Writing Functional Impact Evidence That Helps NDIS Access and Reviews

There are many readers of the psychology profession, other psychologists, courts, schools, and insurers, and each has its conventions. The NDIS report is its own type, and the standards of the profession are against it.

History, tests, diagnosis and clinical reasoning are very important and can be well written to impress a client whose eligibility is clear from the therapy room, but the shorter and plainer the better the report, because the scheme's assessors are not reading for formulation. They're reading for two purposes: functional impact, and permanence, from the perspective of decision makers, often not clinicians. Psychologists who have an understanding of the genre write evidence that has a favorable impact on the outcomes in less time than the typical report takes, and this article is the genre guide.

Write for the actual reader

The change lies in the audience. A delegate is a person who has received training as a decision maker and uses legislative criteria, not someone who will read meaning into clinical shorthand. "She does not eat unless someone prompts her, not opened mail in 4 months, can't sequence steps of leaving house without support" transmits a lot more to this reader than does "severe MDD with marked anhedonia and executive dysfunction" and, not incidentally, is the same clinical picture. The discipline is the translation of all the clinical constructs into their behavioural expression in everyday life across the domains assessed by the scheme: self-care, self-management, social interaction, communication, learning, mobility where applicable. If a sentence in the report fails to give the reader a picture of what this person really needs on Tuesday, then that sentence is taking up room that the functional evidence should be taking.

Address permanence like it decides cases, because it does

The permanence test is the area in which the clinically sound application is most frequently missed with psychosocial disability, and psychologists are in a good position to deal with it appropriately. The scheme requires the impairment to be likely to be permanent (permanent does not mean incurable), and in the case of mental health, is likely to persist despite reasonable treatment. The report should then indicate that treatment has been attempted, over how long, and what was the result of the treatment, and provide a candid clinical judgment about the trajectory: the symptoms may continue to be treated and the functional impairment may remain. Explicit descriptions of function during the cycle in between the episodes of the condition, the costs and scaffolding during the good days, and depth of difficulties and pattern across the year are all welcome by the assessor if it is episodic, because otherwise the assessor sees only the person who attended just on that day.

The structure that works

The efficient NDIS report is shorter than the profession's habits and harder: identification and role, how long and in what capacity have you known the client, because the longer the time, the more weight it will have, diagnosis stated briefly, qualifies the evidence without being it; functional impact by domain, concrete, behavioural, exampled, that is the centre of gravity of the report; treatment history and permanence, handled as above; and where the report supports a plan review rather than access, the specific translation of function into support need, what assistance, how often, for what, which is where this library's other series, the support briefs and Tuesday translations, tie to the evidence that funds them. Later articles in this series by psychologists coordinating with a client's existing support team contain the richest functional dataset in the application, and structured, third party observation over time strengthens rather than dilutes.

How this plays out in practice

Imagine a client who had been in therapy for two years, and who applied for access one time, and had a report by a clinician which, by clinical standards, was excellent: history, formulation, diagnosis, prognosis. This resubmission is half its length, and its genre is different: the same psychologist reporting what she sees over the course of two years, the weeks of contact lost due to shutdowns, the supermarket abandoned halfway through, the attempts to find work and their failures, the sister's constant presence, listed day by day, treatment history summarised honestly, sustained therapy, medication trials, engagement genuine, functional impairment persisting, the episodic pattern mapped across this record's own file. Access is given, and the plan pays for daily scaffolding provided by the sister at her own expense. Clinicians did not change their clinical knowledge. The genre did.

Next steps

Now audit one recent letter you have written in the NDIS against the genre, how many sentences are there that have a descriptive language of behaviours for daily function and does permanence get a paragraph or a clause? Recreate the template, it will be faster and stronger the next time around.