Let me say something that might sting a little:
You can write a technically accurate, well-structured, clearly presented AT report — and still have it questioned, pushed back on, or outright rejected by the NDIA.
Not because you got the clinical reasoning wrong. Not because you chose the wrong piece of equipment. But because of where the report started.
This is the gap I see most often when OTs bring their AT reports to supervision or documentation review. And it's worth naming directly.
A supplier can write a features-based report. You can't afford to.
Here's what a good AT report looks like on the surface:
The equipment is described clearly.
The features are outlined.
There's a logical connection between what the product does and what the participant needs.
It reads well.
It's professionally presented.
An AT supplier — a skilled one, anyway — could write that report. They know their product. They know what it does. They can connect product features to participant needs in a way that sounds clinically sound.'
The problem is that this is where a lot of OT-authored reports stop too.A well-written report describes the AT and makes the case for it. A funded report does something different. It starts somewhere else entirely.
Where a funded report actually starts
A funded AT report starts with the participant.
Their goals. Their functional profile. The specific activities and environments where participation is limited or supported by equipment. The outcomes the family is working toward — not just the goals documented in the plan, but what life actually needs to look like for this child and this family.
That's the foundation. Everything else builds from it.
From there, a funded report names the AT solutions that were trialled and considered. This is the piece that gets missed most often — and it's the piece that draws the most push back from the Agency.
The NDIA doesn't just want to know what you chose. They want to know what else you looked at, why you looked at it, and why you didn't recommend it. That comparative reasoning is what separates a clinical prescription from a product request. Without it, the report reads like a shopping list with a letterhead on it.
Then comes the AT solution chosen — and the why. Not just "this chair supports the child's postural needs" but "this chair, rather than the two alternatives trialled, provides X specific outcome because of Y specific clinical reason, which directly addresses Z participation goal."
Goal. Trial. Comparison. Choice. Outcome.
That's the structure of a funded report.
The outcome piece — and why it matters more than goals
There's a distinction worth drawing here between goals and outcomes, because they're not the same thing and reports that conflate them tend to get questions.
A goal is what you're working toward. An outcome is what life looks like when you get there:
"Improve independent mobility in the home environment" is a goal.
"Jaxon will independently navigate between his bedroom, bathroom, and living areas without adult physical assistance, enabling him to participate in morning routines with his family" is an outcome.
The NDIA funds outcomes. They want to understand the functional change the equipment will create — for this child, in this context, in this family's life. The more specifically you can paint that picture, the stronger the justification.
This isn't about writing more. It's about writing differently.
The experience level trap
Here's something worth sitting with — and I'm sharing it because it's come up a lot lately.
I've been called in recently to support a number of senior OTs whose AT prescriptions were questioned or declined by the NDIA. These weren't junior therapists finding their feet. Their clinical reasoning was strong. Their knowledge of the equipment, the child, the family — all of it was there.
My role was essentially devil's advocate. Sitting alongside them and asking the questions a planner would ask. Pushing on the why behind every clinical decision until the justification was on paper, not just in their head.
That's where the gap was. Not in the thinking. In the transfer of that thinking onto the page.
When you're close to a case — when you know this child, when you were at the trial, when you've been working with this family for months — it's easy to assume the reader can see what you see. They can't. The planner reading your report has never met this child. They're working entirely from what's in front of them.
The clinical reasoning was solid. The report just didn't show it in the way the Agency needed to see it.
That's a fixable problem. But you have to know it's there first.
What this looks like in practice
If you're reading this and wondering whether your AT reports have this gap — here are three questions worth asking about your last one:
1. Does the report start with the participant's goals and functional profile, or with the equipment?
If you wrote about the AT before you wrote about the person, the structure is back to front.
2. Does the report name what else was trialled or considered — including lower-cost alternatives — and why those options weren't recommended?
If the answer is no, or if it's a single vague sentence, that's the gap the NDIA will find. This matters even more right now if you haven't specifically addressed lower-cost alternatives. We all know the direction the scheme is heading. Demonstrating that you considered and clinically ruled out a less expensive option isn't just good practice — it's increasingly essential.
3. Does the justification section describe outcomes — specific, functional, participation-based — or does it describe features and goals?
If it's features and goals, it's a good report. It's not yet a funded one.
One more thing — longer is not better
There's a pattern worth naming on the other end of the spectrum.
Some of the reports I've reviewed that had the strongest clinical foundations were also significantly too long. Repetitive across sections. Detailed to the point of obscuring the key justification. The therapist had clearly invested enormous time — often unbillable time — crafting something thorough.
But thorough and fundable aren't synonyms.
A report that takes three hours to write and runs to fifteen pages isn't automatically stronger than one that took ninety minutes and makes the case clearly in eight. In fact, a cluttered report can bury the very reasoning the planner needs to find quickly.
This matters beyond the individual report too. The sector is under real pressure to work efficiently and sustainably. Time spent over-engineering documentation is time that isn't being billed, isn't being spent with clients, and isn't sustainable for anyone — the therapist, the practice, or the participant whose funds are covering it.
Good AT report writing is precise. It says what needs to be said, in the right structure, and stops there.
That's a skill. And like most skills, it develops faster with feedback.
If you want another set of eyes on it
That's what Draft.Lab is for.
Bring your report — a draft, a completed document, a previous report that got push back — and we'll review it together. We'll give you specific, practical feedback on structure, justification, and outcome framing. Not general commentary. Actual edits and reasoning.
Available as a dedicated session, a live working review, or async written feedback. Your choice.
If you want clinical support during the assessment and trial phase — before the report is written — Co.Consult puts one of our senior clinicians in the room with you and your client in real time.
And if AT prescription is a recurring part of your caseload and you want to build genuine capability in this space, 1:1 Clinical Supervision is the longer play.
→ Bring your report to Draft.Lab [LINK: https://www.kidsandcolab.com.au/clinical-supervision]
→ Learn about Co.Consult [LINK: https://www.kidsandcolab.com.au/co-consult]
→ Explore 1:1 Supervision [LINK: https://www.kidsandcolab.com.au/clinical-supervision]