For Hospitals, LHDs and Clinicians

What we provide

My ResponsAbility is a registered NDIS provider supporting participants across the Sydney metropolitan area.

We provide Support Coordination, Psychosocial Recovery Coaching and disability support, including community access, daily living and transport.

Depending on the participant’s needs, NDIS plan and available funding, we can also assist with hospital-to-community transitions, accommodation and tenancy-related goals, and participation in employment, education and the community.

When to refer

A referral may be appropriate when a participant:

• is preparing to leave hospital or another health service and needs disability supports organised for the transition
• has an NDIS plan but is having difficulty accessing, organising or using their funded supports
• needs Support Coordination or Psychosocial Recovery Coaching to help connect and coordinate services
• needs practical disability support with daily living, community access or participation
• is experiencing a change in circumstances or their current support arrangements are no longer working well
• has several services involved and would benefit from better coordination across their support network.

Not sure whether the referral is suitable? Contact us before referring and we can discuss the participant’s circumstances and our current service capacity.

Supporting transitions back into the community

For participants leaving hospital or another inpatient setting, we can work alongside the participant and their treating team to help establish appropriate NDIS-funded supports in the community.

Depending on the participant’s needs and plan, we may:

• participate in discharge or transition meetings
• help identify and organise relevant NDIS-funded supports
• communicate with hospital teams and other services, with the participant’s consent
• help connect the participant with suitable disability support providers
• arrange and match support workers where My ResponsAbility is providing the support
• review relevant support plans, instructions and preparation requirements before supports begin.

More about Hospital-to-Community Transition Support

How we work alongside referrers

We work collaboratively with participants, clinicians and other services involved in their support. How we communicate depends on the role My ResponsAbility has been engaged to provide.

Support Coordination and Psychosocial Recovery Coaching

Where we provide Support Coordination or Psychosocial Recovery Coaching, we can help connect the participant’s NDIS, health and community supports.

With the participant’s consent, this may include communicating with clinicians and providers, participating in planning discussions, following up agreed actions, helping coordinate services and identifying gaps or changes in the participant’s support arrangements.

These roles work alongside clinical and health services and do not replace clinical assessment, treatment or healthcare decision-making.

Support Work

Where we provide direct disability support, communication is focused on the supports we deliver. With the participant’s consent, this may include relevant updates about support arrangements, changes affecting safe service delivery and agreed observations that may assist the participant’s broader support team.

Support workers do not take on the broader coordination responsibilities of a Support Coordinator or Psychosocial Recovery Coach.

Where a participant chooses My ResponsAbility for both coordination or recovery coaching and direct support, the roles remain distinct while appropriate communication between the teams can support clearer handovers and continuity of support.

Sharing participant information

We aim to share information that is relevant to the purpose of the request rather than routinely sharing entire participant records.

With the participant’s consent, communication may include verbal updates, written summaries, relevant support information or specific records where appropriate.

Requests for progress notes or other participant records are considered individually, taking into account the purpose of the request, the participant’s consent and relevant privacy and information-sharing requirements.

Our role and service boundaries

My ResponsAbility provides NDIS-funded disability supports and works alongside health, clinical and community services.

• We are not an emergency, acute mental health or crisis-response service.
• We do not provide clinical assessment, diagnosis, treatment, therapy or counselling.
• We work alongside hospital discharge and transition planning rather than replacing it.
• We do not provide emergency accommodation or act as a housing provider.
• We do not provide tenancy or legal advice.
• Behaviour Support Plans, restrictive practices, complex health needs and other specialised support requirements should be discussed with us before supports commence so we can determine whether the requested support is within our scope and can be delivered safely.

If there is an immediate risk to someone’s safety, contact the appropriate emergency or treating service.

What referral information helps

You do not need to provide a complete clinical history. We ask for information that helps us understand the participant’s needs, assess the referral and plan supports safely.

Helpful information includes:

• what has prompted the referral and what the participant would like help with
• the support being requested and relevant NDIS plan information, where known
• communication, accessibility or decision-support needs
• relevant health, safety or support information that may affect how services are delivered
• current services and key people involved
• for hospital referrals, the expected discharge or transition date, destination and any preparation required before supports can begin.

Relevant supporting documents can also be provided where helpful, such as NDIS plan goals, discharge information, risk or safety plans, Behaviour Support Plans, support instructions or allied health recommendations.

Please provide only information relevant to assessing and safely delivering the requested disability supports. Complete clinical records are generally not required.

How to refer

For referrals from hospitals, Local Health Districts, community mental health services, GPs, specialists, allied health professionals and other health or clinical services, please complete our Hospitals, LHDs & Clinicians Referral Form (PDF, 340 KB).

Email the completed form and any relevant supporting documents to [email protected].

We aim to respond within 1–2 business days. This means we will make contact about the referral within that timeframe; service commencement will depend on the participant’s needs, funding, service fit and current capacity.

To discuss a referral before submitting it, call 02 7205 4859 or email [email protected].

Provider information and in-service sessions

Hospital, LHD and clinical teams are also welcome to contact us to arrange a provider information or in-service session.