Support Plans

Who is Completing this form?

First NameLast Name
Support Plans
Support Coordinator
Date Plan Created

DayMonthYear
Date
When would you like to review this plan again?

DayMonthYear
Date
Complete Support Plan Offline
Download Support Plan:

Download Support Plan
Upload Completed Support Plan

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Or Complete Support Plan Below
This information assists MADE TO HELP to tailor our support services to meet the participant’s individual needs. Please complete all sections of the form. NOTE: A copy of this Support Plan is given to the Disability Support Workers assigned to work with the Participant.

Why is a support plan important?
Individualised Care: Support plans are tailored to the specific needs and goals of an individual. This ensures that the support provided is personalized and effective in addressing the unique circumstances of the person receiving care.

Clarity and Consistency: Support plans outline clear objectives, strategies, and responsibilities. This helps all parties involved, including the participant, caregivers, and professionals, to understand what is expected and how to achieve the desired outcomes. It reduces confusion and ensures that everyone is on the same page.

Goal Achievement: Support plans set measurable goals and milestones. This makes it easier to track progress and determine whether the support provided is helping the individual achieve their desired outcomes. It also allows for adjustments to the plan as needed to ensure continued progress.

Communication and Collaboration: Support plans encourage effective communication among the various individuals and agencies involved in an individual's care. This collaboration ensures that the person's needs are met comprehensively and that no important aspects of their care are overlooked.

Quality Assurance: Support plans can serve as a tool for quality assurance and accountability. They provide a documented record of the care provided, making it easier to assess the quality of services and make improvements as needed.

Empowerment: Involving the person receiving care in the development of their support plan can empower them to take an active role in their own well-being. It fosters a sense of control and autonomy over their life and care decisions.

Resource Allocation: Support plans help allocate resources efficiently by identifying the most critical needs and priorities. This ensures that resources such as time, staff, and funding are directed where they are most needed.

Legal and Ethical Compliance: In certain situations, support plans may be legally required to ensure that care is provided in accordance with laws, regulations, and ethical standards.

Continuous Improvement: Support plans are dynamic and can be adjusted over time as the individual's needs and circumstances change. This adaptability allows for continuous improvement in the quality of care and support provided.

Documentation and Record-Keeping: Support plans provide a valuable record of an individual's care journey, which can be important for auditing, reporting, and future planning. They help maintain a comprehensive history of the individual's care and support.

In summary, a support plan is essential for delivering individualized care, ensuring clarity and consistency in care delivery, achieving specific goals, promoting collaboration among stakeholders, and complying with legal and ethical standards. It is a tool that enhances the quality of care and support provided to individuals in various settings.
OUR TERMS FOR SERVICE PROVISION
Participant's Name

First NameLast Name
Support Coordinator

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
NDIS ID
DOB

DayMonthYear
Date
Age
Religion
Please list any of your cultural Preferences;
Contact of case worker
Is the Participant in Departmental Care or has a Guardianship Court Order?
If yes, Name and Contact of Guardian
NDIS plan provided?
OT report provided?
Behaviour support plan provided?
DISABILITY/DISABILITIES - DIAGNOSIS/SPECIAL NEEDS
Please tell us about your Likes, Dislikes and tell us about your 'strengths' ?

Please list all current medications, if Any:

Rows	Name of Medication	Dosage	Time taken	Frequency
1
2
3
4
5
6
7
8
9
10
11
12

Please list all current PRN medications, if Any:

Rows	Name of Medication	Dosage	Time taken	Frequency
1
2
3

HEALTH CONCERNS THAT REQUIRE SPECIALISED TREATMENT
MEDICATION: All medication must be provided in a Webster pack, as applicable. Other Medication eg. Liquids/creams/PRN medication must have written details of how/when to administer.
ASTHMA: If Yes, Please attach ASTHMAPLAN
ASTHMA PLAN

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DIABETES: If Yes, Please attach DIABETES MANAGEMENT PLAN
DIABETES MANAGEMENT PLAN OR REPORT

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EPILEPSY: If Yes, please attach EPILEPSY PLAN OR OT REPORT
EPILEPSY PLAN OR OT REPORT

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Do you have an Infectious Disease we need to know about?
Podiatry – do you require a podiatry appointment?
Are your vaccinations current? Please list any you have done recently.
Do you have any Dental needs?
Do you have any additional Allied Health documents? If Yes, please provide below:
ALLIED HEALTH DOCUMENTS:

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Mealtime management – do you have mealtime management plan?
Mealtime management plan

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Hepatitis – do you have hepatitis?

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Have you had COVID-19 vaccinations?
Have you suffered from COVID-19 before?
Do you suffer from frequent seizures?
What are your preference's for Services, please list and tell us what you want?
MEDICAL EMERGENCY: Please advise who should be contacted in case of a medical emergency - e.g. Family member, GP or other Health Professionals.
Role
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Role
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Role
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medicare Number
Medicare Expiry Date
Centrelink/DVA Number
Power of Attorney – Medical - Name
Power of Attorney – Medical - Contact Details
Power of Attorney – State Trustees - Name
Power of Attorney – State Trustees - Contact Details
Advocate/Support person - Name
Advocate/Support person - Contact Details
Legal Guardian - Name
Legal Guardian - Contact Details
Emergency Contacts
Emergency Contact - Name and Relationship
Emergency Contact - Contact Details
Emergency Contact - Name and Relationship
Emergency Contact - Contact Details
General Practitioner
Name
Clinic
Contact
Psychiatrist / Psychologist
Name
Clinic
Contact
Mental Health Case Manager
Name
Clinic
Contact
Behaviour Support Practitioner
Name
Clinic
Contact
Occupational Therapist
Name
Clinic
Contact
Physiotherapist
Name
Clinic
Contact
Speech Therapist
Name
Clinic
Contact
Emergency and Disaster Management
Emergency and disaster management plan has been implemented to ensure the safety, health, and wellbeing of all our participants.
An emergency plan will be created for each participant and have the emergency personnel contact details displayed.
Mock emergency evaluations will take place every 6 months or at management discretion using the Form83 –
Emergency Drill Reporting form.
Emergency contact number – 000 for police, fire, and ambulance.
Personal emergency plan – do you have a Personal Emergency Plan in place?
If your services were to be interrupted by an Emergency Event, who will help you?
Upload your Personal Emergency Plan

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LEGAL REQUIREMENTS/DETAILS
INTERVENTION ORDER – against someone else
Name of Person

First NameLast Name
Relationship of person
Address of intervention

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any locations the participant cannot be taken to due to the Intervention Order?
Other Information relevant to the Intervention and Service Delivery:
INTERVENTION ORDER – against you
Name of Person

First NameLast Name
Relationship of person
Do you have an Infectious Disease we need to know about?
Address of intervention

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other relevant information about the order and its service delivery
Do you use any recreational drugs?
Do you have possession of any weapons?
Is there anything else related to legal matters that we should be aware of?
SUPPORT AND ASSISTANCE REQUIREMENTS AND INFORMATION
FOODS ALLERGIES OR SENSITIVITIES - WHAT FOODS MUST BE AVOIDED
CULTURAL CONSIDERATIONS
How would you like to be serviced, please list your preferences
Please share with us your strengths, 'the things you consider that, you do well in your life'
Dietary Considerations
Like and Dislikes
PERSONAL CARE ASSISTANCE
For Each of the following tasks, please tick relevant response and add details of the support required.

Please Note – Where personal care support is provided in the participant’s home, separate detailed written Instructions will be developed with the Participant for the DSW, to ensure their Daily Living routines are followed.

Support Required

Rows	None	Full	Partial	Details of Assistance Required
Dress/Undress
Selecting clothing
Bath/Showering
Grooming
Dental hygiene
Preparing a meal
Eating a meal/drinking
Taking medication
Transfer in and out of bed/chair/car
Continence / toileting
Transferring/Moving
Cooking
Bath/Showering
Money Management

Personal Skills

Rows	Describe	Management Strategies/Support
Communication
Expressing Emotions
Receptive Language
Money Management
Safety in the community
Travelling in vehicle
Cultural Considerations
Inappropriate Behaviour
Activities enjoyed
Specific Activity Supports

Additional helpful information in relation to care needs:
Is any Manual Handling involved in the participant’s personal care?
If Yes, please attach OCCUPATIONAL THERAPIST (OT) PLAN
Do you have an Occupational Therapist (OT) Report
OT Report Attached

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If No, please arrange for an OT assessment as our staff must have an OT approved plan before they are able to use manual handling
AIDS AND EQUIPMENT REQUIRED e.g. Walking Frame, Wheelchair, Bath Chair, Toilet Chair, special cutlery etc.
TRIGGERS/SAFETY CONCERNS/DANGERS
What are your triggers?What things make you angry,anxious, or upset?
How do you express yourself when you are upset or angry? How do you express your emotions?
What will help you calm down? How should we manage your emotions?
Crossing the road
Reading safety signs
Using public transport
Contacting emergency services
Police and law enforcements
Hazards and obstacles on the road
Cybersecurity
Crowded areas
Making decisions
Travelling in cars
Inappropriate behaviours
If you have a behaviour support plan, do you have any restrictive interventions in it? If so, can you provide a copy?

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Are there any other emotional triggers or safety concerns we should be aware of?
Risk assessment
List the Risk and Appropriate Strategy
BEHAVIOURAL SUPPORT
Does the Participant have a Behavioural Support Plan?
If Yes, please supply a copy of the Behavioural Support Plan. Note this plan will be kept securely at the office. This plan will support our staff and support workers to support you for your own safety and their safety as well.

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Does the Participant have any Restrictive Interventions in the Behaviour Support Plan?
If Yes, we will have to check the DHHS RIDS System (Restrictive Intervention Data System) to ensure the participant has a RIDS Plan in place. We will not support restrictive interventions unless there is a registered plan in place on the RIDS system.
RECORD ANY OTHER INFORMATION TO ASSIST IN MATCHING PARTICIPANT WITH SUPPORT NOT COVERED ABOVE:
NDIS GOALS
What does the Participant want to achieve from their support? Use their NDIS Plan as a guide to set their goals. Please make goals achievable and relevant to the support to be provided. Please take into account any financial constraints in regard to Outings for Community Participation
Primary Goal
Sub Goal 1:
Sub Goal 2:
Sub Goal 3:
SHIFT DETAILS
FREQUENCY OF SUPPORT:

DAY and TIME Preferred (Fill in times next to the relevant day of the week)

Rows	Select	Best Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What is your idea of a typical shift?
What activities do you enjoy?
Do you have a gender preference of the support worker?
What qualities should the support worker have?
Would you need to travel in the support worker’s vehicle?
Do you have a companion or MPTP card?
IF NO, GUIDE THE PARTICIPANT HOW THEY CAN GET ONE.
What expectations do you have for your shifts?
Are there any locations or activities you want to stay away from or not do?
Would you like to provide any other information regarding shifts?
PICK UP AND DROP OFF DETAILS RELEVANT TO COMMUNITY PARTICIPATION
Pick Up Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Drop off Address (if different to Pick Up)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are there any locations that would not be suitable for the participant to be taken? (Due to Safety or Behaviour Triggers)
Do you have ONLY one support worker currently supporting you at home or in the community?
If you only have one support worker, please list the steps taken to mitigate the risk involved with having a solo worker supporting you.
Eg. Discussions can be held with the participant around the importance of seeking more then one worker, to prevent them from any vulnerability, NDIS fraud or social isolation...
Does the Participant have a Companion Card? If No, are they eligible for one? If Yes – Please ensure this is available to the Staff for Community Access shifts.
Do you consent to MADETO HELP using your photos for advertisements and our social media pages?
Do you consent to MADETO HELP sharing important information to our support workers and any other necessary parties involved?
Do you consent to MADETO HELP contacting your medical team and emergency contact in times of emergency?
Do you consent to MADETO HELP taking your photos while you are with your support worker?
I confirm that I have provided the above information to MADE TO HELP to assist them in providing appropriate supports for First Name* Last Name*
Name of person who filled in the form with participant

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

Support Plans

Complete Support Plan Offline

Or Complete Support Plan Below

OUR TERMS FOR SERVICE PROVISION

HEALTH CONCERNS THAT REQUIRE SPECIALISED TREATMENT

MEDICAL EMERGENCY: Please advise who should be contacted in case of a medical emergency - e.g. Family member, GP or other Health Professionals.

Emergency Contacts

General Practitioner

Psychiatrist / Psychologist

Mental Health Case Manager

Behaviour Support Practitioner

Occupational Therapist

Physiotherapist

Speech Therapist

Emergency and Disaster Management

LEGAL REQUIREMENTS/DETAILS

SUPPORT AND ASSISTANCE REQUIREMENTS AND INFORMATION

PERSONAL CARE ASSISTANCE

TRIGGERS/SAFETY CONCERNS/DANGERS

BEHAVIOURAL SUPPORT

NDIS GOALS

SHIFT DETAILS

PICK UP AND DROP OFF DETAILS RELEVANT TO COMMUNITY PARTICIPATION