Access to the NDIS - Early intervention requirements

9. Early intervention requirements

Early intervention support is available to both children and adults who meet the early intervention requirements. The intention of early intervention is to alleviate the impact of a person's impairment upon their functional capacity by providing support at the earliest possible stage. Early intervention support is also intended to benefit a person by reducing their future needs for supports.

A prospective participant will meet the early intervention requirements if they meet each of the following requirements:

  • the person:

i. has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent (section 25(1)(a)(i)); or

ii. has one or more identified impairments that are attributable to a psychiatric condition that are, or are likely to be, permanent (section 25(1)(a)(ii)); or

iii. is a child who has developmental delay (section 25(1)(a)(iii)); and

  • the NDIA is satisfied that provision of early intervention supports is likely to benefit the person by reducing their future needs for disability related supports (section 25(1)(b)); and

  • the NDIA is satisfied that provision of early intervention supports is likely to benefit the person by:

i. mitigating or alleviating the impact of the person's impairment upon their functional capacity to undertake communication, social interaction, learning, mobility, self-care or self-management (section 25(1)(c)(i)); or

ii. preventing the deterioration of such functional capacity (section 25(1)(c)(ii)); or

iii. improving such functional capacity (section 25(1)(c)(iii); or

iv. strengthening the sustainability of informal supports available to the person, including through building the capacity of the person's carer (section 25(1)(c)(iv)); and

  • the NDIA is satisfied early intervention support for the person is most appropriately funded or provided through the NDIS (section 25(3)).

Note, in certain circumstances, a person with a degenerative condition could meet the early intervention requirements and become a participant in the NDIS.

For all children under 7 years of age (except children diagnosed with a condition on List A of this Operational Guideline) the NDIA will first consider whether the child meets the early intervention requirements before considering the disability requirements.

9.1 When is an impairment permanent or likely to be permanent for the early intervention requirements?

The NDIA must be satisfied a prospective participant has one or more identified impairments that are, or are likely to be permanent (i.e. lifelong or likely to be lifelong) (section 25(1)(a)(i) and (ii)).

The following principles provide guidance:

  • an impairment is, or is likely to be, permanent only if there are no known, available and appropriate evidence based treatments that would be likely to remedy (i.e. cure or substantially relieve) the impairment (rule 6.4 of the Becoming a Participant Rules);
  • an impairment may be permanent notwithstanding that the severity of its impact on the functional impact of the person may fluctuate or potentially improve (rule 6.5 of the Becoming a Participant Rules);
  • an impairment is, or is likely to be, permanent only if the impairment does not require further medical treatment or review in order for its likely permanency to be demonstrated (rule 6.6 of the Becoming a Participant Rules). In this context, an impairment may be permanent notwithstanding that it may continue to be treated and reviewed after its permanency, or likely permanency, has been medically demonstrated; and
  • if an impairment is of a degenerative nature, the impairment is, or is likely to be permanent if medical or other treatment would not, or would be unlikely to improve the condition (rule 6.7 of the Becoming a Participant Rules). Accordingly, in certain circumstances, a person with a degenerative condition could meet the early intervention requirements and therefore become a participant in the NDIS.

If a prospective participant has multiple impairments, the NDIA will consider each impairment separately and determine whether each impairment is, or is likely to be permanent. However, the NDIA only needs to be satisfied that at least one of a prospective participant's impairments are, or are likely to be permanent.

Where there is a possibility of medical treatment (such as surgery) to treat the prospective participant's condition, and the treatment has some prospect of success, the NDIA should not conclude that the impairment is permanent but should wait until the outcome of the treatment is known (Mulligan and NDIA [2015] AATA 974 at [71] ).

9.2 Developmental delay (early intervention in early childhood)

9.2.1 Requirements for children with developmental delay

Access to the NDIS under the early intervention requirements is also open to children under 6 years of age with a developmental delay (section 25(1)(a)(iii)).

Under the NDIS developmental delay means a delay in the development of a child under 6 years of age that meets all of the following criteria:

  • The developmental delay is attributable to a mental or physical impairment or a combination of mental and physical impairments.
    An impairment is a problem in body function such as physiology or body structure (anatomy) and includes mental functions such as language and cognitive development.
    When assessing children, problems in body function and body structure can also be inferred from what a child does in activities during play and daily tasks, compared to other children of the same age.
    For very young children, where problems in body function and body structure cannot be easily measured, a delay in a child’s development attributable to an impairment can be inferred where there is a significant risk of a future disability diagnosis or developmental delay evidenced by the judgement or informed clinical opinion of a health or allied health professional.
  • The developmental delay results in substantial reduction in functional capacity in one or more of the following areas of major life activity:
    • Self care.
      Everyday activities in self-care can include taking care of yourself and participating in: showering, bathing, dressing, eating, drinking, toileting, grooming, and sleeping.
    • Receptive and expressive language.
      This includes participation in everyday activities that include receptive and/or expressive language, involving skills such as gesture, sign language, listening, giving and receiving information, communicating wants and needs through facial expressions, vocalisations or speech and interaction with others. A substantial reduction in functional capacity for either receptive or expressive language will suffice, it does not need to be both.
    • Cognitive development.
      This involves participation in everyday activities that include learning and applying knowledge, in areas such as: understanding and remembering information, attention, learning new things, practicing and using new skills, planning and making decisions, problem solving, developing pretend play skills, developing play interests, emotional and sensory regulation, developing emotional intelligence, social awareness and safety awareness.
    • Motor development.
      This includes participation in everyday activities like moving around the home and community and manipulating objects.

A child is considered to have a substantial reduction in functional capacity if the things the child does, or can do, in everyday activities are at a significantly lower competency level, or are done in a significantly different way because of reduced capacity, when compared to children of the same age.

The support that the child needs to do the activity would also be significantly greater compared to children of same age.

A substantial reduction in functional capacity will be evidenced by a health, allied health or early childhood professional who uses multiple sources of information. This will include parent or carer report and a combination of standardised assessments of developmental and functional capacity in everyday activities and natural settings. It may also include observations in everyday play, learning, activities or routines to inform their opinion.

For very young children, where functional capacity cannot be measured, a significant reduction in functional capacity can be inferred when there is a significant risk of future disability diagnosis or developmental delay evidenced by the informed clinical opinion of a health/allied health professional.
 

  • The developmental delay results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

To meet access requirements the child must require:

  • a service response that involves more than one professional working as a team to support the child, therefore support is required for multiple activities AND across multiple natural settings (such as the home, community and early childhood centres), beyond the scope of supports typically expected for a child at the same age AND
  • a team that works collaboratively; communicating and sharing information, knowledge and skills to build the capacity of the child's family and other important people in the child's life (such as carers, educators and professionals) in relation to the child's individual needs. This support should be embedded in everyday play, learning, activities and routines AND
  • more support than an individual discipline providing a unilateral response to a single problem AND
  • supports for an extended duration. This means that a health, allied health or early childhood professional who knows the child determines that the support is needed for longer than 12 months. A child is likely to be considered to meet the criteria where the extent and duration of early intervention support required is clearly determined.

This will be evidenced by a health, allied health or early childhood professional who knows the child and recommends that the child requires support for multiple activities AND across multiple natural settings from a team working collaboratively.

For children living in remote areas where there is limited access to a team of professionals, it may be that a sole professional needs to provide the supports to the child for multiple activities AND across multiple natural settings.

The need for early intervention for an extended duration will be evidenced through professional opinion, informed by multiple sources of information including parent or carer report and a combination of standardised developmental and/or functional assessments in everyday activities and natural settings, observations in everyday play, learning, activities, and routines.

Early childhood partners will complete an evidence of developmental delay form to support an Access request. In non-partner areas, evidence of developmental delay can be described by the relevant mainstream, community or health service in a report submitted as an attachment to accompany the Access request.

9.2.2 Determining whether a child has a developmental delay

Please see specific information provided above regarding evidence required under each of the criteria for determining if a child has a developmental delay.

A combination of standardised assessments of developmental and functional capacity will be used to evidence developmental delay. These assessments should occur across everyday activities and natural settings to identify the areas in which a child's development differs from same age norms and identifies children presenting with developmental delay. For example, the Paediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) is one of the functional assessment tools used for children.

The NDIA may specify, in our guidelines, assessment tools that may be used for the purposes of deciding whether a person meets the early intervention requirements (rule 7.2 of the Becoming a Participant Rules, also see section 209(2A) of the NDIS Act).

Without limitation, the NDIA may specify:

  • different tools to be used for adults and children; and

  • tools that are specifically tailored to particular impairments (rule 7.4 of the Becoming a Participant Rules).

A tool must be designed to ensure the fair and transparent assessment of whether a person meets the early intervention requirements and have reference to areas of activity and social and economic participation identified in the World Health Organisation International Classification of Functions, Disability and Health as in force from time to time (rule 7.5 of the Becoming a Participant Rules).

In some circumstances, the NDIA may request further information or request that a prospective participant undergo an assessment or examination (see requesting further information or reports to inform the access decision).

It should be noted that many children who meet the developmental delay access criteria will receive early intervention supports and then exit the NDIS. Therefore, meeting the early intervention criteria does not mean a child meets the disability requirements in the NDIS Act.

9.2.3 Children who do not meet the developmental delay criteria

Developmental concern is a term used by the NDIA for a child who is under 6 years of age, to describe delay or delays in a child’s development, below what is expected for their age, where they do not fully meet the developmental delay definition under the NDIS Act . For example, a child who is under 6 years of age, with developmental concerns may have substantial reduction in functional capacity in one or more areas but it is unclear if support is required from a team of professionals for more than 12 months. Children who are under 6 years of age with developmental concerns may be best supported by the Early Childhood Partner with short term early intervention and other services including connection to a range of mainstream and community supports.

9.2.4 Streamlined process for determining the early intervention requirements for children with a developmental delay

The NDIA will be satisfied the provision of early intervention supports for a child with developmental delay will be likely to benefit the child as required by the early intervention requirements without further assessment (rule 6.8 of the Becoming a Participant Rules).

Therefore, children with a developmental delay will be able to access the NDIS under the early intervention requirements provided the early intervention support is most appropriately funded or provided through the NDIS (section 25(3)).

9.3 Determining whether early intervention supports are likely to benefit the person

The NDIA must be satisfied that the provision of early intervention supports (except for children with developmental delay) is likely to benefit the prospective participant by:

  • reducing the person's future needs for supports in relation to disability (section 25(1)(b)); and

  • achieving one or more of the following four outcomes:

i. mitigating or alleviating the impact of the person's impairment upon the functional capacity of the person to undertake one or more activities (section 25(1)(c)(i)); or

ii. preventing the deterioration of such functional capacity (section 25(1)(c)(ii));

iii. improving such functional capacity (section 25(1)(c)(iii); or

iv. strengthening the sustainability of informal supports available to the person, including through building the capacity of the person's carer (section 25(1)(c)(iv)).

When considering whether the provision of early intervention supports is likely to benefit the person, the NDIA should consider:

  • the likely trajectory and impact of the person's impairment over time (rule 6.9(a) of the Becoming a Participant Rules); and
  • the potential benefits of early intervention on the impact of the impairment on the person's functional capacity and in reducing their future needs for supports (rule 6.9(b) of the Becoming a Participant Rules); and
  • evidence from a range of sources, such as information provided by the prospective participant or their family members or carers. The NDIA may also in some cases seek expert opinion (rule 6.9(c) of the Becoming a Participant Rules).

When considering if a person is likely to benefit from early intervention supports, the NDIA may consider factors such as the time elapsed since the onset or diagnosis of the disability and whether there has been a recent, or impending, significant change in the person's impairment or disability.

9.4 Is the support most appropriately funded or provided through the NDIS?

The NDIA must be satisfied that early intervention support is most appropriately funded or provided through the NDIS (section 25(3)).

Therefore, the NDIA will consider whether a prospective participant's overall, or likely, need for early intervention support is most appropriately funded or provided through the NDIS.

A prospective participant does not meet the early intervention requirementsif the NDIA is satisfied that early intervention support for the person is not most appropriately funded or provided through the NDIS, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered:

  • as part of a universal service obligation; or

  • in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability (section 25(3)).

When deciding if early intervention supports are most appropriately funded or provided through the NDIS, the NDIA must have regard to the considerations outlined in Schedule 1 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (see is the support most appropriately funded or provided through the NDIS?).

9.5 Streamlined process for determining the early intervention requirement for children under 7 years of age

In some circumstances the NDIA will be satisfied that a prospective participant meets the early intervention requirements by reference to List D appended to this Operational Guideline.

List D has been developed to streamline the access process for children under 7 years of age who have been diagnosed with a condition/s included on the list.

9.5.1 'List D' conditions

Where a child under the age of 7 has been diagnosed with a condition/s on List D the NDIA will be satisfied that the child meets the early intervention requirements without further assessment.

A child does not need to have a condition on List D to become a participant in the NDIS.

9.5.2 Early intervention for hearing impairment for people aged 0-25

The NDIA will be satisfied that a person meets the early intervention requirements without further assessment when the person:

  • is aged between birth and 25 years of age; and
  • has confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent or long term; and
  • the hearing loss of the person necessitates the use of personal amplification.

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention support up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case by case basis, having regard to the availability of all relevant evidence.

9.6 Reassessment of early intervention supports

Where a person has become a NDIS participant under the early intervention requirements, the NDIA will reassess their circumstances when reviewing their plan. The purpose of the reassessment is to ensure that early intervention supports continue to provide a benefit to the person, as required by the early intervention requirements.

If a participant no longer meets the early intervention requirements, the NDIA will consider whether the person can continue to access the NDIS under the disability requirements.

In some circumstances, a person's access to the NDIS may be revoked if they do not meet either the disability or early intervention requirements.

Where the participant is a child with developmental delay, there is no requirement to reassess access to the NDIS on the child's sixth birthday, particularly where the child may have only recently gained access to the NDIS. In general, a plan of usual length for others with similar circumstances should be developed for these children (up to 12 months). The child's status may then be reassessed when reviewing their plan.

This page current as of
3 May 2021
Indicates required field
Was this page useful?*
Why?
Why not?