge and the language used. This is where you need to assess the evidence to determine if the person has a disability and if this disability can be attributed to an impairment.

For example - an application stating someone has autistic traits and is recommending that the person undertake an Autism Assessment:

• The person will likely have a disability (as per the definition in Our Guidelines) - this means they will have some sort of reduction or loss of an ability
• However, it can be difficult to attribute this to an impairment (as per the definition in the OGs) if there has not yet been any testing completed to attribute the disability to an impairment, Depending on what the evidence shows we may be inferring that it’s attributable to a neurological impairment. There are circumstances where it will be quite clear that it can be attributed to an impairment which is why someone can meet 24(1)(a) without a diagnosis

Separating Condition, Impairment and Disability:

When looking at 24(1)(a), remember that the definition used for disability and impairment may be different to what we are used to using and also what health professionals use. For instance, society views “Autism” as being a disability, and that is correct, however when we are applying “Autism” to our legislative criteria we need to break it down as per the below:

• Condition: Autism
• Impairment: Why the person can’t do tasks/activities - neurological
• Disability: What the person can’t do/has a reduction in completing - i.e. communication barriers

If a condition is on the DSM, why is it not considered a psychiatric impairment?

A diagnosis does not always mean a person has an impairment, or a disability that can be attributed to an impairment listed in 24(1)(a). It will depend on how this condition impacts the person as to whether it meets 24(1)(a). The DSM is a handbook used to diagnose mental disorders - it sets out the diagnostic criteria and provides information to help clinicians communicate to their patients. Having a mental disorder does not always mean the person’s disability can be attributable to an impairment as a disorder does not always result in a “loss of, or significant change to, your body’s function, structure or how you think and learn” - this is where we need to apply the evidence to the legislative criteria to determine if they meet that criteria.

redacted: s47E(d) - certain operations of agencies

Specific to Case Study 2, why are we requesting a follow up and would we still do this if a past CTO order was not mentioned?

It is important to maintain a participant-first approach when considering the access criteria and the applicant’s circumstances. As there are no blanket rules when considering psychosocial impairments we would expect an Assessor to take into consideration the nature of the condition, and the potential vulnerability of a prospective participant applying with psychosocial disabilities. This would likely be made evident within the EOD provided but a clarifying call may not be appropriate for more high prevalence disorders permitting there are not aggravating factors noted throughout available evidence.

A clarifying call would be encouraged when considering the nature of the condition and the potential vulnerability of the applicant. While evidence provided for case study 2 notes CTO, a clarifying call would still be recommended if the CTO was not noted to ensure we maintain participant-focused.

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National Access QDO & AA — Technical Meetings

Section 24(1)(a)

redacted: s47E(d) - certain operations of agencies@NDIS.GOV.AU

Overview

• Explanation of Section 24(1)(a)
• Explanation of Impairments listed in Section 24(1)(a)
• Advice from Technical Advisory Branch
• Case Study 1 — Specific Learning Disorder
• Case Study 2 — Schizoaffective Disorder
• Case Study 3 — Multiple Sclerosis
• Test your knowledge — True or False
• Key Points
• Questions

Section 24(1)(a)

As defined in the NDIS Act 2013, Section 24(1)(a) states:

“The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition”

Is your disability caused by an impairment? defines the terms disability and impairment as:

• Disability — any reduction or loss in your ability to do things, across all life domains, is because of an impairment.
• Impairment — a loss or significant change in at least one of your body’s functions, structure, how you think and learn.

Therefore to meet this criteria the evidence must demonstrate the person has a reduction or loss of an ability to do things that can be attributed to the loss of, or significant change in, your body’s functions, structure, how you think and learn.

You may also be eligible for the NDIS if you have a psychosocial disability. This means you have reduced capacity to do daily life activities and tasks due to your mental health.

Section 24(1)(a)

From the below examples, which is the disability and which is the impairment?

• The person has a broken leg and is unable to walk without crutches
  • Disability: The person is unable to walk without crutches
  • Physical impairment: The person has a broken leg
• The person has difficulty speaking after having a stroke
  • Disability: The person has difficulty speaking
  • Neurological impairment: Having a stroke
• The person has bilateral knee osteoarthritis and is unable to bend their legs properly
  • Disability: Unable to bend their legs properly
  • Physical impairment: Bilateral knee osteoarthritis

Section 24(1)(a)

It is important not to associate certain diagnoses with not meeting Section 24(1)(a) as there are no lists which have conditions that do not meet Section 24(1)(a). Regardless of the name of the diagnosis, if the evidence demonstrates the person has a disability attributable to an impairment then this criterion will be met. The only blanket rule when it comes to conditions that meet Section 24(1)(a) is if they are listed on List A or List B.

This is as per Do you meet the disability requirements? | NDIS and Is your impairment likely to be permanent? of Our Guidelines:

• List A Conditions

  Where an applicant has been diagnosed with a condition/s on List A the NDIA will be satisfied that the person meets the disability requirements without further assessment. A person does not need to have a condition on List A to become a participant in the NDIS.

• List B Conditions

  Where an applicant has been diagnosed with a condition/s on List B the NDIA will be satisfied that the person has a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment. This therefore means the delegate only needs to assess from Section 24(1)(c) onwards.

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Explanation of Impairments listed in Section 24(1)(a)

• Intellectual — how you speak and listen, read and write, solve problems, and process and remember information
• Cognitive — how you think, learn new things, use judgment to make decisions, and pay attention
• Neurological — how your body functions
• Sensory — how you see or hear
• Physical — the ability to move parts of your body.

NB: You may also be eligible for the NDIS if you have a psychosocial disability. This means you have reduced capacity to do daily life activities and tasks due to your mental health.

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Physical and Neurological Impairments

The following pages will explain the conditions of Multiple Sclerosis, Chronic Obstructive Pulmonary Disease (COPD) and Auditory Processing Disorder related to the term “impairment”.

These examples have been provided to assist in a practical application of the term “impairment”. As a delegate, all information should be taken into consideration when making a decision.

Multiple Sclerosis

As defined by the MS Society, “Multiple Sclerosis is a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. It is characterised by sclerosis a Greek word meaning scars. These scars occur within the central nervous system and depending on where they develop, manifest into various symptoms.“

As demonstrated in the image, a healthy brain does not have lesions, however a brain with MS has neurological differences. Therefore, MS is considered a neurological impairment, not a physical impairment. This is because the impacts of Multiple Sclerosis are neurological in nature — coordination, problems with controlling the body, pins and needles, loss of sensation, changes in memory.

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Chronic Obstructive Pulmonary Disease (COPD)

• As defined by the Lung Foundation (Australia), Chronic Obstructive Pulmonary Disease (COPD) causes narrowing of the bronchial tubes in the lung making it difficult to breathe.
• As demonstrated in the image, a healthy bronchial tube compared to one with COPD is physically different. In this case, COPD has caused a significant change to a physical function. Someone with COPD can find it hard to physically complete tasks and activities such as walking due to the damage to their lungs, therefore COPD can be considered a physical impairment.

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Auditory Processing Disorder (APD)

• As defined by the Raising Children Network (Australia), Auditory Processing Disorder is “a problem with the way the ears and brain work together to understand sound”. People with APD have “normal hearing, but difficulty interpreting the sounds they hear”.
• Therefore, APD by itself is not considered a sensory impairment as someone with APD does not have damage to their hearing.
• Although the brain has difficulty interpreting the sounds there is no loss of, or significant change to the functions of the brain. Therefore, unless there has been specific neurological testing to confirm otherwise, APD is not considered a neurological impairment.
• In most cases, it is likely that APD will not meet Section 24(1)(a) as the disability cannot be attributed to an impairment. There may be instances where the person has undertaken testing and it can be linked to a specific impairment.

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Advice from the Technical Advisory Branch (TAB)

There is nothing in the Section 24(1)(a) that requires the applicant to have a substantial reduction in functional capacity.

The delegate must be satisfied that the applicant has:

1. An intellectual, cognitive, neurological, sensory or physical impairment or an impairment attributable to a psychiatric condition, that results in;
2. A disability

Section 24(1)(a) — Case Studies

Navigate to:

• Access Assessor OneNote
• Technical Meetings and Training
• Section 24(1)(a)
• Read through the case studies

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Case Study 1

• Name: Annie* (*For training purposes only)
• Age: 8 years old
• Diagnosis: Specific Learning Disorder
• Evidence:
  • ARF Support Documentation
  • Psychological Report

Note: This is a de-identified case. For the purposes of the case study, the dates of the EOD are recent.

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Case Study 1 — Q&A

Q: Does Annie have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

A: Yes, based on the evidence provided Annie does have a reduction or loss of an ability to do things, across all life domains, because of an impairment. This is demonstrated in the evidence as a reduction in her ability to learn.

Q: If so, can it this be attributed to one or more impairments?

A: No, although the “Access Request Support Documentation” states that Annie’s disability is attributable to cognitive and neurological impairments when you read the “Psychological Report” the test results show that the majority of her test scores, including her FSIQ is in the average range and therefore would not be considered a “loss of, or significant change in your body’s functions, structure or how you think and learn”. There is also no neurological testing provided to attribute the disability to a neurological impairment. This would not be considered a sensory impairment as there is no loss or significant change to how she sees or hears.

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Case Study 1 — Q&A

Q: Does Annie meet Section 24(1)(a)?

A: No, although Annie has a disability, as stated above it cannot be attributed to an impairment and therefore Section 24(1)(a) is not met.

Q: Should further information be sought?

A: No — there are no red flags to indicate that Annie would meet all criterion if further information was sought. The current evidence demonstrates that the impairment is not permanent or likely permanent, as the health professionals have recommended treatment options. Therefore, even if the delegate was to get information that attributes the disability to an impairment, it would not be considered likely permanent in line with Section 5.6 of the NDIS (Becoming a Participant) Rules 2016.

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Case Study 2

• Name: James* (*For training purposes only)
• Age: 32 years old
• Diagnosis: Schizoaffective Disorder
• Evidence:
  • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent.

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Case Study 2 — Q&A

Q: Does James have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

A: No — although we commonly associate someone living with Schizoaffective Disorder as having a disability, based on the evidence on file, James does not have a disability. The Supporting Evidence Form (SEF) states that he would benefit from transport to activities and someone to mow his lawn; however we do not know why he needs this support.

Q: Does James currently meet Section 24(1)(a)?

A: No — as the current information shows that James does not have a disability.

Q: Should further information be sought?

A: Yes — A psychiatrist does not necessarily focus on functional impact, they mainly focus on the clinical aspect of the disability. They also may not be aware of the day to day functional impacts, possibly seeing the person only a few times a year. A phone call is recommended as we do not know what sort of assistance is required in social interaction and self-management. Following this, if required, a Request for Further Information (s26) letter can be sent.

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Case Study 3

• Name: Lilly* (*For training purposes only)
• Age: 45 years old
• Diagnosis: Multiple Sclerosis
• Evidence:
  • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent.

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Case Study 3 — Q&A

Q: Does Lilly have a disability as defined in Is your disability caused by an impairment? of Our Guidelines?

A: No — based on the evidence provided, Lilly does not have a disability. The GP has ticked “no” in all the domains and has not provided any comments on functional impact. Therefore we cannot determine if Lilly has a “reduction or loss of an ability to do things, across all life domains, because of an impairment”.

Q: Does Lilly have an intellectual, cognitive, neurological, sensory or physical impairment, or one or more impairments attributable to a psychiatric condition?

A: Yes — Multiple Sclerosis is a neurological impairment as someone living with Multiple Sclerosis has lesions on their brain and/or spinal cord. Therefore they have “loss of, or significant change to their body’s functions, structure or how they think and learn”.

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Case Study 3 — Q&A

Q: Does Lilly currently meet Section 24(1)(a)?

A: Yes — Although Lilly does not have a disability (based on current evidence), Multiple Sclerosis is a List B impairment. Therefore in line with Is your impairment likely to be permanent? of Our Guidelines, a person with a List B condition will meet Section 24(1)(a) and (b).

Q: Should a clarification call be made?

A: Yes — It would be beneficial to make a clarification phone call attempt and if required then send an S26 letter. This is because generally people apply for the NDIS because they need assistance. The health professional may have misinterpreted the Supporting Evidence Form, or, the person may not yet have impacts. It is not a requirement to make the call however it is important to make the clarification call for a positive applicant experience.

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Test your Knowledge — True or False

A diagnosis of ADHD does not meet Section 24(1)(a)

False — As a delegate you need to consider the evidence on file. If this shows the applicant has a disability attributable to an impairment, then this criterion is met.

A person living with Huntington’s Disease that has not started showing symptoms (i.e. no disability) meets Section 24(1)(a)

True — although the person does not yet have a disability, Huntington’s Disease is a List B condition. As per Is your impairment likely to be permanent? of Our Guidelines, if someone has a List B condition they will meet Section 24(1)(a) and (b).

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Key Points

• Apart from conditions on List A and B, there are no blanket rules to what does and doesn’t meet Section 24(1)(a) — when making the decision ensure it is all evidence based and not based on past knowledge of that condition, previous cases or lived experience.
• Regardless of the name of the diagnosis, if the evidence shows the person has a disability that is attributable to one of the listed impairments then it will meet 24(1)(a) — this is because you do not need to have a diagnosis to meet access, we assess on the impairment, not the diagnosis.
  • NB: A diagnosis does make it easier to meet the criteria, as we can then determine if there is any treatment available for Section 24(1)(b), but we cannot ask someone to provide a diagnosis.
  • There are some cases that we think should meet 24(1)(a) based on the name of the diagnosis, but the health professional has ticked “no” to everything and there are no red flags to show that require follow up. On the other hand, there are times where the health professional will tick “no” to everything, but due to red flags we need to follow up (i.e. Schizophrenia, not compliant with medication, regular hospitalisation but the health professional has ticked “no” to all the domains).
• List B impairments always meet 24(1)(a) and (b), even if the evidence doesn’t show the person is impacted (i.e. if it wasn’t on List B we would rule out on Section 24(1)(a). This is as per Is your impairment likely to be permanent? of Our Guidelines which states “If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent”.

DOCUMENT 5

1

2 months prior to application

redacted

CALL US TODAY

redacted

Confidential Psychological Report

(This information should not be circulated without the permission from the author)

Service Provider: redacted Consultant Psychologist Provider No: redacted Address: redacted Phone/Fax: redacted

Referrer: redacted Address: redacted Phone/Fax: redacted

Service Provided to: redacted DOB: redacted Address: redacted

Assessments Administered

• Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV AUS)
• Wechsler Individual Achievement Test- 2nd Edition Australian (WIAT-II)
• York Assessment of Reading Comprehension (YARC)
• Conners Comprehensive Behavioural Assessment

Dear GP,

Since your referral dated redacted a battery of assessments have been administered, along with interviews, discussions with persons known to Annie, clinical observation, and elements of therapy, so to ascertain the most appropriate psychological interventions and therapies, adjustments, and accommodations best suited in the management of Annie’s current presentation, development, and associated behaviours. You had noted in your referral that Annie is struggling to comprehend age appropriately indicating a potential learning disorder. She has presented on all occasions with very slow processing skills and poor reading ability.

The following concerns have been highlighted:

• history of poor academic progress-possible learning difficulties
• poor self-esteem
• low confidence
• inattentiveness
• poor concentration
• processing difficulties

Please find below a summary of my findings and recommendations.

Executive Summary

Annie’s learning difficulties would be reflective of a ‘Specific Learning Disorder’ -(Moderate)-Reading 315.00: Word Reading Accuracy and Fluency (Reading rate), Written Expression 315.2: spelling accuracy, grammar and punctuation, and clarity or organization of written expression, and Mathematics 315.1: number sense, memorization of arithmetic facts, and accurate calculation. Clinical review of Annie’s overall development, education, family history, test results, teacher observation, and response to academic interventions, indicates persistent difficulties in reading, writing and arithmetic. Annie exhibits inaccurate

2

and slow and effortful reading, poor written expression that lacks clarity, and difficulties remembering number facts. Annie’s academic skills are well below the average range of scores, are not reflective of the recorded intellectual ability, and is significantly interfering with Annie’s academic performance and self-esteem. These results, cannot be better explained by developmental, neurological, sensory, or motor disorders, on this occasion.

Annie ‘requires substantial and consistent support’ across adaptive functional domains including communication, social, academics, and language. Annie’s current circumstances have, and will continue to, significantly impact on: daily functioning, learning, independence, communication, socialization, and overall well-being without ‘substantial support’ from a range of professionals and organizations that can assist in supporting Annie’s development and progress. Annie will need to develop skills that will enhance independence in learning and adaptive functioning. As Annie has a PERMANENT disability: ‘Specific Learning Disorder’, based on the DSM-V, it is highly recommended that she seeks support from the National Disability Insurance Scheme for Psychology, Speech Pathology, and Assistive Technology.

Pertinent History

• Developmental milestones: were reported as within normal range
• Family Mental Health History: nil
• Family History of Learning Difficulties: nil
• Medical Conditions: ear infections
• Speech Pathologist: redacted reported in June redacted that Annie presents with Within Normal Limits Expressive and Receptive Language. It was reported that although Annie’s Expressive Language is Within Normal Limits her ability to formulate sentences is Borderline Within Normal Limits. Results from the SPAT-R indicate Annie presents with Within Normal Limits Phonological Awareness and Within Normal Limits Non-Word Spelling. Therapy was recommended.

Clinician’s Clinical Observation

• Compliant
• Attentive-did not require redirection of tasks.
• Very polite and well mannered
• Learned helplessness
• Unable to follow instruction
• Establish rapport
• Motivated to perform the tasks
• No signs of resistance, hyperactivity or distractibility
• Slow speed of processing information that required a visual motor response and his resulting frustration

Parent reported concerns

• redacted (redacted Annie’s mother) main concerns are Annie’s difficulties with reading, comprehension, spelling and identifying sounds/letters.
• Annie has had a history of ear infections.
• Annie sometimes needs extra time to respond to questions
• Often misunderstands what has been said.
• Observational skills reported to be exceptional
• Hearing impaired for most of Kindergarten and never caught up
• Wears glasses for reading
• Past intervention to assist in reading has been unsuccessful
• Reported to be uncoordinated.
• Developmentally her gross motor was a little delayed-unable to skip.
• Fine motor skills are excellent.
• Considered to be resilient, intellectual with working memory in tact
• Eats well
• Good confidence and application was exceptional

3

Behavioural, Communication, Social, Sensory, Motor, and Academic Difficulties

Behaviour

• nil reported

Communication

• Difficulty describing events (e.g. forgets some of the detail)
• Doesn’t follow instruction (e.g. gets confused, forgets easily, becomes distracted)

Mental Health

• Low self-esteem (e.g. doesn’t believe in themselves)
• Lack of confidence (e.g. presents as shy, unable to meet their potential, easily intimidated)

Social

• nil reported

Self-care

• nil reported

Attention / Concentration / Organization

• nil reported

Sensory

• nil reported

Gross and Fine Motor Skills

• Appears uncoordinated (e.g. struggles to catch a ball, not keen to ride a bike)

Visual Processing

• Difficulty processing visual material (e.g. prefers verbal instruction, cannot see detail)

Language Skills

• Is a slow reader.

Summary of Results (Refer to Appendix for Detailed Analysis)

Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV AUS)

Annie’s unique set of thinking and reasoning abilities make the overall intellectual functioning difficult to summarize by a single score on the Wechsler Intelligence Scale for Children — Fourth Edition (WISC-IV).

Annie’s verbal reasoning abilities are not as well developed when compared to her recorded nonverbal reasoning abilities. Making sense of complex verbal information and using verbal abilities to solve novel problems is age appropriate. Processing complex visual information by forming spatial images of part-whole relationships and/or by manipulating the parts to solve novel problems without using words is a well-developed ability. Annie’s verbal reasoning abilities as measured by the Verbal Comprehension Index are in the Average range and above those of approximately 66% of her peers. Annie performed comparably on the verbal subtests contributing to the VCI, suggesting that these verbal cognitive abilities are similarly developed. Annie’s nonverbal reasoning abilities as measured by the Perceptual Reasoning Index are in the High Average range and above those of approximately 79% of her peers. The Perceptual Reasoning Index is designed to measure fluid reasoning in the perceptual domain with tasks that assess nonverbal concept formation, visual perception and organization, simultaneous processing, visual-motor coordination, learning, and the ability to separate figure and ground in visual stimuli. Annie performed comparably on the perceptual reasoning subtests contributing to the PRI, suggesting that her visual-spatial reasoning and perceptual-organizational skills are similarly developed. Annie’s ability to sustain attention, concentrate, and exert mental control is in the High Average range. Annie performed better than approximately 75% of her age-peers in this area (Working Memory). Annie’s ability to process simple or routine visual material

4

without making errors is in the Average range when compared to her peers. Annie performed better than approximately 42% of her peers on the processing speed tasks (Processing Speed). Processing visual material quickly is an ability that Annie performs less well than her verbal reasoning ability. Processing speed is an indication of the rapidity with which Annie can mentally process simple or routine information without making errors. Because learning often involves a combination of routine information processing (such as reading) and complex information processing (such as reasoning), a relative weakness in the speed of processing routine information may make the task of comprehending novel information more time consuming and difficult for Annie. Thus, this relative weakness in simple visual scanning and tracking may leave her less time and mental energy for the complex task of understanding new material.

Wechsler Individual Achievement Test- Second Edition Australian (WIAT-II)

Wechsler Individual Achievement Test- Second Edition Australian (WIAT-II) is a comprehensive, individually administered test for assessing the achievement of children, adolescents and adults. The Wiatt-II is comprised of nine subtests that are grouped to form composite scores for Reading, Mathematics, Written Language and Oral Language.

Reading Annie presents with a diverse set of skills on different aspects of reading. Annie performed much better on tasks that assessed her capability to read sentences and paragraphs and answer questions about what was read (Reading Comprehension) than on tasks that required her to correctly read a series of printed words and nonsense words (Word Reading and Pseudo word). A relative strength in comprehension skills as compared to reading words in isolation may indicate that Annie is able to derive meaning from text using context clues but may not have learned vocabulary words to automaticity. For this reason, the Reading Composite score may not be the most accurate manner in which to summarize her reading skills. Annie’s Reading skills are inconsistent and unreliable, with a significant discrepancy between subtest, indicating underlying learning issues.

Mathematics Annie’s performance on tasks that required her to understand number-e.g., add, divide, multiply (Numeracy) was less developed when compared to her ability to complete geometric measurement, basic graphs, and solve one-step word problems (Math Reasoning). Annie’s numeracy skills would be considered to be well below average and reflective of a Specific Learning Disorder.

Written Language Annie’s performance on tasks that required the generation of words within a category, generate sentences to describe visual cues, combine sentences, and compose an organized paragraph (Written Expression) was not able to be computed with a reliable score due to the severe lack of clarity and sequencing. Annie’s performance on tasks that required her to correctly spell verbally presented words (Spelling standard) was below aged peers and up to 18 months behind her peers.

Incorrectly spelt words include: carg (charge), gess (guess), codent (couldn’t), ruff (rough), ouw (owe), skiping (skipping), puzl (puzzle), coclate (chocolate), shear (share),

Ability-Achievement Discrepancy Analysis

• difficulty with achievement in reading.
• specific weakness in tasks that required correctly reading a series of printed words.
• specific weakness in tasks that required correctly applying phonetic decoding rules when reading a series of nonsense words and reading sentences and paragraphs and answer questions about what was read.
• specific weakness in tasks that required generating words within a category, generating sentences to describe visual cues, combine sentences, and composing an organized paragraph.
• specific weakness in tasks that required correctly spelling verbally presented words.

York Assessment of Reading Comprehension (YARC)

Results from the YARC indicate Annie presents with Severe Single Word Reading, Mild Reading

5

Accuracy, Severe Reading Rate and Low Average Reading Comprehension.

Annie’s scores on this assessment indicate that she is reading and comprehending at least 2 years behind her peers with her reading rate and single word reading: very impaired. This score would support the notion that Annie has a Learning Disorder.

Conners Comprehensive Behavioural Assessment

PARENTS

The following section displays additional comments from the parent about Annie.

In addition to the results described above, some of the parent’s responses on the Conners CBRS suggest it is important to consider the following topics in further evaluation of Annie.

• Features in common with youth who have a clinical diagnosis

When asked to rate whether the problems described on the Conners CBRS Parent Form affected the youth’s functioning, the parent responded:

The parent indicated that Annie’s problems very often seriously affect her schoolwork or grades. The parent indicated that Annie’s problems never seriously affect her friendships and relationships. The parent indicated that Annie’s problems occasionally seriously affect her home life.

TEACHER

The following section displays additional comments from the teacher about Annie.

In addition to the results described above, some of the teacher’s responses on the Conners CBRS suggest that it is important to consider the following topics in further evaluation of Annie.

• Behaviours, thoughts, and feelings associated with self-harm
• Features in common with youth who have a clinical diagnosis

6

When asked to rate whether the problems described on the Conners CBRS—Teacher Form affected the youth’s functioning, the teacher responded:

The teacher indicated that Annie’s problems very often seriously affect her schoolwork or grades. The teacher indicated that Annie’s problems never seriously affect her friendships and relationships.

Recommendations

In order to best serve Annie’s needs there are several areas that may be targeted for intervention.

1. Referral to National Disability Insurances Scheme: to address her Permanent Disability-Specific Learning Disorder: requires early intervention- WEEKLY SESSIONS: PSYCHOLOGY, SPEECH PATHOLOGY, PLUS ASSISTIVE TECHNOLOGY as indicated below.

2. Mental Health: Assistive Technology: Annie’s ‘Specific Learning Disorder’ is having a significant impact on her ability to confidently interact with her peers, socialize, feel self-worth, and communicate age appropriately. Without Assistive Technology support programs, Annie’s potential to be an independent learner may be jeopardized.

• Communication: Requires ‘substantial support’ in all reading, comprehension, and written format including: technology- predicted text, word processing, audio processing support to accommodate for the permanent impairment. Limited ability to function age appropriately across a range of occasions and environments without technology support so to enable to socialize and communicate age appropriately. Requires support from others to communicate on a daily basis, external to academic settings. Has a limited ability to be independent and develop age appropriately without support from assistive technology.
• Social Interaction: ‘Specific Learning Disorder’ is having a significant impact on self-esteem and confidence, and triggering anxiety, resulting in socially inappropriate responses requiring psychological interventions, improved social pragmatics, and emotional regulation. Requires support in emotional regulation and development of social skills that supports and accommodates for the Specific Learning Disorder, (language, communication, and written expression impairments), and which will limit potential negative feelings of worthlessness and ‘learned helplessness’. Will require ongoing use of technology programs that directly enhances social skills.
• Learning: ‘Specific Learning Disorder’ is having a significant impact on ability to access learning and meet the identified intellectual potential. Is unable to read and write age appropriately, and respond to tasks that have a written component. Reading and comprehension, and language skills, required to meet academic stage outcomes are well below age level-resulting in significantly poor academic results, limited academic potential, limited options in subject choices, poor development in the areas of peers relationships, less personal development, and significantly delayed academic progress. Requires substantial support in making the necessary accommodations and adjustments, so to enable him to function age appropriately in his child, adolescent, and adult life- so to offer greater independence and become a confident learner. Disability is not likely to improve and can only be supported through technology and remedial forms of interventions plus ongoing Speech Therapy, Occupational Therapy, and Psychological support.
• Self-Management: Has poor executive functioning skills-organizing and planning skills. Hence, needs to acquire technological skills and source specific programs that will assist in functioning on a daily basis competently —age appropriately -reflective of the intellectual ability.

1) PARENT

• Source computer/laptop that can be used solely for communication, adaptive functioning, and generalized learning and which can accommodate for the recommended software listed.
• Support daily usage of software at home and ensure access to programs is available with therapist-when required.
• Have regular contact with school and review progress.

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2) EDUCATION

• Individual Education Plan with adjustments and accommodations.
• Supportive of technology requirements in the classroom.
• Communicate with therapists as required.
• Continue to assess learning and development

3) ALLIED HEALTH WORKERS - NDIS providers

• Support usage of computer programs purchased through NDIS assistive technology.
• Have regular team meetings to review progress and client goals.
• Ensure uniformity, to reduce client confusion.
• Support client’s capacity to undertake a range of therapeutic goals.

4) NATIONAL DISABILITY INSURANCE SCHEME

• Support client’s application for Speech and Psychology individualized therapy (minimum 52 weeks per year).
• Provide ‘Assistive Technology’ funds, allowing for the purchase of the following programs in support of the client’s disability:

a) The C-Pen ReaderPen

• Makes a dramatic difference to the client’s life both emotionally and academically.
• Allows the client to use a convenient C-Pen ReaderPen every day, at home, during community activities, when attending therapy.
• Increases client’s independence, resulting in less reliance on others, parents, therapist, and support workers.
• Supports client’s increasing volumes of reading and writing during their lifespan, with the aim of sustaining age appropriate skills and functional independence.
• eDictionary will becomes a lifestyle tool for the client as it reads out the words as well as gives correct spelling and definition.
• Increases the client’s fluency of reading, improves comprehension, enabling the client to understand the text and extend their vocabulary knowledge which will consequently promote independent learning skills, resourcefulness, and resilience in future life challenges.
• The pen will improve the client’s confidence and self-esteem. It will enable the client to access information from a range of written medians whilst functioning in the community, encouraging not only to read aloud without the use of the pen but ask questions and become self-directed and inquisitive.
• Encourages clients to independently decipher difficult or unknown words whilst functioning at home and in the community.

b) Clicker 7 ANZ (Australian/New Zealand Version)

• As successful development of reading skills is critical for everyday adaptive functioning, effective interventions such as Clicker 7 will support the client’s development.
• The client will achieve a greater acquisition of language: phonological awareness, grapheme awareness, decoding, spelling, and receptive vocabulary. The whole-word multimedia Clicker software will enhance the client’s motivation, promoting positivity, and reducing negative attitudes towards learning and social occasions. Regular usage at home, with therapist, and across the community, will result in less anxiety, aversion, and negative attitudes, and more enjoyment, enthusiasm, and appreciation of the importance of using technology in support of their disability, supporting a lifetime of learning, and creating independence.
• Therapist will be able to provide personalised literacy supports, meeting the clients support needs and goals.
• A built-in planning tool will help the client to prepare for writing. The client will learn to manipulate and link words, pictures and sounds on their Clicker program when required.

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• The client will be able to record their own Voice Notes before they write. This enables the client to vocally rehearse their sentences, and offers a powerful way for the client to capture their initial thoughts and ideas. Giving the client the opportunity to hear their work read back to them in a friendly, age-appropriate voice that they can identify with. This realistic speech feedback encourages the client to actively review and self-correct their work.
• The wizards available will allow the client to self-edit, independently.
• Both ‘Eye Gaze’ and ‘SuperKeys’ can be chosen as an option.
• With Word Pool, the client will be able add any word to Clicker’s knowledge base to ensure its pronounced properly by the speech engine, suggested by the predictor and accepted by the spellchecker. Word Pool will also support the client’s spelling.
• Client will have access to over 3500 lifestyle determined pictures to assist the client in their communication and access to age appropriate adaptive functioning and learning.
• As word prediction is context sensitive it will allow for greater relevance to specific lifestyle skills, communication, and overall learning.
• It is essential that the client has consistent level of literacy support at home, when attending therapy, and accessing community.

c) Co:Writer

• Allows the client to become liberated and feel a sense of self expression.
• Will create greater opportunities for the client, allowing the client to feel more confident about writing when functioning in the community.
• The client will have access to hundreds of built-in topic dictionaries.
• Words and phrases that pertain to the client specifically will be added routinely: friend’s names, street address, names of therapist.
• The client will have access to linguistic word prediction using the whole sentence to predict the next word, providing more accurate prediction.
• FlexSpell will turn around the most egregious spelling errors made by the client.
• Word Bank will help the client with writer’s block, presenting a list of topic-specific words whenever a topic dictionary is selected.
• Text-to-Speech Anywhere will highlight text on-screen, with Co:Writer reading it back to the client.
• Client will be able to enhance their social communication through certain social media platforms by using the writing application: email family, friends and therapist and support workers.
• With over 4 million topics from the internet, the client has access to the world, offering an opportunity to become part of a community.

d) Dragon NaturallySpeaking 13 Premium

• Speech recognition program will enable the client to become more productive, and to correspond with all the family members, friends, therapist, and community.
• Client will become more efficient, using their voice to communicate, create written responses, access the community.
• Dictate and edit written responses, send email, search the web and use social media with unparalleled speed, ease and comfort.
• With client increasingly using technology, there is a need to become increasingly more productive with all computing tasks. As using a keyboard and mouse as your primary computer interface can be slow, require a lot of correction, voice prediction is more natural, accurate and fast to boost productivity potential for some occasions.
• Client’s reading and writing skills will improve over time, increasing the client’s oral reading efficiency, improving word recognition, and pronunciation, as well as reading fluency and comprehension. It will keep the client’s skills in oral language sharper and more precise.
• It will allow therapist working with the client an opportunity to brainstorm their ideas with the client, organize their thoughts, determining their purpose / voice, develop their sentence

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structure, and apply overall writing mechanics by composing with their voice instead of paper and pencil or keyboard. This approach will yield better composition, improved grammar skills and expanded use of vocabulary which the client than can use in their communication with others.

• It provides greater independence and clients keep pace with their non-disabled peers.
• It will take the focus off the mechanics of composition — spelling, sentence structure, etc, so it’s easier to transfer ideas into written words.
• Dragon’s fast, accurate dictation capabilities will make it easier for the client to transfer thoughts and ideas into written text without worrying about spelling mistakes. Dragon also makes it simple to edit and format documents by voice. It provides direct commands for formatting, deleting, and copying words and passages. Furthermore, Dragon provides fine control over the form, spacing and capitalisation of items written in various contexts.
• Dragon will save the client’s time by letting them take notes by simply talking to their computers or speaking into a digital recorder for later transcription on their PC. They can just dictate important facts as they read print or online material and communicate more efficiently and effectively.
• The client will be able to use simple spoken commands to find information on the Internet or files on their computer. They can locate information quickly and easily by simply saying things like, “Search the Web”; “Search Wikipedia”; “Search eBay.”
• Client will communicate through sending emails— entirely by voice. They can use their voice to compose and send both email and instant messages to family, friends, therapist and support workers, enabling full participation that requires ongoing communication, collaboration, and sharing of information.
• Client will be able to dictate text anywhere you normally type within popular applications and “proofread” with natural-sounding text-to-speech and audio playback. Dictate text anywhere you normally type within popular applications and “proofread” with natural-sounding text-to-speech and audio playback.

Please contact me if you require any further information.

Yours Sincerely

redacted

MAPS Consultant Psychologist

APPENDIX

Tests Administered: WISC-IV Australian (27/06/redacted) Age at Testing: (8 years 3 months)

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| Perceptual Reasoning (PRI) | 36 | 112 | 79 | 103-119 | High Average | | Working Memory (WMI) | 24 | 110 | 75 | 101-117 | High Average | | Processing Speed (PSI) | 19 | 97 | 42 | 88-107 | Average | | Full Scale (FSIQ) | 113 | 109 | 73 | 102-115 | Average |

Composite Score Differences

Conners CBRS—Parent Assessment Report

The following graph provides T-scores for each of the Conners CBRS—P Content scales and subscales.

• Emotional Distress (ED): Total: 45
• Upsetting Thoughts (ED subscale): 46
• Worrying (ED subscale): 45
• Social Problems (ED subscale): 49
• Defiant/Aggressive Behaviors: 44
• Academic Difficulties (AD): Total: 88
• Language (AD subscale): 83
• Math (AD subscale): 86
• Hyperactivity/Impulsivity: 40
• Separation Fears: 40
• Perfectionistic and Compulsive Behaviors: 45
• Violence Potential Indicator: 46
• Physical Symptoms: 40

The following table summarizes the results of the parent’s assessment of Ashlee and provides general information about how she compares to the normative group.