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Support Planning and Service Agreement Collaboration

NDIS Practice Standard 3: Provision of Support #

1.0 Purpose #

iSeekSupport’s aim is to work with participants, families, advocates, communities and other providers to achieve the best outcome for the participant. This collaboration allows all parties to share ideas and knowledge to ensure that the supports are relevant, appropriate, and in line with the service agreement.

2.0 Scope #

iSeekSupport is committed to ensuring that our staff understand the beneficial aspects of a collaborative approach for the participant.

3.0 Policy #

Support plans place the participant’s voice and requirements at the centre of developing their successful outcomes. Staff will be persistent and patient in building relationships with participants. Our team will promote a shared understanding of the participant’s preferences, expectations and needs across mainstream, community, informal and paid supports. Support plans will include:

  • Strategies to actively engage and build relations with participants who interact with multiple programs and supports
  • Guardianship and supported decision-making, and compulsory treatment orders
  • Strategies in navigating complex, ambiguous or conflicting service demands, ethical and regulatory environments

This collaborative approach requires staff to work with relevant parties when:

  • Locating key workers with a family and another provider
  • Working with other providers in the supply of supports or services
  • Assisting the participant in transitioning and exiting the service
  • Building the participant’s capacity
  • Planning with supports for the participant
  • Setting participant goals
  • Developing person-centred strategies
  • Developing service agreements.

Staff must cooperate with other agencies in the delivery of service. This collaboration may include initial contact, sharing ideas and input from the participant, their families and advocates, following through on ideas of a provider, and actively listening to discussions.

We will collaborate with all relevant parties to provide participants with the opportunity to access a service network that meets the full range of their needs. The CEO or their managers will establish communication with the relevant service provider, so iSeekSupport can maintain collaborative relationships and protocols and participate in networks with relevant agencies.

Information, knowledge and skills are communicated and shared between the participant, family, advocate, provider, and other collaborating providers. iSeekSupport will work with the participant, their family and advocate to ensure that the participant maintains functionality.

4.0 Procedure #

4.1 Key Worker #

Participants and families may require assistance to locate the right person to work with the participant. To do this, our team will undertake the following process:

  • Discuss the participant’s requirements with the participant, family and advocate.
    • Gain formal written consent to share and gather information with other providers.
    • Contact other service providers working with the participant to collaborate and determine the criteria.
    • Identify at least one (1) key support worker to contact participants, family and advocate, and the other providers.
    • Inform the participant, family, advocate of the identified person for their approval.
    • Record the process undertaken and results in the participant’s service agreement.

4.2 Supporting participants #

Staff creating the support plan must understand the participant and their requirements and undertake the following:

  • Work with the participant to make sense of my NDIS plan, understand how I can use it and how it links to other services or plans in my life.
  • Build understanding of participants’ capabilities and support them to maintain and build their capacity and resilience to achieve my goals.
  • Support the participant to be creative and think outside the box to find and negotiate solutions that meet my goals.
  • Provide information and tailored opportunities for the participant to explore and expand their vision for their future and what it means to have a good life.
  • Share current best practices to support the participant to make connections and find information about support options.
  • Alert the participants to real or potential conflicts of interest when planning and selecting supports, and work with them to make informed choices.
  • Encourage the participant’s specialised and mainstream service providers to recognise and challenge prejudice or lack of vision in service offerings and attitudes.
  • Involve participants in understanding and designing safeguards to keep them safe while supporting their right to take risks and build independence.
  • Work with participants to develop an agreed way to respond to emergencies, crises and foreseeable life events.

4.3 Risk Management #

All participants must have the following risk documents completed and recorded in their files:

  • Individual Risk Profile,
  • Safe Environment Checklist and
  • Personal Emergency Preparation Plan
  • Support Plan

The forms mentioned above must be reviewed annually to ensure that they encapsulate the participant’s needs, preferences, and goals safely. Note: The Personal Emergency Preparation Plan must be trialled, adjusted (as required) and recorded).

Staff undertaking risk assessments must be approved by the CEO or their managers. The risk assessment includes:

  • Consideration of the degree to which the participant relies on our services to meet their daily needs
  • The extent to which the participant’s health and safety is affected due to disruption

4.4 Collaborating with other providers #

The CEO or their delegate will make initial contact with other providers after obtaining consent from the participant, their family and advocate. Various methods will be used to maintain contact, e.g. email, phone and networking. All records of contact are kept in the participant Service Agreement.

4.5 Transition and exit #

The participant’s needs, interests or aspirations may change during the delivery of their supports.

These changes may lead to a need to transition to or exit from their current service. If this occurs, with the consent of the participant, we will contact the relevant service provider to:

  • Collaborate with providers and the participant to develop a plan of action
  • Request or send documents relevant to the participant
  • Confirm current supports, practices and needs to enable the participant to transfer or exit smoothly
  • Identify risks and develop a risk management plan
  • Develop a transition/exit process for the participant and confirm details with the participant
  • Work with the participant during the process
  • Review the effectiveness of the transition upon completion
  • Document the process in the participant support plan.

Risks associated with each transition to or from iSeekSupport are identified, documented and outlined in our Transition or Exit Policy and Procedure and Risk Management Policy and Procedure.

4.6 Capacity building #

The participant’s capacity building process is designed to improve and retain their skills and knowledge to maintain and improve their functionality.

To build and support the participant’s functional capacity, iSeekSupport will collaborate with:

  • A participant, their family, and advocate to affirm, challenge and support
  • Other providers to develop the participant’s skills further and to improve practice and relationships.

4.7 Participant outcomes #

Collaboration with a participant, their family, and their advocate is the basis for ensuring functional outcomes focused on the participant’s needs, priorities, and skills. This process includes:

  • Listening to every person
  • Analysing the information from each person
  • Determine relevant participant outcomes
  • Consult with all parties to reach an agreement on outcomes
  • Record the information in the support plan
  • Set a review date to ascertain if the participant to reaching outcome required
  • Detail collaborates in the service agreement

4.7 Support planning #

During the assessment and support planning process, collaboration is undertaken with a participant, their family or advocate to:

  • Complete a risk assessment (see 4.3 Risk Management)
  • Document a risk assessment
  • Plan appropriate strategies to manage/treat known risks
  • Train staff in strategy implementation
  • Implement appropriate strategies to manage/treat known risks
  • Conduct an annual review, or earlier, according to the participant’s changing needs/circumstances.
4.7.1 Support Plan document #

Staff completing the support plan must identify the participant’s communication needs. This information will determine how they will present and inform the participant on their support plan. Staff must explain and provide the support plan in a mode of communication that suits the participant.

4.8 Service agreements #

iSeekSupport will collaborate with the participant to develop a service agreement that establishes the following:

  • Expectations of both parties
  • Supports to be delivered
  • Conditions associated with the delivery of supports, including details of why particular conditions are attached.

With the consent or direction from the participant ISeekSupport collaborates in the development of the support plan with other providers to:

  • Develop links
  • Maintain links
  • Share information
  • Meet the needs of a participant.

iSeekSupport Policy and Procedure – Published 09.02.2022 #

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