Disability Care Load Assessment (Child) Determination 2009 (Cth)
Disability Care Load Assessment (Child) Determination 20091
Social Security Act 1991
I, Dr Jeff Harmer, Secretary of the Department of Families, Housing, Community Services and Indigenous Affairs, make this Determination under section 38E of the Social Security Act 1991.
Dated 26 June 2009
JEFF HARMER
Secretary of the Department of Families, Housing, Community Services and Indigenous Affairs
Part 1 Preliminary
Name of Determination
This Determination is the Disability Care Load Assessment (Child) Determination 2009.
Commencement
This Determination commences on 1 July 2009.
Interpretation
In this Determination:
ACL means assessment of care load.
ACL questionnaire means an assessment of care load questionnaire mentioned in subsection 6 (1).
Act means the Social Security Act 1991.
child means a person aged under 16.
claimant means a person mentioned in subsection 6 (2).
contributing ACL means an ACL questionnaire whose total score contributes to a qualifying rating.
contributing professional questionnaire means a professional questionnaire whose total score contributes to a qualifying rating.
domain means a particular category of questions in the ACL questionnaire or the professional questionnaire.
professional questionnaire means a questionnaire mentioned in subsection 6 (3).
qualifying ACL score means a score mentioned in paragraph 7 (a), that is 1 of the scores used to determine a qualifying rating.
qualifying professional questionnaire score means a score mentioned in paragraph 7 (b), that is one of the scores used to determine a qualifying rating.
qualifying rating means a rating mentioned in section 7, that must be achieved by a claimant for that claimant to be qualified to receive a carer payment under the Act for the care of a child aged under 16.
Note Some expressions used in this determination are defined in the Act, including:
· lower ADAT score adult
· officer
· Secretary
· treating health professional.
Delegation
The Secretary may, in writing, delegate to an officer all or any of the powers of the Secretary under this Determination.
Disability assessment components
Part 2 of this Determination sets out the Disability Care Load Assessment (Child).
Part 2 Disability Care Load Assessment (Child)
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 may be completed only by a person (the claimant) seeking to claim a carer payment under the Act for the care of a child.
(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 may be completed only by a treating health professional.
Rating method
A claimant will achieve a qualifying rating of intense if:
(a) for each ACL questionnaire, the sum of the scores in each domain that the claimant receives on the ACL questionnaire is a qualifying ACL score; and
(b) the score on the completed professional questionnaire is a qualifying professional questionnaire score.
ACL questionnaire
Scoring method
(1) The questions in the ACL questionnaire are grouped into 4 categories (domains):
(a) 2 Behavioural domains;
(b) Functional Abilities domain;
(c) Special Care Needs domain.
Note The Functional Abilities and Special Care Needs domains are further divided into subdomains.
(2) If a claimant marks more than 1 answer to any question, only the answer that gives the highest score will be taken.
(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 add additional points to the scores for the Behavioural and Functional Abilities domains.
(7) Additional points may only be added by the Secretary to the scores for these domains to reflect unaccounted for care load that is not presently recognised by the ACL questionnaire.
(8) The Secretary must not do the following:
(a) add more than 4 points to the first Behaviour domain, or add more than 7 points to the second Behaviour domain;
(b) add more than 11 points to the Functional Abilities domain;
(c) add any further points to the Special Care Needs domain.
Note The value of additional points that may be added by the Secretary to a domain is equivalent to adding the highest score from 1 extra question in each of the first 3 domains.
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 in 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.
Carer of a child with severe disability or severe medical condition
(1) If a claimant is caring for a child with a severe disability or severe medical condition:
(a) a professional questionnaire must be completed for the child; and
(b) the claimant must complete an ACL questionnaire for the child.
(2) A claimant achieves a qualifying rating of intense if:
(a) the total score for the ACL questionnaire is a qualifying ACL score of 85 or more; and
(b) the score on the professional questionnaire is a qualifying professional questionnaire score of greater than 0.
Combined care of 2 or more children with a disability or medical condition
(1) If a claimant is caring for 2 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:
(a) 1 professional questionnaire must be completed for each child; and
(b) the claimant must complete an ACL questionnaire for each child.
(2) No more than 4 contributing ACLs and 4 contributing professional questionnaires can be used to contribute to a qualifying rating.
(3) A claimant 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 ACL score for that ACL questionnaire is 20 or more.
Carer of 1 or more children with a disability or medical condition and a lower ADAT score adult
(1) This section applies if:
(a) a claimant is caring for 1 or more children with a disability or medical condition and a lower ADAT score adult; and
(b) the adult has been assessed and rated under the Adult Disability Assessment Tool and given a score under that assessment tool of at least 20, being a score calculated on the basis of a total professional questionnaire score of at least 8.
(2) 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.
(3) For subsection (2), the adult is taken to contribute 40 to the total combined score for the contributing ACLs.
(4) No more than 2 contributing ACLs and 2 contributing professional questionnaires can be used to contribute to a qualifying rating.
(5) For subsection (2), an ACL questionnaire is a contributing ACL only if the total ACL score for that ACL is 20 or more.
Schedule 1 Questionnaires
(section 6)
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 number | Question | Response | Answer code |
| 1 | Does the child have extreme difficulty settling before going to sleep at night (eg it usually takes more than an hour before the child is settled at night)? | The child never has difficulty settling before going to sleep at night | a |
| The child rarely has difficulty settling before going to sleep at night | b | ||
| The child sometimes has difficulty settling before going to sleep at night | c | ||
| The child regularly (almost every night) has difficulty settling before going to sleep at night | d | ||
| 2 | Does the child have extremely disrupted sleep at night (eg the child wakes up multiple times during the night, has nightmares etc)? | The child never has disrupted sleep at night | a |
| The child rarely has disrupted sleep at night | b | ||
| The child sometimes has disrupted sleep at night | c | ||
| The child regularly (ie almost every night) has disrupted sleep | d | ||
| 3 | Does the child display behaviours associated with extreme irritability (eg cries persistently and excessively, is not able to be settled or consoled etc)? | The child does not display irritable behaviours | a |
| The child rarely displays irritable behaviours | b | ||
| The child sometimes displays irritable behaviours | c | ||
| The child regularly displays irritable behaviours | d | ||
| 4 | Please indicate whether the child’s speech and language abilities are similar to other children of the same age | The child’s speech and language abilities are similar to or just below those of children of the same age. Go to question 5 | a |
| The child’s speech and language abilities are significantly less than those of children of the same age. Please indicate how the child usually communicates | b | ||
| The child can talk but can only be understood by me or others who have been trained to interpret the child’s speech and language | b1 | ||
| The child cannot talk but can communicate his or her needs and wants in other ways (eg signing, pictures, gestures or a communication device with or without support) | b2 | ||
| The child cannot talk – he/she cannot communicate his/her needs and wants in a way that can be understood by people other than me OR the child cannot communicate his/her needs and wants at all. | b3 | ||
| 5 | Please indicate whether the child’s intellectual abilities (eg memory, problem solving) are similar to other children of the same age | The child has intellectual abilities similar to other children of the same age. Go to question 6. | a |
| The child’s intellectual abilities are less than other children of the same age. Please indicate the level of prompting or supervision that the child requires to complete simple daily activities | b | ||
| The child requires prompting (repetition, reminders) some of the time to complete simple daily activities | b1 | ||
| The child requires prompting most of the time to complete simple daily activities | b2 | ||
| The child requires constant one-to-one direction to complete simple daily activities | b3 | ||
| 6 | Please indicate how the child interacts with other children of a similar age | The child interacts with other children in the same way as other children. Go to question 7 | a |
| The child does not interact with other children in the same way as other children. Please indicate how the child interacts with other children | b | ||
| The child requires occasional assistance from an adult to resolve problems/conflicts or to communicate with other children | b1 | ||
| The child interacts with other children appropriately with some coaxing/prompting, but requires adult supervision | b2 | ||
| The child needs a helper to initiate interactions and prevent and resolve conflicts | b3 | ||
| The child is not able to interact with other children | b4 |
Domain B — Behaviour 2
The following questions are only to be completed by a claimant claiming carer payment for a child aged over 12 months, if the claimant considers that his or her child has more behaviour problems than other children of the same age. The claimant must select only the response that best describes the child’s behaviour and the impact it has on the claimant during the day and the night. If the child’s condition changes from day to day, the claimant must tick the response based on the child’s behaviour when the child’s condition is at its worst.
| Question number | Question | Response | Answer code |
| 7 | Does the child wander away from you or abscond? | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 8 | Is the child verbally disruptive or noisy, for example, the child uses abusive language, makes threats to other people including family members or causes sufficient noise (vocal, non-vocal or both) to disturb other people/family? | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 9 | Is the child physically aggressive and harms others including family members using physical conduct such as hitting, pushing, kicking or biting? | This never happens. The child does not have a problem in this area. I never need to intervene and/or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 10 | Does the child get extremely emotionally distressed and shows that distress by, for example, intense crying OR screaming OR emotional withdrawal OR anxiety OR intense fear? | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 11 | Does the child behave in ways that other people/family think is bizarre or unusual? This may include odd rituals OR repetitive OR obsessive behaviours OR behaviours that indicate that the child is out of touch with reality. | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 12 | Does the child display high-risk and reckless behaviour, and is a danger to himself/herself or others including family members? As a consequence, the child requires supervision and actions such as locking gates, doors and windows to help manage these behaviours. | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 13 | Does the child display self-harm behaviours (intentional or unintentional) that require you to supervise or intervene? | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d | ||
| 14 | Does the child exhibit sexually inappropriate behaviour such as exposing his/her body inappropriately to others including family members or using sexually inappropriate verbal communication? | This never happens. The child does not have a problem in this area. I never need to intervene or supervise because of this type of behaviour. | a |
| This rarely happens. On some occasions I need to intervene or supervise the child to avoid specific situations or triggers that lead to this behaviour. This does not happen very often. | b | ||
| This happens sometimes. I sometimes need to avoid specific situations or triggers that lead to this behaviour, but it does not happen every day. | c | ||
| This happens much or all of the time. I need to constantly (ie every day) supervise the child and avoid specific situations or triggers that lead to this behaviour. | d |
Division 2 Functional Abilities domain
The following questions are only to be completed by a claimant claiming carer payment for a child aged over 12 months, if the claimant considers that his or her child has more problems doing everyday tasks (eg eating, grooming, bathing, using the toilet) than other children of the same age. The claimant must select only the response that best describes the child’s ability. Responses must be based on what the child does, taking into account 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, responses must be based on the child’s ability when the child’s condition is at its worst.
Domain C — Functional abilities — subdomain 1
| Question number | Question | Response | Answer code |
| 15 | Does the child use a spoon, fork or cup? | The child feeds himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help with feeding | b | ||
| The child requires me to provide considerable physical help with feeding | c | ||
| The child is bottle fed OR is completely dependent and requires me to feed him/her | d | ||
| 16 | Does the child do everyday grooming tasks (eg brush teeth, brush/comb hair, wash and rinse hands and face)? | The child grooms himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help with grooming | b | ||
| The child requires me to provide considerable physical help with grooming. | c | ||
| The child is completely dependent and requires me to do all of his/her grooming | d | ||
| 17 | Does the child bathe himself/herself from the neck down (except for his/her back) in a bath, shower, or sponge/bed bath? | The child bathes himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help with bathing | b | ||
| The child requires me to provide considerable physical help with bathing | c | ||
| The child is completely dependent and requires me to bathe him/her | d | ||
| 18 | Does the child dress himself/herself from the waist up? | The child dresses himself/herself from the waist up and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help with dressing from the waist up | b | ||
| The child requires me to provide considerable physical help with dressing from the waist up | c | ||
| The child is completely dependent and requires me to dress him/her | d | ||
| 19 | Does the child dress himself/herself from the waist down? | The child dresses himself/herself from the waist down and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help with dressing from the waist down | b | ||
| The child requires me to provide considerable physical help with dressing from the waist down | c | ||
| The child is completely dependent and requires me to dress him/her | d | ||
| 20 | Does the child wear nappies or incontinence pads during the day? | No. Go to question 20a. | |
| Yes. Mark answer code y for questions 20a, 21, 22 and 23 | |||
| 20a | Does the child wipe himself/herself and adjust his/her clothing before and after using the toilet? | The child uses the toilet and adjusts his/her clothing before and after using the toilet. I do not need to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help when he/she uses the toilet | b | ||
| The child requires me to provide considerable physical help when using the toilet. This includes adjusting clothing before and after using the toilet | c | ||
| The child is completely dependent and requires me to wipe him/her and adjust clothing before and after using the toilet | d | ||
| The answer to question 20 is yes | y |
Domain C — Functional abilities — subdomain 2
| Question number | Question | Response | Answer code |
| 21 | Does the child have bladder accidents? | The child never has bladder accidents and is able to control his/her bladder functions without help from me | a |
| The child has occasional bladder accidents during the day or during the night, but not both | b | ||
| The child has occasional bladder accidents during the day and during the night | c | ||
| The child has frequent bladder accidents during the day or during the night | d | ||
| The child is completely incontinent and requires me to assist him/her with his/her bladder functions (eg requires a catheter) | e | ||
| The answer to question 20 is yes | y | ||
| 22 | Does the child have bowel accidents? | The child never has bowel accidents and is able to control his/her bowel functions without help from me | a |
| The child has occasional bowel accidents during the day or during the night, but not both | b | ||
| The child has occasional bowel accidents during the day and during the night | c | ||
| The child has frequent bowel accidents during the day or during the night | d | ||
| The child is completely incontinent and requires me to assist him/her with his/her bowel functions (eg requires an enema) | e | ||
| The answer to question 20 is yes | y |
Domain C — Functional abilities — subdomain 3
| Question number | Question | Response | Answer code |
| 23 | Does the child sit down and get up from the toilet? | The child can sit down and get up from a toilet by himself/herself and does not require help from me | a |
| The child requires me to provide supervision with or without a small amount of physical help to sit down and get up from a toilet | b | ||
| The child requires me to provide considerable physical help to sit down and get up from a toilet | c | ||
| The child cannot sit on a toilet OR requires me to place him/her on the toilet and lift him/her off it | d | ||
| The answer to question 20 is yes | y | ||
| 24 | Does the child sit down and get up from a chair or wheelchair? | The child can sit down and get up from a chair or wheelchair himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help to sit down and get up from a chair or wheelchair | b | ||
| The child requires me to provide considerable physical help to sit down and get up from a chair or wheelchair | c | ||
| The child cannot sit in a chair OR is completely dependent and requires me to place him/her in a chair or wheelchair and lift him/her out of it | d | ||
| 25 | Does the child get into or out of a bath or shower (whichever is used more often)? | The child can get into or out of a bath or shower and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help to get into or out of a bath or shower | b | ||
| The child requires me to provide considerable physical help to get into or out of a bath or shower | c | ||
| The child is completely dependent and requires me to help him/her get into or out of a bath or shower | d | ||
| 26 | Please indicate how the child usually moves around by selecting the most appropriate response: | The child moves around by walking. | a |
| The child moves around by using a wheelchair or other mobility aids | b | ||
| The child moves around by crawling | c | ||
| The child is not able to move around by himself/herself | d | ||
| 27 | Does the child move around by himself/herself indoors on a level surface? | The child moves around indoors on a level surface by himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help when moving around indoors on a level surface | b | ||
| The child requires me to provide considerable physical help when moving around indoors on a level surface | c | ||
| The child cannot move around indoors by himself/herself | d | ||
| 28 | Does the child move around by himself/herself outdoors on uneven surfaces? | The child moves around outdoors on uneven surfaces by himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help to move around outdoors on uneven surfaces | b | ||
| The child requires me to provide considerable physical help to move around outdoors on uneven surfaces | c | ||
| The child cannot move around outdoors | d | ||
| 29 | Does the child go up and down stairs? | The child can go up and down 12 steps indoors himself/herself and does not require me to provide any help | a |
| The child requires me to provide supervision with or without a small amount of physical help to go up and down 12 steps indoors | b | ||
| The child requires me to provide considerable physical help to go up and down 12 steps indoors | c | ||
| The child cannot go up or down stairs | d |
Division 3 Special care needs domain
The following questions should be completed in relation to a child of any age who has special care needs. The responses should be based on when the child’s condition is at its worst. The claimant must select only the response that best describes the child’s behaviour.
Domain D — Special care needs — subdomain 1
| Question number | Question | Response | Answer code | |
| 30 | Does the child use any of the following to aid breathing? a ventilator (mechanically assisted breathing device) a tracheostomy CPAP/BiPAP (If the child uses a puffer/Ventolin please indicate at question 51) | No Yes | a b | |
| 31 | Does the child receive dialysis? | No. Go to next question | a | |
| Yes. Please indicate where the child receives dialysis: | b | |||
| At your home | b.1 | |||
| In a hospital clinic/dialysis centre | b.2 | |||
| 32 | Do you provide TPN (Total Parenteral Nutrition) for the child? TPN is a technique in which nutrients are given to a person through a tube directly into his or her veins, usually because he or she cannot digest regular food. | No Yes | a b | |
| 33 | Do you do postural drainage for the child? | No. Go to next question | a | |
| Yes. Please indicate how often you do postural drainage for the child | b | |||
| During the day Less than daily | b.1 | |||
| Once or twice a day | b.2 | |||
| Three or more times a day | b.3 | |||
| During the night (ie 10pm to 6am) | ||||
| Less than nightly | b.4 | |||
| Once a night | b.5 | |||
| Two or more times a night | b.6 | |||
| 34 | Do you do suctioning (eg to clear the airways of mucus or saliva) for the child? | No. Go to next question | a | |
| Yes. Please indicate how often you do suctioning for the child | b | |||
| During the day Less than daily | b.1 | |||
| Once or twice a day | b.2 | |||
| Three or more times a day | b.3 | |||
| During the night (ie 10pm to 6am) Less than nightly | b.4 | |||
| Once a night | b.5 | |||
| Two or more times a night | b.6 | |||
| 35 | Do you physically assist or position the child’s jaw to help with chewing or swallowing? | No. Go to next question | a | |
| Yes. Please indicate how often you physically assist with chewing or swallowing | b | |||
| Less than daily | b.1 | |||
| Once or twice a day | b.2 | |||
| Three or more times a day | b.3 | |||
| 36 | Do you PEG feed or use a feeding tube to feed the child? | No. Go to next question | a | |
| Yes. Please indicate how often you PEG feed or use a feeding tube for the child over a 24 hour period | b | |||
| Less than daily | b.1 | |||
| Once or twice a day | b.2 | |||
| Three or more times a day, or continuous | b.3 | |||
| 37 | Do you provide physical assistance to turn or position the child because he/she is unable to do so independently? | No. Go to question 38 | a | |
| Yes. Please indicate how often you physically assist the child to turn or position him/herself | b | |||
| During the day, less than daily | b.1 | |||
| During the day, once or twice a day | b.2 | |||
| During the day, three or more times a day | b.3 | |||
| During the night (ie 10pm to 6am), less than nightly | b.4 | |||
| During the night, once a night | b.5 | |||
| During the night, two or more times a night | b.6 | |||
| 38 | Do you manage any wounds or dressings for the child? | No. Go to question 39 | a | |
| Yes. Please indicate how much time you spend managing wounds or dressings for the child | b | |||
| Less than 30 min per day | b.1 | |||
| 30-60 min per day | b.2 | |||
| 1-2 hours per day | b.3 | |||
| More than 2 hours per day | b.4 | |||
| 39 | Do you provide care or interventions for poorly controlled major seizures? | No. Go to question 40 | a | |
| Yes. Please indicate how often you provide care or interventions for poorly controlled seizures for the child | b | |||
| Less than monthly | b.1 | |||
| Once or twice a month | b.2 | |||
| Three or more times a month | b.3 | |||
| 40 | Do you provide stoma care (eg colostomy, ileostomy) for the child? | No. Go to question 41 | a | |
| Yes. Please indicate how often you provide stoma care for the child over a 24 hour period | b | |||
| Less than daily | b.1 | |||
| Once or twice a day | b.2 | |||
| Three or more times a day | b.3 | |||
Domain D — Special care needs — subdomain 2
| Question number | Question | Response | Answer code |
| 41 | Do you prepare or administer medications related to the child’s medical condition? | No. Go to question 42 | A |
| Yes | B | ||
| Please indicate how many hours PER DAY on average you spend preparing or administering medications | |||
| 42 | Do you regularly travel to and from and attend health care or therapy appointments related to the child’s disability or medical condition multiple times per week? | No. Go to question 43a | A |
| Yes. Please indicate how many hours PER WEEK on average you spend taking the child to and from and attending health care appointments | B | ||
| 43 | Do you provide support with the child’s exercises, therapies, interventions (physical, psychological or emotional), blood testing OR aids, splints, garments or other equipment? | No | A |
| Yes. Please indicate how many hours PER WEEK on average you spend providing support with exercises, therapies, interventions, blood testing or aids, splints, garments or other equipment? | B |
Part 2 Professional questionnaire
Functional domains — abilities
For the functional domains numbered 1 to 8, the treating health professional must mark only the statement that describes the best ability that the child has in each functional domain. The child’s abilities include what the child can do when using the child’s aids, appliances or other special equipment items.
| Question | Response Code |
| 1 | Receptive language skills (listening, reading and understanding) |
| 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 |
| Child’s ability is age appropriate | M-1l |
| 2 | Expressive language skills (talking or signing) |
| 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 |
| Child’s ability is age appropriate | M-2l |
| 3 | Feeding and mealtime skills |
| 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 |
| Child’s ability is age appropriate | M-3l |
| 4 | Hygiene and grooming skills |
| 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 |
| Child’s ability is age appropriate | M-4k |
| 5 | Dressing skills |
| 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 |
| Child’s ability is age appropriate | M-5l |
| 6 | Social and community skills |
| 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 |
| Child’s ability is age appropriate | M-6l |
| 7 | Mobility — fine motor |
| 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 |
| Child’s ability is age appropriate | M-7l |
| 8 | Mobility — gross motor |
| 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 |
| Child’s ability is age appropriate | M-8k |
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 | M-10b |
| 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 has an inherited metabolic disorder that is being treated by medically prescribed diet as the basis of treatment so that it will not lead to neurological disability | M-10l |
| Child is assisted with the administration of medication on a daily basis to control seizures and medication does not substantially reduce the frequency of seizures and the child may require immediate or emergency attention to prevent harm resulting from a seizure | 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 |
Schedule 2 Rating methods
(section 7)
Part 1 Scoring for ACL questionnaire
Step 1 Terminal phase
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 1 b 2 c 3 d 10 2 a 1 b 2 c 3 d 10 3 a 1 b 2 c 3 d 10 4 a 1 b 0 b1 0 b2 10 b3 15 5 a 1 b 0 b1 2 b2 3 b3 15 6 a 1 b 0 b1 2 b2 2 b3 3 b4 15
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 6 0 7 to 15 15 16 to 24 24 25 to 33 37 34 to 100 56
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
7 a 1 b 2 c 3 d 15 8 a 1 b 2 c 3 d 10 9 a 1 b 2 c 3 d 20 10 a 1 b 2 c 3 d 15 11 a 1 b 2 c 3 d 10 12 a 1 b 2 c 3 d 40 13 a 1 b 2 c 3 d 40 14 a 1 b 2 c 3 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 7 0 8 to 16 16 17 to 35 35 36 to 100 100
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 |
| 15 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 16 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 17 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 18 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 19 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 20 | n | no score | |||
| y | no score | ||||
| 20a | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| if y at 20 | 1.09 |
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 |
| 21 | a | 4 | |||
| b | 3 | ||||
| c | 3 | ||||
| d | 2 | ||||
| e | 1 | ||||
| If y at 20 | 1.09 | ||||
| 22 | a | 4 | |||
| b | 3 | ||||
| c | 3 | ||||
| d | 2 | ||||
| e | 1 | ||||
| If y at 20 | 1.09 |
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 |
| 23 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| If y at 20 | 1.09 | ||||
| 24 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 25 | a | 4 | |||
| b | 3 | ||||
| c | 2 | ||||
| d | 1 | ||||
| 26 | a | No score | |||
| b | No score | ||||
| c | No score | ||||
| d | No score | ||||
| 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 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 15 15 20 to 35 35 40 to 55 55 60 to 75 75 80 to 130 100
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 | 69 to < 72 | 2 to < 75 | 75 to < 78 | 78 to < 81 | 81 to < 84 | > = 84 |
| Q15 Self care - 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 |
| Q16 Self care - 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 |
| Q17 Self care - 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 |
| Q18 Self care - 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 |
| Q19 Self care - 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 |
| Q20a Self care - 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 |
| Q21 Self care - 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 |
| Q22 Self care - 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 |
| Q23 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 |
| Q24 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 |
| Q25 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 |
| Q27 Mobility walk/ wheelchair (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 |
| Q28 Mobility walk/ wheelchair (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 |
| Q29 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 20 and 26 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
30 a 0 b 100 31 a 0 b 0 b.1 100 b.2 80 32 a 0 b 70 33 a 0 b 0 b.1 0 b.2 15 b.3 30 b.4 0 b.5 15 b.6 30 34 a 0 b 0 b.1 0 b.2 5 b.3 10 b.4 0 b.5 10 b.6 20 35 a 0 b 0 b.1 0 b.2 5 b.3 10 36 a 0 b 0 b.1 0 b.2 20 b.3 40 37 a 0 b 0 b.1 0 b.2 5 b.3 10 b.4 0 b.5 10 b.6 20 38 a 0 b 0 b.1 0 b.2 15 b.3 30 b.4 50 39 a 0 b 0 b.1 20 b.2 60 b.3 80 40 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 code
Time in Hours
Time calculation
Final score
41 a b if 1 hour or less 0 if more than 1 hour 10 42 a b if less than 1 hour 0 if 1–2 hours 0 if more than 2 hours 10 43 a b if less than 1 hour 0 if 1–5 hours 0 if more than 5 hours 10
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 is an accurate reflection of the child’s functional ability, behaviour and special care needs, the Secretary may add additional points to the scores for the Behavioural and the Functional Abilities domains in accordance with the following table.
(2) Calculate the ACL adjusted total by adding the following:
(a) the ACL grand total;
(b) a maximum of 4 points for domain A;
(c) a maximum of 7 points for domain B;
(d) a maximum of 11 points for domain C.
| Bonus question (Maximum of 1 added score per domain as listed) | The additional question must contain a scale of points according to the following increments with ‘d’ the maximum value that can be added for the respective domain Domain A, B or C | |
| For domain A — Behaviour I | CATA | a= 0 b= 1 c= 2 d= 4 |
| For domain B — Behaviour II | CATB | a= 0 b= 2 c= 4 d= 7 |
| For domain C — Functional Abilities | CATC | a= 0 b= 2 c= 7 d= 11 |
where:
a means the care load impact is negligible.
b means the care load impact is infrequent.
c means the care load impact is noticeable but not constant,
d means the care load impact is constant.
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 | 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 | -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 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.
Note
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See
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