NDIS Eligibility for Complex Behaviour Support: What You Need to Know

Understanding NDIS eligibility can be complex, particularly when it comes to accessing funding for complex behaviour support. Many Participants and their families find the process overwhelming. This blog post aims to clarify the criteria and provide practical steps to navigate the NDIS process successfully.

See our complete NDIS Complex Behaviour Support guide for more in-depth information.

Complex behaviour support aims to reduce behaviours of concern and improve a Participant's quality of life. It focuses on understanding the reasons behind behaviours and developing strategies to promote positive changes. This may involve specialised assessments, developing behaviour support plans, and training for Support Workers and family members.

Key NDIS Considerations for Complex Behaviour Support

The NDIS provides funding for supports that are considered "reasonable and necessary." To determine if complex behaviour support meets this criteria, the NDIS will consider several key factors:

1. Disability Requirements:

• Permanent and Significant Disability: To be eligible for the NDIS in the first place, a person must have a disability that is permanent and significantly impacts their ability to participate in everyday activities. This disability must be likely to be lifelong. Behaviours of concern must be directly linked to the impact of this disability.
• Impact on Functional Capacity: The NDIS assesses the impact of a person's disability on their functional capacity across various domains such as communication, social interaction, learning, mobility, self-care, and self-management. Behaviours of concern often significantly impact these areas.

2. The "Reasonable and Necessary" Test:

Once disability requirements are met, the NDIS considers whether the requested support is “reasonable and necessary.” This involves a multi-faceted assessment, focusing on:

• Relationship to Disability: The proposed support must be directly related to the Participant's disability. In the context of complex behaviour support, this means the behaviours of concern must be a direct consequence of the disability, not just a personality trait or situational reaction.
• Effectiveness and Benefit: The NDIS will assess whether the proposed support is likely to be effective and beneficial in achieving the Participant's goals. This often requires evidence-based strategies and the involvement of qualified professionals.
• Value for Money: The NDIS will consider whether the cost of the support is reasonable in relation to the expected benefits. This doesn't mean opting for the cheapest option but rather ensuring the support is cost-effective and represents a good investment in the Participant's well-being.
• Responsibility of Other Systems: The NDIS is not responsible for providing supports that are the responsibility of other systems, such as healthcare or education. However, the NDIS can fund supports that are supplementary to these systems and address the specific needs arising from the Participant's disability.

3. Types of Supports Available:

The NDIS Plan may include funding under various support categories relevant to complex behaviour support. Key categories include:

• Capacity Building – Improved Relationships: This category often funds positive behaviour support plans developed by qualified behaviour support practitioners. It also covers training for Support Workers and family members in implementing these plans.
• Capacity Building – Improved Daily Living Skills: This category can fund supports that help the Participant develop skills to manage their behaviour and reduce reliance on restrictive practices.
• Core Supports - Assistance with Daily Life: If the implementation of a behaviour support plan requires additional support in daily living, funding may be allocated under this category for assistance with personal care, household tasks, or community access.
• Capital Supports - Assistive Technology: Sometimes, assistive technology can help manage behaviours of concern. Examples may include communication devices or environmental modifications to reduce triggers.

4. Restrictive Practices:

The NDIS has strict regulations regarding the use of restrictive practices. If a behaviour support plan involves any restrictive practices (e.g., physical restraint, seclusion, medication for behaviour control), it must be developed and implemented in accordance with NDIS guidelines and state/territory laws. Any restrictive practices must be the least restrictive option possible and used only as a last resort to prevent harm. The NDIS Quality and Safeguards Commission oversees the use of restrictive practices.

Practical Steps to Accessing NDIS Funding for Complex Behaviour Support

Navigating the NDIS process can be challenging. Here are some practical steps to increase your chances of accessing funding for complex behaviour support:

1. Gather Comprehensive Evidence:

   • Obtain assessments and reports from relevant professionals, such as psychologists, psychiatrists, behaviour support practitioners, and occupational therapists. These reports should clearly describe the behaviours of concern, their impact on the Participant's life, and the recommended support strategies.
   • Keep detailed records of incidents involving behaviours of concern, including the date, time, location, triggers, and consequences. This provides valuable evidence of the impact of the disability.
   • Collect letters of support from family members, Support Workers, and other relevant individuals who can attest to the Participant's needs.

2. Clearly Articulate Your Needs and Goals:

   • During the NDIS planning meeting, clearly articulate the Participant's needs and goals in relation to managing behaviours of concern. Focus on how these behaviours impact their quality of life and participation in everyday activities.
   • Explain how the proposed support will help the Participant achieve their goals and reduce the behaviours of concern.

3. Engage a Qualified Behaviour Support Practitioner:

   • Working with a qualified behaviour support practitioner is crucial. They can conduct comprehensive assessments, develop evidence-based behaviour support plans, and provide training for Support Workers and family members. Ensure the practitioner is registered with the NDIS Quality and Safeguards Commission.

4. Request Specific Support Categories:

   • When requesting funding, be specific about the support categories you need. For example, request funding under "Capacity Building – Improved Relationships" for behaviour support plan development and training.

5. Appeal Unfavorable Decisions:

   • If your NDIS Plan does not adequately address the Participant's needs for complex behaviour support, you have the right to request an internal review. If the internal review is unsuccessful, you can appeal to the Administrative Appeals Tribunal (AAT).

6. Consider Early Intervention:

   • Addressing behaviours of concern early can prevent them from escalating and becoming more challenging to manage. Explore early intervention options and access supports as soon as possible.

7. Utilize Support Coordination:

   • If your NDIS Plan includes funding for Support Coordination, work closely with your Support Coordinator to navigate the NDIS system, connect with relevant service providers, and advocate for your needs.

Conclusion

Securing NDIS funding for complex behaviour support requires a clear understanding of the NDIS eligibility criteria and a proactive approach to gathering evidence and advocating for your needs. By following the practical steps outlined in this blog post, you can increase your chances of accessing the supports necessary to improve the quality of life for Participants with complex behaviours of concern. Remember to regularly review and update the NDIS Plan to ensure it continues to meet the Participant's evolving needs. You are not alone, and with the right support and information, you can navigate the NDIS system successfully.