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Disability Care Load Assessment (Child) Determination 2010

Authoritative Version
  • - F2010L01874
  • In force - Superseded Version
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Determinations/Other as made
This Determination revokes the Child Disability Assessment Determination 2001 (CDAD) and the Disability Care Load Assessment (Child) Determination 2009 and sets out a method for giving a qualifying rating to a carer claiming carer allowance for care of a child as well as retaining the method for giving a qualifying rating to a carer claiming carer payment for care of a child. This Determination also includes the list of Recognised Disabilities previously contained in the CDAD.
Administered by: Social Services
Made 30 Jun 2010
Registered 30 Jun 2010
Tabled HR 28 Sep 2010
Tabled Senate 28 Sep 2010

I, JEFF HARMER, Secretary of the Department of Families, Housing, Community Services and Indigenous Affairs, make this Determination under sections 38D and 38E of the Social Security Act 1991.

Dated               30 June                                                2010

Jeff Harmer


Part 1                 Preliminary

  

1              Name of Determination

                This Determination is the Disability Care Load Assessment (Child) Determination 2010.

2              Commencement

                This Determination commences on 1 July 2010.

3              Revocation

         (1)   This Determination revokes the Child Disability Assessment Determination 2001.

         (2)   This Determination revokes the Disability Care Load Assessment (Child) Determination 2009.

4              Definitions

                In this Determination:

ACL means assessment of care load, as determined under the ACL questionnaire.

ACL questionnaire means the assessment of care load questionnaire contained in Part 1 of Schedule 1.

Act means the Social Security Act 1991.

child means a person aged under 16.

contributing ACL means a score from an ACL questionnaire which contributes to a rating of intense.

contributing professional questionnaire means a score from a professional questionnaire which contributes to a rating of intense.

domain means a particular category of questions in the ACL questionnaire or the professional questionnaire.

professional questionnaire means the questionnaire contained in Part 2 of Schedule 1.

qualifying rating means a rating mentioned in section 9 that must be achieved by a person for that person to be qualified to receive:

(a)       a carer payment under the Act for the care of a child; or

(b)  a carer allowance under the Act for the care of a disabled child.


 

Note   Some expressions used in this determination are defined in the Act, including:

·         disabled child

·         lower ADAT score adult

·         officer

·         Secretary

·         treating health professional.

5              Delegation

                The Secretary may, in writing, delegate to an officer all or any of the powers of the Secretary under this Determination.

6              Disability assessment care load components

         (1)   Part 2 of this Determination sets out the Disability Care Load Assessment (Child) (Carer Payment) in respect of a person claiming for carer payment;

         (2)   Part 3 of this Determination sets out the Disability Care Load Assessment (Child) (Carer Allowance) in respect of a person claiming for carer allowance.

7              Recognised Disabilities

                Schedule 3 of this Determination declares, for the purposes of section 953 of the Act, recognised disabilities.

8              Questionnaires

         (1)   Part 1 of Schedule 1 sets out a questionnaire (the ACL questionnaire) about the functional ability, behaviour and special care needs of a child.

         (2)   The ACL questionnaire must only be completed by a person seeking to claim:

(a)  a carer payment under the Act for the care of a child; or

(b)  a carer allowance under the Act for the care of a disabled child.

                     Note  Subsection 10(6) allows the Secretary to amend a completed ACL questionnaire in certain circumstances.

         (3)   Part 2 of Schedule 1 sets out another questionnaire (the professional questionnaire) about the functional ability, behaviour and special care needs of a child.

         (4)   The professional questionnaire must only be completed by a treating health professional.

9              Rating method

                A person will achieve a qualifying rating if they achieve a rating of intense in accordance with Part 2 or Part 3.


 

10            ACL questionnaire

Scoring method

         (1)   The questions in the ACL questionnaire are grouped into 4 categories (domains):

                (a)    2 Behavioural domains; and

               (b)    Functional Abilities domain; and

                (c)    Special Care Needs domain.

Note   The Functional Abilities and Special Care Needs domains are further divided into subdomains.

         (2)   If a person marks more than 1 answer to any question, excluding questions 54 and 55 which allow multiple responses, only the answer that gives the highest score will be taken into account.

         (3)   Part 1 of Schedule 2 sets out details of the scoring for questions within each domain, and the method used to determine the total score for each ACL questionnaire.

         (4)   The total score for each domain must not be less than 0.

Secretary to be satisfied

         (5)   The Secretary must be satisfied that a completed ACL questionnaire is an accurate reflection of the functional ability, behaviour and special care needs of the child to whom it relates.

         (6)   If the Secretary is not satisfied that the completed ACL questionnaire is an accurate reflection of the child’s functional ability, behaviour and special care needs, the Secretary may amend the scores for any of the domains if a question is deemed to have been missed or misinterpreted.

         (7)   Additional points may only be added by the Secretary to the scores for any of the domains to reflect unaccounted for care load that is not presently recognised by the ACL questionnaire.

11        Professional questionnaire

Scoring method

         (1)   Part 2 of Schedule 2 sets out the method for scoring a child, on the basis of the answers given by the treating health professional as completed in relation to the child.

         (2)   For all calculations for the purposes of Part 2 of Schedule 2, numbers extending to more than 2 decimal places must be rounded to 2 decimal places.

         (3)   The total professional questionnaire score may be less than 0.

Secretary to be satisfied

         (4)   The Secretary must be satisfied that a completed professional questionnaire is an accurate reflection of the functional ability, behaviour and special care needs of the child to whom it relates.

         (5)   If the Secretary is not satisfied that the professional questionnaire is an accurate reflection of the child’s functional ability, behaviour and special care needs, the Secretary may request a replacement professional questionnaire that is to be completed by a different treating health professional.

 

Part 2                 Disability Care Load Assessment (Child) (Carer Payment)

  

12        Carer of a child with a severe disability or severe medical condition

         (1)   This section applies to a person who is caring for a child with a severe disability or severe medical condition.

         (2)   If this section applies to a person:

                (a)    a professional questionnaire must be completed for the child; and

               (b)    the person must complete an ACL questionnaire for the child.

         (3)   For the purposes of paragraph 197B(1)(b) of the Act, the person achieves a qualifying rating of intense if:

                (a)    the total score for the ACL questionnaire is 85 or more; and

               (b)    the score on the professional questionnaire is greater than 0.

 

13            Combined care of 2 or more children with a disability or medical condition

         (1)   This section applies to a person who is caring for two or more children with a disability or medical condition whose care needs combined are equivalent to those of a single child with a severe disability or severe medical condition.

         (2)   If this section applies to a person:

                (a)    1 professional questionnaire must be completed for each child; and

               (b)    the person must complete an ACL questionnaire for each child.

         (3)   No more than 4 contributing ACL questionnaires and 4 contributing professional questionnaires can be used to contribute to a qualifying rating.

         (4)   For the purposes of paragraph 197C(1)(b) of the Act, the person achieves a qualifying rating of intense if:

                (a)    the total score from combining the contributing ACL questionnaires is 85 or more; and

               (b)    the contributing professional questionnaire for each child has a score of greater than 0.

         (5)   For subsection (4), an ACL questionnaire is a contributing ACL only if the total score for that ACL questionnaire is 20 or more.

 

14            Carer of 1 or more children with a disability or medical condition and a lower ADAT score adult

         (1)   This section applies if a person is caring for 1 or more children with a disability or medical condition and a lower ADAT score adult.

         (2)   If this section applies to a person:

                (a)    one professional questionnaire must be completed for each child; and

               (b)    the person must complete an ACL questionnaire for each child.

         (3)   For the purposes of paragraph 197D(1)(b) a qualifying rating of intense is achieved if:

                (a)    the total combined score for the contributing ACLs is 85 or more; and

               (b)    the score on the contributing professional questionnaire for each child is greater than 0.

         (4)   For subsection (3), the adult is taken to contribute 40 to the total combined score for the contributing ACLs.

         (5)   No more than 2 contributing ACLs and 2 contributing professional questionnaires can be used to contribute to a qualifying rating.

         (6)   For subsection (3), an ACL questionnaire is a contributing ACL only if the total score for that ACL questionnaire is 20 or more.



Part 3      Disability Care Load Assessment (Child) (Carer Allowance)

15        Carer of a single disabled child

         (1)   If a person is caring for a disabled child:

                (a)    a professional questionnaire must be completed for the child; and

               (b)    the person must complete an ACL questionnaire for the child.

         (2)   For the purposes of subparagraph 953(1)(e)(ii) the person achieves a qualifying rating of intense if:

                (a)    the total score for the ACL questionnaire is 85 or more; and

               (b)    the score on the professional questionnaire is greater than 0.

16            Carer of 2 disabled children

         (1)   If a person is caring for 2 disabled children:

                (a)    1 professional questionnaire must be completed for each child; and

               (b)    the person must complete an ACL questionnaire for each child.

         (2)   No more than 2 contributing ACL questionnaires and 2 contributing professional questionnaires can be used to contribute to a qualifying rating.

         (3)   For the purposes of subparagraph 953(2)(e) the person achieves a qualifying rating of intense if:

                (a)    the total score from combining the contributing ACLs is 85 or more; and

               (b)    the contributing professional questionnaire for each child has a score of greater than 0.

         (4)   For subsection (3), an ACL questionnaire is a contributing ACL only if the total score for that ACL questionnaire is 20 or more.



 

 

 

 

Schedule 1        Questionnaires

(section 8)

Part 1          Assessment of care load questionnaire

Division 1       Behavioural domains

Domain A — Behaviour 1

                For each question, the claimant must tick only the response code that best describes how well the child in care usually manages.

 

Question 1:

 

The child’s ability to do everyday things (e.g. eating, bathing, talking, walking and mixing with other people etc) is:

Improving over time (i.e. the child is likely to require less help in the future)

Becoming worse over time (i.e. the child is likely to require more help in the future)

Relatively stable (i.e. the child is likely to require the same level of help in the future)

Fluctuating or episodic (i.e. the child’s condition and ability to do everyday things goes up and down from day to day or week to week)

Unsure



 

 


Domain A: Behaviour

 

Question 2:

 

Settling down to sleep at night

(e.g. repeated efforts needed to get the child to go to sleep at night)

 

The child never has difficulty settling down to sleep at night

The child sometimes has difficulty settling down to sleep at night (e.g. one or two nights a week)

The child often has difficulty settling down to sleep at night (e.g. more than two nights a week)

The child always has difficulty settling down to sleep at night (e.g. every night)

 

 

Question 3:

 

Disrupted sleep at night

(e.g. waking up many times during the night, awake for long periods during the night, or having nightmares)

 

The child never has disrupted sleep at night

The child sometimes has disrupted sleep at night (e.g. one or two nights a week)

The child often has disrupted sleep at night (e.g. more than two nights a week)

The child always has disrupted sleep at night (e.g. every night)

 


 


Domain A: Behaviour (Cont.)

 

Question 4:

 

Irritable behaviour

(e.g. crying all the time, not able to be calmed down, or for an older child, continually agitated, prone to angry outbursts)

 

The child never has irritable behaviour

The child sometimes has irritable behaviour (e.g. one or two days a week)

The child often has irritable behaviour (e.g. more than two days a week)

The child always has irritable behaviour (e.g. every day)

 

 

Question 5:

 

Speaking and Communicating

(i.e. speaking and communicating everyday needs)

 

The child’s speech and communication is appropriate for their age (e.g. the child can speak and communicate their everyday needs in the same way as other children of the same age.  For young babies this may include crying when hungry, smiling or babbling.)

The child has difficulty speaking or communicating their needs in other ways (e.g. speech is unclear and can only be understood by people who know the child very well or the child is aged over 4 years and can only say or sign a few words)

The child uses other ways to communicate (e.g. sign language, picture board, electronic communicator, gestures, pointing)

The child cannot talk or communicate their needs effectively in any way


 


Domain A: Behaviour (Cont.)

 

 

Question 6:

 

Understanding speech

(i.e. the child understanding what you say to him or her)

 

The child is able to understand everything that I would expect for a child of this age

The child sometimes needs me to speak more simply, repeat things or give reminders (e.g. once or twice a day)

The child often needs me to speak more simply, repeat things or give reminders (e.g. the child has a lot of difficulty understanding what I say several times a day)

The child cannot understand most things I say (e.g. the child does not appear to understand simple instructions or questions such as ‘do you want a drink?’)

 

 

Question 7:

 

Playing and mixing with other children

 

The child plays and mixes with other children as expected for a child of his/her age

The child sometimes needs help to play and mix appropriately with other children (e.g. once or twice a week)

The child often needs help to play and mix appropriately with other children (e.g. several times a week)

The child cannot play or mix with other children at all (e.g. the child has extreme behaviour problems or the child cannot play with other children because of a severe disability or medical condition)



 


 

Question 8:

 

Is the child aged under 3 years?

 

No

Go to next question.

Yes

Go to question 21.

 

Domain B — Behaviour 2

 

9:  Questions 10 to 20 ask you about the child’s behaviour (e.g. running away, aggressive behaviours, self-harming behaviours, extreme anxiety or withdrawal).  For each question, please select the response that best describes the child’s behaviour and the effect that this behaviour has on you during the day and the night.

 

Question 10:

 

Does the child have severe behaviour difficulties?

 

No

Go to question 21.

Yes

Go to next question

Not sure

Go to next question

 


 


Domain B: Behaviour (Cont.)

 

Question 11:

 

The child wanders, escapes or runs away from home, school or community settings.

Never (The child never has this behaviour)

Sometimes  (e.g. the child sometimes wanders or runs away but not every week)

Often  (e.g. the child would wander or run away at least once a week if not closely supervised)

Always (e.g. the child continually wanders or runs away unless hand is held or doors and gates are locked)

 

 

Question 12:

 

The child shouts, screams at or threatens other people or makes so much noise that other people become alarmed.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 


 


Domain B: Behaviour (Cont.)

 

Question 13:

 

The child becomes physically aggressive and harms others by hitting, pushing, kicking, biting or throwing objects.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 

Question 14:

 

The child gets extremely upset for little or no apparent reason (e.g. the child has episodes of intense crying or screaming and is very difficult to calm down).

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 


 


Domain B: Behaviour (Cont.)

 

 

Question 15:

 

The child gets extremely anxious, fearful or becomes emotionally withdrawn.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 

 

Question 16:

 

The child has very strange behaviours such as unusual routines, repetitive or obsessive behaviours, hearing voices or seeing things that are not there.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 


 


Domain B: Behaviour (Cont.)

 

 

Question 17:

 

The child displays high-risk behaviour that causes a danger to himself/herself or to others, including family members.  The child requires supervision and actions such as locking away household items that would not normally have to be locked away, preventing the child from running into traffic, etc.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 

 

Question 18:

 

The child behaves in ways that result in injury to himself/herself.  This may include head-banging, hand-biting or other self harming behaviours.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 


 


Domain B: Behaviour (Cont.)

 

 

Question 19:

 

The child has displayed suicidal behaviours (e.g. the child has suicidal thoughts and has planned or attempted suicide).

Never (The child has never displayed suicidal thoughts or behaviours)

Sometimes  (The child has displayed suicidal behaviours once or twice in the past two years)

Often  (The child has displayed suicidal behaviours more than twice in the past two years)

Always  (The child is continually displaying suicidal thoughts or behaviours e.g. suicidal thoughts every week and several suicide attempts in the past two years)

 

 

Question 20:

 

The child does or says things that are sexually inappropriate.

Never (The child never has this behaviour)

Sometimes  (The child sometimes has this behaviour, but not every week)

Often  (The child often has this behaviour e.g. at least once a week)

Always  (The child has this behaviour all the time e.g. every day)

 


 


Domain C - Functional Abilities

 

Question 21:

 

Does the child have more problems and need more help doing everyday tasks (e.g. eating, grooming, bathing, using the toilet, walking) than other children of the same age?

No

Go to question 39.

Yes

Go to next question

Not sure

Go to next question

 

Question 22:

 

Is the child aged under 12 months?

No

Go to next question.

Yes

Go to question 39.

 

Instructions for Domain C:

 

23:  Please read this before answering the following questions

Questions 24 to 38 ask you to rate the child’s ability to perform a number of different tasks.  You must answer all of these questions.

For each question, select the response that best describes the child’s ability.

Please base your responses on what the child does when using any aids, appliances or home modifications that assist with the care of the child.

If the child has a condition that changes from day to day, please base your answers on the child’s usual ability i.e. what the child is able to do most of the time.

Help includes supervision, prompting, reminding or training required as well as physical help.

The child’s age will be taken into account when assessing your responses.

 


 


Domain C — Functional abilities — subdomain 1

 

Question 24:

 

Does the child feed himself or herself once food is prepared?

The child feeds himself/herself with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent on me to feed him/her (e.g. I have to hold the child’s bottle, spoon feed the child or feed the child through a naso-gastric feeding tube, gastrostomy or Percutaneous Endoscopic Gastrostomy (P.E.G.))

 

 

Question 25:

 

Does the child do everyday grooming tasks (e.g. brush teeth, brush/comb hair, wash and rinse hands and face)?

The child grooms himself/herself with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent on me to do his/her grooming

 


 


Domain C: Functional abilities – everyday tasks (Cont.)

 

 

Question 26:

 

Does the child wash himself/herself from the neck down (except for his/her back) in the bath, shower or sponge/bed bath?

The child washes himself/herself with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent and needs me to wash him/her

 

 

Question 27:

 

Does the child dress himself/herself from the waist up (e.g. putting on singlets, t-shirts, jumpers, jackets)?

The child dresses himself/herself from the waist up with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent and needs me to dress him/her

 


 


Domain C: Functional abilities – everyday tasks

 

 

Question 28:

 

Does the child dress himself/herself from the waist down (e.g. putting on underpants, skirts/pants/trousers, socks, shoes)?

The child dresses himself/herself with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent and needs me to dress him/her

 

 

Question 29:

 

Does the child wipe himself/herself and adjust his/her clothing before and after using the toilet?

The child uses the toilet with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent for toileting, or wears nappies or incontinence pads day and night

 


 


Domain C — Functional abilities — subdomain 2

 

Question 30:

 

Does the child have bladder accidents (i.e. wets his/her pants or nappy)?

The child never has bladder accidents (e.g. the child is dry during the day and at night)

The child has bladder accidents during the night but is dry during the day (e.g. the child wets the bed or nappy at night only)

The child has occasional bladder accidents during the day and at night (e.g. the child sometimes wets their pants or nappy during the day and wets the bed at night)

The child has frequent bladder accidents during the day and at night (e.g. the child wets their pants or nappy several times during the day AND wets the bed or nappy most nights, or the child has a catheter or stoma to pass urine)

 

Question 31:

 

Does the child have bowel accidents (i.e. soils his/her pants or nappy)?

The child never has bowel accidents

The child sometimes has bowel accidents (e.g. the child occasionally soils his/her pants or nappy during the day or night)

The child often has bowel accidents (e.g. the child soils his/her pants or nappy several times a week)

The child is completely incontinent of faeces (e.g. the child has no bowel control, or the child needs an enema or suppository to have a bowel motion, or the child has a stoma to pass faeces such as from a colostomy or ileostomy)


 

Domain C — Functional abilities — subdomain 3

 

Question 32:

 

Does the child sit down and get up from the toilet or potty?

The child sits down and gets up from the toilet or potty with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent for toileting (e.g. the child needs to be lifted on and off the toilet or potty or cannot sit on a toilet or potty)

 

 

Question 33:

 

Does the child sit down and get up from a chair or wheelchair?

The child sits down and gets up from a chair with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child cannot sit in a chair or is completely dependent (e.g. the child needs to be lifted on and off the chair or wheelchair)

 


 


Domain C: Functional abilities – everyday tasks (Cont.)

 

 

Question 34:

 

Does the child get into or out of a bath or shower (whichever is used more often)?

The child gets into and out of a bath or shower with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. prompting, reminding or a small amount of physical help)

The child needs a lot of help (e.g. a lot of physical help)

The child is completely dependent (e.g. the child cannot get into or out of a bath or shower and needs complete physical help or lifting)

 

 

Question 35:

 

How does the child move around?

The child moves around by walking

The child moves around using a wheelchair or other mobility aids (e.g. stroller, crutches, walking sticks, walking frame or other mobility equipment)

The child moves around by crawling, rolling or bottom-hitching (e.g. the child does not walk but can move around on the floor)

The child is not able to move around by himself/herself

 


 


Domain C: Functional abilities – everyday tasks (Cont.)

 

 

Question 36:

 

Does the child move around by himself/herself indoors on an even surface?

The child moves around on an even surface with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. supervision or a small amount of physical help from me)

The child needs a lot of help (e.g. a lot of physical help from me)

The child is completely dependent (e.g. the child cannot move around indoors by himself/herself)

 

 

Question 37:

 

Does the child move around by himself/herself outdoors on uneven surfaces?

The child moves around outdoors on uneven surfaces with no help (e.g. the child needs no help from me)

The child needs a little help (e.g. supervision or a small amount of physical help from me)

The child needs a lot of help (e.g. a lot of physical help from me)

The child is completely dependent (e.g. the child cannot move around outdoors by himself/herself)

 


 


Domain C: Functional abilities – everyday tasks (Cont.)

 

 

Question 38:

 

Does the child go up and down stairs?

The child goes up and down a flight of stairs with no help from me

The child goes up and down two or three steps with no help from me

The child goes up and down a single step or kerb with no help from me

The child needs physical help from me to go up and down steps or stairs OR the child cannot use steps or stairs at all

 


 

Domain D - Special care needs

 

Instructions for special care needs questions

 

39:  Please read this before answering the following questions

Questions 40 to 56 ask you to indicate the child’s special care needs.

If the child has a condition that changes from day to day, please base your answers on the child’s usual and ongoing needs.

 

Domain D — Special care needs — subdomain 1

 

Question 40:

 

Does the child use any of the following to help with breathing?

Please tick any that apply:

 

Tracheostomy (A tracheostomy is an opening made by a surgeon through the front of the child’s neck into the windpipe.  A tracheostomy tube is used to keep the tracheostomy open)

 

Ventilator (A ventilator is a machine which breathes for the child and connects to the child’s airway – usually through a tube into the windpipe known as a tracheostomy tube)

 

Oxygen  (The child is regularly given extra oxygen to breathe from an oxygen cylinder at home as directed by a medical practitioner)

 

CPAP/BiPAP  (A CPAP or BiPAP machine helps to keep the child’s airway open by providing a flow of air at pressure, usually through a mask fitted firmly to the face)

 

NO - Go to next question

 

 


 


Domain D: Special care needs (Cont.)

 

 

Question 41:

 

Does the child receive dialysis (due to a kidney condition)?

(Dialysis is the assisted removal of waste products from the body for people with kidney failure.)

 

No

Yes

 

 

Question 42:

 

Do you provide Total Parenteral Nutrition (TPN) for the child?

 

TPN is a technique in which nutrients are given to a person through a tube directly into their veins, usually because they cannot digest regular food.

 

No

Yes

 


 


Domain D: Special care needs (Cont.)

 

 

Question 43:

 

Do you do postural drainage for the child?

Postural drainage means using positioning to help drain mucus from the child’s lungs and airways.  This often includes physical techniques such as patting the child’s chest with cupped hands (percussion) to help clear the secretions.

No

 

Go to next question

Yes

Please indicate how often you provide postural drainage for the child

 

During the day

 

Less than daily

Once or twice a day

Three or more times a day

During the night (i.e. 10pm to 6am)

 

Less than nightly

Once a night

Two or more times a night

 


 


Domain D: Special care needs (Cont.)

 

 

Question 44:

 

Do you clear the child’s airways through suctioning?

Suctioning is the use of a tube connected to equipment to remove mucus or saliva from the child’s mouth, throat or airway.

 

No

Go to next question

Yes

Please indicate how often you provide suctioning for the child

 

During the day

 

Less than daily

Once or twice a day

Three or more times a day

During the night (i.e. 10pm to 6am)

 

Less than nightly

Once a night

Two or more times a night

 


 


Domain D: Special care needs (Cont.)

 

 

Question 45:

 

Do you physically assist or position the jaw of the child to help with chewing and/or swallowing?

 

No

Go to next question

Yes

Please indicate how often you physically assist with chewing and/or swallowing

 

Less than daily

Once or twice a day

Three or more times a day

 

 

 

Question 46:

 

Do you Percutaneous Endoscopic Gastrostomy (P.E.G.) feed or use a feeding tube to feed the child?

When a child is P.E.G. fed they have a tube or button that goes directly into their stomach, and are fed through that tube.

 

No

Go to next question

Yes

Please indicate how often you P.E.G. feed or use a feeding tube for the child over a 24 hour period

 

Less than daily

Once or twice a day

Three or more times a day

 


 


Domain D: Special care needs (Cont.)

 

Question 47:

 

Do you provide physical assistance to turn or position the child because he/she is unable to do so independently?

 

No

Go to next question

Yes

Please indicate how often you physically assist the child to turn or position himself/herself

 

During the day

 

Less than daily

Once or twice a day

Three or more times a day

During the night (i.e. 10pm to 6am)

 

Less than nightly

Once a night

Two or more times a night

 

Question 48:

 

Do you manage any wounds and/or dressings for the child?

 

No

Go to next question

Yes

Please indicate how much time you spend managing wounds or dressings for the child

 

Less than 30 mins per day

30-60 mins per day

1-2 hours per day

More than 2 hours per day

 

 

Domain D: Special care needs (Cont.)

 

 

Question 49:

 

Do you give emergency medication or first aid for poorly controlled seizures?

 

No

Go to next question

Yes

Please indicate how often you give emergency medication or first aid for poorly controlled seizures

 

Less than monthly

Once or twice a month

Three or more times a month

 

 

 

Question 50:

 

Do you provide stoma care (e.g. colostomy, ileostomy) for the child?

 

A stoma is an opening in the abdominal wall and is used to enable waste materials from the intestines to empty into a pouch or bag.

 

No

Go to next question

Yes

Please indicate how often you provide stoma care for the child over a 24 hour period

 

Less than daily

Once or twice a day

Three or more times a day



 

 


Domain D — Special care needs — subdomain 2

 

Question 51:

 

Does the child have an eating disorder that has been diagnosed by a medical practitioner (e.g. anorexia nervosa or bulimia)?

 

No

Yes

 

 

Question 52:

 

Is the child receiving a course of chemotherapy or radiotherapy treatment?

 

No

Yes

 

 

Question 53:

 

Do you prepare or administer medications related to the child’s medical condition?

(Medications include tablets, other oral medicines, injections, puffers/inhalers, suppositories, enemas, ointments or creams prescribed by a medical practitioner)

 

No

Go to next question

Yes

Please indicate how many minutes PER DAY on average you spend preparing and/or administering medications

 

minutes per day

 


 


Question 54:

 

Do you provide any of the following supports or treatments for the child? 

Please tick any that apply.

 

Attending health care appointments related to the child’s disability or medical condition multiple times per month

 

Exercises prescribed by a physiotherapist, speech therapist, occupational therapist or other specialist at least twice a week

 

Applying daily splints, braces, special garments or mobility aids recommended by a health practitioner

 

Behavioural program recommended by a psychologist, psychiatrist or other therapist

 

Early childhood intervention activities recommended by a teacher, therapist or other disability specialist

 

Sign language or hearing equipment where the child is deaf or has a severe hearing impairment

 

Equipment or tactile aids or other assistance around the home where the child is blind or has a severe visual impairment

 

Blood testing or urine testing performed by you at least three times a day

 

 


 


Question 55:

 

Do any of these other care needs apply to you and the child you care for?

Please tick any that apply.

 

I am unable to access general child care, after-school hours care or vacation care programs due to this child’s special care needs

 

I am often called to the child’s school or child care to attend to their special care requirements or collect them due to their health or behavioural problems

 

This child has been excluded from school or child care for more than one day in the last school term because of their health care needs or behavioural issues

 

This child can only attend school part-time due to the severity of his/her disability or medical condition or because school supports are not available

 

I have to attend and stay at school or child care to provide care for my child due to the severity of his/her disability or medical condition or because school supports are not available

 

I can only leave this child in the care of others when they have had specific training and are willing to manage the child’s care needs

 

 

 

Question 56:

 

Please describe any other care needs that the child has.

 

 

Question 57:

 

Please describe any other effects that the child’s disability or medical condition has on you (e.g. any other effects on your daily routine, ability to take up paid employment, your health, social activities or emotional effects).

 

 

Question 58:

 

If there are any other comments about your situation that you feel are relevant, please write them in the space below.

 

 


 

 

Part 2          Professional questionnaire

Functional domains — abilities

·          Please indicate the statement that describes child’s usual ability

·          If the child cannot do any of the skills listed in a question, tick the last box.

·          If the child’s ability is appropriate for the age of the child, tick the first box.

·          The child’s abilities include what he/she can do when using his/her aids, appliances of special equipment items.

·          Where the child’s disability or medical condition is episodic or is only apparent at certain times, the question should be answered for what the child is currently able to do most of the time.

 

Question

Response Code

1

Receptive language skills (listening, reading and understanding)

 

 

Child’s ability is age appropriate

M-1l

 

Child understands adult speech or signed language of normal speed and complexity. Child demonstrates full understanding of why they are interacting with a health professional

M-1j

 

Child can read and interpret a paragraph from the front page of a daily newspaper

M-1i

 

Child can read a paragraph or page from a children’s story book appropriate for the child’s age group. Child can recall a list of three common objects 30 seconds after the list is read to them

M-1h

 

Child understands and responds appropriately to simple questions such as ‘do you go to school?’ and ‘what is your favourite colour?’

M-1g

 

Child follows 2 step instructions such as ‘pick up the book and put it on the chair’. Child uses toys appropriately for their intended purpose in meaningful play

M-1f

 

Child knows the difference between ‘big’ and ‘little’. Child can demonstrate what common objects are used for

M-1e

 

Child recognises pictures of common objects, for example points appropriately when asked ‘where’s the dog?’ or ‘which one is the truck?’

M-1d

 

Child responds appropriately to very simple questions, for example points to, or looks at, mother when asked ‘where’s mummy?’. Child uses objects purposefully, for example to make a sound

M-1c

 

Child responds to sound. Child tracks noise-making objects

M-1b

 

Child looks momentarily at speaker’s face

M-1a

 

Child cannot do any of the things listed above

M-1k

2

Expressive language skills (talking or signing)

 

 

Child’s ability is age appropriate

M-2l


 

Child has almost a full adult vocabulary. Child can discuss and debate complex issues such as politics or religion with an adult

M-2j

 

Child can describe his or her experiences in detail using complex sentences

M-2i

 

Child can tell a complex story involving several characters. Child can write a short story

M-2h

 

Child can write his or her own first name by handwriting or typing. Child can state his or her name and home address

M-2g

 

Child talks or signs well and can use 6 or more words in a sentence. Child can describe an event, for example a visit to a special place

M-2f

 

Child can say sentences with 3 to 4 words. People other than family members can understand the child’s speech

M-2e

 

Child can clearly say or sign more than 20 words and can use 2 words in combination, for example ‘Daddy’s car’

M-2d

 

Child can say or sign 3 or more simple words, for example ‘mum’, ‘dad’, ‘drink’, ‘bed’

M-2c

 

Child smiles and babbles or makes purposeful sounds, for example to attract attention. Child demonstrates good eye contact

M-2b

 

Child makes a vocal sound other than crying

M-2a

 

Child cannot do any of the things listed above

M-2k

3

Feeding and mealtime skills

 

 

Child’s ability is age appropriate

M-3l

 

Child can use all cooking equipment and kitchen appliances, for example, a microwave oven, electric frypan, or mixer, without assistance

M-3j

 

Child can follow a recipe and prepare a simple meal

M-3i

 

Child can cook a simple snack, for example, toast

M-3h

 

Child can prepare a simple uncooked snack, for example, a sandwich

M-3g

 

Child can use a fork and spoon at mealtimes

M-3f

 

Child can eat most solid foods if the food is cut up, for example, a raw apple

M-3e

 

Child uses spoon well

M-3d

 

Child can drink from a normal cup without help and can feed himself or herself with finger foods

M-3c


 

Child can drink from a modified cup when the cup is held by an adult

M-3b

 

Child can suck from a breast or baby’s feeding bottle

M-3a

 

Child cannot do any of the things listed above

M-3k

4

Hygiene and grooming skills

 

 

Child’s ability is age appropriate

M-4k

 

Child can style own hair and clean and cut own finger and toe nails without assistance

M-4i

 

Child can attend to basic hygiene, for example toileting, showering and brushing hair, without assistance

M-4h

 

Child manages basic hygiene, for example toileting, showering and brushing hair, with little assistance

M-4g

 

Child can wash hands and face and brush own teeth

M-4f

 

Child is reliably toilet-trained during the day and can manage own toileting with minimal assistance

M-4e

 

Child can indicate toilet needs during the day but needs some assistance with clothing and wiping

M-4d

 

Child is toilet-timed during the day or is indicating toilet needs, for example asking for the toilet or potty even if it’s too late or telling parent that pants or nappy are wet

M-4c

 

Child requires full assistance with toileting

M-4b

 

Child cries when nappy is soiled or wet

M-4a

 

Child cannot do any of the things listed above

M-4j

5

Dressing skills

 

 

Child’s ability is age appropriate

M-5l

 

Child can purchase and care for own clothing without assistance

M-5j

 

Child can wash and iron own clothing if required to with little assistance

M-5i

 

Child can choose own clothing appropriate to the weather and can dress and undress without any assistance

M-5h

 

Child can do up buckles and untie shoelaces

M-5g


 

Child can do up buttons and zippers

M-5f

 

Child dresses and undresses himself or herself but needs assistance with buttons, laces or tight clothing

M-5e

 

Child can undress with little assistance

M-5d

 

Child tries to help with dressing

M-5c

 

Child lifts arms to be picked up

M-5b

 

Child snuggles in to an adult when cuddled

M-5a

 

Child cannot do any of the things listed above

M-5k

6

Social and community skills

 

 

Child’s ability is age appropriate

M-6l

 

Child can use all major community facilities, for example shops, banks, doctors, with little assistance. Child has basic understanding of community laws and regulations

M-6j

 

Child is able to undertake basic activities in the community, for example shopping, with little supervision

M-6i

 

Child understands basic personal safety, for example how to cross the road and not to go with strangers. Child relates well to both children and adults

M-6h

 

Child is aware of being left in the care of others, for example a school teacher or child care worker, without getting unduly upset. Child understands basic concepts of right and wrong

M-6g

 

Child plays with other children and forms close friendships with other children. Child joins in simple games such as ‘chasey’ and ‘hide and seek’ but may not understand or follow rules of a game

M-6f

 

Child takes turns in conversations, for example speaks and then listens. Child knows whether they are a boy or a girl

M-6e

 

Child initiates contact with other people and involves other people in games or activities. Child is starting to cooperate in play with other children

M-6d

 

Child responds to affection from familiar people. Child recognises the difference between strangers and familiar people

M-6c

 

Child laughs and giggles when happy and cries when upset or angry. Child is interested in people and enjoys attention

M-6b

 

Child smiles. Child settles when picked up and cuddled

M-6a


 

Child cannot do any of the things listed above

M-6k

7

Mobility — fine motor

 

 

Child’s ability is age appropriate

M-7l

 

Child can use a variety of tools or hobby items with accuracy, for example for woodwork, sewing, painting or model building

M-7j

 

Child can write clearly

M-7i

 

Child can write all letters of the alphabet clearly

M-7h

 

Child can hold a pencil and draw basic shapes such as squares and triangles. Child can clearly write his or her own first name

M-7g

 

Child can manipulate smaller objects accurately, for example jigsaw puzzle pieces. Child can draw at least a head and body on a person stick figure style

M-7f

 

Child can build a tower of 9 blocks. Child can copy a circle and a cross

M-7e

 

Child can manipulate larger objects and toys, for example can push or pull toys, use posting box toys or build small tower of blocks. Child can copy a straight vertical line

M-7d

 

Child can make purposeful movements with objects, for example bang on a drum or clap hands

M-7c

 

Child grasps and releases objects such as rattle or feeding bottle

M-7b

 

Child can grasp an adult finger but may need assistance to release it

M-7a

 

Child cannot do any of the things listed above

M-7k

8

Mobility — gross motor

 

 

Child’s ability is age appropriate

M-8k

 

Child can hit a ball with a bat and can kick a ball with reasonable accuracy

M-8i

 

Child can catch a small ball, for example a tennis ball. Child skips well or rides a two-wheel bike

M-8h

 

Child can jump and can hop on each leg. Child can bounce a ball and catch it

M-8g

 

Child can run fast. Child can balance on 1 leg for 3 seconds. Child can hop on 1 leg

M-8f

 

Child can balance briefly while standing on 1 leg. Child can pedal a tricycle

M-8e


 

Child can walk and can run a few steps. Child can walk up and down steps

M-8d

 

Child has even muscle tone and strength in all limbs. Child can pull himself or herself from floor to a standing position and may be able to stand independently

M-8c

 

Child can independently move between prone and supine positions. Child can crawl or otherwise propel himself or herself along

M-8b

 

Child can lift head when in prone position. Child makes random movements with arms and legs

M-8a

 

Child cannot do any of the things listed above

M-8j

Functional domains — behaviour and needs

For the functional domains numbered 9 and 10, the treating health professional must mark any statement that describes the child’s behaviours or special care needs in each functional domain. The response should be based on an assessment by the treating health professional and, if available, any clinical assessments and written reports on the child from other treating health professionals (if any) who have assessed the child. If the child is receiving prescribed medication, the response should be based on the child’s behaviours when the child is receiving the prescribed medication.

Note   The treating health professional may mark more than 1 statement for each domain.

 

 

Question

Response Code

9

Behaviour

 

 

Child is consistently uncooperative and disruptive during treatment or assessment episodes

M-9a

 

Child demonstrates self injurious behaviour such as head banging or hand biting and has injuries or signs of past injuries consistent with such behaviours

M-9b

 

Child displays aggressive behaviour or violence towards other people or property in the treatment or assessment setting

M-9c

 

Child persistently attempts to leave or abscond from the treatment or assessment setting

M-9d

 

Child is extremely active and is unable to concentrate on a task for more than 30 seconds

M-9e

 

Child displays obsessional repetitive behaviours, for example obsession with particular objects or twirling or spinning objects for extended periods of time

M-9f

10

Special care needs

 


 

Child receives all food and fluids by nasogastric or gastrostomy tube or percutaneous enterogastric tube (PEG)

M-10a

 

Child has a tracheostomy

Child requires a ventilator to support respiration.

Child requires regular oxygen therapy at home.

Child requires a CPAP or BiPAP machine.

M-10b1

M-10b2

M-10b3

M-10b4

 

Child is aged over 4 years and is incontinent both day and night

M-10c

 

Child is aged over 3 years and cannot stand without support

M-10d

 

Child requires a wheelchair and requires assistance to propel the wheelchair

M-10e

 

Child requires a wheelchair, quad sticks, prosthesis, crutches or walking frame but can move around with little assistance using the equipment

M-10f

 

Child uses an electric wheelchair

M-10g

 

Child requires urinary catheterisation several times each day

M-10h

 

Child requires specialised equipment, prosthesis or technology to communicate, for example a computerised communicator, telephone typewriter (TTY), voice synthesiser, cochlear implant, hearing aids or adaptations to a standard computer

M-10i

 

Child is over the age of 5 years and has persistent difficulties with memory, concentration, planning and organisation

M-10j

 

Child has chronic and progressive suppurative lung disease for which ongoing daily airway clearance is provided or enzyme replacement therapy and nutritional supplements are required and provided on a daily basis

M-10k

 

Child is receiving a course of chemotherapy or radiotherapy treatment for cancer

M-10l

 

The child has poorly controlled seizures which frequently require emergency medication or first aid?

M-10m

 

Child is assisted on a daily basis with at least 2 blood tests to measure blood glucose levels, injections and special dietary management and the child is not capable of determining medication levels, food intake or self-administration of medication

M-10n


 

Child has a severe eating disorder such as anorexia nervosa or bulimia.

M-10o

Schedule 2        Rating methods

(section 9)

Part 1          Scoring for ACL questionnaire

Step 1    Terminal phase [Note: this Step 1 only relates to Carer Payment.]

                No further steps need to be taken in the assessment of care load, if a medical practitioner has certified that:

                (a)    a child has a terminal condition; and

               (b)    the average life expectancy for a child with the same or similar condition is not substantially longer than 24 months.

Step 2    Domain A score

         (1)   Calculate a score for each question in domain A of the ACL questionnaire as follows:

                (a)    locate the value in column 3 of the following table that corresponds to the answer code for the question in column 2;

               (b)    copy this value into column 4 of the table.

         (2)   Calculate the total score for domain A by adding the scores in column 4 of the table.

Domain A — Behaviour I

Question number

Answer code

Value

Score

1

a

0

 

 

b

0

 

 

c

0

 

 

d

0

 

 

e

0

 

2

a

0

 

b

1

c

2

d

5


3

a

0

 

 

b

1

 

 

c

3

 

 

d

6

 

4

a

0

 

 

b

1

 

 

c

5

 

 

d

8

 

5

a

0

 

 

b

2

 

 

c

5

 

 

d

10

 

6

a

0

 

 

b

1

 

 

c

5

 

 

d

10

 

7

a

0

 

 

b

2

 

 

c

4

 

 

d

10

 

Step 3    Care load score for domain A

                Calculate the care load score for domain A as follows:

                (a)    locate the score range in column 1 of the following table into which the total score for domain A fits;

               (b)    the care load score is the corresponding conversion score in column 2 of the table.

Score range

Conversion score

Care load score

0 to 4

0

 

5 to 16

10

 

17 to 30

20

 


31 or more

40

 

Step 4    Score for domain B

         (1)   Calculate a score for each question in domain B of the ACL questionnaire as follows:

                (a)    locate the value in column 3 of the following table that corresponds to the answer code for the question in column 2;

               (b)    copy this value into column 4 of the table.

         (2)   Calculate the total score for domain A by adding the scores in column 4 of the table.

Domain B — Behaviour 2

Question number

Answer code

Value

Score

11

a

0

 

 

b

1

c

10

d

15

12

a

0

 

 

b

1

c

6

d

10

13

a

0

 

 

b

2

c

12

d

20

14

a

0

 

 

b

1

c

5

d

10

15

a

0

 

 

b

1

c

5

d

10

16

a

0

 

 

b

1

 

 

c

5

 


 

d

10

 

17

a

0

 

 

b

2

 

 

c

10

 

 

d

20

 

18

a

0

 

 

b

2

 

 

c

10

 

 

d

20

 

19

a

0

 

 

b

2

 

 

c

10

 

 

d

20

 

20

a

0

 

 

b

2

 

 

c

10

 

 

d

20

 

Step 5    Care load score for domain B

                Calculate the care load score for domain B as follows:

                (a)    locate the score range in column 1 of the table into which the total score for domain B fits;

               (b)    the care load score is the corresponding conversion score in column 2 of the table.

Score range

Conversion score

Care load score

0 to 9

0

 

10 to 19

15

20 to 29

30

30 or more

85

Step 6    Score for subdomain C (1)

         (1)   Calculate a score for each question in subdomain C (1) as follows:

                (a)    locate the value in column 3 of the following table that corresponds to the answer code for the question in column 2;

               (b)    copy this value into column 4 of the table.


 

         (2)   Calculate the age-adjusted score for each question as follows:

                (a)    locate the score for the appropriate age category in the age adjustment table in step 13, and copy this score into column 5 of the following table;

               (b)    divide the raw score in column 4 by the score in column 5.

         (3)   Calculate the total score for subdomain C (1) by adding the age-adjusted scores in column 6.

Note 1   The age-adjusted score can never be less than zero.

Note 2   The lower the age adjusted total score, the greater the disparity between the functional ability expected of a child of that age and the child’s actual ability, and the higher the likelihood of care load for the carer.

Domain C — Functional abilities — self care subdomain C (1)

Question

Answer code

Raw value

Raw score

Score from age adjustment table

Age adjusted score

24

a

4

 

 

 

b

3

c

2

d

1

25

a

4

 

 

 

b

3

c

2

d

1

26

a

4

 

 

 

b

3

c

2

d

1

27

a

4

 

 

 

b

3

c

2

d

1


28

a

4

 

 

 

 

b

3

 

 

 

 

c

2

 

 

 

 

d

1

 

 

 

29

a

4

 

 

 

 

b

3

 

 

 

 

c

2

 

 

 

 

d

1

 

 

 

Step 7    Adjusted score for subdomain C (1)

                Calculate the adjusted score for subdomain C (1) as follows:

                (a)    locate the score range in column 1 of the following table into which the total score for subdomain C (1) fits;

               (b)    the adjusted score is the corresponding conversion score in column 2 of the table.

Score range

Conversion score

Adjusted score

0 to 2.20

40

 

2.21 to 4.04

20

 

4.05 to 100

0

 

Step 8    Score for subdomain C (2)

         (1)   Calculate a score for each question in subdomain C (2) as follows:

                (a)    locate the value in column 3 of the following table that corresponds to the answer code for the question in column 2;

               (b)    copy this value into column 4 of the table.

         (2)   Calculate the age-adjusted score for each question as follows:

                (a)    locate the score for the appropriate age category in the age adjustment table in step 13, and copy this score into column 5 of the following table;

               (b)    divide the raw score in column 4 by the score in column 5.

         (3)   Calculate the total score for subdomain C (2) by adding the age-adjusted scores in column 6.


 

Domain C— Functional abilities — self care subdomain C (2)

Question

Answer code

Raw value

Raw score

Score from age adjustment table

Age adjusted score


30

a

4

 

 

 

 

b

3

 

 

 

 

c

2

 

 

 

 

d

1

 

 

 

31

a

4

 

 

 

 

b

3

 

 

 

 

c

2

 

 

 

 

d

1

 

 

 

Step 9    Adjusted score for subdomain C (2)

                Calculate the adjusted score for subdomain C (2) as follows:

                (a)    locate the score range in column 1 of the following table into which the total score for subdomain C (2) fits;

               (b)    the adjusted score is the corresponding conversion score in column 2 of the table.

Score range

Conversion score

Adjusted score

0 to 0.73

60

 

0.74 to 1.34

40

1.35 to 100

0

Step 10  Score for subdomain C (3)

         (1)   Calculate a score for each question in subdomain C (3) as follows:

                (a)    locate the value in column 3 of the following table that corresponds to the answer code for the question in column 2;

               (b)    copy this value into column 4 of the table.

         (2)   Calculate the age-adjusted score for each question as follows:

                (a)    locate the score for the appropriate age category in the age adjustment table in step 13, and copy this score into column 5 of the following table;

               (b)    divide the raw score in column 4 by the score in column 5.

         (3)   Calculate the total score for subdomain C (3) by adding the age-adjusted scores in column 6.


 

Domain C — Functional abilities — mobility subdomain C (3)

Question

Answer code

Raw value

Raw score

Score from age adjustment table

Age adjusted score

32

a

4

 

 

 

 

b

3

 

 

 

 

c

2

 

 

 

 

d

1

 

 

 

33

a

4

 

 

 

 

b

3

 

 

 

 

c

2

 

 

 

 

d

1

 

 

 

34

a

4

 

 

 

b

3

c

2

d

1

35

a

No score

 

 

 

b

No score

c

No score

d

No score

36

a

4

 

 

 

b

3

c

2

d

1

37

a

4

 

 

 

b

3

c

2

d

1


38

a

4

 

 

 

b

3

c

2

d

1

Step 11  Adjusted score for subdomain C (3)

                Calculate the adjusted score for subdomain C (3) as follows:

                (a)    locate the score range in column 1 of the following table into which the total score for subdomain C (3) fits;

               (b)    the adjusted score is the corresponding conversion score in column 2 of the table.

Score range

Conversion score

Adjusted score

0 to 2.20

30

 

2.21 to 4.04

15

4.05 to 100

0

Step 12  Total score for domain C

                Calculate the total score for domain C by adding the adjusted scores for subdomains C (1), (2) and (3).

Step 13  Care load score for domain C

                Calculate the care load score for domain C as follows:

                (a)    Use the total score for Domain C as derived at Step 12 and locate it within an applicable score range in column 1 of the following table;

               (b)    the care load score is the corresponding conversion score in column 2 of the table;


                (c)    if the total score for domain C is 0, the care load score is 0.

Score range

Conversion score

Care load score

1 to 20

20

 

30 to 55

40

 

60 to 75

60

 

80 to 130

85

 



 

 


Age adjustment table

 

Age

1

1

1

1

2

2

2

2

3

3

3

3

4

4

4

4

5

5

5

5

6

6

6

6

7

Age grouping in Months

12 to < 15

15 to < 18

18 to < 21

21 to < 24

24 to < 27

27 to < 30

30 to < 33

33 to < 36

36 to < 39

39 to < 42

42 to < 45

45 to < 48

48 to < 51

51 to < 54

54 to < 57

57 to < 60

60 to < 63

63 to < 66

66 to < 69

 69to < 72

 72 to < 75

75 to < 78

78 to < 81

81 to < 84

> = 84

Q24 - Eating

1

1

1

1

1

1

2

2

3

3

3

3

3

3

3

3

3

3

3

4

4

4

4

4

4

Q25 - Grooming

1

1

1

1

1

1

1

1

2

2

2

2

3

3

3

3

3

3

3

3

3

3

3

4

4

Q26 - Bathing

1

1

1

1

1

1

1

1

2

2

2

2

2

2

3

3

3

3

3

3

3

3

3

3

4

Q27 - Dressing - upper

1

1

1

1

1

1

1

1

2

2

2

3

3

3

3

3

3

3

3

3

3

3

4

4

4

Q28 - Dressing - lower

1

1

1

1

1

1

1

1

2

2

2

2

3

3

3

3

3

3

3

3

3

3

4

4

4

Q29 - Toileting

1

1

1

1

1

1

1

1

2

3

3

3

3

3

3

3

3

3

3

3

3

4

4

4

4

Q30 - Bladder

1

1

1

1

1

1

1

1

1

1

1

1

3

3

3

3

3

3

3

3

4

4

4

4

4

Q31 - Bowel

1

1

1

1

1

1

1

1

1

1

1

1

3

3

3

4

4

4

4

4

4

4

4

4

4

Q32 - Mobility Toilet

1

1

1

1

1

1

1

1

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

Q33 - Mobility Chair/ Wheelchair

1

1

1

1

1

1

2

2

3

3

3

3

3

3

4

4

4

4

4

4

4

4

4

4

4

Q34 - Mobility Bath/Shower

1

1

1

1

1

1

2

2

3

3

3

3

3

3

3

3

3

3

3

4

4

4

4

4

4

Q36 - Mobility Walk/Whlchair (indoors)

1

1

1

1

1

1

2

2

3

3

3

3

3

4

4

4

4

4

4

4

4

4

4

4

4

Q37 - Mobility Walk/Whlchair (outdoors)

1

1

1

1

1

1

2

2

3

3

3

3

3

4

4

4

4

4

4

4

4

4

4

4

4

Q38 - Mobility Stairs

1

1

1

1

1

1

1

2

3

3

3

3

3

3

3

3

4

4

4

4

4

4

4

4

4

 

 

Note   Questions 21, 22, 23 and 35 are excluded from this table as they are non-scoring questions.


 

Step 14  Total score for subdomain D (1)

         (1)   Calculate a score for each question in subdomain D (1) as follows:

                (a)    locate the value in column 3 of the following table that corresponds to the answer code for the question in column 2;

               (b)    copy this value into column 4 of the table.

         (2)   Calculate the total score for subdomain D (1) by adding the scores in column 4.


 

Subdomain D (1) — Special care needs — interventions

Question

Answer

Value

Score

40

a

85

 

 

b

85

 

 

c

30

 

 

d

20

 

e

0

41

a

0

 

 

b

85

 

42

a

0

 

b

70

43

a

0

 

b

0

b.1

0

b.2

15

b.3

30

b.4

0

b.5

15

b.6

30

44

a

0

 

 

b

0

 

 

b.1

0

 

 

b.2

5

 

 

b.3

10

 

 

b.4

0

 

 

b.5

10

 

 

b.6

20

 


45

a

0

 

b

0

b.1

0

b.2

2

b.3

5

46

a

0

 

b

0

b.1

0

b.2

20

b.3

40

47

a

0

 

b

0

b.1

0

b.2

5

b.3

10

b.4

0

b.5

10

b.6

20

48

a

0

 

b

0

b.1

0

b.2

15

b.3

30

b.4

50


 

49

a

0

 

 

b

0

 

 

b.1

20

 

 

b.2

60

 

 

b.3

80

 


50

a

0

 

b

0

b.1

0

b.2

20

b.3

40

Step 15  Total score for subdomain D (2)

         (1)   Calculate the score for each question in subdomain D (2) as follows:

                (a)    copy the number of hours into column 3 of the following table;

               (b)    locate the range of hours in column 4 of the table into which the number of hours fits;

                (c)    the score is the corresponding final score in column 5 of the table.

         (2)   Calculate the total score for subdomain D (2) by adding the final scores for the questions.

Subdomain D (2) — Special care needs — time

Question

Answer

Value

51

a

0

 

b

10

52

a

0

 

b

10

 

 

 

Question

Answer code

Time in Minutes

Time calculation

Final score

53

a

 

 

0

b

 

if 1 hour or less

0

if more than 1 hour

5

 

 

 

Question

Answer

Value

54

a

2

 

b

2

 

c

1

 

d

2

 

e

2

 

f

2

 

g

1

 

h

1



55

a

1

 

b

1

 

c

1

 

d

1

 

e

1

 

f

1

Step 16  Total score for domain D

                Calculate the total score for domain D by adding the total scores for subdomains D (1) and (2).

Step 17  Care load score for domain D

                The care load score for domain D is the total score for domain D.

Step 18  ACL grand total

                Calculate the ACL grand total by adding the care load scores for domains A, B, C and D.

Step 19  Additional points for scoring of ACL if Secretary is not satisfied

         (1)   If the Secretary is not satisfied that the completed ACL questionnaire is an accurate reflection of the child’s functional ability, behaviour and special care needs, the Secretary may amend the scores for any of the domains if a question is deemed to have been missed or misinterpreted.

Step 20  ACL adjusted grand total

                Calculate the ACL adjusted grand total by adding any extra points from the Secretary to the ACL grand total.

Part 2          Scoring for professional questionnaire

Step 1    Chronological age

                Calculate the child’s chronological age at the date of completion of the questionnaire.

Step 2    Scores for functional domains 1, 2, 3, 5, 6 and 7

         (1)   Calculate the child’s scores for functional domains 1, 2, 3, 5, 6 and 7 from the following table based on:

                (a)    the child’s chronological age calculated in step 1; and

               (b)    the child’s functional age, based on the responses marked in functional domains 1, 2, 3, 5, 6 and 7 in the questionnaire.


 

         (2)   Record the scores in column 2 of the table in step 6.

 

Chronological age

Functional age

Birth
to <6 months

6 months to <1 year

1 year to <2 years

2 years to <3 years

3 years to <4 years

4 years to <6 years

6 years to <9 years

9 years to <12 years

12 years to <15 years

15 years or older

Birth to <6 months (response a)

0

+1

+2

+3

+4

+5

+6

+7

+8

+9

6 months to <1 year (response b)

-1

0

+1

+2

+3

+4

+5

+6

+7

+8

1 year to <2 years (response c)

-2

-1

0

+1

+2

+3

+4

+5

+6

+7

2 years to <3 years (response d)

-3

-2

-1

0

+1

+2

+3

+4

+5

+6

3 years to <4 years (response e)

-4

-3

-2

-1

0

+1

+2

+3

+4

+5

4 years to <6 years (response f)

-5

-4

-3

-2

-1

0

+1

+2

+3

+4

6 years to <9 years (response g)

-6

-5

-4

-3

-2

-1

0

+1

+2

+3

9 years to <12 years (response h)

-7

-6

-5

-4

-3

-2

-1

0

+1

+2

12 years to <15 years (response i)

-8

-7

-6

-5

-4

-3

-2

-1

0

+1

15 years or older (response j)

-9

-8

-7

-6

-5

-4

-3

-2

-1

0

No skills demonstrated (response k)

+1

+2

+3

+4

+5

+6

+7

+8

+9

+10

Age appropriate (response l)

0

0

0

0

0

0

0

0

0

0

 

Step 3    Score for functional domain 4

         (1)   Calculate the child’s score for functional domain 4 from the following table based on:

                (a)    the child’s chronological age calculated in step 1; and


 

               (b)    the child’s functional age, based on the response marked in functional domain 4.

         (2)   Record the score in column 2 of the table in step 6.

 

Chronological age

Functional age

Birth to <1 year

1 year to <2 years

2 years to <3 years

3 years to <4 years

4 years to <6 years

6 years to <9 years

9 years to <12 years

12 years to <15 years

15 years or older

Birth to <1 year (response a)

0

+1

+2

+3

+4

+5

+6

+7

+8

1 year to <2 years (response b)

-1

0

+1

+2

+3

+4

+5

+6

+7

2 years to <3 years (response c)

-2

-1

0

+1

+2

+3

+4

+5

+6

3 years to <4 years (response d)

-3

-2

-1

0

+1

+2

+3

+4

+5

4 years to <6 years (response e)

-4

-3

-2

-1

0

+1

+2

+3

+4

6 years to <9 years (response f)

-5

-4

-3

-2

-1

0

+1

+2

+3

9 years to <12 years (response g)

-6

-5

-4

-3

-2

-1

0

+1

+2

12 years to <15 years (response h)

-7

-6

-5

-4

-3

-2

-1

0

+1

15 years or older
(response i)

-8

-7

-6

-5

-4

-3

-2

-1

0

No skills demonstrated (response j)

+1

+2

+3

+4

+5

+6

+7

+8

+9

Age appropriate (response k)

0

0

0

0

0

0

0

0

0

Step 4    Functional domain 8

         (1)   Calculate the child’s score for functional domain 8 from the following table based on:

                (a)    the child’s chronological age calculated in step 1; and


               (b)    the child’s functional age, based on the response marked in functional domain 8.

         (2)   Record the score in column 2 of the table in step 6.

 

Chronological age

Functional age

Birth
to <6 months

6 months to <1 year

1 year to <2 years

2 years to <3 years

3 years to <4 years

4 years to <6 years

6 years to <9 years

9 years to <12 years

12 years or older

Birth to <6 months (response a)

0

+1

+2

+3

+4

+5

+6

+7

+8

6 months to <1 year (response b)

-1

0

+1

+2

+3

+4

+5

+6

+7

1 year to <2 years (response c)

-2

-1

0

+1

+2

+3

+4

+5

+6

2 years to <3 years (response d)

-3

-2

-1

0

+1

+2

+3

+4

+5

3 years to <4 years (response e)

-4

-3

-2

-1

0

+1

+2

+3

+4

4 years to <6 years (response f)

-5

-4

-3

-2

-1

0

+1

+2

+3

6 years to <9 years (response g)

-6

-5

-4

-3

-2

-1

0

+1

+2

9 years to <12 years (response h)

-7

-6

-5

-4

-3

-2

-1

0

+1

12 years or older (response i)

-8

-7

-6

-5

-4

-3

-2

-1

0

No skills demonstrated (response j)

+1

+2

+3

+4

+5

+6

+7

+8

+9


Age appropriate (response k)

0

0

0

0

0

0

0

0

0

Step 5    Scores for functional domains 9 and 10

                Calculate the child’s scores for functional domains 9 and 10 by:

                (a)    copying the responses for each functional domain in the questionnaire into the following table; and

               (b)    allocating a score of +2 for each response marked M-10k and M-10l; and

                (c)    allocating a score of +1 for all other responses marked; and

               (d)    adding up the score for each functional domain.

         (2)   Copy the scores into column 2 of the table in step 6.

Functional domain

 

Score

(allocate a score of 1 for each response marked)

Functional domain 9

 

 

M-9a

 

                                   

M-9b

 

                                   

M-9c

 

                                   

M-9d

 

                                   

M-9e

 

                                   

M-9f

 

                                   

Total:

 

                                   

Functional domain 10

 

 

M-10a

 

                                   

M-10b

 

                                   

M-10c

 

                                   

M-10d

 

                                   

M-10e

 

                                   

M-10f

 

                                   

M-10g

 

                                   

M-10h

 

                                   

M-10i

 

                                   

M-10j

 

                                   

M-10k

 

                                   

M-10l

 

                                   

M-10m

 

                                   


M-10n

 

                                   

M-10o

 

                                   

Total:

 

                                   

Step 6    Interim treating health professional questionnaire score

         (1)   Calculate the questionnaire weighting in column 3 of the following table by dividing each score in column 2 by 2.

         (2)   Calculate the milestone weighted scores in column 4 for functional domains 1, 2, 3, 5, 6 and 7 by multiplying the score for each domain in column 3 by 10 and then dividing the result by 10.

         (3)   Calculate the milestone weighted scores for functional domains 4 and 8 by multiplying the score for each domain in column 3 by 10 and then dividing the result by 9.

         (4)   Calculate the self care score in column 5 by adding the scores in column 4 for functional domains 3, 4 and 5, and dividing the result by 3.

         (5)   The raw scores in column 6 are the following:

                (a)    the scores in column 4 for functional domains 1 and 2;

               (b)    the self care skills score in column 5;

                (c)    the scores in column 4 for functional domains 6, 7 and 8.

         (6)   Calculate the functional weighting in column 7 by multiplying the score in column 6 for functional domain 1 by 1.2, and multiplying the score in column 6 for functional domain 10 by 2.

         (7)   The total scores in column 8 are as follows:

                (a)    the scores in column 7 for functional domains 1 and 10;

               (b)    the scores in column 6 for the remaining functional domains.

         (8)   Calculate the interim treating health professional questionnaire score by adding the total weighted scores in column 8 together.


 

Functional domain

Scores in steps 2 to 5

Questionnaire weighting

Milestone weighting

Self care skills score

Raw score for each domain

Functional weighting

Total weighted score

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 


7

 

 

 

 

 

 

 

8

 

 

 

 

 

 

 

9

 

 

 

 

 

 

 

10

 

 

 

 

 

 

 

Interim treating health professional score

 

 

 

Step 7    Age amended treating health professional score

                If the child is 12 years or older, calculate an age amended treating health professional score by completing the following steps.

Treating health professional score

Score

Interim treating health professional questionnaire total score from step 6:

                       

If child is aged 12 years but less than 15 years, take 1 away from the interim treating health professional total score:

                       

OR

 

If the child is aged 15 years or over, take 1.5 away from the interim treating health professional total score:

                       

Age amended treating health professional total score:

                       

Note   If, after completing step 7, the age amended treating health professional total score is greater than 0, the child satisfies the criteria. Otherwise, continue to step 8.

Step 8    Age amended treating health professional total score

         (1)   Calculate an age amended score using the following tables if:

                (a)    the age amended treating health professional total score mentioned in the table in step 7 is less than or equal to 0; and

               (b)    the child is between:

                          (i)    5 years, 9 months of age and 6 years of age; or

                         (ii)    8 years, 9 months of age and 9 years of age; or

                         (iii)    11 years, 9 months of age and 12 years of age; or

                        (iv)    14 years, 9 months of age and 15 years of age.

         (2)   Copy the scores obtained from steps 2 to 5 into column 2 of the following table.

         (3)   Calculate the new scores in column 3 of the table as follows:

                (a)    if a score in column 2 is less than or equal to 0, calculate the corresponding score in column 3 by adding 1 to the score in column 2;

               (b)    if a score in column 2 is greater than 0, copy the score into column 3.


         (4)   Using the scores in column 3, repeat steps 6 and 7, and calculate the new age amended treating health professional total score.

Functional domain

Original scores from steps 2 to 5

Calculation of new score

Recalculation of age amended treating health professional total score

1

 

 

 

2

 

 

 

3

 

 

 

4

 

 

 

5

 

 

 

6

 

 

 

7

 

 

 

8

 

 

 

 Step 9   Qualifying rating

                To contribute to the qualifying rating, the age amended treating health professional total score must be greater than 0.


Schedule 3        List of Recognised Disabilities

(section 7))

Part 1 Recognised Disabilities

1.         Moderate to severe multiple disability or moderate to severe physical disability (including neurological disability) where the child is, or is likely to be, dependent for mobility indoors and outdoors from the age of 3 onwards.

Example: A child who has cerebral palsy, lower limb deficiencies or spina bifida and is dependent on a stroller, wheelchair, crutches or walking frame.

2.         Severe multiple or physical disability (including uncontrolled seizures) requiring constant care and attention where the child is less than 6 months of age.

3.         Epilepsy (uncontrolled while on medication).

4.         Chromosomal or syndromic conditions that are not specified elsewhere in this Part and where there is moderate or severe intellectual disability and/or multiple, major and permanent physical abnormalities as diagnosed by a paediatrician, paediatric subspecialist or clinical geneticist.

5.         Neurometabolic degenerative conditions including lysosomal storage disorders where there is moderate or severe intellectual and/or moderate or severe physical disability and where the condition is diagnosed by a paediatrician, paediatric sub-specialist or clinical geneticist.

6.         Neurodegenerative disorders where there is moderate or severe intellectual and/or moderate or severe physical disability and where the condition is diagnosed by a paediatrician, paediatric sub-specialist or clinical geneticist.

7.         Any of the following neuromuscular conditions:

(a)        Duchenne (or Becker) muscular dystrophy;

(b)        Autosomal recessive muscular dystrophy;

(c)        Spinal muscular atrophy conditions (e.g. Werdnig‑Hoffman);

(d)        Friedreich’s ataxia.

8.         Moderate, severe, or profound intellectual disability where IQ is less than 55, (including a child with a known syndrome).


9.         Autistic Disorder or Asperger’s Disorder (not including Pervasive Developmental Disorder not otherwise specified) when diagnosed by a psychiatrist, developmental paediatrician, or a psychologist experienced in the assessment of Pervasive Developmental Disorders and using the current Diagnostic and Statistical Manual of Mental Disorders (DSM).


10.       The following conditions diagnosed by a psychiatrist using the current DSM:

(a)        Child Disintegrative Disorder;

(b)        Major depression of childhood;

(c)        Childhood schizophrenia.

11.       Any of the following sensory impairments:

(a)        Bilateral blindness where:

(i)         visual acuity is less than or equal to 6/60 with corrected vision; or

(ii)        visual fields are reduced to a measured arc of less than 10 degrees;

(b)        Hearing loss - a 45 decibels or greater hearing impairment in the better ear, based on a 4 frequency pure tone average (using 500, 1000, 2000 and 4000Hz);

(c)        Deaf-blindness - diagnosed by a specialist multidisciplinary team, including a professional audiological and opthalmological evaluation.

12.       The following dermatological conditions:

(a)        Epidermolysis Bullosa Dystrophica;

(b)        The following types of Ectodermal Dysplasias:

(i)         Hypohidrotic ectodermal dysplasia (synonym: anhidrotic ectodermal dysplasia);

(ii)        Hay Wells syndrome (synonym: ankyloblepharon, ectodermal dysplasia and clefting [AEC] syndrome);

Note: These are specific terms and do not apply to other ectodermal dysplasia which may have some degree of reduced sweating.

(c)        The following severe congenital ichthyoses:


(i)         Lamellar ichthyosis;

(ii)        Harlequin ichthyosis;

(iii)       Sjogren Larsson syndrome;

(iv)       Netherton syndrome;

(v)        Severe congenital ichthyosiform erythroderma;

(vi)       Generalised bullous ichthyosis (synonym: bullous ichthyosiform erythroderma, epidermolytic hyperkeratosis).

13.       Phenylketonuria (PKU).

14.       Other inborn errors of metabolism not specified elsewhere in this Part that are treated by medically prescribed diet to prevent neurological disability and/or severe organ damage.

15.       Cystic Fibrosis.

16.       Moderate to severe Osteogenesis Imperfecta with two or more fractures per year and/or significant pain that significantly limits activities of daily living.

17.       Down syndrome.

18.       Fragile X syndrome.


 

Part 2 Medical Conditions

1.         Chronic or end stage organ failure where the child is receiving organ specific treatment and/or awaiting transplant.

2.         HIV/AIDS where the child is symptomatic (in addition to having lymphadenopathy) and requires treatment with a three or more drug antiviral regimen.

3.         Immunodeficiency where the child requires regular immunoglobin infusions.

4.         The following Haematological/Oncological Conditions:

(a)        Leukaemia, Haemophagocytic Lymphohistiocytosis and other childhood malignancies where the child is undergoing chemotherapy, radiotherapy or palliative care;


(b)        Haemophilia with Factor VIII or Factor IX deficiency (less than            10%);

(c)        Thalassaemia or Haemoglobinopathy requiring chelation            therapy;

(d)        Chronic Transfusion Dependent Anaemia requiring chelation therapy;

(e)        Langerhan Cell Histiocytosis: disseminated (multi-organ) disease requiring chemotherapy for longer than 6 months;

(f)         Severe congenital Neutropenia (Kostman’s variant, dependent on Filgrastin).

5.         The following Chronic Respiratory Conditions:

(a)        Chronic Respiratory Disease requiring home oxygen;

(b)        A condition where the child is dependent for his or her health on an external apparatus/machine called a ventilator to assist with breathing, either on a continuous or intermittent basis;

(c)        Long term tracheostomy where the child is cared for at home.

6.         Severe atopic dermatitis which involves at least 75% of the body surface and which has required two or more hospitalisations of at least 5 days duration in the previous calendar year, and/or the use of immunosuppressive therapy.

7.         Significant burn where more than 30% of body surface area is affected, or a lesser burn where there is significant impairment of function of the hands or feet or assistance is required with feeding or toileting to a greater degree than is age appropriate for the child.

8.         Gastroenterological condition or other medical condition requiring total parenteral nutrition for an extended period, with medical treatment and medical supervision required for at least 12 months.

9.         Final stage of Ulcerative Colitis where the condition is no longer responding to medical treatment and where a sub‑total colectomy and ileo-rectal anastomosis with formation of a J-pouch is required.

10.       Polyarticular course Juvenile Arthritis requiring regular multi-disciplinary therapy, including immunosuppressive medication.

11.       Diabetes Mellitus Type 1 (where the young person is under 10 years of age).


 

Note

1.       All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See http://www.frli.gov.au