Submission 30 — The Australian College of Nurse Practitioners — Inquiry into the Thriving Kids initiative

Australian College of Nurse Practitioners response to:

Response to the Terms of Reference — Thriving Kids Inquiry Department of Health, Disability and Ageing House Standing Committee on Health, Aged Care and Disability

Contact: redacted Australian College of Nurse Practitioners PO Box 33175 Melbourne Vic 3004 Office: St Kilda Rd Towers, Suite 502 1 Queens Road Melbourne

redacted 1300 433 660 www.acnp.org.au

22 September 2025

Hon Mark Butler Department of Health, Disability and Ageing House Standing Committee on Health, Aged Care and Disability

By online survey portal, date: 22 September 2025

Dear Hon Mark Butler,

Thank you for the opportunity to provide a submission to the House Standing Committee on Health, Aged Care and Disability regarding the Thriving Kids initiative. This submission responds directly to the Terms of Reference (ToR) and offers practical, evidence-informed recommendations to strengthen early identification and supports for children with mild-to-moderate developmental delay and/or autism, with a strong emphasis on equity and culturally safe care.

The Australian College of Nurse Practitioners (ACNP) is the leading national body representing Nurse Practitioners (NPs). We drive the advancement of nursing practice, strengthen consumer access to care, and ensure high-quality, evidence-based healthcare delivery. Nurse Practitioners are uniquely equipped to address unmet healthcare needs in communities across Australia, especially underserved and vulnerable populations, including children, whose developmental, physical, and mental health needs require timely and holistic support.

The Australian Government highlights that children with mild-to-moderate developmental delay or disability can be better supported outside the National Disability Insurance scheme (NDIS) but must continue to have access to funded, high-quality mainstream services. The ACNP understands Thriving Kids is designed to deliver targeted interventions for children under nine years of age with mild-to-moderate developmental delays or autism within mainstream systems like schools, childcare, and health services.

Our understanding of this reform is to:

• Preserve the sustainability of the NDIS by reserving resources for those with permanent and significant disability;

• Ensure continuity of care for current NDIS participants, with reforms carefully considering the impacts on existing participants, including timing and transition arrangements for children;

• Deliver carefully designed transitions, co-developed with early childhood experts and parents and carers; and

• Maintain the NDIS focus on disability, ensuring children with significant and permanent needs continue to be fully supported.

The ACNP supports the Government’s assurances that care and interventions for existing NDIS participants will not be disrupted. To maximise the impact of the Thriving Kids initiative it is essential that children who are newly diagnosed or undergoing assessment are not financially disadvantaged or subjected to reduced service provision during the transition period. These children must receive the necessary funding and support to meet their developmental needs, so they are not left to fall through the cracks, potentially risking poorer outcomes, widening inequities, and creating greater long-term reliance on more intensive support through the NDIS.

Nurse Practitioners are a vital part of the primary care workforce, and are embedded across maternal and child health, general practice, and community health services. With appropriate funding, NPs can strengthen early identification and intervention, ease service demand on specialised behavioral pediatricians, and improve equity of access across metropolitan, rural, and remote settings. Purposefully integrating this workforce into the Thriving Kids model would provide a sustainable, system-wide approach to supporting children to thrive outside of the NDIS.

In this submission, the ACNP will address the following Terms of Reference (ToR):

Term of Reference 1

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

ACNP Response

In response to ToR 1, the ACNP recommends fully funding the introduction of a nationally consistent and standardised, multidisciplinary indicator assessment tool for use by parents, carers, Maternal and Child Health Nurses, NPs, Early Childhood Educators, Primary Healthcare Nurses, General Practitioners, allied health providers, and psychologists.

Early recognition of developmental and behavioural concerns is critical to ensuring children receive timely support and intervention. However, these early signs are often overlooked or minimised, often described as “something the child will grow out of” or “just a quirk.” Without a consistent approach to referral, supported by a simplified and universal indicator assessment tool, delays in referral, assessment, and treatment are more likely, and some children may not be identified at all.

For example, in Victoria the Parents’ Evaluation of Developmental Status (PEDS) tool is used by Maternal and Child Health Nurses during routine “Key Ages and Stages” visits.1 The PEDS is an evidence-based screening tool that enables parents to raise developmental or behavioural concerns and supports early identification and referral.1 While PEDS has proven effective within a universal service, its availability and consistent use across jurisdictions

1 Department of Health Victoria. Enhanced Maternal and Child Health Program Guidelines [Internet]. Melbourne: Department of Health; 21 Jul 2025 [cited 2025 Sep 18]. Available from: https://www.health.vic.gov.au/publications/enhanced-maternal-and-child-health-program-guidelines health.vic.gov.au

remain limited. A national, standardised approach that builds upon tools like PEDS, accessible to all services and carers, would promote equity, ensure consistency, and enable streamlined assessment and timely referral for a more comprehensive paediatric developmental evaluation.

Furthermore, parents and carers also consistently report fears of their child being “labelled,” which perpetuates stigma and discourages them from raising or acting on developmental concerns. This proposal highlights the importance of normalising early conversations about development and reducing stigma, by framing referrals as opportunities to support a child’s growth and learning rather than as labels that define them.

A universal, structured, and longitudinal multidisciplinary indicator assessment tool (supported by training for professionals and early childhood educators working alongside parents and carers) would embed a consistent, practical approach across maternal and child health, early education, and healthcare services.

In addition, this tool could:

• Normalise all developmental conversations with parents and carers, reducing stigma around “labelling” and validating their observations;

• Provide clear indicators to support early and confident identification of developmental, behavioural, and functional concerns and early referral for a comprehensive assessment and or follow up/review;

• Standardise assessment (what to look for) across health, education, and early childhood settings to ensure consistency in recognising red flags. These may include repetitive play, feeding difficulties, sensory sensitivities, limited food intake and variety, poor or delayed fine and gross motor skills, intense focus or restricted interests, rigid routines, delayed language development (including echolalia), limited eye contact, regression of skills, toe-walking, and unusual patterns of social play;

• Establish consistent referral pathways to paediatricians, NPs, GPs, psychologists, speech pathologists, occupational therapists, and other relevant services, which are integrated into the tool;

• Improve consistency in identifying and responding to concerns raised by parents and carers across service providers, reducing delays in diagnosis and intervention by clarifying when concerns should trigger a referral for further assessment. Parents and carers often report raising developmental concerns about their child that are subsequently dismissed. A standardised tool could help validate these concerns. The ACNP supports constructive, compassionate communication with parents, carers, and families, ensuring their concerns are taken seriously and that referral processes remain consistent;

• Empower early childhood educators to play a central role in recognising developmental differences in group settings, and to discuss findings with parents and carers openly within a clear framework. This approach can also help prevent negative outcomes where stigma exists, such as parents feeling their child may be being singled out;

• Promote and fund MBS access to early assessment and intervention under Thriving Kids. Early referral, timely assessment, and commencement of interventions are strongly associated with improved developmental, social, and educational outcomes. This should include block-type funding, along with MBS items for assessing,

diagnosing, and treating patients with a complex neurodevelopmental disorder (such as autism spectrum disorder). This funding should include NP-led assessment and management;

Strengthen multidisciplinary collaboration, linking maternal and child health, education, primary care, and allied health professionals into a shared digital pathway for early intervention for individuals using the MyHealthRecord, or similar;

Promote equity of access, particularly for children in regional and remote areas, Aboriginal and Torres Strait Islander peoples, and other marginalised communities. This should include extending the non-face-to-face rule for telehealth to children aged over 12 months, as the current exemption only applies to those aged 12 months and under;

Fund training for best-practice assessment and embed nationally consistent, validated screening tools (e.g., ASQ-32, PEDS-R3, SACS-R4) into routine GP, NP, child health nurse, and early education settings once initial screening tools are complete and referrals are received from parents, early childhood educators and teachers;

Provide nationally consistent communication training and resources for professionals to support sensitive and constructive engagement with parents and carers. Standardised guidance will ensure professionals can raise developmental concerns consistently and compassionately, validate parental observations, and reduce the stigma associated with “labelling”;

Enhance parental and carer support services, including navigation assistance and case coordination, to help manage complex and often confusing service pathways, particularly for those with poor health literacy, or from culturally and linguistically diverse (CALD) populations, disadvantaged groups, and rural/remote communities;

Fully recognise, fund and utilise the full scope of the healthcare and early childhood workforce, including NPs, to lead developmental screening alongside Pediatricians, General Practitioners, psychologists, and allied health professionals; to initiate referrals; and to provide family education, particularly in marginalised communities;

Develop plain-language, culturally safe guides to support parents and carers, available in multiple formats (print, digital, video, and translated materials) to ensure accessibility and appropriateness for Aboriginal and/or Torres Strait Islander persons and for culturally and linguistically diverse (CALD) communities; and

Integrate screening results into digital systems (e.g., MyHealthRecord, Services Australia apps).

2 Paul H. Brookes Publishing Co., Inc. Ages & Stages Questionnaires®, Third Edition (ASQ-3) [Internet]. Baltimore: Paul H. Brookes Publishing Co.; [cited 2025 Sep 14]. Available from: https://agesandstages.com/products-pricing/asq3/

3 Royal Children’s Hospital, Melbourne. Parents’ Evaluation of Developmental Status-Revised (PEDS-R) [Internet]. Parkville: The Royal Children’s Hospital; [cited 2025 Sep 14]. Available from: https://www.rch.org.au/ccch/peds/About_PEDS-R/

4 Autism CRC. Autism screening tool - world’s most effective [Internet]. Brisbane: Autism CRC; 2022 Mar 14 [cited 2025 Sep 14]. Available from: https://www.autismcrc.com.au/news/latest-news/autism-screening-tool-worlds-most-effective

Recommendations

1. Fully fund and introduce a nationally consistent, multidisciplinary developmental indicator tool across health, education, and early childhood services.

2. Provide national communication training and resources to ensure professionals can engage families constructively and reduce stigma.

3. Expand MBS block-funding for early assessment and intervention, including NP-led assessments and referrals.

4. Provide plain-language, culturally safe resources for parents and carers in multiple formats and languages.

5. Fund structured navigation support and case coordination for families.

Term of Reference 2

Examine the effectiveness of current (and previous) programs and initiatives that identify children with developmental 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.

ACNP Response:

• Re-invest in the Helping Children with Autism (HCWA) Package (or similar), a former federal initiative that was phased out but previously provided vital financial support for autistic children. Launched in 2008, the package funded early intervention services for children with autism spectrum disorder (ASD) and other pervasive developmental disorders (PDD). It offered Medicare rebates for assessments and therapy, including up to 20 treatment sessions with allied health professionals such as speech pathologists and occupational therapists. The initiative also supported autism advisors, playgroups, and professional development for teachers.

• Review and build upon Early Childhood Early Intervention (ECEI) to ensure that 1:1 access to community-based intervention remains accessible and affordable, across allied health services including exercise physiology, physiotherapy, occupational therapy, speech pathology, feeding and nutrition services, medical and nursing care, and psychology.

• Strengthen funding, accessibility, and resources within mainstream touchpoints, primary health, playgroups, early education, and schools. If the Government aims to enhance early intervention through a settings-based approach, this must be fully integrated into both public and private early childhood centres and schools nationwide. This will ensure that children receive individualised services and that parents and carers are actively also involved, receiving timely feedback on progress and clear guidance on how to best support their child at home.

Recommendations

1. Re-invest in the HCWA Package to restore funding for allied health therapies, assessments, playgroups, and teacher training.

2. Strengthen and expand ECEI to maintain affordable, 1:1 community-based intervention across allied health, psychology, and nursing.

3. Ensure early intervention is fully embedded within early learning centres and schools, with active involvement of families.

Term of Reference 3

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

ACNP Response:

• Partner with National Aboriginal Community Controlled Health Organisation (NACCHO) and Aboriginal Community Controlled Health Organisation (ACCHOs) and first nations families and carers: Co-design culturally grounded pathways for First Nations children that recognise the intersection of culture, geography, and socioeconomic factors.

• Develop multilingual and accessible resources: Provide resources in multiple languages and formats (visual, digital, oral) to support CALD families, recognising that health literacy, migration status, and service trust can intersect to limit access.

• Prioritise disadvantaged and rural/remote families: Address barriers faced by families in rural/remote areas who may also experience poverty, transport disadvantage, digital exclusion, or limited workforce availability. This includes removing the face-to-face requirement for access to Medicare rebateable telehealth services.

• Embed workforce cultural capability: Train and support clinicians to respond sensitively where intersectionality is identified for example, a child with disability in a CALD family living in a rural area.

• Support holistic, wrap-around services: Advocate for care pathways that acknowledge families may face simultaneous challenges (e.g., housing insecurity, intergenerational trauma, limited health literacy) and therefore need coordinated, multidisciplinary responses.

Recommendations

1. Co-design culturally grounded pathways with NACCHO, ACCHOs, and First Nations families.

2. Develop multilingual and accessible resources in multiple formats to support CALD communities.

3. Remove face-to-face restrictions for telehealth for children over 12 months who require assessment and access to disability and autism-related care.

4. Build workforce cultural capability training into all child health, education, and allied health roles.

5. Support wrap-around services that address social determinants such as housing insecurity, trauma, and poverty.

Term of Reference 4

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

ACNP Response:

• Train NPs, GPs, child health nurses, allied health, and educators in developmental surveillance and culturally safe engagement, as mentioned above in ToR 3.

• Consider MBS item numbers which support Multidisciplinary Team (MDT) case conferencing, which can be initiated by a GP, NP and/or an allied Health professional.

• Incentivise workforce distribution to rural and remote regions and fund telehealth services to ensure services are accessible and affordable, without the need for an initial face-to-face consultation

• Introduce interdisciplinary training modules to align practices.

• Invest in retention and support strategies for providers to reduce burnout.

Recommendations

1. Fund training for NPs, GPs, child health nurses, allied health, and educators in developmental screening and culturally safe engagement.

2. Introduce MBS item numbers for multidisciplinary team case conferencing, led by NPs, GPs, or allied health.

3. Provide incentives for rural and remote distribution and ensure telehealth is fully funded and accessible.

4. Invest in workforce retention strategies, including measures to reduce burnout.

Term of Reference 5

Draw on domestic and international policy experience and best practice.

ACNP Response

National autism strategies provide the foundation for coordinated action and measurable improvements in outcomes for people living with autism. International examples, such as Scotland’s Autism Strategy5, highlight the importance of strong government leadership, cross-agency collaboration, involvement of Autistic people, caers and families in decision-making, timely access to diagnosis, and targeted supports for education and employment. Evidence also demonstrates that well-designed strategies deliver long-term cost savings by reducing the high costs of inaction or fragmented services.

Domestically, Australia has now established its own National Autism Strategy 2025–316, released by the Hon Amanda Rishworth MP. This strategy sets out a coordinated national approach across four key domains:

• social inclusion,
• economic inclusion,
• diagnosis/services/support,
• health and mental health

It is accompanied by a First Action Plan (2025–26), which provides immediate steps to turn commitments into action.

Lessons from both domestic and international experience demonstrate that successful national strategies must:

• Set clear targets and embed robust data collection to measure outcomes.
• Increase community awareness and reduce stigma, as inclusion relies heavily on community attitudes.
• Improve timely access to autism assessment and diagnosis, while ensuring demand is managed to avoid unsustainable waitlists.
• Recognise the role of evidence-based early supports in achieving long-term social, educational, and economic participation.

Recommendations

1. Embed measurable targets and robust data collection in the National Autism Strategy.
2. Fund national stigma-reduction campaigns to shift community attitudes.

5 Autism Toolbox. The Scottish Autism Strategy [Internet]. Edinburgh: Autism Toolbox; [cited 2025 Sep 18]. Available from: https://www.autismtoolbox.co.uk/scottish-context/legislative-and-policy-framework/the-scottish-autism-strategy/ autismtoolbox.co.uk

6 Australian Government Department of Health, Disability and Ageing. National Autism Strategy 2025–2031 [Internet]. Canberra: Department of Health; 14 Jan 2025 [cited 2025 Sep 18]. Available from: https://www.health.gov.au/sites/default/files/2025-07/national-autism-strategy-2025-2031.pdfhealth.gov.au

3. Prioritise timely access to diagnosis and intervention to avoid unsustainable waitlists.
4. Ensure long-term funding for evidence-based early supports to achieve social, educational, and economic outcomes.

Term of Reference 6

Identify mechanisms that would allow a seamless transition through mainstream systems for all children with mild to moderate support needs.

ACNP Response:

• Enhance digital enablement and expand the use of electronic health records and establish a single point of information sharing to reduce duplication of forms, repeated assessments, and the communication burden on parents and carers;

• Enable interoperability and implement electronic referrals, secure messaging between providers, and telehealth platforms that are integrated across health, education, and community services;

• Establish a national digital “screen–guide–refer” pathway and develop a scalable, evidence-based tool that can be used by any provider to screen, guide, and refer children. This tool should enable longitudinal tracking of each child’s progress, including developmental milestones, service access, and professionals involved in their care;

• Reduce fragmentation and inequities: Ensure digital systems are accessible and user-friendly for providers across metropolitan, rural, and remote settings, with strong protections for privacy and cultural safety;

• Funding support to enhance school-based and place-based supports and interventions to ensure children’s early intervention needs are met, strengthening service provision through schools and early learning centres. Delivering supports where children are learning allows identified areas of need to be addressed in real time, promotes inclusion, and ensures timely intervention in familiar, supportive environments;

• Ensure Thriving Kids provides parents and carers with adequate financial support to access case coordinators where required; and

• Launch stigma-reducing national awareness campaigns.

Young children in statutory care consistently experience poorer physical, developmental, and emotional health outcomes compared to their peers. Ensuring health needs are assessed each time a young child enters care allows timely screening, referral, and support, which can prevent avoidable poor health and wellbeing outcomes at a critical stage of development.7

In recognition of this need, the Victorian Government invested $37.8 million in July 2023 (over four years) to improve statewide access to health screening and assessment for children and young people in care. This investment underscores the importance of integrated and proactive health responses and provides a strong example of how Thriving Kids could align with existing initiatives to ensure vulnerable children under eight are supported early and consistently.5

A seamless transition requires strong integration between new initiatives such as Thriving Kids and existing programs that already provide wraparound supports. One example is the Pathway to Good Health program in Victoria, which delivers health screening, assessment, planning, and referral for children aged 0–17 years entering or re-entering statutory care, including kinship, foster, and residential care settings. The program is delivered through a designated health provider in each of the seventeen areas, ensuring consistency of access.

By embedding Thriving Kids within such models, supports can be coordinated across health, education, and child protection systems, avoiding duplication and ensuring that young children, particularly those already marginalised, do not fall through the cracks. Leveraging these established frameworks demonstrates how Thriving Kids could integrate with existing mainstream services, ensuring that children under eight with mild to moderate developmental support needs transition smoothly, receive timely intervention in the environments where they learn and live, and are supported to thrive.

The Thriving Kids initiative will succeed when parents, families and carers are well supported to continue to recognise and respond to concerns early, act with confidence, and access timely, culturally safe care in the settings they already trust. Alongside parent and carer friendly resources and guidance and a capable, well-supported workforce, Australia can meaningfully improve developmental outcomes for children with mild to moderate needs under the Thriving Kids program.

Recommendations

1. Establish a national digital “screen–guide–refer” system integrated with the MyHealth Record and Services Australia platforms.
2. Fund school and place-based supports to embed early intervention in learning environments.
3. Provide financial support for parents/carers to access case coordinators.
4. Align Thriving Kids with existing state-based programs to reduce duplication and fragmentation.
5. Launch stigma-reducing national campaigns to normalise early conversations about development.

7 Victorian Government. Pathway to Good Health for Children in Care [Internet]. Melbourne: Department of Health; [cited 2025 Sep 14]. Available from: https://www.health.vic.gov.au/populations/vulnerable-children/pathway-to-good-health-for-children-in-care

Conclusion

The Thriving Kids initiative is a vital opportunity to ensure children with developmental delay and autism receive timely, equitable, and culturally safe support. ACNP strongly urges the Commonwealth to adopt a nationally consistent approach, leverage the expertise of NPs, and invest in digital integration and workforce capability. With these measures in place, Australia can deliver meaningful outcomes for children, families, and communities, while reducing long-term reliance on the NDIS.

ACNP Recommendations:

1. Co-Design and Consultation- Ensure reforms are co-designed with the disability community, families, carers, and sector stakeholders, guided by the principle of “nothing about us without us.”

2. Embed a National Developmental Indicator Tool - Implement a consistent, evidence-based screening tool across maternal and child health, early education, and primary care settings to identify developmental concerns early and enable timely referral for specialist assessment. Tools such as the Parental Evaluation of Developmental Status (PEDS) used in Victoria provide a strong model to scale nationally.

3. Sustained Early Intervention and Support - Recognise that early intervention is not a “cure” but a foundation for lifelong independence, learning, and participation. Ongoing assessments and equitable funding pathways must extend beyond eight years of age — via the NDIS or alternative mechanisms, to ensure children continue to access affordable and appropriate supports.

4. Nurse Practitioners as a Key Workforce - Fund and enable NPs to lead developmental screening, initiate referrals, and provide family education and early intervention. Their integration across primary care, maternal and child health, and community services will strengthen equity of access, particularly in rural and underserved areas.

5. Integrated Digital Pathways and Navigation Support - Establish a nationally integrated digital “screen–guide–refer” system to streamline assessment and referral processes, reduce duplication, and track developmental progress. Pair this with structured navigation support and culturally safe resources for families, ensuring timely access and reducing the burden on parents and carers, particularly for First Nations, CALD, disadvantaged, and rural/remote communities.

The ACNP commends the recognition and thoughtful consideration of the contributions and value nurse practitioners bring throughout this consultation process. We highlight the critical need to address the ongoing limited awareness among the public and healthcare professionals regarding the existence, capabilities, scope of practice, and contributions of nurse practitioners.

Thank you for the opportunity to participate in this important review. We welcome further engagement and are available to provide additional clarification as needed.

Yours sincerely

redacted

Adj Assoc Prof Chris Helms Chief Executive Officer

redacted

1300 433 66

References:

1. Department of Health Victoria. Enhanced Maternal and Child Health Program Guidelines [Internet]. Melbourne: Department of Health; 21 Jul 2025 [cited 2025 Sep 18]. Available from: https://www.health.vic.gov.au/publications/enhanced-maternal-and-child-health-program-guidelines health.vic.gov.au

2. Paul H. Brookes Publishing Co., Inc. Ages & Stages Questionnaires®, Third Edition (ASQ-3) [Internet]. Baltimore: Paul H. Brookes Publishing Co.; [cited 2025 Sep 14]. Available from: https://agesandstages.com/products-pricing/asq3/

3. Royal Children’s Hospital, Melbourne. Parents’ Evaluation of Developmental Status-Revised (PEDS-R) [Internet]. Parkville: The Royal Children’s Hospital; [cited 2025 Sep 14]. Available from: https://www.rch.org.au/ccch/peds/About_PEDS-R/

4. Autism CRC. Autism screening tool - world’s most effective [Internet]. Brisbane: Autism CRC; 2022 Mar 14 [cited 2025 Sep 14]. Available from: https://www.autismcrc.com.au/news/latest-news/autism-screening-tool-worlds-most-effective

5. Autism Toolbox. The Scottish Autism Strategy [Internet]. Edinburgh: Autism Toolbox; [cited 2025 Sep 18]. Available from: https://www.autismtoolbox.co.uk/scottish-context/legislative-and-policy-framework/the-scottish-autism-strategy/ autismtoolbox.co.uk

6. Australian Government Department of Health, Disability and Ageing. National Autism Strategy 2025–2031 [Internet]. Canberra: Department of Health; 14 Jan 2025 [cited 2025 Sep 18]. Available from: https://www.health.gov.au/sites/default/files/2025-07/national-autism-strategy-2025-2031.pdf health.gov.au

7. Victorian Government. Pathway to Good Health for Children in Care [Internet]. Melbourne: Department of Health; [cited 2025 Sep 14]. Available from: https://www.health.vic.gov.au/populations/vulnerable-children/pathway-to-good-health-for-children-in-care