This post is a follow on from 5 Things Special Needs Parents Should Know About the NDIS. In this post, my guest NDIS planner tackles a common source of angst during the NDIS planning process – the number of therapy hours requested vs the number of therapy hours funded. This provides important insight into how the NDIA views therapy and how it should be delivered through the NDIS. These are important points to keep in mind when you next review your child’s NDIS plan.
Paediatricians and therapists are likely to state that specialist therapy is required at least one hour per week (and sometimes up to 70 hours per week depending on the doctor or therapist) for your child to meet their goals and gain the best benefit. For any person, in any situation the more we practice a skill the better we get. Similarly, the better the homework strategies we use the quicker we will pick it up.
For example, if I need to improve my maths skills (which, to be honest I do) I could:
a) try and practice maths on my own and continue to face the same barriers of not understanding by using the same strategies that aren’t working,
b) go five days per week to an expensive maths tutor who spends some of the time teaching me new strategies and some of the time observing me while I implement the new strategies, or
c) take the strategies taught to me by the math tutor and show them to my brother and colleague (who are good at math) and get them to help me implement them and keep me on course when I get my strategies confused in my everyday life.
The third option is how the NDIS has been built to deliver ongoing therapies. If we bring it back again to sustainability (having enough money for everyone who needs it for as long as they need it by not having to spend as much money on the maths tutor) and consider the benefit of me practicing math at home and at work (not just when I’m sitting with the tutor so I’m learning how it applies in different contexts) we can see how the outcome I’m aiming for can still be achieved without having to see the tutor five times a week or perhaps even once per week. It might be that I see them once a month or every two months to update my strategies and check on my progress.
Here is a quote from the NDIS Price Guide (2016) which all registered providers (including the therapists who want to see your child once a week) have signed up for, the bits in blue are my explanations:
“Maintenance Therapy – Where maintenance therapy is reasonable and necessary (your child needs ongoing therapeutic support because of their disability), it is funded as part of ongoing direct support hours (delivered by carers who can be trained in this if required), not funded as ongoing therapy. (It is expected that the therapists train therapy assistants or mum and dad in how to provide the support, not just weekly therapy in the therapist’s office).
For some participants whose medical condition or disability requires a particular regime to maintain functioning of a body part, or to slow the deterioration of a medical condition or body part, NDIS will fund reasonable and necessary training for non-qualified personnel to assist the individual as part of usual daily care. (If your child requires physical exercises from a physiotherapist, occupational therapist or exercise physiologist to maintain strength and mobility, it is expected that they come up with the exercise plan and then you do the exercises with your child as part of day to day life).
Where a skilled therapist is involved in establishing a therapy program for a participant, funding can include the development of a plan and training for a therapy assistant or for informal or funded carers, as part of usual care. The NDIA’s approach will include building capacity with family and carers to undertake therapy or exercises under the supervision of the skilled therapist (again, the speech therapist or occupational therapist should come up with strategies to improve communication strategies or independence in self-care but, the expectation is that they train you or a therapy assistant in implementing these strategies with your child as part of everyday life).
This way, the benefit for the participant is not solely limited to therapist sessions. (Your child will get much better at making their sandwich and brushing their teeth if you and your child practice it at home together daily, using the strategies taught to you by the occupational therapist, rather than relying on practising these skills once a week in the therapist’s office).
Funding of a skilled therapist can be considered where monitoring and adjustment may be required to a program delivered by carers. (Depending on your child’s age, goals and capacity they may pick some skills up quickly and you’ll need to go back to the therapist and learn some new strategies for the next steps)” (page 43, NDIS Price Guide, 2016).
You may be concerned that your child won’t listen to you or follow the therapy exercises if you are the one to deliver them. You may also have more than one child requiring therapy and you just can’t see how you can ensure they all get the help they need. If this is the case, you may want to consider requesting support through the NDIS in the form of a therapy assistant.
A therapy assistant is generally a support person who is not fully qualified as a therapist (they may be a general care worker or a therapy student) who can be hired for the purposes of implementing the strategies developed by the allied health therapist. These assistants can come to your home, or even in some instances the child’s school, to practice the exercises set out by the therapist. In terms of the old “scheme sustainability” argument, a therapy assistant charges around $42 per hour, as opposed to the therapists $175, that’s about four hours of therapy practice for the price of one!
Because this information is all included in the Price Guide which, if you are using a registered therapist, they have signed up for, therapists should be using this model to support families.
However, your therapist may not be using this model for several reasons:
- maybe the complexity of your child’s situation and the frequency with which the strategies must be changed is as such that they really need to be under constant supervision by a therapist,
- it may be due to the financial incentive getting that $175 per hour in the pocket as opposed to teaching you their tricks and doing themselves out of a job,
- or it may just be that old habits die hard and that they are used to a model of support where therapists hold the power in building the capacity of individuals with disabilities rather than the family and community.
There are more efficient ways to make your NDIS capacity building funding last by taking this model into account and it’s more likely your child’s skills and capabilities will be transferrable across contexts.
The NDIS is new, it’s big and it’s complicated. It can be easy to get caught up or confused by red tape, legislation and all the different information that’s flying around. This article was designed to give some insight and some tips into how decisions and how you can support your child to get the right supports the first time around. I wish you all the best in navigating this system and hope the NDIS can support your child and your family to be happy, independent and have all your needs met.
You can find further information about the NDIS at www.ndis.gov.au.
If you have questions about your child or their plan you can email firstname.lastname@example.org.
If you have feedback regarding your or your child’s experience of the NDIS you can email email@example.com.