NDIA Accountability Project

Submission 227 — Women's and Children's Health Network — Inquiry into the Thriving Kids initiative

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Submission to the Thriving Kids inquiry

Submitted by the Neurodiversity Education Health Collaborative – Women’s and Childrens Health Network

Women’s and Children’s Health Network:

The Women’s and Children’s Health Network (WCHN) is South Australia’s leading provider of specialty care and health services for women, babies, children and young people, and their families. The Women’s and Children’s health network includes some of the following services:

  • Women’s and Children’s Hospital
  • Aboriginal Health Division
  • Child and Adolescent Mental Health Service
  • Child and Family Health Service
  • Child Protection Service
  • Children’s Disability Services
  • Metropolitan Youth Health Services
  • Cedar Health Service
  • Yarrow Place Rape and Sexual Assault Service
  • 3D Health Division

Central Early Childhood and Family Services:

The Central Early Childhood and Families Service (CECFS) is a service within WCHN that aims to support the health and wellbeing of children with suspected or identified developmental delays.

CECFS provides family centred, early intervention services in the community which focus on the current developmental concerns/goals identified in collaboration with the child’s parents/carers. The service is provided by an interdisciplinary team comprising of speech pathologists, occupational therapists and developmental social workers.

Inclusion Criteria

  • Children 0 – 4 years (or children not yet eligible for/attending full time pre-school).
  • Children who are not meeting their developmental milestones.
  • Living within the geographical catchment area for CECFS. Children must reside within the WCH central metropolitan catchment zone; except for those suburbs historically serviced by NALHN including: Athelstone,

Campbelltown, Hectorville, Magill, Newton, Paradise, Rostrevor, Tranmere.

Exclusion Criteria

  • Children over 4 years or eligible for/enrolled in full time pre-school
  • Children living outside of the geographical catchment area for CECFS.
  • Children who have been made eligible for the National Disability Insurance Scheme.
  • Primary concern of significant emotional/behavioural issues in the absence of developmental concerns. These children should be directed to CAMHS.

Children who continue to have severe communication delays when they commence full time preschool are transferred to Department for Education Speech Pathology. The transfer is a formalised state-wide process between Health and Education.

Similar multidisciplinary early childhood community teams operate within Southern Adelaide Local Health Network and Northern Adelaide Local Health Network and service children within their catchment suburbs.

Neurodiversity Education Health Collaborative:

The Neurodiversity Education Health Collaborative (NEHCo) is a South Australian service committed to improving how education systems understand and respond to behaviours of concern in students with disabilities and complex health needs, particularly those with neurodevelopmental disabilities. Funded by the Department for Education (South Australia) and governed by the 3D Health Division within Women’s and Children’s Health Network, the team receives referrals through the Complex Case Review Panel (CCRP) within Disability Policy and Programs.

NEHCo helps educators and families better understand the contributing factors to student behaviour including physical health, regulation, sensorimotor integration, cognition, social communication differences, and relational contexts. Through expert consultation and collaboration, the team supports the development of individualized health and behaviour support plans, bridging the

gap between education and health to improve student engagement and access to mainstream services.

With a proactive, collaborative, and culturally responsive approach, NEHCo promotes developmentally appropriate, multidisciplinary support while preventing service fragmentation and unmet health needs. The team comprised of a Medical Consultant, Social Worker, Occupational Therapist, and Nurse Consultants that partners closely with educators to deliver evidence-informed interventions that uphold every child’s right to access quality health and education.

Referral Pathway to NEHCo

Access to NEHCo is based on a stepped referral process. Initially, the Department for Education engages its internal support system, the Student Support Services (SSS), a team of approximately 500 FTE professionals who work with students experiencing developmental delays, disabilities, learning difficulties, behavioural challenges, health concerns, disengagement, attendance issues, and communication difficulties.

Only after SSS has exhausted all available avenues for support are cases referred to NEHCo for specialist input.

Observations and Recommendations

NEHCo supports students with the most complex neurodevelopmental needs. A recurring observation in our work is the clinical and behavioural overlap between Autism Spectrum Disorder (ASD) and trauma-related presentations (Hoch & Youssef, 2020; Stavropoulos, Bolourian & Blacher, 2018). Despite similar presentations, effective interventions differ. We advocate for a shift away from reliance on diagnostic labels as the gateway to support. Diagnoses should not be the sole path to intervention especially when they result in lifelong labelling without adequate consideration of the child’s experiences and individuality.

We understand that environmental factors, particularly caregiver-child relationships, can influence neurodevelopment. Secure attachment provides a

strong foundation for brain development, while insecure attachment can increase risk for neurodevelopmental vulnerabilities (Antonucci et al., 2018). Recent research (Chen et al., 2024) highlights that ASD may arise from internal and external disruptions during critical developmental periods. Where trauma underlies developmental delays, the brain’s neuroplasticity offers hope for recovery and growth.

We strongly advocate for relational approaches such as DIR/Floortime, which centres on emotional and relational development as foundational to learning. In our experience, students show marked improvement when relational models are adopted over traditional behavioural approaches. When children feel seen and heard, they engage more deeply with education and demonstrate improvements in functioning.

Behaviourist approaches have often failed for the students referred to our service. Relational methods meet children where they are, rather than forcing them to conform to predetermined norms. Other valued models include Circle of Security (attachment theory), Marte Meo, and Mentalization-Based Therapy.

Early Intervention

A more integrated and responsive system is required. Child and Family Health Service has contact with every child in South Australia, offering a critical opportunity for early identification and support. Programs like Inklings, which supports infants (6–18 months) showing differences in interaction and communication, help empower caregivers to respond more effectively. Additionally, CECFS that supports early intervention for children with developmental concerns. We also recognise the important work of the Perinatal and Infant Mental Health Services (PIMHS), which delivers mental health support to parents and infants. These programs reflect best practice in relation to understanding relationships an attached as critical for neurodevelopment.

Human Rights-Based Practice

All systems such as schools, childcare, healthcare, workplaces must adopt a human rights perspective. Inclusion and belonging should not depend on a

diagnosis. When children are embraced for their individuality in naturalistic settings (schools, childcare, communities), their growth is supported holistically.

While clinical interventions are critical in some cases, many general systems are not yet structured to support children with neurodevelopmental differences effectively. These further places children at risk of not being afforded the opportunity to participate meaningfully in society due to issues of equity and justice.

Quality Over Quantity in Service Provision

We often observe children supported by multiple NDIS providers working in overlapping areas, with minimal measurable outcomes. This fragmentation not only causes confusion but can also disempower families, fostering dependency on external providers rather than building confidence and self-efficacy in parenting.

We recommend engaging fewer but highly skilled, outcomes-focused providers, with clear accountability and minimal duplication. This enables families to focus on meaningful progress and capacity building.

Provider Oversight

The current NDIS landscape which is a fee-for-service model can sometimes require activities that do not fully accommodate the necessary components of non-face-to-face care, such as reflective supervision and interdisciplinary team discussions. These elements are considered the gold standard in delivering comprehensive assessment and intervention, as they foster collaboration, critical reflection, and cohesive planning across professionals involved in a participant’s care.

Within the current NDIS landscape, there exists a mix of providers, some committed to ethical, evidence-based, and client-centred practices, and others whose approaches risk being exploitative or misaligned with best practices. This variability underscores the urgent need for strengthened accountability and robust government oversight to safeguard quality and ethical standards across the sector.

One potential improvement could involve appointing NDIS Support Coordinators as government employees, rather than relying solely on external contractors. This structural change could help ensure that coordination services consistently adhere to ethical frameworks, prioritize evidence-based interventions, and focus on genuinely child-centred outcomes. By embedding support coordination within the public sector, there is greater opportunity to align practices with multidisciplinary collaboration, reflective supervision, and a unified commitment to participant wellbeing.

Early Identification and Integration in Education Settings

Embedding allied health professionals and nursing staff within early learning centres and schools is key to identifying children at risk of neurodevelopmental delays early and referring them to appropriate services. Early intervention is critical to achieving long-term positive outcomes.

Teams like NEHCo bring a human rights and neuro-affirming lens to education when coaching educators to adopt relational and inclusive practices. We envision a future where specialist teams across the country can work collaboratively with schools to foster environments that honour every child’s unique developmental journey.

References

Antonucci, L. A., Taurisano, P., Coppola, G., & Cassibba, R. (2018). Attachment style: The neurobiological substrate, interaction with genetics and role in neurodevelopmental disorders risk pathways. Neuroscience and Biobehavioral Reviews, 95, 515-527. https://doi.org/10.1016/j.neubiorev.2018.11.002

Chen, Z., Wang, X., Zhang, S., & Han, F. (2024). Neuroplasticity of children in autism spectrum disorder. Frontiers in Psychiatry, 15, 1362288. https://doi.org/10.3389/fpsyt.2024.1362288

Hoch, J. D., & Youssef, A. M. (2020). Predictors of trauma exposure and trauma diagnoses for children with autism and developmental disorders served in a community mental health clinic. Journal of Autism and Developmental Disorders, 50(2), 634-649. https://doi.org/10.1007/s10803-019-04331-3

Stavropoulos, K. K. M., Bolourian, Y., & Blacher, J. (2018). Differential diagnosis of autism spectrum disorder and post traumatic stress disorder: Two clinical cases. Journal of Clinical Medicine, 7(4), 71. https://doi.org/10.3390/jcm7040071