Document 4 from FOI23.24 1400 Disclosure log documents.pdf

FOI 23/24- 1400
DOCUMENT 4
ASD Stocktake of Resources
Request: Provide a summary of all the resources and tools that TAT use to inform decisions
about Autism Spectrum Disorder (ASD).
A summary of recent AAT cases and TAT advice requests (planning and access) and a data
capture of all ASD related matters identifies the recurring key issues relating to ASD that
TAT provide advice for.
1. Data capture 2017-2019 ASD related advice requests
2. HPRM ASD case search
3. AAT cases specific to ASD (planning and access)
4. Data capture 2014-2019 ASD related AAT cases
The resources have been split into the following categories:
5. NDIA resources (legislation, guidance, SOP’s)
6. Individual information specific to person
7. TAT published advice
8. Yammer groups for NDIS staff relating to ASD
9. Key research resources
10. IRABINA related resources
Summary
The majority of referred to advices (1015 identified in the data table below) do not address
autism beyond referencing that they are included (often as a co-presenting condition) among
the participant’s circumstances.
The vast majority of advices that the TAT research team were able to locate made no
reference to any tools specific to Autism. In the majority, they refer to interpretation of
legislation, or other internal instructions. Many are simply mandatory escalations to TAT
regarding assistive technology for people whose complex circumstances include Autism.
The research team skimmed approximately 100/1015 identified ASD advices and consider
the vast majority of advices reviewed not actually relevant to ASD. For example, these
advices are about AT, communication, intellectual disability or other conditions and do not
consider ASD specifically. The data simply reflects advices where ASD was one factor, not
necessarily the primary issue being considered.
The most common request escalated related explicitly to Autism appears to be request for
AT/communication devices for participants who are non-verbal. Most commonly an Apple
tablet and associated accessories to support the communication application ProLoQuo2go.
The only discussion regarding these requests appears to be the requirement for evidence of
having trialled the devices, and the guidance to refer to base model devices rather than
premium versions. The specific advice appears to be universal to communication devices for
people with communication impairments and unrelated to Autism as a specific condition. The
practice of trial before purchase, and use of base/’necessary’ models rather than luxury
models is effectively universal to assistive technology requests and is unrelated to Autism.
In cases where the question of access to the Scheme is raised, adequate evidence of
diagnosis is the only discussion the TAT research team have been able to locate being
referenced. The criteria to establish adequate evidence is not generally expanded upon
within the advice, with the only specific example located indicating a brief discussion of not
including diagnosis by a paediatrician. The advices the TAT research team have been able
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to locate appear to predominantly refer to Autism as one of multiple conditions experienced
by a participant being considered for access.
From the access escalations to TAT that the TAT research team have reviewed, it can be
concluded that they reflect circumstances in which none of the participant’s individual
circumstances met access, and where the delegate has sought advice regarding the
possibility that the sum capacity reduction of diverse circumstances may meet access.
Also, from informal conversations that the TAT research team has had with access
delegates and advisors in the past that the guidelines for access to the scheme for
participants with Autism are relatively clear and relate to the Autism CRC national guidelines
and that a participant of the Scheme and require suitable evidence of diagnosis of ASD
Level 2 or 3 under the criteria established in the DSM V.
The TAT research team have not yet located any access escalations to TAT where the
evidence provided was clear and compliant with the CRC national guidelines. In cases
where participants clearly have a disability level capacity reduction associated with Autism –
the CRC guidelines are well understood by providers and closely match the established
practices of providers in the sector. After analysis, the TAT research team have concluded
that it would be relatively rare that a case containing ambiguous evidence would reach the
TAT for advice.

1) DATA capture of ASD Advice Requests 2017 to 2019
Key data capture from 2017-2019 where advice request lists ASD as primary disability.
Theme
2017
2018
2019  Grand Total
Access - Initial Access
1
1

Access - Internal Review
3
3

Access - Other
2
1
3

Access - Revocation
6
2
8

Behavioural Supports / Psychosocial
Disability
15
2
17

Capacity-Daily Activity
13
27
11
51
Capacity-Social, community & civic
participation
3
5
1
9
Choice & control
2
1
3

Chronic Health Advice
4
15
19

Compensation
1
1

Complex AAT Reviews
3
3

Complex Assistive Technology
45
174
179
398
Complex Internal Reviews
9
9

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Complex Physical Disability / Therapies
6
6

Consumables
1
3
6
10
Core-Daily activity
35
108
40
183
Core-Social, community & civic
participation
1
9
3
13
Early Childhood
8
8

Employment
1
2
3

Functional Impact of Impairment
1
1

General R&N Advice
43
43

Health & Wellbeing
1
1

Home Modifications
32
39
71

Home Modifications-Complex
26
27
53
Home Modifications-SDA
26
26

Operational Policy Guidance
4
9
6
19
Other
1
1
2

Prosthetic & Orthotics
9
2
5
16
Relationships
3
2
2
7
Social, community & civic
1
1

Support Coordination
3
3

Transport
2
8
4
14
Vehicle Modifications
4
2
4
10
Grand Total
247
474
294
1015

2017
2018
2019
Total
Autism
245
462
294
1001
Autism (secondary)
2
12
14

Total
247
474
294
1015

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2) HPRM ASD case search
These 1000+ advices can be found through searching the TAT teams HPRM using the
below search strings:
Title / Subject
Search String
AAT Actuary Report Autism Therapy
NED18/145609
20180621
Advices – Core Support
ADV + ASD + ADL
Advices – Restrictive Practices (behaviour
ADV + ASD + THER
support, ABA, other therapy interventions)
Advices – Assistive Technology
ADV + ASD + AT
Advices – Home Modification
ADV + ASD + HMOD

Specific HPRM advices that contain research docs
As mentioned above many of the 1015 TAT ASD advices identified as relating to ASD are
not primarily about ASD. However during the skim review of 100 these two advices were
isolated because they contain references to specific ASD resources.

HPRM NED19/137843 - Adv 2018/7294 relates to an assistance animal for a participant
with a service animal and provides some context and expansion around the decision that
may be relevant to this review of resources.
It indicates that in March 2016 NDIA commissioned La Trobe University to review the
evidence of effectiveness of assistance animals – see NDIA LTU Advice on Assistance dogs
ADV 2018 7294
NDIA LTU advice on
CORE assistance ani as  sistance do gs.pd  f

HPRM – NED19/100608 - Adv 2018 / 7867 regarding ABA therapy for a 6 year old includes
substantial research and several external links and resources.
ADV 2018 7867
THER 20 hours per w





3) AAT Cases Specific to ASD
The historical/active cases have been split into access and planning.
Access:
ASD matters we receive through the AAT for access:
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•  The TAT AAT access team have received a number (not sure exactly how many
as there are a few advisors who work on the access cases) of applications from
adults (over 40 and even in their 60’s) who have had a fairly recent diagnosis of
ASD Level 1.  They are requesting access for assistance with social skil s noting
that they lack the ability to build and maintain relationships.
•  The main argument used is that they have obviously always had ASD as this is
not something you suddenly ‘get’.
o  All the Applicants have finished their education, worked, married and had
children prior to their diagnosis.
o  They have been able to manage their life, albeit some have had some
difficulty with social interaction and communication, however, they do not
meet the criteria of their impairment resulting in substantially reduced
functional capacity.
•  Many believe that simply having the diagnosis should grant them access to the
Scheme.
•  The TAT AAT access team also have adults being diagnosed with ASD because
they have children with the diagnosis and then they are referred for assessment.
•  The team have engaged independent occupational therapists to undertake a full
functional assessment of the Applicant in their home to determine what dif iculties
they experience in the domain areas of Mobility, Learning, Communication,
Social Interaction, Self-Management and Self-Care (these are the domain areas
considered for access to the Scheme). They need to have substantial impact in
one or more of these areas to meet access.
•  As yet, the team have not had any assessment that supports the Applicant meets
the threshold of substantially reduced functional capacity.
•  The difficulties the TAT AAT team experience is that many health and allied
health professionals are familiar with the wording used for a person to be granted
access to the Scheme, particularly for early intervention. The team have identified
some health/allied health professionals who note that the person requires
intensive speech or psychological therapy to improve their current function and
this would alleviate future disability support needs. If the person is an adult and
there is no evidence of any intervention being completed in the past they may
meet EI criteria for access.  We have granted access in these instances.
•  Another issue the TAT AAT team have identified is that many adults are not
diagnosed using the DSM-V but rather the ADOS-2.
o  While the ADOS-2 is regarded by those who use it as ‘gold standard’, the
severity level does not align with the DSM-V.
o  As List A notes a person with Level 2 or Level 3 ASD does not need to
provide any evidence around the impact of their condition and would meet
the access criteria, it is difficult to align an ASD diagnosis when no level of
severity is provided if the diagnosis was made using the ADOS-2.

Planning:
ASD matters we receive through the AAT for planning have the following key themes:
•  Families of pre-schoolers and early school years age children with ASD requesting
high level of therapy supports to pursue ABA.
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•  In many therapy has been delivered at high levels (greater than 20 hrs/week) for
several years.
•  These parents have often done their own research (or at times advised by the
paediatrician) to determine that ABA is the ‘gold’ standard treatment.
•  Early experiences of limited/no success with conventional therapy which often looks
like individual SP perhaps with OT.
•  Greatest number of requests for high levels of ABA proceeding to AAT coming from
NSW.
•  While centre based ABA therapy approaches exist in all states, in Victoria there are a
number seeking funding for a 27hr/week program run by Autism Partnership. There
may be an argument for this support for those children not able to manage in an
Early Learning & Care (EL & C), but in most other situations the relative
responsibilities of NDIS in terms of support and parent responsibility of funding EL &
C opportunities is not clear.
•  Overall limited evidence ECEI best practice in intervention with children and families
with ASD.
o  Claims by ABA providers of following ECIA best practice in Early Childhood
intervention National Guidelines when clearly they do not.
o  Provider reports  often fuel parent expectations that more therapy is better
and wil  overtime eliminate the delay between their children and others (no
matter the severity of the ASD presentation)
•  Parents and ABA providers using the reference to the recommended 20 hrs/week of
early intervention referred to in Roberts and Wil iams 2016  to mean ABA therapy
•  Parents not seeing/valuing the intervention they provide (often reinforced by
providers saying parents needed to be parents) & providers breeding dependence by
stressing skil s need to be mastered with therapists before being ‘generalised’ by
parents into other areas.

The fol owing AAT cases relating to ASD planning matters that resulted in published
findings have been identified:

Title
Date
Brief detail of
Link
decision
TKCW and National
23-Jul- Intervention
http://www.austli .edu.au/cgi-
Disability Insurance
14  requirements -
bin/viewdoc/au/cases/cth/AATA/2014/501.h
Agency [2014] AATA
reasonable and
tml?context=1;query= National Disability
501 (23 July 2014)
necessary supports   Insurance
Agency;mask path=au/cases/cth/AATA
ZNDV and National
25- Support not
http://www.austli .edu.au/cgi-
Disability Insurance
Nov-14  reasonable, relative  bin/viewdoc/au/cases/cth/AATA/2014/921.h
Agency [2014] AATA
to likely benefits ; To  tml?context=1;query= National Disability
921 (25 November
incorporate the
Insurance
2014)
terms of a further
Agency;mask path=au/cases/cth/AATA
plan
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McGarrigle and
15-Jul- Not reasonable and  http://www.austli .edu.au/cgi-
National Disability
16  necessary supports ;  bin/viewdoc/au/cases/cth/AATA/2016/498.h
Insurance Agency
transport costs; taxis   tml?context=1;query= National Disability
[2016] AATA 498
Insurance
(15 July 2016)
Agency;mask path=au/cases/cth/AATA
LJJY and National
18- Not satisfied that it is  http://www.austli .edu.au/cgi-
Disability Insurance
Sep-18  a reasonable and
bin/viewdoc/au/cases/cth/AATA/2018/3506.
Agency [2018] AATA
necessary support;
html?context=1;query= National Disability
3506 (18 September
subsection 34(1)(c)
Insurance
2018)
and subsection
Agency;mask path=au/cases/cth/AATA
34(1)(d)

4) Data capture for AAT matters relating to participants
with ASD (Asperger’s and Autism)

There have been 334 AAT matters relating to participants with an ASD (Asperger’s and
Autism) during the 2014-2019 period. The increased number in AAT cases in 2018 likely
reflects the timing of state and territory full scheme transitions, particularly SA.
Split by Year;

Year Received
AAT Matters Relating to ASDs
2014
5
2015
10
2016
19
2017
80
2018
208
2019
12
Total
334

Split by Age;
  Age Range  AAT Matters Relating to ASDs
0-6
                                                                58
7-18
                                                             185
Adults
                                                                87
No Age
Recorded
                                                                  4
Total
334

Relating Exclusively to ASD (no other disability listed)
  Disability
AAT Matters Relating to ASDs
ASD and other disability
56
ASD only
278
Total
334
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Row Labels
AAT Matters Relating to ASDs
ASD and other
disability
17%
ASD only
83%
Total
100%

5) NDIA resources (legislation, guidance, SOP’s)
There are key pieces of legislation, practice guidance, operational guidance and SOP’s that
provide the overarching framework for all TAT access and planning advice.
NDIA resource
Link
Legislation
The National Disability Insurance Scheme Act 2013 (the
NDIS Act)
The National Disability Insurance Scheme (Supports for
Participants) Rules 2013 (the Supports for Participants
Rules)
NDIS Restrictive Practice and Behavioural Support Rules
2018
NDIS (Supports for Participants) Rules 2013
Practice Guide
Practice Guide – Intensive Super Intensive Participants.
Standard Operating Procedures
SOP Behaviour Intervention Supports
Scheme Actuary
Autism Therapy Support – Potential Impact on
Scheme Financial Sustainability (June 2018)

6) Individual information specific to person
When TAT provide advice an access or planning decisions (including AAT cases),
participant specific information is always considered. This is because advice is always given
on a case by case basis. For example, clinical assessments, expert opinions, letters from
medical or other health professionals wil  be considered.

7) TAT Published Advice
TAT publishes a list of de-identified, general advices on the TAT Digest page NDIS Intranet.
A recent tracking exercise has identified that the TAT Digest page is widely utilised across
the agency as a key resource.
There are eight TAT Published Digest relating to ASD:
Request title: Funding of out of school hours  https://intranet.ndiastaff.ndia.gov.au/service-
care, 6 hours access to community on
delivery/Technical-Advisory-
Saturday, 576 hours short term
Team/Documents/COPA%20ADL%20THER%20fu
accommodation for a 10 year old.
nding%20of%20access%20to%20community%20a

nd%20short%20term%20accommodation%20for%
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2010%20year%20old%20with%20autism%202018
0514%20KRN451.pdf

https://intranet.ndiastaff.ndia.gov.au/service-
Request title: Review of high cost plans for
delivery/Technical-Advisory-
twin brothers submitted for approval and
Team/ layouts/15/WopiFrame.aspx?sourcedoc=/s
determination of reasonable and necessary
ervice-delivery/Technical-Advisory-
supports.
Team/Documents/ADV%202016%201556%20%20
2016%201557%20BEH%20THER%20Review%20
of%20high%20cost%20plan%20for%20twins%20w
ith%20ASD%2020160227%20SH0031.pdf&action
=default

https://intranet.ndiastaff.ndia.gov.au/service-
Request title: Assistance Animal for a child
delivery/Technical-Advisory-
with Autism and Epilepsy
Team/Documents/THER%20Empowerment%20As
sistance%20Dog%20for%2018%20year%20old%2
0man%20with%20Autism%20SAP%20592.pdf

https://intranet.ndiastaff.ndia.gov.au/service-
Request title: Request for NDIS to fund
delivery/Technical-Advisory-
Applied Behavioural Analysis (ABA) link
Team/Documents/ADV%202016%201112%20THE
therapy and Music Therapy for 10 year old
R%20Requested%20supports%20fund%20Behavi
child with Autism Spectrum Disorder (ASD).
our%20Analysis%20(ABA)%2010%20year%20old
%20child%20with%20Autism%20(ASD)%2020170
406%20KM0032.pdf?

https://intranet.ndiastaff.ndia.gov.au/service-
Request title: AT - Freedom jogger pusher
delivery/Technical-Advisory-
fitted with Pelvic strap, Rain canopy and
Team/Documents/AT%20Freedom%20strol er%20
Highback Kit.
with%20accessories%20for%2010%20year%20old
%20child%20with%20ASD%20and%20a%20Chro
mosomal%20disorder%20-
%20201709%20MF0018.pdf

https://intranet.ndiastaff.ndia.gov.au/service-
Request title: Weighted Blanket for
delivery/Technical-Advisory-
participant with Autism
Team/Documents/AT%20Weighted%20Blanket%2
0Autism%2020161107%20BSK479.pdf

https://intranet.ndiastaff.ndia.gov.au/service-
Request title: Swimming and flexible
delivery/Technical-Advisory-
respite/recreation/holiday care for a 6 year
Team/Documents/ADV%202016%202529%20swi
old with Autism.
mming%20and%20flexible%20respite-recreation-
holiday%20care%20for%20a%206%20year%20old
%20with%20Autism.pdf?

8) Yammer groups for NDIS staff relating to ASD
There are two Yammer groups for NDIS staff discussion that some TAT advisors use:
  Autism Spectrum Disorders
  Understanding the Autism Spectrum by Dr Bennett, PHD

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9) Key research resources
The below resources have been frequently made reference to in advices or TAT advisors
have indicated that these are key resources they make reference to.
  Autism CRC – Source of the Autism CRC National Guidelines
o  The TAT Research team has been advised that the CRC is frequently used
by advisors for assessment/diagnosis for informal advices.
Autism CRC
National Guideline O

  Raising Children – Autism – An Australian parenting resource with an extensive
series of Autism resources.
o  The TAT Research team has been advised that the raising children website is
frequently used by advisors for best practice information.
  Neurofeedback in autism spectrum disorder
  Early Intervention for Children with Autism Spectrum Disorders: ‘Guidelines for Good
Practice’ 2012 (DHS Australia)
  Richard Simpson, Evidence-Based Practices and Students With Autism Spectrum
Disorders

  Aspect Australia – Australia’s largest service provider
  Autism Advisory Board – The national Autism peak body
  Amaze Resources – The Victorian Autism Peak Body’s resources page
  Asia Pacific Autism Conference 2021 – A major conference scheduled for late 2021
that wil  likely be relevant in future.
10)
IRABINA related resources
Information stated by IRABINA advises that “IRABINA is Australia’s only Autism specific
service provider for children and young people with the only severe behaviour program in the
Asia Pacific Region. We wil  not turn anybody away and provide every Autism specific
service. We can deliver services in your home, school, kindergarten or at one of our three
sites across Melbourne”.
IRABINA is a reputable provider of services for high end behaviour support / complex
behaviour support for children with ASD.
Over the past year TAT have worked with Steph Gunn and IRABINA regarding best practice
and costings for two specific participants requiring CSIR (TAT can provide names if
required). These two participant cases demonstrate specific information about the IRABINA
program and how TAT worked out funding advice.
One of the participant’s being discussed through CSIR with IRABINA was receiving supports
through the ‘server behaviours program’. A summary of this IRABINA program can be found
in this attachment.
IRABINA severe
behaviours program
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Deb Clark – TAT Branch Manager is now the key Agency contact for IRABINA.
There are general resources that can be found on the IRABINA website.
IRABINA frequently provide additional supporting documents and clinical reports to enable
NDIA reasonable and necessary decision making to be made.

The following are the advices directly related to IRABINA as the provider of high cost
behavioural supports for children with ASD:
•  Electronic Document      NED18/197780
o  ADV 20182325 IR ADL THER HMOD request for home extension home
modifications person to person supports and communication device child with
autism behaviours of concern  20181017 KRN451
o  15/10/2018 at 1:16 PM
•  Electronic Document      NED19/67206
o  ADV 20181281 ADL THER Core Supports and High Cost Severe Behaviour
plan 2018.08.31 KRN451
o  28/09/2018 at 2:23 PM
•  Electronic Document      NED18/223024
o  ADV 20182530 ADL THER One month review of high cost three month ABA
intervention for a 12 year old with autism and severe intellectual disability
20181411 KRN451
o  13/11/2018 at 3:11 PM

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