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Early childhood supports

Quick summary: Early childhood supports are capacity building supports for participants younger than 7 that we may include in NDIS plans. They are specialised supports and therapy. They support your child to develop skills and strategies to take part in everyday activities at home, childcare, preschool, and school. Early childhood supports are provided by early childhood professionals. They work in partnership with you, and other important people in your child’s life, to understand your family and child’s needs. They work with you to develop strategies that support your child. These strategies are for everyone to use. They are used across all your child’s activities to give them the best possible start in life. This guideline explains what early childhood supports are and how we make decisions about them. If your child is not an NDIS participant, and you have concerns about their development, they may be supported through early connections. Learn more about early connections. Learn more about therapy supports and behaviour support for participants 7 and older. Note: • When we say ’you’, we mean anyone responsible for the care of a child. You may be a parent, carer, or legal representative. • When we say ‘child’, we mean a child younger than 7 who gets early childhood supports in their NDIS plan. • When we say ‘we’, we mean the NDIA. This includes NDIA staff, early childhood partners and local area coordinators. What’s on this page? This page covers: • What are early childhood supports? • Who can provide early childhood supports? • Why is a team around your child important? • What information do we need to make a decision about early childhood supports? • How do we make decisions about early childhood supports? • What if you don’t agree with our decision?

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• How do you get early childhood supports in your child’s plan? • What happens after your child gets early childhood supports in their plan? You might also be interested in: • Early childhood approach • Early connections • Mainstream and community supports • Creating your plan • Principles we follow to create your plan

What are early childhood supports?

Early childhood supports are specialised supports and therapy we include in an NDIS plan. These are for a child younger than 7 who has met access criteria and become a participant of the NDIS. Early childhood supports are part of the early childhood approach. Read more about the early childhood approach. Early childhood supports may also be called early childhood intervention. Early childhood supports are best provided by suitably qualified professionals. The types of specialised supports and therapy they provide for families could include: • Programs that are structured and time limited for individuals and groups. • Strategies that are individualised to pursue goals, meet needs and promote development. • Approaches and practices that follow best practice principles and are evidenced based. Early childhood supports are also known as early childhood intervention. Early childhood supports should build on learning opportunities as part of your child’s everyday activities in the: • home and where the family spend time together • community, like playgrounds, shops, and friend’s homes • mainstream settings, like childcare, preschool and school. We include these supports so you and other important people in your child’s life can help to maximise your child’s independence and participation in daily life. Early childhood supports include all the work your early childhood professional does. Early childhood professionals work in partnership with you, your child, family, and the other OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 2 Page 2 of 88

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important people in your child’s life. Having early childhood supports in your child’s plan doesn’t mean your child must be with early childhood professionals for all the hours funded in their plan. Early childhood supports are also for you, your family, and the important people in your child’s life. Learn more about early childhood professionals. We have NDIS Practice Standards for early childhood supports. They describe what high quality early childhood supports looks like and what you should expect from your early childhood professionals.1 We expect early childhood professionals to deliver culturally safe supports. They need to respect the values, knowledge, preferences, and cultural perspectives of your child and family. They need to listen to what is comfortable and safe for you. We expect early childhood professionals to demonstrate respect for Australia’s First Nations Peoples. They need to listen to First Nations children and families on how to best deliver supports. This support will strengthen cultural connection and identity. Learn more about what we expect from early childhood professionals.

When can early childhood supports help your child?

The early stages of a child’s life are the most important time for them to learn and develop. We include early childhood supports in NDIS plans for children with developmental delay who are younger than 6 or children with disability who are younger than 7. When a child has developmental delay or disability, they often need a lot more help than others to learn and develop. Your family and other important people in your child’s life have the most powerful influence on your child’s development. Early childhood professionals will support you and other important people in your child’s life. They will help you put strategies in place in your child’s everyday activities. This is good for your child as it helps them learn in their natural settings. When we say natural settings, we mean places where children learn and develop everyday abilities and skills, including the home, community and early childhood education and care services. The national guidelines on best practice in early childhood intervention shows that children learn best from: • The people they spend most of their time with. This is often their family and friends as they have the most powerful influence on the child’s development. • Everyday activities in the home, community, or early childhood setting. For example, childcare, preschool, or at school.

1 NDIS (Provider Registration and Practice Standards) Rules 2018 OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 3 Page 3 of 88

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The national guideline for supporting autistic children shows that children on the autism spectrum and their families are supported best when: • children are helped to develop functional and personal skills that are meaningful to them • families and those around them develop new skills • families and those around them create safe, accessible, and enjoyable spaces. We’ve looked at the evidence from the Autism CRC early intervention report research. It told us: • It is important for families and other people in the child’s life to implement strategies that support the child. This has a similar, and at times greater, effect on outcomes compared to specialised supports and therapy provided by early childhood professionals alone. • There is no one size fits all approach. Each child and family is unique and supports should be individualised to meet their needs. • There is no consistent evidence to suggest that more therapy leads to better outcomes. Your child and family are more likely to achieve your goals when you get the right specialised supports and therapy early. It can also mean less need for funded supports in the future.

What are intensive early childhood supports?

Sometimes, intensive early childhood supports may be funded in your child’s NDIS plan. We include these when there is evidence your child and family need very substantial support with capacity building Most children with developmental delay or disability do not need intensive early childhood supports. This is something we think about when we decide how much support to include in your child’s plan. Intensive early childhood supports mean many hours of specialised supports and therapy across several days in the week, for a set period of time. For some children this may be for up to 12 months. For some it could be a period of a few weeks, a couple of times a year, where an increased level of support is needed. For example, to help to support critical developmental milestones, or to start using a new piece of assistive technology. For others, it can be a different amount of specialised supports and therapy before and after they start in a new setting. For example, when a child transitions to childcare, preschool, and school.

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Who can provide early childhood supports?

Early childhood supports are best provided by suitably qualified early childhood professionals. We might also call these people providers. Read more about suitably qualified early childhood professionals in the NDIS Pricing Arrangements and Price Limits. Early childhood professionals provide supports funded through an NDIS plan. They are different to early childhood partners. Early childhood professionals are people who: • are experienced with working with children and have a university qualification • are either early childhood teachers, educators, or allied health professionals • have current registration or membership with a professional body. They can include: • Occupational therapist – works with you to help build your child’s independence and how they take part in everyday activities. For example, help with self-care and advice about toys, games and play activities. It could also be advice on how to adjust your child’s settings at home or childcare. They can help with fine motor development and sensory processing. For example, help your child to use their hands to reach, hold and use objects. • Physiotherapist –works with you to help your child’s movement skills. For example, sitting to play and moving between positions, like how they move from lying down to sitting up. They also focus on fitness and skills needed for recreation and sport. For some children this could be specialised equipment, like shoe inserts, a walking frame or adjusting their bike. • Psychologist –helps with the way your child thinks, behaves, and learns. This support will help you understand how your child might learn best and why your child might behave in a certain way. They will also support you and your child’s social- emotional well-being. • Social worker – can support you with information about supports and services in the community. They can also give you information and help you choose the right services for your child. • Speech pathologist –works with you to help your child learn ways to communicate, process information and develop their social skills. They also can help with eating and drinking.

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• Early childhood teacher or educator – works with you to help your child with their social, emotional, physical, and educational needs. An early childhood teacher or educator has a bachelor’s degree or higher in early childhood education or special education. They have a current registration with their state or territory education department. • Developmental educator – is like an early childhood teacher or educator. A developmental educator has a bachelor’s degree, or higher, and current full membership with Developmental Educators Australia Incorporated. • Other early childhood professionals – these are professionals not listed above. However, they do deliver services in line with NDIS Commission’s NDIS Practice Standards and Quality Indicators for Early Childhood Supports. These people have a bachelor’s degree or higher in their specific area. They hold current registration or membership with their relevant professional body. When a person assists in the delivery of a support, such as a therapy assistant, they must work under the delegation and supervision of an allied health professional. The therapy assistant must be covered by the professional indemnity insurance held by their employer. The employer could be their allied health supervisor or professional provider. If you need help to understand more about choosing early childhood professional and supports for your child talk to us. We can help you connect with early childhood professionals. Early childhood professionals work with you when doing functional assessments, goal setting, creating, implementing, and evaluating a written program. They will write, direct, and supervise programs. The program will support capacity building for your child, family, and other important people in your child’s life. It includes writing an NDIA requested progress report. Your provider writes reports so you can see the impact funded supports have on you and your child’s daily life. You should be included at every step.

Why is a team around your child important?

Sometimes more than one professional will work best for you and your child. This will depend on your child’s needs. Early childhood professionals usually work together, in partnership with you, as a team around your child. Your child and family will benefit most when everyone involved in the care and support for your child work together. This way the team get to know you and your family. They will work together to support how your child learns and develops in their everyday routines and activities. Your team could include early childhood professionals from the same or different services. The team around your child may use key worker model. Your team should share information and ideas with you to support your child and family. Learn more

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about early childhood professionals forming a team around the child in our guideline about the early childhood approach.

What is the key worker model?

Some organisations use the key worker model as part of their service. Your key worker is an early childhood professional. They are the main person in your child’s support team who provides and coordinates early childhood supports. Your key worker works in partnership with you, and other important people in your child’s life. With you, they develop and use strategies that support your child to take part in everyday activities. They usually see you and your child in your family home, and other places where your child spends time, like childcare. Your key worker may bring in other early childhood professionals to provide support when needed, if you and they think it is beneficial. This means you will not have many different appointments with different therapists. Your key worker can support you to manage services for your child. They can make sure your team members keep up to date with each other. They can also tell you about other community or mainstream services, such as planning to start school. The research shows that a key worker model results in the best outcomes for children. It is more family-friendly, less stressful, and saves time. It also makes the most of funding from your child’s NDIS plan.

Example

Lola is 4 years old and goes to preschool 3 days per week. Lola’s first NDIS plan has recently been approved. Lola has developmental delay and needs support for communication, physical development, and self-care skills. Lola’s parents, Karl and Maree, want Lola to be able to tell others what she wants. When at home, they also want her to dress herself and when she eats, be able to do it herself. When outside, they want Lola to be confident to use the playground equipment at the local park and preschool. Karl and Maree would also like to connect with other parents. Lola’s parents choose an early childhood intervention provider who uses the key worker model to put a team around Lola. This team works with Lola’s family and other services, such as Lola’s preschool. Lola and her family’s team are led by a key worker, who is an early childhood teacher. Lola also has a physiotherapist as part of her team. The team spends time with Lola and her family to observe and assess her during everyday activities. This includes at home, the playground and preschool. Then, with Karl and Maree, the team develop practical strategies they can use in the home and community. The physiotherapist can see that an adjustable chair would help Lola improve her posture. It will

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make her stable to be able to eat on her own at the table. The physiotherapist sets up an assessment. For all areas of Lola’s development, the key worker and family bring the strategies into her everyday life. The key worker goes to Lola’s preschool to share what is working at home. The other team members, when needed, join the key worker on her home and preschool visits. This is to make sure the family, preschool and key worker know how they can best support Lola. The key worker also provides Karl and Maree with some options in their local community where they can connect with other parents. The key worker continues with team updates. Joint visits happen when needed. As Lola achieves her goals, the team, including the family, set new goals. These new goals support Lola to be more self-reliant and to be part of things going on around her.

How do you choose your early childhood professionals?

Most professionals will deliver a mix of supports you can choose from. These include supports for: • You and the family – to work in partnership with you to build your family’s capacity to support your child’s independence. To help them take part in everyday activities in the home and community. This could be working with your family in your home. Or offering groups where you and your family can take part with other families. • Your child – to work one-on-one with them or in a group. To help build their independence and participation in everyday activities, in the home and community. This does not include providing direct support to your child in mainstream settings when it is a community and mainstream responsibility. For example, at childcare, preschool, or school. • Other important people in your child’s life – to work with them to understand how to best support your child. This will help make it easier for your child to go to different places, be more independent and join in activities. These are people like childcare staff, school staff, sports coaches, or disability support workers. Read more about who can provide early childhood supports. When you are choosing specialised supports and therapy, if you want, you can talk to us or to your child’s health professional or early childhood professional. We can help you know what to ask and what to look for when making a decision. For example, asking how you will be involved as part of your child’s sessions. If you need help to connect to services or use your child’s NDIS-funded supports, you can contact us.

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What information do we need to make a decision about

early childhood supports?

We gather information about your child to create their NDIS plan. We get this information in different ways. We will work with you and your child to do this together. The information will help us work out which supports go into your child’s plan. By this we mean what type of supports and how much support you and your child need.

What type of information do we ask for from parents, carers, and family

members?

Families know their child best, so we want to learn from you. We want to find out what your child is doing in everyday activities. We will look at what they do in the home, in the community, and at childcare or school. This helps us work out what is going well for your child and any concerns you may have. A child’s goals are an important part of their early childhood supports.2 So we will ask you about goals and the main areas you would like your child and family to focus on.3 If you want, we can help with this. We will also ask about your child’s strengths and needs across the following developmental areas:4 • Motor development – how your child moves around, such as, crawling, walking, and running; and how they use their hands to pick up things. • Self-care – how they look after themselves or their own needs, like, how they bathe, dress themselves, eat, drink, use the toilet and sleep. • Cognitive development – how they understand and remember information. How they learn, practice, and use new skills. How they problem solve, go between activities and places, play with toys, and develop their safety awareness. • Receptive and expressive language – how they communicate with other people to express their wants, needs, preferences and ideas. How they understand and use words, gestures, signs, and facial expressions to do this. • Emotional development – how they recognise, understand, express, and regulate their feelings and their sensory needs. How they build their confidence, self-identity and wellbeing. Whether there are any behaviours that are challenging or behaviours of concern.

2 NDIS Act s 33(5)(a). 3 NDIS Act s 33(5)(a); NDIS (Supports for Participants) Rules r 4.1(a). 4 NDIS (Supports for Participants) Rules r 4.1(a). OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 9 Page 9 of 88

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• Social development – how they build and nurture relationships with family and with others. How they develop their interests, interact, and connect with others through play and childhood activities, and make friendships with peers.

What community and mainstream services are you linked with?

We will talk to you to find out what community or mainstream services you and your child are linked with. We can record this in your plan if you want. This information helps us work out other community and mainstream supports you and your child can link with. It helps us understand and make decisions about what supports to include in your child’s NDIS plan. We also look at what other community and mainstream supports may be useful or available for you and your family. For example, your local community may run sporting or cultural activities for children. They may have parent to parent support groups, or information sessions on specific topics like positive parenting. We can help you link in with them if you like. Learn more about mainstream and community supports.

What assessment tools do we use?

To help us learn more about your child’s development and what they can do, we use functional assessments and screening tools.5 By this we mean the steps we take to find out what your child can do and how this is different from other children of a similar age. When your child gets NDIS funded early childhood supports, the results of assessments help us understand if the supports have been helpful for your child. If we ask you for more information and need further functional assessments, we will include NDIS funded supports for this in your child’s plan. The functional assessments and screening we do are different to diagnostic assessments. Diagnostic assessments are completed for the purpose of making a diagnosis such as doing an IQ test or, tests for a diagnosis of autism spectrum disorder. We do not fund diagnostic assessments. You can access these through mainstream and community supports.

Will we ask to see your child in their natural settings?

We may ask to see your child in their natural settings. This gives us the chance to see what your child is good at, their interests and the areas where they may need more help. By observing your child in their natural settings, we are more likely to see their everyday behaviours. This information helps us understand your child’s support needs.6

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What reports do we ask for?

If your child’s health and educational professionals have any available reports, we will look at this information.7 This could also be what the key worker or one of your other early childhood professionals tell us. When your child gets early childhood supports, we will ask your early childhood professional for a progress report.8 There is an early childhood provider report form available. We strongly recommend your early childhood professional uses it, even if it is just once a year. We use these when we reassess your child’s plan. Provider reports should include information on how the early childhood supports have helped your child and family. Provider reports include information on: • what early childhood supports have been implemented and how they have helped your child and family progress towards goals • your child’s functional capacity, independence and how they take part in daily activities • the results from outcome measurement tools • future early intervention goals which are right for your child, that can measure their progress, are realistic to achieve, and at the right time in your child’s life • recommendations for community, mainstream and NDIS supports if needed. You can give us this information through your My NDIS contact, when we meet or check in with you or, send it to enquiries@ndis.gov.au.

Is there any other information we will ask for?

We may ask you for further information to make a decision about your child’s supports. If you’re not sure about what evidence you need to give us, talk to your My NDIS contact or support coordinator who will help you.

How do we make decisions about early childhood supports?

We work with you to develop your child’s NDIS plan. Your child’s NDIS plan will have goals, supports, and services that relate to your child’s life to help build their capacity. We think about the needs of you and your child as a whole. This helps us to get the right mix of supports. We also consider the needs of your family. For example, if there are other members of the family who are also getting NDIS funded supports.

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Your child’s NDIS plan has NDIS funded supports, like early childhood supports. Other supports provided by school, the health system, family, friends, and community services can also be listed on your child’s NDIS plan. We make decisions about the supports to include in your child’s NDIS plan. We look at all the information we have gathered so far. We think about: • the early childhood supports your child needs • other types of supports that your child may need • the responsibilities of mainstream and community services • the principles we follow to create your plan – these principles explain how we make sure you get the reasonable and necessary supports you need • the length of your child’s plan – learn more about plan length in Our Guideline – Creating your plan • the research and national guidelines. All supports we fund must meet the NDIS funding criteria. We fund reasonable and necessary early childhood supports. Some of the things we think about are: • how it can help to work towards child and family goals9 • if it will work and fit in with daily life10 • how long it will take to achieve that outcome11 • what the research is telling us about the supports12 • why these supports can work better than other supports.13 Early childhood supports work best when they are part of your child’s everyday activities. They link your child’s goals across a mix of home and community settings. To be practical, early childhood supports need to work with your family’s routines. This means, supports are not likely to meet the NDIS funding criteria if they:

9 NDIS Act 2013 ss 34(1)(a), 34(1)(e); NDIS (Supports for Participants) Rules rr 2.3(a), 3.4(a)(iv). 10 NDIS Act 2013 s34(1)(b); NDIS (Supports for Participants) Rules r 2.3(b). 11 NDIS Act 2013 s34(1)(c); NDIS (Supports for Participants) Rules r 3.1(b). 12 NDIS Act 2013 s34(1(d); NDIS (Supports for Participants) Rules r 3.2(a). 13 NDIS Act 2013 s34(1)(c); NDIS (Supports for Participants) Rules r 3.1(a). OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 12 Page 12 of 88

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• take your child away from their everyday activities and away from activities with their family, friends, or peers.14 For example, your child should not regularly leave preschool or school to go to therapy sessions • do not fit with any routines or activities your child takes part in15 • add stress to your family, such as you find it hard to fit the therapy sessions into the week16 • add stress to your child, such as they are too tired to go to childcare, preschool, or school17 • are not enjoyable for your child, or they consistently react negatively to taking part in the support.18 It is important the supports in your child’s plan protect your child’s right to learn, relax, play, and spend time with family and friends. The national guidelines on best practice in early childhood intervention tells us this will help your child learn and develop best. Early childhood supports work best when they are activity-based and linked to the right goals. These are the goals which are part of your child’s everyday routines. They are across a range of home and community settings.

How do we work out the early childhood supports that are right for your

child and family?

Once we understand what supports are already in place, we make a decision about what goes in your child’s plan. We consider if early childhood support is needed for: • Your family to build their confidence and capacity in supporting how their child learns and develops.19 This is because we know children learn best from the people they are closest with and spend the most time with. A child’s family has the most powerful influence on their development. • Your child to continue to learn and develop. These supports will help them to build skills in daily life with their family, and to do things with friends and peers.20

14 NDIS Act 2013 s34(1)(b); NDIS (Supports for Participants) Rules r 2.3(b). 15 NDIS Act 2013 s34(1)(b); NDIS (Supports for Participants) Rules r 2.3(b). 16 NDIS Act 2013 s34(1)(e); NDIS (Supports for Participants) Rules rr 3.4(a)(iii), 5.1(a). 17 NDIS (Supports for Participants) Rules r 5.1(a). 18 NDIS (Supports for Participants) Rules r 5.1(a).

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• Your child’s inclusion. This is so they can be part of community life and join in with others in an early childhood setting or school.21 This is important. We know all children learn best when they are part of things and when they join activities in settings with their peers. This is to complement supports provided by community and mainstream services. • Your child’s transition to new settings like childcare, preschool, or school.22 To support them to have the best possible start and to work with community and mainstream supports. When we say transition, we mean the supports to help your child understand the move from one setting to another. We look at how your child’s developmental strengths and areas for development impact on the activities they take part in. This will be different for everyone. When there are needs in a few developmental areas impacting some activities, the funding for early childhood supports will be less than for a child with greater support needs. A child with greater support needs may have needs across many developmental areas. These may impact a wide range of daily activities and across multiple settings and may need specialised assistive technology. We look at whether early childhood supports are needed to help with support for your child’s behaviours that are challenging to manage. This could include behaviours where a child harms themself or others. These are called behaviours of concern. Early childhood professionals can help you with parenting and behaviour management strategies. The aim of this support is to work out the reasons for your child’s behaviour. It offers strategies that will help you and your child find other ways to meet their needs. If the supports for your child’s behaviours includes the use of, or need for regulated restrictive practices, we will put additional supports in your child plan. Learn more about behaviour supports (link yet to be provided).

Example

Kara is a social 3-year-old who lives with her parents. Kara’s child health nurse recommended her family contact their local early childhood partner. This was due to concerns about her language and social skills development. The early childhood partner supported Kara and her family to apply to the NDIS. Kara met access for the NDIS under developmental delay and her parents used early childhood supports to engage a team of early childhood professionals. Kara and her family’s team are led by a key worker, who is an early childhood teacher. Her team also includes a speech pathologist, and an occupational therapist. The key worker started visiting Kara weekly at home and preschool.

21 NDIS Act (Supports for Participants) Rules r4.1(b). 22NDIS Act (Supports for Participants) Rules rr4.1 (b), 4.1(c).

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More recently, Kara’s parents noticed she is having trouble separating from them when being dropped off at preschool. They speak to Kara’s teacher and the key worker to understand what is happening. Together, they observe that Kara’s having difficulty following new routines and instructions. She becomes frustrated and withdraws from activities when she is not understood. She throws things, cries, and pushes others away to communicate. Kara wants to play with other children, but they are having trouble understanding her. This is happening daily, and it’s hard for Kara to make friends. This is leading to Kara no longer wanting to go to preschool. The key worker consults with the speech pathologist. The key worker and speech pathologist work with Kara’s parents and preschool teacher. They develop strategies to increase Kara’s communication, confidence, and play. This includes: • visual supports for instructions and choices • ideas for activities the educator could use with Kara and her peers that support her language skills • modelling to support play • strategies to support Kara to separate from her parents at drop off time. The key worker provides Kara’s parents and teachers with guidance so they can implement strategies at home and preschool. After a few months, Kara’s frustration reduces. As the strategies are embedded in preschool, she and her peers are interacting more positively. Kara now likes going to preschool. Her key worker changes her visits to fortnightly, alternating between Kara’s home and the preschool. Her key worker continues to review Kara’s progress and support needs and consults the speech pathologist as needed.

Example

Note: When we talk about autism, we use the terms ‘autism spectrum’ and ‘participants on the autism spectrum.’ Some families and individuals prefer person first language for example, I am a person with autism. Others prefer identify first language, for example, I am autistic. Jordan is 3 ½ years old and lives with his mum and sister. He goes to childcare 2 days a week while his mum is at work. Jordan is on the autism spectrum and needs support for communication, social skills, emotional development, cognitive skills, and self-care skills. Jordan is an NDIS participant. He has just received his NDIS plan with funding for early childhood supports. His mum engages a team of early childhood professionals. This is made up of a key worker, who is a psychologist, and a speech pathologist.

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The key worker and speech pathologist are doing joint home visits to meet with Jordan and his family. They are also visiting his childcare to observe how he plays with other children. They talk to the childcare educators about his needs. Jordan’s family and educators talk with his team. Jordan wants to play with other children. He has difficulty understanding how to share and play in a cooperative way. Jordan tends to move into other children’s personal space and likes rough play. This can lead to other children moving away from him. Jordan doesn’t currently recognise when his peers are upset. For example, he can continue to follow them when they move away from him. Jordan loves cars and trains and plays with them all the time. When introduced to a new activity Jordan doesn’t show interest and will move back to his cars and trains. This is impacting his learning opportunities. His childcare educators are looking for ideas on how to support him to move between activities, and to join group activities. Jordan’s mum tells the team that Jordan has a very limited diet. She would like him to have more variety. Jordan is not currently indicating when he has a wet or soiled nappy. The team complete a functional assessment with Jordan, the family, and educators. They set goals and make a plan together. The family goals for Jordan are: • learning the names of peers and skills to build friendships • learning to take turns during play and when talking with his peers • supporting opportunities to play with his peers and try new play activities • learning to name basic emotions and linking them to what is happening • learning to prepare for changes in routines, by following a visual timetable • trying new foods and increasing the variety and textures he will tolerate • recognising and communicating when he is wet or soiled, learning to pull his pants up and down and washing his hands after a nappy change. The key worker helps the family prioritise which goals they would like to work on first. The key worker starts visiting Jordan weekly, alternating visits at home and at childcare. The key worker helps the family and educators embed strategies. These support Jordan’s goals in his daily routines and activities. These are the best places where Jordan can be supported to learn and practice new skills. At the same time, the speech pathologist enrols Jordan and his mum in a 12-week social communication program. The program includes: • home visits • weekly online parent education sessions

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• weekly small group sessions with other children and their parents • online parent-to-parent support. The speech pathologist completes a pre and post program assessment with the family. Throughout the 12-week program, the speech pathologist consults monthly with Jordan’s family, key worker, and educators. This is so they can use strategies in all his settings. After 12 weeks the speech pathologist reviews Jordan’s progress in the program. They discuss this with his family and key worker. Everyone agrees that moving forward they will focus on building Jordan’s social and communication skills at home and childcare. The key worker will continue to provide weekly supports. This includes supporting Jordan, his family, and educators with social communication strategies. The speech pathologist will do monthly consultations. They work together with the family, key worker, and educators to develop new strategies or ideas they can use. Over time, Jordan’s family and educators will continue to receive support from his team as he makes progress. His team and family will assess Jordan’s progress towards his goals and set new goals. They change the supports and strategies to best fit what Jordan, his family and childcare needs.

How do we make decisions about intensive early childhood supports?

We’ve looked at the best practice guidelines.23 It tells us that intensive early childhood supports delivered in greater amounts do not consistently lead to better outcomes for children and families. It told us that a small amount can be more beneficial than a lot. We can only include intensive early childhood supports in your child’s plan if they meet NDIS funding criteria. There are other important things we need to think about when making decisions about intensive early childhood supports. When we consider intensive early childhood supports, we look at whether your child needs very substantial support for independence and participation in daily life. When we talk about very substantial support, we mean: • your child needs a lot of person-to-person support for most of their day • there are many barriers for your child – like, being part of family and home life, and joining in with others for community and mainstream activities • your child’s support needs are much greater than what other children with developmental delay or disability usually need

23 National Guidelines – Best Practice in Early Childhood Intervention OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 17 Page 17 of 88

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• the support your child needs is at an important time in their development. For intensive early childhood supports we think about your child’s needs and whether they are very substantial for all of the following: • Main areas of diagnosis: evidence to show the support is effective for your child’s suspected or diagnosed disability.24 For example, it shows that the recommended intensive support will help your child to gain skills in core areas. The evidence shows this will lead to real outcomes with increased independence and social participation.25 Your child needs very substantial support to learn skills in other developmental areas that impact on independence and social participation. These skills are outside the main areas of the diagnosis. • Daily life in the home: to be part of a range of routines and activities in the home relative to age.26 Your child needs very substantial support across many daily activities, such as bath time, meals time, sleep routine, and play time with family. • Daily life in the community: to be part of a range of community activities relative to age.27 Your child needs very substantial support for many community activities, such as visiting friends, going shopping, to the playground, or to the doctor. Your child needs this level of support on top of the supports given through community services.28 Learn more about community and mainstream supports. • Early childhood education and care or school: to take part in early childhood education and care (childcare, preschool) or school relative to age.29 Your child needs very substantial support to: o start or re-start in a mainstream service o keep going to a mainstream service if at risk of withdrawing due to impact of disability; or o increase mainstream attendance if attending part time due to impact of disability. Your child needs this level of support on top of the supports given through mainstream services.30 Learn more about mainstream and community supports. For a child going to school or legally required to be at school, it is unlikely that intensive early childhood

24 NDIS Act 2013 s34(1)(d); NDIS (Supports for Participants) Rules r 3.2. 25 NDIS Act 2013 s34(1)(b); NDIS (Supports for Participants) Rules r 3.1(b). 26 NDIS Act 2013 s 34(1)(b). 27 NDIS Act 2013 s 34(1)(b). 28 NDIS Act 2013 s 34(1)(f). 29 NDIS Act 2013 s 34(1)(b). 30 NDIS Act 2013 s 34(1)(b). OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 18 Page 18 of 88

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  supports will meet the NDIS funding criteria unless there are very exceptional
  circumstances.
We do not consider this if your child is unable to go to an early childhood education
 and care service because they are too young or have a serious medical or health
   condition.

• Family life: for capacity building when the family feels their child and family would benefit from intensive early childhood supports. It will positively make a difference to their child and family’s quality of life.31 We think about: if the family think their child will find the amount or type of support enjoyable; if the support fits with the child and family’s week; if the support limits your child from being part of everyday activities; if the amount of support causes lots of stress to your child and family; if the support is consistent with cultural and family views about raising their child.32 Learn more about how long can your child have intensive early childhood supports?

When would intensive early childhood supports be needed?

We looked at the research. It tells us that intensive early childhood supports are likely to benefit children with very substantial support needs who have a diagnosed disability. They can also benefit children who are waiting for an assessment to diagnose a disability. We may ask to see this information. If intensive early childhood supports are best for your child, it is because very substantial support is needed to maximise their independence and participation. Before including intensive early childhood supports, we think about: • Information you share with us. • Observations and other assessments we may do. • Reports by health or early childhood professionals who know your child. These reports will include goals that are specific, measurable, achievable, realistic and timely. They will include results of functional assessments and recommendations. This includes results of outcome measurement tools when this applies. • The research and national guidelines to show the recommended supports will give positive outcomes related to your child’s specific disability. It is best practice for all your early childhood professionals to come together and agree on the recommendations for intensive early childhood supports. It is also a good idea to talk with your child’s treating health professional about these supports.

31 NDIS (Supports for Participants) Rules r 3.2(a)(iv). 32 NDIS (Supports for Participants) Rules rr 3.4 (a)(iii), 5.1(a). OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 19 Page 19 of 88

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If your child has a degenerative neurological condition, we want to make sure their treating health professional agrees to including intensive early childhood supports. We want to make sure this is considered as part of their overall health plan. With your consent, your key worker can manage the recommendations from all your child’s early childhood and health professionals. Learn more about how we make decisions about intensive early childhood supports.

Example

Leo is 5 years old and lives with his family. He is nearing the end of preschool and will transition to primary school next year. Leo is on the autism spectrum. He has very substantial support needs for his language and communication skills, behaviours that challenge, sensory regulation, self-care skills, play skills and social skills. These impact many areas of his daily life. Leo is an NDIS participant. Leo’s family use the funding for early childhood supports to engage a team of early childhood professionals. Leo’s team is led by a key worker who is a speech pathologist. His team also includes an occupational therapist, a psychologist, and a therapy assistant. Leo’s team recommended 12 months of intensive early childhood support before he starts school. Leo’s team spend several hours a week working together with his family and teachers. They work at home, in the community and at preschool. These are the best places to support Leo to learn and practice new skills. The team supported Leo, his family, and his teachers with Leo’s goals. These are: • learning how to use a device to support Leo’s communication • helping to manage behaviours of concern that occur at: o bath time o when brushing his teeth o brushing his hair o when changing his continence aids, and o when communicating his wants and needs. • learning to do more things by himself, like putting on clothes, feeding himself and staying longer at an activity • helping with getting him into the car to go to preschool, the shops, playground or visiting his cousins • helping Leo to separate from his parent when they drop him off at preschool

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• helping Leo take part in preschool routines, like group time, snack time, bathroom, indoor activities, outdoor activities, and toileting • helping Leo to try new activities and play near others • helping with sleep because Leo sleeps in his parent’s bed and wakes a lot. The key worker helps the family prioritise which goals they would like to work on first. The key worker gives the family information about groups and programs in the community that may interest them. Like a parent-to-parent support group for young children on the autism spectrum. Leo’s early childhood professionals support the family and therapy assistant with how to use strategies in the home. Leo’s preschool receives support from their local inclusion agency. They help the preschool with practical advice and support to make their service inclusive. These are mainstream early childhood education and care supports. Using this support Leo’s preschool made an adjustment by employing an additional educator to support him and other students to take part in preschool activities. Leo’s team of early childhood professionals regularly come to his preschool to support his teachers with strategies for Leo’s goals. Leo is starting school next year. His preschool and school are holding school readiness meetings for the family to help prepare for school. Leo’s new school has applied for funding for students with disabilities. These are mainstream education supports. Leo’s team of early childhood professionals help by providing information and attending school meetings. This will help his school get to know Leo and learn how to support him. Leo’s parents are pleased that he has made progress and will be starting school next year. When Leo starts school, his team and family will review his supports and strategies. The early childhood supports will reduce and will no longer be at an intensive level. This is because Leo’s new school will take up a big part of Leo’s week. They are responsible to help him take part and learn at school. Leo’s team will continue to support him and his family at home and in the community to pursue his goals. They balance this with rest, play and time to spend with his family and friends.

Example

Miriam is 3 years old and lives with her parents. They would like her to begin childcare. Miriam has cerebral palsy. She has very substantial support needs for her physical development, language and communication skills, self-care skills and play skills. These impact many areas of her daily life.

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Miriam is an NDIS participant and has 12 months of intensive early childhood support in her NDIS plan. Her paediatrician recommended this level of support. This is so she gets the right strategies and equipment at an important time in her physical development. Miriam’s family are using the funding for early childhood supports from her NDIS plan to engage a team of early childhood professionals. Miriam’s team includes a key worker who is a physiotherapist. Her team also includes a speech pathologist and an occupational therapist. They work with Miriam’s family several hours a week so that Miriam’s family can implement strategies to support her development. Some weeks Miriam and her family receive increased home visits from her team. This is helping her at key times in her physical development. For example, to help her go from crawling to weight bearing. Or, when Miriam received new bathroom seating equipment and the specialised stroller. Her team do additional home visits to help her family to set up the equipment and learn to use it safely. This is the best place to support Miriam to practice and learn new skills. The team support Miriam and her family with Miriam’s goals. These are to: • sit upright on the floor using her hands for support, maintaining this position for longer periods of time and to support her with equipment for seating • independently explore her home environment, by moving from rolling and crawling to weight bearing and standing, with assistance for short periods of time • get out into the community, using a specialised stroller with additional postural support • communicate her needs and wants with her family and explore other communication options • play and take part in everyday play activities, by handling larger balls, blocks, and other toys, with additional postural supports • take part in self-care tasks, such as to finger feed at mealtimes, rub her hands together to wash them after nappy changes, and to be supported with equipment to help her take part in bathing and brushing her teeth • to begin childcare. The key worker prioritises supporting Miriam to begin childcare. This is one of the goals the family would like to work on first. Miriam’s family have found a local childcare centre they want her to go to. Miriam’s team support her family to complete enrolment forms and attend orientation days. They support the childcare centre to identify reasonable adjustments and to work with the local inclusion agency. This helps them make changes at the centre so that Miriam can take part in activities. This includes:

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• moving tables and chairs so Miriam had the space to move around the childcare centre • making sure the bathroom is accessible • adapting activities so that they are suitable for Miriam and other children. When Miriam settles into childcare, her team and family will review her supports and strategies. Her team will continue to support Miriam, her family, and her childcare educators.

What other types of supports may be included in your child’s NDIS plan?

Some children may need other types of supports in their NDIS plan. We can include other supports in your child’s NDIS plan if they meet the NDIS funding criteria. We’ll base this on their individual needs. Other types of support could be equipment, technology, and disability-related health supports. Or, if the supports for your child’s behaviours include the use of, or need for regulated restrictive practices, we will put additional supports in your child’s plan. Learn more about behaviour supports (link yet to be provided) Learn more about other types of supports you can access for your child.

How do you get early childhood supports in your child’s

plan?

Once we have all the information and evidence we need, we’ll make a decision about funding early childhood supports in your plan. If they meet the NDIS funding criteria, we’ll include the funding for your child’s early childhood supports in their NDIS plan. If we decide some or all of the early childhood supports recommended in the evidence don’t meet the NDIS funding criteria this means we can’t fund them. We’ll explain our decision about the supports included in your child’s plan, and give you written reasons why we made the decision. If this happens, we’ll talk to you about which supports we can fund in your child’s plan. We’ll also talk to you about the supports we don’t fund and tell you why. If you don’t agree with a decision we make, you can ask for an internal review of our decision. Learn more about creating your plan.

What happens after your child gets early childhood

supports in their plan?

Once you have early childhood supports funding in your plan, you can use it to get the supports your child needs. OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 23 Page 23 of 88

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Your child’s NDIS plan is flexible. This means you can use the capacity building funding for early childhood supports across one or more early childhood professionals. This flexibility will help you choose the best mix of specialised supports and therapies for you and your child.

Will early childhood supports in your child’s plan reduce over time?

It is reasonable to expect that, for most children, the early childhood supports in their plan will reduce over time as their independence and participation increases. We’ll check in with you about your child’s support needs to see if these have changed. Your child’s developmental delay or disability support needs may change as your child becomes more independent. Or as they start participating in other services such as early childhood education and care or school. Your child’s early childhood education and care service or school will now provide some of the supports your child needs. We explain fair early investment and fair support across service systems in the principles we follow to create your plan.

How long can your child have intensive early childhood supports?

If your child’s NDIS plan has intensive early childhood supports, it will typically go for 12 months. If your child has received intensive early childhood supports, when we reassess your child’s plan we want to know: • how the support has helped to build you and your child’s skills to maximise their independence • how your child takes part at home, in the community, and in mainstream settings. • if the supports have helped your child use the skills they have learned with different people, across different settings and activities • whether your child continues to use the things they have learned over time. Almost always, the need for intensive early childhood supports will be less over time.33 If your child’s early childhood or health professional recommends more intensive early childhood supports, we’ll need evidence for this. We’ll think about the: • NDIS funding criteria • community and mainstream responsibilities • outcomes for your child and your family

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• changes to life situation, such as starting preschool or school in the near future. • the research and national guidelines. We think about how these impact recommendations for the type, frequency, and duration of supports. We also think about how it will support your child to access community and mainstream early childhood settings.

Does your child’s eligibility for the NDIS change?

When your child became an NDIS participant, they would have met either the disability requirements or the early intervention requirements. Learn more about the disability requirements and the early intervention requirements. If your child is eligible under the early intervention requirements, their support needs are more likely to change. We’ll check each time we reassess your plan whether your child still meets the early intervention requirements. You can talk to us at any time about transitions that will happen throughout your child’s early years. We can support you and your child to: • leave the NDIS and maintain linkages with mainstream and community services • continue to receive support if your child remains eligible, through a local area coordinator or planner after your child turns 7.

Can you ask us for a change to your child’s plan?

You can ask us for a change to your child’s plan at any time, and we can decide to do a change to your child’s plan at any time.34 A change to your child’s plan isn’t used to review a decision we’ve already made. We’ll work with you to complete the change to your child’s plan. We‘ll talk with you about your child’s situation to work out what we need to change. Learn more about your plan and changing your plan.

What if you don’t agree with our decision?

If we decide early childhood supports don’t meet our NDIS funding criteria, we can’t include them in your plan. We’ll give you written reasons why we made the decision. You can contact us if you’d like more detail about the reasons for our decision. If you don’t agree with a decision we make about early childhood supports, you can ask for an internal review of our decision.35

34 NDIS Act 2013 s48(1)(3) 35 NDIS Act s 100. OFFICIAL: SENSITIVE OG – Early childhood supports APPROVED v1.0 2023-05-10 25 Page 25 of 88

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You’ll need to ask for an internal review within 3 months of getting your plan.36 Learn more about reviewing our decisions.

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Version Control Table

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DOCUMENT 2 FOI 24/25-1233 The contents of this document are OFFICIAL. PXC - Cover Page Agenda item: [insert number and title]

                                 Page 28 of 88

OFFICIAL PXC meeting of 18th May 2022 FOI 24/25-1233 Agenda Item: # Agenda Item: [insert title] Paper Type: For Recommendation SES Sponsor: Christine redacted: [s47F - personal privacy](/foi-library/releases/759e22e37354-foi-24-25-0593-decision-document/release-materials/material-001__s47f-personal-privacy/) Draft resolution: PXC to support the ECS Branch policy position on determining capacity building supports in early childhood for external publication.

1. Purpose

1.1. To seek recommendation for an agreed policy on determining capacity building funding in early childhood for external publication.

2. Recommendation

2.1. PXC to recommend publication of the policy on determining capacity building funding in early childhood in OGs, based on current processes. This includes the information provided in the Early Childhood Planning Practice Guide (attachments A, B & C) but excludes any specific dollar amounts or hours.

3. Background

3.1. The early childhood planning documents for children younger then 7years of age (attachments A, B & C) have been developed by the Early Childhood Services team of early childhood intervention subject matter experts based on best available evidence. They are internal documents and therefore cannot be applied consistently across all decision making points within the NDIA (initial decision, internal review and Administrative Appeals Tribunal (AAT)). NDIA staff and partners cannot be fully transparent with families and external stakeholders about how they make their decisions regarding capacity building supports in early childhood NDIS plans. 3.2. NDIS plans with an intensive level of capacity building support continue to rise. This is largely driven by providers who develop standardised quotes based on their business models, rather than an individualised assessment of need. Quotes range up to redacted: [[[s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/) Often provider quotes do not meet the Reasonable and Necessary criteria and cannot be used to determine a level of support in the plan. 3.3. When considering matters before the (AAT), the Tribunal cannot refer to the NDIA’s internal early childhood planning guidance as it is not an external NDIS policy. This has led to reversing of some decisions and increased funding in plans, along with contributing to mixed messaging for families and providers. Inconsistency in decision making has led to reduced trust in NDIA decisions and increased incidence of reviews. Most importantly, young participants and their families are confused and distressed by the process. 3.4. The Early Childhood Early Intervention (ECEI) Reset recommendations 3 and 18 state that the NDIA has made a commitment to be consistent and transparent about decision making processes for all EC participants, including publishing new guidance about reasonable and necessary support for children with Autism (Attachment E). 3.5. Early childhood NDIS plans include capacity building supports for early intervention. For most children, a level of reasonable and necessary capacity building support ranging from redacted: s47E(d) - certain operations of agencies will meet their developmental and functional needs. This is calculated using the internal Guide (Attachment A). The Guide has been successfully used to determine the level of capacity building supports in early childhood plans since 2015. 3.6. The Guide provides 5 levels of funding and considers the individualised circumstances of the participant to determine the level of support, such as, number of areas of need and level of functional impact that require support, level of support required for the child and family/carers in natural settings and level of support required for mainstream participation (including transition support to mainstream), consistent with best practice. 3.7. Capacity building supports for children above the Guide level redacted: s47E(d) - certain operations of agencies are considered to be at an intensive level. An intensive level of funded support is where very OFFICIAL Page 29 of 88 1

OFFICIAL PXC meeting of 18th May 2022 FOI 24/25-1233 substantial support is required for a child and family to build capability and to increase independence and participation in daily routines and activities. It typically represents multiple hours of early intervention across multiple days in the week. 3.8. All requests for an intensive level of capacity building supports in an early childhood plan are considered against the R&N criteria using the internal Intensive form (Attachment B). It supports NDIA staff to consider the impact of disability on daily life, level of participation in mainstream settings, early intervention goals and outcomes for the child and family, and whether provider recommendations/quotes meet R&N. 3.9. When there is evidence that both the request for intensive supports and the provider quote meet R&N, the level of support placed in the early childhood plan is based on the provider quote. In these circumstances, NDIA staff are easily able to communicate with families about the level of supports placed in the plan because it matches their and/or the provider’s requests. 3.10. When provider quotes do not meet R&N or are not available, yet there is sufficient evidence that the participant requires an intensive level of CB support, NDIA staff must find another way to determine the funding level. 3.11. To meet this need, the ECS Branch developed the alternative method (Attachment C) for internal use. When developing the alternative method, current research evidence was considered but there is no consistent evidence to suggest that greater amounts of early childhood intervention leads to better outcomes, or that there is an optimal amount of intervention a child should receive (Attachment D). 3.12. The alternative method takes into account the level of support required to enable child and family capacity building and to support increased mainstream participation. It is based on an analysis of the range of funded supports that have been placed in early childhood plans that were at an intensive level since 2015. The alternative method provides consideration of capacity building support ranging from approximately redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/) . (Attachment D, slides 16 to 24 show examples). 3.13. The alternative method was presented to the Autism Advisory Group as a possible solution to guide determination of intensive supports for children with Autism. The Autism Advisory Group have endorsed the use of a consistent and transparent approach to determining levels of capacity building support in children’s plans (Attachment D). 3.14. The early childhood planning documents as described in this paper are proposed to be developed into an external policy to support determination of capacity building supports in early childhood. Just as the TSP for participants over the age of 7 years is not published, we suggest not to include the calculations or levels of funding themselves until further consultation and co design is complete as part of the consistent decision making framework.

4. Risks

     4.1. Despite having access to information on how decisions are made, if a child does not receive
         the level of support, they, or their provider requested, some families may remain unsatisfied
      and request an internal review. Providers may continue to encourage families to request
        unreasonably high levels of capacity building supports or to appeal decisions because their
        business models may be impacted. NDIA staff will continue to support families with
         information on how to request a review of a decision, as per current process. The availability
          of public facing policy will mean the AAT can apply the same guidance in their decision
       making as the original decision maker.
     4.2. Publishing guidance material on how decisions are made, not including the funding calculation
       methods may not fully resolve transparency issues. Future iterations of the policy may move
          to include this when additional evidence is available from research currently underway. The
         consistent decision making framework co design work will also further strengthen and approve
           propertyPath
             this policy and the transparency and consistency of the process to determine NDIS funding for
             all participants.

5. Impacts

                              OFFICIAL

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OFFICIAL PXC meeting of 18th May 2022 FOI 24/25-1233 5.1. Families and other stakeholders will have access to information about how decisions are made regarding capacity building and intensive supports for children younger than 7 years of age. It will assist to manage expectations about what is R&N that the NDIS will fund in early childhood. 5.2. The policy will support all NDIA staff, including EC Partners, planning delegates, Internal Reviews team and Administrative Appeals Tribunal/Branch to make consistent decisions and to openly communicate to families about how decisions were made. This is expected to positivity impact scheme sustainability and participant experience.

6. Sustainability Impacts

     6.1. A policy will support consistent decision making and will provide clear messaging and
        transparency on how decisions are made.
     6.2. Positive impact on Scheme sustainability as a result of reduced number of AAT cases in the
          future.

7. Responsibility and next steps

     7.1. The proposed next steps is to publish the policy in a new Operational Guideline for capacity
          building supports in early childhood. Service Guidance and Practice Branch are responsible
           for the creation of Operational Guidelines and Early Childhood Services Branch are
         responsible for policy content.

Internal use only

Internal use only

Checklist

Internal use only – Alignment with national frameworks

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OFFICIAL PXC meeting of 18th May 2022 FOI 24/25-1233 Please indicate alignment of this work with the relevant Outcome Area(s) under Australia’s Disability Strategy 2021- 2031:

Please indicate alignment of this work with the relevant Priority Reform area(s) of the National Agreement on Closing the Gap

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The Guide

Attachment A: The Guide Extracted from Practice Guide – Early childhood planning, ECS Practice Guides, SOPs and Tools (ndia.gov.au)

9.2 Appendix 2: Guide for calculating early childhood capacity

building supports (the Guide)

Following the early childhood approach, the reasonable and necessary funded supports in a plan are built based on the family and carers’ goals for the participant, the functional impact of participant’s disability or developmental delay on daily life and the level of support required to pursue the plan goals. This Guide is used to select a level of Capacity Building supports to meet a participant’s plan goals. Information regarding functional impact of developmental delay or disability on a participant’s daily life is gathered during the planning conversation with the family. A summary of this information is recorded in the Pre-planning Interaction – Planning conversation and the justification comments – Capacity Building. This information is used to identify the ‘high areas of need’ and ‘medium to low areas of need’ when selecting an appropriate level of funding for Capacity Building supports based on the tables below. The areas of need consider current functioning across the developmental areas: Physical Development, Cognitive Development, Language and Communication skills, Emotional Development, Social Development, Self-Care skills, Hearing and/or Vision. The justification comments are placed in the Review and submit draft plan tab in the System, and copy and pasted into the Interaction - Early childhood plan submitted for approval – Initial plan or plan review (full). There are 5 levels of supports that can be recommended using this Guide: ‘mild’, ‘mild-moderate’, ‘moderate’, ‘moderate-severe’ or ‘severe and profound’. The funding levels enable the delivery of best practice in early childhood intervention, which includes the key worker model. Where appropriate, additional hours can be considered for the support required by the participant in early childhood settings (for example, preschool or childcare) and to support transition to the first year of school. For goals that may require consultation with a psychologist (high areas of need emotional development and/or cognitive development) or with a physiotherapist (high area of need physical development) include additional hours to allow for the higher rates that a provider may claim, as per the current NDIS Pricing arrangements. This will ensure sufficient funding is included in a plan should a family or carer choose to access support from a psychologist and/or physiotherapist during the course of the plan. There are state or territory based differences relating to the claimable rates for psychologists and physiotherapists and guidance is provided in the tables below to assist with what to include in a plan. Please note, for NT, SA, TAS and WA although there are two options for including additional hours, only one addition is made to a

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The Guide

plan at (b) (that is b(i) or b(ii)). When plan goals may require both psychology and physiotherapy support include the amount at b (i) only. This is because the additional funding has been calculated with respect to all the Capacity Building hours and any adjustment needs to only be factored in once. The level of Capacity Building support is recorded in the justification comments – Capacity Building. The funding is then transferred to the System on the Capacity Building Support Item Name ‘Capacity Building Supports for Early Childhood Interventions – Other Therapy’ (Support Item Number 15_005_0118_1_3).

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S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

S47E(d) - certain operations of agencies

Form

Intensive capacity building supports in early

childhood

This form is for internal use only. This Intensive form will help the early childhood partner or plan developer consider the information received to make Capacity Building recommendations. It will also help the delegate make a reasonable and necessary decision when considering an intensive level of Capacity Building supports for a participant younger than 7. There are 9 parts to this form. You must complete all parts in order (Part A to Part I), unless prompted otherwise. Before completing this form, make sure you understand the intensive level of Capacity Building supports in early childhood. You will find this information in the Practice Guide - Early childhood planning. In the Practice Guide’s appendices you will find the ‘Guide for calculating early childhood capacity building supports’ (the Guide) and ‘the alternative method’. Do not use this Intensive form when: • the requested level of Capacity Building support is less than or equal to the ‘severe and profound’ level in the Guide. • an intensive level of support is recommended by a professional, but the parent or carer does not want this. Instead, record this in the Interaction template- Pre-planning: Early childhood planning conversation. • requests relate to Core supports, disability related health supports, supports in Capacity Building (CB) Relationships (for example restrictive practices) or Assistive Technology supports (AT). Once this form is completed, upload as an Inbound Document to the participant’s record in the NDIS Business System (System). If you are not recommending intensive supports or recommending less than what was requested complete an Interaction template - Planning - Early childhood declined supports in the participant’s record in the System. If you require further support to complete this form, please talk to your team leader or request advice from the Early Childhood Services Branch.

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Form

Part A: Participant details

Part B: Supporting information and reports

Part C: Request for support

3.1 Who is requesting the intensive level of Capacity Building supports?

Select all that apply

☐ Parent or carer

☐ Service provider

☐ Health professional

☐ Early childhood partner or plan developer

☐ Other, please specify in the cell below.

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Part D: Are intensive supports likely to be needed?

4.1 Intensive supports criteria

In the table below, select all that apply.

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4.2 Are all the criteria in 4.1 met?

☐ No. Use the Guide to calculate supports. Note: This form is now complete.

☐ Yes, intensive supports are likely to be reasonable and necessary. Go to Part E.

Part E: Participation in early childhood education, childcare or school

5.1 What were the child’s participation levels in the past 12 months?

For example, type of activity, days per week, start/end date.

5.2 What are the child’s participation levels planned for the next 12 months?

For example: type of activity, days per week, start date.

5.3 What are barriers to the child’s participation?

5.4 Eligible mainstream funding

If applicable, comment on eligible mainstream funding for inclusion or disability supports for the child at childcare, preschool or school.

Part F: Provider reports

6.1 Are current provider reports available?

☐ No. Recommend a 12 month plan with 3 months of intensive supports. Go to Part I

☐ Yes. Complete the table in 6.2, below.

6.2 Provider reports and parent or carer information

In the table below, select all that apply.

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6.3 Are all the criteria in 6.2 met?

☐ Yes. When you calculate funding, recommend a plan with up to 12 months of intensive level of supports that meets the reasonable and necessary criteria.

☐ No. When you calculate funding, recommend a 12 month plan with 3 months of intensive supports.

Part G: Evaluate provider recommendations

7.1 Provide a breakdown of each of the provider’s recommendations

In the cell below, include service type (for example: group, individual, parent training) and setting (for example: centre based, home based, natural settings), professionals involved (for example: qualifications, registrations), frequency and rates for each support.

7.2 Further considerations against reasonable and necessary criteria

In the table below, select all that apply to the recommendations received.

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Consideration of provider recommendations (with any parent or carer information relating to the recommendations) against the reasonable and necessary criteria.

☐ Calculations in the quote that do not represent value for money (NDIS Act 2013 s 34(c)). For example, hourly rates in provider reports are above prices in the NDIS Support Catalogue, or 52 weeks of the year calculated rather than 48 weeks.

☐ Supports are not considered value for money; the requested hours are excessive compared to the outcomes to be achieved (NDIS Act 2013 s 34(c)). For example, the provider recommends an increase in funding which is not justified in reports, the provider recommends funding for an intensive toilet training program in addition to a comprehensive early intervention program which supports the area of self-care.

☐ Hours for provider travel (not including remote MMM6, very remote MMM7), report writing, multiple staff attending the same meeting, professional development, does not represent value for money (NDIS Act 2013 s 34(c)).

☐ Recommendations made by a professional who is not qualified for example a therapy assistant has written the therapy program (NDIS Act 2013 s 34(d)).

☐ Delivery of service by professionals who are inappropriately qualified. For example, a behaviour therapist who is not qualified to supervise a therapy program (NDIS Act 2013 s 34(d)).

☐ Programs with a low evidence base (NDIS Act 2013 s 34(d)). For example, equine therapy, dance therapy.

☐ Support which replaces mainstream and community supports (NDIS Act 2013 s 34(f)). For example, it is not reasonable and necessary to fund therapy assistant in a preschool, therapist teaching a child to read, therapy recommended on days when the child should be at a mainstream setting.

☐ Other concerns, please specify: Click or tap here to enter text.

7.3 Your recommendation

Have you selected any of the criteria in 7.2?

☐ Yes. The recommendations are not likely to meet the reasonable and necessary criteria and you are unable to base funding on the provider quote. Go to Part I.

☐ Yes. The recommendations are likely to meet the reasonable and necessary criteria after minor adjustments are made to the provider quote, so it represents value for money (NDIS

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Act 2013 s 34(c)). For example, removing provider travel, accepting number of hours but applying NDIS rate, reducing 52 week recommendation to 48 weeks. Go to Part H.

☐ Yes. However, there are exceptional circumstances and the provider recommendations have been discussed with a team leader or the ECS Branch. Please record these details in the cell, below. Go to Part H.

Name of team leader/ECS Branch colleague: Click or tap here to enter text.

Describe the exceptional circumstance: Click or tap here to enter text.

☐ No. No concerns identified. The recommendations are likely to meet the reasonable and necessary criteria. Go to Part H.

Part H: Funding informed by the provider quote

8.1 Calculate the funding you are recommending

Based on your response to Part F, use the provider quote to calculate funding in the plan for either:

• 3 months of intensive supports within a 12 month plan and the remaining 9 months based on the Guide (pro rata for 9 months). Plus 9 hours for assessment, or
• a plan with up to 12 months of intensive supports.

In the cell below, include your calculations and the total hours that will be entered into the System, using the line item Capacity Building Supports for Early Childhood Interventions – Other Therapy. Add total hours recommended to the Capacity Building justification comment.

Enter your staff member details and this form is complete.

Part I: Funding based on an alternative method

9.1 Use an alternative calculation method

Use the alternative method if the recommendations in 7.3 were not likely to meet reasonable and necessary criteria and you were unable to base funding on the provider quote.

Use an individualised approach instead of the alternative method when:

• the required supports are intensive and for shorter timeframes, or
• the alternative method comes to an amount that is greater than the total provider recommendations.

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Form

Use the information in Part E to consider the child’s current and future mainstream participation in your calculations.

Based on your response in Part F, calculate funding in the plan for either:

• 3 months of intensive supports within a 12 month plan and the remaining 9 months based on the Guide (pro rata for 9 months). Plus 9 hours for assessment, or
• a plan with up to 12 months of intensive supports.

In the cell below, include your calculations and the total hours that will be entered into the System, using line item Capacity Building Supports for Early Childhood Interventions – Other Therapy. Add total hours recommended to the Capacity Building justification comment.

Enter your staff member details below and this form is complete.

Staff member details

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Attachment C: Alternative method

Extracted from Practice Guide – Early childhood planning, ECS Practice Guides, SOPs and Tools (ndia.gov.au)

5.2.1 Intensive level of Capacity Building supports in early

childhood

The Guide will typically provide a level of Capacity Building supports that will allow participants and families to pursue their plan goals. In exceptional circumstances however, an intensive level of Capacity Building support may be required. The Intensive capacity building supports in early childhood form (Intensive form) is an internal document and must be completed for all requests for intensive supports.

A request for an intensive level of Capacity Building support is where the requested level of Capacity Building support is greater than the ‘severe and profound’ level in the Guide including funding to support natural settings and/or transition to school.

The request must be considered irrespective of the number of high areas of need identified. For example, if a provider and parent have requested 180 hours of support (this is above the severe and profound level on the Guide), the request must be considered by completing the Intensive form.

Where more than one provider is engaged, the requested level of intensive supports refers to the sum of requests of all the Capacity Building supports across all the providers.

It is important that you look at both the hours and the rates that form part of the request. This is because some supports, like group or therapy assistance, are likely to be quoted at a different rate compared to the individual rate for ‘Capacity Building Supports for Early Childhood – Other Therapy’. redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

5.2.1.1 When should you complete the Intensive form?

You must complete this form when:

• a family or carer request an intensive level of Capacity Building support
• a provider or health professional recommends an intensive level of Capacity Building support; and/or
• when you believe an intensive level of Capacity Building support is required.

Do not complete the Intensive form where a parent or carer does not want to access the level of intensive supports (their request fits within the Guide) requested by a provider, a health professional/s or the early childhood partner. Instead complete the Interaction template – Pre-planning – Planning Conversation to record a summary of your conversation with the family or carer during the planning process.

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Do not complete the Intensive form for supports relating to:

• core supports
• disability-related health supports (for further information on disability-related health supports go to our guidelines).
• assistive technology, or Capacity Building supports related to assistive technology
• behaviour support plans with restrictive practices.

Note: If you are recommending intensive support for a child with a degenerative condition, complete the Intensive form and contact your local ECS Branch State Inbox to request advice.

5.2.1.2 What to consider when completing the Intensive form

The Intensive form is made up of 9 parts. Parts A to C ask you to record participant details, any available reports and who is making the request. Parts D to E prompt you to consider the impact of the participant’s disability on daily life, including mainstream participation, to determine if intensive supports are needed. If intensive supports are needed, Parts F to G prompt you to consider provider recommendations and other evidence against the reasonable and necessary criteria. Part H supports you to make a funding recommendation informed by the provider quote, if it is reasonable and necessary to do so. Part I supports you to make a funding recommendation based on an alternative method, where provider recommendations cannot be used.

The Intensive form will help you to consider the available evidence relating to a request or the need for an intensive level of support. It is expected that a request and the evidence be considered against the principles of the early childhood approach, the principles relating to plans (NDIS Act 2013 s 31), the reasonable and necessary criteria (NDIS Act 2013 s 34) and the NDIS (Supports for Participants) Rules 2013.

The below documents should also be considered when reviewing a request:

• Autism CRC early intervention report.
• best practice principles in early childhood intervention which underpins the early childhood approach.
• The evidence can come from multiple sources, including but not limited to:
• parent or carer information (for example information gathered during a planning conversation, parent or carer’s statement),
• information from childcare, preschool, and schools,
• providers and other professionals involved with the child (for example paediatrician).

When more than one provider is engaged, consider the information that is available from all providers to address the questions on the Intensive form. Reference the evidence you have considered in Part B of the intensive form, stating who reported the information (for example mother’s name, provider’s name) and the date. This information must be uploaded onto the System, in Inbound Documents for reports or

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statements and in the case of conversations, these are recorded as an Interaction template – Pre-planning – Planning Conversation.

It is important to remember that provider recommendations will be considered against the reasonable and necessary criteria. The NDIS plan includes funding for reasonable and necessary supports to help the family pursue their child’s goals. It is the family’s choice to engage with their preferred provider(s) which can include accessing specific programs.

5.2.1.3 Where provider reports are not available and/or evidence is insufficient

to meet the reasonable and necessary criteria

There will be instances where the answers to Part D of the intensive form demonstrate that an intensive level of support is required, however, provider reports are not available (Part F 6.1) or there is insufficient evidence to meet the reasonable and necessary criteria (Part F 6.3). This may occur for participants who are yet to receive their first NDIS plan, participants who are yet to commence early intervention, or if the professional report does not have the required information.

When this occurs, funding for a 3 month period of intensive support can be included in a 12 month plan. Funding for the remaining 9 months of the plan is built using a pro rata amount based on the Guide. You can add 9 hours to the plan on the support item ‘Capacity Building Supports for Early Childhood – Other Therapy’ to allow for an assessment and report to be completed. This will enable the family to begin (or continue) with services whilst obtaining the required evidence to address Part F 6.2.

It is not expected that the report will include information on outcomes for this period. Appendix 3 provides examples of how to calculate 3 months of intensive supports within a 12 month plan.

It is important to make every effort to gather the necessary evidence before recommending or approving a plan (12 months) with a 3 month period of intensive supports. If sufficient evidence can be obtained and 12 months of intensive funding can be considered it will negate the need for a participant requested plan review.

When the family has gathered the required evidence, they can ask for a plan review if their situation and support needs have changed since the plan was approved and the plan no longer meets the participant’s needs. Any new evidence and recommendations will be considered to help decide if we approve the plan review.

This is different to the family requesting a review of the decision. A family can ask for an internal review if they do not agree with the original decision. For example, if the family are not satisfied with the original decision to include 3 month period of intensive supports within a 12 month plan. Supporting the family with information to help them select the right review may prevent any delays in having the review considered.

For further information on participant requested plan reviews refer to Our Guideline – Plan reviews and Our Guideline – Reviewing our decisions or use the Choose the right review tool.

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5.2.1.4 Calculating funding for a level of intensive supports

When you have determined that intensive supports are likely to be required (Part D) and have considered the information relating to the child’s mainstream participation (Part E) you will need to consider the level of Capacity Building support you recommend funding in the plan. At Part F (6.1 or 6.3), you have already determined whether in a 12 month plan the intensive supports will be funded for a 3 month period or up to the 12 months. The next step is to determine whether you will be basing your funding recommendation for intensive supports, on provider recommendations or you will be using an alternative method.

When provider report(s) are available and they include recommendations for funded supports it is important to consider each of the provider recommendations and evaluate them against the reasonable and necessary criteria (Part G). Based on your evaluation, if there are no significant reasonable and necessary concerns identified, the provider recommendations may be used to inform your funding recommendation at Part H. This can also include making minor adjustments to the provider recommendation to ensure it meets all the reasonable and necessary criteria. For example adjustment like: removing provider travel, accepting the requested hours but applying NDIS rate, and adjusting 52 week recommendation to 48 weeks (or for 3 months) to represent value for money. When using provider recommendations to inform your funding recommendations, do not include additional funding based on the Guide for the period of the plan that is at an intensive level.

If provider reports are not available (Part F 6.1), or the provider recommendations are not likely to meet the reasonable and necessary criteria after any minor adjustments are considered (Part G), your funding recommendation in the plan will be based on an alternative method (Part I). Refer to Appendix 3 to calculate a level of intensive Capacity Building supports using an alternative method that is not based on a provider recommendation. However, the alternative method should not be used when the required supports are intensive, for shorter bursts of time (for example, sometimes seen in recommendations for supports for children with physical disabilities) or when the alternative method comes to a total amount that is greater than the provider’s recommendations. Instead an individualised approach will be required, and your recommendation is included at Part I. For further assistance speak to your team leader or contact the ECS Branch.

All funding for intensive supports must be entered on the System as a funded support category ‘Daily Activities’ using the support item ‘Capacity Building Supports for Early Childhood – Other Therapy’. If you are using the provider recommendation to inform your calculations, be sure to convert any hours that are typically funded at lower rate (for example: therapy assistant hours, group therapy hours) to the equivalent hours before placing your recommendation on the support item ‘Capacity Building Supports for Early Childhood – Other Therapy’.

The completed Intensive form should be referenced in the justification comments – Capacity Building in the Review and Submit Draft Plan tab on the System and within

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the Interaction ‘Early childhood Plan Submitted For Approval’ on the System. The Intensive form should also be attached in the System in Inbound Documents.

Complete an Interaction for Early childhood – declined supports if you are recommending less than what was requested by the family or carer. For example, when you have adjusted the provider quote, or when you are recommending 3 months of intensive supports within a 12-month plan.

Add an alert to the System when 3 months of intensive supports are funded in a 12- month plan. For example – ‘Funding for a 3-month period of intensive CB support has been included within a 12-month plan for an assessment and report. Contact once this is available. Refer to interaction number .

9.3 Appendix 3: An alternative method to calculating intensive

supports above the Guide (alternative method)

There will be instances where there is evidence that intensive Capacity Building supports is required (as demonstrated in the Intensive form), but you will not be determining the level of funded supports based on the parent or carer request or provider recommendation. This may be because provider recommendations do not always consider the principles relating to plans (NDIS Act s.31), the reasonable and necessary criteria (NDIS Act s.34) and NDIS (Supports for Participants) Rules 2013 and the principles of the early childhood approach. In the absence of acceptable provider recommendations, the plan developer may consider applying an alternative calculation. The alternative method (below) can be used where the supports that are required are regular, intensive and for a sustained period of time.

9.3.1 Steps for calculating an intensive level of early childhood support

Step 1: Apply the Guide as per the usual process. In order to build this part of the Capacity Building budget consider: a. (i) the number of high areas of need and number of medium to low areas of need, b. addition for ‘high’ area/s of need in emotional development, cognitive development and/or physical development, c. whether supports are required in the natural settings, and finally, d. whether supports for transition to school are required. Insert your recommendations into the justification comments in the Review and submit draft plan tab, funded supports section, ‘Capacity Building (CB Daily)’.

Step 2: Apply the following method to allocate the additional levels of intensive support that are required.

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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redacted: [[s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

redacted: s47E(d) - certain operations of agencies

Step 4: Add total hours from Step 2 and 3. Show your calculations on the Intensive form (Part I).

9.3.2 Participation in a community or mainstream setting

When thinking about the level of intensive funding and the intent of the supports in the plan, consider whether the child:

• Has attended or are they currently attending a community or mainstream setting, such as childcare or preschool (including specialised or disability specific early childhood settings).
• Should be attending a mainstream setting, as would be expected given the child’s age. Note: Children have a legal right to attend school at the compulsory school age set by the state’s education department, unless they have an exemption in place.
• Will be starting in a mainstream setting during the course of the plan.

This information may influence the level of supports funded in a plan.

At times, there is information that suggests the child will be reducing or withdrawing attendance in a mainstream setting. Consider the reasons for this and how this may influence the level of intensive supports funded in a plan. For example:

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• What supports are (or may be) available in these mainstream settings? For example, could the child attend the setting and be provided with supports for inclusion through the key worker role (funded supports)?
• Was eligibility for mainstream inclusion supports explored for example inclusion support State or Commonwealth funding for childcare or preschool settings?
• Are the child’s needs better met in a specialised or disability-specific early childhood setting?
• Is there an education department issued exemption in place for a school aged child?

Note: If there is insufficient information to understand why the child is reducing, withdrawing or not attending a community or mainstream setting, only fund the level of support in the week that does not replace this attendance. This is to ensure that funded supports do not inadvertently reduce a participant’s community or mainstream participation and/or that the funded supports are not duplicating supports that are available in community and mainstream settings.

9.3.3 Examples of intensive levels of early childhood capacity building

supports using the alternative method

These are brief snapshots for illustration purposes and more information would need to be provided to support your recommendations. Please note that the rates in the NDIS Support Catalogue are regularly updated and any recommendations made must always reflect the current NDIS Support Catalogue rates.

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Discussion: R&N decision making

for intensive levels of support

Presenters: Christine redacted: [s47F - personal privacy](/foi-library/releases/759e22e37354-foi-24-25-0593-decision-document/release-materials/material-001__s47f-personal-privacy/), Peter redacted: s47F - personal privacy and Loretta redacted: s47F - personal privacy

Agenda item 2.1

Confidential and Draft (AAG) – for discussion only

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Context

Purpose and desired outcome

To continue discussion on the identified 5 key short term strategy areas previously presented, with a focus on addressing the concerns that arose from last meeting around mainstream participation.

To reach agreement about the next steps regarding the ‘alternative method’ for determining a level of intensive supports for an autistic child when the recommendations from a provider do not meet the reasonable and necessary criteria.

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Objectives:

Update:

Strategy 2 - guidance for determining intensive level of support

• Update of progress on the 5 key short-term strategies

Strategy 3 – Provider evidence of outcomes and functional needs

• Revisit the principals behind the ‘alternative method’
• Present case studies to demonstrate the way a child’s budget determined via the alternative method might be utilised in various real-life scenarios
• Update re publishing and consultation

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Update on strategy areas

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Strategy 2. Guidance for

determining intensive level of support

Key principles

• The Applied Principles and Tables of Support to Determine Responsibilities NDIS and other service
• Evidence base - Lancet article – An evidence-based framework for determining the optimal amount of intervention for autistic children
  • Plausible
  • Practical
  • Desirable
  • Defensible

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Strategy 2. Guidance for

determining intensive level of support

Key principles

• Reasonable and necessary criteria
• Best practice principals
• Social model of disability

“There is no consensus among existing clinical guidelines and practice recommendations regarding intervention amount.”

“Research evidence for the optimal amount of intervention autistic children should receive is inconsistent and scarce”

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Plausible

• What is the theoretical mechanism of action?
• Is there evidence that the theoretical mechanism exists?
• Is there evidence that the theoretical mechanism will support the desired intervention outcome?
• Is the identified evidence applicable to the individual child and family context?
• Why might it work better at one point, compared with others?

Practical

• Is the amount of intervention feasible within the child’s and family’s time schedule?
• Is the amount of intervention sufficient priority within the hierarchy of child and family needs?
• Is a service provider available that can deliver the amount of intervention?
• Does the family have the financial resources to support the amount of intervention?

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Evidence based Lancet Article

Desirable

• Is the amount of intervention consistent with cultural and caregiver views regarding the child rearing?
• Is the amount of intervention consistent with caregiver views regarding the need to focus on the child versus the environment, in order to reduce disability?
• Is the child likely to find the amount of intervention desirable?
• How will the child’s and family’s response to the amount of intervention be monitored?

Defensible

• What are the proposed therapeutic benefits for the child and family?
• What are the probable costs (including opportunity costs) to the child, family ,support networks, and community?
• Why is this amount of intervention recommended instead of the alternative options?
• How might the child view this intervention decision in later life?

David T, Waddington H, Sulek R, et al. An evidence-based framework for determining the optimal intervention amount for autistic children, The Lancet, 2021

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The National Early Childhood System

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Strategy 2 – Guidance for determining

intensive level of support

Current state:

• Assessment of need is based on information from parents/carers, and professionals
• Provider recommendation for funded supports are evaluated against reasonable and necessary criteria. If provider recommendations meet R&N, this is used to build funded supports in the plan.
• If provider reports are not available, or the provider recommendations do not meet reasonable and necessary criteria, the funding recommendation in the plan is based on an alternative method.

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Strategy 2 – Guidance for determining

intensive level of support

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Alternative Method – Step 1

Step 1:

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Alternative method step 2

Step 2:

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Alternative method step 3

Step 3:

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Alternative method step 4

Step 4:

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Case study examples - Leo

• Leo (2 years) has a substantial reduction in functional capacity impacting many areas of his daily life.
• His paediatrician and provider have recommended an intensive early intervention program.
• Leo is not attending childcare. His mother feels this would be too difficult because of his significant level of delay and behaviour difficulties.
• The alternative method was used based on Leo not yet attending childcare.

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Case study - Leo

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Case study - Mehran

• Mehran (aged 3 years) has a substantial reduction in functional capacity impacting many areas of her daily life.
• Mehran has been attending childcare 2 days per week, with mainstream inclusion support. They have made reasonable adjustments to the program to support her participation.
• She continues to require significant support to develop her functional skills, to assist her participation and manage her behaviours of concern, both at home and in childcare.
• The Alternative method was used based on Mehran attending childcare 2 days/week.

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Case study – Mehran

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Case study – Mehran

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Case study – Hugo

• Hugo (aged 4 years) attends preschool 3 days per week with mainstream inclusion support. They have made reasonable adjustments to the program to support his participation.
• He will be starting school halfway through the plan. He will require support for transition to school. A school application for disability program funding will be lodged.
• The Alternative method is based on attendance at preschool for the first half of the plan, and attendance at school for the second half of the plan.

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Case study – Hugo

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Case study – Hugo

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Case study - Hugo

redacted: [s47E(d) - certain operations of agencies](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/)

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Inclusion benefits all

“Research shows that inclusion benefits all. Children with additional needs as well as children without additional needs benefit academically and socially from interacting and participating in inclusive settings.[1] Inclusion can lead to stronger skills in literacy and numeracy as well as positive changes in children’s confidence, self-esteem and understanding of diversity (through respecting the uniqueness of others).[2] Inclusion also supports all children’s rights, consistent with the United Nations (UN) Convention on the Rights of the Child and other international conventions, including the UN Convention on the Rights of Persons with Disabilities and UN Declaration on the Rights of Indigenous Peoples.[3]”

From: Inclusion Support Program (ISP) Guidelines - Department of Education, Skills and Employment, Australian Government (dese.gov.au)

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Next steps:

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OFFICIAL

The contents of this document are OFFICIAL.

Attachment E: ECEI Recommendations 3 & 18

Extracted from: Early Childhood Early Intervention (ECEI) Implementation Reset, Project Consultation Report, National Disability Insurance Agency (NDIA), November 2020.

Recommendations

The proposed package of 23 recommendations to implement the future state intent is comprised of overarching recommendations as well as recommendations along the three main stages of the ECEI Approach: early support (including access to the NDIS); planning and implementation; and transition.

A. Overarching recommendations and enablers

Recommendation 3: Develop and publish new Early Childhood-specific Operating Guidelines – so our decision-making processes and best practice evidence are transparent and implemented consistently by partners and NDIS planners.

C. Recommendations for planning and

implementation

Recommendation 18: Publish new guidance about what is considered ‘reasonable and necessary’ when making decisions around support for children on the autism spectrum, based on evidence found in the Autism Cooperative Research Centre (CRC) 2020 report.

OFFICIAL

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