Head Office: Arnhem Road, Nhulunbuy NT 0880
Phone: (08) 8939 1900
Facsimile: (08) 8987 1670
GPO Box: 4322 Darwin NT 0801
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25 November 2025
House Standing Committee on Health, Aged Care and Disability
PO Box 6021
Parliament House
CANBERRA, ACT 2600
Via e-Mail: Health.Reps@aph.gov.au
SUBJECT: Additional Evidence: Parliamentary Inquiry into Thriving Kids - Public Hearing 17 November 2025
Dear Standing Committee,
Thank you for the opportunity to attend the roundtable for the Inquiry into Thriving Kids, held on 17 November 2025. Following the request from the Committee Chair, Dr. Mike Freelander, Miwatj Health Aboriginal Corporation (Miwatj Health) provides this overview of our child and adolescent models of care, focusing on the Yothuw Mulka program.
Miwatj Health is an Aboriginal Community Controlled Health Organisation (ACCHO), operating across East Arnhem Land since 1991. We deliver community health services that are Yolnu focused and delivered together, Yolnu and Balanda (white/European people).
The child and adolescent models of care outlined below demonstrate Miwatj Health’s strategic approach to delivering quality health care across East Arnhem Land.
Scheme (NDIS) Operations
Miwatj Health commenced NDIS service delivery in 2016 as part of the rollout of the NDIS in remote East Arnhem Land. Our Support Coordination programs now comprise a team of Level 2 and Level 3 Support Coordinators who provide services to around 280 participants. Approximately 22% of these participants are children under the age of eight, and of this group, 82% have a diagnosis of Autism and/or Developmental Delay.
In 2017, Miwatj Health also became the first nationally appointed trial site for the Remote Community Connector (RCC) Program. Today, this program employs Yolnu RCCs across seven East Arnhem communities, providing culturally informed NDIS brokerage to support participants to understand, navigate, and engage with the scheme.
Yothuw Mulka: Home Visiting Program
Yothuw Mulka translates to ‘a safe place for a baby to be held and protected’ and is Miwatj Health’s maternal home visiting program. It ensures babies have the best start in life by building maternal confidence, strengthening family support, and empowering families to access essential services.
The program was permanently established in the Miwatj Health’s service model following the successful trial of the Maternal Early Childhood Sustained Home-visiting (MECSH) program in the Northern Territory (2019-2024) and has been operating under the Yothuw Mulka name for approximately 10 months.
Program Scope and Target Population
- Location: Milingimbi, Gapuwiyak, Galiwin’ku, and Ramingining.
- Clients: Pregnant Yolnu women and families caring for babies and young children under three years old. The mother or primary carer is the program ‘client,’ with support extended to all caregivers.
- Delivery: A combination of home and centre-based visits delivered individually and to family groups, as well as group sessions for interested caregivers.
- Values: Family-centred, culturally respectful, strengths-based, and trauma-informed.
Guiding Principles
In response to community feedback from the MECSH evaluation, the Yothuw Mulka model is built around three core domains:
- Information & Education: Pregnancy, birth, child growth and development, early brain development, responsive parenting, attachment, bonding, language, and family health.
- Emotional Support: Strengthening mothers’ mental health and wellbeing, brief counselling, connection to specialist services, and cultural connections.
- Practical Support: Accessing essential services (Clinic, Centrelink, NDIS, legal), screening/assessment (e.g., ASQ TRAK), and addressing health concerns.
Key Program Outcomes
- Improved Birth and Child Health Outcomes: Higher uptake of antenatal care, and improved uptake of timely health care checks and immunisations for the baby.
- Increased Parental Confidence: Evidence by enrolment and engagement in Yothuw Mulka and improvements measured by the developing self-efficacy tool.
- Local Workforce Capacity: Providing standardised education for local staff to share timely, culturally appropriate health promotion messages.
- Strengthened Family Health: Building on existing parenting strengths through culturally appropriate support and evidence-based information.
- Early Detection: Supporting timely screening to facilitate referral to allied health professional
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services for developmental delays.
Yolnu-Led Staffing Model
The Yothuw Mulka program is transitioning to a predominantly Yolnu-staffed model. This shifts from a Nurse/Community Worker pair to a team of Yolnu staff in each community, supported by two nurses across the four communities.
This model recognises and values local knowledge and the importance of first-language communication.[^2] The model improves the continuity of care with Yolnu staff more likely to remain in community, and build or already have trusting relationships with the program’s clients.
Impact and Current Challenges in Child Health
The Yothuw Mulka model enhances Miwatj Health’s comprehensive Child and Adolescent Model of Care across seven East Arnhem communities by providing a specialised workforce for early identification and response to vulnerable children’s needs.
Northern Territory Health Key Performance Indicators (NTHKPIs)
Recent Miwatj Health data from the NTHKPIs demonstrates the urgent need for expanded intervention:
- 0-4 Health Checks: Only 29% of children (0-4) received a health check (NT average: 39%), with some communities as low as 8%.
- Underweight: 9% of children were underweight (NT average: 5%).
- Anaemia: 34% of children tested were anaemic, indicating missed early intervention.
- Developmental Screening: Rates are extremely low due to limited trained assessors.
Gaps in Developmental Screening and Diagnostic Pathways
The lack of consistent screening and poor diagnostic pathways are major barriers to supporting children with additional needs:
- Limited Screening Capacity: The gold-standard culturally adapted tool, ASQ-TRAK, is currently delivered by only two nurses (one Child Health Nurse in Yirrkala and the program lead).
- Missed Opportunities: Families not engaged in Yothuw Mulka or Family as First Teachers (FAFT) are at significant risk of being missed, delaying critical early detection.
- The Diagnostic Trap: Children identified with delays often cannot access a formal diagnosis (required for continued NDIS support beyond the age cut-off, currently 7, moving to 9).
- NDIS/ECEI Limitations: Early Childhood Early Intervention (ECEI) providers generally cannot use NDIS funding for diagnostic assessments.
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- Therapist Gaps: East Arnhem-based therapists often lack paediatric training.
- Result: Children frequently lose funded support because they could not access the required formal diagnosis (cognitive/autism assessment, paediatric review) due to exceedingly long waitlists in the NT, leading to many children falling out of the system entirely between the ages of 7-10.
Current Successes and Innovative Models
Miwatj Health has used innovative, often temporary, funding to create critical specialised roles:
- Ear Health Coordinator: Trains Yolnu staff, Remote Area Nurses, and schools in video otoscopy and tympanometry. Critical for early detection of Otitis Media, which heavily impacts language and learning.
- Paediatric Complex Care Coordinator: Provides case management for children with developmental delay and complex medical needs. Established using residual COVID-19 funding; provides crucial continuity and case coordination despite an unsustainably large workload.
- School Health Nurse (Galiwin’ku): Miwatj Health’s only dedicated school-based nurse. This successful model delivers health education (ear health, hygiene, etc.), school-age health checks, immunisations, and supports chronic conditions. It is a highly effective way to identify and follow up on unmet health needs that are otherwise missed.
- The Essential Role of a Yolnu Workforce: A strong Yolnu workforce is fundamental to the success of child health services. When non-local clinicians work alongside dedicated Yolnu Allied Health Practitioners (AHPs) or community workers, engagement, follow-up, and accuracy of screening (e.g., ASQ-TRAK) dramatically improve due to trust and first-language, culturally aligned explanations.
Nutrition Program Overview
The Miwatj Nutrition team provides one of the most comprehensive primary health nutrition and dietetic services in the NT, integrating clinical dietetics, public health nutrition, and food security services.
- Growth: Established in 2019 with one Public Health Nutritionist, the team now includes a Team Lead and three dual Clinical Dietitian/Public Health Nutrition roles, all of which fly-in from Darwin to seven NEAL communities and Homelands.
- Cultural Integration: The team has established three Yolnu Allied Health Assistant (AHA) roles and a Yolnu Allied Health Cultural Advisor who are training to deliver education in Yolnu Matha and embed cultural safety.
- Service Demand: The program is severely constrained by resources. We have over 700 patients on our clinical dietitian lists, limiting time for essential preventative public health
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programs to reduce morbidity and mortality.
Paediatric Nutrition Needs
Children are a key priority group, as early nutrition supports future physical and cognitive development.
- High Need: Approximately 16% of the clinical list are children aged nine and under, many referred for malnutrition related to food insecurity and complex psychosocial determinants.
- Funding Challenge: Despite this need, the program receives no dedicated paediatric funding.
- NDIS Revenue: Securing adequate NDIS funding for young children not only enables appropriate specialist support but also generates revenue to make the program more self-sustaining and increase culturally appropriate care delivery.
Recommendations for Thriving Kids
Miwatj Health recommends the following reforms be incorporated into the Thriving Kids initiative, specifically designed for remote First Nations communities:
1. Workforce Protection & Expansion
- Dedicated Child Health Nurses (CHNS): Fund dedicated Child Health Nurses for the 0-8 demographic in each community, exempt from on-call/acute workloads, and focused solely on well-child care (developmental checks, immunisation, etc.).
- Mandate First Nations Health Workers: Create and fund a dedicated First Nations AHP or Community Worker to work alongside every CHN, central to engagement, first-language communication, and sustained family participation.
2. Strengthen Developmental & Diagnostic Pathways
- Universal Screening: Resource ACCHOs to deliver ASQ-TRAK and ASQ-SE screening universally at key ages, co-delivered with First Nations staff.
- Fund Timely Diagnostics: Fund timely diagnostic pathways (developmental paediatric appointments, cognitive/autism assessments) to prevent children from losing NDIS access simply because they could not obtain a diagnosis before the age cut-off.
3. Integrated, ACCHO-Led Early Intervention
- ACCHO Allied Health Teams: Fund an Allied Health Early Intervention Team within ACCHOs to provide community-based speech pathology, occupational therapy, and behavioural support through a coordinated, community-hub model.
- School-Based Health: Fund the expansion of the School Health Nurse model (similar to Galiwin’ku) across all remote communities to improve identification and follow-up of school-age health needs.
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4. Cohesion and Governance
- Strengthen, Not Replace: Guarantee that Thriving Kids strengthens, not replaces, existing NT Government services (like Community Allied Health Team - CAHT) to form a cohesive early childhood ecosystem.
- Community Governance: Embed First Nations leadership at all stages of Thriving Kids design, governance, and evaluation, prioritising co-design and strengths-based, community-led approaches.
Please contact redacted for further information.
Sincerely,
redacted
Chief Operating Officer
Miwatj Health Aboriginal Corporation