School-aged child with autism, ADHD, and PDA access issues (Provider experience)

Submission 2794

​Submission to the Senate Community Affairs Legislation Committee Inquiry into the​ ​National Disability Insurance Scheme Amendment (Securing the Scheme) Bill 2024​

​Submitter​: Individual speech pathology clinician and private practice owner​

​Location​: East Perth, Western Australia​

​Relevant experience:​ ​- Speech pathology provider in NDIS since the scheme’s rollout in Canning Vale, WA​ ​- Private practice owner full-time since 2006 - 2025 (19 years)​ ​- Downsized practice in September 2021 to operate with only myself and an allied health​ ​assistant (AHA) due to increasing NDIS pricing and compliance pressures​ ​- Closed my clinical practice in December 2025 because NDIS pricing, compliance burden, and​ ​payment delays made solo practice unsustainable​ ​- Now working as an allied health business coach and mentor​ ​- Caseload focused on early childhood and school-aged children​ ​- Supervisor and mentor of rural and remote speech pathology therapists nationally​

​Contact​:​ ​- Name: ​ ​- Email: ​

​1. Purpose of this submission​

​This​ ​submission​ ​outlines​ ​concerns​ ​from​ ​a​ ​clinical​ ​speech​ ​pathology​ ​provider​ ​about​ ​how​ ​the​ ​proposed Bill may:​

​- Reduce access to early intervention and ongoing supports for children and families​ ​- Threaten service sustainability through pricing, travel, and fee settings​ ​- Worsen workforce shortages and loss of experienced therapists​

Submission 2794

​-​ ​Undermine​ ​rural​ ​and​ ​remote​ ​access,​ ​particularly​ ​through​ ​reduced​ ​telehealth​ ​and​ ​travel​ ​support​ ​- Disrupt early intervention funding and continuity of care​ ​- Exacerbate planner inconsistency and its impact on participants and providers​

​These​ ​concerns​ ​are​ ​grounded​ ​in​ ​direct​ ​clinical​ ​and​ ​supervisory​ ​experience​ ​with​ ​NDIS​ ​participants​ ​in​ ​Western​ ​Australia,​ ​including​ ​families​ ​in​ ​Perth​ ​metropolitan​ ​areas​ ​and​ ​rural​ ​regions​ ​such​ ​as​ ​Kalgoorlie.​ ​As​ ​a​ ​provider​ ​who​ ​closed​ ​my​ ​19-year​ ​practice​ ​due​ ​to​ ​NDIS​ ​unsustainability,​ ​I​ ​speak​ ​from​ ​both​ ​clinical​ ​experience​ ​and​ ​the​ ​reality​ ​of​ ​provider​ ​financial​ ​pressures.​

​2. Early intervention pathway and access issues​

​# Example: school-aged child with autism, ADHD, and pathological demand avoidance (PDA)​

​A​​child,​​already​​diagnosed​​with​​autism,​​ADHD,​​and​​PDA,​​presented​​with​​severe​​school​​refusal,​ ​escalating​ ​violence​ ​toward​ ​parents​ ​and​ ​siblings,​ ​absconding,​ ​vandalism​ ​at​ ​school,​ ​and​ ​significant family tension.​

​The child:​

​-​ ​Finds​ ​it​ ​hard​ ​to​ ​make​ ​friends,​ ​have​ ​conversations,​ ​listen​ ​and​ ​focus,​ ​follow​ ​multi-step​ ​instructions, and be more independent​ ​- Struggles to communicate wants, needs, thoughts, and feelings and to organise and plan​ ​-​​Exhibits​​meltdowns,​​swearing,​​and​​threatening​​language​​that​​frightens​​peers,​​contributing​​to​ ​social isolation and difficulty attending school​

​-​  ​Is​ ​at​ ​risk​ ​of​ ​self-harming​ ​behaviour​ ​and​ ​deteriorating​ ​mental​ ​health​  ​if​ ​behaviour​ ​and​

​regulation are not managed​

​The​​child’s​​behaviour,​​emotional​​dysregulation,​​meltdowns,​​and​​violent​​outbursts​​make​​leaving​ ​the​ ​house​ ​very​ ​difficult.​ ​The​ ​mother​ ​is​ ​the​​primary​​caregiver​​and​​cannot​​manage​​the​​child’s​ ​behaviour​ ​while​ ​also​ ​supporting​ ​three​ ​other​ ​siblings.​ ​She​ ​is​ ​physically​ ​and​ ​psychologically​ ​unable​​to​​cope​​and​​is​​desperately​​in​​need​​of​​support​​such​​as​​a​​Support​​Worker​​to​​provide​​1:1​ ​support.​ ​She​ ​is​ ​also​ ​socially​ ​isolated,​ ​does​ ​not​ ​have​ ​a​ ​car,​ ​and​ ​cannot​ ​safely​ ​take​ ​all​ ​four​ ​children on public transport.​

Submission 2794

​Current​​supports​​at​​the​​time​​involved​​speech​​pathology​​and​​occupational​​therapy.​​The​​family​ ​was​ ​seeking​ ​psychology​ ​and​ ​positive​ ​behaviour​ ​support​ ​(PBS).​ ​The​ ​child​ ​had​ ​an​ ​education​ ​assistant​ ​but​ ​did​ ​not​ ​trust​ ​her​ ​and​ ​would​ ​run​ ​away​ ​from​ ​her.​ ​The​ ​School​ ​claimed​ ​to​ ​have​ ​accommodations​ ​in​ ​place​ ​but​ ​refused​ ​to​ ​allow​ ​speech​ ​pathology​ ​and​ ​OT​ ​into​​the​​school​​to​ ​observe.​ ​In​ ​meetings,​ ​the​ ​mother​ ​was​ ​being​ ​blamed​ ​for​ ​the​ ​issues.​​The​​school​​pushed​​back​ ​strongly on half days or early pick-ups.​

​Providing consistent 1:1 support would allow the child to:​

​- Access regulated environments such as parks or play centres to regulate​ ​- Learn flexibility in turn-taking, waiting, and winning/losing​ ​- Develop skills that support playing games with peers and building friendships​ ​- Improve mental health, decrease self-harming, and increase community access​

​# Why this matters for the Bill​

​If​​early​​intervention​​pathways​​become​​more​​restrictive​​or​​funding​​is​​reduced,​​children​​like​​this​ ​will face:​

​- Delayed or denied support at a critical developmental window​ ​- Ongoing school refusal, possible exclusion, and loss of educational opportunity​ ​- Escalating violence and risk at home, increasing the likelihood of family breakdown​ ​- Greater risk of self-harm, mental health deterioration, and long-term social isolation​ ​- Increased risk of involvement with the justice system as the child grows older​ ​- Long-term impacts on the ability to work, connect with family, and live independently​

​These​ ​consequences​ ​extend​ ​far​ ​beyond​ ​the​ ​child​ ​and​ ​family.​ ​They​ ​have​ ​community-wide​ ​implications,​​including​​increased​​pressure​​on​​schools,​​mental​​health​​services,​​youth​​justice,​​and​ ​adult​ ​disability​ ​supports.​ ​The​ ​long-term​ ​costs​ ​of​ ​delaying​ ​or​ ​denying​ ​early​ ​intervention​ ​are​ ​likely to be far higher than the short-term savings from reduced funding.​

​Research​ ​links​ ​adverse​ ​childhood​ ​experiences,​ ​including​ ​maltreatment​ ​and​ ​family​ ​stress,​ ​to​ ​increased​​adolescent​​offending​​and​​poorer​​adult​​outcomes.​​Early​​intervention​​is​​not​​just​​about​ ​therapy hours; it is about preventing long-term harm to the child, family, and community.​

Submission 2794

​3. Cost growth cap and sibling access​

​# Example: sibling on the autism waitlist in an already-known family​

​A family already in the NDIS system has:​

​- A 7-year-3-month-old child diagnosed with autism is receiving supports​ ​- A 4-year-old sibling on the waitlist for diagnosis and assessment​

​Under​ ​tighter​ ​funding​ ​and​ ​cost​ ​growth​ ​caps,​ ​the​ ​4-year-old​ ​may​ ​be​ ​unable​ ​to​ ​access​ ​the​ ​funding​ ​and​ ​support​ ​needed.​ ​This​ ​child​ ​is​ ​already​ ​known​ ​to​ ​the​ ​family’s​ ​therapists,​ ​who​ ​understand their context, strengths, challenges, and family dynamics.​

​The sibling requires 1:1 therapy focusing on:​

​- Language and communication​ ​- Perspective-taking​ ​- Executive functioning skills​

​When​​services​​are​​already​​known​​to​​the​​family,​​the​​cost​​of​​services​​typically​​decreases​​over​ ​time because:​

​- Therapists know what works and what does not​ ​- Therapy can be targeted and coordinated​ ​- Families can plan toward successful independence from services more efficiently​

​If funding is reduced or access is delayed, the sibling may:​

​- Not receive the support they actually need when it is most effective​ ​- Receive funding for therapy that is not well targeted, leading to longer overall intervention​ ​- Experience worsening skills, school problems, behaviour concerns, and family stress​ ​- Face difficulty with literacy acquisition, homework completion, and consolidating learning​ ​- Require more intensive, longer-term therapy later, increasing overall system costs​

Submission 2794

​This​​demonstrates​​the​​false​​economy​​of​​reducing​​access​​for​​children​​who​​are​​already​​showing​ ​functional​​need.​​Delaying​​targeted​​early​​intervention​​is​​likely​​to​​increase​​long-term​​costs​​rather​ ​than contain them.​

​4. Rural and remote access: Kalgoorlie and regional WA​

​As​​a​​supervisor​​and​​mentor​​of​​rural​​and​​remote​​speech​​pathology​​therapists​​nationally,​​I​​hear​ ​weekly​ ​about​ ​the​ ​lack​ ​of​ ​services​ ​in​ ​areas​​such​​as​​Kalgoorlie.​​Returning​​to​​Perth​​for​​weekly​ ​therapy is not possible for many families.​

​Key issues include:​

​-​​Insufficient​​travel​​remuneration:​​The​​50%​​reduction​​in​​travel​​fees​​has​​significantly​​hurt​​families​ ​living​​in​​rural​​and​​remote​​areas.​​Therapists​​based​​in​​the​​region​​face​​disincentives​​to​​travel​​to​ ​smaller communities when fees are reduced so substantially.​

​-​ ​Telehealth​ ​limitations:​ ​Telehealth​ ​is​ ​not​ ​an​ ​optional​ ​extra;​ ​for​ ​many​ ​families,​ ​it​ ​is​ ​the​ ​only​ ​service​ ​they​ ​receive.​ ​However,​ ​not​​all​​children​​or​​diagnoses​​are​​suitable​​for​​telehealth.​​Some​ ​require in-person support, school-based therapy, or the presence of an education assistant.​

​-​ ​FIFO​ ​and​ ​fly-in​ ​models:​ ​Metropolitan​ ​therapists​ ​who​ ​do​ ​not​ ​understand​ ​the​ ​nuances​ ​of​ ​regional​​living​​may​​provide​​supports​​and​​strategies​​that​​do​​not​​work​​because​​they​​do​​not​​know​ ​what​​they​​do​​not​​know.​​Trust​​is​​harder​​to​​establish,​​and​​retention​​in​​FIFO/fly-in​​services​​is​​poor,​ ​leading to frequent therapist rotation.​

​-​​Regional​​therapists:​​A​​therapist​​based​​in​​the​​region​​knows​​the​​town,​​the​​people,​​the​​needs,​​and​ ​the​​resources.​​They​​can​​build​​trust​​and​​rapport,​​leading​​to​​more​​successful​​therapy.​​They​​can​ ​service​​multiple​​schools​​and​​clients​​in​​a​​region​​in​​a​​single​​day,​​making​​service​​delivery​​more​ ​efficient.​

​-​ ​School​ ​and​ ​clinic-based​ ​therapy:​ ​The​ ​clinicians​ ​I​ ​support​ ​can​ ​deliver​ ​both​ ​school​ ​and​ ​clinic-based​ ​therapy.​ ​Recruitment​ ​of​ ​therapists​ ​is​ ​difficult,​ ​and​ ​even​ ​when​ ​therapists​ ​are​ ​employed,​​travelling​​to​​smaller​​communities​​is​​hard​​when​​there​​is​​such​​a​​significant​​reduction​​in​ ​fees.​

​Over-reliance​ ​on​ ​visiting​ ​services​ ​can​ ​stifle​ ​the​ ​development​ ​of​ ​well-resourced,​ ​funded,​ ​and​ ​staffed​ ​local​ ​primary​ ​healthcare​ ​systems,​ ​creating​ ​a​ ​dependency​ ​cycle​ ​rather​ ​than​ ​a​ ​sustainable solution.​

Submission 2794

​Resident​ ​health​ ​professionals​ ​are​ ​more​ ​attuned​ ​to​ ​local​ ​community​ ​needs,​​leading​​to​​better​ ​patient​​outcomes​​through​​consistent,​​continuous​​care.​​Resident​​models​​support​​the​​long-term​ ​stability​ ​of​ ​rural​ ​health​ ​infrastructure,​ ​whereas​ ​FIFO​ ​is​ ​often​ ​viewed​ ​as​​a​​“necessary​​evil”​​or​ ​interim solution rather than a remedy.​

​Telehealth​ ​must​ ​remain​ ​funded​ ​and​ ​accessible,​ ​with​ ​flexibility​ ​for​ ​families​ ​to​ ​purchase​ ​necessary supports such as:​

​- Headsets with microphones for speech sound work​ ​- Support persons attending with the child​ ​- Therapy at school with an education assistant for children not ideal for telehealth​

​5. Registration and compliance burden​

​I​ ​am​ ​currently​ ​an​ ​unregistered​​provider.​​I​​closed​​my​​clinical​​practice​​in​​December​​2025​​after​ ​downsizing​​in​​September​​2021​​due​​to​​NDIS​​pressures.​​The​​client​​examples​​in​​this​​submission​​are​ ​from 2024 and 2025.​

​The​ ​average​ ​price​ ​for​ ​NDIS​ ​registration​​audits​​varies​​significantly​​based​​on​​service​​risk​​level​ ​and organisation size:​

​- Verification audits (lower-risk services): typically $900–$3,000​ ​- Certification audits (higher-risk services): typically $3,000–$15,000+​

​These​​costs,​​combined​​with​​the​​paperwork​​and​​time​​required​​to​​understand​​and​​get​​support​​to​

​truly​ ​understand​ ​what​ ​NDIS​ ​audits​ ​and​ ​registration​  ​entail,​ ​are​ ​unsustainable​  ​for​ ​solo​

​practitioners.​

​The benefits of solo practitioners include:​

​- Long-term continuity: I had been in my practice for 19+ years​ ​- Deep knowledge of the local community and families​ ​- Higher retention and trust compared to high-turnover corporate or FIFO models​

Submission 2794

​I​​agree​​with​​more​​oversight​​and​​stronger​​safeguards,​​including​​severe​​penalties​​for​​breaches​ ​(bans,​ ​fines,​ ​criminal​ ​sanctions​​for​​fraud).​​However,​​compliance​​settings​​must​​be​​streamlined​ ​and proportionate to provider type:​

​-​​A​​support​​worker​​who​​is​​unregistered,​​does​​not​​have​​a​​governing​​body,​​and​​has​​limited​​admin​ ​expectations​ ​needs​ ​more​ ​oversight​ ​than​ ​a​ ​speech​ ​pathologist​ ​who​ ​already​ ​has​​professional​ ​registration, supervision, documentation expectations, and quality systems​

​- Solo practitioners need simpler, more proportionate audits and reporting requirements​

​Stronger​​safeguards​​with​​better​​streamlining,​​and​​more​​oversight,​​but​​less​​red​​tape,​​depending​ ​on the provider type, is the appropriate approach.​

​6. Planner inconsistency and decision-making​

​I​ ​have​ ​seen​ ​plans​ ​for​ ​self-managed​ ​participants​ ​that​ ​remove​ ​all​ ​choice​ ​and​ ​control,​ ​stating​ ​exactly:​

​- The funding amount allocated for each therapy type​ ​- The name of the therapist they can access​

​Some​​plans​​are​​12​​months,​​some​​2​​years,​​and​​some​​5​​years.​​Some​​participants​​have​​not​​had​ ​their​​plan​​reviewed​​for​​5+​​years.​​Some​​clients​​get​​a​​plan​​rollover,​​and​​then,​​3–6​​months​​later,​ ​their funding is cancelled.​

​This affects:​

​- Therapy success and client progress​ ​- Participant and family stress​ ​- Provider’s ability to plan and deliver consistent services​

​I have seen an example where:​

​-​​A​​single-parent​​family​​had​​two​​children​​on​​the​​NDIS;​​plans​​were​​reviewed​​in​​December,​​but​ ​new plans in January did not have enough funding​

Submission 2794

​- Their mother took the plan to the tribunal, requiring lawyers, adding extra family stress​ ​- No therapy could be accessed during this time​ ​- Children’s skills deteriorated, with massive behavioural issues emerging​ ​-​​18​​months​​later,​​funding​​was​​restored,​​but​​the​​therapy​​team​​then​​had​​so​​many​​behaviours​​of​ ​concern and issues to deal with​ ​-​​Fortnightly​​therapy​​moved​​to​​weekly,​​but​​with​​two​​children,​​this​​created​​a​​huge​​burden​​on​​the​ ​mother​ ​-​​School​​stress​​built​​up,​​school​​refusal​​became​​significant,​​the​​mother​​experienced​​burnout​​and​ ​could not do home practice​

​All​ ​of​ ​this​ ​occurred​ ​because​ ​it​ ​took​ ​18​ ​months​ ​for​ ​the​ ​tribunal​ ​to​ ​reverse​ ​the​ ​decision​ ​and​ ​provide​​the​​funding​​that​​was​​requested.​​If​​the​​new​​plans​​had​​been​​correct​​initially,​​none​​of​​this​ ​would​ ​have​ ​happened.​ ​The​ ​children​ ​were​ ​both​ ​making​ ​good​ ​progress​ ​and,​ ​in​ ​12–18​ ​months,​ ​would have needed minimal intervention.​

​Inconsistent​ ​planning​ ​decisions​ ​generate​ ​avoidable​ ​distress,​ ​higher​ ​later​ ​support​ ​needs,​ ​and​ ​inefficient use of public resources.​

​7. Recommendations​

​The committee should consider the following recommendations:​

​1.​​Do​​not​​implement​​an​​8%​​cost​​growth​​cap​​that​​restricts​​access​​for​​children​​and​​families​​who​ ​already demonstrate functional need, particularly in families already known to services.​

​2.​​Maintain​​current​​early​​intervention​​criteria​​and​​ensure​​that​​complex​​children​​with​​autism,​​PDA,​ ​and​ ​co-occurring​​behavioural​​and​​mental​​health​​risks​​are​​not​​excluded​​due​​to​​rigid​​pathway​ ​separation.​

​3.​​Protect​​telehealth​​access​​and​​funding,​​including​​flexibility​​for​​families​​to​​purchase​​necessary​ ​equipment​​(e.g.,​​headsets​​with​​microphones)​​and​​supports​​(e.g.,​​support​​persons,​​school-based​ ​therapy with education assistants).​

Submission 2794

​4.​ ​Review​ ​travel​ ​fee​ ​settings​ ​for​​rural​​and​​remote​​areas​​to​​ensure​​therapists​​can​​sustainably​ ​travel​​to​​regions​​such​​as​​Kalgoorlie​​and​​that​​families​​can​​access​​both​​in-person​​and​​telehealth​ ​services.​

​5.​​Standardise​​planner​​decision-making​​and​​reduce​​inconsistency​​across​​regions​​and​​planners,​ ​including clearer guidance on funding levels, provider choice, and review periods.​

​6.​​Streamline​​registration​​and​​compliance​​for​​solo​​practitioners​​and​​experienced​​professionals,​ ​with proportionate audits and reporting based on provider type and risk.​

​7.​​Support​​regionally​​based​​therapists​​over​​FIFO/fly-in​​models​​to​​build​​sustainable​​local​​health​ ​infrastructure, trust, and continuity of care.​

Submission 2794

​8. Conclusion​

​These​ ​concerns​ ​are​ ​grounded​ ​in​ ​direct​ ​clinical​ ​and​ ​supervisory​ ​experience​ ​with​ ​NDIS​ ​participants​ ​in​ ​Western​ ​Australia.​ ​The​ ​proposed​ ​changes​ ​risk​ ​reducing​ ​access​ ​to​ ​timely,​ ​targeted​ ​early​ ​intervention,​ ​undermining​ ​service​ ​sustainability,​ ​and​ ​worsening​ ​outcomes​ ​for​ ​children, families, and the broader community.​

​Early​​intervention​​is​​not​​just​​about​​therapy​​hours;​​it​​is​​about​​preventing​​long-term​​harm​​to​​the​ ​child,​​family,​​and​​community.​​Reducing​​funding​​or​​access​​now​​may​​appear​​to​​save​​money​​in​ ​the​​short​​term,​​but​​is​​likely​​to​​increase​​long-term​​costs​​through​​higher​​support​​needs,​​increased​ ​system use, and poorer life outcomes.​

​This​ ​submission​ ​respectfully​ ​requests​ ​that​ ​the​ ​committee​ ​consider​ ​these​ ​concerns​ ​and​ ​recommendations when reporting on the Bill.​