NDIS Application Form

Specialty: Occupational Therapist NDIS Application Form PDF **Participant Details** * **Given Name(s):** Amelia * **Family Name:** Sharma * **Date of Birth:** 15/03/2010 * **Gender:** Female * **Address:** 123 Wattle Street, Brunswick, VIC 3056 * **Contact Number:** 0412 345 678 * **Email:** amelia.sharma@example.com **Primary Disability:** * Autism Spectrum Disorder (ASD) **Impact of Disability on Functional Capacity (Occupational Therapy Assessment):** Amelia, a 14-year-old female, presents with significant challenges across multiple functional domains due to her Autism Spectrum Disorder. Her primary difficulties lie in social interaction, communication, emotional regulation, and executive functioning, which collectively impact her participation in age-appropriate activities of daily living (ADLs), instrumental activities of daily living (IADLs), education, and community engagement. * **Social Interaction:** Amelia experiences considerable difficulty initiating and maintaining reciprocal conversations, understanding social cues, and forming peer relationships. This leads to social isolation and anxiety in group settings, severely limiting her ability to participate in school clubs, community events, and casual social gatherings with peers. * **Communication:** While verbally fluent, Amelia's communication can be literal and she struggles with abstract concepts and non-verbal communication. She often misinterprets tone and facial expressions, leading to misunderstandings and frustration in social and educational environments. * **Emotional Regulation:** Amelia exhibits difficulties in managing strong emotions, often leading to meltdowns or withdrawal when overwhelmed by sensory input or unexpected changes in routine. This impacts her ability to attend school consistently, participate in family outings, and manage independent tasks. * **Executive Functioning:** Challenges with planning, organisation, task initiation, and cognitive flexibility are evident. Amelia requires significant prompting and structure to complete homework, manage personal belongings, and follow multi-step instructions, impacting her independence at home and school. * **Sensory Processing:** Hypersensitivity to certain sounds (e.g., loud noises, crowded places) and textures (e.g., certain clothing fabrics) significantly limits her comfort and participation in various environments, including public transport, shopping centres, and school assemblies. **Goals for NDIS Support (Occupational Therapy Perspective):** 1. **Improve Social Participation:** Increase Amelia's ability to engage in social interactions and recreational activities with peers, aiming for participation in one structured social group per week. 2. **Enhance Emotional Regulation Skills:** Develop and implement strategies to manage anxiety and sensory overload, reducing the frequency and intensity of meltdowns, thereby improving her ability to cope with daily stressors. 3. **Develop Independent Living Skills:** Improve executive functioning for tasks such as personal organisation, planning daily routines, and managing simple household chores to foster greater independence at home. 4. **Facilitate Sensory Regulation:** Identify and implement sensory strategies and tools to better manage sensory sensitivities, allowing for increased comfort and participation in community environments. **Recommended Supports (Occupational Therapy Justification):** * **Therapeutic Supports:** * **Individual Occupational Therapy Sessions (weekly):** To address social skills, emotional regulation strategies (e.g., Zones of Regulation), executive functioning coaching, and development of daily living skills through direct intervention and tailored strategies. * **Social Skills Group Therapy (fortnightly):** To provide a structured environment for practising social communication and interaction skills with peers, facilitated by an experienced therapist. * **Assistive Technology:** * **Sensory tools:** Noise-cancelling headphones, weighted blanket, fidget toys to assist with sensory regulation in various environments. * **Visual schedules and organisational apps:** To support executive functioning and improve independence in daily routines. * **Support Coordination:** To navigate the NDIS system, connect with appropriate service providers, and manage the implementation of Amelia's plan. **Date of Assessment:** 1 November 2024 **Assessing Clinician:** Dr. Sarah Jenkins (Occupational Therapist) **Registration Number:** OT-12345