3 October 2025
Standing Committee on Health, Aged Care and Disability Email: Health.Reps@aph.gov.au
RE: Inquiry into the Thriving Kids initiative
Thank you for the opportunity to lodge a submission to the Inquiry into Thriving Kids.
The Australian Orthotic Prosthetic Association (AOPA) is the peak professional body for certified orthotist/prosthetists. Certified orthotist/prosthetists are tertiary trained allied health professionals that assess the physical and functional limitations of people resulting from disease, illness, trauma and disability, including limb amputation, and neuromuscular conditions, such as stroke. Orthotic and prosthetic services may involve the provision of orthoses and prostheses to restore function, prevent deterioration, and improve quality of life.
Certified orthotists/prosthetists play a vital role in supporting children with mild to moderate developmental delay and autism by designing and providing customised orthotic devices that enhance mobility, posture, and functional independence. Their work involves careful assessment of each child’s physical and sensory needs, collaborating closely with families, and other health professionals to ensure that devices are comfortable, effective, and tailored to the child’s developmental goals. For children with autism, Certified orthotists/prosthetists also consider sensory sensitivities and behavioural factors when selecting materials and designing devices, aiming to reduce anxiety and improve compliance. Through ongoing management and adjustments, they help children participate more fully in daily activities, promoting confidence and inclusion in educational and social environments.
Certified orthotists/prosthetists manage a wide range of conditions in children with mild to moderate developmental delay, including:
- Toe walking - often seen in children with autism or sensory processing differences; managed with ankle-foot orthoses to encourage heel strike and proper gait. Children that are toe walkers habitually walk on the balls of their fees without letting their heels touch the ground. If left untreated, persistent toe walking in children with developmental delay or autism can lead to shortened Achilles tendons, reduced ankle mobility, muscle imbalances, and long-term gait abnormalities that may affect motor function, posture, and overall physical development. Certified orthotists/prosthetists design and fit orthotic devices that gently stretch the calf muscles and Achilles tendon, encouraging a normal heel-to-toe walking pattern.
- Flat feet and pronation - can lead to poor foot alignment and instability, affecting balance, coordination, and endurance during walking and play. If left untreated, it can lead to persistent foot misalignment, reduced stability and endurance, and increased risk of joint pain, muscle fatigue, and long-term gait abnormalities. It is treated with supramalleolar orthotics (SMOs) or shoe inserts to improve foot alignment and balance.
- Hypotonia (low muscle tone) - this condition in characterised by reduced muscle tone, which can lead to poor postural control, delayed motor milestones, and challenges with balance and coordination during everyday activities. If left untreated, it can lead to delayed
motor milestones, poor posture and balance, reduced endurance, and long-term difficulties with coordination, speech, and daily functional activities. Children with this condition are supported with orthoses that provide stability and improve posture during movement.
- Balance and coordination issues - can result in clumsiness, difficulty with motor planning, and challenges in performing everyday tasks like walking, running, or playing safely and confidently. If untreated, this can lead to ongoing motor difficulties, reduced participation in physical and social activities, lower self-esteem, and increased risk of injury due to poor body awareness and control. These issues can be addressed with lightweight orthoses that enhance proprioception and joint alignment.
- Mild joint instability or hypermobility - this can lead to excessive looseness in the joints, which can lead to fatigue, poor posture, and difficulty with coordinated movements during everyday activities. Leaving this untreated can lead to chronic joint pain, fatigue, frequent sprains, poor posture, and delayed motor development, potentially impacting participation in physical and social activities. The condition is managed with braces or inserts to prevent fatigue and improve functional endurance.
- Behavioural issues - the physical behaviour of some children with autism can put them at risk of serious injury to their body including their head. The provision of a protective helmet helps to reduce the risk of injury and protects the head of children with autism. This is classified as a restrictive practice and there are clinical pathways under NDIS and regulation. Without access to these devices, children are at risk of unintentional self-harm.
- Fatigue - autism is often not recognised as a physical issue under the NDIS and fatigue is an issue for these children. The provision of carbon foot plates or carbon ankle foot orthoses (AFOs) assists in fatigue management.
These interventions are often part of a multidisciplinary approach, aiming to enhance mobility, independence, and quality of life for children with developmental challenges.
AOPA notes the Terms of Reference of the Inquiry and has focused a response on:
- Domestic and international best practice approaches
- Mechanisms that allow for access to mainstream services
Summary of recommendations
Recommendation 1: AOPA recommends that Thriving Kids implement a multidisciplinary team model of care including Certified orthotists/prosthetists to meet the needs of children with mild to moderate developmental delay and autism.
Recommendation 2: AOPA recommends that members of the multidisciplinary team including Certified orthotists/prosthetists are enabled to deliver their full scope of practice with opportunity to conduct assessments and provide direct referral.
Recommendation 3: AOPA recommends that innovative models of multidisciplinary care for people in regional rural and remote communities include use of outreach, telehealth and professional guidance from Certified orthotists/prosthetists, due to the existence of thin markets.
Recommendation 4: AOPA recommends that Allied Health Professions Australia (AHPA) as the peak professional body for 40 allied health professions be invited to join the Thriving Kids Advisory Group.
Recommendation 5: AOPA recommends that the Commonwealth Government expand the recognition of allied health professions in Medicare to include Certified orthotists/prosthetists to ensure access to the whole multidisciplinary team.
Recommendation 6: AOPA recommends that Medicare provides fair and reasonable remuneration to provide capacity for the allied health multidisciplinary team including Certified orthotists/prosthetists to intervene early and deliver evidence-based care.
Recommendation 7: AOPA recommends that funding for assistive technology such as ankle foot orthoses be included in the Thriving Kids initiative.
Recommendation 8: AOPA recommends that provision of services through the education system include assessments that identify the need for orthoses and direct referral to a Certified orthotists/prosthetists.
Best Practice Approaches
AOPA supports the use of multidisciplinary and integrated models of care for children with mild to moderate developmental delay and autism. A multidisciplinary team of health professionals offer significant benefits when assessing, diagnosing, and managing children. By bringing together a range of professionals such as speech pathologists, occupational therapists, psychologists, physiotherapists, and Certified orthotists/prosthetists, the team ensures a holistic understanding of each child’s unique strengths and challenges. This collaborative approach allows for comprehensive assessments that consider communication, motor skills, sensory processing, emotional regulation, and behaviour. Shared goal-setting and coordinated care plans lead to more consistent interventions across different environments—home, school, and therapy settings—resulting in faster skill development and improved generalization of learned behaviours.
Children benefit from tailored strategies that are reinforced by multiple professionals, enhancing their confidence, independence, and overall well-being. Families also experience reduced stress, as they receive unified support and clearer communication from the team. Importantly, early and integrated intervention can significantly improve long-term outcomes, helping children thrive socially, academically, and emotionally. The multidisciplinary model fosters a dynamic and responsive care environment, where professionals continuously adapt strategies based on real-time feedback and progress. Ultimately, this team-based approach empowers children and their families, promoting meaningful development and a higher quality of life.
It is imperative that the model supports members of the multidisciplinary team to work to their full scope of practice, be enabled to deliver assessments to directly refer to each other where appropriate. Development of a model for Thriving Kids that includes the whole multidisciplinary team will be an important step in ensuring that children and their families will be able to access the support in a timely and effective manner.
Additionally, models may need to be considered to account for rurality. Certified orthotists/prosthetists are a small profession and offer their services in thin markets. This means that access for people living in rural and remote areas are challenging and Thriving Kids will need to consider innovative models to service these areas. Models such as the WA statewide model of outreach, telehealth, and guided support collaborating with members of the multidisciplinary team may provide a solution.
Peak professional organisations have an important role in providing advice to support the design, implementation and evaluation of Thriving Kids. AOPA notes the first meeting of the Thriving Kids Advisory Group has already taken place. This Advisory Group includes representation from peak organisations from across a range of sectors, however, representation from the peak organisation representing 40 allied health organisations and 195,000 health professionals, Allied Health Professions Australia (AHPA) is absent. This is particularly concerning as the views from across the allied health sector are not represented and are unable to contribute at this level to a model to best support children and their families across Australia.
Recommendation 1: AOPA recommends that Thriving Kids implement a multidisciplinary team model of care including Certified orthotists/prosthetists to meet the needs of children with mild to moderate developmental delay and autism.
Recommendation 2: AOPA recommends that members of the multidisciplinary team including Certified orthotists/prosthetists are enabled to deliver their full scope of practice with opportunity to conduct assessments and provide direct referral.
Recommendation 3: AOPA recommends that innovative models of multidisciplinary care for people in regional rural and remote communities include use of outreach, telehealth and professional guidance from Certified orthotists/prosthetists, due to the existence of thin markets.
Recommendation 4: AOPA recommends that Allied Health Professions Australia (AHPA) as the peak professional body for 40 allied health professions be invited to join the Thriving Kids Advisory Group.
Access to Mainstream Services
The most significant issue in relation to private mainstream services from an orthotic/prosthetic perspective for children with mild to moderate development delay is access to:
- Clinical support - this includes activities that are not directly involved in the actual provision of the orthoses and include the initial consultation, completion of forms and reports, as well as other appointments for casting, fitting, reviews and repairs.
- Funding for Assistive technology - There is rarely funding in NDIS packages for ankle-foot orthoses (AFOs), and if it is included, it is often only after these children have developed muscle contractures (shortening) and are being treated with serial casting. By this stage they are often unable to recover sufficient range to use jointed AFOs. The better model would be to include a funding pathway for AFOs for those children that exhibit early signs of toe walking, to enable this gait re-training treatment to commence when they still have good
ankle range of movement. The only avenue to access support will then fall to the public health system.
Currently, Medicare does not support services delivered by a Certified orthotist/prosthetist despite there being a recommendation from the MBS Review Taskforce on 6 February 2019 for a new item number.
Even though there is no item number for Certified orthotists/prosthetists in Medicare, access to allied health is limited and not currently fit for purpose to support multidisciplinary care as part of the Thriving Kids initiative. The current limitations of the Medicare funded items to support developmental delays and autism include:
- Assessment and referral - a limited number of allied health professions are recognised to deliver assessments. Referrals are not an option between allied health professionals and can only be made by a paediatrician or psychiatrist (or in some cases, a GP for eligible disabilities).
- Rebate - current Medicare rebates for allied health services are misaligned with actual service costs and durations, often resulting in unaffordable gap fees for families.
- Service location - allied health services should be delivered in natural, everyday settings, but existing Medicare items rarely support this best-practice approach.
- Dosage of sessions - Medicare caps on session numbers do not reflect children’s evolving needs, and future funding must allow flexible, evidence-based service delivery.
- Team based care - Medicare currently lacks mechanisms to support collaborative, multidisciplinary allied health care, which is essential for many children’s developmental needs.
- Individualised funding for the person - funding should support both direct therapy and capacity-building for families and carers, rather than limiting services to the individual alone.
Concern is expressed about suggestions to access services for children with mild to moderate developmental delay through the Education System. This may work for some allied health professions, but it wouldn’t work for accessing services from a Certified orthotist/prosthetist. This has been deemed as not a practical solution for several reasons including:
- Lack of appropriate facilities to conduct assessments, fittings and ongoing management.
- Absence of a parent to provide consent around photography/video as this is required for manufacturing purposes. Additionally, their absence is problematic for education on how orthoses are fitted, managed and monitored for optimal functionality.
- Regulation in the school environment results in significant unpaid training hours to comply with standard and mandatory induction/credentialling. This is a significant financial burden for solo private practitioners, and this would be a barrier to accessing services from Certified orthotists/prosthetists as they currently operate in thin markets.
Recommendation 5: AOPA recommends that the Commonwealth Government expand the recognition of allied health professions in Medicare to include Certified orthotists/prosthetists to ensure access to the whole multidisciplinary team.
Recommendation 6: AOPA recommends that Medicare provides fair and reasonable remuneration to provide capacity for the allied health multidisciplinary team including Certified orthotists/prosthetists to intervene early and deliver evidence-based care.
Recommendation 7: AOPA recommends that funding for assistive technology such as ankle foot orthoses be included in the Thriving Kids initiative.
Recommendation 8: AOPA recommends that provision of services through the education system include assessments that identify the need for orthoses and direct referral to a Certified orthotists/prosthetists.
We trust that this feedback will be of assistance in the development of recommendations for the Inquiry and AOPA thanks the Standing Committee on Health Aged Care and Disability for the opportunity to be involved.
Yours sincerely,
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Jessica Landers Chief Executive Officer Australian Orthotic Prosthetic Association