Early Childhood Approach (ECA) Referral

Please complete this form to enquire about how the NDIS Early Childhood Approach (ECA) can support a child aged 0-6 with a disability or developmental delay, living in the Local Government Areas of Logan City, Redland City, Brisbane City or Moreton Bay in QLD, Australia. 

If you are enquiring about ECA support for a child living outside of these four Local Government Areas in QLD, please check the NDIS website for the details of the relevant Partner in the Community: https://www.ndis.gov.au/understanding/ndis-each-state 

 

Early Childhood Approach (ECA) is funded by the National Disability Insurance Scheme (NDIS) and can offer a range of supports for children aged 0-6 with developmental delay or disability including:

  • Information;
  • Referral to mainstream services;
  • Early supports; or
  • Where required, assistance to access a funded plan through the NDIS.   

Please ensure that ALL Mandatory fields marked with a red asterisk are completed. If you do not complete all of the mandatory fields, your form will not successfully submit. When you have successfully submitted this form you will be taken to a success page.

 

Child's Details
Child's details
Does the child identify as Aboriginal or Torres Strait Islander or both?* - required
PLEASE NOTE: The Child must reside in one of the following QLD local government areas to proceed with this referral: Brisbane, Logan. Redlands City or Moreton Bay. If they do not reside in this area, please do not continue completing this form and instead check the NDIS website for the details of the relevant Partner in the Community: https://www.ndis.gov.au/understanding/ndis-each-state 
Residency or Citizenship Status* - required
Are there any guardianship, parenting or other court orders pertaining to this child? If yes to above, please clearly indicate the order type and purpose including any implications on legal decision-making responsibility for the child or restrictions on information sharing. If possible, please also upload a copy of the relevant order(s) at the end of this form.* - required
Does the child have a:
If “disability” is ticked, please select a primary disability
Details of person completing this form
Referring person's details
Do you identify as Aboriginal or Torres Strait Islander or both?* - required
Do you need an interpreter?* - required
Referral Reason

Reasons for Referral

Please describe your main concerns about the child across each of the following domains (if no concerns noted please write “none” or “N/A")

Supporting Document Attachments
Please attach any relevant documents to support this referral including consent forms, health or school reports, letter of diagnosis, court orders, etc.
Would you like to add additional support documents?* - required
Mandatory field(s) marked with *

To know how we collect, use and store your personal information, please see our Privacy Collection Notice.

You can also get more information about our processes in our Privacy Policy. You can also access the NDIS Privacy Policy here.

Important Privacy Information

Please read this section carefully. If you have any questions, contact The Benevolent Society ECEI on benevolent.ecei@ndis.gov.au

The Benevolent Society Privacy Policy
You are providing personal information to The Benevolent Society ABN 95 084 695 045 (we, us or our).

Who do we collect your personal information from?
We generally collect your personal information directly from you. However, in some cases, we may receive your personal information from a third party (for example from your guardian/carer and/or authorised
representative, medical and other health providers, government agencies and other nongovernment service providers). In these cases, we will take reasonable steps to ensure you are aware that we have collected personal information about you and the circumstances of the collection.

Why do we collect your personal information? We collect your personal information to:

  • provide you with information and updates about our services.
  • assess your eligibility for our services and determine how we can best help you.
  • provide our services to you and in some instances, this will include health services.
  • research, monitor and evaluate our services so we can continue to improve the quality
    and outcomes of our services as well as develop new services.
  • advocate for the improvement of service quality and outcomes.
  • meet our funding, professional and legal obligations in providing you with our services.
  • process and respond to any complaint made by you.
  • provide information to third parties as authorised or required by law.

Some of the information we collect is to satisfy our legal obligations including in some circumstances to enable us to discharge our duty of care. Laws governing or relating to our operation may also require certain information to be collected and disclosed, for example, child protection, mental health, and health or ageing laws.

What would happen if we didn't collect your personal information?
Without your personal information we may not be able to provide the full scope of our services to you, respond to your complaint, improve our service to meet your needs and/or meet our funding, professional
and legal obligations.

Who are the types of bodies and persons to whom we usually disclose your personal information?
To achieve the best possible outcomes for your individual circumstances, we collaborate with others. In doing so, your personal information may be disclosed to:

  • other government and non-government service providers to assist them in providing
    services to you
  • medical and/or other health providers (including members of your treatment team, such
    as health providers involved in your diagnosis, care or treatment for any particular
    episode of care) to assist them in providing services to you and to the extent necessary
    to improve or maintain the individual’s health or manage a disability
  • our funders and regulators
    Ver. 2.4 12
  • our affiliates, subsidiaries and other related companies, and
  • external professional individuals or organisations, in circumstances where a TBS employee is subject to external professional supervision or peer review.

We will only disclose your personal information as set out in this notice and our privacy policy or to third parties as authorised or required by law or a court/tribunal order. In all other circumstances, we will disclose your personal information only with your prior consent.

Do we disclose your personal information overseas? We do not disclose personal information outside of Australia. However, we do use cloud based data storage services and social media platforms (like Facebook and LinkedIn) to facilitate our business activities, who store information overseas in the United States and Singapore.

Other useful information
Our privacy policy contains information about how you may access and correct your personal information, as well as how to complain about a breach of the Australian Privacy Principles and how we will deal with such a complaint. It also contains other useful information. Our privacy policy is available on our website at www.benevolent.org.au or email us at privacy@benevolent.org.au for a copy. Please feel free to direct queries on our privacy practices to our Privacy Officer at: M - PO Box 257, Broadway NSW 2007 T - 02 8262 3400 E - privacy@benevolent.org.au