Functional Capacity Assessments, or FCAs, are one of the most common services performed by occupational therapists working within the NDIS. They involve a comprehensive review of a person’s function, environment, and support network to make recommendations about how a participant’s NDIS funding should be allocated to optimise their participation. Sounds perfectly suited to the OT skillset, doesn’t it? But unfortunately, it’s not as simple as it seems. Even experienced OTs can have room for improvement in their FCA reports, especially when they are new to the NDIS.

I have experience completing FCAs as an independent OT for participant’s contesting funding decisions at the AAT. I also provide clinical supervision and report review services for OTs completing FCAs. This has meant I’ve seen lots of different FCAs completed by many different OTs. I’m not claiming to be perfect at writing FCAs myself, but based on what I’ve seen, here are five ways I think OTs could be doing FCAs better…

1.       Ensure the type of FCA report you complete suits the purpose.

FCAs can be completed for a variety of reasons. Having a clear understanding of the purpose of the report before you even start your face-to-face assessment is essential, so that you can provide your client with a clear outline of what to expect (e.g. how long the FCA process will take), and so that you can be more targeted in your information gathering to use your time efficiently. Here’s some examples:

-          Some clients will need an FCA to access the NDIS in the first place. These reports need to focus on addressing one of the key eligibility criteria for NDIS access – does the person’s disability result in substantially reduced functional capacity, and if so, in which NDIS domains?

-          Participants may require an FCA if there has been a change in their circumstances and they require increased funding to cover needs that hadn’t been anticipated at the time their plan was created. It could be a sudden, unexpected deterioration in function, or the loss of their informal support network. If you don’t explain what the change was, and how the person’s functional capacity has been impacted, you haven’t justified the need for the ‘change in circumstances’ application.

-          Sometimes a referrer will request an FCA report, but what they are really after is a SIL or SDA report. To meet the purpose of being a SIL or SDA report, you can’t just add a one-line recommendation like “this participant would benefit from SIL/SDA” at the end of your report. You need to specifically address the eligibility criteria for SIL and/or SDA (whichever you are applying for!), meaning a longer, more detailed report.    

2.       Get the language right – it needs to suit the audience.

An NDIS report is different to OT reports written in other settings. OTs need to remember that the primary audience for an FCA report is an NDIS planner or other staff member. Many NDIS staff do not have any specific qualifications or experience in health or disability, so we need to use plain language and remember that OT or medical jargon may have no meaning whatsoever. Here’s what I mean:

-          OTs learn to use terminology such as upper limb, dexterity, or postural control, early in our training, but this doesn’t mean that everyone understands this language. Here’s a test – if you said these words to a family member or friend who was an accountant or hospitality worker, would they know what you meant? Possibly not.

-          Instead of these terms, use layman’s terms. For example, say “hands and arms” instead of upper limbs.

-          If you can’t avoid using the OT or medical jargon, include a brief definition or example as well. For example, if you mention “impaired postural control”, give some more details about what this looks like for your client (e.g. difficulty maintaining an upright sitting position).

3.       Fix your formatting so key information is easy to find!

You may have great information in your report, but if it is hidden in long, wordy paragraphs or a report with no structure, the NDIS planner will never find it. Some key things to remember:

-          Use clear section headings and sub-headings using words the reader will be looking for, such as writing up your recommendations section using sub-headings like “Core, “Capacity Building” and “Capital”.

-          Dot points and tables can allow you to present information succinctly and clearly. Also, white space is your friend; use extra line spacing between sections to improve clarity.

-          If it’s a long report, consider adding a summary section on the front page that gives the reader a feel for who the client is, what the report is about, and one or two lines summarising your key findings and recommendations, to help set the scene before they start reading.

4.       Provide enough details and evidence to demonstrate your clinical reasoning.

Remember that the NDIS staff member reading your report may never get to meet your client in person. What seems obvious to you from even a brief observation won’t be clear to the reader without a good description. Here’s some strategies:

-          State what your reasoning is based on. Did you observe the client completing a task, or is your description based on client self-report or carer report?

-          Consider including photos (with your client’s permission) to highlight key recommendations. Rather than simply stating the client is unable to safely access their kitchen bench while in their wheelchair, include a photo that shows your client attempting to reach their bench.

-          If your recommendations can be supported by research evidence, say it! It doesn’t need to become a fully referenced uni assignment, but including a few key references to clinical practice guidelines or journal articles helps show that your recommendations are evidence-based.

5.       Include standardised assessments if relevant, but use them effectively.

Standardised assessments are a common part of most FCA reports, but there’s no magic formula for which ones to include. You need to have a clear reason for which ones you choose to include and ensure they are adding value to your report. Here’s some ideas to help you do this:

-          The NDIS has preferred assessments for some common health conditions or disability types; make sure you include the assessments the NDIS will be expecting to see (if relevant for your client).

-          Choose assessments that are going to highlight your client’s functional needs. Don’t include assessments that only describe symptoms, choose an option that highlights how these symptoms impact on function.

-          When reporting the findings of your assessments, don’t just give raw scores. If available, state how your client’s scores compare to norms, cut-off scores, or severity ratings, to put them into context.

So, what were you thinking as you read through those points? If you were thinking – “Yep, I do all those things already”, then good on you – you’re probably on the right track! If you were thinking “Eek, I don’t do that (and I wouldn’t even know how!)” then don’t panic, there are lots of options to improve. Invest in some training and ensure you are receiving clinical supervision to plan and complete your FCAs; there are plenty of options on the Your OT Tutor website!

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