FOI 22.23 0633 Decision Documents.pdf

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FOI 22/23-0633
Practice Guide – Understanding
Therapy Supports
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1.  Purpose
The content of this document is OFFICIAL. This Practice Guide provides guidance on what to
consider when including therapy supports in the participant’s plan. It contains information to
guide conversations about how therapy supports may help participants to achieve their goals.
The areas covered include:
•  roles of allied health professionals and how they can assist participants to build
independence
•  reports
•  assessments
•  planning conversation considerations
•  justifying decisions.
2.  To be used by
•  Plan Developers – Planners and NDIS Partners in the Community (Early Childhood
Partners and Local Area Coordinators [LACs]).
3.  Scope
Therapeutic supports assist participants to develop skills to build independence in the home,
community, place of education and work. Allied health professionals (AHPs) develop
therapeutic supports in their specialist area. They may also prescribe assistive technology.
AHPs develop strategies to improve outcomes for participants in areas including:
•  mobility
•  movement
•  personal and social well-being
•  managing diets and nutrition
•  organisation
•  communication
•  self-care
•  cognitive capacity
•  social skills
•  moods and emotion
•  modifying the environment to make it more accessible.
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This Practice Guide provides you with considerations for making a reasonable and necessary
decision on the therapeutic supports to include in the participant’s plan.
3.1  Early Childhood Early Intervention (ECEI)
Refer to Early Childhood Services Branch resources if you are using an Early Childhood
Early Intervention approach to develop a plan for the participant aged under seven.
3.2  Multidisciplinary teams
A multidisciplinary team is a team of professionals who work with one another and share the
job of evaluating, planning and providing therapy services to the participant. Individuals may
be treated by one or more AHPs from different specialisations at the same time to optimise
benefits and outcomes of therapy.
3.3  Assessments
You can ask the participant to have an assessment when you need further information to
make a decision on supports. This can help you determine if the request for therapeutic
supports meets the reasonable and necessary criteria.
When the participant first requests therapy supports it is important that you have the
information you need to demonstrate that the support is best practice, value for money and
will assist the participant to meet their goals. You will also need guidance from a suitably
qualified allied health professional on the amount of support that the participant will need to
achieve their goals. You can get this information through an assessment.
Before asking the participant to have an assessment you need to:
•  review all existing information and determine that additional information is needed
•  consider the costs and benefits of the request
•  consider how it will assist you to decide whether to approve funded supports
•  determine the type of assessment that is likely to produce the information you need
•  specify the information to be provided in the assessment
•  make sure the request aligns with the objects and general principles in the NDIS
Act.
When you request an assessment for therapeutic supports, make sure you include funding
for the assessment. See 6.1 Capacity Building supports.
Requests should clearly specify:
•  The functional area to be assessed. Some examples are communication, activities
of daily living, balance and mobility, orthotics.
•  The information you need in the assessment. For example:
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-  How the therapeutic support will build the participant’s independence.
-  How the participant’s informal, community and mainstream supports will help
them to achieve their goals.
-  How the gains or outcomes will be measured.
-  The expected time the participant will need to achieve the outcome.
•  The NDIS contact person to forward the information to.
If this is not the participant’s first plan have a discussion with your team leader to consider if
an auto-extension of the participant’s current plan would be appropriate and reschedule the
plan review to a time suitable for the participant.
3.3.1  Assistive Technology or Home Modification Assessments
When including Assistive Technology (AT) or Home Modification (HM) support in a plan an
assessment may be required that considers the participant’s environment, skill building,
selection of support and ongoing support. Templates to help participants and assessors
provide the information required are located on the Providing assistive technology page of
the NDIS website.
Detailed information on the ATHM process can be found in:
•   Our Guidelines – Assistive Technology
•  ATHM guidance on the Planning resources Intranet page
3.3.2  Housing
Participants who identify a housing goal will need to undergo relevant assessments by AHPs
to determine their most suitable housing solution and support needs. These will be used to
assist with determining whether the participant’s housing and support needs are reasonable
and necessary. Detailed information on housing supports is in the Practice Guide –
Identifying Housing Solutions.
3.4  Progress Reports
As the goal of therapy supports is to build or maintain the participant’s independence,
requests for future therapy support will generally reduce over time. There may be instances
where supports remain the same or increase. Some examples include:
•  the participant has not progressed as expected
•  a change in circumstance
•  the participant had difficulty attending sessions.
If the report does not have enough information to justify continued support at the same level
or an increase in support you should talk to the participant during the planning conversation
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to gather further information. Refer to 5.1 Planning conversations about therapy supports and
6.1.2 What if I decide not to include all of the AHP recommendations?
Progress reports should also include information on how the proposed supports will further
increase independence and the risks or impacts on other supports.
A progress report should include:
•  a summary of the supports provided
•  how the support has helped the participant achieve or work towards their goals
•  the measurable gains the participant has made since receiving therapeutic
supports
•  how the participant has been linked to additional informal, community or
mainstream supports to help them achieve their goals
•  any barriers encountered and how these have been resolved
•  any risks to the participant or others.
4.  Allied Health Practitioners
AHPs hold a university qualification, specialise in different areas and work directly with the
person requiring support. AHPs are not part of the medical, dental or nursing professions.
AHPs may be, but are not limited to; occupational therapists, psychologists, speech
pathologists, physiotherapists, exercise physiologists, prosthetist or orthotists, podiatrists,
dieticians or respiratory therapists. They assess, prevent, diagnose and treat a range of
conditions and illnesses to help people:
•  develop skills and abilities to manage their disabilities
•  become more independent
•  become healthier and more active
•  increase function to build capacity.
The information below will give you a snapshot of information for each AHP including:
•  their role
•  how they support people
•  tasks and approaches they use and the benefits of these
•  where to go for further information.
Note: Not all activities listed in this section will meet the reasonable and necessary criteria.
For guidance on the responsibility of other government services or broader systems of
support refer to Mainstream Interfaces intranet page.
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4.1   Allied Health Assistants
Allied health assistants (AHAs), also known as therapy assistants, work under the
supervision of AHPs. AHAs can have a range of skills and qualifications. These include TAFE
certificates, working towards a qualification in an AHP discipline, experience working in
specific areas and, in remote or rural areas, AHAs may receive on the job training.
AHAs assist with less complex clinical and non-clinical tasks. These tasks will vary based on
the AHA’s experience, knowledge and skill level. Some of the tasks include but are not
limited to; assisting with therapy or exercise programs, implementing a therapy program
developed by the AHP, supporting and supervising activities of daily living, and working
towards independence goals.
4.2  Dietitian
Dietitians support people to maintain or improve their health and wellbeing through nutrition
and dietetics. Doctors may refer individuals to dietitians to help them with specific health
conditions and to address nutritional concerns which may include weight, nutritional
deficiencies and other diet related conditions. Dietitians provide evidence-based nutrition
services, dietary counselling and therapy.
Refer to the Dietitians Association of Australia (external) for more information.
Dietitians can support NDIS participants with Disability Related Health Supports. For further
information refer to the Our Guideline – Nutrition supports including meal preparation.
Task/Approach
Benefit
Develop a healthy eating or
•  assist, guide and build your capacity to eat a
nutritional meal plan so you
healthy diet
can:
•  receive nutritional needs and consume adequate
nutrients to keep healthy
•  improve your overall quality of life through healthy
eating
•  train you, family members or support staff to
implement a nutritional meal plan.
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Task/Approach
Benefit
Address sensory eating
•  work to build willingness to try and accept different
difficulties so you or your
foods and textures
child can:
•  reduce level of discomfort at mealtime
•  improve food intake
•  increase independence
•  feel more comfortable when sharing a meal with
friends or family
4.3  Exercise Physiologist
Exercise physiologists assess people who have existing, or are at risk of developing, medical
conditions or injuries. Exercise physiologists are different to personal trainers. Personal
trainers work with people to improve their physical fitness in order to stay healthy. Exercise
physiologists treat medical conditions or injuries using exercise-based interventions that may
include health and physical activity education, advice and support.
Refer to the Exercise and Sports Science Australia (external) for more information.
Task/Approach
Benefit
Develop a personalised
•  improve your physical and mental wellbeing
exercise plan so you can:
following; stroke, acquired brain injury, mental
health, multiple sclerosis, etc.
•  increase your endurance so you can perform
activities for longer periods of time
•  improve your overall quality of life through
exercise
4.4  Maintenance Therapy
Maintenance therapy can also be called maintenance care. It is used to assist the participant
to maintain their current capacity, achieve small incremental gains or prevent further decline.
Maintenance care can be provided through a ‘delegated’ model. This means that the
therapist can train family or staff to provide support to the participant to implement strategies
on a more regular basis. You should discuss using a delegated model of maintenance care
with the participant.
When using a delegated model the therapist will regularly reassess the participant’s
maintenance program to make sure it continues to meet their needs. They may need to
adjust a program or update training to the participant and their supports.
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Requests for maintenance therapy should be supported by an assessment or report that
includes recommendations of supports and how the participant will be linked to additional
informal, community or mainstream supports to help them to achieve their goals.
4.5  Music Therapy
Registered Music Therapists (RMTs) have a university degree in music therapy. They are
registered and abide by the Australian Music Therapy Association Code of Ethics.
Music therapy is different to music lessons. RMTs use research-based practice and work as
part of a multidisciplinary team to assist people with communication, motor skills, mobility,
mood, emotions, cognitive capacity, identity and self-confidence. Music therapists always
work with other AHPs and would not generally be funded in isolation.
Refer to the Australian Music Therapy Association (external) for more information.
Task/Approach
Benefit
Use rhythmic and
•  increase your range of movement
motivational elements of
•  increase your fine motor skills
music to:
Work with other AHPs to
•  motivate you to complete a phrase
write a song to:
•  motivate you to practice multi-word phrases
•  motivate you to participate in movement activities
•  motivate you to use speech
•  support your emotional regulation
Vocally improvise with
•  motivate you to use pre-speech sounds
people to:
•  motivate you to practice how to produce pre-
speech sounds
4.6  Occupational Therapist
Occupational therapists (OTs) work with people to teach them how to be as independent as
possible with their everyday tasks. This can include taking care of themselves, working,
volunteering, and participating in hobbies, interests and social events. They support people to
build knowledge and skills, modify existing skills, find new ways of doing activities, and to
manage change.
OTs can also prescribe assistive technology supports like wheelchairs, shower chairs and
scooters and can make recommendations on home or vehicle modifications, if required.
Refer to the Occupational Therapy Australia (external) for more information.
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Task/Approach
Benefit
Develop memory activities
•  remember people’s names
so you can:
•  remember routines
•  recall instructions
•  remember where you put things
Recommend modifications
•  be more independent
or equipment for your
•  manage fatigue
everyday environment so
you can:
•  manage pain and discomfort
•  improve accessibility of your home
Make recommendations on
•  develop skills required to enter into work
functional skills for the
•  support you to meet the functional requirements of
workplace so you can:
the workplace
Develop a management
•  be more independent at home
plan for everyday activities
•  be more independent in the community
so you can:
•  increase activities in the community
Use manual therapy
•  move more easily to perform everyday activities
techniques on the upper
such as self-care, eating, dressing and play
body so you can:
Develop attention and focus
•  play sports/games
so you can:
•  engage and contribute to conversations
•  read, write or watch a movie
•  write a list and do the grocery shopping
•  prepare a meal
Develop adaption activities
•  cope with meeting someone new
for managing change so you
•  be imaginative and creative
can:
•  develop or build your sense of humour
Develop your fine motor
•  hold a pencil and write your name
skills so you can:
•  improve your writing, colouring, drawing, etc.
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Task/Approach
Benefit
•  manage smaller objects such as pegs, knives,
forks, etc.
Develop self-caring skills so
•  manage your own showering and toileting
you can:
•  tie your shoe laces
•  get dressed, clean your teeth, brush your hair, etc.
Develop hand-eye co-
•  throw, catch, kick, etc.
ordination activities so you
•  learn to complete daily activities
can:

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4.7  Orientation and Mobility Specialist
Orientation and Mobility Specialists (O&MS) work primarily with people who are blind or have
low vision to learn skills that enable them to move as independently as possible in a range of
indoor and outdoor environments. An O&MS supports participants to build on their
confidence, knowledge and skills which can include the use of mobility aids, orientation to a
range of environments, vision education and development of sensory awareness.
O&MS’s can equip participants with the skills and concepts they require to move safely and
confidently through their chosen environment, be it moving within their home, getting to
school, using public transport for work or recreation purposes, or generally accessing the
community.
Refer to Orientation and Mobility Association of Australasia (external) for further information.
Task / Approach
Benefit
Provide strategies and skill
•  access the community and services
development to move safely
•  access education services
within your chosen
environments, so you can:
•  increase mobility skills and confidence to perform
self-care independently
•  feel safe and familiar within your surroundings
•  maintain your orientation in a range of
environments
•  reduce isolation.
Provide advice,
•  access information indoors and outdoors related
assessments and the
to travel information such as signage and
prescription of mobility aids,
wayfinding
devices and assistive
•  use smart phones and other technologies to
technology suited to
access information in ‘real time’ such as public
individual need, so you can:
transport timetables, maps and notifications
•  use a mobility aid or device to enable safer access
to the community
•  continue to access the community.
Develop concepts, so you
•  build an understanding of body awareness, spatial
can:
and positional concepts; travel and locational
concepts.
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Task / Approach
Benefit
Make various
•  work in collaboration with your other practitioners
recommendations based on
so they are aware of your low vision needs and
functional O&M
build capacity in their role when working with you
assessments that support
•  make recommendations related to safe access to
allied health practitioners
indoor and outdoor environments.
and other stakeholders in
their delivery of services
and care, so you can:
4.8  Orthoptist
Orthoptists work with people of all ages who have vision loss due to an eye condition or
neurological involvement that causes difficulty understanding what is seen. Orthoptists
provide participants with knowledge about how their vision works and support participants
build skills in enhancing their functional vision for everyday activities. They are experts in
helping participants to use their vision to improve independence and confidence to live the
life they choose.
Orthoptists either modify the existing ways in which participants use their vision or develop
new strategies that help people partake in activities and manage change. They do this by
providing therapy training to help improve the way participants optimise their remaining
vision. This may include eccentric viewing training to help utilise peripheral vision or scanning
training to help navigate through their environment or easily locate objects.
Orthoptists can also make various recommendations for assistive equipment to assist with
near and distance vision including electronic or portable magnification devices, equipment
that utilises optical character recognition, lighting enhancement and glare control. Refer to
Orthoptics Australia (external) for more information.
Task / Approach
Benefit
Provide strategies to use
•  access the community
your residual vision with
•  access education services
daily routines, so you can:
•  improve mobility to move confidently and safely in
your environment
•  perform self-care independently
•  search and find objects you are looking for
•  feel comfortable and safe using household
appliances
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Task / Approach
Benefit
•  participate in social and recreational activities
•  participate and contribute to household activities
•  engage in play activities
•  support concept development of daily tasks such
as eating, drinking, dressing, communication and
maintain personal hygiene.
Make various
•  work in collaboration with your other practitioners
recommendations based on
so they are aware of your low vision to
the functional vision
complement their role with you
assessment to support other
•  develop balance and proprioception skills during
allied health practitioners in
mobility
their delivery of services
and care, so you can:
•  use vision to develop gross and fine motor control
•  incorporate vision into developing communication
and language
•  establish daily routines.
Provide input on the size
•  read books and magazines
and detail of pictures and
•  access mobile phone and other electronic devices
print materials and
alternative communication
•  access the community by reading signs etc.
systems, so you can:
Improve visual attention, so
•  read, write, play games and use the computer
you can:
•  engage in conversation and develop/maintain
relationships
•  participate in a hobby or play activities
•  learn new daily tasks or hobbies.
Help coordinate vision with
•  look, reach and engage in objects, toys, games,
movement, so you can:
hobbies
•  participate in daily activities
•  play ball games.

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4.9  Physiotherapist
Physiotherapists assess, diagnose, treat, and prevent a wide range of health conditions and
movement disorders affecting the muscles and/or bones. For example, they help repair
damage, reduce stiffness and pain, increase mobility, and improve quality of life.
Refer to the Australian Physiotherapy Association (external) for more information.
Task/Approach
Benefit
Joint mobilisation or
•  improve mobility to move more easily and to
manipulation so you can:
perform self-care more independently
•  do activities you enjoy for a longer time
•  manage and possibly reduce pain and discomfort
Muscle stretching and
•  improve your coordination, strength and flexibility
tailored exercises so you
•  manage your own health and wellbeing
can:
•  improve your mobility
Assess and recommend
•  feel confident that the equipment you are using is
mobility aids or assess
suitable for you, for example, walker, wheelchair
whether the mobility
or standing frame etc.
equipment you are using
•  feel comfortable and safe using the equipment
suits your needs so you
recommended to you by your allied health
can:
practitioner(s)
4.10  Podiatrist
Podiatrists assess, diagnose, treat, and manage conditions of the feet, ankles and legs. They
also provide rehabilitation for people when they have medical and surgical conditions which
affect their lower limbs. A podiatrist may prescribe foot orthoses to provide pressure
distribution to treat and prevent corns, calluses and ulcers.
Refer to the Australian Podiatry Association (external) for more information.
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Task/Approach
Benefit
Assess and recommend
•  improve your independence to complete your
foot orthoses so you can:
daily living activities
•  increase your mobility and enable you to
participate in the activities you choose
•  reduce pain so that you can participate more
enjoyably in life
•  increase your independence in the community
Develop a management
•  maintain foot health
plan so you can:
•  manage and possibly reduce discomfort
4.11  Prosthetist or Orthotist
Prosthetists/orthotists assess and treat the physical and functional limitations caused by
illnesses and/or disabilities including limb amputations. They can prescribe, design, fit, and
monitor prostheses or orthoses.
The easiest way to explain the difference between a prosthetist and an orthotist is:
•  a prosthetist works with devices designed to replace a limb, or another part of the
body
•  an orthotist works with devices designed to assist a limb or another part of the
body
A prosthetic device is used to replace a person’s limb entirely (for example, foot, leg or arm)
while an orthotic device is used to enhance/support a person’s limb or other body part (for
example, spinal braces, leg splints or foot supports).
Refer to the Australian Orthotic Prosthetic Association (external) for more information.
Task/Approach
Benefit
Assess and prescribe
•  improve your independence to complete your
devices so you can:
daily living activities
•  increase your mobility and enable you to
participate in the activities you choose
•  reduce pain so that you can participant more
enjoyably in life
•  increase your independence in the community
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4.12  Psychologist
A psychologist is a person who is trained in the science and profession of how people think,
behave, and learn. Psychologists work with people, and often their families, to help them
make desired changes to behaviours. For example, to overcome relationship problems,
anger issues, substance abuse or provide strategies to better manage a person’s mental
health disorders (for example, anxiety, depression, eating disorders or bipolar disorder).
Refer to the Australian Psychological Society (external) for more information.
Task/Approach
Benefit
Counselling so you can:
•  develop your skills to help you deal with anxiety
and/or depression
•  understand and work through your relationship
problems
•  work through overcoming eating disorders,
learning difficulties, substance abuse, etc.
•  learn to deal with any trauma or abuse you may
have experienced
•  develop skills to help you deal with any mental
health issues you face on a daily basis
Controlled breathing
•  reduce your stress levels
techniques, grounding skills
•  remain calm when you are in difficult a situation,
or relaxation techniques so
for example, using public transport, in a noisy or
you can:
confronting environment, etc.
•  feel more in control when you are distressed
•  decrease symptoms of depression, increase
motivation and manage anxiety
•  improve the quality of your sleep and daily routine
•  increase your confidence to help you with building
and maintain existing and new relationships
•  take part in activities in the community that you
enjoy

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4.13  Speech Pathologist
A speech pathologist can diagnose and treat communication disorders. This includes
supporting those who have difficulties with speaking, listening, understanding language,
social skills and stuttering. They work with people to help improve communication using their
voice or through assistive technology (for example, Picture Exchange Communication
Symbols, talking buttons). They can also help people who experience difficulties swallowing
food and drink safely.
Refer to the Speech Pathology Australia (external) for more information.
Speech Pathologists can support NDIS participants with Disability Related Health Supports.
For further information refer to Our Guideline - Dysphagia supports.
Task/Approach
Benefit
Develop a plan to form
•  learn new sounds and use new words
speech and words so you
can:
Develop communication
•  build your understanding of language
skills so you can:
•  speak more fluently
•  develop your social skills
•  learn new sounds and use new words
Develop language skills so
•  learn how to ask for something
you can:
•  tell someone how you are feeling
•  learn how to convey a message
•  improve your relationships
•  improve your social skills
•  build your confidence to have conversations
Develop speech fluency so
•  learn new skills to help reduce stuttering
you can:
•  have a flowing conversation with someone
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Task/Approach
Benefit
Develop saliva control
•  increase your self-esteem
techniques so you can:
•  prevent your lips or skin from drying and cracking
•  improve your speech
•  prevent infection and discomfort
•  eat and drink more comfortably
Develop mealtime
•  learn how to chew and swallow so that you can
assistance strategies so you
eat and drink in a safe way
can:
•  become more independent at meal times
•  socialise more independently
5.  Pre-planning
5.1  Planning conversations about therapy supports
The planning conversation gives you an opportunity to understand the participant and the
way previous and future therapeutic supports will assist them to achieve their goals.
These points can guide you to get the information you need to make a reasonable and
necessary decision about future therapeutic supports in an understanding manner.
5.1.1  Preparing for the meeting
•  Review all allied health reports or assessments prior to the planning meeting.
These will give you an understanding of how effective the supports have been
across the plan period and provide an indication of future needs. For further
information, refer to 3.4 Progress reports and 3.3 Assessments.
•  Be aware this is a sensitive conversation. Participants have individual needs and
progress towards goals at different rates. It is important to build rapport and display
empathy, as well as make sure the participant understands this is a confidential
conversation and they can choose who does and does not attend the meeting.
5.1.2  Planning conversations
•  Provide information to the participant about the role of the allied health professional
to build their independence and capacity – the Allied Health Practitioners section
can assist.
•  Encourage the participant to talk about their experiences with allied health
professionals. Are they progressing as they expected? Are they happy with the
people providing the support?
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•  Talk about the bigger picture. How are all of the participant’s supports working
together to reinforce strategies?
•  Are people working together to help the participant achieve their goals? For
example, if they have strategies to help them increase their gross motor skills and
attend school, is the school helping them to implement these strategies throughout
the day?
•  What people in the participant’s life can help them to apply the strategies? It is
important to acknowledge that informal supports are not therapy assistants or
support workers. They may however be able to reinforce suggestions by allied
health professionals and create consistency. For example, if the participant is
learning to communicate through exchanging pictures, family members can learn
the right way to exchange pictures with them to communicate what they need or
want.
•  If the participant has support workers to assist with activities of daily living and an
occupational therapist has provided some strategies to build their independence in
this area, are support workers assisting them to build their independence by
encouraging them to use these strategies?
•  If the participant has not progressed towards their goals as expected and is
requesting a similar amount of support, have a discussion about any barriers they
may have experienced:
o  Are the providers meeting their expectations?
o  Were there barriers to attend sessions? If yes, how were or will these be
addressed?
o  How will this support assist them to do more things on their own?
o  What differences do they expect following the supports? Describe how this
looks in day-to-day life.
o  Do the important people in their life know how to support them to build
independence?
o  If they will continue to require support how will this allow them to build
independence?
•  Where an allied health professional has/will develop recommendations and
strategies for the participant:
o  How will the participant be supported to implement the strategies?
o  Are there things that can be done in other environments to support the
participant to build these skills? For example, where the participant is building
independence in communicating, are there strategies that others at their place
of employment can implement?
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o  How can people where they live support them to improve their independence at
home?
5.1.3  Following the meeting
Compare the information provided in the planning conversation.
•  Does it match the information in the allied health report?
•  Does it match information from other reports such as other allied health
professionals, support workers, family, the accommodation they live in, school,
other services?
If you notice a difference talk, to the participant to determine the support that they want.
6.  Planning
Refer to Our Guideline – Reasonable and Necessary Supports.
6.1  Capacity Building - Daily Activity supports
The frequency of therapy will depend on the participant’s individual circumstances. When
making a reasonable and necessary decision about the therapeutic supports to include in the
participants plan use the following information:
•  the participant’s knowledge and experience with how therapeutic supports interact
with their condition
•  assessments
•  reports
•  published information about the therapeutic supports such as the TAT digest or
research journal articles.
All information is important in determining if the support meets the reasonable and necessary
criteria for the participant. Where information from all four information sources do not match
talk to your line manager. If you are still uncertain refer to the Technical Advisory Branch
(TAB) .
6.1.1  Value for money
Value for money considers:
•  whether a support will represent value for money over time
•  the cost of other available supports that can help the participant reach the same
goal.
When determining if therapeutic supports are value for money, consider:
•  If investing in therapeutic supports early is likely to have the long-term benefit of
significantly improving life stage outcomes for the participant or reducing their
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support needs. For example, is it likely that the use of therapeutic supports for
early intervention will increase the participant’s independence and decrease
reliance on supports throughout life?
•  If investing in therapeutic supports is likely to reduce the participant’s support
needs in the short and medium term. For example, will increasing the participant’s
independence in self-care reduce the amount support worker hours needed each
day.
•  If investing in the support will delay the need, or avoid reliance, on additional
supports. For example, will maintenance therapy delay the functional impact of a
degenerative condition allowing participants to maintain independence for longer?
•  Whether there are similar supports that would have the same outcome at a lower
cost.
6.1.2  What if I decide not to include all of the AHP recommendations?
The AHP providing the assessment or report is a qualified professional who has met and
worked with the participant.
There may be times when you do not believe the supports the AHP recommends meet the
reasonable and necessary criteria. Some reasons may include:
•  the information conflicts with other reports or information you collect in the course
of the planning conversation
•  the support hours requested are higher than expected
•  the supports requested may not be considered best practice
•  the supports requested may not seem value for money
When this happens, you need to:
•  review all reports and supporting information
•  review your planning conversation with the participant
•  speak to the AHP to get further information and discuss any differences
•  seek advice from your team leader
When this is not the participant’s first plan and you still require more information you should
have a discussion with your team leader to consider if an auto-extension of the participants
current plan is appropriate to allow the participant to submit the required information. You will
then be able to develop a plan that includes the reasonable and necessary therapeutic
supports, reducing delays and the need for an unscheduled plan review.
When you make a decision to include supports in the participant’s plan that are different to
the AHP’s recommendations you must:
•  write a clear justification detailing:
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o  the reason the supports recommended do not meet the reasonable and
necessary criteria
o  evidence to support this decision (for example, consultation with your team
leader or TAB advice)
o  what other lower cost/alternative supports were considered
•  Speak to the participant and clearly communicate:
o  the funding that was included in the plan
o  a justification for any decision that is different from the AHP’s recommendation.
For example, rather than the participant receiving weekly physiotherapy from
an AHP it is considered best practice that the participant build their capacity to
complete self-managed physiotherapy exercises at home with the program
regularly reviewed by the physiotherapist. Provide information on where you
sourced this information.
You need to make sure you are open and transparent with your decision making to avoid
confusion for the participant and unnecessary plan reviews.
6.1.3  Comments
The comments printed on the plan should provide information the participant needs to
understand the purpose of therapeutic supports. You must include:
•  the purpose of the funding
•  the goals the therapy is supporting the participant to achieve. For example,
communication, activities of daily living, assistive technology, identifying housing
needs.
•  the amount of funding. Including an amount of funding in the plan instead of
support hours enables the participant to negotiate supports with their provider. If
the participant would like more information on working with providers, show them
the Making a service agreement page on the NDIS website.
•  any expectations of the AHP to submit a progress report or assessment.
For example, ‘$900 of funding for a speech pathologist to assess and provide strategies to
increase your expressive communication skills. Assessments and reports tracking your
progress must be submitted to the NDIS 6 weeks before your plan review.’
6.1.4  Justifications
Your justification for therapeutic assessments and supports will include:
•  how the supports will assist the participant to achieve their goals
•  the amount of support included
•  the information you have used to come to this decision
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•  how this will help the participant join in social and/or economic activities
•  how the support will build independence and reduce reliance on supports
•  how this support is required in addition to support received from families, carers,
informal networks and the community
For example:
•  <The participant> has a goal to improve their expressive communication as they
currently use one or two words to communicate and become frustrated when not
understood. <The participant’s> workplace have reported that this frustration is
impacting their ability to maintain friendships and is reducing the independence
<the participant> previously had at work. An OT assessment in the previous plan
period recommended that <participant> works towards improving their
communication skills to reduce frustration. Information indicates that the last
communication assessment was conducted when <participant> was in high school,
12 years ago.
•  15 hours of therapeutic support has been included for a speech therapist to
assess, provide recommendations and develop resources for <participant> to
develop expressive communication skills. The assessment is to include strategies
for <participant> and their family and carers to increase verbal communication. The
expected outcome of the communication strategies is to increase <participant’s>
independence, reduce their frustration, improve interpersonal relationships and
improve independence in the workplace.
•  The participant will be supported to implement these strategies at home by family
members, supported by employees at their workplace, and supported by informal
and formal supports in the community to use identified strategies when they are
having difficulty communicating.
6.2  Case example - Multidisciplinary team using music therapy
Arnold is a 10 year old boy who lives at home with his parents and two older siblings.  He has
a diagnosis of Down Syndrome and is experiencing difficulty with communication, social skills
and mobility. He attends a mainstream school where he receives support from a teacher’s
aid. During the previous plan, Arnold had difficulties building rapport with his therapists due to
negative behaviours and difficulty travelling to, and waiting in, the therapist’s office. This
resulted in intermittent engagement and Arnold not using all of his capacity building supports.
Assessments from the previous plan period have recommended using a multidisciplinary
approach of music, occupational, and speech therapy focused on skill building in Arnold’s
natural environments to assist him to achieve his goals.
6.2.1  Assessment recommendations:
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•  16 hours Occupational Therapy to work towards Arnold’s goal of “To join in
playground games with friends.”
o  Develop strategies to assist Arnold to increase motor control.
o  Develop strategies to assist Arnold to increase social skills.
o  Provide guidance to important people in Arnold’s life on ways he can be
supported to join in games and the types of exercises and games he can do to
build his endurance and muscle control.
Expected Outcomes: Arnold will participate in a structured climbing activity or game
with two peers with minimal adult support.
•  12 hours of speech therapy to work towards Arnold’s goal of:
“Be able to tell people what I want or need.”
o  Communicate using 1-2 word phrases.
o  Support communication through picture exchange while developing speech.
o  Provide guidance to the important people in Arnold’s life on techniques specific
to Arnold to assist with communication.
Expected outcomes: Arnold will use 1-2 word picture exchange to request a
motivating item or a need.
•  7 hours of music therapy to develop strategies to motivate Arnold to engage with
other therapists by:
o  Writing a song to motivate Arnold to participate in 1-2 word phrases.
o  Use rhythmic and motivational elements of music to encourage Arnold to
engage and participate in gross and fine motor activities.
Outcomes - Arnold will engage with the occupational therapist, speech pathologist
and music therapist to develop his communication and motor skills.
•  $300 of Low cost AT to develop communication supports. Picture exchange
•  Travel associated with delivery of supports in Arnold’s natural environments
•  10 hours of report writing
6.2.2  Planning conversation
During the planning conversation, Arnold and his family discussed with the planner how they
and other people in Arnold’s life can assist him to develop his skills and become more
independent. The strategies they discussed included:
•  AHPs will meet at the start and mid-way through Arnold’s plan to discuss strategies
and how these will complement each other.
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•  Each AHP will develop strategies to assist Arnold to work towards his goals and
guide the people in Arnold’s life on building his skills and independence.
•  The school is using picture exchange with other students and will support Arnold to
use picture exchange if he is unable to verbalise his wants or needs.
•  Arnold’s siblings are close to him and enjoy playing games. They can find it difficult
when he gets upset. Arnold’s parents and siblings have shown enthusiasm with
structuring some group activities/games with the family to help him develop his
social skills.
•  Arnold attends Scouts on a Thursday night. He has a support worker to assist him
to attend and participate in activities. The support worker can implement strategies
to assist Arnold to be more independent in interactions with peers.
6.2.3  Justifications
Core – Consumables
$300 of Low Cost assistive technology has been included for the development of
individualised picture exchange cards as recommended by the speech pathologist. These
cards will support Arnold to communicate which will develop independence and increase
participation in social, school and community activities. This will reduce reliance on supports
in the future. Funding has been included in Capacity Building – Daily Activities for Arnold’s
supports to receive training on implementing communication strategies.
Capacity Building – Daily Activities
45 hours of support has been included in for a multidisciplinary team to build Arnold’s
capacity in communication, mobility and social skills. The multidisciplinary team will meet at
the start and mid-way through the plan period to create consistency in their approach.
Arnold has difficulties in the last plan period engaging with therapists and is highly motivated
by music. A report from allied health professionals has recommended a music therapist be
engaged to develop strategies that will motivate Arnold to engage with other therapists to
develop his skills. This will increase participation in school, home and community life and is
likely to result in a reduced need of supports in the future.
Arnold will be assisted to implement communication, mobility and social skills strategies by
his family at home, teacher’s aide at school and support worker during Scouts.
Funding has been included for:
•  16 hours Occupational Therapy to work with Arnold to achieve his goal of joining in
playground games with friends. The OT will provide training to informal and formal
supports on how to implement these strategies.
•  12 hours of speech therapy to work with Arnold to achieve his goal of telling people
what he wants or needs. The speech therapist will work with Arnold to develop
strategies to communicate using picture exchange while he develops 1-2 word
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phrases in speech. The speech therapist will provide training to informal and formal
supports on how to implement these strategies.
•  7 hours of music therapy to develop strategies to motivate Arnold to engage with
other therapists.
•  10 hours of report writing to understand the benefits and gains achieved by Arnold
across the plan period.
Funding has been included for travel of the allied health professionals to deliver supports in
Arnold’s natural environments.
6.2.4  Outcomes
This information provides enough evidence for the planner to make a reasonable and
necessary decision to include the recommended therapeutic support hours in Arnold’s next
plan. This included information from the planning conversation on the participant’s lived
experience and information in the allied health reports.
7.  Supporting material
•  Our Guideline - Disability-related health supports
•  Early Childhood Services Branch resources
•  Practice Guide – Assistive Technology
•  Practice Guide – Identifying Housing Solutions
•  Our Guideline - Nutrition supports including meal preparation
•  Our Guideline – Dysphagia supports
•  Our Guideline – Reasonable and Necessary Supports
•  Speech Pathology Australia (external)
•  Australian Psychological Society (external)
•  Australian Orthotic Prosthetic Association (external)
•  Australian Podiatry Association (external)
•  Australian Physiotherapy Association (external)
•  Occupational Therapy Australia (external)
•  Australian Music Therapy Association (external)
•  Exercise and Sports Science Australia (external)
•  Dietitians Association of Australia (external)
•  Mainstream Interfaces intranet page
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•  Objects and general principles in the NDIS Act 2013
•  Our Guidelines – Planning - Appendix 1 - Table of guidance on whether a support
is most appropriately funded by the NDIS | NDIS
•  Our Guidelines – Requesting further information or reports to inform a participant’s
plan
•  Our Guidelines – Assistive Technology

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8.  Feedback
If you have any feedback about this Practice Guide, please complete our Feedback
form.
9.  Version change control
Version  Amended by
Brief Description of Change  Status
Date
No
6.0
JC0075
Minor changes to when
APPROVED
2020-12-04
staff should refer to TAB for
advice.
Class 2 approval
7.0
NAN927
Class 1 edits and approval
APPROVED
2021-01-06
Minor change to comments
required in plan.
Updated AT link to external
OG.

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