What the NDIS High Intensity Skills Descriptors Require

The high intensity support skills descriptors are supplementary guidance from the NDIS Commission setting out the skills and knowledge a support worker needs to safely deliver each high intensity support. Each of the eight is built to the same structure: setting out its relationship to the Module 1 practice standard it supports, its relationship to other skills descriptors, the context a provider needs to have in place, the scope of who it applies to, and the training required.

Co-requisite descriptors

Several categories are designed to be used together, not in isolation, where a participant’s needs overlap.

Enteral feeding and dysphagia support are linked in both directions, a participant who requires enteral feeding and also has dysphagia needs workers trained against both descriptors, and the same applies in reverse. Ventilator support and tracheostomy support work the same way, a participant requiring ventilation who also has a tracheostomy needs workers meeting both. Complex wound management also has a stated connection to subcutaneous injections, specifically where the participant’s wound care needs relate to diabetes.

A provider registered for one of these categories without checking whether a participant’s needs trigger the linked descriptor is a common gap. The skills descriptors are explicit that the linked training is expected, not optional, wherever the co-occurring need exists.

What the context requirement actually asks for

Every skills descriptor’s context section expects that a support plan for the relevant activity has been developed and is overseen by a relevant health practitioner, and the participant was involved in developing it. The plan is up to date, easily available, and clear enough that a worker can follow it’s instructions and guidance. Participants are supported to get regular, timely reviews of their health status, and the plan is communicated, with consent, to the participant’s support network, other providers and relevant government agencies where appropriate.

It won’t be sufficient to only have a generic policy about high intensity supports. Your auditor will be looking at whether each individual participant has a current, practitioner-overseen plan, whether that plan was developed with them, and whether workers are demonstrably working from it rather than from general training alone.

The three-phase skill structure

Every descriptor breaks the required skills and knowledge into three phases: preparing to deliver the support, implementing the support plan, and reviewing the support.

• Preparing to deliver support covers things like confirming the worker has the correct, current plan for that participant, checking the participant’s preferences and communication needs, and getting hygiene, infection control, equipment and consumables ready before support begins.
• Implementing the support plan is where the specific procedural and clinical knowledge sits, e.g. positioning the participant correctly, following the plan’s specific instructions, recognising signs that something isn’t right, and knowing when and how to escalate to a health practitioner.
• Reviewing support covers checking in with the participant about whether the plan is still meeting their needs, and documenting and reporting where it isn’t.

The knowledge expected at each phase is participant-specific, not generic. A worker isn’t assessed against bowel care generically, they’re assessed against whether they understand this participant’s plan, this participant’s risk factors, and this participant’s preferences.

What this means for a provider’s obligations

Registered NDIS providers must comply with the NDIS Code of Conduct and are obligated to meet the National Disability Insurance Scheme (Provider Registration and Practice Standards) Rules 2018 as a condition of registration, along with the National Disability Insurance Scheme (Quality Indicators) Guidelines 2018. Where a provider delivers high intensity supports, an independent Approved Quality Auditor uses the skills descriptors, among other things, to assess whether the provider has demonstrated conformity to the Practice Standards and Quality Indicators.

In practice, that means an auditor won’t be satisfied by a training certificate alone. Theyll want to confirm that training and competency assessments are documented and current, that reassessment has happened where a worker hasn’t delivered a support for more than three months or a participant’s plan has changed, and that the records reflect the specific participant a worker is supporting, not a generic competency sign-off.