OT Unplugged: Community of Practice Insights

Occupational Therapists are frequently asked to provide ‘robust evidence’ for NDIS funding decisions, but what does that really mean? Explore why observation, clinical reasoning and context matter when assessing functional capacity.

When Occupational Therapists write reports for the NDIS, one phrase appears repeatedly: robust evidence. Whether it’s a funding review, access request, assistive technology application or change in support needs, Therapists are often asked to provide stronger justification and more comprehensive evidence.

The challenge is that there is no clear definition of what robust evidence actually looks like. As a result, many OTs are left wondering how much evidence is enough and what information carries the greatest weight.

The answer often lies in moving beyond self-report and gathering information from multiple sources to build a complete picture of a person’s functional capacity.

Why self-report is only part of the story

Most assessments begin with conversation. We ask people about their daily routines, the tasks they complete independently and the areas where they need support. These discussions provide valuable information, but they are only one piece of the puzzle.

People naturally interpret their abilities through their own experiences and expectations. Some individuals may overestimate their independence, while others may underestimate what they can do. This is why Occupational Therapists are trained to look beyond verbal responses and consider how a person actually performs tasks in real-world situations.

The value of observation in functional assessments

Observation remains one of the most powerful assessment tools available to OTs.

A person may report that they independently manage meal preparation, household tasks or personal care. However, observing the environment can reveal important details that provide additional context.

A walk through the home may identify signs that tasks are not being completed consistently. Alternatively, it may demonstrate a level of independence that exceeds what was initially reported. Both outcomes are clinically important.

Environmental observations, task completion and functional demonstrations help Therapists validate information, identify barriers and understand how a person’s abilities translate into everyday life. This observational evidence often strengthens the overall assessment and contributes to more robust clinical reasoning.

Understanding function within context

One of the most important principles of occupational therapy is that function does not occur in isolation.

Performance can vary significantly depending on the environment, available supports and expectations placed on the individual. A person may demonstrate greater independence in one setting and require substantial assistance in another.

For example, some individuals may perform tasks independently in structured environments such as school, work or day programs, while requiring significantly more support at home. In other situations, highly supportive family members may unintentionally complete tasks on behalf of the person, masking their true abilities.

Without considering context, Therapists risk drawing incomplete conclusions about a person’s functional capacity.

Why clinical reasoning matters

Robust evidence is not simply about collecting more information. It is about interpreting that information accurately.

Occupational Therapists draw on clinical knowledge, experience and evidence-based practice to identify patterns and understand how a person’s diagnosis may impact their function. This becomes particularly important when working with conditions characterised by fluctuating capacity.

A snapshot assessment conducted on a person’s best day may not accurately reflect the support they require over time. Likewise, a single observation may not capture the impact of fatigue, pain, mental health challenges or episodic symptoms.

Strong clinical reasoning allows Therapists to synthesise multiple sources of information and determine what is most representative of the individual’s everyday experience.

The role of standardised assessments

Standardised assessments can provide valuable objective data when selected appropriately and interpreted correctly.

However, assessment scores alone rarely tell the full story. A percentile rank or functional score only becomes meaningful when the Therapist explains what it represents and how it relates to everyday function.

The most effective reports integrate standardised assessment results with observational findings, collateral information and clinical interpretation. This approach creates a comprehensive picture of a person’s strengths, challenges and support needs.

The challenge of future support needs assessments

As discussions continue around NDIS support needs assessments, many OTs have raised concerns about the potential loss of observation-based assessment.

Functional capacity cannot always be accurately understood through questionnaires or interviews alone. Observation, environmental assessment and task analysis provide critical insights that help Therapists distinguish between reported abilities and actual performance.

Without these opportunities, there is a risk that assessments may overlook important nuances that influence a person’s daily functioning and support requirements.

Building truly robust evidence

When Occupational Therapists talk about robust evidence, they are rarely referring to a single assessment tool or a larger volume of paperwork.

Instead, robust evidence comes from combining multiple sources of information, including self-report, observation, standardised assessments, collateral input and professional clinical reasoning.

It is this synthesis that allows OTs to understand not only what a person says they can do, but what they actually do, how they do it and what support they need to participate meaningfully in everyday life.

Key takeaways for OTs
• Robust evidence involves more than self-report and should include observation wherever possible.
• Functional performance must be interpreted within the context of the person’s environment and supports.
• Clinical reasoning is essential when assessing fluctuating capacity and complex presentations.
• Standardised assessments are valuable when appropriately selected and clearly interpreted.
• Observation and task analysis remain critical components of comprehensive functional assessments.
• Strong reports synthesise multiple sources of information to create an accurate picture of support needs.

Pricing uncertainty continues to affect providers

For many providers, annual pricing updates remain a significant source of uncertainty. Business owners are often required to make decisions about staffing and service delivery without knowing exactly what future funding arrangements will look like.

Combined with rising employment costs and workforce reforms, these changes are placing increasing pressure on provider sustainability, particularly for smaller practices.

The growing loss of experienced therapists

Across Australia, many experienced occupational therapists are reconsidering their future within the NDIS. While financial pressures contribute to this trend, increasing administrative demands, system changes and frustration with decision-making processes are also driving clinicians away from the scheme.

The impact extends beyond individual businesses. Experienced therapists bring years of clinical reasoning, assessment expertise and mentorship to the profession. As these practitioners leave, participants lose access to valuable knowledge and support.

Moral injury and professional frustration

Many therapists report feeling that their professional expertise is being given less weight despite extensive assessment and evidence gathering. When recommendations are repeatedly challenged or dismissed, it can create significant professional frustration and contribute to moral injury.

For a profession built on evidence-based practice and participant-centred care, this can be particularly difficult. Over time, the emotional burden contributes to burnout and influences decisions to leave the sector altogether.

Advocacy and sector response

Recent NDIS consultation processes have demonstrated the strength of engagement across the disability sector. Thousands of submissions were lodged by clinicians, providers, participants and advocacy groups, highlighting widespread concern about proposed reforms.

While the outcome remains uncertain, these submissions reflect a profession determined to contribute its expertise and advocate for meaningful outcomes. Advocacy continues to be a core part of occupational therapy practice, both at an individual and systemic level.

AI in occupational therapy

Artificial intelligence is becoming increasingly common across healthcare, particularly for tasks such as note-taking, report drafting and written communication. Used appropriately, these tools can reduce administrative burden and improve efficiency.

However, AI cannot replace clinical reasoning. Occupational therapy relies on contextual understanding, professional judgement and relationship-based practice. Therapists remain responsible for ensuring documentation is accurate, clinically appropriate and reflective of participant needs.

The use of AI also raises important considerations around consent, privacy and data security. Clear communication with participants and strong governance processes remain essential as technology becomes more integrated into practice.

Looking ahead

The coming months are likely to bring further change across the NDIS landscape. Pricing decisions, legislative reforms and technological developments will continue to shape the way occupational therapists work and how participants access support.

While the challenges are significant, the profession’s ongoing commitment to advocacy, clinical excellence and participant-centred practice remains unchanged. Supporting workforce sustainability and valuing professional expertise will be critical to the future success of both occupational therapy and the NDIS.

Key takeaways for OTs

• Pricing uncertainty continues to create challenges for providers and business planning.
• Experienced occupational therapists are increasingly leaving the NDIS workforce.
• Moral injury is contributing to clinician burnout and workforce attrition.
• Strong engagement in consultation processes highlights the sector’s commitment to advocacy.
• AI can improve efficiency but cannot replace clinical reasoning and professional judgement.
• Participant consent, privacy and data security remain essential when using AI tools.
• Supporting workforce sustainability is critical for the future of participant care.

Award changes are reshaping workforce planning

One of the most significant developments for allied health businesses is the recent review of the Health Professionals and Support Services (HPSS) Award.

Although much of the attention has focused on wage increases, the bigger story may be the changes to classification levels and how occupational therapists are positioned within the award structure. The revised framework places greater emphasis on the responsibilities attached to a role rather than simply years of experience.

For many private practices, the most notable change is the inclusion of supervision responsibilities within the Level 2 classification. Therapists who supervise students, therapy assistants or other clinicians may now fall into a different classification than previously expected.

This shift creates important questions for business owners. Student supervision has long been viewed as a professional responsibility and a way of supporting the future workforce. However, if supervision activities influence classification and remuneration, practices may need to reconsider how these responsibilities are allocated and supported.

The changes are expected to commence in October, providing an opportunity for businesses to review role descriptions, employment agreements and career progression pathways before implementation.



Career progression is no longer just about experience

A common misunderstanding within allied health is that clinicians automatically progress through award levels as they accumulate years of experience.

In reality, award classifications are linked to the scope and responsibilities of a role. Leadership responsibilities, supervision duties, advanced clinical expertise and management functions all influence where a clinician sits within the award structure.

This distinction becomes increasingly important as practices grow. Not every experienced clinician will move into a higher classification, just as not every newer therapist will remain in an entry-level role. Progression is tied to responsibilities, not tenure alone.

Clear role descriptions and transparent career pathways can help both employers and clinicians understand what advancement looks like and how different positions align with award expectations.



Rising costs continue to challenge practice sustainability

Award changes are arriving at a time when operating costs are already increasing across the allied health sector.

While salary increases often receive the greatest attention, they represent only one component of the financial pressures facing businesses. Workers compensation premiums, payroll tax, superannuation obligations, insurance costs and administrative expenses all continue to rise.

For occupational therapy practices, particularly those working in paediatrics, overheads can be substantial. Assessment tools, intervention resources, sensory equipment and clinical materials represent ongoing investments that are essential for service delivery but are often overlooked in broader discussions about business viability.

As these costs continue to increase, business owners are being forced to make increasingly careful decisions about staffing structures, leadership roles and growth opportunities.



Why financial awareness matters more than ever

The reality is that many of the most significant costs in running a practice are largely invisible to clinicians.

Insurance premiums, workers compensation, payroll tax and compliance obligations can add tens of thousands of dollars to annual operating expenses. As teams grow, these costs often increase at a rate that outpaces expectations.

This makes financial literacy an increasingly important skill for practice owners. Understanding profit margins, overheads and workforce costs is no longer optional. It is essential for making informed decisions about recruitment, remuneration and long-term sustainability.

With continued uncertainty around future NDIS pricing arrangements, businesses that understand their numbers will be better positioned to adapt to whatever changes emerge.



Preparing for Payday Super

Another important change for employers is the introduction of Payday Super from 1 July.

Although many payroll systems are now equipped to manage the administrative side of these payments, the change will require businesses to think differently about cash flow. Superannuation obligations will become more immediate, reducing the flexibility that previously existed around payment timing.

For practices already managing increasing employment costs, this serves as another reminder of the importance of strong financial planning and forecasting.



NDIS uncertainty remains a significant challenge

Alongside workforce and business pressures, occupational therapists continue to navigate an increasingly complex NDIS environment.

Across Australia, clinicians are reporting inconsistencies in planning decisions, funding outcomes and documentation expectations. Reports are being returned for reasons that often appear contradictory, with different planners applying different interpretations to similar situations.

Questions continue to arise around assessment tools, report formats, assistive technology recommendations and home modification applications. In many cases, therapists are left wondering whether they are seeing a genuine policy change or simply an isolated interpretation from an individual decision-maker.

The lack of consistency can make it difficult for clinicians to determine when they should adapt their practice and when they should challenge a decision.



Looking for patterns rather than reacting to isolated decisions

One of the most effective ways to navigate uncertainty is to avoid overreacting to individual experiences.

A single unusual decision does not necessarily indicate a systemic change. However, when the same issue begins appearing repeatedly across different participants, regions and planners, it may signal a broader trend that warrants attention.

Professional networks and peer communities play a critical role in identifying these patterns. Sharing experiences helps clinicians separate isolated incidents from genuine changes in practice expectations.

Taking a measured approach can reduce unnecessary changes to templates, reports and clinical processes while still allowing therapists to respond appropriately when genuine trends emerge.



Supporting participants through an evolving system

Many clinicians are also becoming more cautious when discussing plan reassessments and funding reviews with participants.

Where there is strong clinical evidence supporting additional funding or supports, recommendations should continue to be made confidently. However, it is equally important that participants understand the potential risks associated with reassessment processes in the current environment.

Open and transparent conversations allow participants to make informed decisions while ensuring recommendations remain grounded in clinical reasoning and functional need.



Looking ahead

Occupational therapists have always adapted to change, but the current environment requires a particularly careful balance between clinical excellence and business sustainability.

The practices most likely to thrive will be those that understand both the operational realities of running a business and the evolving landscape of the NDIS. While uncertainty remains, informed decision-making, financial awareness and strong clinical reasoning will continue to provide the strongest foundation for success.



Key takeaways for OTs

• Review award classifications and role descriptions before the HPSS Award changes commence.
• Ensure supervision responsibilities are clearly defined and aligned with award requirements.
• Understand the true cost of operating a practice, including insurance, payroll tax and compliance obligations.
• Prepare cash flow systems for Payday Super requirements.
• Avoid making significant changes to clinical documentation based on isolated NDIS decisions.
• Look for patterns across multiple cases before adjusting templates or reporting practices.
• Continue making recommendations that are supported by strong clinical evidence.
• Help participants understand both the opportunities and risks associated with plan reviews and reassessments.

P.S. To join the OT Unplugged Podcast dinner, email training@verveot.com.au to reserve your spot. It will be held on Tuesday 23 June following the OTX drinks on Day 1 of OT Exchange.

Occupational Therapy careers rarely follow a straight line. Many OTs begin with a clear idea of where they’re heading, only to find themselves moving into completely different spaces years later.

Clinical work evolves, industries shift and new opportunities emerge. Alongside this, many therapists are recognising the growing importance of connection, mentorship and sustainable ways of working.

The OT career you imagine may not be the one you build

Many OTs enter the profession expecting to work in hospitals, paediatrics or traditional clinical roles long term. Yet careers often evolve into leadership, mentoring, supervision, education, business ownership or advocacy.

For newer therapists, particularly those entering during the NDIS era, private practice can sometimes feel like the default pathway. In reality, occupational therapy offers far more diversity.

Some therapists thrive in specialist clinical roles. Others are drawn to leadership, systems work or education. Neither pathway is better – careers simply change over time.

Why early career OTs don’t need all the answers

Students and new graduates are entering the profession during significant reform and uncertainty. With constant NDIS updates and workforce pressures, it can feel like there’s an endless amount to learn.

But early career therapists do not need to master everything immediately.

Strong clinical foundations still matter most. Confidence, professional identity and career direction develop gradually through experience.

Many experienced OTs working in leadership or education today never imagined those roles when they first graduated.

The hidden opportunities within occupational therapy

Occupational therapy careers are now broader than many therapists originally expected.

Mentoring, supervision, consultancy, training, digital education and professional development businesses have become increasingly visible career pathways. Many clinicians are building portfolio careers that combine clinical practice with leadership or education.

There is no single version of success within OT.

Some therapists prioritise flexibility, others value autonomy and some simply want to become exceptional clinicians. The profession is broad enough to support all of these goals.

Balancing clinical work and sustainability

One of the biggest challenges for experienced OTs is balancing clinical work with growing non-clinical responsibilities.

Supervision, presentations, training development, business administration and leadership all require significant time and energy. For therapists who genuinely love clinical work, reducing caseloads can also feel difficult.

As a result, many OTs are becoming more intentional about workload management, time blocking and protecting non-clinical work time.

There is also growing recognition that sustainable careers matter more than constantly operating at full capacity.

Why connection matters more than ever

Across disability, aged care and healthcare systems more broadly, many OTs are feeling the pressure of constant reform and change.

In response, therapists are increasingly prioritising genuine professional connection over hard-sell marketing or rapid business growth. OTs want spaces where they feel informed, supported and understood.

Community matters because not everyone learns best through policy documents and lengthy written updates. Shared conversations and practical discussions often make complex industry changes feel far more manageable.

This has become especially important throughout ongoing NDIS reform, where therapists are looking for reliable and accessible ways to stay informed.

The value of community during industry change

Conferences, networking events, mentorship spaces and online OT communities are becoming increasingly valuable.

They provide reassurance that therapists are not navigating these challenges alone while also exposing OTs to the incredible diversity within the profession.

At a time of rapid change, professional community is helping many therapists feel more connected, informed and hopeful about the future of OT.

Occupational therapy careers are no longer one-dimensional

The modern OT career is far more flexible than many therapists initially expect.

An OT may begin in hospital work before moving into private practice, supervision, leadership or education. Others may remain deeply clinical throughout their entire careers.

Most therapists will experience multiple versions of their career over time – and that flexibility is one of the profession’s greatest strengths.

Supporting sustainable OT careers moving forward

Sustainable OT careers are not built solely on productivity or growth.

They are built on meaningful work, professional connection, adaptability and the ability to evolve over time.

There is no single ‘correct’ OT career pathway. The profession continues to change – and so do the people within it.

Key takeaways for OTs
• OT careers often evolve in unexpected ways over time
• Professional connection and community are becoming increasingly important across the profession
• Early career OTs do not need to have every aspect of their future career mapped out immediately
• Sustainable careers require balancing clinical work with wellbeing and professional growth
• Occupational therapy offers diverse pathways including leadership, mentoring, education and business development
• Different seasons of life may require different approaches to work and career planning
• Building strong clinical foundations remains valuable even as the profession changes
• Flexibility and adaptability are becoming essential long-term career skills for OTs

A significant period of change
The disability sector is facing another major round of NDIS reform. The proposed legislation has sparked widespread discussion among Occupational Therapists, participants and advocacy groups, with many working to understand what the changes could mean in practice.

Importantly, the reforms are not yet law. The legislation must still progress through consultation and parliamentary processes, creating an opportunity for the disability community to provide feedback and advocate for change.

A shift towards standardisation
Many of the proposed reforms introduce more standardised approaches to eligibility, funding and decision-making. While consistency may improve administrative efficiency, disability support often relies on understanding individual circumstances, environments and goals.

For Occupational Therapists, this tension between standardisation and individualisation sits at the heart of many concerns. The proposed changes raise questions about how effectively future systems will reflect the complexity of people’s lives and support needs.

Changes to NDIS access and eligibility
Several proposed reforms focus on how people access the NDIS and demonstrate eligibility. These include changes to functional capacity assessments and stronger expectations around treatment history before support can be approved. Together, these measures could reshape how disability-related needs are assessed and understood.

A new approach to functional capacity
The draft legislation proposes assessing functional capacity without considering assistive technology or support from others.

For Occupational Therapists, this represents a significant departure from established practice. Functional capacity is rarely understood in isolation. Environmental barriers, informal supports and assistive technology all influence how a person participates in daily life. Removing these factors risks creating an incomplete picture of disability and support needs.

The challenges may be even greater for people with complex, overlapping or fluctuating disabilities, where function can vary significantly depending on context and available supports.

Treatment requirements and access barriers
The proposed legislation would also strengthen requirements for participants to demonstrate they have explored available treatments before accessing the NDIS.

While intended to clarify eligibility, concerns have been raised about how this would work in practice. Access to treatment can be limited by geography, cost or service availability, and some people may reasonably choose not to pursue interventions that carry significant risks or side effects. Questions also remain about how treatment, rehabilitation and capacity-building supports will be distinguished, particularly for people with complex or long-term conditions.

Funding and support decisions
Beyond eligibility, the proposed reforms could influence how supports are funded and which interventions participants can access.

One of the most discussed changes is the introduction of powers that could allow funding limits to be applied across categories of NDIS supports. While current discussion has focused on therapy funding, the proposed mechanism could potentially be used more broadly. This raises concerns about whether future funding decisions will continue to reflect individual circumstances and goals.

The legislation would also provide the NDIA with greater authority to determine which interventions are considered evidence-based. Although evidence-informed practice is essential, research often takes time to catch up with emerging interventions and assistive technology. A lack of extensive evidence does not necessarily mean a support is ineffective, particularly when strong clinical outcomes are being achieved.

There are concerns that stricter interpretations of evidence could reduce participant choice and limit access to supports that are currently delivering meaningful benefits.

The growing role of automation
The legislation also expands the use of automated decision-making processes within the NDIS.

While automation may improve efficiency, disability support decisions often require nuanced understanding of individual circumstances. Maintaining appropriate human oversight will be critical to ensure decisions remain fair, transparent and responsive to participant needs.

Why Occupational Therapist engagement matters
Occupational Therapists bring valuable expertise to conversations about disability, function and participation. Their day-to-day experience provides important insight into how legislative changes may affect people in real-world settings.

As consultation continues, feedback from practitioners can help highlight practical implications and ensure participant experiences remain central to policy discussions. Organisations such as the OT Society for Hidden and Invisible Disabilities (OTSI) and Occupational Therapy Australia are actively supporting advocacy efforts and providing resources to help clinicians understand the proposed reforms.

Looking ahead
The proposed NDIS reforms have the potential to reshape eligibility, funding and service delivery across the disability sector. While many questions remain unanswered, the consultation process offers an important opportunity for Occupational Therapists and participants to contribute to the conversation.

Understanding the proposed changes now will help practitioners, providers and participants prepare for whatever comes next. The decisions made in the coming months may influence disability support and Occupational Therapy practice for years to come.

Key takeaways for OTs
• The proposed NDIS legislation is still under consultation and has not yet become law.
• Many of the reforms reflect a broader shift towards more standardised decision-making.
• Proposed functional capacity assessments may place less emphasis on environmental factors and supports.
• Stronger treatment requirements could create barriers for some participants seeking access.
• Changes to funding powers and evidence requirements may affect participant choice and support flexibility.
• Increased automation highlights the need for ongoing human oversight in decision-making.
• Occupational Therapist perspectives remain critical in shaping the future direction of disability policy.

Links
🖥️ FREE NDIS Insights: Unpacking the Proposed NDIS Bill and Impact to OTs & Participants: https://www.verveotlearning.com.au/free-ndis-insights-unpacking-the-proposed-ndis-bill-impact-to-ots

🔗 Securing the NDIS for Future Generations Bill: https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fbills%2Fr7487_first-reps%2F0000%22;rec=0

🔗 Explanatory Memorandum: https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fems%2Fr7487_ems_35e6531f-c440-4faf-98d6-7c7ddd8bd539%22

🔗 Make a Submission: https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/NDISFutureGenBill