For many people supported under the NDIS, High Intensity Support Skills (HISS) are vital to ensuring complex care needs are managed safely and effectively.
This guide has been created as a detailed resource for providers and support workers delivering these specialised supports within the NDIS framework. Whether you are beginning your journey in high intensity services or seeking to update your skills, this resource explains the requirements, competencies, and compliance measures expected under NDIS standards.
High intensity supports demand additional training and expertise that go beyond general disability support. They include tasks such as complex bowel care, ventilation support, tracheostomy care, catheter management, subcutaneous injections, and other advanced health-related procedures.
The NDIS Commission sets strict rules about who may deliver these supports and the training required. This guide translates those expectations into practical advice, supporting both providers and workers to approach HISS training with clarity and confidence.
Inside, you’ll discover details about recognised NDIS courses, training pathways, and proven strategies for providing safe, effective, and compliant care.
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Key Takeaways
- High Intensity Support Skills are specialised supports requiring additional training beyond standard disability support.
- Modules include bowel care, enteral feeding, tracheostomy, catheter care, ventilation, injections, wound management, epilepsy, and diabetes support.
- Training is mandatory for providers registered under Group 0104 – High Intensity Daily Personal Activities.
- Competency must be verified by qualified health professionals (RNs, NPs, or allied health).
- Best practice delivery combines technical skill with person-centred care, dignity, and independence.
- Ongoing professional development ensures workers remain competent as practices evolve.
Understanding High Intensity Support Skills (HISS)
High intensity supports are defined by the NDIS as activities involving significant clinical risk. Only workers with specialised training and proven competency are authorised to deliver them.
Core HISS Modules
NDIS High Intensity Support Skills
- Covers: Digestive system anatomy, stoma care, digital stimulation, use of suppositories or enemas.
- Risks: Infection, impaction, bowel perforation.
- Escalation: Recognise complications early and follow escalation procedures.
- Supports: Participants using PEG, PEJ, or nasogastric tubes for nutrition.
- Covers: Formula prep, equipment cleaning, medication administration, aspiration prevention.
- Dignity: Maintain participant dignity throughout daily routines.
- Involves: Suctioning, cleaning, monitoring, emergency procedures.
- Covers: Communication strategies, humidity & oxygen administration, blockage prevention.
- Risk: Errors can cause life-threatening airway obstruction.
- Includes: Indwelling and intermittent catheter care.
- Covers: Infection prevention, maintenance, monitoring urine output, troubleshooting.
- Escalation: Know when to involve health professionals.
- Context: Participants may rely on mechanical ventilation.
- Covers: Monitoring machines, cleaning circuits, responding to alarms, managing disconnections.
- Readiness: Emergency drills are essential.
- Used for: Medications such as insulin or anticoagulants.
- Covers: Injection technique, site rotation, sharps disposal, medication safety.
- Covers: Wound stages, dressings, infection prevention, escalation pathways.
- Risk: Poor care can lead to sepsis, hospitalisation, or long-term harm.
- Focus: Seizure recognition, safe response, administering rescue medication (e.g., midazolam).
- Dignity: Keep participants safe and maintain dignity during and after seizures.
- Covers: Blood glucose monitoring, insulin support, recognising hypo/hyperglycaemia, accurate recording.
The NDIS Practice Standards mandate that support workers and providers undertake targeted High Intensity Support Skills training for every module they are involved in, guaranteeing the skills and knowledge needed to deliver safe and effective support to participants with high-level care needs.
Why Proper High Intensity Support Skills Training Matters
High intensity support skills directly impact participant safety. Inadequate training can lead to life-threatening incidents.
A stark example shows why High Intensity Support Skills training cannot be overlooked. In May 2020, a man with complex health conditions—intellectual disability, autism, diabetes, and Prader-Willi syndrome—was served food inconsistent with his mealtime plan, which required soft textures. He choked on a toasted sandwich and later died.
Investigations found that staff had not received the specialised dysphagia training needed to manage the risks. Commissioner Louise Glanville publicly stated the fatality was preventable, and the Federal Court later held that the provider had breached its obligations.
This tragedy highlights that training in high intensity support skills is not just about compliance—it is about protecting lives.
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- Lower the chance of serious incidents
- Notice health risks early
- Respond effectively in emergencies
- Maintain dignity and respect
- Encourage independence and participation
- Build trust with families and participants
- Shows commitment to safe, high-quality support
- Meets NDIS registration requirements
- Minimises risk of penalties and liability
- Enhances staff capability and confidence
- Bolsters the provider’s reputation in the sector
Regulatory Framework for HISS under NDIS
Quality Indicators under the NDIS Practice Standards
The NDIS Practice Standards define the expectations for providers to ensure participant safety and quality of care. For those delivering high intensity supports, compliance with four core modules is required:
- Module 1: Rights and Responsibilities
- Module 2: Governance and Operational Management
- Module 3: Provision of Supports
- Module 4: High Intensity Daily Personal Activities
- Ensuring all staff are trained, qualified, and competent
- Conducting and documenting risk assessments
- Managing participants’ complex healthcare needs safely
- Providing adequate supervision and clear delegation
- Reviewing support delivery regularly to maintain standards
Providers must prove compliance during NDIS audits, demonstrating that their workforce, policies, and procedures meet the established quality indicators to remain registered.
Compliance Obligations: HISS Providers under the NDIS Commission
To deliver high-intensity supports, providers are required to:
- Register with the NDIS Commission in registration group 0104 – High Intensity Daily Personal Activities
- Confirm staff competency through assessments conducted by qualified clinicians
- Document and retain detailed records of training and competency outcomes
- Adopt service-specific policies and procedures for each high-intensity module delivered
- Coordinate health care planning with participants and relevant health practitioners
- Operate incident management systems tailored to high-intensity risks
- Ensure ongoing supervision, mentoring, and support for frontline workers
NDIS Competency Verification Process
To ensure safe and effective delivery of high intensity supports, the NDIS Commission requires competency to be verified by a suitably qualified health professional. This may include:
- Registered Nurse
- Clinical Nurse Consultant
- Nurse Practitioner
- Medical Practitioner
- Allied Health Professional
Verification involves several stages:
- Theoretical assessment – demonstrating essential knowledge of conditions and care procedures
- Practical assessment – performing required tasks under supervision
- Workplace observation – applying skills in real support environments
- Documentation audit – reviewing records for compliance and accuracy
Competency must be renewed regularly — most often on an annual basis — or whenever updated best practice guidelines are introduced.
Training Needs Analysis (TNA)
Providers can conduct a TNA to identify gaps in staff competency and ensure cost-effective training aligned with participant needs.
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- Conduct comprehensive initial assessments for each participant receiving high-intensity supports
- Develop individualised risk management plans tailored to each support
- Perform regular equipment checks and maintenance
- Establish clear and tested emergency procedures
- Maintain comprehensive documentation systems
- Provide regular staff training and refresher updates
- Review and update risk assessments as participants’ needs change
Embedding Person-Centred Practices into High Intensity Support Skills
Delivering high-quality high intensity support skills goes beyond technical competence — it requires a person-centred focus. This means:
- Actively involving participants in shaping their supports, ensuring choice and control are central.
- Maintaining privacy and dignity during complex or intimate procedures to safeguard comfort and respect.
- Promoting independence and self-management wherever possible, instead of defaulting to full worker control.
- Being attentive to cultural and individual values, acknowledging that personal history influences expectations of care.
- Using communication methods that suit the participant best, from plain speech to visual tools or assistive technology.
By combining medical expertise with empathy and respect, support workers ensure that high-intensity support skills enhance quality of life and uphold the participant’s sense of autonomy.
- Support plans detailing delivery of high-intensity supports
- Health care plans developed with health professionals
- Medication charts and records (where relevant)
- Daily progress notes documenting supports and observations
- Incident reports for adverse events or near misses
- Staff training and competency records
- Equipment maintenance logs
- Risk assessments and management plans
- Documentation that is clear, concise, factual, and current
- Records that are secure, confidential, and privacy compliant
Continuous Professional Development for HISS Teams
Maintaining Skills and Knowledge
Competency in high intensity support skills requires continuous professional development. Support workers should:
- Stay aligned with evolving best practices through regular updates and refresher courses
- Complete periodic competency assessments, typically every year
- Engage in peer learning through mentoring, group discussions, and shared experiences
- Access targeted training for specific conditions or participant requirements
- Network through professional communities, forums, and practice groups
For providers, it is essential to put in place systems that track training and ensure all staff maintain verified, up-to-date competencies for the supports they are authorised to deliver.
Frameworks for Supervision and Staff Support
Ensuring Safe and Sustainable Care
Effective supervision safeguards both participants and staff in high intensity support skills settings. Providers are expected to:
Provide scheduled clinical supervision by experienced health practitioners
Create peer support opportunities for collaboration and day-to-day guidance
Establish escalation procedures for unfamiliar circumstances
Facilitate post-incident debriefing to support staff wellbeing and learning
Promote reflective practice sessions that encourage continuous improvement
Importantly, support workers should never be left to manage tasks beyond their training level and must always have access to advice when required.
Driving Quality Improvement in High Intensity Support Skills
Monitoring and Client Evaluation Processes
To maintain excellence, providers must embed ongoing monitoring and evaluation into high intensity support delivery. Participant feedback is a vital driver of change, ensuring services reflect lived experience.
Key areas to measure include:
- Adverse events and complication rates
- Hospitalisation linked to high-intensity care
- Trends in reported incidents
- Workforce capability and confidence
- Outcomes that reflect participant independence and life quality
Audits, benchmarking, and detailed incident analysis allow providers to pinpoint gaps and implement corrective strategies before risks escalate. Aligning outcomes with sector standards strengthens accountability.
Insights gained should directly shape policy, staff education, and service design, ensuring improvement efforts remain continuous and participant-focused.
Applying Best Practice in High-Intensity Supports
Keeping Pace with Change
Advances in healthcare and technology mean that high-intensity support practices are constantly shifting. Providers need to ensure that their services reflect contemporary standards.
Organisations that excel typically collaborate with specialist health services and maintain memberships with peak bodies such as the NDIS Commission and clinical organisations. This guarantees timely access to updates on regulations and industry developments.
Policies and procedures should be scheduled for routine review, ensuring new evidence is integrated promptly. Involvement in research and pilot projects contributes to sector growth and enhances provider credibility.
When providers also share feedback with regulators, they help refine practice standards for the entire sector. Ultimately, a commitment to best practice delivers safer, higher quality supports that improve participant outcomes.
Safe, Effective, and Respectful High Intensity Support Skills Training
Comprehensive training, professional development, and robust quality processes enable providers and workers to deliver high-intensity supports that build independence, protect health, and enrich quality of life.
The NDIS requirements surrounding high intensity support skills act as protective measures rather than red tape, ensuring participants are assisted by skilled professionals. Providers who adopt these standards demonstrate dedication to safety and sector excellence.
With the NDIS constantly adapting, so too must best practice. Those who keep their knowledge current, listen to feedback, and embed participant choice in all decisions will remain well-prepared for future changes.
Excellence in this field is achieved not only through technical expertise but also through compassion, dignity, and respect, which together define truly person-centred high-intensity care.
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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
Online and Print Resources
- Queensland Health Department Clinical Practice Guidelines
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: 1. Rights and Responsibilities, 2. Provider Governance and Operational Management, 3. Provision of Supports, 4. Provision of Supports Environment
This is a sector-wide framework that defines expectations for disability support worker capabilities, complementing HISS training.
Training varies by module. At FirstAidPro Sydney, each unit of the high intensity support skills requires approximately 2-3 hours of face-to-face training, preceded by 2 hours of online reading / learning.
Providers risk non-compliance, penalties, and participant harm. Untrained staff must not deliver HISS.
