S7E01 - It’s Not the Tool, It’s the Process: The ICAN Conversation

The recent announcement confirming the ICAN tool as the foundation for future NDIS support needs assessments has sparked serious discussion across the Occupational Therapy community. While many clinicians recognise the need for a more consistent national approach, the way ICAN is being positioned raises major questions about process, workforce capability and the independence of assessments. Used as part of a broader OT evaluation, ICAN can be useful. Used alone to determine funding it risks misrepresenting function and undermining the professional reasoning OTs bring to complex cases.

Beyond the tool itself: why process matters more than the platform ICAN is currently used with participants under the Disability Support for Older Australians (DSOA) program. It provides a framework across domains such as mobility, self-care, cognition and communication. The concern lies not in the tool’s existence but in its unstructured nature. Assessors decide which domains to explore, what questions to ask and how deeply to probe. There are no standardised questions, norms or benchmarks meaning two assessors could reach entirely different conclusions about the same person.

This flexibility demands significant clinical experience and interviewing skill – qualities that develop over years of OT practice. Without that depth, important details can be missed especially when assessments rely heavily on self-report rather than observation. The training for ICAN focuses mainly on how to complete the form, not how to interpret or validate the information gathered. When used by non-clinical assessors the potential for bias and inaccuracy increases sharply.

Reliability, bias and the independence problem The NDIS has indicated that the agency itself will employ assessors to complete support needs assessments. When the same organisation controls both assessment and budget setting questions of neutrality are unavoidable. Current legislative wording requires assessors to consider NDIA-requested assessments but only may consider other professional reports. That single word – “may” – creates uncertainty about whether participant-provided clinical evidence will be given proper weight.

This approach mirrors earlier concerns raised during the independent assessment debate of 2021. If an NDIA-employed assessor’s findings can override treating clinicians’ data without opportunity for clarification, participants risk losing access to necessary supports and OTs risk having their evidence dismissed without review. The process must allow for right of reply, transparent reasoning and consistent standards across assessors.

What makes ICAN different from functional assessments Unlike structured tools such as the Vineland or other standardised measures, ICAN lacks normative data and published inter-rater reliability. It generates narrative statements rather than comparable scores. While it may complement a clinical assessment it should never replace comprehensive observation, task analysis and validated functional measures. The risk is that a conversational checklist could be treated as a definitive reflection of capacity when it captures only part of the picture.

For now, ICAN is intended for participants aged 16 and over but paediatric therapists should still pay attention. The broader reform agenda signals a long-term move away from current functional capacity assessments (FCAs) so understanding the principles and limitations of ICAN will help clinicians prepare for future expectations.

How OTs can safeguard quality, ethics and business continuity In the meantime OTs can take practical steps to strengthen practice and protect service viability.

First, continue writing clear and defensible reports that link observed function, assessment data and participation outcomes. Be explicit about what was trialled, what worked, what didn’t and why.

Second, corroborate self-report with direct observation, caregiver input and measurable results wherever possible. Simple ad