Submission to the House Standing Committee on Health, Aged
Care and Disability: Thriving Kids inquiry
3rd October 2025
Submission to the House Standing Committee on Health, Aged
Care and Disability: Thriving Kids inquiry
Prepared by
Professor Helen Dickinson, University of New South Wales, Canberra
Dr. Catherine Smith, University of Melbourne
Professor Anne Kavanagh, University of Melbourne
Professor Dennis Petrie, Monash University
Enquiries about AHEAD should be sent to AHEAD@Monash.edu
This submission is made on behalf of the Research Alliance for Youth Disability and Mental Health (RAY) and Achieving Health Equity for all People with Disability (AHEAD).
We note the terms of reference for the inquiry are expansive and will need thorough investigation. Rather than address each of the terms of reference directly our submission is structured around a set of recommendations.
About AHEAD and RAY
Funded by the National Health and Medical Research Council, RAY and AHEAD primarily focus on addressing the social determinants of health that lead to inequalities for people with disability.
Our research demonstrates that Australians with disability are less likely to be employed, are less likely to have completed school or have participated in higher education, live on lower incomes, more likely to face violence, abuse, neglect and discrimination, and are more likely to be socially isolated, all which are likely to contribute to their poorer health outcomes (Kavanagh et al., 2013, 2015, 2016, Fortune et al., 2022, Bishop et al., 2024). Moreover, children and young people with disability are found to have significant inequalities in mental health (Bishop et al., 2023, Leung et al., 2023). Many drivers of these inequalities relate not to the impairments of individuals but to social determinants such as health, housing, community attitudes, employment and education.
The early years of a child’s life are crucial and can play an important role in determining life trajectories. The service system that supports Australia’s children and families therefore plays a key role in ensuring the health and wellbeing of the population in the future. Investing in appropriate services and supports during childhood years can also be more efficient over the longer term, with individuals able to be more independent and included in society.
The current system
We recognise and understand a number of the drivers for the creation of the Thriving Kids program. It is clear that the NDIS system of personalised budgets and
disconnected fee-for-service providers is not working well for some supports for some children and that the creation of the NDIS has, for some, moved supports away from the natural environments that children and young people live, play and learn in. In addition, it has created incentives for organisations, such as schools, to shift responsibility and costs to the NDIS. Moreover this shift of responsibility has led to significant gaps between those who are able to access services and supports (e.g. through the NDIS) and those who miss out further pushing families to apply for NDIS support. The NDIS has also led to significant gaps between different systems (e.g. health, education) which has led to services and supports often being experienced as uncoordinated to children and families. This has led to significant input needed from families and supporters to navigate the system to join up education, health and supports for these children.
Despite the research data we (and others) have gathered through programmes of research, the research and data infrastructure surrounding the NDIS is not fit for purpose and this poses a significant barrier in engaging in evidence-informed reform. The NDIS data currently has information on budget allocation and payments but lacks rigorous information on the types and quality of services provided and outcomes achieved. Furthermore, while the NDIA is now making data available to external researchers, which theoretically should enable greater oversight, there are still major issues in terms of information about the data so researchers are ‘in the dark’ about the meaning of data items and whether all the information is in the dataset. Moreover, beyond the NDIS there is a complex infrastructure of different evidence sources across different sectors that is not always joined up making it difficult to understand how children and their families navigate service systems.
The Thriving Kids proposal provides an opportunity to deal with these issues if it is well designed in collaboration with children, families, communities and a range of relevant professionals. Careful consideration is needed on how this programme is implemented and that there is sufficient timeframe and budget for planning, continual monitoring and modifying the programme based on outcomes and consideration of the latest evidence. But to be successful Thriving Kids would also need a systems response engaging not only children and young people with disability and their families but also stakeholders from health, education,
early childhood education and care and a variety of other local actors. This landscape is complex and any reforms will likely have both intended and unintended consequences for other parts of the system. The various stakeholders will also likely respond to changes in incentives. It is therefore important that any reforms are iterative, with opportunities for ongoing learning and evaluation, and careful consideration is given to the impacts of these for children and families and broader systems of supports. We also emphasise that there is unlikely to be a ‘one size fits all’ solution.
In this submission, we make seven recommendations and outline important issues that must be addressed for Thriving Kids to be successful. We strongly recommend that the timeline for implementation of this initiative be extended by at least one year and/or staggered across areas to enable genuine co-design, provide opportunities for cross-sector collaboration, test and evaluate potential approaches to find out what works, and develop the systems and structures to fund this work across multiple sectors and levels of government.
Recommendations:
- Take a systems-based response - To be successful Thriving Kids needs a systems response where there is full consideration given to the impact of these reforms to different systems elements; for example if schools experience pressure to provide more supports without significant uplift in resourcing and skills, it could see them nudge children with more significant developmental delay to move into specialised school settings or to move to schools that are willing to provide such support but are based further away from where they live.
- Take a place-based approach recognising that services and supports will be integrated into local communities where children live, learn and play and so Thriving Kids will need to vary across Australia, with national guardrails and evidence-informed recommendations.
- Genuine co-design to ensure that Thriving kids addresses the needs of each local community. This means that co-design needs to be more than a national
approach but will require intensive investment in co-design at a local level involving a broad range of stakeholders from families, schools, early childhood, primary health networks, maternal and child health care centres. This will require some flexibility as the needs and resources within communities will vary. 4. Identify and scale-up existing supports that are supported by evidence and are working well. 5. Invest in building an evidence base with transparency in communication of findings. This ultimately will lead to efficient and effective investments and greater buy in from all stakeholders. This requires action multiple fronts: - 5a Build a culture and commitment to continual learning and innovation so Thriving Kids can evolve and deliver better outcomes for children over time. - 5b. Continual monitoring of intended and unintended outcomes, including feedback from stakeholders to hold the system to account and identify areas for improvement. - 5c. Test and evaluate reforms through a series of place-based trials to enable an evidence base to be generated and potential unintended impacts on children and families and other service systems are identified before rollout across the entire Australian population, noting that one of the major problems with the current approach has been a lack of commitment to evaluation. In the early days of the NDIA committed to ‘building the plane while flying it’ and this has occurred with a lack of focus on costs and little attention to outcomes. - 5d. Build the research and data infrastructure that enables rigorous evaluation of programs. The current data is not ‘fit for purpose’ as it was designed for actuarial purposes (i.e., to project future costs) with the inevitable consequence of costs being the primary driver of reform decisions. Without careful design with the disability community and researchers we will be in the same position again and will lose the opportunity to identify unintended consequences, learn together, evaluate and improve further. This infrastructure must be built now to enable before and after evaluation. Building this infrastructure requires greater collaboration and transparency and commitment to co-design of data systems between all levels of government, researchers and the disability community. It also requires
investment in building the analytic capacity - at the moment Australia does not have sufficient capacity within government and academia to conduct the complex analysis required for rigorous evaluation. Despite being a decade in, don’t know which groups of children the NDIS has worked well for, those it has not, and the outcomes for children who have developmental delay or other issues. Thriving Kids is being introduced in this vacuum. 6. Identify the investment and uplifts needed in other sectors, such as health and education, to deliver the Thriving Kids programs and the funding mechanisms to achieve this. Many of the systems expected to implement Thriving Kids such as the early childhood education and care and schools are already under extreme pressure; addressing these is critical to the success of Thriving Kids. 7. Lengthen the timetable for full implementation of the Thriving Kids program so that: - There is adequate time and resources for genuine co-design. - There are existing supports where evidence exists and they are already working and these should be built on. - Place-based reforms will best meet the needs of communities and Thriving Kids will need to look different across various places although with an appropriate national framework and clear guard rails. - Mainstream services (e.g. education, health) are uplifted so that they are able to appropriately meet the needs of children with disability. - Fit for purpose research and data infrastructure is in place
With so little information about how Thriving Kids will operate it is difficult to respond to these proposals in a detailed way as many elements of the system design are yet to be determined. Given this, and that many areas of the system (e.g Early Childhood Education and Care, Education) are currently under significant pressure, we believe that the timescales outlined for the programme are too tight. There is insufficient time to give genuine commitment to co-design and to enable development of an evidence-base to ensure that any reforms are informed by good practice. There are a number of existing examples of good practice around the country (e.g. child and family hubs). These should be identified and carefully studied to ensure that any reforms are evidence-informed. This would be best done through
a series of pilot programs across the country that have evaluation built into these to ensure that they have the intended impact.
Local context is important and careful consideration will need to be given to the design of Thriving Kids in different areas. One model will not fit all areas and place-based approaches can empower local communities and help reflect the needs of children and families (Badland et al., 2025, Alderton et al., 2025). Thriving Kids could provide a national framework with evidence-informed recommendations but must also have flexibility so that local areas can choose to develop the responses that work most effectively for their context. This program must also come with resources to help fund the collaboration that will be needed across local systems to ensure that the most appropriate systems can be developed. The role of joining up various service systems (e.g. health, education) cannot be left to families and needs active consideration to which individuals and/or organisations will have responsibility and support this role. Moreover, this will require robust data and monitoring to make sure that systems are well designed, implemented and evaluated.
There needs to be careful consideration given to intersectional disadvantage and the impact that these reforms might have on different groups (e.g. Indigenous populations, culturally and linguistically diverse populations, people living in rural or remote areas). This will need authentic co-design to ensure any interventions are culturally safe and diverse and are communicated in a variety of ways to ensure equity of access to services and equity in the outcomes from these services.
Rural and regional communities face thin markets for allied health and general practice (Carey et al., 2018, Dickinson et al., 2022c). In these locations, in-reach models, telehealth with privacy safeguards, and commissioning flexibility are essential to ensure Thriving Kids does not simply export inequity (AMA, 2023; Department of Social Services, 2024). Price differences between NDIS, Medicare and community services can pull providers toward the highest payer; if Thriving Kids is to function as intended, it must anticipate provider behaviour in thin markets and support local partnerships and commissioning (Early Childhood Education and Care/schools, Maternal Child Health, community services) that keep services anchored where children live, learn and play.
First Nations and CALD families must not be retrofitted into generic models. Co-design with First Nations communities, recognition of local knowledge and languages, trained interpreters, and navigators are not optional add-ons—they determine access and trust. Existing evidence and national guidance on rights and privacy emphasise participation and control of data, as well as culturally safe delivery (United Nations Committee on the Rights of the Child, 2021; ARC Centre of Excellence for the Digital Child, 2025).
Teacher shortages, and limited GP and allied-health availability and the costs of accessing these service, are the binding capacity limits in many communities (Department of Education, 2022; AMA, 2023). Thriving Kids design and timelines must calibrate expectations to local supply. Where staffing is thin, documentation should be interoperable (reuse Individual Education Plans/NCCD), and delivery should prioritise in-reach and shared roles that make best use of scarce professionals. Funding will work equitably where it is used to purchase time and coordination—teacher release for consultation and adjustment follow-through, coaching and supervision, and navigators who reduce the burden on families.
Evidence demonstrates that children and young people with disability experience a range of challenges in schools and Early Childhood Education and Care settings including bullying with substantial impacts on the mental health, restrictive practices, exclusion and suspension and a perception that educators do not have the training or resources to make appropriate adjustments or accommodations (Dickinson et al., 2022, Dickinson et al., 2023a, 2023b, Smith et al., 2025a, 2025b). Parents and young people often identify that this is not the fault of individual teachers but of school systems lacking the time, funding and capability to address their needs appropriately.
Meta‑analyses and inquiries show that students with disability—particularly autistic students—are significantly more likely to experience peer victimisation, with pooled estimates around 40% reporting bullying in school‑age samples, alongside disproportionate exposure to restraint, seclusion and other exclusionary practices; these exposures are associated with elevated anxiety/depression and disengagement from learning (Maïano et al., 2016; Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, 2023; Schacter et al.,
2021). What works evidence indicates that whole‑setting prevention and inclusion frameworks (e.g., School‑Wide PBIS, evidence‑based anti‑bullying programs) can reduce bullying and improve peer norms when implemented with fidelity and coaching—reinforcing that the binding constraint is system capacity, not teacher intent (Gaffney et al., 2021; Waasdorp, et al., 2012).
While providing a range of resources (e.g. psychologists, speech therapists, occupational therapists) nearer to where children learn, play and live will overcome some of the issues of the current individualised system that the NDIS provides, without a significant uplift in the capacity of the education and health systems the challenges associated with mental health and inclusion will not be addressed.
There is a risk that Thriving Kids reforms will place greater strain on educational settings and these will need time and resources to reform existing practices and ensure that children do not miss out. However, moving to uplift mainstream education settings would be beneficial for not only the target group for Thriving Kids but also other learners. When inclusion is well designed and supported, students without disability perform as well as or slightly better academically, and often gain additional social benefits; large syntheses show system-level gains for all learners, meta-analyses and longitudinal work find neutral-to-positive academic effects for peers without disability, district-wide reform studies show growth in math (and reading gains in high-fidelity schools), and preschool research demonstrates beneficial peer-language “spillover” conditions that lift everyone (UNESCO, 2020; Szumski, Smogorzewska, & Karwowski, 2017; Szumski, Smogorzewska, & Grygiel, 2022; Kart & Kart, 2021; Choi, Meisenheimer, McCart, & Sailor, 2017; Justice, Logan, Lin, & Kaderavek, 2014).
One of the potential unintended consequences of Thriving Kids that will need to be considered are the implications for children with more “significant” needs who would still be eligible for the NDIS. While the Disability Royal Commission made a split recommendation about the phasing out of specialist schools, it was acknowledged that too many children with disability are currently attending these education settings and this can be an important driver of segregation over the life course. Despite many in different bodies arguing for the phase out of specialist schools on the basis that it
is not consistent with the UNCRPD, we have seen recent investments in more specialist schools in Victoria and Queensland. Without careful design there is a risk that already stretched schools might see children with more “significant” impairments falling outside of their responsibility and this might push more children into specialist settings enhancing segregation. A systems approach to reform that takes a learning approach and is based on quality education is required so that these types of unintended consequences that have profound life impacts are not created.
References
Alderton, A., Aitken, Z., Hewitt, B., Dearn, E. & Badland, H. (2025) Characteristics of geographic environments that support the health and wellbeing of young people with disability: a scoping review. Social Science and Medicine, 370:117842
Australian Medical Association. (2023). General practice in crisis: AMA position statement. AMA.
ARC Centre of Excellence for the Digital Child. (2025). Submission to the Productivity Commission: Harnessing Data and Digital Technology.
Badland, H., Villanueva, K., Dearn, E., & Alderton, A. (2025). Do Australian Disability Policies Support Accessible and Inclusive Neighbourhoods for Children with Disability and Their Families? Urban Policy and Research, 1–16.
Bishop, G., Kavanagh, A. & Aitken, Z. (2023) Trends in mental health inequalities for people with disability, Australia 2003-2020. Australian and New Zealand Journal of Psychiatry. 57(12)1570-1579.
Bishop, G.M., Llewellyn, G., Kavanagh, A.M. et al. (2024) Disability-related inequalities in the prevalence of loneliness across the lifespan: trends from Australia, 2003 to 2020. BMC Public Health 24, 621.
Carey, G., Dickinson, H., Malbon, E., & Reeders, D. (2018). The vexed question of market stewardship in the public sector: Examining equity and the social contract through the Australian National Disability Insurance Scheme. Social Policy & Administration, 52(1), 387-407.
Choi, J. H., Meisenheimer, J. M., McCart, A. B., & Sailor, W. (2017). Improving learning for all students through equity-based inclusive reform practices: Effectiveness of a fully integrated schoolwide model on student reading and math achievement. Remedial and Special Education, 38(1), 28–41. https://doi.org/10.1177/0741932516644054
Department of Education. (2022). National Teacher Workforce Action Plan. Commonwealth of Australia.
Department of Social Services. (2024). Foundational supports consultation paper. Commonwealth of Australia.
Dickinson, H., Smith, C., Yates, S. & Faulkner, A. (2022) Taking the first step in an inclusive life: Experiences of Australian early childhood education and care. Melbourne: Children and Young People with Disability Australia.
Dickinson, H., Smith, C., Yates, S., & Faulkner, A. (2023a). How deep does it go? Australian students with disability and their experience of entrenched inequity in education: CYDA School Education Survey 2022. Children and Young People with Disability Australia.
Dickinson, H., Carey, G., Malbon, E., Gilchrist, D., Chand, S., Kavanagh, A. M., & Alexander, D. (2022c). Should we change the way we think about market performance when it comes to quasi-markets? A new framework for evaluating public service markets. Public Administration Review 82(5), 897-901.
Dickinson, H., Smith, C., Yates, S. & Faulkner, A (2023b) How deep does it go? Australian students with disability and their experience of entrenched inequity in education. Melbourne: Children and Young People with Disability Australia
Fortune N, Peters R, Badland H, Emerson E, Llewellyn G, Stancliffe R. (2022) Monitoring Inequalities for Australians with Disability – Baseline Data Report.
Gaffney, H., Ttofi, M. M., & Farrington, D. P. (2021). What works in anti-bullying programs? Analysis of effective intervention components. Journal of school psychology, 85, 37-56.
Justice, L. M., Logan, J. A. R., Lin, T.-J., & Kaderavek, J. N. (2014). Peer effects in early childhood education: Testing the assumptions of special-education inclusion. Psychological Science, 25(9), 1722–1729. https://doi.org/10.1177/0956797614538978
Kart, A., & Kart, M. (2021). Academic and social effects of inclusion on students without disabilities: A review of the literature. Education Sciences, 11(1), 16. https://doi.org/10.3390/educsci11010016
Kavanagh AM, Krnjacki L, Beer A, Lamontagne AD, Bentley R. (2013) Time trends in socio-economic inequalities for women and men with disabilities in Australia: evidence of persisting inequalities. Int J Equity Health;12(1):73.
Kavanagh AM, Krnjacki L, Aitken Z, et al. (2015) Intersections between disability, type of impairment, gender and socio-economic disadvantage in a nationally representative sample of 33,101 working-aged Australians. Disabil Health J.;8(2):191–9.
Kavanagh AM, Aitken Z, Emerson E, Sahabandu S, Milner A, Bentley R, et al. (2016) Inequalities in socio-economic characteristics and health and wellbeing of men with and without disabilities: a cross-sectional analysis of the baseline wave of the Australian Longitudinal Study on Male Health. BMC Public Health;16(3):23–31.
Leung, X.Y., Kavanagh, A.M., Quang, Q.T. et al.(2023) A systematic review of the impact of the COVID-19 pandemic on the mental health of adolescents and young people with disabilities aged 15–29 years. BMC Public Health 23, 1390.
Maïano, C., Normand, C. L., Salvas, M.‑C., Moullec, G., & Aimé, A. (2016). Prevalence of school bullying among youth with autism spectrum disorders: A systematic review and meta‑analysis. Autism Research, 9(6), 601–615.
Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. (2023). Final report: Volume 7, Part A – Inclusive education, employment and housing.
Schacter, H. L., White, S. J., Chang, V. Y., Shapero, B. G., & Barstein, J. (2021). Consequences of peer victimization for the physical health of children and adolescents: A review. Pediatrics, 147(1), e2020003434. https://doi.org/10.1542/peds.2020-003434
Szumski, G., Smogorzewska, J., & Grygiel, P. (2022). Academic achievement of students without special educational needs and disabilities in inclusive education: Does the type of inclusion matter? PLOS ONE, 17(7), e0270124. https://doi.org/10.1371/journal.pone.0270124
Szumski, G., Smogorzewska, J., & Karwowski, M. (2017). Academic achievement of students without special educational needs in inclusive classrooms: A meta-analysis. Educational Research Review, 21, 33–54. https://doi.org/10.1016/j.edurev.2017.02.004
Smith, C., Hart, J. & Dickinson, H. (2025a) “I’ve really had to fight for my right to education”: Australia’s education system from the perspective of students with disability. CYDA Youth Education Survey 2024. Melbourne: CYDA.
Smith, C., Hart, J. & Dickinson, H. (2025b) “They lowered the bar rather than raise the child”: CYDA Parent and caregiver education survey 2024. Melbourne: CYDA.
UNESCO. (2020). Global education monitoring report 2020: Inclusion and education – All means all. UNESCO Publishing. https://unesdoc.unesco.org/ark:/48223/pf0000373718
United Nations Committee on the Rights of the Child. (2021). General Comment No. 25 on children’s rights in relation to the digital environment. UNCRC.
Waasdorp, T. E., Bradshaw, C. P., & Leaf, P. J. (2012). The impact of School‑Wide Positive Behavioral Interventions and Supports (SWPBIS) on bullying and peer rejection: A randomized controlled effectiveness trial. Archives of Pediatrics & Adolescent Medicine, 166(2), 149–156.