Preparation and Support Summary for Your NDIS Planning Meeting

Name:

Date of meeting:

Present at meeting:

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My Life Needs What are your current goals & hopes?

Physical health

Recreation, leisure & holidays

Work or Community

participation

Home & home help

Who supports you/your child?

How do you look after your/your child’s health?

What are your/your child’s hobbies and interests?

What do you & your family enjoy doing?

Do you and your family take trips/holidays?

Do you/your family need a break?

How do you manage your home and household tasks?

Do you/your child need any assistance in the home?

Do you/your child experience any pain or discomfort?

Who are the most important people in your/your child’s life?

How do you/your child spend time day to day?

What activities do you/your child hope to do in the future?

Do you/your child need support with personal care?What activities/tasks

do you/your child have difficulties doing?

Money management &

Financial planning

Spirituality

Emotional wellbeing

Learning & Education

Travel & Transport

What is important to you about money?

How do you/your child get around?

Do you/your child need any assistance with travel?

What is important to you and your family?

What has been the impact on you/your family of receiving the diagnosis of disability?

Do you/your child need assistance with learning or life skills?

Do you need any assistance with managing money, funding or finances?

How do you make sense of what you are going through?

How are you feeling about what’s happening with you or your child at the moment?

What do you/your child dream of achieving in life?

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My CP Check-Up™ What are your current needs or concerns with managing your disability?

Assessment

Intervention

Referral to:

Assessment

Intervention

Referral to:

Assessment

Intervention

Referral to:

My/Family concerns in this area:

My/Family concerns in this area:

My/Family concerns in this area:

My cerebral palsy If known, what type of cerebral palsy do you/ your child have?

spastic hemiplegia spastic diplegia spastic quadriplegia dystonia athetosis ataxia generalised hypotonia

If unknown, what part(s) of the body are involved? Please indicate on stick figure.

Using GMFCS E&R, how do you/your child move around? (GMFCS E&R):

Level 1 Level 2 Level 3 Level 4 Level 5

My general health & wellbeing Do you have any worries or concerns about your/your child’s general health? Y / N

Do you/your child experience pain? Y / N

Do you/your child have difficulties with sleep? Y / N

Do you/your child have difficulties with continence/constipation? Y / N

Do you/your child take any medications? Y / N

Do you have concerns about your/your child’s vision? Y / N

Do you have concerns about your/your child’s hearing? Y / N

Do you/your child have any difficulties with epilepsy? Y / N

Do you have any worries or concerns about how you/your child is coping at the moment? Y / N

Do you have any worries or concerns about how other family members are coping at the moment? Y / N

Do you have concerns about how you and your partner are going as a couple at the moment? Y / N

Child specific:

Do you have any worries or concerns about taking care of your child with cerebral palsy or their siblings? Y / N

My mobility & independence Do you have any worries or concerns about your/your child’s gross motor skills? Y / N

Do you/your child use any splints or orthotics for arms/hands? Y / N

If yes, do you have any concerns with how these are fitting/being used? Y / N

Have you/your child had or are due to have botulinum toxin injections in the arms? Y / N If yes, when?_____/_____/_____

Do you/your child use any splints or orthotics for legs/feet? Y / N

If yes, do you have any concerns with how these are fitting/being used? Y / N

Have you/your child had or are due to have botulinum toxin injections in the legs? Y / N If yes, when?_____/_____/_____

When was your/your child’s last hip x-ray done_____/_____/_____

Have you/your child had any surgery for the legs and feet or is any surgery planned? Y / N

Are you aware of any changes in the alignment of your/your child’s spine? Y / N

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R L

Assessment

Intervention

Referral to:

Assessment

Intervention

Referral to:

Assessment

Intervention

Referral to:

My/Family concerns in this area:

My/Family concerns in this area:

My/Family concerns in this area:

My technology, equipment & independenceDo you have any worries or concerns about your/your child’s hand (fine motor) skills? Y / N

Do you have any worries or concerns about your/your child’s self-care skills? Y / N

Using MACS how do you/your child use your/their hands?

Level 1 Level 2 Level 3 Level 4 Level 5

Do you/your child use any aids or equipment? Y / N

Do you currently have any questions about the use and access to assistive technology e.g. equipment provision, seating, powered mobility, computer access, and communication? Y / N

Do you currently have any questions about transport e.g. car seat, vehicles, getting around? Y / N

Do you currently have any questions about environmental modifications e.g. home setup & access? Y / N

My swallowing & communicationDo you/your child have any concerns with communication? Y / N

Using CFCS how do you or your child communicate?

Level 1 Level 2 Level 3 Level 4 Level 5

How do you/your child communicate?

Verbal Non-verbal Combination of verbal &

augmented communication

Do you/your child find it difficult to get the message across? Y / N

Do you/your child seem to get frustrated if can’t get a message across? Y / N

Do you have any worries or concerns about your/your child’s mealtimes/swallowing? Y / N

Do you/your child have difficulties swallowing food? Y / N

Do you/your child have difficulties drinking? Y / N

Does it take more than 25 minutes for you/your child to have a meal? Y / N

Are you concerned about your/your child’s weight? Y / N

Are you concerned about your/your child’s nutrition? Y / N

Do you/your child have difficulty in managing saliva? Y / N

My learning & participationDo you currently have any questions about your/your child’s progress or general development? Y / N

Do you have any concerns with you or your child’s thinking or learning skills? Y / N

Do you have any concerns about your/your child’s self-esteem, feelings or emotions? Y / N

Do you have any concerns about your/your child’s behaviour? Y / N

Do you have any concerns about how you/your child get along with others? Y / N

Would you like the opportunity to connect up with others e.g parents, families and/ or people with cerebral palsy? Y / N

Do you need any information about funding, resources and other supports available for you/your child or family? Y / N

Would you like support with your/your child’s participation in community activities e.g. sport, leisure, play? Y / N

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Monday Tuesday Wednesday Thursday Friday Saturday Sunday

MORNING

Current services & supports

Future needs for services & supports

DAYTIME

Current services & supports

Future needs for services & supports

AFTERNOON

Current services & supports

Future needs for services & supports

EVENING

Current services & supports

Future needs for services & supports

My formal & informal supports & services

(Include detail of type of service/support & number of hours this service/support is provided/needed)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

MORNING

Current services & supports

Future needs for services & supports

DAYTIME

Current services & supports

Future needs for services & supports

AFTERNOON

Current services & supports

Future needs for services & supports

EVENING

Current services & supports

Future needs for services & supports

Additional notes

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Current Aids & Equipment

Type of aid/equipment How often is the aid/equipment used?

How well is it working? Action

Assessment

Intervention

Assessment

Intervention

Assessment

Intervention

Assessment

Intervention

Type of aid/equipmentWhat is the purpose

of the aid/equipment/where will it be used?

How often is the aid/equipment to be used? Action

Assessment

Intervention

Assessment

Intervention

Assessment

Intervention

Assessment

Intervention

Do you feel you will need support/assistance to coordinate your plan and/

or your personal budget?

Any reports or materials to take with you to your appointment?

Some suggestions:

Medical Reports

Therapy Reports

Existing Individual/Family Service Plans

Other:

What are you hoping for or expecting from the National Disability

Insurance Agency (NDIA) as your funding support provider?

What are you hoping for or expecting from Cerebral Palsy Alliance as

your service provider?

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Questions (that you raised with Cerebral Palsy Alliance) to remember for your appointment:

Notes

Cerebral Palsy Alliance uses National Carbon Offset Standard certified printed products

This printed product is certified carbon neutral under the Australian Government’s Carbon Offset Standard.

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Therapy

Lifestyle support

Aids and equipment

Technology

Communication

Behavioural support

Employment

Training

We have centres throughout NSW and ACT - visit to find

your nearest service.

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