Submission 100 — Brisbane North Primary Health Network (PHN) — Inquiry into the Thriving Kids initiative

Submission to the House Standing Committee on Health, Aged Care and Disability Inquiry into the Thriving Kids Initiative

The Health Alliance, a joint initiative between Metro North Health and Brisbane North PHN.

redacted

W: https://healthalliance.org.au/

Executive Summary

Australia’s systems for identifying and supporting children with mild to moderate developmental delay or disability are fragmented, referral-heavy, and often inequitable. Families face long wait times, complex navigation requirements, and high out-of-pocket costs.

At the heart of this response is the need for a minimum national framework of child development services to guide provision where service mix may vary by region, but all communities have access to the same range of core supports. It supports a three-tier approach, with Thriving Kids positioned to deliver targeted assistance for children with mild to moderate, or single domain, developmental needs. Allied health professional (AHP) support and intervention without the need for complex referral pathways, co-located and accessible services, streamlined pathways and workforce development and accountability are central functions of this approach. Embedding allied health into primary care, frontline settings such as child health centres, schools, and community hubs, offers a more effective, equitable and sustainable solution for children presenting with concerns on single developmental domains or mild concerns across multiple domains.

A commissioning approach to Thriving Kids could provide a structured way to design and deliver services that are genuinely responsive to community needs. Instead of applying a uniform national model, commissioning enables supports to be provided which are responsive, locally tailored, and delivers best value for impact. By focusing on what already exists, commissioning would also help to avoid duplication, build on current strengths, and close service gaps. Importantly, it would embed a cycle of monitoring and evaluation guided by evidence and the provision of high quality care.

Primary Health Networks (PHNs) are uniquely positioned to maximise the impact of the Thriving Kids initiative. The Joint Regional Needs Assessments (JRNA), undertaken by PHNs nationwide, highlight the challenges faced by children with developmental delay across regions. PHN’s through their needs assessments, hold a deep understanding of the local service landscape, workforce availability and identifying where the gaps lie. PHNs can additionally strengthen both universal and NDIS supports by promoting integrated service provision, coordinating health, allied health, and disability services to ensure timely, seamless, and person-centred care for children and families. PHNs bring proven commissioning expertise, with established systems to manage funding in a way that ensures accountability, transparency and value for money. Their localised approach supports equity of access, directing investment into communities and populations where vulnerabilities are highest. In addition, PHNs can leverage their strong relationships with GPs and allied health to strengthen the capacity of the frontline workforce. This would enable optimal use of Thriving Kids funding to ensure timely, integrated and cost-effective supports.

A Multi-layered Response

This submission recommends a three -tiered framework for developmental supports to best meet the needs of children experiencing developmental delay. It is through this framework that the six terms of reference will be addressed:

Base Tier – Universal Supports

• Includes universal health and early years services available to every child and family regardless of developmental concern, such as child health nurses, GPs, early childhood educators, maternal and child health checks, kindergarten programs, playgroups.
• Provides accessible information, screening, and guidance that promote healthy development, identifying developmental concerns early and support embedded in everyday settings.
• PHNs can enhance universal services by promoting awareness of developmental milestones and recommended checks, while collaborating with GPs, child health services, and local Hospital and Health Services (HHSs) to ensure timely, accessible, and coordinated early support for all children.

Middle Tier -Thriving Kids:

Integrated Allied Health Professional (AHP) Support commissioned by local PHN’s

• For children with emerging or mild to moderate developmental concerns who need more targeted help than universal services can provide.
• Local PHNs are well placed to commission these supports, given their ability to assess community needs, map existing services, and integrate new investment into the broader health and social care system.
• Delivered by allied health professionals (e.g., speech pathology, occupational therapy, physiotherapy, psychology) integrated into existing community and primary care settings, supported playgroups or group programs.
• These supports are designed to be early, timely, and brief, reducing the need for escalation to specialist or long-term services.
• Families can access advice and intervention without needing complex referral pathways or eligibility testing.

Top Tier -NDIS Packages

• For children with complex, persistent developmental delay or disability requiring comprehensive and sustained intervention.
• Provides individualised NDIS funding packages tailored to intensive supports, therapy, and equipment.
• PHNs could strengthen participant support by better integrating health and disability service providers, leveraging their established relationships with local organisations and Hospital and Health Services’ (HHSs’). Additionally, PHN’s can enable the effective

utilisation of NDIS-funded services by identifying local service gaps and coordinating access to allied health providers for participants experiencing challenges of provider availability.

Individual
NDIS
packages
Supported
by PHN
service
integration

Thriving Kids
Supports
AHP input, supported
playgroups
Commissioned by
PHN's according to
local needs

Universal Supports
Child health nurses, GP's,Parenting
programs, playgroups
Strengthened by PHN and HHS community
health promotion and PHN GP/health
provider support

1. Evidence-Based Information and Resources for Parents

Parents are often the first to notice developmental concerns but lack accessible, clear, and trustworthy information. Strengthening parent resources and tools will allow earlier action.

• Co-location of services:

  • Having trusted, familiar sources of information where families already access services (such as child health clinics, schools, or community hubs) increases engagement, outcomes and efficiency of service delivery.

• Embedding evidence-based, reputable, high-quality resources within these settings ensures families receive consistent advice and practical support without needing to seek out multiple, unfamiliar services.

• Human resources:

  • The right people must be in the right place, at the right time. Embedding adequately qualified AHP’s within universal services ensures parents receive point-of-care advice and limited supports early.
  • This reduces escalation into more intensive, downstream services, minimises wait times, and increases the likelihood that families act promptly when developmental concerns are identified.

• Prioritise and promote Developmental checks:

  • The child health record (red book) already provides a structured framework for developmental checks. However, many parents are unaware of its importance or struggle to act on concerns without referral pathways.
  • Point-of-care allied health developmental support within publicly funded supports, such as child health services, would reduce the complexity of service navigation for children with mild-moderate concerns.
  • Alternatively, expansion of dedicated Medicare-funded incentives to GP or AHP could provide timely, more accessible support for families through reduced costs and greater workforce capacity and may be additionally supported by PHN’s familiar with supporting GP engagement.

• Digital tools:

  • Digital Apps such as the Australian-developed Alo app (The Developing Foundation and Queensland University of Technology), provide simple, validated ways for parents to screen for developmental delay and track their child’s progress. While this is currently a paid-subscription service, there is an opportunity for governments to subsidise or adapt similar tools for universal access.
  • Freely available apps, such as the Raising Children “Raising Healthy Minds” app, may be clumsy to use and has a focus on social and emotional well-being. Integrating a child development focus and streamlining user experience on existing or new apps can provide an accessible, future- ready opportunity to engage children and families across demographics.

• Centralised access:

  • Current resources are fragmented. A central, trusted platform should consolidate existing evidence-based information so families can easily access consistent advice. Consider expanded role and promotion of existing resources such as Raising Children website to support greater prompting of, and engagement from, parents and understanding of developmental milestones.

Linking the website directly with digital apps, child health records, and GP services would make developmental advice more accessible and consistent.

2. Effectiveness of Current and Previous Programs

While Australia has invested in programs to identify and support children with developmental delay or disability, many operate on referral-based models that create inequities and long delays.

• Limitations of current systems:

  • Programs like Children’s Health Queensland’s Child Development Program (CDP) provide assessment and diagnostic support for children with developmental delay and requires tertiary referral pathways to access this service. The Child Development Program was not designed, nor has the capacity, to provide even initial assessment support for children experiencing developmental delay on one domain of development only or with milder developmental concerns. Additionally, lengthy wait times of up to two years for children who are eligible is far too long for children in critical developmental stages.
  • Families who can afford private therapy bypass the system, but this results in inequities where children from disadvantaged backgrounds miss out. It raises additional complexities when families may need to re-enter the public health system due to costs or the need for re-assessment.

• Effective models:

  • Evidence consistently demonstrates that embedding allied health support directly into child health and community teams and co-location of services provide timely access for families with more moderate concerns.
  • The School Readiness Program (commissioned by Brisbane North PHN and delivered by Youthrive in collaboration with Micah Project’s Young Mothers for Young Women program) is an effective example and is attached with this submission. It delivers early intervention to children aged 3–5 years within familiar community settings. By integrating services into programs families already attend, it removes the need for additional referrals and reduces barriers to engagement.

• PHN commissioning role:

  • Primary Health Networks (PHNs), have the local knowledge to commission targeted models through their Joint Regional Needs Assessments (JRNA) that are evidence-based, locally responsive, and cost-effective.
  • By commissioning services, PHNs can reduce duplication, align workforce supply with demand, and support innovative models such as co-location of allied health in community hubs.

3. Equity and Intersectional Issues

Children from Aboriginal, Torres Strait Islander, and culturally and linguistically diverse (CALD) backgrounds, families living in low socioeconomic areas or experiencing adversity face additional barriers to accessing timely support. Services are fragmented, referral-based, and difficult to navigate, creating barriers that disproportionately impact families already experiencing disadvantage. Many supports are designed around assumptions of high health literacy, knowledge of both health and disability sectors and solid understanding of child development, leaving many families who do not fit this model without timely help. As a result, concerns are frequently identified late and children miss critical opportunities for early intervention, widening gaps in developmental outcomes and compounding existing inequities.

• Reducing system navigation complexity:

  • Families should not be required to navigate multiple referral points and complex systems for non-complex cases. Referral-heavy pathways disadvantage families with fewer resources or limited English proficiency. Multiple service handovers create opportunities for disengagement and children “falling through the cracks”.
  • Embedding AHPs directly in universal settings (such as schools or child health clinics) reduces the need for parents to navigate multiple referral points and provides access to timely support close to home.

• Cultural responsiveness:

  • Services must be delivered through trusted, culturally safe providers without an interest in profiteering from the scheme. Aboriginal Medical Services and local CALD not- for-profit organisations play an important role in ensuring families feel safe and supported. Delivering services through these trusted settings also reduces stigma and encourages earlier engagement.
  • Increasing availability and access to government funded Translating and Interpreting Services would support parents or caregivers to be optimally engaged in their child’s development and progress.

• Addressing inequities through commissioning:

  • PHNs are uniquely positioned to commission additional, targeted supports, especially in regional communities of greater disadvantage where access and availability is limited.
  • Equity-based commissioning ensures that children most at risk of missing out, such as First Nations, CALD, low-income families and families with low health literacy receive supported access to universal developmental supports.

4. Workforce Support and Training Gaps

The effectiveness of early intervention depends on a skilled, accountable workforce that can deliver consistent and high-quality support. Current gaps include:

• Lack of accountability:

  • No clear structures hold services accountable for outcomes. Outcome measurement is inconsistent, and there is no system-wide responsibility for ensuring child and family needs are met.

• Therapy models:

  • Ongoing services foster dependency through ongoing therapy sessions. This burdens families and taxpayers while failing to build long-term capacity.
  • The evidence base supports goal-based, milestone-focused interventions at key developmental stages. These short blocks of therapy help parents learn strategies to support their child at home.

• Accreditation gaps:

  • There is currently no requirement for early intervention providers to be accredited, meaning variable quality across the sector. Accreditation currently disincentivised as there is no requirement to do so and accredited providers may be audited at financial cost to provider.
  • A national accreditation framework would ensure providers are evidence-based, skilled, and accountable.

• Workforce development

  • The role of allied health professionals in providing early, coordinated supports is integral for children experiencing developmental delay. Currently, a bulk of AHP’s operate as individual private providers under the NDIS, siloed from a broader health team, with far fewer not-for-profit or larger for-profit organisations providing multidisciplinary care. Investing in AHP positions as part of frontline multidisciplinary teams would greatly support communication and more coordinated, effective and thus time-limited care than existing models of paediatric support.
  • Investing in the workforce development and training of early years educators is critical, as they are often the first to notice developmental delays given their ability to baseline children against broader peer development, which reinforces the central role of early years settings and school readiness programs.

• Flexible workforce models:

  • PHNs can leverage their commissioning role to design flexible, multidisciplinary teams with the right skill mix to meet local needs. This may include embedding AHPs in GP clinics, schools, or community hubs where families already access services.

• PHN’s direct engagement with general practice positions them well to better support the relationship between allied health services and GP’s, which is central for both short-term and longer-term management of a child’s health needs.

5. Best Practice

Best practice shows that universal, integrated supports embedded in frontline services lead to the best developmental outcomes.

• Domestic models:

  • Programs like Brisbane North PHN’s School Readiness Program, delivered by Youthrive, demonstrate how embedding AHPs into accessible services reduces complexity and supports parents to act early.
  • State-based universal child health nurse programs also demonstrate success, though these could be complemented and extended by more extensive support from allied health professionals.
  • Mobile clinics to screen and provide time-limited intervention can be an effective way to support children in regional and remote areas and support health equity. Examples, such as Western Australia’s Earbus model partner with local community groups and provide wraparound support to families who would not access mainstream services or where adequate services are not available.
  • Integration with a child or families GP is integral for continuity of care and coordinated management of a child’s developmental needs. Models such as many Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) which provide integrated AHP support in collaboration with the child’s GP demonstrate both efficacy of efficient use of health services and improved outcomes for child health and development.

• International experience:

  • International models (such as New Zealand’s Plunket and the UK’s Health Visitor system) demonstrate the value of universal allied health roles embedded in frontline child health services. These models empower parents, focus on milestone-based interventions, and reduce fragmentation between health, education, and community systems.

• Key features of best practice:

  • Integration of services across systems rather than siloed operations of health and disability sectors as these are intrinsically linked for young people.
  • Co-location of professionals in child health and community hubs including GP’s and AHP to provide coordinated, holistic care.
  • Reduced reliance on navigator roles by providing direct support within universal settings.

6. Mechanisms for Seamless Transitions Through Mainstream Systems

Children with mild to moderate needs often fall between systems, with no clear transition from early childhood to school-aged supports. Mechanisms are needed to create smoother pathways.

• Embedding AHPs in universal settings:

  • Child health centres, schools, and early childhood education settings should be the first points of access. No referral to tertiary services should be required for children with mild to moderate concerns. Less complexity of referral pathways supports capacity to provide “upstream” services, reducing need for more intensive supports and burden on tertiary services.

• Integrated services:

  • PHNs are ideally placed to commission integrated supports that co-locate multiple services (e.g. speech, OT, child health nurses, GPs) and reduce the need for complex referral pathways. Co-location additionally allows for soft-entry referrals and wraparound care for children and families enabling greater accessibility and engagement.

• Reduce reliance on navigators:

  • Navigation roles add costs but do not deliver direct outcomes. Instead, direct access to AHPs at universal entry points reduces the need for extra layers.

• Shared data and collaboration:

  • Shared measurement and data systems across health, education, and community providers allow smooth handovers as children transition from early years into school.