NDIA Accountability Project

Submission 233 — Anglicare Victoria — Inquiry into the Thriving Kids initiative

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ANGLICARE VICTORIA SUBMISSION

Inquiry into Thriving Kids: House Standing Committee on Health, Aged Care and Disability

1 October 2025

Central Office
Collingwood
103 Hoddle Street
Collingwood VIC 3067
Tel: 03 9412 6133
anglicarevic.org.au

Table of Contents

1 Introduction

This submission to the Parliamentary Inquiry into the Thriving Kids Initiative seeks to highlight the circumstances and challenges in accessing service delivery facing children in out-of-home care (OOHC) who are living with a disability, and other families facing significant disadvantage.

Anglicare Victoria is one of Victoria’s largest providers of OOHC, including residential, foster and kinship care. We are also one of the state’s largest providers of family services, financial counselling and family violence services. This gives us unique insight into the challenges that vulnerable families, and children who are under statutory care in accessing assessment and diagnosis and services to help the child to manage their condition.

This submission focusses on the issues facing children in OOHC and other vulnerable families in seeking to access assessments and services, and highlights some of the unique challenges and circumstances that must be considered in order to improve access to services for these children and families. Different approaches are needed for this group, whose living circumstances, access to services, and personal experiences differ significantly from children with similar challenges who live with their parent/s.

Similarly, vulnerable and disadvantaged families often struggle to access timely and appropriate assessments and services for their children. This is not only a significant equity issue but is also a vital part of enabling families to overcome disadvantage. Poor access to appropriate assessments, services and supports will only service to deepen inequity and further entrench inequity and disadvantage, including the inter-generational disadvantage experienced by First People.

When a child is in care, and the state is acting as ‘corporate parent’ in loco parentis its obligation to provide for the unique needs of these children is clear. This will not be achieved through reliance on generalist services, but requires a tailored response.

We hope this submission with provide the Inquiry with some insight into the issues facing children in out-of-home care and other vulnerable families.

Anglicare Victoria would be pleased to discuss the issues raised with you in this submission in more detail.

2 Identifying development delay for disadvantaged children, including

those in care

2.1 Recognising the needs of children in care

Globally, child welfare services (CWS) are increasingly challenged to identify and address neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention- deficit/hyperactivity disorder (ADHD) and other related conditions among vulnerable children and young people. These populations, including children in foster care, those exposed to maltreatment, and those living in socioeconomically disadvantaged environments, present unique complexities for diagnosis and intervention.

Over the past 15 years, researchers and practitioners have developed numerous processes, systems, services, multi-disciplinary team frameworks, and clinical trials to support CWS in detecting and responding to NDDs, as outlined in Appendix One.

While there are tools available to assist with assessments for children in care as outlined in the Appendix, not all specialists and practitioners will be familiar with the tools most appropriate for this cohort, or have the skills required to work with a child with a complex history and comorbidities that often include significant trauma that complicates diagnosis, and may also display behaviours that are difficult to manage, particularly in the group setting of a residential care home. Outreach models are much more likely to successfully engage young people in care than appointment or “office based” models, but these are offered by very few professionals.

It is important to note that many young people in care experience placement instability and carer changes. This increases the risk that planned assessments are missed due to change in carer or location or child protection case manager, or that the child’s circumstances have altered so significantly since the assessment that further review is required.

Further, while family services and residential care staff have much to contribute in supporting young people, they are not qualified to carry out assessments that require specialist input. Therapeutic specialists in residential care, who do have relevant qualifications, can play a positive role here in bringing the professional gap between care staff and other clinical services.

Over the past 15 years, the field has witnessed substantial innovation in processes, systems, services, multidisciplinary team structures, and clinical trials aimed at supporting child welfare services in identifying neurodevelopmental disorders among vulnerable children and young people. Continued collaboration, research, and investment are essential to further enhance the capacity of CWS to ensure timely and accurate detection, leading to better outcomes for affected children and their families.

A one-size fits all approach that relies on parental intervention and engagement with generalist services will never be sufficient for this unique cohort.

2.2 Supporting vulnerable families

AV’s experience is that these challenges are even greater for families who may be faced with complicating factors and stressors such as housing instability, family violence, justice and legal issues or behavioural challenges affecting multiple members of the family. This may include parents and or

other family members themselves living with a disability or neurodiversity which may or may not have been formally diagnosed and for which they may or may not be accessing support. Planning and provision of support is even more complex if there are other comorbidities such as mental health issues or harmful substance use present.

Our family services teams across the State report that State brokerage funding — intended to provide disadvantaged families with supports and opportunities to enhance their wellbeing and circumstances - is often spent on securing assessments. Some teams report that up to 80% of brokerage funding is being expended to secure assessments, as securing support for the child is the most urgent priority of the family, particularly in cases of high risk. However, brokerage is finite and this means that there is limited capacity to assist families in other ways.

In those cases, our staff report that families will often “fall through the gaps” until they encounter difficulties at school or childcare. Even then, there is a high risk of school disengagement prior to assessment of treatment plans being secured.

The challenges that families face is securing assessments are well documented, and even where families are able to afford private assessments, waiting times can be significant and it can be difficult for parents to negotiate advice to find a positive path forward for their child.

3 Programs and initiatives that identify and support vulnerable

children and families experiencing disadvantage, including those in care

Mainstream services such a playgroups, maternal and child health and can play a critical role in recognising that a child may require assessment for developmental delay, ASD or both. For vulnerable families in particular, the difficulty that children and their families have in engaging with mainstream services may be the catalyst for further investigation.

However, many highly vulnerable families do not have positive experiences of generalist services, nor do generalist services have the capacity to manage the multiple needs of a family with complex presentations. In these cases, families may seek or be referred to the kind of family supports that Anglicare Victoria provides.

Family services staff also play a critical role in recognising that difficulties that a family is experiencing in parenting of behaviour management may be — wholly or in part — due to undiagnosed developmental delay or ASD. Similarly, when a child is in out-of-home care, residential care workers or kinship and foster carers may be the first to recognise that issues such as ASD or developmental delay may be an issue for a child. However, for this group behaviours and habits that might otherwise be deemed worthy of assessment may have been overlooked or attributed to a trauma response.

As outlined above securing the assessments needed to quality for support can be very challenging for all families, particularly those who may be financially struggling or dealing with multiple challenges and issues at once. When assessments have occurred, our staff have also reported that some families may

struggle to interpret the findings, and if they have had previous contact with child protection services, may be afraid to ask.

Staff cited one example of a family who was eligible to receive speech pathology for their child, but had not accessed it because they were confident their child could speak well — and there was not sufficient information available to them, presented in a way they understood, to understand how that service might help. There is a significant disequilibrium of information that makes it difficult for vulnerable families to make informed choices. Much of the information and resources that are available assume a level of literacy and access to computers, affordable internet and information and analysis that not all families enjoy — particularly if they are experiencing homelessness or severe financial hardship.

Specialist assessments and interventions must therefore continue to be available for vulnerable and complex families and children, in the context of a range of social supports and services to address multiple and complex needs.

It is critical that services are available that are able to work with the family as a whole in these cases, rather than viewing the child’s diagnosis or suspected diagnosis in isolation. Even if the child is experiencing moderate delay, management and support for the child can be very difficult in the context of a family with multiple needs.

The risk, if families are not supported, is that the child misses out on critical supports and that opportunities for early intervention are missed. This can be a catalyst for families in crisis. In rare cases (less than 5% of children in care), children enter care as a result of the family deciding they are unable to care for them. Research shows that lack of support in managing a disability of some kind is a factor in 40 — 60% of “voluntary” relinquishments.

This carries a high personal cost for all concerned, and is a poor use of finite public resources given the poor health, wellbeing, social and economic outcomes experienced by children in care. A comparatively small investment to facilitate timely assessment and effective, family-based support will deliver much better outcomes.

4 Equity and intersectionality

Children and people who are in the care of the state are one of the most disadvantaged groups in our society. They experience poorer outcomes that their peers across a range of domains, including health, mental health, wellbeing, employment, education and training, and housing. The disadvantage they experience during their childhoods, and the impact of the trauma and neglect that in most cases has led to their placement in care, has impacts throughout their life course.

Despite their unique needs and circumstances, and despite the fact that governments are in loco parentis, playing the role of parent for these children, they are frequently over-looked in research and public policy. For example, they are not mentioned in the review documentation that informed Thriving Kids.

Further, addressing the needs of children in out-of-home-care is a key part of ensuring that we improve outcomes for First Nation children and families. Nationally, the rate of First Nation children aged 0-17 years in OOHC was 50.3 per 1000, and the rate is worsening. This compared to a national rate of about

8 per 1000.

Improving outcomes for children with a disability in OOHC will directly impact on a range of Closing the Gap targets by improving outcomes across a range of health, wellbeing and economic domains.

“The removal of Aboriginal and Torres Strait Islander children contributes to poorer outcomes in relation to health, education, housing and employment (AIHW 2018; Healing Foundation 2013). There is also a link between out-of-home care, juvenile justice and the over-incarceration of Aboriginal and Torres Strait Islander adults in the criminal justice system (ALRC 2017).” (Productivity Commission, n.d.)

There is no national prevalence data on the number of children in OOHC who are First People and have disabilities, although the Bringing them Home report did identify that over half of the children in care in the Northern Territory were Indigenous, and of those, almost half had a disability (Human Rights and Equal Opportunity Commission, 1997).

4.1 Disability and Out-of-Home Care

Children and young people with a disability are significantly over-represented in OOHC. A survey in 2024 of 438 children in AV’s care found that 64% had a diagnosed or suspected disability.

This is consistent with the findings of a review of 166 files of young people living in care over 15 years old conducted by the Commissioner for Children and Young People that found that 67% has a disability, compared to an estimated 10% in the general population.

A number of access issues have been identified for these young people:

  • Children and young people can wait up to 18 months for a disability assessment to determine their eligibility for the NDIS
  • Once a plan is made, young people face waits for up to 8 months for a provider. Further, plans often don’t match their needs and are not regularly reviewed to reflect changing support needs.
  • Children and young people in care are not able to readily access their plan or seek a review of their plan.
  • 16-17 year olds in care run out of time — some leave care without eligibility assessments, making them ineligible for the NDIS or supported housing options — effectively rendering them homeless.

There is also evidence to show that children who have a disability have different experiences of care and experience different outcomes when leaving care. These issues were highlighted in a University of Sydney Literature review (Children with disability in out-of- home care — summary of the literature, 2022) which notes that

The complex intersections between OOHC and disability have implications for policy and practice. However, despite the overrepresentation of children with disability in OOHC there has been limited attention to this group in research, policy or practice. At present, there remains significant gaps and

a lack of collaboration between disability services such as the National Disability Insurance Scheme (NDIS) and child welfare services supporting children and young people with disability in OOHC and transitioning out of care. (Children with disability in out-of- home care — summary of the literature, 2022)

The University of Sydney paper notes that

  • Young people with a disability are more likely to experience negative outcomes when transitioning from care compared to others
  • Young people with a disability in OOHC are at higher risk of abuse and poor outcomes than both their peers without a disability in OOHC and their peers with a disability in the general population
  • The relationship between disability and maltreatment is complex and bidirectional such that children with a disability are not only more susceptible to abuse and neglect but maltreatment itself can increase the child’s risk of acquiring a disability
  • Children with a disability experience higher rates of placement disruption and longer stays in care than children without a disability.
  • Young people with a disability in OOHC have poorer outcomes, lower quality and life and more restrictive placements that other young people in care and young people with a disability who are not in care — this includes being more likely to be placed on mediation

Young people transitioning from care with social/emotional disabilities are at higher risk of poor outcomes including unsafe housing, low education attainment, unemployment, and incarceration, compared to their peers with other types of disabilities (Cheatham et al., 2020; Kang-Yi & Adams, 2017; Lee et al., 2022; McCauley, 2021; McCauley, 2022; Mendes & Snow, 2014; Snow et al., 2016 quoted in (Children with disability in out-of- home care — summary of the literature, 2022)).

The care environment is challenging for all young people, but some of the characteristics of the care environment can be particularly difficult for those children who are living with a disability. For example, care guidelines note that for many children with ASD and/or sensory difficulties, significant life changes, or changes to routines in the environment can be unusually challenging and disruptive.

Young people in residential care are often exposed to frequent changes in their households and routines, including placement instability affecting themselves or other members of their household. This makes it a challenging environment for them, as well as presenting the practical and logistical difficulties in establishing and maintaining care routines, accessing and maintaining services and therapeutic relationships, and the regular review of plans that guidelines recommend. The high likelihood that they are living with other children and young people with disability- or trauma-related behavioural issues who may or may not have access to supports further contributes to sometimes volatile household dynamics in residential care and a high risk of escalation when disruptions do occur¹.

Despite this demonstrable need, in 2021 disability in status was only available for 57% of children in OOHC is Australia. This makes it difficult to quantify the impact that any changes in services would have for this cohort.

¹ One of the consequences of this is higher rates of occupational violence and worker stress and burnout, which in turn contributes to staffing instability and higher costs related to workplace harms.

5 Workforce support and training

Access to allied health services is a significant gap for all families, but particularly for families living in rural areas, in low-income areas, and for low-income families who are reliant on the public system to access allied health support.

Access to paediatricians is an area of particular concern that leads to significant waiting times, particularly in rural areas.

As discussed elsewhere in this submission, accessing services including mainstream services such as general practice and maternal and child health is particularly challenging for families who are have multiple and complex needs, and children who are living in out-of-home care, as this will make assessment, care planning and service delivery more difficult to arrange and access.

Access to practitioners of all kinds who are trained and capable in delivering care in a way that is trauma informed — particularly when working with children and young people in out-of-home care — presents and additional challenge.

In 2023, AV conducted a survey of our practitioner workforce in relation to their capacity and confidence to work effectively with clients experiencing disability. 94% of practitioners across our range of services indicated that they “regularly” or “mostly” worked with clients experiencing disability.

Further, whilst the majority of practitioners indicated that they were confident they could identify signs of undiagnosed neurodevelopmental disability and work effectively to meet the support needs of such clients, around a third of practitioners indicated that they were only ‘somewhat’ confident or less. AV has since put in place a number of training initiatives to improve skills and knowledge across our practitioner workforce.

However, it is important to note that training for the child welfare workforce needs to be complemented by strong and effective disability support, as the latter is outside the scope or practice and service and regulatory frameworks within which residential care operates.

6 Domestic and international policy experience and best practice.

6.1 International evidence

Please refer to Appendix One for a review of approaches and practices applicable in child welfare settings for both assessment and management.

6.2 Aspire 2 Be

In 2022, AV and Yooralla joined forces to develop the Aspire 2 Be program, which aimed to improve the support provided to young people with a disability who were living in out-of-home care, including both residential and home-based care types.

Yooralla provided staff from both its NDIS Support Coordination teams and its Specialist Behaviour Support teams, supported through an initial funding commitment from AV. The trail was then extended

further after additional funding was provided by the Victorian Department of Fairness, Families and Housing (DFFH).

Type of disability Number Percentage
ADHD 4 3%
ASD 81 64%
Developmental delay / intellectual disability 23 18%
Foetal alcohol spectrum disorder (FASD) 4 3%
Mental health issue / personality disorder (with substantial impact on function/capacity) 8 6%
Neurological issue / brain injury 3 2%
Other 4 3%

As shown in the above table, most common diagnoses of these client were ASD and developmental delay.

It is also important to note that of the initial 108 clients of the program 57% were not accessing the NDIS or had no support coordinator at the time of referral.

This, and the significant uplift in services that was identified in order to meet these young people’s needs (see graphic) demonstrates the systemic under-servicing that these vulnerable young people experience.

It is critical that the implementation of the Thriving Kids program and the associated changes to NDIS services and accessibility works to enhance and improve access to services by vulnerable young people including those is care.

6.3 Transition and the role of mainstream systems

As noted above, many of the children and families that AV works with have difficulty accessing mainstream services, experience barriers (including stigma and discrimination) in accessing mainstream services. In some cases, such as the children and young people we work with through our Navigator and TEACHAaR programs, children are engaged in our services specifically because they are disengaged from school and other key mainstream services.

For those families that are able to access mainstream services and supports, our staff report that inconsistencies in services requirements in terms of documentation, evidence and assessment presents a significant barrier to families. Issues cited from our staff include

  • Complex and time-consuming assessment processes which can be very difficult for families to complete, particularly in they have poor comprehension and/or English language literacy skills or have difficulties processing and understanding information
  • Time and resource constraints, particularly if there are multiple members of the family requiring assessment and or service. This is particularly difficult for families who may struggle to access or afford transport, or who work in the ‘gig-economy’ and must forgo wages in order to attend appointments.
  • Parents/carers of the child have a disability themselves, including those with other comorbidities such as poor mental health or harmful substance use

Our staff report that transition between service types can be particularly challenging for families, and a source of significant delay and concern. Examples include needing to meet different requirements when changing services as a child ages, or when seeking support from schools.

When parents are given a plan or advice about what services their child needs, it is not always clear to them what the service is for or what it will achieve for their child. For example, families are not always clear about why a referral to a speech pathologist or occupational therapist has been recommended, as there is a significant disequilibrium in information about the role those practitioners can play in supporting communication and behaviour management.

Most of AV’s clients are reliant on publicly funded services, which are characterised by significant waiting times and limited availability. This can create a self-perpetuating cycle in which families are unable to gain timely access to the supports they need, and as a result opportunities to better manage challenging behaviours are lost. While services are delayed, behaviours can escalate leading to further exclusion from schools, child-care and other generalist/mainstream services. Earlier access means earlier intervention. Earlier intervention means better outcomes for children, families and funders.

Many of the vulnerable families we work with have multiple and complex needs. These vary from family to family but may include co-morbid health and disability conditions, parenting and child welfare concerns, or experience of family violence, trauma, housing instability and homelessness and justice engagement. Many mainstream services, such as general practices, maternal and child health services, schools and childcare centres will have little or no experience and capacity in dealing with this level of complexity. Most are designed to work primarily with a single individual, rather than taking the whole of family approach needed to embed effective and sustainable management plans.

7 References

Achenbach, T. M., & Rescorla, L. A. (2013). Manual for the ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

Bailey, C., et al. (2016). Multidisciplinary approaches to neurodevelopmental disorders in child welfare populations. Child and Adolescent Psychiatry and Mental Health, 10, 16. [URL]

Bishop, S. L., et al. (2011). Identification of autism spectrum disorders in children in foster care. Journal of Autism and Developmental Disorders, 41(6), 775-784. [URL]

Child Health and Wellbeing Subcommittee of the Australian Population Health Development Principal Committee with input to Clinical Assessment Framework from the Nous Group. (2011). National Clinical Assessment Framework for Children and Young People in Out-of-Home Care (OOHC). Canberra: Australian Government Department of Health and Aging.

Brenner, M., Kidston, C., Hilliard, C., Coyne, I., Eustace-Cook, J., Doyle, C., . . . Barrett, M. J. (2018). Children’s complex care needs: a systematic concept analysis of multidisciplinary language. European Journal of Paediatrics.

Cheng, Z., Masimiliano, T., & Katz, I. (2023, September). [[ChildAbuseandNeglectOutcomesforchildrenwithdisabilityinout-of- homecareEvidencefromthepathwaysofcarelongitudinalstudyinAustralia.pdf#page=Outcomes for children with disability in out-of-home care Evidence from the pathways of care. Child Abuse and Neglect.

Cheng, Z., Massimiliano, T., & Katz, I. (2024). Children with Disability in Out-of-Home Care: Prevalence and Characteristics.

(2022). Children with disability in out-of- home care — summary of the literature. University of Sydney, Research Centre for Children and Families. Sydney: University of Sydney.

Dawson, G., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17-e23. [URL]

Fitzgerald, M., et al. (2015). The Neurodevelopmental Assessment Protocol for children in child welfare: Results from a multicenter randomized controlled trial. Child Abuse & Neglect, 45, 89-98. [URL]

Fixsen, D.L., et al. (2015). Implementation science and child welfare: Improving outcomes for children and families. Child Welfare, 94(2), 55-73.

Ford, T., et al. (2017). Mental health screening among children in foster care: The UK experience. British Journal of Psychiatry, 211(5), 285-292. [URL]

Fletcher, J., et al. (2019). Specialist neurodevelopmental clinics: Improving diagnostic accuracy in child welfare. BMC Pediatrics, 19, 134. [URL]

Gatwiri, K., McPherson, L., & James, S. (2024). Experiences of Children and Young People with a Disability in Out-of-Home Care in Australia: A Scoping Review. Health and Social Care in the Community. Retrieved from doi.org/10.1155/2024/3456823

Gonzalez, A., et al. (2022). Predictive analytics in child welfare: Identifying neurodevelopmental risk. Child Maltreatment, 27(1), 28-39. [URL]

Goodman, R., et al. (2010). The Strengths and Difficulties Questionnaire: A decade of research. European Child & Adolescent Psychiatry, 19(2), 87-97. [URL]

Huang, L., et al. (2015). Integrated electronic health records for vulnerable children: Lessons from child welfare. Journal of Health Care for the Poor and Underserved, 26(1), 20-34. [URL]

Neurodisability Among Children at the Nexus of the Child Welfare and Youth Justice System. (n.d.). Retrieved from https://www.researchgate.net/publication/340707176_Neurodisability_among_Children_at_the_ Nexus_of_the_Child_Welfare_and_Youth_Justice_System

Productivity Commission. (n.d.). Socio-economic Outcome are 12: Aboriginal and Torres Strait Islander chidlren are not overrepresented in the child protection system. Retrieved from Closing the gap Infomation Repository: https://www.pc.gov.au/closing-the-gap-data/dashboard/outcome- area/child-protection/

8 Appendices

8.1 Appendix 1: About Anglicare Victoria

AV works with children, families and young people to build better tomorrows. We work to find solutions for children in need, create opportunities for young people, and support families to stay safe and together. We take action today to deliver better and fairer outcomes tomorrow.

Every child has the right to be safe and happy. AV works with our clients to understand their challenges and see their strength. We are single-minded in our mission to create positive change and support the people we work with in their journey towards a better future.

Please visit us at http://www.anglicarevic.org.au/ for more information

8.2 Appendix 2: Identifying Neurodevelopmental Disorders in Vulnerable Children and

Young People: A Comprehensive Review of Developments in the Last 15 Years

8.2.1 Introduction

Globally, child welfare services (CWS) are increasingly challenged to identify and address neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention- deficit/hyperactivity disorder (ADHD), and other conditions affecting the brain and mind among vulnerable children and young people. These populations, which include children in foster care, those exposed to maltreatment, and those living in socioeconomically disadvantaged environments, present unique complexities for diagnosis and intervention. Over the past 15 years, researchers and practitioners have developed numerous processes, systems, services, multi-disciplinary team frameworks, and clinical trials to support CWS in detecting and responding to NDDs. This paper provides a comprehensive overview of these advances.

8.2.2 Processes and Systems for Identification

8.2.2.1 Screening and Assessment Tools

One of the foundational approaches to identifying NDDs in child welfare populations has been the systematic adoption of validated screening and assessment tools. The use of instruments such as the Strengths and Difficulties Questionnaire (SDQ) and the Child Behaviour Checklist (CBCL) has shown efficacy in preliminary detection of emotional and behavioural difficulties, often associated with NDDs (Goodman et al., 2010; Achenbach & Rescorla, 2013). More specific tools, such as the Social Communication Questionnaire (SCQ) for ASD and the Vanderbilt ADHD Diagnostic Rating Scale, have been integrated into initial child welfare intakes, improving early detection rates (Bishop et al., 2011; Wolraich et al., 2019).

Advancements in digital health have enabled the adoption of web-based screening systems, allowing for scalable and consistent assessment across diverse settings (Kelleher et al., 2018). For example, the Mental Health Screening Tool for Children in Care (MHS-Care), developed and trialled in the UK and Australia, demonstrated improved sensitivity in identifying NDDs within foster care populations (Ford et al., 2017; Tarren-Sweeney, 2013).

8.3 Referral Pathways and Data Integration

Robust referral pathways are essential for translating screening results into clinical action. The development of integrated digital record systems has enhanced collaboration between CWS, health, and education sectors. Shared electronic health records and case management platforms facilitate real- time communication regarding assessments and referrals (Huang et al., 2015). The integration of predictive analytics within these systems has also been trialled to flag children at risk of NDDs based on cumulative adverse childhood experiences (ACEs) and behavioural data (Gonzalez et al., 2022).

8.4 Services Developed for Vulnerable Populations

8.4.1 Specialist Diagnostic Clinics

Recognizing the complexity of NDD presentations in children exposed to adversity, specialist clinics dedicated to neurodevelopmental assessment have emerged. These clinics offer multidisciplinary evaluations, combining medical, psychological, and educational perspectives. The “Child and Adolescent Neurodevelopmental Service” (CANS), trialled in Canada and the UK, provided comprehensive assessments resulting in increased diagnostic accuracy and tailored intervention plans (Fletcher et al., 2019; McDonnell et al., 2021).

8.4.2 Outreach and Mobile Assessment Teams

For children in remote communities or unstable care settings, outreach services and mobile teams have been established. These teams deploy clinicians to foster homes, shelters, and community centres, conducting assessments and providing ongoing monitoring. Studies have shown that mobile outreach improves access to diagnostic services for Indigenous and rural populations, reducing disparities in NDD identification (Pearson et al., 2019; Williams et al., 2020).

8.4.3. Telehealth Services

Telehealth platforms have become increasingly prominent, especially since the COVID-19 pandemic. Virtual assessments for ASD and ADHD using structured video interviews and digital observation tools have demonstrated moderate-to-high reliability compared to in-person evaluations (Juarez et al., 2018; Parmar et al., 2022). Telehealth also enhances continuity of care and reduces geographic barriers for vulnerable young people (Pickard et al., 2016).

8.5 Multi-disciplinary Teams and Collaborative Models

8.5.1 Integrated Care Teams

Multi-disciplinary teams (MDTs) have been central to effective identification and management of NDDs in child welfare populations. These teams typically comprise paediatricians, psychologists, social workers, occupational therapists, speech-language pathologists, and educational specialists. The integration of MDTs within child welfare agencies has resulted in earlier identification, more accurate diagnosis, and better coordinated interventions (Bailey et al., 2016; Noritz et al., 2013).

8.5.2 Cross-Sector Collaboration

Collaborative models involving health, education, and social care sectors have shown promise in addressing the multifaceted needs of children with NDDs. The “Wraparound” model, for instance, builds individualized service plans through coordinated input from all relevant sectors, demonstrating improved outcomes in trials involving children in foster care (Walker & Bruns, 2015). Inter-agency training initiatives have improved professionals’ capacity to recognize and respond to NDDs (Stahmer et al., 2015).

8.6 Clinical Trials and Evaluative Studies

8.6.1 Randomized Controlled Trials (RCTs)

RCTs have played a critical role in evaluating the effectiveness of various identification processes and services. For example, a multicentre RCT of the “Child Welfare Neurodevelopmental Assessment Protocol” demonstrated significantly higher detection rates of ASD and ADHD among children in foster care compared to standard practice (Fitzgerald et al., 2015). Another trial evaluating the “Early Start Denver Model” for young children with ASD found that children in child welfare settings who received the intervention showed greater improvement in social communication skills (Dawson et al., 2010).

8.6.2 Longitudinal Studies and Implementation Science

Longitudinal studies have highlighted the importance of sustained monitoring and flexible service delivery for children at risk of NDDs (Siskind et al., 2019). Implementation science frameworks have been applied to optimize integration of screening and assessment into routine child welfare practice, ensuring scalability and sustainability of evidence-based approaches (Fixsen et al., 2015).

8.7. Conclusions

Despite significant advances, challenges remain, including variability in access to services, cultural and linguistic barriers, and under-recognition of NDDs in children with complex trauma histories (Murray et al., 2014). Ongoing research is needed to refine screening tools for diverse populations, develop culturally sensitive assessment approaches, and enhance workforce training.

Over the past 15 years, the field has witnessed substantial innovation in processes, systems, services, multidisciplinary team structures, and clinical trials aimed at supporting child welfare services in identifying neurodevelopmental disorders among vulnerable children and young people. Continued collaboration, research, and investment are essential to further enhance the capacity of CWS to ensure timely and accurate detection, leading to better outcomes for affected children and their families.