Participant Service Agreement 2023.docx

Item 1 Provider Details Company Name: Momentum Learning Services ABN: 88 162 156 032 Postal Address: PO Box 124 Alexandria NSW 2015 Phone Number: (02) 8593 2664 NDIS Organisation ID: 4050002680 Item 2 Participant Details Surname: Other Names: Date of Birth: Add...

Item 1 Provider Details Company Name: Momentum Learning Services ABN: 88 162 156 032 Postal Address: PO Box 124 Alexandria NSW 2015 Phone Number: (02) 8593 2664 NDIS Organisation ID: 4050002680 Item 2 Participant Details Surname: Other Names: Date of Birth: Address: NDIS Participant Number: Item 3 Participant Representative #1 Full Name: Relationship to Participant: Email Contact: Phone Contact Participant Representative #2 Full Name: Relationship to Participant: Email Contact: Phone Contact Item 4 NDIS Plan Details Plan ID Number: Plan Start Date: Plan End Date: Item 5 Funding details (These details are located on your NDIS Plan) Funding Management Type: Invoices to be emailed to: Primary budget category to invoice to: Secondary budget category to invoice to: ‘Other’ budget category (if not listed in drop down menu above) Definitions and Explanatory Notes This agreement outlines the responsibilities and expectations between Momentum Learning Services Pty Ltd referred to within this document as ‘Provider’ (See Schedule Item 1) and you as the Participant (See Schedule Item 2). Where the Participant is a minor, then this also includes the Participant’s Representative (see Schedule Item 3). This agreement is subject to the laws of New South Wales. Times referred to in this agreement are Australian Eastern Standard Time or Australian Eastern Daylight Savings Time, as applicable in Sydney, NSW, from time to time. “Support” refers to any activity engaged in by the Provider and its employees for the purposes of training, consultation, program design, implementation, and review. “MLS team member/s” refers to directly employed representatives of the Provider. “Behavioural Consultant” refers to the person appointed by the Provider to oversee the design, delivery, and review of the Participant’s supports. “The Director” refers to Mr. Paul Harris, Director of Momentum Learning Services Pty Ltd. Please read the following information carefully and, if you have any questions, please contact our office on (02) 8593 2664. Service Scope The Provider agrees to deliver supports in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act 2013 and rules, and the Australian Consumer Law. Employees of the Provider are responsible for providing only those interventions based on the principles of Applied Behaviour Analysis (ABA) in accordance with The Behaviour Analyst Certification Board’s Professional and Ethical Compliance Code for Behaviour Analysts. A copy of the current code can be found here. Procedures, strategies, and programs that are not based on the principles of ABA will not be implemented by employees of the Provider, unless approved by the Participant’s Behavioural Consultant. Employees of the Provider will only practice within their scope of experience. This means that they will only provide supports that they have developed the skills, experience, or training in or under the supervision of someone who is so qualified. If the Participant requires supports beyond this scope, a referral will be provided to a more appropriate Provider wherever possible. If a direct referral is not possible, the Provider will engage an appropriate person to provide Travel All services are provided in the Participant’s home, school or other community settings as indicated by the Participant. To minimise fatigue, staff turnover and operating costs, travel time and mileage will be a key consideration in the scheduling of supports. This includes scheduling, cancellation, and other operating policies. Employees of the Provider will be generally limited by the following: A maximum of 30 minutes travel as calculated in real time and based on Participant to Participant or Participant and home travel. A maximum of 20km via non-toll roads Each service provided incurs a single charge for Provider travel time, in one direction, that is calculated to a maximum of 30 minutes of the standard hourly rate for that service. Consideration for commutes that involve additional mileage may be granted pending an agreement on additional charges for per kilometre travel to cover the distance exceeding the 20km limit. Video and phone conferencing of specific services are available to Participants to eliminate typically associated travel charges. Operating Hours Our general hours of operation for clinical services are 8am to 7pm Monday to Friday. Weekends are subject to availability. Office hours are typically 10am‐5pm, Monday to Friday. Regularly scheduled services that fall on public holidays are cancelled by default. If services are requested by and provided to the Participant during a public holiday, this will be subject to agreement of the relevant Provider’s MLS team member and the relevant penalty rates will apply. Contacting Us & Correspondence The Participant can expect that they will receive a reply to any request within 48 hours of receipt from an MLS team member. At a minimum, a reply will include confirmation of receipt of your email and an estimated response time, if the request can’t be met fully within this time frame. MLS team members will limit their responses to Participant/ Participant Representative correspondence to between our standard operating hours, except for service cancellations. In instances where an MLS team member must cancel a session, they will attempt to forewarn the Participant between 7am and 10pm. As often as possible, MLS team members will respond in kind, when receiving correspondence from the Participant, i.e., the MLS Team member will reply via the means you contacted us on. The Provider will make the following efforts to ensure that the Participant’s privacy is protected during correspondence: Use multi-factor encryption software and local servers for storing and processing our data. Use the Participant’s initials when referencing them in emails. Ensure that the individual email addresses of Participants are protected from view by other Participants. The Provider will typically make contact in the following ways, dependent on the purpose of correspondence: An email if it is the Participant’s preferred method of contact or the issue is non-urgent (a response can wait more than 2 days). An SMS or phone call if it is the Participant’s preferred method of contact or the issue is more time sensitive (a response is required in less than 2 days). A phone call in emergency situations. Both the Provider and Participant agree to always correspond respectfully, otherwise correspondence may need to be suspended until it is possible to do so. Probationary Period The Participant understands that service provision is subject to a 90-day probationary period, effective from the date this agreement is signed. The Provider reserves the right to end the Agreement, effective immediately, for any reason, if they feel the ability to provide services is in any way compromised by the actions, capacity, or ability of either the Provider or the Participant during this period. The costs of any assessment and intake processes conducted within the probationary period will be refunded in full to the Participant if the Provider ends the Agreement in this probationary period. This does not include costs associated with direct parent training, teaching sessions, overlaps or team meetings provided in this time. Participant Engagement The Participant agrees to engage actively in the supports the Provider delivers and have been agreed to. Active participation includes, but is not limited to: Maintaining the level of agreed and recommended services in the signed Schedule of Supports. Collecting data as required to support program development and measure outcomes. Implementing agreed behaviour support plans. Providing requested learning materials promptly to avoid delays in working on goals. Passing on relevant information to the Provider which may affect the integrity of the Participant’s program. The Participant understands that failing to actively engage in the supports provided may adversely impact on goal progress and efforts will be made to address these barriers to participation. If efforts to improve engagement are not successful, the Provider may find it necessary to consider suspending or terminating the provision of supports and refer the Participant to alternate services. Learning Resources The Participant will be primarily responsible for the costs associated with producing learning materials for use when receiving services. The Provider’s employees may use their own materials occasionally, however this will vary considerably between employees/ based on their individual access to such resources. Learning materials include: Augmentative and Alternative Communication systems Printing provided pdf workbooks/ worksheets Flashcards: either by direct purchase of commercially available systems or DIY printing and laminating of our available photo stock. Toys/Play activities Highly preferred items for use as reinforcers The Provider will recommend only those resources that are essential and look to identify the most cost-effective ways for the Participant to acquire them. The Participant’s Behavioural Consultant will be responsible for adapting and individually tailoring resources for the Participant if required. If the time taken to develop individualised materials exceeds the allocated programming time, then Behavioural Consultant responsible will negotiate a fixed fee for doing so with the Participant or assign it as a task for another MLS team member to complete in lieu of a future late cancellation by the Participant. Confidentiality of Information The Provider and all its employees will manage all information and records, including data collected on the Catalyst platform regarding the Participant, securely and confidentially, with the following safeguards in place: Applying the following legislation: National Disability Insurance Scheme (Protection and Disclosure of Information) Rules 2013 (Protection and Disclosure of Information Rules); Sections 6 and 52(1) of the Privacy Act 1988 (Privacy Act) Archives Act 1983 (Archives Act) Australian Privacy Principles (APPs) Ensuring access to all personal information is strictly based on a need‐to‐know basis. Gaining written consent from the Participant for the Provider to release information to 3rd parties other than the Participant and their undersigned Representatives or the Provider and its employees. Configuring all electronic devices used by the Provider and its employees to store or record electronic data about the Participant with password protection and software for erasing content remotely from the device should it be required to do so. When an MLS team member leaves, their access to the Provider’s electronic information is removed promptly. Minimum Service Requirements All in-person Behaviour Technician services must be billed for a 2-hour minimum. Where the Participant requests a shorter in-person service, the remaining time will be used for Participant-specific activities as agreed between the Participant/Participant’s Representative and the Participant’s Behavioural Consultant While each Participants supports are uniquely determined, to ensure that the Participant’s goals are being identified, planned for, and effectively implemented and reviewed, the following services are mandatory: An Intake Meeting for the purposes of identifying specific skill acquisition and behaviour intervention needs that will generate support recommendations for the Participant’s program. A minimum of 1-hour of Behavioural Consultancy per month, for the duration of this service agreement, to support the maintenance of the Participant’s program. This hour will be used for: Programming where a team meeting has taken place in the same month If no team meeting has occurred, then this hour may be used for any service that the Behavioural Consultant and the Participant/ Participant’s Representative agree upon, within the same month. Independently sourced persons who are responsible for implementing the Participant’s MLS program, i.e., ‘independent therapists’, are required to be evaluated by an MLS team member at least every 6 months. It is expected that Participants will maintain the minimum service requirements wherever possible. Participants can expect to have access to some form of reporting for every billable service they receive as indicated below: Service delivered Reporting Initial Assessment An Offer of Service with program goals and a Schedule of Supports Adaptive Assessment A structured assessment report ABA Sessions Catalyst session notes and data collection Parent Training A summary of training discussion points Overlaps (practical training) A copy of the completed field evaluation or training assessment Team Meeting Team Meeting Notes Multidisciplinary (Team) Meeting Summary notes of actions/ recommendations School Observation School Observation Summary Behaviour Support Plan (BSP) All include a written plan, potentially a Functional Behaviour Assessment Team Meetings Team meetings are a critical component to supporting the integrity of each Participant’s MLS program They provide an opportunity to adjust the existing program, ensuring that all possible attempts are made to maximise the effectiveness of the program in meeting the Participant’s goals. All Employees who routinely deliver the Participant’s program must attend the team meeting or view it’s recording, if available. This includes your Behavioural Consultant and Behaviour Technicians. Team meetings are charged at the hourly rate for all employees attending, not exceeding a total cost of $300 per hour (not including travel or programming costs) Team meetings may be conducted either online or in-person at the Participant’s home, dependent upon MLS team member and Participant availability. Wherever possible, as many Behaviour Technicians as possible who can attend in person will do so. Scheduling Each Participant will receive access to a personalized Google Calendar link. This will be considered the point of reference for the Participant’s schedule, including where requested changes and cancelations will be recorded. Any recurring appointments and scheduling changes must be confirmed by our office administrator in writing before they take effect; including any arrangements made directly with an MLS team member of the Provider. Specific scheduling requests by the Participant will be considered and whenever possible accommodated but cannot be guaranteed in any way. This includes requests for times, days of the week and personnel. Participants are aware that owing to the mobile nature of the supports the Provider and its employees provide, that scheduling options are heavily dependent on both MLS team member and Participant location. Changes in location of either party may affect scheduling arrangements. Both parties agree to provide 14 days’ notice of relocation to address the impact on future services. Schedules are subject to change owing to issues within and outside of the Provider’s control. The Provider will do its best to anticipate such changes, provide adequate warning and minimise program disruption wherever possible. The Provider will prioritise meeting the scheduling requirements of currently engaged Participants over waitlisted Participants where the resources match both Participant’s needs. The Provider cannot make any guarantees regarding the length of time any MLS team member will remain with the Participant as this is subject to variables including location, availability, promotion, and personal circumstances that can’t be accounted for. Participant Cancellation The Provider requires 3-business days’ notice for to avoid late cancellation charges. The late cancellation charge is equivalent to 100% of the scheduled service fee. Requests to change service times, including shortening of sessions or moving start and end timings will be considered a form of late cancellation and the participant will be required to pay for the original, scheduled service period if those changes can’t be accommodated by the MLS team member. Cancellations of scheduled services for more than 2 consecutive days for pre‐planned reasons, e.g., going on holidays, should be made in writing to notify the Provider with a minimum of 10 business days’ notice. Participants are encouraged to inform the Provider of potentially extended absences for medical reasons as soon as possible. Participant cancellations will be recorded in each Participants calendar to measure service fulfillment and identify issues impacting on it. Where Participant-initiated cancellations reduce the actual service hours provided to less than 80% of the agreed scheduled hours within a single month, then sessions may be forfeited and reassigned elsewhere after a reminder. Provider Service Fulfillment Obligations The Provider will aim to ensure that MLS team members maintain as many of their scheduled service hours as possible through routine feedback and incentivization schemes. MLS team members will communicate directly any pre-determined absences such as holidays, time of for study, in advance (a minimum of 10 days advance warning) so that potentially alternate arrangements can be made to supplement those missing sessions for the Participant. MLS team members will provide as much notice as possible if cancelling owing to illness or sudden and unexpected circumstances. The Provider will encourage MLS team members to offer make-up sessions within the same month wherever possible to minimise the impact of cancellations on Participant progress. MLS team member cancellations will be recorded in each Participants calendar to measure service fulfillment and identify issues impacting on it. If an MLS team member is late, then the Participant should engage in the following: Notify the Participant that they are running late before the scheduled start time of the service with a new estimated time of arrival. On arrival, offer to extend the session to make up the time missed or amend their timesheet accordingly. The Participant should expect that late notice cancellations (less than 10 days’ notice) by the same TeaMLS member, occur no more than once per month. If an MLS team member is canceling scheduled services more often than once per month then please report this to the Provider so that the issues contributing to frequent cancellations can be addressed. Work Health & Safety A carer or guardian be at the premises while services are being provided to the Participant. If they are not able to be present, then the Provider or Participant Representative must be able to contact the Participant’s Representative in the event of an emergency. The Participant agrees to provide a safe, clean, and respectful working environment for the Provider’s employees to provide services in. A risk assessment will be routinely conducted, (including at intake) to identify and manage potential Work Health & Safety issues in any environment where supports are being provided. Employees of the Provider will always have access and opportunity to leave the work environment, e.g., keys are readily available to open locked doors to exit property. The Participant and Provider agree to cancel or end therapy services on any occasion if the Participant is ill and displays symptoms which indicate that their illness may possibly be contagious or infectious. This includes coloured discharge from the nose, frequent coughing, vomiting, diarrhea, extreme lethargy, or a measurably high fever. The Participant and MLS team members reserve the right to decline services taking place if they reasonably assess that the other party is ill to such a degree either on arrival or during the session. In all such instances, if the MLS team member is ill, then the Participant will not be charged for any part of the service. If the Participant is deemed ill, then they will be charged for the entire scheduled appointment, even if it is ended early. The supervision and safety of the Participant’s siblings, peers and other individuals who may be participating in elements of the Participant’s treatment program is solely the Participant’s responsibility. The Provider and its employees may not operate a vehicle to transfer a Participant or anyone else during the delivery of services. The Participant is aware that the Provider’s employees are considered mandatory reporters. As such they are legally required to identify potential risks of significant and immediate harm to any Participant to the relevant government agencies. Providing toileting assistance is the responsibility of the Participant or Participant Representatives unless such assistance is clearly defined as part of the Participant’s formal plan goals. In such cases, specific toileting‐related support will be provided by the Provider as part of the delivery of supports. Provider employees are required to always wear close-toed footwear when delivering services. If a Participant has a ‘shoes off’ policy in the home, Provider employees will switch to footwear for indoor use only that will have minimal impact on surfaces. Behaviour Support The Provider agrees to ensure that any behaviour support plan is developed with an emphasis on reinforcement-based procedures using evidence-based strategies. The Participant understands that identified behaviours of concern can only be targeted for intervention through a behaviour support plan (BSP) where adequate functional assessment of the behaviour of concern has taken place. An adequate functional assessment will include at a minimum, one of the following, as determined by the Participant’s Behavioural Consultant: Antecedent-Behaviour-Consequence (ABC data) data Direct assessment of the behaviour of concern by the Participant’s Behavioural Consultant Indirect assessment tools such completed behaviour questionnaires A functional Analysis MLS team member will only engage in intervention procedures that have been approved by the Participant’s Behavioural Consultant, most typically indicated in a behaviour support plan. Requests for MLS team members to engage in alternative interventions, outside of a current behaviour support plan must be addressed with and approved by the Behavioural Consultant directly, before doing so. The Participant has the right to request that the MLS team members cease implementing any currently approved behaviour support plan until a review of the procedure and its implementation has been provided to their satisfaction or amended in agreement with the Participant’s Behavioural Consultant. If the continuation of the current behaviour support plan will lead to immediate and significant risk to the Participant, themselves or others in the environment, MLS team members will act to prioritise safety above everything else. they may need to make a reasonable determination to intervene in a way other than what has been agreed to as part of an existing behaviour support plan (Crisis Management). In such instances, the MLS team member will document and inform the Participant’s Behavioural Consultant within 24 hours of the intervention being applied for further recommendations. Use of Restrictive Practices The Provider acknowledges that the use of restrictive practices is an infringement of a Participant’s human rights as it inhibits the participant’s dignity of risk, i.e., the opportunity to experience and learn from the natural consequences of one’s actions. The Provider commits to the following relating to the use of restrictive practices: That all appropriate reinforcement-based interventions will be considered and attempted first, where there is no immediate and significant risk of harm in doing so to the Participant. That any restrictive practices implemented will be used in the least restrictive way and for the shortest time possible as a last resort. That all instances of a restrictive practice being implemented, whether unauthorised or authorised, will be documented, and reported accurately and completely. That after the first instance of any reported unauthorised restrictive practice being implemented by an MLS team member the necessary functional behaviour assessment and behaviour support plans (interim or comprehensive) will be put in place. That all MLS team members will only engage in the use of restrictive practices in accordance with the following legislation and guidelines: Persons with Disability (Regulation of Restrictive Practices) Bill 2021 Communities & Justice’ Restrictive Practices Authorisation policy National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018 Use of Prohibitive Practices Prohibited practices are against the law and must not be used in any circumstances to manage the behaviour of a Participant by either the Provider, MLS team members, . Prohibited practices include: any form of corporal punishment (for example, smacking or hitting) any punishment that's intended to humiliate or frighten a Participant any punishment that involves immobilising them with a chemical or physical restraint force-feeding or depriving a Participant of food necessary for maintaining good health use of medication to control or restrain a child without a Behaviour Support Plan, proper medical authorisation, or legal consent use of punishing techniques, such as putting a Participant in a hot or cold bath, putting spice in their food, or squirting liquid on their face or body over-correction, where the punishment is out of proportion to the behaviour (for example, making a Participant clean an entire room because they tipped their meal on the floor) confinement or containment (for example, a Participant being forced to remain in a locked room or other place that they can't leave) punishment that involves threats to withhold family contact or change any part of a Participant's Case Plan denying access to basic needs or supports unethical practices, such as rewarding a child or young person with cigarettes any other act or failure to act that is an offence under the civil or criminal laws of NSW. If an MLS team member is alleged to have engaged in a prohibitive practice with a Participant: They will be stood down from delivering all services until an investigation has been conducted. If the allegations are substantiated with evidence, then the MLS team member will be subject to disciplinary proceedings, formal reporting to the relevant authorities and any other legal requirements. Participants understand that the MLS team members are required as mandatory reporters to communicate any suspicions or evidence of the use of prohibitive practices to the relevant authorities. Participants agree to receive supports from the Provider to engage in alternative behaviour support strategies to replace prohibitive practices. Continued use of prohibitive practices, in lieu of the alternate behaviour support strategies recommended will be grounds for immediate termination of services. Emergency & Disaster Management If a state of emergency or disaster occurs, we agree to have a plan in place to minimise the disruption caused to your services. Under these conditions, we will ensure that we continue to deliver services, if withholding them is likely to increase the risk of significant harm as long as it is safe to do so. If it is not safe to do so, we will make one of the following arrangements: Offer an alternate staff member to provide the service instead of the person usually designated. Reschedule the service as soon as possible to the original date. Offer telehealth support to assist in managing the risks remotely if feasible. COVID-19 Precautions The Provider and its employees endeavor to minimise the risk of exposure to infection from the COVID-19 virus for themselves and the Participants they work with by implementing reasonable and effective measures including: Routine handwashing and sanitizing. Only delivering services when fit and well enough to do so (no symptoms). RAT or PCR testing if an MLS team member becomes a close contact and, if tests are negative, communicating their status to Participants so they can decide on whether they would like to continue with services. Owing to the individual circumstances for different Participant and MLS team member combinations, both Participants and MLS team members reserve the right to wear masks during service delivery. MLS team members will also wear face masks if the Participant requests them to do so. Invoicing & Payment All services provided by the Provider’s employees will be arranged and billed through the Provider directly. The Participant will be invoiced every Monday via email for services provided during the previous week. Payment is required within 7 days from date of invoice. Credit cards and bank transfers are accepted as payment. Cash payments and cheques are not accepted. If Participants are accessing funding provided by third parties, e.g., respite agencies, trusts or the National Disability Insurance Agency (NDIA), it is the Participants responsibility to ensure that they or the nominated third parties they have assigned to provide payment, do so. Participants are responsible for monitoring their own funding balances so that they can meet their payment obligations. Should Participants exceed their third‐party funding arrangements then they are responsible for ensuring that any outstanding amounts are paid. Late payment of invoices may incur additional fees. Supports delivered by the Provider to the Participant will be suspended immediately until any outstanding amount is paid in full if the outstanding amount is 14 days or more overdue. The Participant will report any issues relating to non‐payment to the Provider at least 7 days prior to the suspension of supports for additional consideration and remediation by the Provider where possible. This includes invoicing errors, missing invoices, or notification of 3rd party delays. Non‐Compete & Dual Relationship Restrictions The Participant may not enter private hire arrangements with the Provider’s employees for any reason, either similar or dissimilar to the supports being provided whilst accessing the Provider’s services. The Provider or its employees may not engage in any activities with the Participant that are outside the purpose of their employment with the Provider. This includes but is not limited to accepting gifts and invitations to personal events; knowingly paying or bartering for services from the Participant or Participant Representatives or providing preferential treatment for the purpose of personal gain with a Participant. The Provider and Participant agree that in situations where they feel they are engaging in behaviour that could or has established a dual relationship, that they will discuss this directly with the Director to determine arrangements to eliminate the potential risks of this relationship. If the Participant seeks to privately engage an ex-MLS team member, the Provider reserves the right to determine if that is a suitable arrangement. If the Provider determines that the arrangement is detrimental to the Provider’s business interests, team culture or creates a conflict of interests in the delivery of supports, then the Provider holds the right to end the Service Agreement immediately. Training & Supervisory Support The Provider commits to ensuring all its employees receive ongoing training, mentoring and evaluation as part of their employment. Where training of an MLS team member is taking place, the Participant will only be charged for the time of the trainer, at a rate no greater than the cost of a team leader-level, behaviour technician. ‘Training’ relates to overlaps with new Participants or joining established Participant’s programs, where the trainer is demonstrating, coaching, and providing direct feedback to the trainee. Where assessment and evaluation of an MLS team member is taking place, the Participant will only be charged for the time of the MLS team member being assessed and evaluated. ‘Assessment & Evaluation’ relates to a senior level MLS team member directly or indirectly observing another MLS team member’s performance. Independent therapists are not considered Employees of the Provider and no responsibility is taken by the Provider for their working arrangements, tax responsibilities or professional misconduct. The Provider and its employees are required to deliver feedback to all those implementing supports arranged by the Provider and may recommend additional training, evaluation, or termination of any individual if it is in the best interests of the Participant’s progress. Any training offered by the Provider to any other individual involved in the Participant’s support is at a total cost to the Participant. While the level of experience and qualifications between the Provider’s employees may vary, every effort will be made to train and support them to ensure that their skills match the Participant’s needs. In instances where concerns are raised regarding a specific MLS team member of the Provider, additional training and evaluation will be offered to assess the situation and remediate any issues. The Participant has the right to cease the provision of supports by any MLS team member of the Provider from their team, at any time for any reason. Such removal will be effective immediately. A replacement will be offered as soon as one becomes available. Complaints & Complaints Resolution All Participants have the right to make a complaint, at any time without it negatively impacting on the continued delivery of services where it can be avoided. Attempts are made by the Provider to resolve any complaints in a timely manner and to update the Participant regarding any actions taken to address them. All complaints, actions taken to resolve them, and final outcomes will be documented by the Provider and available to the Participant for review. Issues pertaining to the clinical elements of service provision, e.g., the Provider’s employees’ performance, progress concerns or program management should be directed to the Participant’s Behavioural Consultant in the first instance or the Director if the issue relates to the conduct of a Behavioural Consultant. Issues pertaining to administration, e.g., scheduling, billing and operational policy, should be directed to our office administrator in the first instance and on to the Director if it is still unresolved. Please note that information, concerns, or complaints raised with any of the Provider’s employees by the Participant will be forwarded to the appropriate person for resolution and may not be withheld by the MLS team member. If you would like to make an initial complaint directly to the Director, then please email to [email protected] or by making an appointment through our office on (02) 8593 2664. If, in the process of attempting to resolve a complaint, behaviour that either the Provider or the Participant deem as unproductive, threatening, or harmful occurs, then the interaction should cease immediately, and the Director should be contacted to arrange for formal mediation and determine the most appropriate actions regarding existing services in the interim. Both the Provider and the Participant agree to manage any complaints or concerns in confidence with the parties directly involved and not sharing identifiable details to the public, including posting to social media, when sharing their experiences. Ending the Service Agreement & Terminating Supports The Participant takes responsibility for informing the Provider of any changes relating to the current NDIS plan identified in Item 3. This includes: Cancellation of the existing plan Replacement of the existing plan with a new one prior to the end of the current review date. Changes to the current plan that may have an impact on the ability of the Provider to continue to deliver A new Service Agreement (including a new Schedule of Supports) will be generated by the Provider for each new NDIS Plan and must be signed by both the Provider and the Participant for supports to continue within 14 days of the new plan starting. The Participant may end the existing service agreement at any time with confirmation of this request made in writing to the Provider. If the Provider determines that it is necessary to terminate supports to the Participant, the Provider must: Have documented attempts to resolve the issues leading to the termination of services. Provide 30 days’ notice in writing to the Participant. Offer 2 referrals to alternate service Providers to the Participant. The Provider may determine it necessary to end the delivery of supports owing to one or more of the following reasons: Participant’s request for services outside of the scope of the Provider’s expertise, philosophy or recommendations. An ongoing lack of program engagement by the Participant and/or Participant’s Representative, where this can reasonably be attributed to a lack of Participant progress within the program. Serious breaches of the Participant Service Agreement. The Provider, upon exit, will ensure that the Participant or the Participant’s Representative is provided with the following: A copy of the completed Participant Exit form. A soft copy of the raw data from Catalyst and all reports written during the course of service delivery. An opportunity to provide experience feedback via our Exit Acceptance of the Conditions of Agreement The following parties understand and agree to the terms and conditions of the Participant Service Agreement document. Participant Participant Representative #1 Participant Representative #2 Signature: Signature: Name: Name: Date signed: Date signed: Behavioural Consultant Director Signature: Signature: Name: Name: Date signed: Date signed: About Providing Consent Please complete this form to give Momentum Learning Services permission to provide Participant-related information on your/the Participant’s behalf. Every effort will be made to only provide information essential for the purposes of supporting the Participant more effectively. The information the Provider will share typically includes details regarding: The Participant’s learning and support needs The services the Participant is/has/will be receiving with MLS Information in reports generated by MLS You do not have to give your permission if you do not want to share Participant information. If a situation arises and information is requested from us regarding the Participant, we will contact you first to obtain verbal or written approval to do so. If you give us permission and then decide that you don’t want us to share your information anymore, you can withdraw your consent by contacting us. You can do this in writing or verbally. Consent will automatically elapse and require renewal at the onset of each new NDIS plan. We will not share your personal information to anyone unless you have given your permission, or the disclosure of your information is required or authorised by law. Preauthorised Parties Preauthorised parties are those organisations or individuals who you consent for us to share information with, without seeking prior approval. Parties you may want to consider for preauthorisation include: School staff such as teachers and principals The Participant’s general practitioner Allied Health Professionals such as speech pathologists, occupational therapists and psychologists I consent to the MLS giving information about the Participant named at Item 2 of this document, to the following people and/or organisations: Person’s Full Name Organisation/Relationship Best Contact Details (email or phone number) Acceptance of the Conditions of the Consent to Provide Information document The parties below understand and agree to the terms and conditions of the Consent to Provide Information document. Participant Participant Representative #1 Participant Representative #2 Signature: Signature: Name: Name: Date signed: Date signed: Definitions Recording refers to the ability to store data, sound, and images to review later. It typically includes video recording, photographs, audio recording and transcribing of events. Remote viewing refers to the ability to watch an event in real time without being in the same environment at the time where the event is taking place. It typically includes live feed video viewing such as Zoom or Skype or listening by phone. Purpose On occasion, it may be deemed ‘necessary’ to request to record or remotely view the Participant in the process of receiving services from the MLS team members or during their interactions with others. Reasons considered ‘necessary; include: Opportunities for in person services is difficult owing to environmental barriers such as distance, availability, space constraints and infection control. The issue to be addressed is susceptible to reactivity, i.e., the Participant or the MLS team member is likely to respond less naturally if being directly observed and this may misrepresent needs and capacities of the Participant. It is not safe for direct observation to be conducted for either the Participant or the MLS team members. Activities which may be the subject of recordings or remote viewing include (but are not limited to): Evaluating the capacity of existing support persons working with the Participant to implement services. Training new support persons to provide services to the Participant in line with the Participant’s goals and Provider’s scope of practice. Conducting assessments of skills and behaviours of concern to determine strategies that support ongoing learning for the Participant. Demonstrating progress and change across time by comparing skills pre assessment, during service provision and on review of services. Permissions A written request either by email or text will always be sent to confirm consent prior to any recording or remote viewing being conducted. Participant’s can suspend or decline permission to record or remote view services at any time and for any reason. All parties who are captured in a recording or will be viewed must be informed before the process begins to ensure they provide consent to doing so. The Participant will have access to all recordings that the Participant appears in for their own viewing. Privacy, dignity, and confidentiality The Participant’s dignity and privacy will always be protected as much as possible during the recording and viewing process. It is highly likely that the Participant’s identifying information such as their name and appearance will be recorded or included when viewing; every effort will be made to minimise any other identifiable information. When remotely viewing or reviewing recorded material, it will be done in a secure manner to ensure that access is limited to the persons whom the Participant or Participant Representatives have given approval to share it with. When collecting and storing recordings, the following practices will be implemented: Recordings will be collected on MLS team members recording devices which are password protected. The recording will be uploaded to a secure cloud service and the files will be protected with an additional password. Once stored in the cloud the original recording will be permanently deleted from the Provider Representative’s device. Both the Participant, Provider and their respective Representatives agree that they will not use the footage in social media, for marketing or promotional purposes without prior written agreement. Doing so may be grounds for termination of the service agreement. Accessing Recording Files Participants have the right to access any footage that they are in. All recording files will be protected by a password in the cloud server. Access to the recording will be restricted to those approved by the Participant . Access will be limited to viewing only. Downloading, editing and sharing will be blocked to minimise the possibility that the video is shared beyond those with approved access. Acceptance of the Conditions of the Permission to Remotely View and Record Service Provision document The parties below understand and agree to the terms and conditions of the Permission to Remotely View and Record Service Provision document. Participant/Participant Representative #1 Participant Representative #2 Signature: Signature: Name: Name: Date signed: Date signed: Behavioural Consultant Director Signature: Signature: Name: Name: Date signed: Date signed: