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KARITANE®

Partnerships made for parents

Submission to the House Standing Committee on Health, Aged Care and Disability inquiry into the Thriving Kids Initiative

Grainne O’Loughlin, CEO
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Table of Contents

• Letter to Dr Freelander \
• Executive Summary and recommendation.
  Response to the Inquiry into the Thriving Kids Initiative\
• 1. Examine evidence-based information and resources that could assist parents identify if their child has mild to moderate development delay and support parents to provide support to these children \
• 2. 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 \
• 3. Identify equity and intersectional issues, in particular, children who identify as First Nations and culturally and linguistically diverse \
• 4. Identify gaps in workforce support and training required to deliver Thriving Kids \
• 5. 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 for children with mild to moderate support needs

® KARITANE.COM.AU CONTACT DETAILS
02 9794 2300 | PO Box 241, Villawood, NSW 2163

3 October 2025

Dr Mike Freelander
Federal Member for Macarthur
PO Box 6021
Parliament House
CANBERRA
ACT 2600

Dear Dr Freelander

Submission to Thriving Kids Initiative Inquiry

Karitane thanks the Department of Health, Aged Care and Disability for the opportunity to contribute to the Thriving Kids Initiative Inquiry. Karitane has structured this document against the Terms of Reference for the Inquiry.

ABOUT KARITANE

Karitane is recognised as a respected and trusted evidence-based service leader in child and family health, perinatal infant and child mental health, early parenting, preventative and targeted early intervention services in Australia. Established in 1923, Karitane is a NSW Affiliated Health Organisation (AHO) under the governance of the Karitane Board of Directors and through a Service Level Agreement to the NSW Ministry of Health and the South West Sydney Local Health District (SWSLHD). Karitane is also a registered charity and not-for profit/NGO entity.

Karitane operates at the nexus of the health, social services, foundational supports and early education systems, with a range of services provided in each domain across NSW and a growing national footprint in Queensland, Tasmania and in virtual care programs nationally. We are therefore uniquely strategically positioned with a holistic purview across the child and family ecosystem, with expertise across the social determinants of health and integration across the early years and social sectors.

We are highly geared towards strategic partnerships and partner with NGOs, pre-schools, schools, universal health service providers, peer organisations, universities, State and Commonwealth Governments, PHNs, corporate organisations and Foundations, who share our values and vision to support the First 2000 Days. We are funded by the NSW Government, Federal Government, Medicare, grants, research, donations, philanthropic grants and own source revenue streams to support comprehensive child and family and perinatal infant mental health services, delivering high quality, evidence-based support for families with children aged 0-5 years.

Thriving Kids offers bold, system-wide reform to improve child development, reduce inequities, and lift Australia’s child wellbeing global ranking (currently 35th of 38). This reform aligns with major national initiatives—universal ECEC, the Building Early Education Fund, Closing the Gap, and place-based programs—underpinned by frameworks like the Early Years Strategy and National Standards for

Foundational Supports. Thriving Kids is the convergent policy investment needed to deliver lasting change.

We welcome the opportunity to attend a Hearing and look forward to the findings and recommendations arising from this Inquiry.

Yours Sincerely

Grainne O’Loughlin
CEO

Executive Summary & Recommendations

The first 2000 days of life lay the foundations for lifelong health, learning, and wellbeing. During this period, the presence or absence of early support has profound effects on a child’s developmental trajectory. Yet in Australia today, too many children with mild to moderate developmental delays are missed or left waiting until school age before support is offered. The 2024 Australian Early Development Census (AEDC) shows 12.5% of children start school developmentally vulnerable in two or more development key domains—the highest rate since 2009. Developmental vulnerability is higher in disadvantaged communities, where 1 in 5 children are developmentally vulnerable on two or more key domains compared to 1 in 13 in the least disadvantaged areas.

Families describe a fragmented system: inconsistent information, unclear pathways, and services that are either too hard to access or simply unavailable. The gap between universal services and the National Disability Insurance Scheme (NDIS) has created a ‘missing middle’ — children who are not eligible for specialist disability funding but whose needs are too great for standard universal services to meet. 23.6% children were identified by teachers for further assessment due to medical, physical, behavioural, emotional, or cognitive concerns. This has risen from 18% in 2009. We cannot wait until children get into the school system as we have missed the critical window period for early intervention and prevention. The First 1000 Days needs to be a focus to stem the tide of children arriving at school developmentally vulnerable and Thriving Kids offers the opportunity to provide a system level response. A suite of services that includes evidence-based advice and information, digital navigation supports, playgroups, structured family programs, and peer support networks to ensure we are building parenting confidence and social connection.

Karitane has worked alongside families for more than 100 years, delivering services across New South Wales and nationally. Through programs such as the Fairfield Child and Family Hub, Village Connect Young Parent Hub, Supported Playgroups, Careline and Parent Child Interaction Therapy (PCIT) Centre of Excellence for children with disruptive behaviours, Karitane has consistently demonstrated how relational, community-embedded approaches make developmental support accessible, trusted, and effective.

This submission makes clear that:

• Parents need evidence-based, practical information delivered relationally and in culturally safe ways.
• Integrated services like Child and Family Hubs and supported playgroups provide effective platforms for early identification and support, especially during pregnancy and the first 1000 days for early intervention, prevention and family preservation.
• Accessibility must be embedded at every stage, recognising the specific needs of all families including Aboriginal, CALD, refugee, and socioeconomically disadvantaged families.
• A skilled and supported multi-disciplinary workforce is essential, with investment in evidence based training such as relational care, Family Partnership training, and postgraduate education

pathways.

• Australia can learn from domestic and international best practice, embedding inclusion, navigation, and sustained investment to achieve seamless transitions across systems.

Karitane’s recommendations align with our vision that every child in Australia should thrive — we are not alone in that ambition, and this will only be possible if the ‘missing middle’ is addressed through early, relational, and accessible supports.

Broader system reforms

Child & Family Hubs can play a critical role in realising the vision for Thriving Kids and must be complemented by broader system reforms to ensure all children and families receive the right support, at the right time, in the right place.

Thriving Kids when aligned with other national investments and reforms, including the Building Early Education Fund, the Investment Dialogue for Australia’s Children (IDAC), Partnerships for Local Action and Community Empowerment (PLACE), Closing the Gap, the Early Years Strategy, the Better and Fairer Schools Agreement, creates an unprecedented window for lasting change. Central to this reform is co-design and co-development with children, families, and communities to ensure solutions are grounded in lived experience and local context.

We recommend Thriving Kids is used to drive system-wide reform centred around three core elements:

Uplift of mainstream health and education systems: Strengthen universal systems to meet children’s developmental needs by embedding proportionate responses in everyday settings. This includes uplifting workforce capability to identify and respond to children’s developmental needs, and enabling trauma-informed, culturally-safe, collaborative multidisciplinary approaches.

Local solutions with national guardrails: Place-based, local approaches empower communities and services to design responses that reflect the needs of children and families. Thriving Kids can provide a national framework with clear guardrails to ensure local solutions are inclusive of children’s needs. Child and Family Hubs offer a tangible mechanism for delivering locally responsive, integrated support.

Enabling parents to understand and act on best practice early intervention: Thriving Kids should ensure parents have universal, inclusive, and responsive supports to understand child development, strengthen parenting skills, navigate services, and build social and community connections.

SUMMARY OF CONSOLIDATED RECOMMENDATIONS IN THIS PAPER

TERMS OF REFERENCE 1

1. Develop a national suite of parent-facing developmental resources.
2. Ensure resources are culturally safe and accessible for parents with low literacy or disability linguistically accessible.
3. Ensure consumer voices and strengths-based approaches, engaging families to identify barriers and recommendations for improvement and, when needs are identified empowering families using a non-stigmatising, culturally safe and strengths-based approach (e.g. Family Partnership, NEST, Healthy Outcomes from Positive Experiences - HOPE) framework including peer-parent and family and community support networks.
4. Embed developmental conversations in universal settings.
5. Ensure accessibility for both place based and virtual models of care and maintain offline access for digitally excluded families. Support technological innovations, virtual and e-hubs and e-navigation. Embed integrated hybrid tiered care pathways as a continuum from community/primary to specialist and place-based settings using tiered care pathways and navigation support as a joined-up system including e-navigation and e-hub to place-based hubs in health, early childhood education and social care settings based on child and family needs and preferences.
6. Resource community navigators to deliver information relationally.
7. Integrate developmental checks into routine child touchpoints.

TERMS OF REFERENCE 2

8. Sustain and expand Integrated Child and Family Hubs.
9. Invest in Supported playgroups
10. Embed developmental advice into universal health and education services.
11. Fund programs on a 5-10-year cycle, not short pilots.
12. Address the ‘missing middle’ with dedicated funding outside the NDIS.
13. Strengthen referral pathways by co-locating allied health in community settings to ensure a ‘wrap-around’ approach to support and intervention.

TERMS OF REFERENCE 3

14. Embed cultural safety across all Thriving Kids initiatives.
15. Prioritise partnerships with Aboriginal Community Controlled Health/Community Organisations (ACCHOs/ACCOs).
16. Invest in bilingual and bicultural workforce roles.
17. Apply equity-weighted funding formulas to direct resources to high-need areas.
18. Deliver services in trusted community venues.
19. Design for intersectionality, addressing compounding disadvantage.
20. Monitor and report outcomes by population group, inclusivity and priority populations

TERMS OF REFERENCE 4

21. Expand Family Partnership Model training across sectors.
22. Embed relational and trauma informed care as a workforce competency.
23. Sustain centre of excellence e.g. in PCIT and evidence based early intervention programs for toddlers and workforce training.
24. Build career pathways for Aboriginal, bilingual, and bicultural workers.
25. Strengthen postgraduate education pipelines with universities.
26. Fund reflective supervision and wellbeing frameworks..
27. Incentivise workforce participation in rural and disadvantaged areas.
28. Embed 10-year workforce planning and investment to support the Thriving Kids Initiative
29. Embed a peer workforce model with appropriate supports in place.
30. Empower staff to increase their confidence in meeting the needs of families

TERMS OF REFERENCE 5

29. Expand and support Child and Family Hubs nationally.
30. Fund supported playgroups as trusted entry points.
31. Strengthen universal platforms such as Careline and eHubs & Hybrid models of Care
32. Embed navigation roles (and e-Navigation) across services.
33. Develop integrated digital records for developmental information.
34. Learn from international best practice in inclusion and cultural authority.
35. Commit to sustained, long-term investment in early years programs.

Addressing the Terms of Reference

1. Examine evidence-based information and resources that could assist parents identify if their child has mild to moderate development delay and support parents to provide support to these children

The first 2000 days of life are the most critical period for shaping a child’s future. This is the window where 90% of brain development occurs, and where early relationships, language, and experiences create the foundation for lifelong learning, health, and wellbeing. Parents are at the centre of this developmental journey. They are the first and most consistent observers of their child’s growth, yet they often lack access to practical, reliable, and culturally relevant resources that help them recognise developmental differences and seek help when needed.

Karitane’s century of service has consistently demonstrated that parents want to do the right thing but often struggle to find information that is clear, accessible, trustworthy, and free of stigma. When families are left without support, developmental delays are not identified early, and interventions are postponed until school entry, where children already face entrenched challenges.

What families tell us

Parents describe a mix of confusion, stigma, and frustration when trying to navigate available resources. Common themes include:

Inconsistent advice: Families are told different things by different professionals, leaving them unsure about whether to act.

Language barriers: CALD parents often receive poorly translated resources or none at all, while Aboriginal families report materials that do not reflect their cultural context.

Digital exclusion: Increasing reliance on online resources leaves many families behind, particularly those with low digital literacy or without reliable /affordable internet access.

Fear of judgement: Parents worry about being blamed if they raise concerns about their child’s development. Many say they avoid services because they “don’t want to be seen as a bad parent.”

One mother attending Karitane’s Village Connect playgroup shared:

“I felt something wasn’t quite right with my son’s speech, but everyone kept saying boys just talk later. When I asked my GP, they told me to wait and see. I didn’t know who else to ask. Coming here, I felt heard for the first time. They gave me simple things to try at home and helped me book an appointment. I wish I had known this earlier.”

Why relational delivery matters

Karitane’s experience shows that providing information on its own is not enough. A pamphlet, website, or checklist rarely changes behaviour. What makes the difference is relational delivery and working in partnership with families— when trusted people listen, validate parents’ concerns, and work together to find pathways forward that best suit the needs of the families, recognising their expertise in understanding their own family.

In Karitane’s Fairfield Child and Family Hub, developmental information is embedded into ordinary conversations with bilingual staff, Aboriginal health workers, and child and family health nurses. Parents report that the trusting relationship makes them more willing to act. Similarly, in Village Connect Young Parent Hub, conversations about milestones and strategies happen alongside play, building trust with families and non-stigmatising.

This relational approach aligns with Karitane’s commitment to partnership and relational care, which places listening, respect, and building trust with families at the core of practice. Relational care ensures that information is not only delivered, but understood, trusted, and acted upon.

What works in practice

Karitane’s programs highlight the elements that work:

Embedding information in universal settings: Parents are more open to developmental advice when it is offered at playgroups, immunisation visits, schools, and hubs, rather than requiring a separate appointment.

Cultural safety and bilingual delivery: Families engage when information is presented in their own language, with examples that reflect their cultural context. Bilingual educators and interpreters and Aboriginal staff act as cultural brokers and trusted navigators.

Practical, everyday strategies: Parents prefer examples that can be integrated into daily routines, such as talking during mealtimes, singing, or using everyday objects for play within natural environments (home, park, shops, playgroup.

Multiple formats: Families benefit from resources that are visual, story-based, and multimodal — combining print, videos, group discussions, and one-to-one conversations. Offline options remain essential for families excluded from digital platforms. For example, Careline provides state-wide access to advice from trained child and family health nurses. Data from Careline consistently shows high demand for simple, practical, evidence-based strategies that parents can use immediately. The use of online webinars, virtual care, ehubs, online resources, APPs for frequent topics of concern for parents are also becoming increasingly popular and in demand.

System gaps

Despite good practice examples, system gaps remain. Developmental information is not consistently available or embedded in routine contacts. Resources are often produced without family co-design, leading to poor uptake. There is no single national suite of parent-facing resources, and information differs across jurisdictions.

This patchwork approach means that parents in some communities have rich, relationally delivered resources, while others rely on Google searches or word of mouth. The lack of consistency perpetuates inequity and delays identification.

Karitane’s contribution

Karitane has built a strong foundation of parent-facing developmental supports through:

Fairfield Child and Family Hub: integrated services provide parents with on-the-spot developmental conversations and direct links to supports.

Village Connect: Supported playgroups and navigators that integrate developmental learning in a safe and culturally inclusive way. Including Allied Health in Supported playgroups, access to timely advice and early conversations as well as anticipatory guidance in these settings.

Careline: A trusted statewide phone service for parents seeking advice.

Education leadership: Training of all staff including child and family health nurses, health education officers, navigators and allied health professionals to embed relational communication and parent coaching and Family Partnership Model.

These services demonstrate the value of relational care, integrated Child and family hubs, and workforce development in making information accessible and usable for families.

Recommendations for TOR 1

Karitane recommends that governments:

• Develop a national suite of parent-facing developmental resources, co-designed with families, Aboriginal communities, and CALD communities.
• Ensure resources are culturally safe and linguistically accessible, with investment in bilingual and Aboriginal community workers to deliver them.
• Embed developmental resources into universal settings such as maternal and child health visits, playgroups, schools, GPs, ECEs and Centrelink interactions.
• Maintain offline access options through print, audio, and community-based delivery for families excluded from digital platforms.
• Train and resource community navigators (including bilingual staff, Aboriginal health workers, and peer parents) to deliver information relationally.

• Integrate developmental conversations into every child’s routine touchpoints, ensuring families do not need to navigate multiple systems to access advice.

2. 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.

Introduction

Over the past two decades, governments at both state and federal levels have trialled a wide variety of programs aimed at identifying and supporting children with developmental delay, autism, or both. Some of these initiatives have demonstrated promising results, yet very few have been scaled or sustained beyond their pilot phase. For families, this creates the impression of a revolving door of programs, where each new initiative disappears before trust is established or long-term outcomes are achieved.

Karitane’s experience as both a direct service provider and a system-level partner shows that effectiveness depends not just on the design and efficacy of individual programs, but on the consistency of funding, integration with mainstream services, and relational delivery of support. Programs that are short-term, fragmented, or overly medicalised rarely reach children with mild to moderate support needs.

Learning from past initiatives

Past initiatives such as the Healthy Kids Check (2008-2012) and early autism-specific programs highlighted the value of structured screening, yet suffered from limited workforce training, timings of the checks and poor integration with community settings. Evaluations found that while screening rates improved temporarily, families often did not receive timely follow-up. Without strong referral pathways and case navigation, screening & identification alone did not lead to better outcomes.

Similarly, the transition to the National Disability Insurance Scheme (NDIS) shifted resources toward children with significant disability, leaving a “missing middle” of children with mild to moderate developmental delay. Many families in this group report being told that their child’s needs are not severe enough for NDIS, yet universal services do not provide the level of support required. This policy gap has been a consistent source of frustration and inequity. The complexity of the NDIS system for

those that do access it and the fact that it is not a family-based system, rather and individual deficit based system.

What works in Karitane programs

Karitane’s own programs offer evidence of what is effective in supporting children and families:

FAIRFIELD CHILD AND FAMILY HUB The Hub truly integrates child and family health services, developmental paediatrician, allied health outreach, supported playgroups and other wrap around support services for priority populations in a trusted community space. Parents can raise concerns informally, receive developmental advice, and be directly linked to speech pathology, occupational therapy, or parenting programs. Hub evaluations show earlier engagement, reduced wait times, and higher uptake of referrals compared with families outside the Hub.

VILLAGE CONNECT YOUNG PARENT HUB Village Connect is an integrated relational, multidisciplinary team delivering a community-based program for young parents. Developmental advice is provided in a non-stigmatising environment, where bilingual and Aboriginal staff normalise conversations about milestones. Families describe feeling “safe to ask questions” and “more confident” in supporting their children. This program has demonstrated high levels of engagement from families who are often marginalised by mainstream services. We often see this because a differentiating factor is that families may attend playgroups for longer periods of time before building enough trust to engage in more targeted supports/interventions.

CARELINE NSW AND STEPPED CARE VIRTUAL AND ONLINE SERVICES Operating as a statewide telephone service, Careline gives families immediate access to trained child and family health nurses. Analysis of call data shows that developmental concerns are among the top reasons parents call, alongside sleep, behaviour, and feeding. Careline exemplifies the effectiveness of accessible, universal-entry points for evidence-based advice.

PARENT-CHILD INTERACTION THERAPY (PCIT) Karitane has established itself as a centre of excellence in PCIT, an internationally recognised intervention for children with behavioural and developmental concerns. PCIT not only improves child behaviour outcomes but also strengthens parental confidence and the parent-child bond. Importantly, PCIT demonstrates that intensive support can be delivered effectively in community settings when the workforce is well-trained. A stepped care model of intervention and approach to children with disruptive behaviours is a critical consideration.

Common success factors

From both Karitane’s work and broader evaluations, effective initiatives share the following characteristics:

• Integration with universal services: Embedding developmental support within everyday touchpoints such as schools, playgroups, and child health checks ensures broad reach.
• Relational care: Parents engage more readily when support is offered within a partnership framework that is non-judgemental, respectful and built on the trust of the relationship.

• Cultural safety: Aboriginal-led services and bilingual workers increase trust and uptake in diverse communities.
• Practical accessibility: Flexible modes of delivery (drop-in hubs, phone support, outreach) reduce barriers for time-poor, isolated or digitally excluded families.
• Sustained investment: Programs that are funded for only 1-2 years rarely achieve systemic impact. Families disengage when services disappear.

System gaps and barriers

Despite these strengths, significant gaps remain:

• Short funding cycles: Effective programs such as supported playgroups or integrated hubs are often funded as pilots, through philanthropy, research (or combinations of these) and discontinued or unable to be sustained despite positive evaluations.
• Fragmentation: Families are required to navigate multiple agencies, with little coordination between health, education, and social services.
• Eligibility gaps: Children with mild to moderate delays often fall through the cracks between universal services and specialist disability supports and are picked up far too late when starting pre-school/school
• Workforce constraints: Even where programs exist, limited workforce capacity (e.g. in speech pathology) leads to long wait times.

Family perspectives

Parents consistently emphasise the difference that trusted, ongoing programs make. One father at the Fairfield Hub explained:

“When my daughter needed help with speech, the Hub made it easy. I didn’t have to ring five numbers or wait for months. They spoke to me here, set up the referral, and we started sessions within weeks. Without this place, I don’t know how long we would have waited.”

These stories underline the importance of relational, accessible, and well-integrated services that reduce barriers to support.

Recommendations for TOR 2

Karitane recommends that governments:

1. Sustain and expand integrated Child and Family Hubs as trusted access points for developmental support.
2. Invest in supported playgroups which reach families early and provide developmental advice relationally.
3. Embed developmental advice into universal services, ensuring consistent access at schools, child health checks, and community programs.
4. Fund programs for at least 5-10 years, replacing short-term pilots with long-term investment.
5. Address the “missing middle” by creating a dedicated funding stream for children with mild to moderate developmental needs outside the NDIS.
6. Strengthen referral pathways by co-locating allied health in community settings and resourcing navigators to support families through systems.
7. Embed relational care and cultural safety as core principles in all funded programs.

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3. Identify equity and intersectional issues, in particular, children who identify as First Nations and culturally and linguistically diverse.

Introduction

Children who identify as Aboriginal or Torres Strait Islander, those from culturally and linguistically diverse (CALD) backgrounds, and those living in communities experiencing entrenched disadvantage face higher barriers to developmental identification and support. Unless equity is explicitly addressed, the Thriving Kids vision will fail the very families who stand to benefit most.

Karitane’s work across New South Wales, particularly in Western and South-Western Sydney, has placed us at the centre of some of Australia’s most diverse communities. Fairfield, Liverpool, and Canterbury-Bankstown are home to families from dozens of cultural backgrounds, as well as some of the highest rates of socioeconomic disadvantage. Our Reflect and Innovate Reconciliation Action Plans (RAPs) also commit us to ongoing reconciliation, Aboriginal leadership, and cultural safety across all our services.

Barriers experienced by families

Parents in these communities often describe feeling invisible or unwelcome in mainstream systems. The pace of services is a critical factor as parents need time to establish trust. We cannot continue a “three strikes and you are out” approach to parent contact. Common barriers include:

• Language and communication: Families may not understand written resources in English, and interpreters are not always available in healthcare or education settings.
• Cultural mismatch: Mainstream services may not respect cultural practices, leaving families feeling that their parenting is judged or misunderstood.
• Financial stress: The cost of private assessments or therapy sessions excludes many families. Often working parents cannot access services in work hours
• System distrust: Some Aboriginal families avoid mainstream services due to intergenerational experiences of racism, discrimination and judgement about parenting
• Intersectional disadvantage: Families living in poverty who are also Aboriginal or from refugee backgrounds face compounded challenges, with fewer social supports and less confidence navigating systems.

A grandmother raising her granddaughter in South Western Sydney told us:

“I didn’t feel safe going to the clinic. They looked at me like I was doing something wrong. At the Hub, I felt welcome. No one judged me, they just asked how we were going and what we needed.”

Karitane’s contribution to equity

Karitane has built trust with diverse communities by embedding equity into program co-design:

• Aboriginal partnerships: Karitane employs Aboriginal health workers and collaborates with Aboriginal Community Controlled Health Organisations (ACCHOs & ACCOs). Our RAPs guide our commitment to cultural safety, representation, and reconciliation.
• Bilingual staff and bicultural workers: In Village Connect and the Fairfield Hub, bilingual and First Nations staff act as bridges between families and mainstream services, providing advice in first languages and normalising developmental conversations.
• Cultural safety training: All Karitane staff undertake cultural competence training, and relational care approaches as well as working in partnership training, ensure that families feel listened to and respected.
• Locally embedded services: By delivering programs in familiar community venues — schools, playgroups, libraries, and hubs — families feel safe to attend without stigma.

Equity in practice: examples

• Fairfield Hub: Bilingual playgroup leaders work alongside Aboriginal educators to provide culturally safe environments where families discuss milestones without fear. These playgroups consistently attract families from refugee backgrounds who may not otherwise engage with services.
• Fairfield Hub: Located in one of Australia’s most culturally diverse LGAs, the Hub offers families access to developmental checks with direct referral to allied health. Families report higher levels of trust and reduced anxiety compared with traditional clinical settings.
• Careline: Provides state-wide access for families who may not attend face-to-face services. For CALD parents, the anonymity of phone support can reduce stigma, and interpreters can be arranged where needed.

Intersectional considerations

Families experiencing multiple layers of disadvantage — for example, Aboriginal families in low-income households, or newly arrived refugee families raising children with additional needs — require tailored approaches. These approaches must integrate health, education, housing, and social supports, recognising that developmental challenges are exacerbated by material hardship.

Karitane’s integrated models of care, such as the Fairfield Hub, Wolli Creek and Village Connect Hubs, demonstrate how intersectional needs can be addressed in one location. Parents receive not only developmental advice but also support with housing, financial stress, and mental health. This integrated approach reduces the burden on families of navigating multiple agencies.

Policy implications

Without explicit equity measures, reforms risk widening gaps. Universal programs often fail to reach families facing the highest barriers, entrenching disadvantage. To avoid this, governments must invest in targeted supports, Aboriginal-led services, and culturally informed delivery. Funding formulas must be weighted to ensure greater investment in communities with greater need.

Proportionate universalism ensures all families receive support through antenatal care, child and family health, early childhood education and care, and schools. This shifts services from a “seek and refer” model to “seek and respond,” integrating evidence-based practices that build on family strengths and deliver both universal access and tailored support within the same service.

Recommendations for TOR 3

Karitane recommends that governments:

1. Embed cultural safety across all Thriving Kids initiatives, guided by Aboriginal leadership and RAP frameworks.
2. Prioritise partnerships with ACCHOs/ACCOs and Aboriginal-led services, ensuring self-determination and cultural authority.
3. Invest in bilingual and bicultural workforce roles, peer workforces, recognising their critical role as navigators of developmental information.
4. Apply equity-weighted funding formulas, directing greater resources to communities facing higher disadvantage.
5. Ensure services are locally embedded, delivered in trusted community venues to reduce stigma and incentivise integration between health/disability/social services and ECI/ECE providers
6. Design services for intersectionality, recognising and addressing compounding disadvantage such as poverty, disability, and cultural exclusion.
7. Monitor outcomes by population groups, ensuring accountability for reducing disparities in access and outcomes.

4. Identify gaps in workforce support and training required to deliver Thriving Kids.

Introduction

The success of Thriving Kids hinges not only on funding and service design but on the capacity and capability of the workforce. No policy reform can succeed if the professionals delivering care are overstretched, under-supported, or inadequately trained. Families consistently tell us that what matters most is the quality of their interaction with practitioners and staff — whether they feel listened to, respected, understood, and empowered.

Karitane has long positioned itself as a leader in workforce development in child and family health. Through training, supervision, and innovative education partnerships, we have invested in building a workforce skilled in relational care, cultural safety, and integrated family support. Our leadership in Family Partnership Model training, Parent Child Interaction Therapy (PCIT), and postgraduate education with WSU highlights the central role Karitane plays in shaping practice across New South Wales and beyond.

Karitane also recognises the value and contribution of volunteers and peer workers within the model of supporting families early. Karitane has a comprehensive training framework for training volunteers and onboarding peer workers. Peer workers and volunteers provide a unique support for families who are navigating the system, building trust in their community and services. The para-professional workforce assists in eliminating stigma, builds family capacity and facilitates pathways to more intensive services as needed by the family

Current workforce challenges

Workforce capacity and sustainability are the greatest constraints on meeting the needs of children with developmental delays and their families. Common challenges include:

• Workforce shortages: There are not enough child and family health nurses, speech pathologists, occupational therapists, psychologists, and allied health professionals to meet demand. Waitlists extend months or even years. Diversifying workforce models is essential ie including peer workers and volunteers to walk alongside families, building relationships and trust, enabling other professionals with varying skills to implement specific interventions.
• Burnout and attrition: Staff in frontline roles report high stress and emotional fatigue, particularly in under-resourced communities. Without adequate supervision and professional development, turnover is high, and the risk of psychosocial hazards increases
• Uneven distribution: Professionals are concentrated in metropolitan centres, leaving rural, regional, and remote families with limited or no access to early intervention services.

• Variable training: Many practitioners have limited exposure to relational, family-centred models of care, reducing their effectiveness in engaging families with complex needs.
• Fragmented systems: Professionals often work in isolation from one another, with limited structures for multidisciplinary collaboration. Families experience this as disjointed and confusing.

Karitane’s leadership in workforce training

Karitane has consistently contributed to workforce capacity through a range of initiatives:

• Family Partnership Model (FPM) Training: Karitane is a leading provider in Australia of this internationally recognised model, which equips professionals with the skills to work collaboratively with families, listen deeply, and empower parents as partners in care. Embedding this model across health, education, and social care systems has transformed the quality of engagement with families.
• Relational Care and Living Collaborations Training: Karitane’s unique training in relational care strengthens the ability of practitioners to build trust and address family needs holistically. Living Collaborations extends this by fostering interagency collaboration & integration, ensuring that workforce development is not confined to individual organisations and takes a whole of sector approach eliminating service system barriers to access
• Parent-Child Interaction Therapy (PCIT) Centre of Excellence: As a hub for PCIT in Australia, Karitane trains clinicians in evidence-based behavioural interventions that directly improve child outcomes while enhancing parental confidence.
• University Partnerships: Karitane co-leads the Masters in Child and Family Health at Western Sydney University, shaping the next generation of child and family health nurses and midwives with a strong grounding in developmental science, family partnership, attachment frameworks and cultural safety.
• Clinical Placements and Supervision: Karitane hosts student placements, provides clinical supervision, and invests in mentoring to ensure workforce sustainability.

Relational care as the foundation

At the heart of Karitane’s workforce development philosophy is the belief that skills must go beyond technical expertise. Developmental screening tools and therapeutic programs only work when delivered by professionals who can work in partnership, forming genuine, trusting relationships with families. This is particularly critical for families who have experienced exclusion, trauma, or intergenerational disadvantage.

Relational care ensures that practitioners:

• Listen first, without judgement.

• Deliver advice in a way that is empowering, not directive.
• Recognise the parent as the expert in their child.
• Build confidence and self-efficacy rather than dependency.

Families consistently report that these qualities matter more than the number of tools or checklists a practitioner can administer.

Workforce equity

Just as families experience inequity, so too does the workforce. Aboriginal practitioners, bilingual workers, and community-based navigators often carry disproportionate responsibilities without equal recognition, pay, or career pathways. Thriving Kids must invest in a diverse workforce pipeline that values community navigators and bicultural workers alongside clinical professionals., peer workers and trained volunteers.

This means:

• Supporting Aboriginal workforce leadership, including partnerships with ACCHOs/ACCOs.
• Providing career pathways for bilingual and bicultural staff.
• Recognising community navigators as essential members of multidisciplinary teams.

System-level workforce needs

To deliver Thriving Kids effectively, the system must address:

• Training consistency: Embedding family partnership and relational care training across the workforce.
• Supervision and wellbeing: Ensuring practitioners have access to reflective supervision and support to prevent burnout.
• Collaboration/Partnership structures: Establishing multidisciplinary, cross-sectoral hubs and joint partnership training to break down silos.
• Recruitment and retention: Incentivising service in rural and disadvantaged areas through scholarships, placements, and salary loading.
• Long-term planning: Funding education and workforce initiatives on a sustained, not pilot, basis.

Family voice

Families consistently highlight the difference skilled practitioners make. As one parent at a Village Connect group said:

“The nurse listened to me like I was the only parent in the room. She explained things in a way I understood. That’s what made me follow through with the referral.”

Recommendations for TOR 4

Karitane recommends that governments:

1. Expand investment in Family Partnership Model training across health, education, and early childhood sectors.
2. Recognise and embed relational care as a core competency for all child and family practitioners.
3. Sustain and expand Karitane’s role as a centre of excellence in PCIT and child/family workforce training.
4. Build career pathways for Aboriginal, bilingual, and bicultural workers, navigators ensuring equitable recognition and pay.
5. Strengthen partnerships with universities to grow postgraduate education pipelines.
6. Fund reflective supervision and wellbeing support to reduce burnout and turnover.
7. Incentivise service delivery in rural and disadvantaged communities.
8. Embed workforce planning and funding into 10-year strategies rather than short-term cycles.

5. Identify mechanisms that would allow a seamless transition through mainstream systems for all children with mild to moderate support needs. Draw on domestic and international policy experience and best practice.

Introduction

Australia has made significant investments in early childhood intervention, yet outcomes remain uneven and fragmented. Too many children with mild to moderate developmental delays continue to fall through the cracks, caught between universal services that cannot provide enough support and disability systems that exclude them because their needs are not considered “severe enough.” To break this cycle, Thriving Kids must learn from both domestic innovations and international best practice, with a focus on inclusion, integration, continuity, and relational models of care.

Karitane brings a unique lens to this work, drawing on a century of leadership in child and family health, contemporary service innovation, and international engagement, including our CEO’s recent participation in the International Foundation Integrated Care (IFIC) Summer School at Oxford University in the United Kingdom. These experiences reaffirm that no single program or agency can meet the complexity of children’s developmental needs — what is required is integrated, whole-of-system reform grounded in family partnership and relational care.

Domestic best practice examples

CHILD AND FAMILY HUBS Refer also the submission from the National Child & Family Hub Network (NCFHN), STARS For Kids and ACaFSA submissions. Karitane is a founding member and contributor to each of these alliances and fully supports their submissions to the Inquiry.

Across Australia, Child and Family Hubs have emerged as one of the most effective models for early identification and support. Hubs integrate health, allied health, parenting, and social services, NGOs and critical wrap-around supports with navigators in trusted community settings. Evaluation of hubs show: , Higher rates of developmental screening.

• Faster access to allied health services.
• Stronger parental engagement due to reduced stigma.

Karitane’s Fairfield Child and Family Hub, Wolli Creek Hub and Village Connect Hubs are great examples of this model. Located in culturally diverse and disadvantaged communities of NSW, they bring together child and family health nurses, allied health professionals, navigators, NGOs, First nations and bilingual staff in a single accessible space. Families report feeling more confident and less judged, with referral follow-through rates far higher than in traditional models.

Supported Playgroups

Supported playgroups, including those run through Karitane’s Village Connect and Linking Families programs and Playgroups in partnership with Playgroups NSW, have proven particularly effective in engaging families who might otherwise avoid mainstream services. By embedding developmental conversations and activities within everyday play, families gain knowledge in a relaxed, non-stigmatising environment. Evidence shows that supported playgroups increase parental confidence, improve social connectedness, and support earlier referral to allied health services and other services.

Careline NSW

Careline demonstrates the power of accessible universal entry points. By providing immediate access to advice from child and family health nurses, Careline has reached thousands of families who might otherwise delay seeking help. Its integration with referral pathways further highlights the role of telehealth and digital platforms in supporting equity of access and supports the need to expand virtual eHubs nationally as a low-stigma, equitable, high-reach mechanism to facilitate access to evidence-based resources and support.

INTERNATIONAL BEST PRACTICE

Australia’s commitment to the United Nation Convention on the Rights of persons with disabilities was ratified in 2008 and means we need to follow through on the commitment for services to facilitate the inclusion of children and adults with a disability in all community and medical services. This ratification resulted in many important national initiatives such as NDIS and the National Autism Strategy

United Kingdom: Integrated Care Systems (ICS)

The UK has pioneered Integrated Care Systems, which pool budgets across health and social care to deliver joined-up services for children and families. Children’s Centres and Family Hubs provide accessible entry points, reducing duplication and making navigation easier for families. Evaluations highlight the importance of sustained investment and community governance. Karitane’s CEO is part of a global network sharing examples of best practice and problem solving in these models of care.

Scandinavia: Universalism with targeted support

Countries such as Norway, Sweden, and Denmark embed developmental monitoring within universal child health systems, with additional targeted supports for families with greater needs. Their models emphasise equity through universalism, ensuring all children are reached while reducing stigma for those requiring additional help.

New Zealand: Whānau Ora

New Zealand’s Whānau Ora model empowers Maori families to define their own needs and solutions, supported by navigators who coordinate services across health, education, and social care. This approach demonstrates the power of self-determination, cultural authority, and holistic support.

Canada: Early Years Centres

Canada has invested in Early Years Centres, providing developmental information, play-based learning, and family support under one roof. Evaluations show these centres improve parental confidence and readiness for school, while reducing fragmentation.

Seamless transitions across systems

A consistent theme across best practice examples is the importance of seamless transitions for families. Too often in Australia, families experience hand-offs between services that result in delays, duplication, or disengagement. Mechanisms to improve transitions include:

• Navigation support: Dedicated staff who walk alongside families, ensuring referrals are completed and appointments attended.
• Shared records: Integrated digital platforms that allow professionals across sectors to access developmental information and reduce duplication.
• Continuity of relationships: Assigning families to a consistent practitioner, keyworker or navigator who remains a point of trust across transitions.
• Universal entry points: Services like hubs or Careline, e-hubs that ensure families do not “fall between the cracks” of eligibility systems.

Karitane’s Hubs demonstrates how these models of care work in practice.

Policy lessons for Thriving Kids

From both domestic and international experiences, several policy lessons emerge:

1. Integration, not fragmentation: Services must be co-located, integrated, coordinated, and delivered through shared governance structures.
2. Relational delivery: Families engage when they trust providers. Relational care must be embedded as a workforce standard.
3. Universal access with proportionate investment: Every child must have access to developmental monitoring, with greater investment directed to families with greater need.
4. Navigation and case coordination: Families need consistent guidance across systems, not hand-offs between disconnected services.
5. Cultural authority: Programs must be Aboriginal-led and culturally safe, learning from Whanau Ora and RAP frameworks.
6. Sustained investment: Short-term pilots undermine trust. Successful models must be funded over decades, not years.

Family voices

Parents emphasise the importance of seamless transitions. As one mother said at the Fairfield Hub:

“Before, I felt like I was on my own, being sent from one place to another. Now it’s all here. Someone walks with me, and I don’t have to explain my story five times.”

This testimony highlights the difference between fragmented and integrated systems — and why Thriving Kids must prioritise seamlessness.

Recommendations for TOR 5

1. Expand Child and Family Hubs nationally
2. Fund supported playgroups as trusted entry points.
3. Strengthen universal platforms such as Careline and eHubs for statewide /national reach.
4. Embed system and service navigation roles to ensure seamless transitions, drive integration between services and systems as well as service navigation for families.
5. Develop shared digital records for developmental information.
6. Learn from international best practice in integration, universalism, and cultural authority.
7. Ensure all programs are funded on a long-term basis to build trust and sustainability.