2 Brunswick Rd Mitcham VIC 3132

Thriving Kids Inquiry submission

Contact: Jaclyn Sikic, Director and Practice Principal, Kid Link Occupational Therapy

Jackie@kidlink.net.au | www.kidlink.net.au | www.kidlinkeducation.com.au | redacted | Mitcham VIC

Service Scope: We offer a variety of services including individual and group-based occupational therapy, school consulting, family education and coaching, supervision of occupational therapists, professional development, and speaking and consulting.

Service Areas: daycares, kinders, schools, alternative education settings, home and community settings

Practice Location: 2 Brunswick Rd, Mitcham VIC 3132

Telehealth available Australia-wide

Executive Summary

Families must be central to therapy. Parents should observe, participate, and be coached as the constant support in a child’s life. Best practice approaches in early intervention and risks for not accessing early intervention are well documented.
Current education-setting-based models risk excluding families from direct involvement due to conflicts of interest if the employer is the school.
Siloing OTs, speech pathologists, and other therapists within schools, without regular onsite supervision, impacts on service quality, retention of OTs and increased inconsistency between geographical areas.
Most OTs want to work for OTs, or under senior clinicians, where they receive daily supervision and mentoring. Filling out employment directly by councils, kinders, or schools risks major workforce shortages.

Screening, educator training, and general supports (such as sensory spaces and access to tools and adjustments) are valuable for inclusion, but they are not a replacement for targeted intervention by qualified allied health professionals.
The allied health workforce is already workforce ready. Many sole traders, private practices, NGOs, and others are trained, operating, and able to provide supports in playgroups, daycares, kinders, schools, home schooling, and alternative education. Barriers usually exist because of settings limiting access.
The workforce is ready to pivot towards more consultancy and coaching models within children’s settings. This will be sustainable, cost-effective, and achieve long-term outcomes for children with lower support needs.
There is no need to reinvent the wheel by building new, untested programs or shifting therapists into education department roles. By working with the existing workforce, alongside academics and families with lived experience, there is a straightforward way to cut costs and achieve outcomes through best practice outside of the NDIS.
Medicare must fund the full service, not just rebates, to ensure equitable access for all families. The OT Society for Invisible Disabilities has provided a solution and framework titled ‘Focused Functional Interventions’.

Lived Experience and Concerns

1) Families being excluded in education settings

In many current school-based therapy models:

Families are discouraged from attending or observing sessions.
Therapists are restricted to rooms and times determined by schools. Many lack space to provide 1:1 support or coaching and/or don’t allow therapists inside the classroom.
Teacher requests may override family goals (for example, “work on handwriting” rather than sleep, dressing, or community participation).
This already happens in Special Development Schools with employed therapists. Families have little to no contact and usually access additional therapy privately. Teachers dictate who they request consultation for within their classroom and advice is given with minimal family direction.

This approach disconnects therapy from the child’s daily life and prevents families from learning strategies to sustain progress.

2) Concerns with “therapists in kinders” programs

Recent initiatives (as referred to in a recent ABC article: https://www.abc.net.au/news/2025-09-30/thriving-kids-autism-developmental-delay-design/105793852), promoting “therapists in kinders” have been welcomed as innovative but raise significant concerns. Without outcome tracking, these risk becoming another short-term program. Similar models such as the Early Start Denver Model have already had huge questions raised, with many therapists leaving due to burnout and misalignment with my best practice.

Key concerns include:

Families positioned as an afterthought. Often, professionals within the kinder determine what supports a child needs and only later involve families. The following year, with a new teacher and peer group, families remain in the dark. This is not family-centred practice.
Therapists employed in silos. OTs employed directly by education settings frequently juggle very large caseloads across multiple sites. This makes it almost impossible to keep families central to goal setting and therapy.
Lack of training and supervision. Who is training the educators? Often, the therapists. And who is supervising the therapists? In many models, no one. This does not build sustainable workforce capacity or quality.
Workforce reality. In practice, there would be very few OTs who are both willing and skilled to work this way. In regional areas, the workforce shortage makes this model even less viable. Many early career OTs accept these roles without fully understanding the limitations, while schools simply tick the box of “position filled.”

3) Therapists are not all generalists

A key risk in placing a single OT in a school or kindergarten is the assumption that one clinician can meet the diverse needs of every child eligible for foundational supports. Allied health professionals are not generalists. They have specialist scopes of practice. For example, feeding support requires additional training and experience that many OTs and speech pathologists do not provide.

By employing “one school OT/speech pathologist” rather than enabling access to a local network of allied health providers, schools inadvertently block families from receiving the right professional support at the right time. This creates gaps in care and delays intervention for children with complex or specific needs.

4) Classwide supports are not a replacement for therapy

Schools and kinders can and should provide inclusive environments such as sensory spaces, regulation strategies, universal screening, and teacher training. These are valuable for participation, but they are not a replacement for intervention from qualified allied health professionals. Families often report frustration when these general supports are offered without strategies that meet the individual needs of their child or are informed by the parents’ experience in the home and community.

There are already systems in place to promote more general adjustments, accommodations and supports through funding such as Disability Inclusion Profiles (the new funding system being rolled out in Victorian Schools). This type of support should be offered for day cares and kinders.

5) Workforce challenges for OTs in school employment

Most OTs want to work for OTs, with OTs, not for schools. They seek:

Daily access to supervision from senior clinicians
Informal peer support before and after more complex sessions or observations
A culture of professional development and clinical accountability

When OTs are employed directly by schools, they often work alone or alongside other disciples without supervision. In my early career, this lack of mentoring meant I sometimes provided therapy that looked busy but did not achieve meaningful outcomes. Expanding this model risks inconsistency at scale.

6) Screening without follow-up

Universities and schools have piloted screening programs, which are valuable for early identification. But too often, families don’t receive a pathway to individualised strategies. Screening without funded, targeted intervention that involves upskilling the family is a missed opportunity.

7) Children experiencing School Can’t being underserviced

A growing number of children are unable to attend school due to a number of complex challenges. These children require therapy in the home or community before they can re-engage with school. Current education-based models overlook them entirely.

8) Costs and risks for not providing evidence-based family-centred early intervention

Here’s a list of potential costs and impacts for kids who don’t receive effective early intervention by qualified professionals:

Reduced skill development → motor, cognitive, social, communication delays
Limited participation in daily activities (school, play, self-care, community)
School attendance issues including “school can’t” and disengagement
Family stress and burnout from managing without support and skill development
Caregiver employment impact due to needing to stay home or reduce work hours
Increased reliance on support workers across childhood and adulthood
Poorer educational outcomes leading to reduced employment prospects
Mental health risks → higher rates of anxiety, depression, self-harm
Physical health risks → hospitalisations, secondary health conditions
Increased service costs later (intensive therapy, crisis care, long-term support packages)
Greater likelihood of placement breakdowns (e.g., out-of-home care if needs aren’t met)
Social isolation for both child and family
Loss of confidence and self-esteem in the child leading to multiple adverse outcomes
Higher risk of justice system involvement in adolescence/adulthood due to unmet needs
Intergenerational effects → siblings and future family dynamics impacted
Reduced community participation → sports, groups, social inclusion limited

Proposals for Strengthening the Thriving Kids Model

1) Harness the private allied health workforce through Medicare and education-based funding.

Mobilise experienced therapists (OTs, speech pathologists, psychologists, dieticians, physiotherapists) through expanded Medicare items and education-based funding (similar to DIP aide hours but with allowance for therapy support and consultation).
Medicare must fund the full service, not just a rebate, otherwise the most vulnerable families are excluded. It also needs to offer flexibility in terms of school support and parent only sessions. I support the proposal from the Occupational Therapy Society for Invisible Disabilities (OTSi) for ‘Focused Functional Intervention’ framework which could be funded through a new medicare item or grants allocated by PHNs for both early childhood and psychosocial disability.
Example process:
1. Screening: Trained GPs, EC educators, MCH nurses, school staff or supervised OT/allied health students complete a standardised screen and understand local referral pathways. NDIS access will still be explored for children who may meet eligibility.

Observation: Local allied health providers conduct a classroom, kinder, or home observation.
Care team meeting: Clinician, family, and teacher to co-design functional goals.
Family coaching: Focus on equipping parents and educators to embed strategies into daily routines. Funding response: Education funds and/or Medicare cover a short block of therapy for assessment, training, or consultation.

For children with School Can’t, funding should flex to cover therapy in the home or community.

2. Partner with daycares, kinders, and schools via external providers

Education sites should contract with local allied health providers to work with and for the family and school rather than employing therapists directly.
Benefits:
- Therapists remain within professional teams, receiving supervision and CPD.
- Families are included in therapy and goal setting.
- Avoids conflicts of interest with the school seeking support also being the employer of the therapist providing advice.
- Providers can offer a broad mix of supports such as:
  - Individual therapy where needed
  - Training for teachers and aides
  - Parent workshops and coaching
  - Environmental consultation
Workforce ready: These services can already be provided by sole traders, private practices, NGOs, and community providers. They are trained, operating, and aligned with best practice.
Funding: Delivered via a school and early learning support allowance, tied to evidence of meaningful and safe school participation and family engagement outcomes. Could be coupled with Medicare item numbers for assessment, parent coaching, home/school programs and recommendations.

3. Link universities with local providers for structured screening and workforce development

Universities contribute by:
- Training students to deliver supervised screening
- Partnering with local providers to link children and families into services
- Allowing students to shadow both individual therapy and short-stream training, addressing placement shortages
This builds a workforce pipeline while maintaining quality and family-centred practice.

Benefits of this approach

Family centred: Parents are involved and able to sustain strategies long-term.
Specialist-led: Children access the right allied health professional for their needs, not a “one-size-fits-all” school therapist.
Workforce ready: Sole traders, private practices, NGOs, and others are already trained, available, and able to deliver services now. This is about pivoting the existing workforce, not reinventing it.
Broad scope of services: Clinicians provide individual therapy, training, consultation, and environmental adaptation, ensuring children outside the NDIS can still access best practice.
Efficient: Avoids wasting resources by trying to shift therapists into new employers (for example, education departments) or training non-allied health staff to do what clinicians are already qualified to do.
Inclusive but accountable: General supports like education and access to sensory tools are provided, but backed by qualified intervention where needed.
Inclusive of all children: Children experiencing School Can’t or participating in alternative education are supported through home and community services.

Conclusion

Universal supports and environmental modifications assist day cares, kinders and schools to become more inclusive and supportive of participation for all, but they are not a replacement for targeted therapy that supports long term outcomes. Therapy does not need to look like long term capacity building (I.e. NDIS supports) but should still work towards family and child capacity building to reduce long term costs in the long term.

Employing a single OT in a school creates the false impression that all allied health needs can be met on-site. In reality, therapy requires access to a network of specialised professionals such as those with expertise in feeding, AAC, literacy, or mental health. One clinician cannot provide this breadth, and without recognition of this, children risk missing out on the right support at the right time. It also positions the family as secondary. This is not evidence based and means the following year new teachers and support staff need training again. It is more effective for a parent to be equipped to facilitate transition and implementation of changing supports for their child as they grow.

The allied health workforce is already established and ready to pivot. We can provide consultancy, coaching, and training within children’s settings that are sustainable, cost-effective, and aligned with best practice. This approach allows children with lower support needs to achieve long-term outcomes while keeping families central.

There is no need to reinvent the wheel by building new, untested programs or shifting therapists into education department roles. By working with the existing workforce, alongside academics and families with lived experience, we can identify straightforward ways to reduce costs and achieve outcomes through best-practice, family-centred approaches outside of the NDIS.

Side note on autism and language

Autism is lifelong and not a developmental delay. Terms such as “mild” or “moderate” are not affirming and are not used in diagnostic manuals or current guidelines. The appropriate framing is around support needs. Within this approach, autistic children with lower support needs still require access to individualised early supports to enable participation across settings. Effective assessment and screening are essential when considering NDIS eligibility, as children who are not eligible will instead rely on Foundational Supports through Thriving Kids. These supports must therefore deliver meaningful outcomes, albeit potentially at a lower intensity and cost.