Decision: The Tribunal sets aside the decision under review pursuant to subsection 105(b) of the Administrative Review Tribunal Act 2024 (Cth).

..............................[sgd]..........................................

NATIONAL DISABILITY INSURANCE SCHEME - review of statement of participant supports - request for support worker funding at 3:1 ratio - request for transport funding for support workers - reasonable and necessary supports - applicant sought review of statement of supports to allow for funding for support workers - decision under review set aside

Administrative Appeals Tribunal Act 1975 (Cth)

Administrative Review Tribunal Act 2024 (Cth)

National Disability Insurance Scheme Act 2013 (Cth)

National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) (NDIS Supports) Act 2024 (Cth)

National Disability Insurance Scheme (Supports for Participants) Rules 2013

National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024

Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634

G v Minister for Home Affairs [2019] FCAFC 79 [18]

McGarrigle v National Disability Insurance Agency [2017] FCA 308

Madelaine and National Disability Insurance Agency [2019] AATA 4025

National Disability Insurance Agency v WRMF (2020) FCR 415

National Disability Insurance Scheme Operational Guideline

1. This application regards whether the Applicant, JGJJ, can receive funding for the cost of daily support workers at a 3:1 ratio, and the travel costs for such workers, from the National Disability Insurance Agency (the Agency) as part of his funded supports. JGJJ's mother seeks review of a decision made on by a "reviewer" under s 100(6) of the National Disability Insurance Scheme Act 2013 (Cth) ('NDIS Act') ('Decision Under Review').[1] This decision confirmed an earlier decision by the Agency on not to approve such funding as part of his funded supports.
2. In this decision I will refer to the Applicant as either JGJJ or the Applicant, and the Agency as either the Respondent or the Agency
3. The Administrative Review Tribunal's ('the Tribunal') jurisdiction arises under s 12 of the Administrative Review Tribunal Act 2004 (Cth) ('ART Act'), operating in conjunction with

s 103 of the NDIS Act. 4. For the reasons set out below, the Decision Under Review is varied as the Tribunal is satisfied that JGJJ has established that the requested supports meet the reasonable and necessary criteria under s 34(1) of the NDIS Act.

1. JGJJ is a 17-year-old young man who lives in regional South Australia. He lives with his mother and stepbrother.
2. JGJJ has the following diagnosed physical and psychosocial medical conditions:
   • Autism Spectrum Disorder (Level 2);
   • Obsessive Compulsive Disorder (OCD);
   • Tourette's Syndrome;
   • An intellectual disorder; and
   • Type 2 Diabetes.
3. Due to his conditions JGJJ presents with a range of behavioural issues including:
   • Physical and verbal aggression;
   • Threats of harm to others;
   • Suicidal ideation;
   • Self-harming behaviour;
   • Running away in public placing himself and others at risk;
   • Inappropriate sexualised behaviour; and
   • Experiencing distressing hallucinations.
4. JGJJ requires assistance with all daily activities.
5. JGJJ has been previously approved as a participant in the Scheme. Since then, he has had several support plans approved, including the current plan.
6. On 20 June 2022, the Agency approved a statement of supports for a one-year plan with funding to be provided from 20 June 2022 to 20 June 2023 (the original decision).
7. The plan forming the subject of this review is a one-year plan spanning between 23 August 2022 and 23 August 2023, which added additional supports to the original decision after JGJJ's mother requested an internal review.
8. The supports approved in that August 2022 plan were as follows:

• Improved life choices: $1,485.74 (designed to cover financial management costs)
• Improved daily living: $9,699.50 (Plan Managed)
• Improved relationships: $20,879.45 (NDIA Managed)
  • This included funding for 60 hours of specialist behaviour intervention support and 35 hours of training in behaviour management strategies.
• Level 2 Support Coordination: 72 hours $7,210.08 (Plan Managed)

1. The NDIS plan approved on 23 August 2022, which is the subject of this review, specified JGJJ's goals:
   • I want to learn to manage my mental health to stabilise my emotions on a daily basis.
   • I would like supports to help me with regulating my emotions and behaviours of concern with strategies and recommendations from therapists.
   • I would like to have support to engage more in the community and find activities or groups to build friendships and new interests.
   • I would like to be supported to develop my communication skills to make positive relationships in my new school and in the community.
   • I would like support to have therapeutic intervention with animals.
2. The Tribunal notes that while the matter has been before the Tribunal, the plan has been regularly extended for either 6 or 12 months. The most recent and current plan expires on 10 April 2026.

Decision under review and application for review to this tribunal

1. As noted above the Respondent provided an approved statement of supports for JGJJ on 20 June 2022 (the original decision).
2. Shortly after receiving the June 2022 plan, JGJJ's mother requested that the Respondent conduct an internal review of the original decision.
3. In her application for an internal review, JGJJ's mother requested that the following additional supports be incorporated into his plan:

• Increased funding for Capacity Building: Relationships

• Increased funding for Capacity Building: Daily Activity - in relation to 2:1
  • Support and active overnight support
  • Increased funding for Social Community and Civic Participation
  • Increased funding for Support Co-Ordination (levels and hours)
  • Increased funding for Capacity Building: Daily Activity
  • Change from Plan Managed to Self-Managed
  • A culturally appropriate mentor

4. The Tribunal notes that it is not entirely clear from the material what was the exact amount of the additional supports that JGJJ's mother requested.
5. The Respondent conducted its internal review and on 23 August 2022 it advised that it had approved several of the requested additional capacity building supports and had not approved some of the other requested supports.
6. The additional supports which were approved or partly approved were:

• Funding for 90 hours of specialist behaviour intervention support and 35 hours for a Behaviour Management Plan, including training in behaviour management strategies.
• High intensity 2:1 support including active overnight support.
  • Funding has been provided for 2:1 supports between the hours of 6am to 6pm, though excluding school hours (9am - 3pm).
  • Funding has been provided for 1:1 support from 6pm to 10pm and active overnight support, as during these hours two workers were deemed to be not necessary, given JGJJ's available informal supports.

Social Community and Civic Participation (SCCP) budget

• Funding for high intensity 2:1 support for four hours per week to access the community has been provided.

• Funding for 6 hours per month of Level 2 support coordination and a total of 40 hours of Level 3 support coordination has been provided

Increased funding for Capacity Building: Daily Activity

• Funding for 80 hours of therapy has been provided.

1. Listed below are the requested supports that were not approved (the reviewable decision):
   • Additional high intensity support at 2:1, including active overnight support over and above that which was approved;
   • Increased funding for high intensity 2:1 community access support, over and above the 4 hours per week approved;
   • Funding for 156 hours per annum of level 3 support coordination;
   • Funding for 115 hours per annum of occupational therapy plus two hours of travel per visit to allow for occupational therapy in the home every fortnight;
   • Changing from Plan-Managed to Self-Managed funding; and
   • Funding for a culturally appropriate mentor.
2. The reasons given in the reviewable decision for refusing the requests for the additional supports were as follows:
   • 2:1 support for daily activity: value for money (section 34(1)(c)), and not the responsibility of NDIS to fund (section 34(1)(f))
   • Increased funding for high intensity 2:1 community access support: Reasonable expectation of families (Section 34(1)(e)) and the support relates to day-to-day living costs (NDIS (Supports for Participants) Rule 5.1(d)).
   • 156 hours per annum of level 3 support coordination: Value for money (section 34(1)(c)).
   • Capacity Building Daily Activity (115 hours of occupational therapy plus 2 hours of travel per visit to allow for occupational therapy in the home every fortnight): Value for money (Section 34(1)(c)), and not the responsibility of the NDIS to fund (section 34(1)(f))
   • Change from Plan Managed to Self-Managed: Section 44 (2)(a) states that "The statement of participant supports in a participant's plan must not provide that the participant is to manage the funding for supports under his or her plan to a particular extent if the CEO is satisfied that management of the plan to that extent would present an unreasonable risk to the participant: Reason given was overspend in previous plans.
   • Culturally appropriate mentor: Value for money (section 34(1)(c)), Responsibility of the NDIS to fund (section 34(1)(f)).
3. On 30 August 2022, JGJJ's mother applied to the then Administrative Appeals Tribunal (AAT) for the AAT to conduct an independent review of the reviewable decision.
4. In the application for review, JGJJ's mother noted the following as reasons why she considered the reviewable decision was wrong:

The decision was wrong to take self-funding away because they had no ground to do so.

1. Before moving on to outline the evidence and relevant legislation, I note that the issues remaining to be determined in this dispute in this matter are the following:
   • 3:1 support worker assistance 24/7; and
   • Transport costs for each support worker to travel to and from Adelaide to JGJJ's home, totalling $474,500.
2. However, just prior to the hearing of the matter, JGJJ's mother advised that the additional supports being sought were:
   • 3:1 support worker assistance for her son to attend medical and allied health appointments in Adelaide; and
   • The related transport costs of her son attending those appointments; and
   • Funding for him to participate in community access.

1. The NDIS has been in operation for over ten years. It was at the time it was enacted landmark social legislation dedicated to the idea that people with disability have the right to realise their potential for physical, social, emotional and intellectual development.[2] This is one of a series of general principles guiding actions set out in section 4 of the Act. Other important principles in section 4 of particular relevance to the present case include:

(2) People with disability should be supported to participate in and contribute to social and economic life to the extent of their ability...

(4) People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports (...)

(5) People with disability should be supported to receive reasonable and necessary supports, including early intervention supports...

(11) Reasonable and necessary supports for people with disability should:

(a) support people with disability to pursue their goals and maximise their independence; and

(b) support people with disability to live independently and to be included in the community as fully participating citizens; and

(c) develop and support the capacity of people with disability to undertake activities that enable them to participate in the community and in employment.

1. The NDIS is administered by the Agency established under the Act. The Act sets out the matters that must be included in a participant's plan. Subsection 33(2) provides:

A participant's plan must include a statement (the statement of participant supports), prepared with the participant and approved by the CEO, that specifies:

(a) the general supports (if any) that will be provided to, or in relation to, the participant; and

(b) the reasonable and necessary supports (if any) that will be funded under the National Disability Insurance Scheme; and

(c) the date by which, or the circumstances in which, the Agency must review the plan under Division 4; and

(d) the management of the funding for supports under the plan (see also Division 3); and

(e) the management of other aspects of the plan.

In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:

(a) have regard to the participant's statement of goals and aspirations; and

(b) have regard to relevant assessments conducted in relation to the participant; and

(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and

(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of section 35; and

(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and

(f) have regard to the operation and effectiveness of any previous plans of the participant; and

(g) have regard to whether section 46 (acquittal of NDIS amounts) was complied with in relation to any previous plan for the participant.

(1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:

(aathe support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see section 24) or the early intervention requirements (see section 25);

(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;

(b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;

(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;

(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;

(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;

(f) the support is an NDIS support for the participant.

(a) the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and

(b) a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.

(2) The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1) (aa) to (f).

1. The term "support" is not given a meaning in the NDIS Act. A "support" is defined in section 9 of the NDIS Act as including "general supports", being those defined in subsection 13(2) as the kind of supports provided by the Agency itself. However, the term "support" and the phrase "reasonable and necessary" are not further defined in the NDIS Act. In McGarrigle v National Disability Insurance Agency [2017] FCA 308 at 91 (McGarrigle), Mortimer J observed, with respect to those words.

Whether a support is "reasonable" requires a different assessment to whether a support is "necessary". Again, it is not necessary in the context of this proceeding to be definitive about the nature and extent of the meaning of the phrase, or its components. It is enough to observe that using the concept of necessity would appear to tie one aspect of the CEO's assessment to an evaluation of the kinds of factors set out in s 34(1)(a) and (b) and (d). The word "reasonable" would appear to be directed at factors such as those set out in s 34(1)(c) and (f). That is not to say the meaning of each word is exhausted by the factors set out in s 34(1): rather, it is to illustrate the different work that each concept does as an adjective in the phrase "reasonable and necessary supports".

1. The National Disability Insurance Scheme (Supports for Participants) Rules 2013 ("the Rules") made pursuant to subsection 35(1) of the NDIS Act provides further guidance with respect to the assessment of reasonable and necessary supports that will be funded. Pursuant to section 209 of the NDIS Act, the Rules are a legislative instrument and are therefore binding to the Tribunal. In this case the relevant Rules include:

3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:

(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost.

(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long‑term benefit to, the participant.

(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);

(d) for supports that involve the provision of equipment or modifications:

1. the comparative cost of purchasing or leasing the equipment or modifications; and
2. whether there are any expected changes in technology or the participant's circumstances in the short term that would make it inappropriate to fund the equipment or modifications.

(e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides.

(f) whether the support will increase the participant's independence and reduce the participant's need for other kinds of supports (for example, some home modifications may reduce a participant's need for home care

1. Part 5 of the Supports Rules sets out the general criteria for supports and supports that will not be funded or provided:

5.1 A support will not be provided or funded under the NDIS if:

(a) it is likely to cause harm to the participant or pose a risk to others; or

(b) it is not related to the participant's disability; or

(c) it duplicates other supports delivered under alternative funding through the NDIS; or

(d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant's disability support needs.

• 5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports):

(a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs;

(b) costs that are ancillary to another support that is funded or provided under the participant's plan, and which the participant would not otherwise incur.

• 5.1 The following supports will not be provided or funded under the NDIS:

(a) a support the provision of which would be contrary to:

(i). a law of the Commonwealth; or

(ii). a law of the State or Territory in which the support would be provided.

(b) a support that consists of income replacement.

1. As of 3 October 2024, the Act was amended under the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Act (Amending Act).
2. Under the Amending Act, new Rules were also put into effect. Of particular relevance to this matter is the National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 (the Transitional Rules).
3. It is important to note that both the Amending Act and the Transitional Rules came into effect immediately and apply as of 3 October 2024.
4. The Amending Act and the Transitional Rules are designed to provide greater clarity as to what types of requested supports will receive funding approval under the Act and those supports that generally will not be approved.
5. As a result of the Amending Act, the definition of what constitutes a NDIS support in section 10 has changed with the new section reading as follows:

(1) Subject to subsections (4) and (9), a support is an NDIS support for a person who is a participant or prospective participant if the support is declared by National Disability Insurance Scheme rules made for the purposes of this subsection to be an NDIS support for:

(a) participants or prospective participants generally; or

(b) a class of participants or prospective participants that includes the person.

Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).

(2) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (1), the Minister must be satisfied:

(a) for rules to which paragraph (1)(a) applies - that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or

(b) for rules to which paragraph (1)(b) applies - that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class.

(3) National Disability Insurance Scheme rules may declare a support for the purposes of subsection (1) only if at least one of the following applies:

(a) the declaration of the support implements Australia's obligations under:

(i) the Convention on the Rights of Persons with Disabilities done at New York on 13 December 2006; or

(ii) any other agreement with one or more other countries;

(b) the declaration of the support enables the provision of sickness benefits.

(4) The National Disability Insurance Scheme rules may declare that a support is not an NDIS support for:

(a) participants or prospective participants generally; or

(b) a class of participants or prospective participants.

Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).

1. Rule 5 of the Transitional Rules is as follows:

What supports are NDIS supports - general rule.

Supports that are NDIS supports unless otherwise provided:

1. For the purposes of subsection 10(1) of the NDIS Act, a support covered by column 2 of an item in the table in clause 1 of Schedule 1 to this instrument is an NDIS support (subject to subsections 10(4) and (9) of the NDIS Act and subsection (2) of this section) for:

(a) participants specified in column 3 of the item who have old framework plans; and

(b) prospective participants specified in column 3 of the item, other than prospective participants who, if they were participants, would be required to be given notice under subsection 32B(2) of the NDIS Act (participants that are to have new framework plans).

Note 1: Subsection 10(4) of the NDIS Act allows supports to be declared to not be NDIS supports for participants or prospective participants. Those supports are declared under subsection (2) of this section.

Note 2: Subsection 10(9) of the NDIS Act provides that a support is not an NDIS support for a participant or prospective participant if the support consists of the provision of:

(a) sexual services; or

(b) alcohol; or

(c) drugs, the possession of which is a contravention of a law of the Commonwealth,

(d) a State or a Territory.

Supports that generally are not NDIS supports:

1. For the purposes of subsection 10(4) of the NDIS Act, a support covered by column 2 of an item in the table in clause 1 of Schedule 2 to this instrument is not an NDIS support for any participant (subject to subsection 10(6) of the NDIS Act) or prospective participant.

Note 1: Subsection 10(6) of the NDIS Act allows the CEO, on application by a participant, to determine that a support is taken to not be declared under subsection 10(4) of that Act in relation to the participant if, among other things, the CEO is satisfied that the support would replace one or more other supports that are NDIS supports for the participant.

Note 2: Determinations under subsection 10(6) of the NDIS Act are referred to in this instrument as replacement support determinations. For additional rules about replacement support determinations, see section 7 of this instrument.

1. This rule gives effect to section 10(4) of the Act which states that the Support Rules may declare that a support is not a NDIS support for a participant or a prospective participant.
2. Schedule 2 of the Rules contains a categorised list of requested supports that are declared not to be NDIS supports. Once again, the relevant section is listed below:

Schedule 2 - Supports that generally are not NDIS supports:

1 Supports that generally are not NDIS supports.

The following table sets out supports that are not NDIS supports for:

(a) a participant (unless a replacement support determination covering the support is in force for the participant); or

(g) standard recreational equipment and tools, including toys, balls and racquets.

(q) general health, fitness, social or recreational costs or services.

1. Also, of importance to an assessment of this matter are both section 10(6) of the Act and Rule 7 of the Transitional Rules.
2. Section 10(6) is as follows:

The CEO may determine, in writing, that a support is taken to not be declared under subsection (4) in relation to a participant if:

the support is prescribed by the National Disability Insurance Scheme rules for the purposes of this paragraph; and

the support would, apart from subsection (4), be an NDIS support for the participant; and

the participant applies to the CEO in accordance with subsection (7) for the determination; and

the support would replace one or more other supports that are NDIS supports for the participant; and

the cost of the support is the same or lower than the total of the costs of the supports it would replace; and

the support would provide the same or a better outcome for the participant than the supports it would replace; and

any other conditions specified in the National Disability Insurance Scheme rules for the purposes of this subparagraph are met in relation to the support, the participant, or both.

1. Rule 7 of the Transitional Rules is as follows:

1. For the purposes of paragraph 10(6)(a) of the NDIS Act, the CEO may make a replacement support determination in relation to a support covered by column 1 of an item in the table in subsection (3) of this section.
2. For the purposes of subparagraph 10(6)(d)(iv) of the NDIS Act, the CEO must be satisfied that the conditions set out in column 2 of an item in the table in subsection (3) are met before making a replacement support determination in relation to a support covered by column 1 of the item.
3. The table is as follows:

1. Standard commercially available household items

(a) The funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and community to be necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements; and

(b) increase whole task independence; and

(c) reduce or eliminate the need for a support worker or disability specific assistive technology.

What these two provisions specify is that a participant may apply to have a support that would otherwise be considered not to be an NDIS support considered as a replacement support determination, subject to it meeting the requirements specified in Rule 7(3).

1. I may return to the relevance of the Transitional Rules to this case when I consider whether the requested additional support can be found to be reasonable and necessary under the Act.
2. The NDIS Act and its Rules are supplemented by operational guidelines. The operational guidelines represent government policy and, to the extent that they are consistent with the relevant legislation, should be applied by the tribunal unless here is a sound reason not to do so.[3]
3. The National Disability Insurance Scheme Operational Guidelines - Planning provides:

This Operational Guideline provides an overview of the National Disability Insurance Scheme (NDIS), including the legal and policy framework it operates within and the variety of different ways it provides support and assistance to people with disability.

In addition, this Operational Guideline outlines the objects and general principles of the National Disability Insurance Scheme Act 2013 and provides a summary of the information which is available in the remainder of the NDIS' Operational Guidelines.[4]

1. There is no power conferred by the NDIS Act to make Operational Guidelines, and they are issued in an exercise of executive power.[5] The Tribunal is therefore not bound by any policy set out in the Agency's Operational Guidelines; however, in Re Drake and Minister for Immigration and Ethnic Affairs (No 2)[6], the Federal Court held that a Tribunal should take into account relevant government policy which is not inconsistent with the provisions or objects of the legislation, however they should not be bound by it. Further guidance for the proposition that the Tribunal is not bound by policy is found in G v Minister for Immigration and Border Protection,[7] where Mortimer J (as her Honour then was) held:

'Justice or injustice is not found within a policy. It is found by looking at the overall circumstances of an individual's case with the principal focus being on the purpose and context of the statutory power, not the executive policy framed to guide it**...'**

2. Therefore, unless the Access Guidelines are inconsistent with the provisions or objects of the legislation, they should be considered in any determination of whether the request for 3:1 support worker assistance meets the reasonable and necessary criteria.

1. As part of the review process, the Tribunal was provided by the Respondent with those documents previously submitted as part of the original application process (the T Documents). Of potential relevance to this decision are the following reports:
   • AAT Application for Review of Decision dated 30th August 2022, attaching:
   • Internal Review Decision (Applicant's Copy) dated 25th August 2022.
   • Internal Review Decision (Respondent Copy) dated 25th August 2022.
   • Letter confirming Learning/Behaviour and Wellbeing Plan by Kathryn Hese (Assistant Principal) dated 28th April 2021
   • Incident Report by Cheryl Davies (Director) dated 23rd September 2021.
   • Bail Remand Information Report by Josephine Wanjiru (Case Worker) and Sarah Bishop (Supervisor) dated 24th September 2021.
   • Court Update Letter by Josie Wanjiru (Assessment Case Coordinator) dated 29th September 2021.
   • Report by Kirsten Hickey (Occupational Therapist) dated 13th December 2021.
   • Medication Consult Report by Adeline Tan (Accredited Pharmacist) dated 23rd January 2022.
   • Interim Behaviour Support Plan by Tianlin (Grace) Wu (Positive Behaviour Support Practitioner) dated 2nd February 2022.
   • Email from Grace Wu (Positive Behaviour Support Practitioner) dated 3rd February 2022.
   • Letter Request to Prescribing Practitioner, Tianlin (Grace) Wu (Positive Behaviour Support Practitioner) dated 3rd February 2022.
   • Case Conference Minutes by Sandra Byrne (Senior Social Worker) and Chlea Steele (Support Coordination and Psychosocial Recovery Coach) dated 7th February 2022.
   • Positive Behaviour Support Summary of Home Visit (Unknown Author) dated 7th February 2022.
   • Zones of Regulation Chart dated 7th February 2022.
   • Positive Behaviour Support Summary of Home Visit (Unknown Author) dated 27th February 2022.
   • Positive Behaviour Support Summary of Home Visit (Unknown Author) dated 4th March 2022.
   • ABC Chart Incident Report from I Can Jump Puddles 11th March 2022.
   • Positive Behaviour Support Summary of Home Visit (Unknown Author) dated 12th March 2022.
   • Positive Behaviour Support Summary of Home Visit (Unknown Author) dated 14th March 2022.
   • Letter, Dr Hsu-en Lee (Senior Consultant Psychiatrist) dated 7th April 2022.
   • Interagency Risk Management Plan, AAA Supports dated 26th April 2022.
   • Review ABC Data Report by Tianlin (Grace) Wu (Positive Behaviour Support Practitioner) dated 27th April 2022.
   • Email from Grace Wu (Positive Behaviour Support Practitioner) dated 28th April 2022.
   • ABC Chart Incident Report from I Can Jump Puddles dated 12th May 2022.
   • Letter of Support by Sandra Byrne (Senior Social Worker) and Neville O'Loughlin (Senior Aboriginal dated 12th May 2022.
   • ABC Chart Incident Report from I Can Jump Puddles dated 26th June 2022.
   • Authority to Act, DACSSA Disability Advocacy dated 6th July 2022.
   • Functional Assessment Report by Caitlin North (Senior Occupational Therapist) dated 15th July 2022.
   • Extract of Interaction Record, Review Request dated 22nd July 2022.
   • Email, Branka Carter (Branch Manager, Internal Reviews and Complaints Branch - NDIS) dated 26th July 2022.
   • Functional Behaviour Assessment Report by Tianlin (Grace) Wu (Positive Behaviour Support Practitioner) dated 1st August 2022.
   • Report and Letter of Support by Paul Glaze (Disability Advocate) dated 4th August 2022.
   • Completed Medication Purpose Form by Dr Jodi Hunt (General Practitioner) dated 5th August 2022.
   • Comprehensive Behaviour Support Plan by Tianlin (Grace) Wu (Positive Behaviour Support Practitioner) dated 5th August 2022.
   • Positive Behaviour Support Client Risk Assessment Report by Tianlin (Grace) Wu (Positive Behaviour Support Practitioner) dated 5th August 2022.
   • Email from Chlea Steele (Support Coordination and Psychosocial Recovery Coach) dated 10th August 2022.
   • Carer Impact Statement - Undated.
   • Progress Report by Chlea Steele (Support Coordination and Psychosocial Recovery Coach) - Undated.
   • Environmental Restrictive Practice Behavioural Support Protocol Report from I Can Jump Puddles - Undated.
   • Letter of Support, Rhys Nayna (Consultant Liaison Officer - Australian Greens Senator for Victoria) - Undated.
   • Medication Purpose Form from I Can Jump Puddles (Incomplete) - Undated.
   • NDIS Plan Review Report, Chlea Steele (Support Coordination and Psychosocial Recovery Coach) - Undated.
   • Responsive Support Strategies from School - Undated.
   • Seclusion Restrictive Practice Behavioural Support Protocol Report from I Can Jump Puddles - Undated.
   • Contact List of Key Stakeholders, Steele Supports - Undated.
   • Therapeutic Letter by Grace Wu (Positive Behaviour Support Practitioner), Chlea Steele (Support Coordination and Psychosocial Recovery Coach) and Angela Duigan (Disability Royal Commission Advocacy Coordinator) - Undated.
   • Behaviour Incident Report Notes by Karma Gurung - various dates.
   • Case Notes (Unknown Author) - various dates.
   • ABC Chart Incident Report from I Can Jump Puddles - various dates.

• NDIS Plan - 19th April 2022 to 19th April 2023 dated 19th April 2022.
• NDIS Plan - 20th June 2022 to 20th June 2023 dated 20th June 2022.
• NDIS Plan - 23rd August 2022 to 23rd August 2023 dated 23rd August

1. The following additional documents were lodged with the Tribunal on JGJJ's behalf:
   • Report of Dr Marshall Watson, Child and Adolescent and Adult Forensic Psychiatrist, Carrington Street Consulting, dated 14th April 2023.
   • Report of Prof. Helen Milroy, Child and Adolescent Psychiatrist, dated 18th June 2023.
   • Interim Behaviour Support Plan of Muhammad Tayyab Qazi, Behaviour Support Practitioner, Crystal Care, dated 18th October 2023.
   • Functional Capacity Assessment of Michael To, Occupational Therapist, Crystal Care, dated 2nd February 2024.
   • Refresher of Positive Behaviour Support Strategies (undated, likely 2023).
   • Report of Delia McCann, Behaviour Support Practitioner, Lifestyle Solutions, dated 25th July 2024.
   • Interim Behaviour Support Plan, Delia McCann, Behaviour Support Practitioner, Lifestyle Solutions dated 24 September 2024.
   • Comprehensive Behaviour Support Plan, Delia McCann, Behaviour Support Practitioner, Lifestyle Solutions, 13 December 2024.
   • Applicant's requested transport funding by JGJJ's mother.
   • A carer's impact statement from JGJJ's mother dated December 2023.
   • Progress notes from Tracey Dryden-Mead dated 3 January 2025.
   • Progress notes from Tracey Dryden-Mead dated 1 March 2025.
   • Updated Occupational Therapist's report dated 16 April 2025.
   • Letter from Dr Mohammed Usman to Dr Jodi Hunt of 28 April 2025.
   • Minutes of support team meeting dated 19 November 2024.
   • Carelink Services case notes between September and November 2025.
   • Confirmation of enrolment at Mannum Community College dated 10 November 2025.

1. On 25 July 2024 Ms Delia McCann, JGJJ's Behaviour Support Practitioner in a letter to the Agency requested that his support worker ratio be increased to 3:1 whilst participating in activities in the community. Ms McCann cited the following behaviours of concern as reasons why additional support worker assistance is required:
   • Self-harm, including:
     • Attempting to run into oncoming traffic
     • Cutting his body with items, resulting in many scars
     • Bitten big chunks of skin out of his hands and arms, requiring medical attention
     • Broken his hand
     • Attempted to jump out of a moving vehicle
     • Hitting himself with large rocks
   • Constant threats of harm to others (including family members and people in the community);
   • Physical assault (typically stemming from delusions);
   • Suicidal ideations and delusional thoughts, including:
     • Wanting to die
     • Delusional thoughts
     • Hallucinations (seeing monsters in the faces of people) that have involved punching a small child and a young girl in the face
   • Physical aggression, including:
     • Assaulting people
     • Being aggressive towards his family members
     • Being aggressive towards his support workers
   • Verbal aggression, including
     • Constant threats of harm - threats to kill
     • Swearing
     • Verbal abuse
   • Property damage, including:
     • Damaging cars
     • Damaging walls
   • JGJJ also displays:
     • Difficulties in communicating, as he constantly hallucinates, including seeing monsters and imaginary girlfriend, which he will talk about constantly
     • Reduced capacity across life domains including independent living, self-care tasks
2. Ms McCann stated that JGJJ requires supervision at all times when out in the community due to his self-harming tendencies and physical aggression toward others.
3. These incidents occur daily and the intensity ranges from high to extreme. JGJJ would also need constant supervision in the community as his more recent behaviour includes masturbating in public toilets.
4. The standard practice in the Tribunal is for both an Applicant and Respondent to provide the Tribunal and each other with a Statement of Facts, Issues and Contentions (SFIC). The purpose of a SFIC is to provide an outline of that party's case what they consider to be the relevant facts, what may be the relevant parts of the Act and related Rules the Tribunal should consider and identify where the parties disagree on these points.
5. During the conduct of the Tribunal's pre-hearing procedure, both parties filed with the Tribunal Statements of Issues and Statements of Facts, Issues and Contentions.
6. The most recent of these documents will be referred to throughout this decision.

1. I note that JGJJ's mother has not submitted to the Tribunal any formal documentation (other than the medical and other evidence) which addresses why she believes that the requested supports meet the various reasonable and necessary criteria as specified in the NDIS Act and the Rules.
2. Therefore, for the purposes of this decision, I will assume that her position is that the requested supports meet those criteria.

1. The Agency's most recent Statement of Facts Issues and Contentions is dated 25 July 2025.
2. The Agency noted the following areas where there was a degree of ambiguity about JGJJ's current level of participation at school. In this regard there was documentation indicating he has not attended school for 18 months, that he is not attending school due to his aggressive behaviour, or that he participates in a supported home-schooling program facilitated by a Service Provider in Murray Bridge.
3. In the absence of this evidence, the Agency noted that its contentions would assume that JGJJ would require 2:1 24/7 support worker assistance, in line with the recommendations made by Mr Stuart Burgoyne, the Occupational Therapist engaged by the Agency as an Independent Medical Expert.

1. The Agency acknowledged that the evidence provided indicates that JGJJ requires significant support with all aspects of his daily life.
2. The Agency contends that its proposed package of supports for daily activities based on 24/7 2:1 supports, supplemented by short term accommodation STA and 10 weekday hours of social and economic community participation (SECP) at high intensity rate to enable JGJJ to attend appointments and access the community, is reasonable and necessary.
3. The Agency noted in its Statement of Suggested Evidence dated 25 March 2025, that it had recommended a range of additional reports and other evidence that may assist the Tribunal however this additional evidence has not been submitted.
4. One of the suggested reports was a further functional capacity assessment prepared by Paediatric Play, which the Agency understood had been completed and provided to JGJJ's mother. The Agency noted that this report had never been filed with the Tribunal.
5. The Agency referred to the Functional Capacity Assessment report of Michael To, of Crystal Care, dated 2 February 2024. The report recommends 2:1 support, except when accessing community participation, which recommended support at a 3:1 level.
6. The Agency considered that the reasoning behind Mr To's recommendations was unclear and contained broad statements without reference to functional capacity-based support needs, including the following examples:
   • [JGJJ's] challenges with social interactions, trust issues and susceptibility to anxiety necessitate a 3-on-1 support model (p33)
   • Given [JGJJ's] history of aggression and self-harming behaviours, the 3-on-1 support model provides an added layer of safety and comfort. Support workers can promptly respond to challenging situations, ensuring that JGJJ remains safe and minimising potential harm to himself or others (p33)
   • For his transportation needs, a 3-on-1 support model is recommended. This not only ensures his safety during travel and when reaching his destinations. (p34)
   • [JGJJ's] engagement in the community must be supported by 3:1 support staff to ensure that he is safe and the community is safe and to encourage him to engage as much as possible. (p34)
   • [JGJJ's] community participation should be limited at this time due to his aggressive behaviour, instead support workers can engage in a 3:1 ratio to ensure that he is safe and the community is kept safe from him. (p34).
7. The Agency submitted that the report provided by Mr To did not provide a clear indication what each of the three support workers would be doing, or why support as a 2:1 ratio would not be sufficient.
8. The Agency submitted that it relies on the report provided by Mr Burgoyne. In this regard Mr Burgoyne's considered that 2:1 support is required 24 hours a day, 7 days a week, including active overnight support. Mr Burgoyne noted that 3:1 support is not regarded as a standard model of care but may be temporarily required in high-risk community settings.

With regard to support for community access, Mr Burgoyne considered that a ratio of 2:1 should be sufficient to address JGJJ's high-risk behaviours, including aggression (e.g. hitting children in public), faecal smearing and rectal insertion of objects, public masturbation and sexualised speech and delusional conversations (such as with a fictional girlfriend "Kathy").

1. The Agency contends that the reasonable and necessary level of support is 24/7 2:1 support, with active overnight support.
2. Addressing the section 34(1) criteria, the Agency contends that the requested 3:1 support:
   • does not represent value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, as required by s 34(1)(c) of the Act.
   • will be, or is likely to be, effective and beneficial for JGJJ, having regard to current good practice, as required by s 34(1)(d) of the Act.
3. While the Agency acknowledged that Mr To has recommended 3:1 support for community participation, this was not supported by other clinical observations regarding JGJJ's functional capacity, and the reasoning Mr To provided was vague. The support of a third worker appears to be, at least in part, in the form of standby support to keep others and the community safe when JGJJ is in an elevated state, which the Agency considers is not appropriate for it to fund in the magnitude sought.

Travel costs for support workers ($474,500 yearly)

1. The Agency provided a breakdown of these proposed mileage costs based on a summary provided by JFJJ's mother. These costs are based on a per kilometre rate of $1.00 and based upon a trip each way between JGJJ's home and the Adelaide CBD and the provision of three support workers providing support during the day and a further three providing this support overnights.
   • Day carers $600.00 ($200 each).
   • Day carer providing community access $100
   • Night Carers $600 ($200 each)
   • Yearly cost = $1,300 a day x 365 days = $474,500.
2. JGJJ's mother's summary also noted the following:
   • JGJJ has not attended school for 18 months.
   • He has community access every day from 9 AM to 6 PM for educational trips and medical and allied health appointments.
   • His mother attends appointments with help of fuel vouchers from Moorundi Health Services.
   • He is not safe to transport by his mother due to the potential for violent outbursts in the car while driving.
3. The Agency submitted that the Tribunal would need to be satisfied that the requested mileage claim meets each of the criteria in section 34(1) of the NDIS Act, along with the applicable Rules, Guidelines and Pricing Arrangements in considering what, if any, travel costs are reasonable and necessary for the NDIS to fund.
4. The Agency submitted that a starting point in assessing this requested support is item 6 of Schedule 2 of the Transitional Rules provides that transport for children as part of their reasonable care and support provided by families or carers, as well as fuel costs, are not NDIS supports. Accordingly claimed travel costs should not seek to replace these day-to-day living costs. The relevant parts of the provision are the following items:

6 Day‑to‑day living costs - travel and transport

(g) transport for children as part of their reasonable care and support provided by families or carers;

1. The Agency referred to the NDIS Pricing Arrangements and Price Limits 2024-25 (Pricing Arrangements).
2. The Pricing Arrangements specify when a service provider may claim from a participant's plan for travel costs in relation to the delivery of a support item if all the following conditions are met:
   • The Pricing Arrangements indicate that providers can claim for Provider Travel in respect of that support item;
   • The proposed charges for the activities comply with the Pricing Arrangements;
   • The activities are part of delivering a specific disability support item to that participant;
   • The support is delivered directly (face-to-face) to the participant;
   • The provider explains the activities to the participant, including why they represent the best use of the participant's funds (that is, the provider explains the value of these activities to the participant);
   • The provider has the agreement of the participant in advance (that is, the Agreement between the participant and provider should specify the travel costs that can be claimed); and
   • The provider is required to pay the worker delivering the support for the time they spent travelling because of the agreement under which the worker is employed; or the provider is a sole trader and is travelling from their usual place of work to or from the participant, or between participants.
3. The Agency submitted that the evidence before the Tribunal does not establish any of the necessary factors for the Tribunal to be satisfied that the funding of travel for support workers would be a reasonable and necessary support. Importantly, the Pricing Arrangements make clear that travel costs are not funded for commuting to and from work, but between participant appointments and the usual place of business.
4. The Agency further submitted that the current evidence has not established why support workers are being sourced from Adelaide. In these circumstances, the Agency submitted that where there is no evidence establishing the need for travel, the Tribunal cannot be satisfied that the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support. Here, the alternative support is assistance from support workers that does not require such significant travel costs, with the engagement of locally based support workers.
5. The Agency submitted that by utilising the NDIS Provider Finder it has identified that there are locally based NDIS provider in the locality and nearby areas such as Murray Bridge.
6. On the current evidence, the Agency contends that the Tribunal would not be able to be satisfied that the supports are reasonable and necessary and meet all the requirements for payment in accordance with the Pricing Arrangements due to absence of evidence addressing:

• Details of the provider(s) of support work have not been given. It is unknown whether it is single provider, with several employees or whether each worker engaged is individually
• The address of the usual place of business of the provider(s)
• The address in Adelaide that the support workers are travelling from (if not the usual place of business of the provider(s)
• The actual distance travelled by support workers
• A copy of the service agreement(s) between the provider(s) and the applicant, including details of travel costs agreed upon and circumstances in which they are charged
• The reason for engagement of Adelaide-based providers.
• Whether costs of workers cannot be shared
• Information regarding the nature of the rate sought to be charged. The maximum rate is up to $0.99 per kilometre and information should be provided as to why the maximum amount is reasonable to charge (such as with reference to vehicle type and cost).

1. Addressing the section 34(1) criteria, the Agency contends that the evidence has not established that the requested provider travel and activity-based travel costs:
   • Are necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (section 34(1) (aa))
   • Represent value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support (section 34(1)(c))
   • Take account of what it is reasonable to expect families, carers, informal networks and the community to provide (section 34(1)(e))
2. In conclusion, the Agency made the following offer of additional supports and requested that the Tribunal find they are reasonable and necessary:
   • A package of supports for Daily Living based on 24/7 2:1 support, supplemented by STA and 10 hours per week of weekday SECP at high intensity rate for the applicant to attend appointments and access the community. The offer of 10 hours per week of weekday SECP at high intensity rate is contingent upon the applicant not attending schooling
   • 100 kilometres per week of activity-based transports funded at $0.85 per kilometre
3. The Agency noted that such funding would be for a period of six months. This would provide an opportunity for JGJJ's mother to provide further information concerning his mental health as the current treatment he receives remains unclear. This additional information would assist in the developing of a new plan thereafter.

1. On 25 March 2025, the Agency provided a statement of suggested evidence that could be provided by JGJJ's mother and that may assist the Tribunal.
2. The Agency subsequently provided a report prepared by Mr Stuart Burgoyne (Occupational Therapist) acting as an Independent Medical Expert dated 27 June 2025.
3. Mr Burgoyne's report is quite lengthy, so I do not propose to provide a summary here. Much of Mr Burgoyne's findings will be addressed when I record his oral evidence to the Tribunal.

1. The hearing of this matter took place between 10 November and 13 November 2025.
2. The following people gave evidence at the hearing:
   • JGJJ's mother.
   • Mr Musidaf Hussein (owner of the company providing JGJJ's support workers).
   • Ms Delia McCann (Behaviour Support Specialist).
   • Mr Stuart Burgoyne (Occupational Therapist and Independent Medical Expert)
   • Dr Mohammed Usman (Psychiatrist)
   • Dr Jodi Hunt (JGJJ's General Practitioner).

1. JGJJ's mother provided the following information:
   • She and her sons moved to their current location in 2020 largely to have a better life.
   • JGJJ started having problems when he was aged about 7. He started experiencing hallucinations and imaginary friends who tell him he needs to die.
   • When he was still attending mainstream school, he was seeing people in the classroom windows and when then proceed to smash the window which scared his classmates. He left public school in 2022 and has been home schooled since then.
   • He is now prescribed an antipsychotic medication, haloperidol. He had been prescribed olanzapine and sodium valproate, however both had significant side effects often leading to hospital admissions. His last hospital admission was in March or April 2025.
   • During a previous admission he was restrained by mental health staff and placed in seclusion which was traumatic for him, and he now will not willingly go to the hospital. She stated that he needs to have three support works to go with him on those trips to Adelaide however he does not have the funding for this. As a result, he has not seen Dr Usman or his Occupational Therapist for quite some time.
   • JGJJ goes to the Murray Bridge school property 5 days a week and will sometimes go there over the weekend. The property is about 25 to 30 minutes' drive from his home. He is taken there by his support workers using a company vehicle. He tends a garden there which he takes great pride in. He is generally there between 9 am and 3 pm.
   • The property is owned and operated by the company that provides his support workers. The education component is conducted by a local community college and is a modified SAT certificate program. One day each week is dedicated to online tuition with a teacher who will provide him with projects he will work on over the following days.
   • He will also go on outings in the community which may be to a local museum or a park or wildlife sanctuary.
   • JGJJ's mother said there was a serious incident around Anzac Day 2024, when he was being transported to an appointment in Adelaide. While they were on the freeway, JGJJ experienced hallucinations and in responding to them, he attacked the driver. The support worker had to quickly pull over and call emergency services.
   • JGJJ has not been to appointments in Adelaide for at least a year as there is no funding for three support workers, which JGJJ's mother considers necessary to make that journey safely. The onset of his hallucinations is hard to predict and can happen at any time.
   • Because of this, he has not seen Dr Usman in person in over a year. Dr Usman has continued to see him via telehealth. The last appointment was about three months ago.
   • There have been a number of concerning incidents in which JGJJ has reacted to hallucinations while in the community. On these occasions he may see something in a car window and then smash that window. He has on occasion overpowered the two workers with him and police needed to be called.
   • During another incident where he smashed a car window, the owner who had a young family said that he has a gun at home, and if JGJJ came near the house again he would shoot him.
   • On another occasion, whilst out in the community, JGJJ again experienced hallucinations and ran out into traffic. One of his support workers had to redirect the traffic and the other had to stop members of the public from intervening or attacking JGJJ.
   • A further occasion was when JGJJ punched a little girl who was on a merry-go-round. Due to his hallucinations, JGJJ thought she was a demon and again his support workers had to intervene to deescalate the situation and restrain members of the public who appeared to want to harm JGJJ.
   • Having only two support workers to accompany him on community access visits restricts the place they can go. Places where there may be a lot of people, particularly children, such as the museum, zoo, cinemas and wildlife parks will be more likely to trigger JGJJ.
   • JGJJ does not have a current behaviour support practitioner (BSP) and have sought to engage another BSP. However, the waiting list is about two years long. The previous BSP had started work with another company who indicated they would not support the provision of three support workers as they considered this would amount to a restrictive practice.
   • In the meantime, the support workers continue to use the previous behaviour support plan prepared in 2024.
   • JGJJ has not been seeing a psychologist for some time as they are also in Adelaide and it's not safe to travel there under the current level of support.
   • JGJJ is still experiencing thoughts of self-harm, most recently only 2 days before the hearing.
   • Asked whether she could act in the role as a third support person for the trips to Adelaide, JGJJ's mother said that she could not go to Adelaide as she needed to stay at home to care for her other son. Also, she would be unable to restrain her son due to his size and strength, and she reacts poorly in such situations. Finally, she wants to preserve her maternal relationship with her son.
   • JGJJ sleeps in a caravan outside the house and has the two support workers in with him. He is not a good sleeper and on occasion will come into the house, have a cup of herbal tea and have a chat with her.
   • She also spends time with him before and after school and over the weekend. JGJJ also spends time with his brother, and they now have a good relationship. They often play video games together and talk about the games they play
   • Asked about transport costs for the support workers, JGJJ's mother said these are significant. All the support workers live in Adelaide and drive to their home and take JGJJ to the school. She has tried locally based support workers, however they proved to be inappropriate in their behaviour. The current support workers have been with him for some time and JGJJ now has a good relationship with them. She wants to keep this team together as they have proved effective in managing her son and keeping him safe.
   • JGJJ's mother said she is looking to engage a new psychologist and occupational therapist. The psychologist has indicated that their preference is that they see JGJJ in person. They have a current waiting list of a year.
   • JGJJ has been seeing a naturopath since 2015 who prescribes a number of herbal preparations which she believes addresses some of the side effects from JGJJ's other medications. She said that she has always advised Dr Usman and the chemist of these.
   • She said that she considers that the haloperidol has been more effective in reducing the intensity of JGJJ's hallucinations. He takes 5 milligrams in the morning and a further 5 milligrams at night.

1. Mr Hussein is the owner and Manager of the company which provides the support workers for JGJJ. He provided the following information:
   • His company, Care Link Services, has been working with JGJJ since 2022. The company is based in Adelaide.
   • The company uses contractors who act as JGJJ's support workers. There are around 10 support workers who regularly assist JGJJ. Most of them have been with JGJJ since 2022, with only two recent additions. He said that any new worker needed to be a right match for JGJJ.
   • The support workers all live in Adelaide and travel to JGJJ's home and local school. He is currently allocated two workers 24/7.
   • They will perform their allocated shift and then write up notes of what had taken place during their shift.
   • The place where he attends daily is a house owned by his company. JGJJ does his education there and also, he looks after a garden there which he very much enjoys. He is also receiving training in life skills such as cooking and self-care.
   • The schooling is conducted by an online teacher who gives him assignments to do which might include tasks in his garden or other practical skills.
   • The house is largely used by JGJJ but is used for respite by other participants when he is not using it.
   • JGJJ uses it most days of the week and will occasionally sleep over in the house.
   • Mr Hussein was asked about some case notes which Ms Buxton tendered into evidence. He confirmed that he reviews those notes regularly.
   • In the event of JGJJ becoming agitated, the practice was to have a support worker try and redirect him and secure items such as sharps, cups and glasses.
   • The support workers have been told that restraining JGJJ is a last resort. Restraint is not required frequently. He gave a recent example, in which a baby in the property next door was crying and JGJJ had wanted to kill the baby which required the support workers to intervene.
   • He told the Tribunal that the behaviour support specialist, Delia McCann, had been working with his support workers but that this was no longer the case. He was not sure why she was unable to continue working with JGJJ. They continue to use the current behaviour support plan. He noted that JGJJ's presentation is complex and providing support for him is difficult.
   • Asked about using an alarm in the event of an incident Mr Hussein, said they are not currently using an alarm. The support workers can call him anytime if they have any concerns.
   • He confirmed that he does not currently charge mileage to the NDIS and he absorbs this cost.
   • Asked about the support arrangements when travelling by car, Mr Hussein said this was for trips to and from the property where JGJJ goes to school, to visit health professionals in Adelaide, and for locally based social outings.
   • He said that three people would be required to be with him when travelling to Adelaide as they have to use the main highway.
   • On these occasions there are two workers with him. The company has its own vehicle at the school. It is a standard vehicle and does not have a plastic shield around the driver's seat.
   • There have been about 10 incidents of concern with JGJJ when driving in the car.
   • There appears to be a few triggers for JGJJ's outbursts such as being in loud or busy areas.
   • He has active overnight support from two workers who are in the caravan which JGJJ uses as his bedroom. He needs two workers as he can be unpredictable and absconds and he has a history of attacking a neighbour.

1. Ms McCann was JGJJ's former behaviour support practitioner. She gave the following information:
   • She has worked as a behaviour support practitioner since July 2023. Prior to this she has worked in the disability field as a support worker, support coordinator and a Supported Independent Living (SIL) Manager.
   • She confirmed that she has worked with other clients with autism and presenting with similar behaviours to JGJJ.
   • She said she first became involved with JGJJ in June 2024. At that time, she spoke with JGJJ's mother to ascertain his support needs. She also spent some time with JGJJ in the community when he was with his support workers.
   • On the basis of these interactions, she then prepared an interim behaviour support plan in October 2024 and the complex behaviour support plan in December 2024.
   • She considered that she was able to develop some rapport with JGJJ and felt he was able to communicate what he liked and his needs.
   • She told the Tribunal of the content of his hallucinations including a girlfriend called Cathy who lives in outer space and some of his preoccupations with life after death.
   • After recording the history of JGJJ's behaviours she created a QR code which could then be used by his support workers to record the date, time, duration and the intensity of his behaviours. This would then be uploaded and then sent to her by email or a text.
   • She said she was not sure if JGJJ's support workers consistently recorded this information.
   • She used the data to keep her plan under review and updated.
   • There would be regular meetings involving JGJJ's mother, his psychiatrist, allied health practitioners and support workers. These meetings would be organised by the support coordinator.
   • She would also organise training for his support workers.
   • She was asked if she had received reports of JGJJ's behaviour when in the car and said she believed that was probably the case. When asked about a particular occasion when the driver of the car had to pull over to the side of the road due to JGJJ escalating, she said she could not recall that exactly.
   • In terms of the appropriate level of support while driving she considered two support workers could be adequate with one driving and another sitting behind the driver and next to JGJJ in the passenger seat.
   • She said that JGJJ did not like being restrained or otherwise having physical contact and restraint should only be used as a last resort to keep JGJJ and others safe.
   • In terms of strategies to be used when JGJJ became heightened while travelling in a car, she recommended immediately pulling the car over, give JGJJ some distance and redirect him if that was possible. If he has really heightened, she would recommend giving in to what he wanted. Again, if that did not resolve the situation, the support works should contact South Australian police or the ambulance service.
   • In such a very heightened scenario two people may be needed to restrain JGJJ with the third support worker contacting emergency services.
   • She said that her role as a behaviour support practitioner was to monitor any restrictive practices and either reduce them or remove them altogether. She would also wish to build JGJJ's capacity and independence and improve his quality of life.
   • In this regard having someone in her role, the OT and psychologist working collaboratively would be important people in nurturing JGJJ's capacity.
   • She said that community access visits should not take in busy locations with lots of people, however it was important that he have regular access to the community.
   • She considered that 2:1 support generally with active overnight support was appropriate but that 3:1 may prove beneficial while JGJJ is accessing the community.

1. After providing a summary of his professional qualifications and experience, Mr Burgoyne provided the following information:
   • He had originally attended JGJJ's home to conduct an assessment, however no one was at home. The appointment was rescheduled to take place on 8 August 2025.
   • He spent between 90 minutes and 2 hours conducting the assessment.
   • He mainly spoke with JGJJ's mother but did speak briefly with JGJJ. He said that JGJJ appeared calm but not very engaged with him.
   • When asked about what he considered an appropriate level of support worker support, Mr Burgoyne said that 2 support workers would be sufficient. He also recommended some environmental changes such as a fence around the house and the caravan, and some assistive technology such as an emergency distress alarm. He was unable to comment on the appropriateness of JGJJ sleeping in the caravan with his support workers with him. He considered having two support workers with one awake and the other sleeping was sufficient in terms of overnight support.
   • Asked about whether JGJJ has a behaviour support practitioner, Mr Burgoyne said that he was told that he does not have a behaviour support specialist at present, however there is an existing BSP.
   • Having a BSP in place was important as was a team approach between the family, support workers and allied health practitioners.
   • Mr Burgoyne said that building JGJJ's capacity would also be important and indicated that he would need regular sessions with a psychologist and Occupational Therapist. These preferably would be face-to-face-sessions at least initially. He said that he understood that JGJJ was not currently engaged with these allied health professionals. He expressed concern this was the case as it could lead to JGJJ becoming less independent over time.
   • In terms of community access for JGJJ, Mr Burgoyne said that this may be tricky due to JGJJ's hallucinations and would be better suited to small groups of people at least initially. He did not think it wise to take JGJJ to locations with lots of people such as the cinema or the museum as there would be the risk of sensory overload for JGJJ. He noted that certain places may have designated quiet times or days where this may be more practicable.
   • Asked about the request for 3:1 support on journeys to Adelaide and the incident in April 2024, Mr Burgoyne said that he would need more information about what had happened. He said that he was not sure what 3 people could do that 2 people couldn't. He said it was conceivable that a third person could ring for emergency assistance leaving the other two workers to manage JGJJ.
   • Asked about possible vehicle modifications that may address the identified risk factors, Mr Burgoyne suggest that a Perspex screen around the driver's seat may be useful.
   • He said the recent incident where JGJJ had managed to get off the family property indicated that his support workers had been unable to keep him calm using the techniques advised by the BSP.

1. After providing a summary of his qualifications and professional experience, Dr Usman provided the following information to the Tribunal:
   • He has been caring for JGJJ since 2023.
   • JGJJ has been prescribed haloperidol and an antidepressant medication for about 18 months. His presentation has improved over that time; however, the doctor did not want to ascribe that benefit solely to the medication citing factors such as his stable home life.
   • He described the risks to JGJJ arising from his hallucinations including suicide and self-harm. These generally occur when his is in a distressed state. He believes that these hallucinations are not psychotic in nature. He said that JGJJ's level of intellectual disability is unlikely to improve as he gets older.
   • The response to such incidents is the provision of stabilising medications, nursing interventions and hospital admissions. He has been involved with a number of hospitals where JGJJ has been, to ensure they provide consistent care. He also works with his support workers and allied health practitioners largely with the assistance of the mental health nurse Ms Tracey Dryden. Ms Dryden will do home visits with JGJJ and has meeting with his support team.
   • JGJJ will attend appointment with him and Ms Dryden in Adelaide accompanied by his support workers.
   • He told the Tribunal that JGJJ's cognitive age is about 7 years and his reactions when distressed reflect this. He will act impulsively and will seek to flee a perceived threat.
   • He is also a big boy and because of this, he is difficult to either restrain or contain and this may need to happen to prevent injury to himself or others.
   • Dr Usman agreed that in certain situations such as when driving on longer journeys three people may need to be with him in the event, he becomes dysregulated. He said that if an episode occurred, one person would need to keep JGJJ safe, one would be responsible for summoning help and the third to follow up if he ran away.
   • Asked as to alternatives such as an ambulance response, Dr Usman stated that had its own challenges and may require restraining JGJJ or sedating him. In this regard if restraint was necessary, it should only be performed by those he knows and trusts.
   • He agreed that building JGJJ's capacity was a key aspect to his management strategy. He has had a consistent team working with him which has been helpful.
   • As he is now aged 17, he will need to transfer to an adult mental health service next year. Going forward he would certainly benefit from engaging with an Occupational Therapist; however, he was less convinced of the ongoing engagement with a psychologist.
   • He considered there was a specialist adult mental health team in Adelaide with experience with those with intellectual disability he could be referred to, with his primary care managed by his GP.
   • He considered that having his current support workers responding to when he was becoming distressed was the best response rather than a mental health hospital admission.

1. Dr Hunt is JGJJ's General Practitioner and provided the following information:
   • She has been JGJJ's GP since the family moved to the area in 2022.
   • While the frequency of seeing him varies, she generally sees him on a monthly basis.
   • Dr Usman is currently managing his prescribed medications and he is visited by his mental health nurse.
   • When he attends appointments with her, JGJJ will come with his mother and either two or three support workers.
   • While she has sometimes spoken with JGJJ when he is unaccompanied, this has not happened for some time.
   • JGJJ's behaviours have deteriorated in the last three to four years and has needed hospital admissions assisted by the ambulance service.
   • Dr Hunt confirmed that she participates in multi-disciplinary team meetings involving the hospital, the ambulance service and his support workers.
   • She has also engaged with his previous behaviour support specialist and has a copy of his current behaviour support plan.
   • In terms of her future role with JGJJ, she agreed that an adult psychiatrist would need to work with her in a shared care model.
   • She said that she did have concerns about the risks when JGJJ was travelling in a car. He is at risk of harm to himself and others particularly due to his height and size. She agreed that having three to one with him when travelling was not unreasonable as one carer alone could not restrain him. He needs at least two support workers to do this with the third responsible for seeking assistance. She agreed that physical restraint should be used as a last resort.
   • She agreed that using PRN sedative medication may be an option it has potential down sides including over sedation leaving JGJJ unable to effectively participate.
   • She believed that there may be suitable allied health practitioners in the local area although there is a shortage of psychologists. In many cases, those practitioners would have waiting lists. In the meantime, he should continue engaging with his current practitioners who he has developed a relationship with and know him well.
   • Asked about the potential use of telehealth appointments, she considered that JGJJ would find it harder to engage using that method.

1. After providing a summary of his qualifications and professional experience, Ms Dryden-Mead provided the following information to the Tribunal:
   • She commenced working with JGJJ in January 2023.
   • The frequency with which she sees him has depended upon whether he has been stable or experiencing a crisis. When he has been more unsettled, she would see him frequently.
   • She said that more recently (in the last 12 to 15 months) he has been more settled and therefore has had less frequent engagement with him.
   • She will see JGJJ in a range of settings including at home, at his school environment and in the community.
   • In her most recent home visit, he was settled but less engaged with her, which she considered was because home is his safe place.
   • She said that he can become dysregulated at any time. He has been most dysregulated when in hospital, but it has been some time since she saw him in hospital.
   • She will leave it to JGJJ to decide where he would like to meet her, however, would also be led by his support workers as to how busy a potential location may be.
   • When asked about the potential of using telehealth for appointments, she said she did not consider it a good medium to assess and provide support to JGJJ and those around him or reduce potential risks.
   • She meets with the other allied health practitioners including his behaviour support specialist and support workers.
   • The feedback she has gained from such meetings is that JGJJ has not been able to attend his various appointments in Adelaide and has been told that it is not safe by JGJJ's mother and the support workers for him to travel in a car.
   • There have been instances where while travelling he became dysregulated requiring the car to pull over and for assistance to be sought.
   • Asked for her view as to an appropriate level of support she said that it would not be possible for one support worker to restrain JGJJ if the other support worker was driving.
   • She said that JGJJ has to travel to Adelaide for appointments with his psychiatrist and others as they do not have the capacity to visit regional South Australia.
   • While the transition to an adult mental health team takes place, she would recommend seeing him every two months. She and Dr Usman could see him together. It is likely there is a waiting list for the adult mental health team before they can see JGJJ, but she would be actively assisting that transition.
   • In terms of other ongoing supports, she said that a new behaviour support specialist would be required to see him every two weeks. While there may be some benefit in seeing a psychologist, this would depend on if JGJJ was open to talking as this did vary.
   • Asked on the availability of allied health practitioners in JGJJ's area, she indicated there would not be many and very few who could deal with complex needs participants.
   • Asked about any potential downsides to having support workers with him overnight, she said that like all teenagers JGJJ wants to be more independent, but this must be done safely.
   • In terms of future capacity building, she said this was hard to predict however JGJJ will always require a level of care and adult supervision. While his need for support may reduce over time, it was hard to predict this need to say in ten years' time
   • Concerning community access for JGJJ, she said this was important to increase his exposure to and awareness of others, this would need to be managed carefully and done gradually over time.
2. At the conclusion of the hearing, both JGJJ's mother and Ms Buxton indicated that they would prefer to provide written rather than oral submissions. I therefore directed the following timetable for these as follows:
   • The Respondent to provide their written closing submissions by 18 December 2025.
   • The Applicant's mother to provide her final submissions by 7 January 2026.

1. Mr Husein sent the following email in response to a query from the Agency's Solicitor concerning whether he wishes to have the company's mileage costs met by the NDIA:

It has become increasingly unsustainable for CareLink Support Services to continue absorbing [JGJJ's] transport expenses. On average, we travel approximately 150 kilometres per day, which at the rate of $1.00 per kilometre amounts to around $54,600 per year.

In addition to this direct cost, the vehicle experiences significant wear and tear from the extensive travel. We are required to service the car and replace tyres roughly every four months, further adding to our operating costs.

We have raised this matter with the NDIS several times but have consistently been advised that it remains before the AAT. We therefore respectfully request that:

1. The NDIS reimburse the transport costs already incurred since we began supporting [JGJJ]; and
2. A variation be implemented to ensure these transport costs are funded prospectively going forward.

Addressing this issue promptly would not only relieve the financial strain on our organisation but also ensure [JGJJ's] ongoing access to consistent and reliable support.

Thank you for your understanding and continued assistance.

1. The Agency's post-hearing submissions were received by the Tribunal on 19 December 2025. I do not propose to record those submissions in their entirety; however I will make reference to what I consider are its salient points.
2. The Agency again noted that the issues for the tribunal to determine are:
   • Support one - the extent of 3:1 support worker assistance (as opposed to 2:1), and whether the third support worker (when funded) should be paid at standard or intensive/complex needs rates; and
   • Support two - the nature and extent of transport costs for support workers.
3. The submission noted that a further witness, Jordan Price, Developmental Educator, Paediatric Play, was unavailable to give evidence and the Respondent was therefore unable to cross-examine him on the matters contained in the functional capacity assessment report he had prepared (and was produced under summons). The Respondent submitted that in these circumstances, the Tribunal should give minimal weight to this report and should prefer the evidence of the independent occupational therapist, Mr Burgoyne.
4. The respondent also noted that further documentary evidence had been provided in addition to the Joint Tender Bundle with a further Joint Tender Bundle being provided to the Tribunal on 18 November 2025, which included excerpts of the summons material referred to during the course of the hearing. This included materials from the following organisations:
   • Centre for Positive Behaviour Support (CPBS)
   • Paediatric Play
   • South Australian Ambulance Service
   • Carelink Support Services
   • Adelaide Women's and Children's Hospital (CAMHS)
5. The submission also noted that after the conclusion of the hearing, Mr Hussein from Carelink Services provided two emails as prompted by JGJJ's mother and requested by the Tribunal. The Agency submitted that the information in those emails should be disregarded by the Tribunal in reaching its decision. This was because Mr Hussein, at the time they were sent, was no longer under oath, and also given that the contents of these emails raised matters that Mr Hussein had not raised in his oral evidence before the Tribunal.
6. The Agency's submission then provided a summary of the evidence heard by the Tribunal as well as a statement of its revised position at the conclusion of the Tribunal hearing evidence. I will now refer to the Agency's revised position
7. In terms of the request for funding for the provision of support workers at a 3:1 ratio the Agency stated that it was prepared to fund 349.5 hours per annum of 3:1 support worker assistance with the third support worker funded at the standard rate. The breakdown of that funding was as follows:
   • 6 return trips to Adelaide for appointments with the Applicant's Cardiologist (3.5 hours each return trip);
   • 6 return trips to Adelaide for appointments with the Applicant's Endocrinologist (3.5 hours each return trip);
   • 3 return trips to Adelaide for appointments with the Applicant's Psychiatrist (3.5 hours each return trip);
   • 26 return trips to Adelaide for appointments with the Applicant's Psychologist (3.5 hours each return trip);
   • 26 return trips to Adelaide for appointments with the Applicant's Behaviour Support Practitioner (3.5 hours each return trip);
   • 26 return trips to Adelaide for appointments with the Applicant's Occupational Therapist (3.5 hours each return trip); and
   • 4 outings for Social and Economic Participation (SECP) (6 hours each trip).
8. In relation to JGJJ's mother's request for funding for mileage for JGJJ's support workers, the Agency considered the following support to be reasonable and necessary:
   • Mileage for the 97 return trips to Adelaide at $1.00 per km x 160 km round trip = $15,520.00.
   • Mileage for the trips the Applicant takes daily from his home to the Murray Bridge House and travel associated with SECP calculated at $1.00 per km x 500 km per week = $24,000.00.

Funding for Support Worker at 3:1 for attending medical/allied health appointments

1. Addressing the requested 3:1 supports, the Agency noted that JGJJ's mother had revised her original request that such support be provided 24/7 and now requested that this level of support was necessary for her son's travel by car to attend health appointments in Adelaide, and when he was accessing social and economic community participation (SECP). This request was on the basis that on these longer road journeys, JGJJ was at greater risk of emotional dysregulation and behaving in a way that placed himself and others at risk.
2. The Agency submitted that it considered that the evidence regarding the nature of supports provided by a third support worker indicated that this could be funded at a standard rate. This was because the support provided by the third support worker was to be available for the potentially limited number of occasions when JGJJ's behaviour required a higher level of intervention. In this regard it relied upon the following evidence:
   • Dr Usman stated that one support worker would deal with keeping JGJJ safe, another would make a phone call to emergency services, while the third would remain on standby if he chose to run.
   • Dr Hunt's evidence was that it could take two support workers to restrain the Applicant, so the role of the third worker would be to contact emergency services.
   • Mr Burgoyne had not specifically considered the safety risks when the Applicant was travelling by car but was aware that the Applicant was spending a lot of time in the car. When asked whether he could conceive of a scenario where three support workers would be required specifically while travelling in a car, he stated that the only conceivable scenario would be that the third person would seek assistance by making a phone call, but certainly two trained support workers could otherwise manage the situation.
3. Based upon that evidence which indicates the limited role of a third support worker, and the relative infrequency of events in which that level of additional support may be required, the Agency submitted that the standard rate of support worker assistance would be appropriate. It submitted that the funding of the third support worker at the intensive/complex needs rate is not considered reasonable and necessary in these circumstances.

Funding for Support Worker at 3:1 for social and community participation

1. As noted earlier, the Agency considered that the evidence heard by the Tribunal supported the conclusion that 3:1 funding for SECP was necessary, however, then addressed what an appropriate level of such funding would be.
2. In support of its revised position, the Agency provided a detailed summary of the evidence the Tribunal heard on this topic. I do not propose to record that summary of the evidence in detail; however, I may address specific aspects of such evidence in my assessment.
3. As to the proposed funding for a third support worker for a limited number of "excursions", the Respondent submitted that it cannot fund supports which relate to a participant's education, as such costs are the responsibility of the relevant state Department of Education.
4. In this regard the Respondent submitted that four such "excursions" represents a reasonable and necessary allowance in circumstances where the evidence indicates that the Applicant finds visits to new places, or places where he may encounter challenging crowds, and which place him at increased risk of dysregulation. The evidence indicates that JGJJ may not be capable of benefiting from visits to, for example, museums or the zoo without further behaviour support intervention. The Respondent submitted that it is not able to fund supports which may place the Applicant, or others, at risk of harm.
5. The Agency also noted that JGJJ's plan includes funding for Short Term Accommodation (STA) (now referred to as Short Term Respite) for 30 Saturdays and 30 Sundays per year. It submitted that for the purpose of reviewing a reviewable decision, the Tribunal may exercise all the powers and discretions that are conferred on the decision maker and is considered as being in the shoes of the person whose decision is in question. The Tribunal is therefore able to consider whether, on the evidence adduced during the hearing, funding for STA continues to be a reasonable and necessary support for inclusion in the Applicant's plan.

1. The Agency noted that JGJJ's mother's initial request for the mileage cost was the amount of $474,500 per annum. This cost represented the cost of three support workers travelling between Adelaide and JGJJ's home on a daily basis.
2. Mr Hussein gave evidence that his company absorbs these costs as part of their service in providing the support workers.
3. The Agency, at the Tribunal's suggestion, sent two emails to Mr Hussein after he had given his evidence. The first email sought clarification concerning whether his company charged mileage. Mr Hussein confirmed the company was absorbing this cost and had never charged mileage during the time it has provided support workers to JGJJ.
4. JGJJ's mother again insisted that the Tribunal should consider the provision of funding for mileage. This prompted a further email being sent by the Agency to Mr Hussein as to whether he wished to charge for mileage in the future.
5. In response, Mr Hussein stated that he wished to be reimbursed for the cost of mileage for its past services and wished to be funded for this expense on an ongoing basis.
6. With regard to the evidentiary value of these subsequent emails from Mr Hussein, the Agency submitted that I should provide it little, or no weight, and instead rely upon the clear evidence he provided when giving evidence before the Tribunal.
7. In conclusion, the Agency made the following observations concerning JGJJ's mother's concerns about potential changes in her son's circumstances, and for his funding to reflect these possibilities:
   • If there were to be a material change in her son's situation, his mother could at any time lodge a change of circumstances request with the Agency.
   • It has included a 'cushion' in its suggested funding to address potential unforeseen circumstances, including funding to attend therapies with which he is not currently engaged, and which may not recommence for several weeks, or months, if suitable therapists with capacity to provide therapy are not immediately available. Further, the evidence from Dr Hunt indicated that there may be suitable therapists who may be sourced closer to the Applicant's home, thereby reducing the number of trips to Adelaide that may be required.
   • The Agency further noted that if more than one appointment could be scheduled in Adelaide on the same day, this would potentially be more cost effective, freeing up funds by way of contingency funding. Further, if he is unable to attend an appointment due to illness, dysregulation or so on, unused funding allocated for that appointment would also be available for later use.
   • The Agency also noted that the evidence indicated that telehealth may be a viable option in limited circumstances, obviating the need to travel to Adelaide.
   • Finally, the Respondent highlights that JGJJ's mother gave evidence that she attends the medical appointments and some of the allied health appointments with JGJJ in Adelaide (driving in a separate car). Given the evidence established that the role of the third support worker was to telephone emergency services in the event the Applicant were to become dysregulated (and given the evidence that the necessity to do so has become increasingly less frequent), the Respondent submits that it is reasonable that the Applicant's mother could drive in convoy with the Applicant and his support workers to perform this role on occasion.
8. The Agency provided an annexure to its final submissions which summarised the revised supports it was prepared to fund in JGJJ's plan. I have recorded here only those related to the matters before the Tribunal:

• Assistance with Daily Living 24/7 at 2:1 at the high intensity supports rate including active overnight support (it is noted that funding within this category not available for those periods, if any, for which funding is available and utilised for STA): $1,271,834.00
• Additional support worker assistance at the standard rate (to a total ratio of 3:1) for 349.5 hours totalling ($24,545.00) in respect of:
  • Six return trips to Adelaide for appointments with his cardiologist (3.5 hours each return trip)
  • Six return trips to Adelaide for appointments with his endocrinologist (3.5 hours each return trip).
  • Three return trips to Adelaide to see his psychiatrist (3.5 hours each return trip)
  • 26 return trips to Adelaide for psychology (3.5 hours each return trip)
  • 26 return trips to Adelaide for behaviour support therapy (3.5 hours each return trip)
  • 26 return trips to Adelaide for occupational therapy (3.5 hours each return trip).
  • Four outings for social and economic participation (SECP (6 hours each trip).

• 30 Saturdays per year at 2:1 at high intensity rate.
• 30 Sundays per year at 2:1 at high intensity rate.

• 97 return trips from JGJJ's home to Adelaide and return at $1.00 per km at 160km per return trip (for medical appointments, therapy and SECP excursions).
• 500km per week for 48 weeks at $1.00 per km (for local travel).

1. JGJJ's mother did not provide any final submissions to the Tribunal. However, I did not complete my decision until after the final date I permitted for her to make any submissions namely, 7 January 2026.

1. The issues before me are:
   • Whether the requested 3:1 support worker assistance to accompany JGJJ to medical and allied health practitioners in Adelaide and when accessing community activities is reasonable and necessary; and
   • Whether the request for transport funding for support workers is reasonable and necessary.
2. The Agency, for its part, has accepted that these supports are reasonable and necessary and has put forward a model of funding to accommodate these. I therefore do not need to independently assess the reasonable and necessary criteria and will confine myself to the concerns raised by JGJJ's mother in her submissions.
3. I have reviewed the frequency of the journeys to Adelaide to attend medical and allied health appointments. In my view, these largely accord with the recommended number of appointments made by each of these health professionals.
4. I note that the Agency has indicated that it considers that three appointments with JGJJ's psychiatrist is appropriate. I also note that once JGJJ turns 18, he will begin transitioning from the current adolescent mental health service to a specialised adult mental health service. While it is unclear as to the timing and nature of that transition, I consider he may require further appointments both to facilitate that transition and to have face-to-face consultations with the psychiatrist and related staff in the adult team.
5. I consider that five appointments would therefore be appropriate. This is because it is unclear from the evidence what degree of community outreach the adult service may provide, and a certain number of in-person sessions with that team may be required to help JGJJ develop trust and rapport with the team's psychiatrist and mental health workers.
6. The only other aspect of the proposed additional funding is for a third support worker that I consider may not be sufficient is related to the proposed four trips for JGJJ to have access to the community.
7. In this regard, I have taken into account the evidence of both Ms McCann and Ms Dryden-Mead, who have indicated that such community access should be managed carefully in a staged manner over time, and in conjunction with any recommendations made by his behaviour support specialist.
8. This access to the community will be a crucial part of JGJJ's social development and for that reason I consider that six such journeys at 3:1 support would be a more appropriate number.

1. As previously noted, the Agency has conceded that a certain amount of transport funding is reasonable and necessary. Again, taking into account the Agency's revised position, I do not consider it necessary to separately assess the criteria.
2. The Agency's proposal is to provide transport funding in relation to its proposed funding for 3:1 support to enable JGJJ to attend medical and allied health appointments in Adelaide and for him to access the community, being:
   • 97 return trips from JGJJ's home to Adelaide and return at $1.00 per km at 160km per return trip (for medical appointments, therapy and SECP excursions).
   • 500km per week for 48 weeks at $1.00 per km (for local travel).
3. Overall, I consider that proposed funding is appropriate, however as I noted above, I consider that allowance be made for a further two journeys to attend appointments with his current and future mental health team as well as an additional two SECP outings. This will therefore increase the proposed 97 journeys to 101 such trips.

1. The Tribunal is satisfied that the requirements in ss 34(1) (aa)-(f) have been met with respect to the following requested supports:
   • Additional support worker assistance at the standard rate (to a total ratio of 3:1) for 363.5 hours for the following:
     • Six return trips to Adelaide for appointments with his Cardiologist (3.5 hours each return trip)
     • Six return trips to Adelaide for appointments with his Endocrinologist (3.5 hours each return trip).
     • Five return trips to Adelaide to see his psychiatrist (3.5 hours each return trip)
     • 26 return trips to Adelaide for Psychology (3.5 hours each return trip)
     • 26 return trips to Adelaide for Behaviour Support Therapy (3.5 hours each return trip)
     • 26 return trips to Adelaide for Occupational Therapy (3.5 hours each return trip).
     • Six outings for social and economic participation (SECP (6 hours each trip).
   • Mileage for the trips the Applicant takes daily from his home to the Murray Bridge House and travel associated with SECP calculated at $1.00 per km x 500 km per week = $24,000.00.
   • Mileage for the 101 return trips to Adelaide at $1.00 per km x 160 km round trip.
   • Mileage for the trips the Applicant takes daily from his home to the Murray Bridge House and travel associated with SECP calculated at $1.00 per km x 500 km per week.

1. The Tribunal sets aside the decision under review pursuant to subsection 105(b) of the Administrative Review Tribunal Act 2024 (Cth) as it relates to the supports specified in paragraph 137 of this decision.

.............................[sgd]...........................................

[1] Documents lodged under s 37 of the Administrative Appeals Tribunal Act 1975 (Cth) ('TD').

[2] National Disability Insurance Scheme Act 2013 (Cth), subsection 4(1).

[3] Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634; Madelaine and National Disability Insurance Agency [2019] AATA 4025.

[4] National Disability Insurance Agency, 'Operational Guidelines: Overview of the NDIS Operational Guideline' .

[5] G v Minister for Home Affairs [2019] FCAFC 79 [18].

[6] Re Drake and Minister for Immigration and Ethnic Affairs (No 2) [1979] AATA 179; [1979] 24 ALR 577 [590].

[7] G v Minister for Immigration and Border Protection [2018] FCA 1229.