Supporting Thriving Kids through evidence informed program design to deliver outcomes for children and families consistent with the NDIS reforms.

Submission to the Thriving Kids Parliamentary Inquiry

Submitted by: Early Childhood Intervention Best Practice Network

Executive Summary

The Independent Review into the National Disability Insurance Scheme Final Report (‘The Review’), published in December 2023, recommended the establishment of Foundational Supports to complete the disability support ecosystem and improve NDIS sustainability.

Young children and their families require support that is designed to meet their unique needs. Early childhood is a period of critical developmental windows and significant consequences when development is not supported adequately. Thus, the Review recommended that early intervention for children and families should be based on best practice and be more focused within mainstream and foundational supports, while building capacity of the family of the child.

There are currently gaps in support offerings for children and families with developmental concerns and delays. Many wait long periods for access to early childhood Partners in the Community, are not eligible for these supports, or are not eligible for the NDIS. This is a significant risk to these children and their families, who require timely developmental support when concerns are identified.

This document proposes the concept and design of a model for potential delivery under Thriving Kids. It is aligned to what the research and evidence supports for early childhood development to assist children with delay or mild to moderate conditions. This model delivers life changing outcomes by supporting children and families with developmental concerns and delays using an evidence-based Key Worker model and a streamlined access pathway. It improves family experience by ensuring coordination and collaboration between agencies, reducing duplication of services and building capacity of families and mainstream services.

Consistent with the needs of Government the vision for this proposed model is to:

• Ensure families, children and young people’s needs are met early to prevent the escalation of vulnerability
• Ensure families can access support early in the lives of their children and young people, through one consistent coordinated source of support and information
• Avoid unnecessary referrals to the NDIS, children and families have all risk factors addressed in the service ecosystem of early childhood in their community: and
• Aboriginal children, culturally diverse and rural children, families and communities have access to timely, effective, accessible and culturally safe support and services

This proposed model outlines a system of delivery partners, using established Early Childhood Intervention (ECI) providers. This model is replicable and can be scaled up consistently across Australia over the next 4 years.

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The model seeks to:

• Support the National Best Practice Framework for Early Childhood Intervention.
• Provide a model which could be implemented in the new Foundational Support ecosystem for children and families, by establishing:
  • An evidence base regarding the efficacy of the proposed Foundational Support model for
    • short- and long-term child and family outcomes;
    • improving outcomes for other systems (e.g., health, education).
• Provide cost effect outcomes through focus investment to deliver the objects of all Governments:
• Relieve the pressure on families to eligible to access the NDIS to be supported.

This model has been developed with due regard to all relevant evidence, reviews and inquiries and as a proposal to partner with all Governments to deliver what families and children with delay or disability need. It is based on evidence and builds on what has been learnt in Australia and Internationally over the past 60 years in what works for children and supports their optimal development and their family to thrive through the supports received through Government programs and investment.

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Supporting Thriving Kids through evidence informed program design to deliver outcomes for children and families consistent with the NDIS reforms

ABOUT THE EARLY CHILDHOOD INTERVENTION PRACTICE NETWORK

The network comprises 18 not-for-profit child and family organisations that provide early childhood intervention services and/or early childhood education with an average of 55 years of experience. Together, we support over 6,000 children in early childhood intervention under the NDIS and over 22,000 children and young people and their families annually in metropolitan and regional areas. While we primarily operate across NSW, we also have representation in Victoria and the ACT.

Our network members have long-standing experience in the early childhood intervention sector through the former Early Childhood Intervention Association NSW/ACT Chapter. In 2021, we united again to advance best practice models under the NDIS leading us to sector reform advocacy starting with the NDIS Early Childhood Reset. In 2023, we formalised our network through the development of a governance structure and Terms of Reference. At the time of formation, we had 14 providers. The purpose of the current group is to collectively advocate as not-for-profit providers for high quality, evidence-based early childhood intervention to support children and young people 0-16 years old in Australia. Since our formation in 2023, our membership has grown to 18 organisations that meet fortnightly to:

• share collective experience within the sector with a solutions-focused approach;
• work together to understand the reform context and form a united view regarding impacts and opportunities;
• pursue an advocacy agenda that promotes best practice interventions, access and equity for children and young people with developmental concerns, delays, differences or disabilities and their families.

We have a shared vision that all children and young people should have timely access to emotional support and if necessary, best practice early intervention within a community context. We seek a policy and operational environment that promotes this vision.

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PARLIAMENTARY INQUIRY TERMS OF REFERENCE

This submission responds to the following Terms of Reference:

• Examine evidence-based information and resources that could assist parents identify if their child has mild to moderate development delay and assist parents to provide support to these children.
• Examine the effectiveness of current (and previous) programs and initiatives that identify children with development delay, autism or both, with mild to moderate support needs and support them and their families. This should focus on community and mainstream engagement, and include child and maternal health, primary care, allied health playgroups, early childhood education and care and schools.
• Draw on domestic and international policy experience and best practice.
• Identify mechanisms that would allow a seamless transition through mainstream systems for all children with mild to moderate support needs.

We outline a proposed model for responding to the needs of families and children with mild to moderate support needs with developmental delay or disability.

CURRENT STATE

The National Disability Insurance Scheme (NDIS) has been designed as a system for those with the highest support needs and is not to stand alone but, rather, sit within a broader system of support. The NDIS Review found that children and families experience a complex and fragmented system of support and, as it stands, the only option for children with developmental concerns, delays or disabilities in many cases is to enter into the NDIS.

The design and approach of the NDIS is more suited to adults. The funding model and structure of the scheme does not incentivise Best Practice as the focus and has become transactional access to services. This is further complicated by the multiple layers of process and infrastructure the NDIS has rolled out in various iterations of design. All research and evidence clearly indicate that a child with concerns and their families are best supported by a single point of contact and professional voice that guides, coaches and supports them on the child’s developmental journey in the community.

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The following table indicates the massive overhead of the design of the NDIS, introduced to early childhood intervention in Australia, through a one size fits all design.

The current approach under the NDIS is disparate, fragmented and has no accountability for outcomes to the family or the Government. A holistic approach embedded in everyday routines and delivered by a transdisciplinary team, working together across multiple systems and funding streams at the community level, is required to deliver effective early childhood intervention.

In August 2025, The Hon Mark Butler MP, Minister for Health and Ageing and Minister for Disability and the National Disability Insurance Scheme, announced an intention to build a system that support families and their kids to thrive as part of the foundational supports system. Minister Butler went on to say:

“Unfortunately, the NDIS has been the only port in the storm for them. All of those systems we had for years or decades to support parents whose kids weren’t hitting milestones were largely deconstructed, and all the money was put into the NDIS. But the NDIS is not the right fit for them. That is a scheme for permanent and significant disability. I’m going to make sure that everyone who is on the NDIS now remains on it, subject to the usual arrangements. But over the next couple of years, we’ll introduce a new scheme for Thriving Kids that will support those kids coming through those ages and their parents in the way that, frankly, they should be.”

WHAT WE KNOW

Prior to the NDIS many States and Territories learned that supporting children in natural environments and in their communities provided the best developmental and life outcomes. The specialist services working in a coordinated and supportive role with families and early childhood

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services provided a model of support that was sustainable, cost effective and provided enduring positive outcomes.

More recently the NDIS Early Childhood Approach has provided us with learnings over the last 10 years. The Early Childhood Partners (EC Partners) have been seen as a gateway to the NDIS rather than supporting children and families with concerns. This leaves a vital gap for families with concerns who are often passed back and forth between GPs, Specialists, state community health services and EC Partners, leaving inconsistent service delivery and further complicating supports for children and families.

As a result of review and unintended consequences leading to the EC Partners being seen as a gateway to NDIS, children with developmental delays or additional needs are often not receiving support early and this impacts meaningful participation in their community, including their family, and natural settings such as early childhood services and education, thus increasing costs and onsite support needs later in life.

This is further complicated and detrimental to the child and family, as the journey passes them through multiple systems and professionals all providing conflicting or repeating information and often focused not on the child’s development but on funding available as part of that system.

CREATING THE FUTURE STATE

The NDIS review indicated a future state very like best practice principles, coordinated services, removal of complexity and duplication of the previous quality providers of services to children and families in the system that existed prior to the NDIS, with some potential improvements.

Solution: The right support at the right time for the right outcome. The Key Worker Model design we outline in this submission has vision and outcomes at its core. Effective early childhood intervention delivers outcomes that are consistent with:

• Key findings of the Independent Review of the National Disability Insurance Scheme - NDIS Review 2023,
• National Action Plan for the Health of Children and Young People 2020 to 2030: and
• Early Years Strategy 2024-2034.

Universal access to Foundational Supports for Children and Families reflects the Australian Government’s vision for the early years - that every child deserves the opportunity for the best start to life, no matter where they are born or raised or their abilities. They will then ‘have the opportunity to reach their full potential when nurtured by empowered and connected families who are supported by strong communities’.

The Early Childhood Intervention Best Practice Network believes that there are critical elements required to support children and families.

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This document proposes a model which focuses on family outcomes. (See appendix A). With all program logic the starting point for this program is ensuring the right outcomes sought by all stakeholders are central to design and implementation. This is further enhanced by ensuring:

• Fair, timely and transparent access
• A sustainable support system
• Linking services to need
• Strengthening families — enabling children with a disability to grow up in a family and participate in the community;

We outline a core Key Worker Model (like the Leader Practitioner role outlined in the NDIS Review) of direct support services, which provides direct early childhood intervention and links the child and family to other supports. These components are designed to work in the broader foundational and mainstream systems to deliver optimal value for money and drive the outcomes sought by families and Government.

This will streamline the experience for families and ensure they receive timely developmental advisor and service delivery is focused on improving outcomes in their natural setting. It seeks to resolve gaps within the current service system, eliminate duplication and expensive unnecessary intermediaries for families of children with developmental concerns, including delays in accessing timely information and appropriate advice and ECI services, and eligibility restrictions for access to supports.

Supporting Elements to Model

Advice Line/Information Line

A critical element we see necessary in the Thriving Kids infrastructure is an Advice/Information Line which ensures all families, regardless of location, can access timely developmental information regarding their child. This Advice/Information Line would also be available to professionals who require guidance.

Of paramount importance for Governments, the conversation starts with support for the child and family.

Depending on the more developed purpose and role of the Advice/Information Line the network would support policy makers to understand the role of such a function in the proposed system. What is of paramount importance is that the advice/information is consistent with the principles of best practice.

At one end of the scale the line would limited to:

• Providing general information on child development and support to parents/carers through connection to relevant information such as the Raising Children Network.
• Providing information of local services in the community service available regional and state-wide, provide the referral process and support the parent/carer in making contact.

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At a more complex end the function could be an advice line that is staffed by professionals who can provide guidance to parents/carers on their child’s developmental needs. This, however, would need to be in the context of the information the professional would have access to make those judgments.

Further, it provides an avenue for other professionals to seek advice regarding developmental concerns as well. For instance, early childhood educators who are observing a delay and unsure of how to support the child or where to direct the family, can call to get general advice and direction.

The Advice Line in this model would provide:

• General developmental advice – for instance:
  • tips and strategies to support children’s development on a particular topic/area of focus
  • tips on things to consider when delays are observed (e.g., hearing tests, socialisation opportunities, etc.)
  • normalising development for parents/professionals to provide reassurance, as appropriate.
• Information about existing resources which may support families such as the Raising Children’s Network, Thrivary app, etc.
• Information about other supports which may assist, such as Peer Support, Parenting Programs, Playgroups, etc.

The Advice Line would be resourced with trained early intervention professionals such as Early Childhood Teachers, supported by a national oversight committee linking into latest research, developments and best practice information.

Other Foundational Supports

Other Foundational Supports are conceptualised as being in two groupings and providing families with support that is timely and useful. Many aspects of this will be included in the emerging Advice Line and the Key Worker Model role.

General Foundational Supports:

• Accessible information to connect children and their families to the right support for them – like peer support groups, or social and emotional support for parents and carers.
• Giving families and carers the tools and information they need to support their children. This could include help to navigate services, support with setting up routines, access to short courses and practical parent support workshops or training programs.

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Targeted Foundational Supports:

Targeted supports operate between mainstream services (e.g. in areas like early childhood education and care (ECEC) settings and schools) and the specialist supports accessed through the NDIS. They might include specific supports like:

• Support from allied health including one-off or low intensity access to speech pathology, physiotherapy, psychology, occupational therapy or other services.
• One-off or low-cost assistive technology that can make a child’s everyday life easier and safer.
• One-on-one support for people caring for children by giving them skills and information. This could include self-advocacy skills, connecting families with supports and services, practical strategies and emotional support.

The Key Worker Model supports the referral to multiple community and family-based programs that currently exist but are not easily accessible for NDIS participants, nor are they valued with regard to their benefit and suitability.

Further investment and enhancements could be targeted at Foundational Supports such as

• Peer Support programs which provide essential support through individuals who share similar experiences, promoting emotional support and empowerment in various contexts, particularly in the early days and during periods of change.
• Capacity building of other systems in particular in education to ensure children with mild to moderate disability can be supported in mainstream classrooms.
• Parenting Programs – supporting parent capacity through facilitated, evidence-based parent capacity building programs (e.g Now & Next).
• Sibling Programs - Siblings of individuals with delay or disabilities can access a variety of support programs designed to help them navigate their experiences and improve their well- being.
• Virtual Hubs – interagency collaborations which connect services. This is particularly beneficial in regional/remote areas which may not have direct access to local services.

Key Worker Model (Early Childhood Intervention)

Supported by the above components, we propose that all families eligible for Thriving Kids who have children with developmental concern, delay or disability should be provided more direct support tailored to individual circumstances.

This support could be provided under a Key Worker Model by a network of appropriately qualified organisations working to deliver the Government reform agenda and support the growth of best practice evidence informed early childhood intervention.

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These organisations would be commissioned to provide a national workforce of Key Workers who could be specialist early childhood teachers, early childhood developmental specialists, allied health practitioners with appropriate early childhood focus and other professionals. The organisations would provide the Key Worker with appropriate:

• Clinical and professional supervision
• Quality assurance systems,
• Practice support, and
• Professional development in early childhood intervention

The Key Worker support will use evidence-based best practice in early childhood intervention. Specifically, the implementation of a collaborative Key Worker model to support families with concerns about their child’s development.

Families with children who are screened to have an identified delay, will be allocated a Key Worker who provides support that is grounded in four elements:

• Child and Family Support – building capability to identify needs, build support plans, providing information and advice, providing support to navigate the system, service coordination, emotional support and building confidence and empowerment through peer support and knowledge acquisition.
• Intervention – direct early childhood intervention. This is provided as part of a transdisciplinary team with support from Key Worker’s discipline, and input from other disciplines as need. There is a focus on embedding strategies in everyday routines and activities;
• Collaboration – to and with other service systems (ECEC, school, community);
• Capability-building – of key people in the child’s life (family, community and mainstream services) so they can implement interventions and strategies day-to-day for the child.

The weighting of each element varies, based on the goals identified by each family, to ensure a response and outcome-focused support is provided.

The program would be run by local community organisations who know and understand their communities, and have a collaborative team of paediatric, allied health professionals and early childhood teachers to deliver services.

These key components are part of a customer journey map that aims to provide foundational supports to children and families.

Families would move through the following journey which supports child and family centered models:

• Eligibility for Thriving Kids established – this could include a formal child screening/ assessment. We would recommend this eligibility occur through existing universal services families would be naturally interacting – e.g., GPs or Child and Family Health Nurses.

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• Initial supports – provided by a Key Worker, with a focus on emotional support, identifying needs, providing navigation, information and advice (including recommendations to support development) and service-co-ordination to connect with other services.
• Early childhood intervention – provided by a Key Worker, if needed, with a focus on implementing strategies to support the child’s development. The frequency and duration would be determined based on the needs of the child and family with tiered packages of support based on need. The transdisciplinary Key Worker would deliver specific early intervention using Best Practice Guidelines within the natural settings (environments where children ‘live, learn and play’) of the child and family and engage support from other disciplines, as required. This would include consulting and collaborating with key people in the child and family’s life.
• Follow up stage – with a focus on connecting families back to mainstream supports, once their goals are achieved. To ensure there is a continuum of support and ongoing monitoring of outcomes, the Key Worker would stay connected to the child and family and check in at regular intervals after their service delivery concludes. There will be opportunities to have quarterly follow-up post support and the family would be given the opportunity to circle back, if their needs change or new goals are identified. If required, the Key Worker would work with the family should further support be needed to obtain a diagnosis and access to the NDIS. The Key Worker would refer to the ECI Partners in this case.

A graphical representation of this proposed model, the family journey and its interface with other aspects of service delivery is shown in Figure 1 below and more details of the model is demonstrated visually in the proposed funding section.

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Journey Concept

Family Journey

ECI Best Practice Network

Family raises concerns/seeks advice/support

Information Line Screening:

Eligibility established

GP Blue Book Reviews

Early Childhood Education and Care

Emerging Health/Medicare investment

Child and Family Nurses

Playgroups

Peers

Community Services

Hospitals

Schools

Practice Leadership and Network Support

Accountability – Data Collection

Mainstream Services

Early Childhood Intervention

Child and Family Health Services

General Practitioners

Hospital

Paediatric Specialists

Allied Health

Longer term support

Allied Health

Qualified professionals place-based

Timely, Efficient, Holistic Mobilisation of Services

Linking of Services

KEY WORKER MODEL

Initial Stage Deeper understanding of child/family needs Appropriate referrals and coordination/support to access those services

Support Stage (if required) Key Worker intervention supported by transdisciplinary team-around-child

Capacity building

Collaboration with key people in the child and family’s life

Follow up Stage (if required)

3, 6, 9 and 12-month check-ins post Key Worker support provision

Link to local community

Playgroups

Early Childhood Education and Care Services

Schools

Allied Health

Peer Support

Capacity Building

Parent Programs

Interconnected services through ‘virtual hubs’

Other Foundational Supports

Aligned with Best Practice Principles and Support for National Autism Best Practice Guidelines

Functional Needs Assessment

The following screens and assessments are a sample of the type of tools used to develop a comprehensive needs assessment for children and their families.

Accountability - Data Collection and Reporting

The critical component of this proposed Key Worker Model is the data and information it provides the family, all levels of Government and other funded services to assist in planning, decision making and focus of investment and growth of services at the local, regional and national level.

Early childhood developmental support is a complex system in the community. Practice requires high levels of collaboration and information exchange; the sharing of this information needs to be supported through best practice and built in from the design phase.

Baseline, progress and outcomes data must be collected consistently and provided as part of the Thriving Kids’ investment.

By this data collection, valuable planning information will be provided on the workforce, service gaps, planning for emerging needs and areas requiring further development. Further, it will provide data on the evidence of the model to help inform continuous improvement and new evidence of this model in the Australian context.

Data collection from these providers will help demonstrate return on investment for government and provide transparency on use of funds.

Practice Leadership and Community of Practice

Under an ideal funding model, providers would be commissioned together so that practice leadership can occur through communities of practice. This model provides the Government with a key mechanism to support continuous improvement in Thriving Kids investment and support implementation of future policy, strategies and best practice guidelines sustainability and with little service disruption.

It is dependent on the Government commissioning providers to deliver this work so that collaboration and practice leadership can occur between commissioned providers.

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Benefits of Practice Leadership

The benefits of practicing leadership and communities of practice are numerous and far-reaching.

1. Enhanced Wellbeing: Networks like the Mental Health Professionals’ Network (MHPN) have shown that peer support networks can significantly improve the wellbeing of mental health practitioners, leading to increased confidence and understanding of collaborative practices. (This was also very prevalent in the early childhood intervention networks prior to the NDIS)
2. Cultural Change Agents: Practice leaders play a crucial role in cultural change within services, ensuring that new practices are consistently implemented and that staff maintain the core values of the organisation/program.
3. Continuous Learning: Engaging in peer advisory networks fosters a culture of continuous learning and adjustment, which is essential for personal and organisational growth.
4. Emotional and Professional Support: Supportive leadership networks provide emotional and professional support, helping leaders navigate challenges and build resilience.
5. Collaborative Problem-Solving: Networks like the International Peer Leadership Network offer a space for peer supporters to share experiences and learn from one another, leading to innovative solutions and improved practices. A similar approach could be taken from commissioned providers.

These benefits highlight the importance of practice leadership and network support in enhancing the quality of care and support provided to individuals and communities. This aspect is an essential requirement for the Thriving Kids initiative to be rolled out nationally in as short a timeframe as possible. This is consistent with needs identified Australian Productivity Commission Report June 2024 - A path to universal early childhood education and care.

SERVICE DELIVERY PARTNERS

Delivery of the Key Worker Model can be scaled through existing community-based not-for-profits who deliver best-practice early childhood intervention.

These providers are local services with deep community connections and partnerships. They are interconnected with other key services such as supported playgroups, community health, early childhood education services, parenting programs, peer supports, etc., and have trust within their local communities.

More than that, they have existing workforce that can be drawn from and are already trained in Key Worker Model. And, their workforce could work across the NDIS, therefore providing continuity of care for families that require a transition to the NDIS due to need.

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As these services operate with significant local connections, they would be able to deliver or operate in a ‘virtual hub’ based model to enable seamless connection to other parts of the system for families.

These providers are available and ready to scale this service quickly and have broad reach. Take for example our network members and our coverage across NSW.

ALIGNMENT TO GOVERNMENT EARLY YEARS STRATEGY

The above model aims to provide early support for families and children with emerging developmental concerns and/or delays by delivering intervention that builds the capacity of parents and carers to support the development of children, thus enhancing outcomes and reducing the need for ongoing services.

The aim is for the family to have one person as the point of contact for all aspects of support and to integrate with existing systems, including mainstream.

The Key Worker Model is based on the five principles of the Early Years Strategy:

1. Child- and family-centred
2. Strengths-based
3. Respect for families and communities
4. Equitable, inclusive and respectful of diversity
5. Evidence-informed

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CASE STUDIES

Current situation

A child and their family notice their child has a speech delay. They spend 3-4 months seeking support through their GP, getting hearing tests, and finally progress to needing access to the NDIS. After waiting 11 months, their Early Childhood Partner contacts them and after several phone calls and observations, they apply for the NDIS. Fourteen months after their initial call and 18 months from their first reach out for support, they get accepted to the NDIS and receive a package.

The family seeks a Speech Pathologist who advises that twice a week speech pathology in a clinic- based model is all that is required to support the child’s disability.

Meanwhile the child’s childcare arrangements are becoming strained. Behaviors the childcare centre struggles with (such as escalating behaviors of harm) go untreated, other children’s parents are complaining, and educators have no support to implement strategies to assist the child. The parents are now routinely called away from their work to pick up their child. They are fighting the NDIA to get more money to assist. Their working arrangements are also becoming strained.

Three months later, the family has to leave the childcare service and try another with the same escalating story. In the end they decide that one parent should leave work to care for their child.

After 6 –12 months and (significant drain on their original NDIS package) the child and family returned to the best practice provider, asking for support as they have seen an increase in behavioural challenges from the child, a decline in all other developmental areas. The parents have been left feeling, tired, disconnected and isolated within their community.

Often, they cannot return to the best practice organisation because they have no funding and the organisation has no resource to assist them. While some providers will deliver support, often it is late and insufficient to assist the child and family to achieve the outcomes required. The needed supports and strategies which should have been implemented in their child’s early learning centre, their home and support to engage with community as a whole through extracurricular activities that the child enjoys, have been missed.

Same Case Study – Under Thriving Kids Key Worker Model

A child and their family identify their child’s speech may be delayed and call the Advice Line for support. The receive some helpful tips and strategies – for instance, have they checked their child’s hearing, a review of the child’s diet and opportunities to adjust that, they learn that reading to their child could support. They are told to go to the GP if the hearing check comes back OK and if they don’t see improvement. They go away and implement these things, feeling more confident.

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After another month, while they have ruled out a hearing problem and are implementing good strategies at home, they are still concerned about the child’s speech so go to their GP who offers them a Key Worker Initial Package of support under Thriving Kids. The GP provides a list of the three local providers who do this work.

They call that afternoon and book an appointment for later that week. The Key Worker meets with the parents and validates their concerns. They attend the childcare centre and home and get input from all of the caregivers around the child about what strategies are underway, what is working and what is not. They then work with the family and educators to implement key word signing with the child and visual aids. They return to provide support to all caregivers to implement this over time and see how the child is responding so they can build on those strengths. They connect the family with a local supported playgroup to provide more socialising opportunities as well, and recommend a Hanen parenting program to support the family.

Now, after three months the child is beginning to make more sounds and has a few words in their vocabulary. Their receptive language is good and further work on expressive language is the focus. The GP provides a Key Worker Support Stage Package and the work continues in those settings, with new activities for both school and parents to implement to strengthen sounds to help the child grow their vocabulary.

After 12 months, the child has caught up with their peers and is expressing themselves and socialising well. The family transitions to the Follow Up stage and receives regular phone calls where they can troubleshoot any concerns. However, as their confidence has grown, they report positive outcomes and no further support is required.

Videos which demonstrate this model:

Shaping Outcomes Video - redacted

Noah’s Inclusion Service Video - redacted

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EVIDENCE TO SUPPORT KEY WORKER MODEL

Over the past 30 years national and international studies and research have clearly demonstrated the benefits of the Key Worker model as the cornerstone of family-centered practice.

Children with developmental delays and disabilities have been living in the community and with their families, or in care, since the 1970s. Since then, there has been a steady building of the evidence base of the key elements of family centered practice through the Key Worker model.

More recently all States and Territories and several key research bodies have conducted numerous critical reviews of early childhood literature. Over the past 15 years all the research as reaffirmed and built on the rich history of practice in early childhood intervention through the Key Worker model.

The delivery of family-centred practice (FCP) within Early Childhood Intervention (ECI) services for young children with a disability or development delay conceptualises that children’s learning environments, parenting, family and community supports intersect to have the greatest impact on the developing child. The transdisciplinary Key Worker Model is considered a best-practice approach within ECI services whereby staff work collaboratively across disciplinary boundaries to plan and implement services for children and their families. Research suggests families who have a Key Worker have better relationships with services, fewer unmet needs, better morale, more information about services, higher parental satisfaction and more parental involvement than those not receiving this service. More important recent studies in Australia and Internationally have shown that the Key Worker role is one of the ways that ECI services can provide support that will help families become stronger. A Research Summary – Key Worker Model is provided at Appendix 5.

One of the great challenges for early childhood services is the ethos of ‘Do no harm’. This is based on the recognition that, despite the best intentions, even services that set out to be helpful can inadvertently make things worse for families. ECI services are no exception. We can make things worse in a number of ways – by failing to listen or respond to parental concerns, by not giving them information about relevant services, or by overloading the family with appointments and information as well as competing demands upon their time and understanding. This is where the Key Worker role is so important. An issue repeatedly highlighted in the research literature is the need for effective coordination of services for families of children with special care needs. Numerous research studies have reported that parents want a single point of contact with services and an effective, trusted person to support them to get what they need.

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FUNDING MODEL

Funding for the Key Worker Model described can be approached in various ways. Of high importance is to build the critical mass to support best practice networks and the workforce required.

Option 1 – Commissioned Model

Ideally funding would be provided to a group of ECI services as part of a network. Each network or lead agency would have a relationship/partnership with Government that set out the key principles, outcomes, obligations and quality standards required by all parties.

Standing up this model requires upfront investment, scaling for projected demand and training of staff into the model and culture are all required to support success and delivery of the Governments stated objectives. A partnership approach of a minimum of 5-10 years is recommended.

Ideally the funding would be made up of 3 components outlined in Appendix 1 as the commissioning model:

• Funded Contract – this funding is would be block funded to cover for the provision of roles and function as described in the model. Funding would be to cover contract administration as well ongoing activities such as workforce attraction, training, community awareness and education, evaluations, system integration and professional development. this contact amount could be determined by volumes of predicted demand and reviewed bi-annually commensurate with the workplan and activity schedule of the entity.
• Child/Family Packages – Funding per child for packages of both ‘Initial Stage’ supports and ‘Support/Follow Up Stage’ supports. For the Support Stage packages, the Network believes three (3) levels would be adequate to cover the known needs of the families that would require this support. Children beyond the higher or ongoing need would most likely require lifetime care and support and would be referred appropriately as part of the service. This contact amount could be determined by volumes of predicted demand and reviewed bi-annually commensurate with actual packages. It is not envisaged that families would receive a ‘package’ and ‘buy services’ transactionally – rather that the provider would receive the funds and distribute appropriately based on need.

Option 2 – Medicare Model

The network has also developed a conceptual model if this was funded through Medicare which is detailed at Appendix 2. Key to this funding approach is being able to fund the key relevant items at a rate that assures outcomes are reached.

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A further key challenge will be the introduction of early childhood teachers and specialists into the Medicare system, including appropriate award rates and remuneration for the flexible delivery of the Key Worker role.

Under a Medicare model, the Network would still suggest that the number of providers delivering this service in each region/geography be ‘commissioned’ so that there are limited number of ‘approved’ providers. This allows for the government to be confident that those delivering this service are delivering in alignment with best practice and their team are appropriately trained in Key Worker model. It also limits duplication of cost to the system.

For both funding options, the Network has developed further detail on the costings, specific line items, and key detail on input costs which can be provided if required.

CONCLUSION

The future envisaged with the introduction of Thriving Kids (and adaptation of existing services) and a reformed disability support ecosystem that is tailored to children with developmental concerns, delays, differences or disabilities will fill a significant gap for children and families.

Of paramount importance is that the approach learns from evidence and the past experiences instead of seeking to only address a single aspect of the necessary change. A holistic plan that builds the collaborations and reform to deliver the outcomes sought by the Thriving Kids design is required.

The Early Childhood Intervention Best Practice Network sees ample opportunity to design the new foundational support and disability ecosystem by adapting existing services and repurposing funding to fill gaps in the early years.

The benefits of the proposed Foundational Supports Key Worker model are:

• Reducing the number of unnecessary professionals involved in a child’s life, improving outcomes for children and families.
• Linking families into their local communities, fostering inclusion, and supporting the whole family.
• Connecting families with evidence-based support early and alleviating wait times for children and families.
• Reducing the cost burden on the NDIS system as early childhood intervention leverages the inclusion and integration of support for the child and is less dependent on disparate unconnected occasions of clinical and varied therapies.
• Reducing workforce shortages by alleviating dependence on specialist allied health professionals.

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• Reducing over servicing for families.

We are keen to work with policymakers, at all levels of government, to collaborate on the development and design of this future support ecosystem. We believe strongly that our extensive history in this space, understanding of the Best Practice Guidelines, and community trust sets us apart in our expertise to contribute to both the design and delivery of foundational supports. We also value and acknowledge the important role of broader child and family community support providers, parents and children in the co-design process.

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APPENDIX 1 - CONCEPT STRUCTURE OF THE IDEAL

COMMISSIONING MODEL

To implement this model of service structure would involve a Lead Agency and a Steering Committee comprising representatives of each participating organisation. This would ensure effective oversight, accountability and strategic alignment to the outcomes of the model and evaluate its effectiveness.

The Steering Committee focus on strategy, performance, shared resourcing, quality of practice, compliance, conflict of interest, risk, policy and communications.

The Lead Agency would be responsible for managing the overall financial performance of the program and serving as the primary contact for funders and external stakeholders. Task teams will be assigned to provide guidance and recommendations to the Steering Committee on specific program areas and take on tasks agreed by the Steering Committee. Lastly, there will be a consortium agreement between all organisations delivering the service.

A mixture of block and individualised funding would be needed to resource the project and support collaboration and evaluation, as well as to ensure initial assessments and support can be provided straightaway and following a more individualised approach to support.

A program logic has been developed that includes short-, medium- and long-term outcomes aligning to government priorities. These will guide decision making, performance measurement and the overall evaluation of the program. Details of the structure are below.

Governance Structure

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Key Principles

Below are the key principles underpinning any decision-making process.

• Rights of children and their families
• Equity, quality and safety
• Choice and control.

The group also has key principles for working together.

1. Equal Voice
2. Transparency
3. Collective Accountability
4. Consistency

Proposed Funding

Indicative funding for model is based on the following assumptions about the Family Journey stages:

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| • Navigation support to understand appropriate other connections | | | Referrals to broad range of mainstream services |

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Initial components of the project would be block funded based on estimated volumes; however, as children and family’s needs were assessed, this would move to three specific sets of funding according to the child and family’s needs.

Evaluation

It is proposed that a formal evaluation partner be appointed for each commissioned consortium, to focus on evaluation of the following outcomes linked to the Program Logic.

The Steering Committee would monitor outputs, and this would be provided as part of the evaluation.

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APPENDIX 2 - ALTERNATIVE COMMISSIONING MODEL UNDER

MEDICARE FUNDING

Whilst we think a commissioned model is the best fit for this Key Worker Model, this could be adapted to be funded under Medicare.

If so, we would recommend the following:

• A panel of approved providers should be commissioned per region (# of providers would be tailored to needs of each region) – the rationale for this is to limit the duplication in the Scheme (e.g., 30 providers travelling to the same place) whilst continuing to allow choice and control for families. Further, it allows government an ability to manage quality of service. Only ‘commissioned’ Thriving Kids providers would be able to deliver Medicare Thriving Kids services.
• Commissioned providers would need to meet a set of standards aligned with best practice in early intervention and child safeguarding.
• Families would receive funding based on the stage of the Key Worker Model they are in. They are provided then reviewed by GP/Child and Family Health Nurse further to additional funding being provided. This tiers the funding based on needs.
• Specialist Teacher must be added to list of approved disciplines as they are key to workforce in early childhood development.

Funding items under Medicare could look as follows for metro regions. Noting, this allows for travel in other more regional areas would be important or could be addressed through the commissioning of providers on the panel):

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APPENDIX 3 - PROGRAM LOGIC

High level Program Logic statements

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APPENDIX 4 - SAMPLE OUTCOMES DATA SURVEY

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APPENDIX 5 - RESEARCH SUMMARY – KEY WORKER MODEL

What are the key points and considerations?

• The use of a key worker in early childhood intervention is an accepted best-practice approach
• The implementation of a key worker model has become highly variable, particularly after the introduction of the NDIS, with the term used to describe a range of practices and roles, in early childhood intervention and in the wider sector
• Broadly, the term key worker is used to describe one person who acts as the contact point and liaison between the family and the wider team.
  • A transdisciplinary key worker not only acts as the main contact point, they are also the main person working with the family on supporting and extending the child’s development (Alexander and Forster 2012)
• There are some models of key worker service delivery that are evidence-informed, with agreed practices that underpin effective implementation
• There is some research that specifically measures the effectiveness of the key worker model (Clapham, Manning and Williams 2015) however the majority of the literature is focused on bringing together principles within early childhood development and intervention to articulate models, frameworks and practices (Alexander and Forster 2012; Early Childhood Intervention Australia 2016; Symes, Moore, Sayers, Swalwell and Johnston, 2011)
  • The review of the Kids Together program (2015) identified that through the delivery of a key worker approach across 15 ECECC sites, 84% of goals were achieved with improvements in skills, inclusion and everyday learning
  • The literature reviews and position papers are of high quality and represent significant pieces of work to bring together relevant research and literature and therefore should be weighted accordingly
  • On a service level, there is significant practice-based evidence to support the effectiveness of a (transdisciplinary) key worker model. For example, at Noah’s Ark family feedback and Canadian Occupational Performance Measure (COPM) score changes both support the effectiveness of a key worker model in family satisfaction and goal attainment

What are the underlying principles?

There are a number of agreed principles underlying effective early childhood intervention services. These are articulated in the Early Childhood Intervention Australia (2016) best

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practice guidelines which explore the areas of family, inclusion, teamwork and universal principles. The guidelines are used by the NDIS to define best-practice early childhood intervention approaches. Department of Social Services have commissioned a review of the guidelines which is currently underway. The Early Childhood Intervention Network’s (2023) discussion paper also summarises current agreed best practice approaches in early childhood intervention.

The Workgroup on Principles and Practices in Natural Environments (2006) developed a set of seven key principles, including an overview of what it looks like and doesn’t look like to guide quality service delivery. This is available here.

What are the high quality practices associated with a key worker model?

A proposed framework for the delivery of Early Childhood Intervention Supports (2011) articulated a framework with five elements:

1. Awareness and identification – focusing on awareness raising in mainstream services
2. Intake and referral – managed by a central team
3. Foundational supports – early support through a key worker as soon as eligibility is established to: a. Bridge waitlists for intensive supports b. Provide immediate emotional support and practical support c. Front load to reduce support needs in the future
4. Full program support – support co-ordination and planning, team support and intensive support, guided by a key worker. At this stage, the full transdisciplinary team becomes involved in providing support
5. Transition support - guiding transition out of early intervention

In this framework, they emphasise the importance of:

• Delivery of services through a key worker model
• Direct help to meet developmental and participation needs and co-ordination of supports and services; and
• Support that complements other existing services and systems

The authors (2011 p. 127) articulated the (transdisciplinary) key worker model using the following figure. It should be noted that the support and co-ordination element in the figure is often articulated as the ‘key worker’ element of a transdisciplinary key worker role.

This paper brings together current literature related to best practices in early childhood and information from a review of the Early Childhood Intervention System and was jointly authored by the Centre for Community and Child Health, the Murdoch Children’s Research Institute and the University of Melbourne. The full paper is available here.

Alexander and Forster (2012) have also published a book titled ‘The Key Worker: Resources for Early Childhood Intervention Professionals.’ This outlines the five key practices associated with the key worker element of a transdisciplinary key worker role. These practices are grounded in extensive review of the evidence and consultation with families and early childhood intervention professionals. The five agreed practices are:

1. Emotional support
2. Information and advice
3. Identifying and addressing needs
4. Advocacy
5. Service co-ordination

The resource goes into detail in relation to each of the practices, particularly their evidence base and key components and also provides a tool for professionals to reflect on their implementation of the practices. This resource is available here.

Capacity-building is assumed in all elements of the implementation of the transdisciplinary key worker role, with a focus on building the competence and competence of caregivers to support their child’s development and meet their family’s needs. Capacity building is also identified as an explicit approach within information and advice, advocacy and service co-ordination practices of a key worker.

THIS SUBMISSION IS ENDORSED BY THE FOLLOWING MEMBERS