Mastering High Intensity Needs

Will, EnableUs Community

Welcome back to The EnableUs Community Podcast . I'm Will, here with Winter. Today we're diving into one of the trickiest aspects of the job—onboarding participants who have high intensity daily personal activities or what the NDIS calls HIDPA, plus complex and challenging behaviors. Look, this isn’t your everyday support setup. We’re talking about medical supports like, uh, complex bowel care, maybe ventilator support, tracheostomy, the whole lot—stuff that honestly, if your team’s not up to scratch, the risks can get scary, fast.

Winter, EnableUs Community

Yeah, absolutely. It’s a different ball game entirely when you’re dealing with high intensity supports, compared to your standard intakes. It’s not just about ticking compliance boxes, but actually laying down the core foundations to keep a participant safe and, you know, moving toward their personal goals. If you miss the mark or, say, mismatch someone’s needs with what your team can actually handle—it can be more than an inconvenience. We’re talking ethical breaches, risk to participant safety, sometimes even legal consequences.

Will, EnableUs Community

Exactly. And—oh, let me just share a quick story here. Ages ago, I knew this provider—let’s call them 'CarePlus' for the sake of privacy. They thought, “Hey, we care, we can probably figure out complex wound care.” But their team didn’t have the right health practitioner signoffs or the hands-on training. Within two weeks, they ran into a bad incident and had to escalate to emergency services. The participant ended up being fine, but it was dicey. The provider lost a lot of trust—not just with that participant but with their whole network. So, the lesson was crystal clear: if you don’t have the qualified staff, saying yes does more harm than good.

Winter, EnableUs Community

That story’s, uh, honestly more common than providers want to admit. Getting it wrong puts lives at risk and can completely derail a participant’s plan and progress. So having that clear definition—like, really understanding what counts as high intensity or complex behavioral support—is step one. If you’re not 100% on it, then pressing pause before committing is the only ethical move.

Winter, EnableUs Community

So, once you’ve established that a participant’s needs hit that high intensity threshold, the very next piece is risk assessment. And this isn’t your stock-standard form, right? It means a proper, detailed review that goes through medical risks, behavioral issues, environmental hazards—basically, anything that could impact the participant or the support team’s safety.

Will, EnableUs Community

Yeah, and—and it’s not something you do solo, either. You have to bring in the right professionals. Like, for the medical side, get registered nurses or other relevant health specialists involved straight away. For complex behaviors, you need registered behavior support practitioners to do a thorough functional assessment and, from there, design tailored behavior support plans. Everyone needs to know exactly what risks are present and what to do when things go sideways.

Winter, EnableUs Community

Collaboration is huge here. I worked a case last year where we brought in not only the RN and behavior support practitioner, but also the participant’s mum—she was the expert on her child’s warning signs, honestly. We sat down to flesh out a really granular support plan with clear step-by-step instructions, timing, equipment, and comms protocols. But what made the real difference was in the emergency preparation. We had an equipment failure drill set up. And wouldn’t you know it, a few weeks in, a ventilator battery died. The team followed the emergency protocol, everyone knew their job, and the situation got deescalated before there was real danger. That level of, um, preparedness—that doesn’t just happen by luck.

Will, EnableUs Community

That’s such a good example. Those support plans—if they aren’t detailed enough for someone brand new to step in and know what to do, then they’re not done yet. Also, clarify up front when to report, who to call in emergencies, and make sure those protocols are, you know, everywhere the team can find them. It’s about removing any chance for confusion when seconds count.

Winter, EnableUs Community

Absolutely. Strong support planning and risk assessment isn’t just about the paperwork—it’s about setting everyone up for safety and success, right from day one.

Will, EnableUs Community

Let’s talk about staff training and consistency, because honestly this is where things fall apart fast if it’s not done right. You absolutely can’t provide high intensity supports unless every single worker is properly qualified and up to date on all their training—no fudging that. For every high intensity task, their competency needs to be checked off by a qualified health pro or specialist. And the kicker? Annual reviews, always. If one of your workers hasn’t handled, say, enteral feeding in over three months, get them reassessed before they even think about picking it back up.

Winter, EnableUs Community

Yeah. There’s also the handover piece. I mean, even if you’ve got a great, consistent team, sometimes you can’t avoid a worker change. So have a system for thorough handovers—shadowing shifts, documentation reviews, side-by-side checks from nurses, even just walkthroughs of routines. It stops the “wait, what do I do with this syringe?” moments. And, honestly, participants notice consistency. It builds trust and avoids unnecessary stress.

Will, EnableUs Community

I do regular check-ins with my team—sometimes it feels like overkill, but it means any gaps are picked up early. We also track all incidents, near-misses, even just ‘weird vibes’ some days. And here’s something that’s made a big difference for us: simulation drills. We run through emergency scenarios, so the team gets muscle memory on it. The first time is always awkward, but by the third round they’re nailing it—and they’re more confident when something real actually happens.

Winter, EnableUs Community

That’s a great point. Routine check-ins, documentation, incident tracking—it sounds a bit tedious, but for high intensity supports, it’s what continuous improvement is built on. And those habits actually make audit time a breeze, too. So, to anyone listening: take the time, put the systems in place, and never skimp on training or review—your participants will thank you for it, even if they never say it out loud.

Will, EnableUs Community

Couldn’t agree more. Alright, that wraps us up for today on mastering onboarding for high intensity participants. Next time, we’ll tackle some digital tools that actually help with documentation and incident tracking, so you’re not buried in paperwork. Winter, always a pleasure.

Winter, EnableUs Community

You too, Will. Thanks everyone for tuning in—stay safe, and we’ll catch you soon.