High intensity supports refer to specialised disability support services that involve complex or invasive procedures, or support for participants with complex needs. NDIS High Intensity Support Skills (HISS) Training is essential for providers and support workers delivering complex care to participants with high-intensity daily personal activities (HIDPAs). These supports require additional training, skills, and expertise beyond standard disability support work.
Key Takeaways
- High Intensity Support Skills (HISS) are specialised services for NDIS participants with complex needs, requiring additional training beyond standard disability support.
- HISS categories include complex bowel care, enteral feeding, tracheostomy management, catheter management, ventilation, subcutaneous injections, wound management, epilepsy, and diabetes care.
- Proper HISS training is critical for participant safety, as demonstrated by real-world incidents where inadequate training led to preventable harm.
- NDIS Commission requires providers delivering high intensity supports to register under group “0104 – High Intensity Daily Personal Activities” and verify staff competency.
- Training pathways include nationally recognised qualifications and specialised module-specific training for each type of support.
- Competency assessment must be conducted by qualified health professionals including registered nurses, nurse practitioners, or relevant allied health professionals.
- Effective HISS implementation requires thorough risk assessment, person-centred approaches, and comprehensive documentation.
- Ongoing professional development, supervision, and quality improvement processes are essential for maintaining high standards of care.
- Common challenges include access to rural training, supporting multiple complex needs, staff turnover, balancing clinical requirements with participant choice, and emergency management.
- Successful HISS delivery combines technical competence with compassion, respect, and person-centred approaches to enhance participants’ independence and quality of life.
Understanding High Intensity Support Skills (HISS) Under the NDIS
The National Disability Insurance Scheme (NDIS) has transformed how support is delivered to Australians living with disability. For many NDIS participants, high intensity support skills (HISS) are essential to ensure their complex care needs are met safely and effectively.
This training guide serves as a comprehensive resource for providers and support workers who deliver high intensity supports under the NDIS framework. Whether you’re new to providing these specialised services or looking to refresh your knowledge, this guide will help you understand the requirements, and how to develop necessary competencies, maintaining compliance with NDIS standards.
High intensity supports require specific training, knowledge and skills beyond standard support work. These services may include complex bowel care, ventilation management, tracheostomy management, urinary catheter management, subcutaneous injections, and other specialised health-related tasks that demand additional expertise.
NDIS High Intensity Support Skills Training: What You Need to Know
The NDIS Commission has established clear guidelines around who can deliver these supports and what training is required. This guide unpacks these requirements in practical terms, helping providers and support workers navigate NDIS high intensity support skills training with confidence.
Throughout this resource, you’ll find information about recognised NDIS courses, training pathways, and practical strategies for implementing high-quality care. Our aim is to equip you with the knowledge and tools to deliver exceptional support while meeting all regulatory obligations.
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What Are High Intensity Supports?
Under the NDIS Quality and Safeguards Commission framework, high intensity supports are categorised into several key modules:
- Complex Bowel Care: Including bowel management techniques, stoma care, and related interventions
- Enteral (Tube) Feeding and Management: Supporting participants who require nutrition through feeding tubes
- Tracheostomy Management: Care for participants with a tracheostomy tube
- Urinary Catheter Management: Including care and maintenance of indwelling and intermittent catheters
- Dysphagia Support: equips support workers with the knowledge and skills to safely manage swallowing difficulties, ensuring safe eating and drinking for NDIS participants.
- Ventilation Management: Supporting breathing through mechanical ventilation
- Subcutaneous Injections: Administration of medication via subcutaneous injection
- Complex Wound Management: Care for complex or chronic wounds
- Epilepsy Management: Including seizure response and management
- Diabetes Management: Blood glucose monitoring and support for diabetes care
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Under the NDIS Practice standards, support workers and providers must complete specific NDIS high intensity support skills training relevant to each module they deliver services in, ensuring they have the expertise to safely support participants with these complex needs.
Importance of Proper HISS Training
Real-world examples illustrate the impact of high intensity skills training. In one significant case, a resident with multiple complex conditions—including intellectual disability, autism, type 2 diabetes, and Prader-Willi syndrome—choked on a toasted sandwich in May 2020. The resident’s prescribed mealtime plan required soft, moist foods to reduce choking risks; however, the meal served did not adhere to these guidelines.
The staff’s lack of specialised dysphagia support training resulted in a failure to recognise and address the inherent risks. In the aftermath, the NDIS Quality and Safeguards Commissioner, Louise Glanville, stressed that the fatality was preventable if proper training had been provided. The subsequent Federal Court ruling confirmed that the Valmar staff were not equipped with the necessary skills, reinforcing that providers who neglect their safety obligations will face severe penalties.
This case serves as a stark reminder of the importance of robust, proper training in high intensity support skills and the fact that it’s not merely a regulatory requirement—it’s a crucial safety measure that directly impacts participant wellbeing.
For providers, ensuring staff are adequately trained in HISS both demonstrates and facilitates:
NDIS Regulatory Framework for HISS
The NDIS Practice Standards establish expectations for the quality and safety of services delivered to participants. For providers delivering high intensity supports, the relevant standards include:
Module 4 specifically outlines the requirements for providers delivering high intensity supports, with quality indicators focusing on:
- Staff qualifications and competency: Ensuring support workers have the necessary training, knowledge, and skills
- Risk assessment and management: Identifying and mitigating risks associated with high intensity supports
- Complex health care needs: Managing complex health conditions safely
- Delegation and supervision: Ensuring appropriate oversight of support workers
- Monitoring and review: Regular assessment of the effectiveness and appropriateness of high intensity supports
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Providers must demonstrate compliance with these standards during audits conducted by approved quality auditors as part of the NDIS registration process.
NDIS Commission Requirements for HISS Providers
Providers delivering high intensity supports must:
- Register with the NDIS Commission in the registration group “0104 – High Intensity Daily Personal Activities”
- Verify staff competency through assessment by a qualified health professional
- Maintain detailed records of staff training and competency assessments
- Implement policies and procedures specific to each high intensity support delivered
- Establish health care planning processes in collaboration with participants and health professionals
- Develop incident management systems specific to high intensity supports
- Ensure ongoing supervision and support for staff delivering high intensity supports
These requirements aim to safeguard participants receiving high intensity supports and ensure consistent quality of care across the NDIS sector.
Training Pathways for HISS Certification
Nationally Recognised NDIS Courses for HISS
Several nationally recognised qualifications and skill sets are relevant to high intensity support work:
- CHC33021 Certificate III in Individual Support (Ageing & Disability) Â provides foundational knowledge for all support workers
- Certificate IV in Disability (CHC43115) includes more advanced skills relevant to complex support needs
- High Intensity Support Skill Set (CHCSS00081) specifically addresses the skills needed for high intensity support work
In addition, several nationally recognised units of competency align with specific high intensity support modules:
- HLTENN007 – Administer and monitor medicines and intravenous therapy
- HLTENN008 – Apply principles of wound management
- HLTENN011 – Implement and monitor care for a person with diabetes
- HLTENN013 – Implement and monitor care of the older person
- HLTENN015 – Apply nursing practice in the primary health care setting
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These courses are delivered by Registered Training Organisations (RTOs) throughout Australia and provide a solid foundation for support workers entering the field of high intensity supports.
Specialised Training for Each HISS Module
Each high intensity support module requires specific training. Here’s what support workers need to know about each:
Complex Bowel Care
Training includes:
- Anatomy and physiology of the digestive system
- Common bowel conditions and management strategies
- Stoma care and management
- Digital stimulation techniques
- Use of suppositories and enemas
- Complications and emergency response
Enteral Feeding Management
Training includes:
- Types of feeding tubes (nasogastric, PEG, PEJ)
- Formula administration
- Equipment cleaning and maintenance
- Complication recognition and management
- Medication administration via feeding tubes
- Mouth care for participants with feeding tubes
Tracheostomy Management
Training includes:
- Tracheostomy anatomy and types
- Routine care and cleaning
- Suctioning techniques
- Emergency management
- Communication strategies for participants with tracheostomies
- Humidity and oxygen administration
Urinary Catheter Management
Training includes:
- Types of catheters and their management
- Catheter care and maintenance
- Infection prevention
- Troubleshooting common issues
- Catheter changes (when delegated by a health professional)
- Monitoring and documentation
Ventilation Management
Training includes:
- Types of ventilation support
- Equipment operation and troubleshooting
- Circuit cleaning and maintenance
- Emergency procedures
- Monitoring techniques
- Communication with ventilated participants
Subcutaneous Injections
Training includes:
- Medication management principles
- Injection techniques
- Site rotation and care
- Sharps handling and disposal
- Medication storage
- Documentation requirements
For each module, support workers must complete both theoretical training and practical skills assessment under the supervision of a relevant health professional.Â
Verification and Assessment of Competency
Competency in high intensity support skills must be verified through a formal assessment process. The NDIS Commission requires that competency assessment be conducted by an appropriately qualified health professional, such as:
- Registered Nurse
- Clinical Nurse Consultant
- Nurse Practitioner
- Medical Practitioner
- Allied Health Professional (relevant to the specific support)
The competency assessment process typically involves:
- Theoretical assessment: Demonstrating knowledge of relevant anatomy, physiology, conditions, and procedures
- Practical demonstration: Performing the required skills under observation
- Workplace assessment: Demonstrating competence in real-world support scenarios
- Documentation review: Ensuring proper record-keeping and reporting
Support workers must maintain their competency through regular reassessment, typically annually or when there are significant changes to best practice guidelines.
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Implementing HISS in Practice
Risk Assessment and Management
Effective risk management is fundamental to safe high intensity support delivery. Providers and support workers should:
- Conduct comprehensive initial assessments for each participant receiving high intensity supports
- Develop individualised risk management plans addressing the specific risks associated with each support
- Implement risk mitigation strategies such as:
- Regular equipment checks and maintenance
- Clear emergency procedures
- Comprehensive documentation systems
- Regular staff training and updates
- Regularly review and update risk assessments as participants’ needs change
Risk management should be collaborative, involving participants, families, support workers, and health professionals to ensure all perspectives are considered.
Person-Centred Approaches to HISS
While technical competence is essential, high-quality high intensity support also requires a strong person-centred approach. Support workers should incorporate numerous person-centred practices into their daily work. This includes involving participants actively in decision-making about how their supports are delivered, ensuring they have genuine input and choice wherever possible.
During intimate or complex procedures, respecting privacy and dignity becomes particularly crucial, with support workers taking care to maintain the participant’s comfort and sense of personal boundaries.
Supporting independence is equally important, with workers encouraged to facilitate self-management whenever appropriate rather than assuming control.
Effective support workers also consider cultural and personal preferences in support delivery, recognising that individual backgrounds and values significantly influence how care should be provided.
Clear communication using the participant’s preferred method is fundamental, whether that involves verbal explanation, visual aids, or alternative communication systems.
Throughout all aspects of high intensity support, workers must thoughtfully balance clinical requirements with quality of life considerations, ensuring that necessary medical procedures don’t unnecessarily restrict the participant’s lifestyle or choices. These person-centred approaches collectively ensure that high intensity supports enhance rather than diminish participants’ sense of control and dignity.
Documentation and Record-Keeping Requirements
Thorough documentation is crucial for high intensity supports. Providers must maintain:
Documentation should be:
- Clear and concise
- Factual and objective
- Timely and current
- Accessible to relevant team members
- Secure and confidential
- Compliant with privacy legislation
Good documentation not only meets regulatory requirements but also supports continuity of care and enables early identification of changing needs or emerging issues.
Ongoing Professional Development for HISS Providers
Continuing Education and Skill Maintenance
HISS competency is not a one-time achievement but requires ongoing education and skill maintenance. Support workers should:
- Stay current with best practice guidelines through regular updates and refresher training
- Participate in regular competency reassessment, typically annually
- Engage in peer learning opportunities such as case discussions and mentoring
- Access specialist training for specific participant conditions or needs
- Engage with professional networks such as disability support forums and communities of practice
Providers should implement systems to track training needs and ensure all staff maintain current competencies in the high intensity modules they deliver.
Supervision and Support Frameworks
Effective supervision is essential for safe high intensity support delivery. Support workers should never be expected to work beyond their level of competence and should always have access to guidance when needed. Providers should establish:
Quality Improvement in HISS
Monitoring and Evaluation
Continuous quality improvement requires systematic monitoring and evaluation throughout the delivery of high intensity supports. Effective providers actively collect feedback from participants about their experiences, ensuring their voices guide service improvements.
A comprehensive approach involves tracking multiple key performance indicators, including complication rates, instances of hospital admissions related to high intensity supports, patterns in incident frequencies and trends, assessments of staff confidence and competence levels, and most importantly, participant outcomes and quality of life measures.
Providers should complement this data collection with regular audits of support delivery measured against best practice standards, creating a structured approach to identifying improvement opportunities. Thorough review and analysis of incident reports helps identify systemic issues before they become widespread problems. When available, benchmarking performance against sector standards provides valuable context for understanding service quality relative to peers.
All this carefully collected data should directly inform ongoing improvements to training programs, organisational policies, and daily support delivery practices, creating a continuous cycle of service enhancement focused on participant wellbeing.
Implementing Best Practice Guidelines
The field of high intensity support continuously evolves alongside advancements in medical knowledge and technologies, requiring providers to stay current with emerging best practices. Forward-thinking organisations maintain strong relationships with relevant health services to access specialist advice and receive timely updates on clinical developments.
Subscribing to regular updates from peak bodies such as the NDIS Commission and clinical specialty organisations ensures providers are promptly informed about regulatory changes and sector-wide developments. Providers should establish regular schedules for reviewing and updating policies and procedures based on emerging evidence, avoiding the risk of practices becoming outdated.
When possible, participating in research and innovation projects not only contributes to the broader knowledge base but also positions providers at the forefront of service improvement.
Proactive providers also contribute to the development of best practice guidelines by providing thoughtful feedback to regulatory bodies based on their operational experiences.
This commitment to staying current with best practice ultimately ensures participants receive the highest quality support based on the latest evidence, rather than outdated approaches that may be less effective or even potentially harmful.
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Common Challenges and Solutions
Challenge 1: Access to Training in Rural Areas
- Solution: Combination of online learning modules, periodic intensive face-to-face workshops, and telehealth supervision
Challenge 2: Supporting Participants with Multiple Complex Needs
- Solution: Interdisciplinary collaboration through regular case conferences involving all relevant health professionals
Challenge 3: Staff Turnover and Knowledge Retention
- Solution: Comprehensive documentation, video resources for key procedures, and structured handover processes
Challenge 4: Balancing Clinical Requirements with Participant Choice and Control
- Solution: Co-design of support plans with participants, offering choices within clinical parameters, and regular review of restrictions
Challenge 5: Emergency Management in Community Settings
- Solution: Detailed emergency response plans, regular simulations, and relationship building with local emergency services
Resources and Further Information
Key Organisations and Contacts
- NDIS Quality and Safeguards Commission: Provides regulatory oversight and guidance for registered providers
- National Disability Services (NDS): Peak body for disability service providers offering resources and advocacy
- State and Territory Health Departments: Provide clinical guidelines and resources for health-related procedures
- Disability Advocacy Organisations: Offer perspective on rights and inclusion for people with disability
- Clinical Specialty Organisations: Provide specialist resources for specific conditions and procedures
HISS Training - Essential For Safe, Effective, and Dignified Support
By investing in comprehensive training, maintaining ongoing professional development, and implementing robust quality systems, providers and support workers can deliver exceptional care that enhances participants’ independence, health, and quality of life.
The regulatory requirements around high intensity supports are designed not as bureaucratic hurdles but as safeguards ensuring that all participants receive supports from skilled and confident workers. By embracing these standards and committing to continuous improvement, the disability support sector demonstrates its professionalism and dedication to participant wellbeing.
As the NDIS continues to evolve, so too will best practices in high intensity support delivery. Support workers and providers who maintain current knowledge, seek regular feedback, and centre the participant in all they do will be well-positioned to meet both current and future standards.
Remember that while technical competence is essential, it is the combination of clinical skills with compassion, respect, and person-centred approaches that truly constitutes high-quality, high intensity support.
Frequently Asked Questions
 The NDIS Practice Standards are a set of quality indicators that registered providers must meet to ensure they deliver safe and quality services to people with disabilities. These standards are designed to uphold the rights of participants and ensure compliance with the NDIS Commission’s regulations.
The Core Module is a fundamental component of the NDIS Practice Standards that all registered NDIS providers must meet. It consists of four key divisions:
Rights and Responsibilities, 2. Provider Governance and Operational Management, 3. Provision of Supports, 4. Provision of Supports Environment
To become an NDIS provider, you must apply for NDIS registration, which involves meeting specific requirements set by the NDIS Commission. This includes demonstrating compliance with the NDIS Practice Standards and developing policies and procedures to ensure quality service delivery.
