Submission to the Thriving Kids Inquiry

Submitted by: Alyce Svensk Role: Paediatric Occupational Therapist. Director - The OT Coach Australia Contact: hello@theotcoach.au

Executive Summary

As a paediatric occupational therapist, former practice owner, and national mentor to hundreds of occupational therapists across Australia, I have seen first-hand the impact of NDIS funding decisions and the risks posed by the proposed Thriving Kids reforms.

Key concerns:

Families are already being removed from the NDIS with no viable alternative supports in many regions.
Significant funding inconsistencies exist between families with similar needs.
Regional and rural families face multi-year waitlists or no services at all.
Barriers such as requiring a diagnosis delay access to critical early intervention.
The Thriving Kids Fact Sheet (August 2025) proposes moving children with mild to moderate developmental delay/autism out of the NDIS into mainstream systems. This risks undermining family-centred practice and excluding children not in school or childcare.
Providers are under severe financial and emotional distress. A 2025 OTA survey of 600 OTs found 14 percent plan to exit the sector, 55 percent reported no profit in 2024-25, and 95 percent believe client access will

decline under current pricing. Between 11,700 and 17,300 clients nationally are expected to lose OT access.

I closed my own service, Sensational Start OT, in 2024 despite overwhelming demand, due to price freezes, rising costs, inability to hire, and sector uncertainty. This left hundreds of families without support.
Families themselves have voiced strong concerns: an Every Australian Counts survey found 80 percent fear reduced access, 75 percent fear loss of choice and control. and only 18 percent support Thriving Kids in its current form.
The paediatric therapy workforce has been primarily developed in private practice, which now carries the burden of training and mentoring new graduates. If private services close, the entire workforce pipeline collapses.

Thriving Kids must prioritise continuity, equity, and sustainability to ensure children receive timely supports and the workforce remains strong.

Introduction

I am an occupational therapist with more than fourteen years of paediatric experience. In 2017, I established Sensational Start OT, a practice that grew to three clinics and a team of more than 15 therapists. For seven years, we provided essential supports to hundreds of children and families across the Hunter and Lake Macquarie regions.

In 2024, I made the difficult decision to close this service. This was not due to lack of demand. The need for paediatric therapy remains overwhelming. Instead, the closure was driven by:

NDIS price freezes failing to match rising service costs
Increased costs of service provision
Inability to recruit staff due to unsustainable conditions

Uncertainty of the private paediatric sector, which made future planning impossible
This decision left hundreds of families without continuity of care.

Through The OT Coach Australia, I now mentor and train hundreds of OTs nationally. Their stories mirror my own: families missing supports, children waiting years for therapy, and providers at breaking point.

Key Issues

1. Families falling through the cracks

In Newcastle, there are no government-funded childhood intervention services, we have access to specialist clinics for physical and medical conditions and an assessment clinic, but no therapy provision for the identified mild-moderate children with developmental delays.

On the Central Coast we have access to a small amount of public services, however these public services carry waitlists of two years. Families removed from the NDIS are left without options, with many ceasing therapy altogether. A parent from the Every Australian Counts survey said: “Without the NDIS … my child will be left to fall through the cracks. That thought breaks me.”

2. Funding inconsistencies and access barriers

Families in similar situations receive very different funding levels.

There are significant barriers in both accessing NDIS, accessing assessments for a diagnosis and then accessing services. At the moment a lot of support for these families is being provided pro bono through private providers and clinics.

Children often cannot access supports without a formal diagnosis, delaying critical early intervention. Many families wait for NDIS approval rather than self-funding, losing valuable developmental time.

In our clinic, my Practice Manager would spend hours of her day assisting families to navigate both their NDIS plans and supports. Our clinic spent many hours building up our knowledge and awareness of both community, therapy and mainstream programs for our families. However, over the years these programs have decreased in availability largely due to changes in government and NDIS funding.

3. Loss of individualised, relationship-based support

Current NDIS supports allow families to access individualised therapy tailored to each child’s needs and goals. This includes the time required to build a therapeutic relationship, which for some children can take many months or even years.

Children with developmental delays, trauma histories, or complex needs often need extended periods of consistency before trust is established and progress is made. Under Thriving Kids, there is a risk that these children will be directed into short- term, block-funded, or group programs in mainstream settings. Such models may not allow for the pace and flexibility needed for sustainable progress.

If children are moved away from individualised supports:

Therapeutic relationships may be disrupted
Gains may be superficial or short-lived
Families may disengage if they feel their child’s needs are not understood or supported over time

A one-size-fits-all approach does not reflect best practice in paediatric therapy. Maintaining individualised supports is critical to ensure children with complex or slower-to-progress needs are not left behind.

4. Risks in the Thriving Kids model

Shifting children with mild to moderate needs into mainstream settings assumes capacity that does not exist. Not all children attend school or childcare, leaving some excluded. Best practice guidelines emphasise family-centred practice, where parents are active partners.

Mainstream-only delivery reduces caregiver involvement and limits generalisation of therapy to home and daily routines. Transitioning from NDIS before mainstream services are adequately resourced risks service gaps and lost progress.

As the model has not been fully provided - it is difficult to provide further concerns regarding the risk. However extensive consultation and submissions have been provided surrounding foundational supports (Occupational Therapy Australia, 2025, Submission to the NSW Select Committee on Foundational and Disability Supports for Children and Young People).

5. Regional and rural inequity

Waitlists in regional and rural areas already stretch years. OTA data shows between 3,160 and 4,560 participants in outer regional and remote areas may lose OT access under current pricing rules. Thriving Kids risks entrenching inequity further, as urban centres may absorb reforms more easily than rural communities.

We have significant concerns about the ability for the current regional and rural workforce to be able to support these changes.

6. Workforce and provider sustainability

The paediatric workforce has been primarily developed in private practice across Australis for the past 10 years, as public services have been scaled back. Private providers now carry a large responsibility for training, supervision, and mentoring new graduates. If private services close, the entire sector may lose training capacity, reducing supervision and skill-building opportunities for the workforce. Many

experienced clinicians are in private practice. If these roles disappear, who will train the next generation of therapists?

7. Workforce distress and closures

OTA’s 2025 survey shows:

55 percent of providers reported no profit in 2024-25
39 percent do not expect to remain profitable, and 43 percent are uncertain about their future
14 percent plan to exit the sector, which equates to around 1,267 practices
95 percent believe client access will decline, affecting 11,700-17,300 clients nationwide
In regional and remote areas, up to 4,560 participants risk losing access

Providers are planning to reduce outreach: 92 percent will reduce travel. 63 percent will reduce regional and remote services, 24 percent will stop complex cases, and 33 percent will stop home and community visits entirely. These changes directly undermine family-centred and natural-environment models. Providers are reporting financial distress and moral distress, with many experiencing burnout and leaving paediatrics altogether.

8. Workforce pipeline at risk

Over the past five years, government and universities have intentionally expanded allied health training pipelines, producing more OT graduates. Many of these graduates have been trained with a paediatric focus.

Yet if private providers close, there may not be jobs or supervision pathways for these graduates to gain competency. This creates a damaging mismatch: more therapists being trained, but fewer paediatric roles available. The long-term effect is an erosion of skills and reduced sector capacity.

Recommendations

Ensure continuity of supports: guarantee uninterrupted access to therapy during critical developmental periods.

Improve access pathways: allow early intervention without requiring a diagnosis, and prevent families being left waiting for NDIS approval before accessing supports.

Strengthen alternative supports: invest in publicly funded early intervention services nationwide, and prioritise reducing waitlists in regional and rural areas.

Protect family-centred practice: embed parents as central partners in therapy, and avoid over-reliance on schools or childcare which excludes children not in those settings.

Address funding inconsistencies: standardise and make transparent funding decisions to reduce inequity.

Develop pathways that support the individual child and family - through consultation.

Support workforce sustainability: align NDIS pricing with the real costs of paediatric service delivery, recognise private providers as key training sites and support supervision capacity, and address provider financial and mental distress to prevent further closures.

Commit to co-design and transparency: families, carers, and people with disability must be genuine partners in reform design, and transparency must be ensured through clear reporting on wait times, service access, and outcomes.

Conclusion

The Thriving Kids Inquiry is an opportunity to build a system that genuinely supports children and families. But as currently designed, the reforms risk creating greater inequity, reduced access, and workforce collapse.

Without urgent action: more families will fall through the cracks, more children will miss critical early intervention, and more providers will close, eroding paediatric expertise for years to come.

I urge the Committee to ensure continuity, equity, sustainability, and co-design are embedded in Thriving Kids so every child has the opportunity to thrive and so the workforce that supports them can survive.