In the NDIS framework, complex care typically refers to participants who have multiple diagnoses, high support needs, challenging behaviours, or require specialised interventions. But this clinical definition misses the human reality: complexity often emerges from years of inadequate support, trauma, and systems that have failed to understand the person's actual needs.
We've worked with people labeled as "complex" who were actually experiencing predictable responses to unpredictable environments. Others whose "challenging behaviours" disappeared when their sensory needs were properly accommodated, or whose "non-compliance" resolved when communication was adjusted to their processing style, particularly when it's non-verbal.
What Creates Complexity?
True complexity isn't just about having multiple diagnoses. It emerges from the intersection of individual factors, environmental barriers, system gaps, and historical trauma responses. Understanding this intersection is key to effective support.
Take Michelle, a 24-year-old with autism, PTSD, and an eating disorder. Previous providers focused on managing her "behaviours" - food refusal, meltdowns, and what they called "manipulation." But when we looked deeper, we found a young woman whose trauma responses were being triggered by inflexible meal routines and support workers who didn't understand sensory processing differences.
Michelle wasn't complex because she had multiple diagnoses, but because her support needs intersected in ways that required creative, individualised approaches rather than standard protocols. Being autistic often means rigidity around food selection, and more restricted choices which are familiar, repetitive and feel 'safe'.
Many providers avoid complex participants because they require more time, staff with specialised skills, and flexible approaches. It's easier to work with people whose needs fit neatly into existing service models than to adapt services to meet complex presentations.
Elements of Complex Care
- Multiple, intersecting diagnoses requiring coordinated support
- Trauma history impacting trust and engagement
- High sensory or communication support needs
- Previous service breakdowns creating additional barriers
- Family dynamics or living situations requiring specialist approaches
Our approach to complex care starts with understanding that behaviours communicate unmet needs. Instead of focusing on compliance or management, we ask: what is this person trying to tell us? What environmental changes, communication adjustments, or support modifications might address the underlying need?
This requires time to build trust, understand patterns, and develop individualised strategies. It requires staff with additional training in trauma-informed practice, neurodivergent communication styles, and mental health support. Most importantly, it requires willingness to try different approaches when standard methods don't work.
Complex care also means understanding that progress isn't always linear. Someone might have weeks of stability followed by a crisis period. Traditional providers often see this as failure, but we understand it as part of the journey. The goal isn't to eliminate all challenging moments but to build resilience and coping strategies.
Quality complex care requires multidisciplinary approaches. Our participants often work with psychologists, occupational therapists, dietitians, and other specialists as part of their support team. Coordination between these professionals is crucial, as everyone involved needs to understand the full picture.
The most important element of complex care is hope. Too many people have been told they're "too difficult" or "too complex" for services. We believe that with the right approach, adequate resources, and commitment to understanding the person behind the complexity, meaningful change is possible for everyone.