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Fetal Alcohol Spectrum Disorder and Fetal Alcohol Syndrome

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Fetal Alcohol Spectrum Disorder and Fetal Alcohol Syndrome

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Fetal Alcohol Spectrum Disorder (FASD) and Fetal Alcohol Syndrome (FAS) can both be accepted as List B conditions.

The diagnostic guide for Fetal Alcohol Spectrum Disorder (FASD) was updated in Australia in early 2020, with FASD now diagnosed as a spectrum disorder. A subsequent 2021 Senate Inquiry Report provided the following description for FASD and FAS:

’FASD encompasses a spectrum of disorders that can arise from alcohol exposure in utero. The spectrum covers physical, neural, behavioural, and learning difficulties from mild through to severe symptoms.

‘Perhaps the most clinically recognisable manifestation of FASD is Fetal Alcohol Syndrome (FAS), which is characterised by physical abnormalities including of the face. In individuals with FAS, there has usually been exposure to alcohol during the first trimester of pregnancy, when the face and other bodily organs are forming.’

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Fetal Alcohol Spectrum Disorder Disability Snapshot

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List A - Guidance

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Intellectual Disability/Intellectual Developmental Disorder

The evidence of disability states one or more of the below:

  • States current DSM as Moderate, Severe or Profound
  • Uses the DSM Code that equates to Moderate, Severe or Profound:
    • 318.0 or F71 = Moderate
    • 318.1 or F72 = Severe
    • 318.2 or F73 = Profound
  • Not sufficient for the evidence to list “Mild to Moderate”
  • Has to be from a listed health professional (multidisciplinary team, paediatrician, psychiatrist or clinical psychologist, neuropsychologist, educational psychologist or developmental psychologist)
    • Ensure that the health professional is registered on AHPRA from one of the above. This may be different to what their signature says.

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  • It is not sufficient to use the DSM code of 299.00 as this applies to the diagnosis of Autism, not the severity level
  • Does not need to state DSM-V — this is because the DSM-V is the only diagnostic tool for Autism that uses Level 2 and 3 is the DSM-V

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  • Has to be from a listed health professional (multidisciplinary team, paediatrician, psychiatrist of clinical psychologist, neuropsychologist, forensic psychologist)
    • Ensure that the health professional is registered on AHPRA from one of the above. This may be different to what their signature says.

To see more practice guidance on Autism (including List A requirements), refer to Autism.

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Registrars and Fellows

If you have evidence from a Registrar or a Fellow (such as a Paediatric Registrar or a Psychiatry Registrar or paediatric fellow) then this is not sufficient to meet List A unless it has also been signed off by one of the treating health professionals for List A. This is because when someone is a registrar/fellow they are still in training for their speciality. We can still accept the diagnosis as they already hold a medical qualification, however are just not finished their speciality training. You will also notice that they will not be registered in AHPRA as the specialist.

Therefore the easiest way to determine if they are suitably qualified is to check their qualifications and specialities on AHPRA.

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Intellectual Impairment/Disability/Developmental Disorder

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Intellectual Developmental Disorder/Intellectual Disability

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Intellectual Impairment and Intellectual Disability

A diagnosis of Intellectual Impairment and Intellectual Disability should not be used interchangeably. When diagnosing an Intellectual Disability, both Intellectual Functioning (FSIQ) and Adaptive Functioning are assessed. Someone can have an intellectual impairment and not meet the criteria for an Intellectual Disability. Further information on diagnosing an Intellectual Disability can be found on the American Psychiatric Association website. Although this is an American website, they are also the developers of the DSM-5.

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List A

The evidence of disability states one or more of the below:

  • States current DSM as Moderate, Severe or Profound
  • Uses the DSM Code that equates to Moderate, Severe or Profound:
    • 318.0 or F71 = Moderate
    • 318.1 or F72 = Severe
    • 318.2 or F73 = Profound

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FOI 24/25-1836 DOCUMENT 4

Developmental Delay

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This page contains the following guidance on Developmental Delay:

  • What is Developmental Delay?
  • Developmental Concerns
  • The role of Early Childhood Partners
  • Providing evidence for developmental delay
  • Multiple Sources of Information
  • Making an Access Not Met decision
  • Requesting Further Information
  • Children turning 6 within 90 days
  • Providing feedback after a Request for Further Information
  • Responding to direct outreach from Early Childhood Partners
  • Chronological Age
  • Developmental Milestones
  • Our Guidelines
  • Helpful resources

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| PEDI-CAT (Paediatric Evaluation of Disability Inventory Computer Adaptive Test) | This is a functional capacity assessment. It’s used to help with understanding a child’s ability to complete tasks in their daily life. The 4 domains of tasks are:

  • Daily Activities
  • Mobility
  • Social/Cognitive
  • Responsibility.

This can assist in assessing the impact a child’s developmental delay has on their daily activities. | The early childhood partner will facilitate the gathering of information from the family using the PEDI-CAT. The answers to the questions will be entered into an external Pearson site which will automatically populate a score based on the answers.

The family may also provide an existing PEDI-CAT completed outside of Pearson, for example from their doctor. If it is from within the last 3 months, the early childhood | Review scores which will be divided into Scaled Scores, T Scores and Age Percentiles.

T Scores:

  • below 30 = decreased functional ability compared to what is typically expected for that age range
  • 30-70 = considered within the expected range for the age
  • Above 70 = above what is typically excepted for that age range

Age Percentiles:

  • <5 = below average
  • 5-24 = low average

The Responsibility Domain will be 0 for children younger than 3 years, | In the child’s Person Account > Functional Capacity Assessment case > Case Activity > Assessments. | Pedi-CAT frequently asked questions | NDIS Record assessment — PEDI-CAT Frequently Asked Questions |

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partner will enter this score into PACE. If it is from more than 3 months ago, the early childhood partner must complete a new one.

because scores are not completed in this domain for this age range.

Please note: The PEDI-CAT is not to be used as the only source of information used to understand the needs of a child. Rather it is used to contribute to other information gathered.

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Developmental Milestones

Developmental Milestones can be used as an information tool to look for patterns of development and behaviour that may suggest that a child is or is not developing as expected. It is important not to use the checklist rigidly or in isolation to interpret information about a child’s development. It should be used in conjunction with all developmental information.

Please refer to the “Developmental Milestones and the EYLF and NQS”.

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Helpful resources

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| Developmental Milestones and the EYLF and NQS | External | This information tool can be used in conjunction with other developmental information to look for patterns of development and behaviour that may suggest that a child is or is not developing as expected. |

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DOCUMENT 5

Stroke

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We have received some feedback from external stakeholders in relation to further information requests being made for people that have recently had a stroke so would like to provide some practice guidance when it comes to assessing these applications. Please note that the below information is general information and as usual, each case should be assessed on the individual information provided:

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  • In relation to Section 24(1)(b), we are looking at the permanency of the impairment (in this case neurological), and not the disability. There are a lot of circumstances where we receive an application from the treating team advising that the person is still undertaking rehabilitation, this does not mean the person automatically doesn’t meet the permanency criteria. Someone can still be receiving rehabilitation and meet the permanency criteria, it is important to note that there are no set timeframes we need to wait before determining that the person has a likely permanent impairment. The aim of rehabilitation is to improve the disability that the person is experiencing, however it is likely that the neurological impairment will be permanent as “a stroke happens when blood cannot get to your brain, because of a blocked or burst artery. As a result, your brain cells die due to lack of oxygen and nutrients” (Reference: Stroke Foundation – What is a Stroke). This therefore meets the NDIAs definition of impairment (outlined in Our Guidelines- Is your disability caused by an impairment?) as the dead brain cells are a “loss of, or damage to, a mental function”. Therefore, in line with Sections 5.4 and 5.6 of the NDIS (Becoming a Participant) Rules, we generally could deem a stroke (the neurological impairment) permanent for one of these reasons:

    • Section 5.4 – The treating team is not recommending any further treatment that will remedy the neurological impairment (remembering we are looking at the definition of impairment, not disability)

    • Section 5.6 – Referring to the section in brackets – “the impairment may continue to be treated and reviewed after permanency has been demonstrated” – this is applicable when the person is still receiving rehabilitation, however the treating team expect that they will still live with an impairment post completion of rehabilitation

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ndis

Evidence of Disability

Eligibility Reassessment

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.

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Learning Outcomes

This session has been designed to help you:

  • recap your knowledge of evidence of disability (EoD), including reviewing different types of evidence
  • clarify how to use evidence and information to make ER decisions
  • know how to check a treating health practitioner’s registration using the AHPRA website
  • understand how to locate and link evidence in PACE
  • understand how to locate evidence in SAP-CRM

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What is Evidence of Disability?

  • Evidence of Disability (EoD):

    • evidence supporting a person’s impairment

  • Evidence of Identity (Eol):

    • evidence confirming a person is who they say they are

NDIS Website: Providing evidence of your disability (external)

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Evaluating evidence in ER decision making

We look at evidence in a big-picture way.

Consider:

  • What the evidence is — i.e. diagnostic or functional
  • Who the evidence was provided by
  • Are the recommendations for NDIS supports?

NDIS Website: Types of disability evidence (external)

Our Guidelines: What does the NDIS fund? (external)

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Consider all the evidence

We must investigate all available information on a participant’s record.

Consider individual circumstances.

Evidence can be from any point in a participant’s life, although in some cases more weight may be given to ‘recent’ evidence

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Key reminders

  • Is the evidence diagnostic or functional? Does it use appropriate assessments and testing?
  • Can we confirm any recommendations for support are NDIS supports? How recent is the report and recommendations?
  • Is the evidence signed by a health professional — physically or digitally?
  • Is the practitioner registered with the Australian Health Practitioner Regulation Agency (AHPRA)?

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The Australian Health Practitioner Regulation Agency (AHPRA)

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AHPRA

  • AHPRA is a regulatory body that works to ensure people residing in Australia have safe, high quality health care.
  • We use the AHPRA website to check if practitioners are registered.
  • Be aware that some health professions (e.g., speech therapists) are not partnered with AHPRA.

PUBLIC SAFETY

Look up a health practitioner to check their registration status, qualifications and suitability to care for you.

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Activity: Look up a practitioner

Look up the AHPRA registration number MED0001391505 then complete the following details:

Name:

Profession:

Registration status:

Registration expiry date:

Conditions:

Specialty Fields:

Principal place of practice:

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Dr John Gerrard: Former QLD Chief Health Officer

AHPRA registration number: MED0001391505

Name: Dr John Gerrard

Profession: Medical Practitioner

Registration status: Registered

Registration expiry date: 30/09/2025

Conditions: None

Specialty Fields: Infectious diseases

Principal place of practice: Southport QLD 4125

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Activity: Explore the AHPRA website

Go to the AHPRA website. Select the ‘Look up a practitioner’ button in the top right corner.

Bookmark the page. Answer the following questions:

  1. Which health professionals can you search for on the AHPRA website?
  2. True or False? You can search for speech pathologists and audiologists on the AHPRA website.
  3. Search for physiotherapists in your area. a. How many can you find? b. Locate their registration number. c. Is their registration current?

Ahpra & National Boards

Look up a practitioner

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Debrief: Explore the AHPRA website

  1. Aboriginal and Torres Strait Islander Health Practitioner; Chinese Medicine Practitioner; Chiropractor; Dental Practitioner; Medical Practitioner; Medical Radiation Practitioner; Midwife; Nurse; Occupational Therapist; Optometrist; Osteopath; Paramedicine; Pharmacist; Physiotherapist; Podiatrist; Psychologist.

  2. False! You can’t search for speech pathologists and audiologists on the AHPRA website.

  3. Registration number and current status:

Registration details
Profession Medical Practitioner
Registration number MED0001391505
Registration status Registered

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Let’s recap!

  • Evidence of Disability (EoD) tells us about a participant’s impairment
  • we assess all of a person’s evidence and information to make fair ER decisions
  • we use AHPRA to check all treating health professionals
  • participant evidence and information is located in many areas of PACE and SAP-CRM

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Questions

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DOCUMENT 7

Reputable Websites for Research

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An important part of decision making is researching the condition through reputable websites. When researching conditions please ensure that you are only using this for background information. The websites will provide generic information that may not be relevant to the applicant or participant (especially in relation to access to treatment, recommended treatment for the individual or functional impacts)

As a guide, reputable websites meet one or more of the below:

  • Are a government website
  • Are a peak body of a condition/disability
  • A top health care website (such as WebMD)
  • Is an education or research institute (such as The Mayo Clinic)

The below list is not an exhaustive list. Some of these websites are American, they still have relevant information about the condition but be mindful of some of the recommendations for treatment as they may not be available in Australia.

  • WebMD
  • The Mayo Clinic
  • Better Health Channel
  • Cerebral Palsy Alliance
  • ASPECT (Autism)
  • Down Syndrome Australia

AHPRA - AHPRA stands for the “Australian Health Practitioner Regulation Agency”. Delegates use AHPRA to confirm the registrations of treating health professionals.

Navigate to Other Resources to learn how to use AHPRA

You can also use the NDIA Resources:

  • Disability Navigator (including Disability Snapshots)
  • Mental Health and the NDIS

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DOCUMENT 8

Talking Points

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Background only – for verbal distribution only. Document strictly not for external distribution.

Update and Reminders Newsletter Edition #20 June 2024

Version control: V1.0 – 18 July 2024

How to use this information

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Key messages

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Ask Us Anything

Reliable Sources of Disability Information

  • If you’re seeking to broaden your understanding of disabilities, either for personal growth or your professional role within the Agency, it’s important to refer to reputable websites.
  • Reputable websites typically meet one or more of the following criteria:
    • They are government websites.
    • They are the official sites of peak bodies for a specific condition or disability.
    • They are top healthcare websites (such as WebMD).
    • They are educational or research institutes (such as The Mayo Clinic).
  • One such reputable source in Australia is the peak disability rights and advocacy organisation, People with Disability Australia (PWDA).
  • They provide a range of resources and videos that may be beneficial to staff.
  • Staff can also access the NDIA’s Disability Navigator to improve awareness and understanding of the lived experience of people with disabilities.
  • While these resources are excellent for enhancing your understanding, it’s important to remember that every applicant, participant, and person with a disability is unique.
  • Research should serve as a tool to provide you with general information, but it should not be used to generalise each applicant and their disability.
  • Remember, everyone is unique.

What’s your question?

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July 2024 — Edition 20

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Ask Us Anything

Reliable Sources of Disability Information

If you’re seeking to broaden your understanding of disabilities, either for personal growth or your professional role within the Agency, it’s important to refer to reputable websites.

Reputable websites typically meet one or more of the following criteria:

  • They are government websites.
  • They are the official sites of peak bodies for a specific condition or disability.
  • They are top healthcare websites (such as WebMD).
  • They are educational or research institutes (such as The Mayo Clinic).

One such reputable source in Australia is the peak disability rights and advocacy organisation, People with Disability Australia (PWDA). They provide a range of resources and videos that may be beneficial to staff. These include informative videos on the Social Model of Disability and a Disability Language Guide. These resources have contributed to the development of the Australian Government’s Style Manual page on Inclusive Language for People with Disability.

Staff can also access the NDIA’s Disability Navigator to improve awareness and understanding of the lived experience of people with disabilities.

While these resources are excellent for enhancing your understanding, it’s important to remember that every applicant, participant, and person with a disability is unique. Everyone’s experience with disability is different. Research should serve as a tool to provide you with general information, but it should not be used to generalise each applicant and their disability.

Remember, everyone is unique.

What’s Your Question?

If there is anything you would like to know about our branch or agency, you can ask anonymously by completing the redacted: s22(1)(a)(ii) - irrelevant material Anything Form.

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