House of Representatives Standing Committee on Health, Aged Care and Disability:

Inquiry into Thriving Kids

Introduction

Occupational Therapy Australia

OTA is the professional association and peak representative body for occupational therapists in Australia. There are more than 34,000 registered Occupational therapists working across the government, non-government, private and community sectors in Australia1. Occupational therapists are allied health professionals whose role is to enable their clients to engage in meaningful and productive activities.

About Occupational Therapy

Occupational therapy is a person-centred health profession concerned with promoting health and wellbeing through participation in occupation (activities). Occupational therapists achieve this by working with people with disability, including children with developmental delays and/or disability, to enhance their ability to engage in the occupations they want, need, or are expected to do; or by modifying the occupation or the environment to better support their occupational participation. Occupational therapists provide services across both clinical and non-clinical settings across the lifespan and have a valuable role in supporting children with developmental disorders including physical, intellectual, chronic and/or progressive disability.

Occupational therapists work in a diverse range of settings including small, medium and large private practice, rehabilitation settings, paediatric services, and community services.

Overview of OTA Submission

OTA welcomes the opportunity to provide input to the House of Representatives Standing Committee on Health, Aged Care and Disability Inquiry into Thriving Kids (the Inquiry).

OTA supports the development of a national system of foundational supports for children, through Thriving Kids. A national approach will ensure consistency and drive the design and implementation of a crucial system of supports for children and their families. Success will be contingent on the ability of states and territories to implement a national approach in a place-based way, that integrates well with other local service systems.

If well designed and implemented, Thriving Kids is an exciting opportunity to transform the early childhood service system for the better. In so doing, we can give children the best possible start in life and create greater efficiencies across the entire health and disability ecosystem. Below, we identify some crucial elements that must be included in the design and implementation of Thriving Kids to ensure that it meets its aims. We also

1 Occupational Therapy Board of Australia (Australian Health Practitioner Regulation Agency), 2024; https://www.occupationaltherapyboard.gov.au/News/Annual-report.aspx

speak to the importance of language and communication regarding Thriving Kids, and the need to adequately define key terminology.

Occupational therapists are a key workforce who already provide support services to children and their families. They have significant expertise and a unique scope of practice and skillset, which can be leveraged to elevate the quality and efficacy of a new Thriving Kids supports system. We provide guidance on how to maximise the value of this core workforce below.

In addition to addressing the specific Terms of Reference, we outline some additional considerations for the Standing Committee. These considerations are vital to ensuring that the risks identified are mitigated and that Thriving Kids has the best chance of success.

It is also important to note at the outset that the proposed start date for Thriving Kids of 1 July 2026 is highly ambitious. It is important to ensure that programs and services are established, evaluated and found to be meeting the needs of children and families, and the aims of Thriving Kids, prior to removing NDIS supports. If not, children are at risk losing access to supports in the interim.

OTA’s consultation with occupational therapists working in the early childhood sector

To ensure that the information provided to the Inquiry is rich, meaningful and current, OTA proactively initiated a consultation process with members.

During September 2025, OTA held a roundtable with leading academics and targeted consultation sessions with occupational therapists working across early childhood, schools, and community and other settings. OTA also collected information from members via an online survey. The information gathered during this consultation process has been incorporated into the submission below.

OTA’s Advice to Governments paper

OTA has also invested significant resources into the development of an Advice to Governments2 paper for the development of foundational supports for children and their families (Advice to Governments). This paper was co-designed with an Expert Advisory Group, convened specifically for this task. As the peak body for occupational therapists in Australia, OTA has taken this proactive approach to:

• support and guide the profession
• provide clear principles and policy guidance to assist with the roll out of foundational supports, and

2 Occupational Therapy Australia. (2025). Advice to governments on the development of foundational supports for children with developmental delay and disability. Occupational Therapy Australia.

• provide guidance on how to best incorporate OT roles in a new system of supports
• The paper has been incorporated into OTA’s response below and provides further detail regarding the key elements outlined. We encourage Standing Committee members to refer to the Advice to Governments paper in addition to OTA’s submission.

Recommendations

• Recommendation 1: Clear definitions must be developed for Thriving Kids, including for the term “mild to moderate”.
• Recommendation 2: Language utilised in the design and implementation of Thriving Kids should be inclusive, evidence-based, and person- & identity-first language grounded in a social model of disability.
• Recommendation 3: Public communications regarding the Thriving Kids program should be inclusive, evidence-based, and person- & identity-first language grounded in a social model of disability. This should include a genuine focus on building trust with the disability community, including the autistic community.
• Recommendation 4: Language should be focused on children’s functional and support needs, and whether they are able to meet the demands or expectations of the environment or situation - rather than on diagnosis alone.
• Recommendation 5: Thriving Kids should specifically acknowledge the United Nations Conventions on the Rights of Persons with Disabilities and ensure that design and implementation align with the Convention’s goals.
• Recommendation 6: The cohort who is eligible for Thriving Kids needs to be clearly defined to ensure that children with disabilities who are not eligible for the NDIS can access Thriving Kids. In particular but not exclusively, children with ADHD, vision and hearing impairments, FASD, Down Syndrome, DCD and Cerebral Palsy.
• Recommendation 7: Develop an early identification and access process for early childhood supports based on best practice that ensures streamlined and coordinated access to all appropriate mainstream and foundational supports, and NDIS supports if required.
• Recommendation 8: Occupational therapists and other allied health professionals must be involved in the design and delivery of early identification, and delivery of tiered, interdisciplinary assessments that support access to programs and supports.
• Recommendation 9: Supports should be delivered by occupational therapists and other allied health professionals as part of an embedded, interdisciplinary team approach that emphasises working closely with educators, caregivers and students.
• Recommendation 10: Supports in educational settings should be made available in an equitable manner regardless of whether they are in government, religious or independent systems.
• Recommendation 11: Services should be designed in collaboration with CALD communities to ensure they are accessible, culturally safe and respond to diverse family and community needs.

• Recommendation 12: Funding must be provided to enable access to culturally appropriate and responsive programs and services. For example, enabling access to interpreters, translation of materials, etc.
• Recommendation 13: OTA recommends the adoption of IAHA’s recommendations to this Inquiry which include:
  • Prioritise an interdisciplinary workforce that is culturally safe, to ensure success of Thriving Kids.
  • Recruit and train Aboriginal and Torres Strait Islander allied health professionals across disciplines (speech pathology, occupational therapy, audiology, social work, psychology, etc.).
  • Introduce mandatory cultural safety and anti-racism training for all Thriving Kids workforce members.
  • Implement a clear national workforce strategy to avoid shortages that would undermine rollout.
  • Link workforce development to government commitments in the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework & Implementation Plan 2021–2031.
  • Adopt international best practice by embedding First Nations co-design, leadership, and governance at every stage of Thriving Kids.
  • The provision of culturally safe case coordination and navigation services.
  • Implement strong accountability measures that include:
    • Disaggregated data (including by Indigeneity, gender, geography) to monitor equity.
    • Independent oversight and evaluation, with Aboriginal and Torres Strait Islander leadership.
    • Outcomes frameworks that track cultural safety, workforce quality, and child and family wellbeing.
• Recommendation 14: The design, delivery and funding of Thriving Kids must deliver equitable access for children and families in regional and remote communities through place based and commissioned services that meet children and families’ needs in everyday settings and their communities.
• Recommendation 15: Services provided under Thriving Kids must be designed, delivered, commissioned and funded in a way that enables flexible and responsive access for families that experience barriers to engagement in health, education and community settings.

• This should include provision of tailored support for families to understand, access and navigate services.
• Recommendation 16: Minimum capabilities in key areas such as developmental science, relationship-based approaches, reflective practice and parent and caregiver engagement must be mandated for Thriving Kids to meet the needs of families.
• Recommendation 17: Establish the skills, scope and experience required by the early childhood workforce to deliver early childhood supports across a range of settings, and identify how they relate to evidence-based practice and the ability to successfully deliver different services and supports.
• Recommendation 18: Adopt and actively implement the National Best Practice Framework for Early Childhood Intervention as the National Framework for Thriving Kids.
• Recommendation 19: The Government should draw on the range of Strategies and Frameworks already in place to ensure that Thriving Kids provides evidence-based best practice supports for children with developmental delay and disability and their families.
• Recommendation 20: Coordination of services and collaboration should be a key area of focus under Thriving Kids. This requires a commitment to supporting collaboration between different providers and services working across different funding programs and settings.
• Recommendation 21: Funding must be available across all programs to support collaboration and coordination and must be flexible enough to accommodate for different combinations of service delivery; funding individual coordination roles will not create collaboration without enabling participation by all providers.
• Recommendation 22: Implement evidence-based best practice as identified in the Best Practice Framework, to ensure effective early identification and assessment is provided under Thriving Kids.
• Recommendation 23: Skilled and qualified health professionals such as occupational therapists, should be recruited for assessment roles to ensure Thriving Kids effectively meets the needs of the children and families who require its services.
• Recommendation 24: Ensure health professionals and other key workers including early childhood educators, teachers, and maternal and child health nurses are trained and supported to monitor for potential signs of developmental delay or disability and have access to more specialised occupational therapy expertise to support verification and assessment.

• Recommendation 25: Thriving Kids should be incorporated into the National Early Years Strategy ensuring a coordinated and strategic approach across Disability, Health, Education and Social Services.
• Recommendation 26: The Committee should recommend that the Thriving Kids Advisory Group consider how Thriving Kids contributes and connects to an eco-system of supports for children, that incorporates Thriving Kids, general and other targeted foundational supports and the NDIS.
• Recommendation 27: Thriving Kids should include funding for assistive technology and home modifications.
• Recommendation 28: Lead Practitioner or key worker models should be recognised as a means of providing coordinated supports for children and families that is sometimes appropriate but may not best align with evidence and needs. This model of delivery should be an option available for practitioners and families to consider rather than a default approach.
• Recommendation 29: Evidence-based decision-making (such as the guide developed under the National Best Practice Framework) should be utilised to support collaborative processes and team development.
• Recommendation 30: Fund Thriving Kids and other targeted foundational supports for children with developmental delay and disability at a level that reflects evidence and supports access to an appropriately skilled and trained workforce.
• Recommendation 31: Undertake formal, ongoing engagement with occupational therapists and other key allied health and early childhood professions to design and implement commissioning models for Thriving Kids. These models should enable participation by private sector allied health organisations of all sizes with demonstrated early childhood expertise, as well as public sector organisations.
• Recommendation 32: New early childhood intervention service models, such as Thriving Kids, should allow for a range of different employment and contracting models, in order to:
  • account for the differences in how individual states and territories, as well as rural and regional localities, provide support in mainstream settings;
  • recognise that the workforce with the necessary skills and experience are spread across both public and private sectors, with the higher percentage now predominantly situated in private practice.
• Recommendation 33: The design of new allied health Medicare items, including for Thriving Kids, should be based on the real cost of services, and not limited by arbitrary annual limits or inefficient referral requirements, and support collaborative team-based approaches.

• Recommendation 34: Robust monitoring and evaluation processes be developed and funded, for the Thriving Kids system of supports, and for individual programs that will be delivered at State and Territory levels. to support continuous improvement of Thriving Kids.

OTA’s Response to the Inquiry into the Thriving Kids Initiative

Background

In late 2023 the NDIS Review Panel released its final report, in which it outlined its proposals for a more integrated, multi-tiered system of early childhood services focused on meeting the needs of children and young people with developmental delay and disability, and their families. OTA supported the recommendations of the Panel for the development of supports for children outside the NDIS. OTA endorsed the Panel’s position that for those who cannot access the NDIS, there are very limited options for support. This means that many families must resort to funding private therapies, or cannot accessing any services at all.

In 2024 the Department of Social Services commissioned a formal review of best practice in early childhood intervention and the development of a National Best Practice Framework for Early Childhood Intervention (Best Practice Framework) and supplementary resources and tools. This work was developed by a consortium of partners led by researchers at the University of Melbourne. It aims to guide practitioners, professionals and families to work together to make sure children with developmental concerns, delay or disability have the best possible start in life. The evidence review and consultation process for this work was extensive and robust. OTA welcomes the Government’s recent release and endorsement of the National Best Practice Framework 3 and urges its adoption as the National Framework for Thriving Kids.

OTA supports, in principle, the development of Thriving Kids as a national system of supports for children aged eight years and under with mild to moderate developmental delay and autism, and their families, outside the NDIS. We particularly welcome the focus on early identification, and scaling and building on existing mainstream and community services that can better support families and children in settings they already are connected to.

3 Australian Government Department of Health. (2025, September 29). About the National Best Practice Framework for Early Childhood Intervention. https://www.health.gov.au/our-work/national-best-practice-framework-for-early-childhood-intervention/about

However, the lack of clarity and detail about what Thriving Kids will deliver and how it will be implemented makes it difficult to provide a robust response to the program and its concepts.

Therefore, the focus of our submission is to identify the key components that should be included in the transformational program that Thriving Kids could be; and the expertise that occupational therapists bring to working with children and families, and how they can contribute to the effectiveness of Thriving Kids.

The role of occupational therapists in Thriving Kids

Occupational therapists work with children, their families and caregivers, and other members of interdisciplinary team, to assess support needs, identify meaningful goals and develop and deliver appropriate services and supports. These services and supports aim to promote meaningful participation, social connection, independence, and to protect and sustain physical and mental health.

Occupational therapists deliver highly skilled assessments services and therapies including:

• Functional capacity assessments. These require an understanding of the complex interplay between an individual’s current skills and developmental challenges, task and environmental barriers, and access to resources and supports.
• Comprehensive developmental assessments. These involve identification of the specific skill-based challenges, as well as underlying developmental challenges, that impact on developmental progress.
• Targeted capacity building interventions. These require clinical reasoning for the development and implementation of this type of intervention, where indicated within assessments. For example, activities of daily living (ADL), or ADL training with children with physical, neurological and behavioural concerns or disability.
• Assessment, recommendations and implementation of task adaptation, assistive technology and/or environmental modifications.
• Comprehensive assessment of environmental, neurodevelopmental, relational, sensory and sensorimotor contributions to behaviour where this is deemed ‘challenging or concerning’.
• Engagement of and intervention with the family and caregiving systems. This is undertaken to understand and support the needs of the child.

Emerging evidence from the Best Practice Framework,4 heavily endorses the role and value of occupational therapy in working with this cohort. It refers extensively to evidence and examples from occupational therapy practice and the principles that underpin the work of the profession.

4 Health Trajectories (2025). ECI Framework. https://healthy-trajectories.com.au/eci-review/ (Accessed on 29 Sept 2025)

Occupational therapy practice is rooted in occupational models that emphasise need to understand the child, their environment (physical, sensory, social, cultural, relational environments), and their occupations, where occupations represent everyday activities and routines.5 6 Occupational therapists draw on these models to work with children and families. This work includes developing collaborative goals, developing contextualised interventions that fit into the child’s everyday environments, and ensuring that areas of developmental need are practiced and reinforced where needed most. This approach and focus is unique to occupational therapy training and practice.

Key considerations for framing the development of Thriving Kids

The importance of language and definitions

Careful consideration must be given to the language used in both how Thriving Kids is described and defined, and in any public communication or information relating to Thriving Kids, and children with disabilities more broadly. This is for two reasons. First, to align with Australia’s goals under the United Nations Conventions on the Rights of Persons with Disabilities (the Convention), and the NDIS Review’s aims, inclusive, evidence-based, and person & identity-first is vital. Second, when language is not evidence-based and definitions are not clear, policy may not translate into practice well enough to achieve the outcomes and goals of the Thriving Kids program.

When incorrect or misused, language and communication can increase stigma and exclusion for children with disability and their families. This is because how we describe and talk about things in society directly shapes public perception, and policy, which has practical implications for how service systems are designed and implemented, and who has access to those service systems. This then impacts on health and disability outcomes for service users. How we talk about disability and people with disabilities also directly impacts on the experience and wellbeing of those people.

Australia is a signatory to the United Nations Convention on the Rights of Persons with Disabilities and has therefore committed to the goal to “promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent

5 Taylor, R. and Kielhofner, G. (2017). Kielhofner’s model of human occupation theory and application. 5th ed. Philadelphia Wolters Kluwer 6 Polatajko, H.J., Townsend, E.A. & Craik, J. (2007). Canadian Model of Occupational Performance and Engagement (CMOP-E). In Enabling Occupation II: Advancing an Occupational Therapy Vision of Health, Wellbeing, & Justice through Occupation. E.A. Townsend & H.J. Polatajko, Eds. Ottawa, ON: CAOT Publications ACE. 22-36.

dignity”.7 Inclusive, evidence-based, and person & identity-first language grounded in a social model of disability supports these aims and must therefore be central to Thriving Kids, and any public communications relating to it8. There is an opportunity in Thriving Kids to draw on the social model of disability and take a non-categorical approach, which will shape the development of Thriving Kids in a way that focuses on how best to set children up for success.

The current terminology being used in relation to Thriving Kids is imprecise and potentially harmful. Feedback from OTA’s consultation to inform this submission was that the term ‘mild to moderate’ is causing confusion for families and the health professionals who work with them. It is unclear whether ‘mild to moderate’ refers exclusively to developmental delay and autism, or whether it also applies to mild to moderate disability more broadly. Further, it is unclear whether ‘mild’ and ‘moderate’ delay or disability will be equated with mild or moderate functional or support needs. If so, this is highly problematic as diagnosis does not equate to functional or support need. A focus on diagnosis alone can detract from a best practice, strengths-based and person-centred approach. The consequence of this is that services and supports provided will not well align to individual and family needs when Thriving Kids is implemented, compromising outcomes.

Further, the language used in relation to autism, particularly the implication that autism can be ‘cured’ or resolved with a defined program of support or intervention, is harmful. This narrative fails to acknowledge the broad and diverse presentation of autism as a lifelong neurodevelopmental condition and overlooks the importance of affirming each individual autistic experience as central to any intervention or support that may be considered. Contemporary best practice does not seek to ‘fix’ or normalize autistic traits.

Clarification is also required about whether the focus on autism and developmental delay excludes other conditions and disabilities from accessing Thriving Kids as the current language suggests an autism-centric program. If so, this overlooks many children and families who may not have access to NDIS supports now, or in the future. This potential failure to meet the needs of all children with disability and developmental delay risks leaving children and families without adequate support. In particular OTA members raised concerns about the exclusion of children with ADHD, vision and hearing impairments, FASD, Down Syndrome, DCD and Cerebral Palsy who do not meet NDIS eligibility criteria. It is vital that Thriving Kids adopts an inclusive approach that recognises and addresses the diverse needs of all children with disability and developmental delay.

Consultation participants were also concerned that terminology will impact on access to services and supports for those who need them, as eligibility will be unclear, and referral and assessment will be difficult. The

7 Productivity Commission. (2004, July 14). Chapter 2: Disability and human rights – Review of the Disability Discrimination Act 1992 [Review of the Disability Discrimination Act 1992]. Productivity Commission. https://www.pc.gov.au/inquiries/completed/disability-discrimination/report 8 Shamsabadipour, A. (2025, February 13). Disability models: Societal impacts and policy implications. Springer. https://link.springer.com/rwe/10.1007/978-3-031-40858-8 409-1

assessment process that is adopted will be critical to ensure that a non-categorical approach can be taken and enable appropriate therapies be provided to children and families aligned with functional and family goals. Getting this right improves outcomes, and system efficiency.

• Recommendation 1: Clear definitions must be developed for Thriving Kids, including for the term “mild to moderate”.
• Recommendation 2: Language utilised in the design and implementation of Thriving Kids should be inclusive, evidence-based, and person- & identity-first language grounded in a social model of disability.
• Recommendation 3: Public communications regarding the Thriving Kids program should be inclusive, evidence-based, and person- & identity-first language grounded in a social model of disability. This should include a genuine focus on building trust with the disability community, including the autistic community.
• Recommendation 4: Language should be focused on children’s functional and support needs, and whether they are able to meet the demands or expectations of the environment or situation - rather than on diagnosis alone.
• Recommendation 5: Thriving Kids should specifically acknowledge the United Nations Convention on the Rights of Persons with Disabilities and ensure that design and implementation align with the Convention’s goals.
• Recommendation 6: The cohort who is eligible for Thriving Kids needs to be clearly defined to ensure that children with disabilities who are not eligible for the NDIS can access Thriving Kids. In particular but not exclusively, children with ADHD, vision and hearing impairments, FASD, Down Syndrome, DCD and Cerebral Palsy.

Underpinning Principles and Components for Thriving Kids

Through analysis of key programs, asking targeted questions, and drawing on OTA’s Advice to Governments paper, we have extracted key principles and components that can inform potential models, for programs and the broader system design of Thriving Kids. We encourage the Standing Committee to include these components and principles in their final report.

The principles below should shape the design, delivery, and evaluation of services.

• Co-design – Services are developed with the involvement of those who use them, which in this case are children with developmental delay and disability and their families, as well as service providers.
• Equity – Services should be available to all families equally regardless of location, capacity to pay, or cultural, linguistic background
• Inclusion and participation – Services should be inclusive of all families, and enable them to be meaningfully involved in activities. Additional supports and adaptations may be needed to make

sure this happens. It is vital that Thriving Kids adopts an inclusive approach that recognises respects the diverse needs of all children with disability and developmental delay and their families and caregivers.

• Universal and accessible services – Services should be available to all children and families, not just those with a diagnosis, and accessible when and where they need them. Universal services should be supported by targeted services for at-risk children and families, and specialist services for those with complex needs.
• Social model of disability– Thriving Kids should be underpinned by the social model of disability, incorporating the active involvement of families, children and communities in identifying, planning, designing and implementing solutions to health issues and unjust health inequalities. It should not be based on the medical model which focuses on illness, diagnosis and deficits-based approach to disability and developmental delay.
• Commitment to cultural safety – Services that recognise and accommodate cultural preferences and practices and that respond to community needs and concerns. See further discussion of this under OTA’s response to Term of Reference 3 below.
• Commitment to a capable and sustainable workforce – Workforce planning will be critical to ensure that new models of service delivery provide access to experienced providers with the scope and experience to deliver outcomes associated with their roles. Service models must ensure that private allied health practices of all sizes are able to participate in delivering supports.

The components below provide practical features, mechanisms, and approaches that can be used to implement the above principles.

• Place-based and community focussed – Funding and development of services should respond to local needs and issues and bring together families, communities and early childhood workers and practitioners to develop collaborative responses.
• Family-led practices – Effective care not only focuses on the cause of the stressor but also identifies and builds on the family strengths to support family functioning. Thriving Kids and other supports should be guided by the needs and concerns of the family while supporting parental capacity building. This will include embedding supports into daily routines and settings while also supporting parent and caregiver wellbeing.
• Rural and remote access – Ensuring availability of services in geographically isolated areas.
• Best practice and evidence-based approaches – Best practice involves a range of approaches including working with families and caregivers, working directly with the child, and parent and

peer-based activities. The new National Best Practice Framework for Early Childhood Intervention should be actively implemented as the National Framework for Thriving Kids.

• Access to early intervention and assessment –Early intervention, support and access to assessment should be implemented across a wide range of settings, particularly mainstream settings in an integrated and consistent approach. We identify examples of effective models for early identification and in our response to ToR 2.
• Access to supports in mainstream settings – Embedding programs in mainstream settings will be vital for the success of Thriving Kids. OTA also stresses that occupational therapy expertise in participation focused practice, in which the emphasis is on building the capacity of everyday settings to be accommodating and acceptable for children with diverse needs, should also be a priority . Examples of programs that enable access to supports in mainstream educational settings are provided below.
• Workforce development – Workforce development and support should be a key consideration for the development and implementation of Thriving Kids. Attention will need to be given in particular to the support required by recent graduates and early career OTs and other AHPs.
• Workforce integration – To support integration of services across sectors and services, there will need to be consideration of the makeup of the workforce and how it will be supported to work in a collaborative and consistent way across these settings.
• System integration – Thriving Kids services and practitioners need to be integrated into the local or regional service system and be embedded in everyday settings. There also needs to be integration within the disability support sector, and across sectors. This will help make sure support is holistic, consistent and easy for families to navigate.
• Support for transitions – Recognition will need to be given to the transition points for children, and their families and caregivers, between developmental stages, educational settings, as well as between and into health, disability, education and family support sectors
• Cross-agency collaboration – Recognition needs to be given to the complex interplay between agencies that many children and families have to navigate to get the services and supports they need. Cross-agency collaboration should be proactive and seamless, so families do not bear the responsibility of making these systems work for them.
• Collaborative and Interdisciplinary approaches - Building strong trusted relationships with children, parents, carers and families as well as between all practitioners involved is essential to ensure positive developmental outcomes and improved wellbeing. Teams which include a variety of expertise and knowledge have been a consistent part of international practice in ECI since the 1980s. Teamwork is one of the principles of the Early Years Learning Framework (2024).

The Early Years Strategy, 2024-2034, also emphasises the importance of collaboration and partnerships between families, practitioners and professionals.

OTA’s response to 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.

Occupational therapists play a vital role in supporting and building the capacity of parents and significant others in a child’s life to identify developmental concerns early and facilitate connections between families and interdisciplinary supports.

Products and resources that that are evidence-based and applied appropriately, avoiding a one-size-fits-all approach, can be useful to build the capacity and understanding of parents and caregivers, in conjunction with in-person supports. Resources and information must be culturally responsive, easily accessible and supported by a collaborative, interdisciplinary team working around the child and family to ensure meaningful support.

Online tools and resources are also important, especially for those in rural and remote areas, single parents, working parents, and others who for a variety of reasons find in-person access to supports difficult.

OTA members who are experts in the provision of early childhood supports and resources have recommended the following evidence-based programs as effective. The resources listed below could provide a model, or be built upon, in the design and implementation of Thriving Kids. However, it is important to avoid an overreliance on information and resources so that children and families still have access to other services and supports.

Envisage Families

The program9 aims to empower caregivers to feel confident and competent to navigate the experience of parenting a child or children with developmental concerns. The program provides free online workshops, resources, information, and tools. It is funded by the Department of Social Services, and developed by researchers from Australian Catholic University, McMaster University, Murdoch Children’s Research Institute, and University of Melbourne. It is delivered across all Australian jurisdictions in partnership with a range of organisations.

9 Envisage. (n.d.). About us. Retrieved October 3, 2025, from https://envisage.community/about-us/

Healthy Mothers Healthy Families

Taking a whole of family approach, this program10 has been in operation since 2012, and has been DSS funded since 2018. It is an example of the effectiveness of the OT contribution to supporting mothers of children with disability. The website, and the content and design of the learning modules provided, are based on research findings by the authors of the site. It also draws on the experiences of many mothers of children with disabilities who have shared their stories or participated in research.

We Care Workshops

This online program11 is founded on strong evidence and is codesigned and peer facilitated. The program and its outcomes were presented at the WFOT Congress in Paris in 2022, ISEI conference in Lisbon in 2025, and PRECI Conference in Surfers Paradise in 2024. Bhopti, McAdam, Mohitian, and Dissanayake (2025) presented We Care workshops for parents of children with Autism Spectrum Disorder, providing evidence of the program’s effectiveness.12

Now and Next Program

This is a fully co-designed and peer led program. An independent evaluation by Murdoch Children’s Research Institute assessed the Now & Next program, highlighting its positive impact on families of children with disabilities13.

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.

During OTA consultations, occupational therapists highlighted effective programs operating across a range of settings. These are listed in Appendix 1. Through analysis of these programs, asking targeted questions, and drawing on OTA’s Advice to Governments paper, we have extracted key principles and

10 Healthy Mothers Healthy Families. (n.d.). About Healthy Mothers Healthy Families. https://healthymothers-healthyfamilies.com/about 11 Shamsabadipour, A. (2025, February 13). Disability models: Societal impacts and policy implications. Springer. https://link.springer.com/rwe/10.1007/978-3-031-40858-8 409-1 12 Bhopti, A., McAdam, C., Mohitian, S., & Dissanayake, C. (2025, August 28). “We Care” workshops for parents of children with Autism Spectrum Disorder: Supporting and building parental capacity and re-engaging in parent occupations — A repeated measures pretest-posttest study [Short oral presentation]. 18th International Congress of the World Federation of Occupational Therapists. https://www.xcdsystem.com/wfot/program/bzxHrTN/index.cfm?pgid=2300&sid=19176&abid=98538 13 Moore, T. G., Fong, M., & Rushton, S. (2018). Evaluation of Plumtree Children’s Services Now and Next program. Centre for Community Child Health, Murdoch Children’s Research Institute.

components as we outlined above, that can inform potential models, for programs and the broader system design of Thriving Kids. We encourage the Standing Committee to include these components and principles in their final report.

As also noted above, the Standing Committee Should ensure alignment with the Convention and the principles underpinning it.

It also is important to note that due to the scarcity of previous program evaluations, with many of them rolling into or ceasing with the introduction of NDIS, the evidence base is not as robust as it could be. To avoid this issue in future, it is essential for funding to be allocated to evaluation of the programs funded under Thriving Kids, as well as the overarching system itself. This should be complemented by clear monitoring and reporting processes established alongside design and implementation. We discuss this further below in the Additional Comments section below.

Accessible Early Identification and Assessment

There are some existing and effective programs that identify developmental delay or other markers, and provide access to assessments by qualified allied health professionals, including occupational therapists. We expand on some of these below. Ensuring access to services and supports in early childhood settings will be crucial to Thriving Kid’s success. This includes access to occupational therapy, especially in programs and settings where occupational therapy can best add value and be best utilised. Critically, OT assessment should occur in everyday environments, and not be separate to those settings, to be effective in promoting participation. For example, if an occupational therapist is working with a child in a school setting but is required to do so in a separate room and outside of the educational context, this will not be conducive to achieving a useful assessment.

Children’s Centres for Early Childhood and Parenting

The South Australian Department for Education established these centres as a result of a recommendation the South Australian 2023 Royal Commission into Early Education and Care14 15 OTA members highlight the effectiveness of families receiving supports through integrated service hubs where multiple services, including occupational therapy and other allied health, are co-located and work collaboratively. Importantly this model provides an accessible and supportive environment for identification, assessment and support. In the words of an OT member who is familiar with this program:

14 Department for Education (South Australia). (2025, April 16). Services and programs offered at children’s centres and children and family centres. https://www.education.sa.gov.au/parents-and-families/child-care-services/childrens-centres/services-offered-childrens-centres-and-children-and-family-centres (Accessed September 29, 2025)

15 South Australian Government (2023, August 27). Final Report. Royal Commission into Early Childhood Education and Care. https://www.royalcommissionecec.sa.gov.au/publications/final-report

“Supporting families to attune and connect with their children in the early years is a huge focus of our work, but we also really look for what is the skill set and how can we support our clinicians in working in those relational frameworks.”

SA expansion of preschool checks and access with support available from allied health professionals

As a result of the Royal Commission’s recommendation South Australia will be the first Australian state to introduce 30 hours of 3-year-old preschool from 2026, in recognition of there being “a growing number of children who are developmentally vulnerable in families from all walks of life in South Australia, so traditional targeting of particular cohorts for assistance will not reach every child who needs it.”16

Alongside this, the Royal Commission recommended expansion of the existing definition of preschool beyond a program of teacher-led learning to the following:

• “Each individual child receives a learning entitlement (including any adjustments required) from an early childhood teacher operating with support from allied health and other professionals as required.
• “There is early identification of a child’s developmental needs on site … and organised pathways to funded interventions, including providing those on site as appropriate.
• There are organised pathways to broader parental and community supports, including those provided on site as appropriate.”(p36)

A key strength of this program will be that it provides not only access to early identification and assessment but also access to allied health and other supports to support the child in that setting.

National Medicare Mental Health Kids Hubs (formerly Head to Health)

OTA members also identified this service as an effective model to on which to base Thriving Kids17. This model builds on the findings of the National Children’s Mental Health and Wellbeing Strategy (2021) and the Mental Health: Productivity Commission: Inquiry Report.

Head to Health Kids (as still branded in Queensland)

Head to Health Kids was identified as a particularly relevant model. Head to Health Kids is a secondary level service for mild to moderate mental health in children 0-12 years and their families with co-occurring complex, multiple, social adversities. Service programs are co-designed with lived experience,

16 South Australian Government. (2023, August 27). Final Report. Royal Commission into Early Childhood Education and Care (p. 36). https://www.royalcommissionecec.sa.gov.au/publications/final-report

17 Australian Government Department of Health, Disability and Ageing. (2025) Medicare Mental Health Kids National Service Model https://www.health.gov.au/resources/publications/medicare-mental-health-kids-national-service-model?language=en (Accessed September 29, 2025)

identified first nations providers and stakeholders to provide a culturally safe, place-based service with access to assessment, targeted brief interventions, and parent-child focussed work in partnership with local community. Allied health professionals, including occupational therapists, and other health professionals, work collaboratively, bringing together mental health and early childhood expertise. A diagnosis, or referral, is not required to access the service, and many Aboriginal and Torres Strait Islander people, and people of Culturally and Linguistically Diverse (CALD) backgrounds feel comfortable in seeking assistance through the service.

A leading paediatric occupational therapist with mental health expertise, described the key learnings and outcomes from this service model:

“We found that offering brief intervention focused on the families’ goals and values aligned to certain functional areas and in an intersectoral way - health staff seeing kids at school, working along and with NGOS supporting DFV or Child safety issues, supporting GP appointments - resulted in the most successful outcomes. We found it stopped the “blocks” and allowed many more children and families to be seen. It was a much more sustainable model. Families were given time limited treatment to address a specific goal or concern at that point in time, but could return as much as they wanted, as long as it was aligned to a specific goal. Families responded well to this and any families that were significantly more complex were supported to “step up” into more tertiary orientated services, although our finding were that it was the families that often needed the connection (due to various adverse experience), not the children.

Family and Child Wellbeing Locals (Victoria)

These services were established as a result of the Victorian Royal Commission into Mental Health, and were identified by Occupational therapists we consulted with as another example of an effective a model providing access to multi-disciplinary team to support families and children18. These services are free for children up to the age of 11 and their families, and no referral is required.

An evaluation of the South Melbourne service was undertaken in 202419 which assessed the service as providing a strengths-based, child-centred and family-focused service with flexible and tailored care for each family.

Good Start in Life for Young Children

18 Department of Health, State Government of Victoria. (n.d.). Children’s Health and Wellbeing Locals. Better Health Channel. Retrieved September 29, 2025, from https://www.betterhealth.vic.gov.au/childrens-health-and-wellbeing-locals

19 Moore, T. G., Fong, M., & Rushton, S. (2025). The co-design of a children’s health and wellbeing Local model of care in Southern Melbourne. Journal of Paediatrics and Child Health, 61(3), 345–351. https://doi.org/10.1016/j.jpeds.2025.01.007

This program provides an example of the importance of early identification in early childhood programs and supporting readiness for school, and shows the value of the involvement of occupational therapists across a range of programs20. It is a research project being undertaken by the University of Canberra and funded through the Medical Research Future Fund (MRFF).

Examples provided by OTA members also include programs that are in line with the Early Childhood Targeted Action Plan21, which forms part of the implementation of Australia’s Disability Strategy 2021-2031, such as:

Brighter Beginnings

This program is delivered through a New South Wales Health and Department of Education partnership to provide a 4-year-old health and development screening program to check progress across a range of domains22. The program is delivered in Early Childhood Education Centres (ECEC) settings across all NSW Health local health districts. Senior early childhood practitioners advise, however, that despite a number of positives, there are several issues with the current approach, with at least in some areas, checks are being carried out by early career staff with limited knowledge and experience leading to potential misdiagnosis and over-referral. This causes stress for families and places additional demand on services without increasing outcomes. This points to the importance of having workforce capability building supports in place, such as supervision.

North West First 1000 Days

This project is led by the University of Tasmania in conjunction with community-based stakeholders and is an important example of the importance of co-design and engagement with community members for successful outcomes23. It is focused on co-design community-led parent education across the north-west region of Tasmania, with parents, carers and professionals involved in the creation and testing of resources focused on children’s critical first two years. It is funded by the Tasmanian Government until April 2026.

An OTA member working in this area described it as:

“[It’s a] Family learning service and they’re working with the community and they’re working with the Council and then they’re designing a project around what’s needed for

20 University of Canberra. (2009) A Good Start in Life for Young Children https://www.canberra.edu.au/research/centres/hri/research-projects/a-good-start-in-life-for-young-children

21 Department of Social Services. (n.d.). Early Childhood Targeted Action Plan. Australian Government. Retrieved September 29, 2025, from https://www.dss.gov.au/early-childhood/early-childhood-targeted-action-plan

22 NSW Department of Education (2024). Brighter Beginnings Program. https://www.wslhd.health.nsw.gov.au/Integrated-and-Community-Health/Child-Family-Health/brighter-beginnings

23 Burnie Works. (2024, April 12). Launching – North West First 1000 Days. https://burnieworks.com.au/launching-north-west-first-1000-days/

that community to provide the best outcomes for children and I think potentially those types of models where it’s like, here’s the community need and this is what we need. And here’s the project I think that that could be a really good solution.”

Victorian Early Assessment Clinic

This service is funded by the Victorian government and run by Olga Tennison Autism Research Centre (OTARC)24. It provides exemplar, multidisciplinary (including occupational therapy), neurodiversity-affirming diagnosis for children under three years of age with a high likelihood of Autism. It involves a 5-step assessment program that includes a combination of telehealth and in-person multidisciplinary assessments. At the conclusion of the program, families receive a comprehensive report and a personalised pathways plan.

Access to supports in mainstream educational settings

Mainstream education settings are settings in which almost all children must engage in, including those with developmental delay and disability. As such, mainstream settings should not only be made more inclusive but be recognised for their role in supporting early identification of developmental delay and disability. When inclusive and accessible, and with the right supports imbedded, these settings can assist children to achieve positive developmental outcomes25. Occupational therapy is a profession that is key to achieving this.

There is emerging evidence from current mainstream education programs that embedding occupational therapists within education systems leads to positive outcomes and is the most effective way to support children with developmental delay and disability in those settings. Occupational therapists are well established in many mainstream education settings and there is significant capacity to ensure consistent access to occupational therapists across jurisdictions and settings.

Occupational therapists work successfully within education departments at a strategic level, as therapists employed by education programs to provide in-reach support to ECEC and school services, and as part of ECEC and school teams. Occupational therapy training and practice is highly relevant to mainstream education settings, as a result of training and experience in community approaches that translate well into mainstream education settings.

OTA’s Advice to Governments paper draws extensively on the expertise and experience of occupational therapists working in this sector to outline how the role of occupational therapists in mainstream

24 La Trobe University. (n.d.). Victorian Early Assessment Clinic. Olga Tennison Autism Research Centre. Retrieved October 2, 2025, from https://www.latrobe.edu.au/otarc/veac

25 Bruder, M. B. (2010). Early Childhood Intervention: A Promise to Children and Families for Their Future. Exceptional Children, 76(3), 339-355. https://doi.org/10.1177/001440291007600306

educational settings could be expanded to be more inclusive and effective in meeting the needs and goals of children and teachers.26

A focus on better inclusive practices in schools will be essential for the success of Thriving Kids. Mainstream education is failing neurodivergent children with over-representation in suspensions and exit from mainstream schooling. Occupational therapy expertise in participation focused practice and environmental modification, will be essential in developing an environment in which children with diverse needs are accommodated.

OTA has also developed key resources to support the roles of occupational therapists working with children, including an information sheet27 which explains the role of occupational therapists in educational settings and the ways occupational therapists can support the school community, teachers and individual students.

It is important to note, however, that if embedded in schools and employed by education, the scope of occupational therapists is often limited to a focus solely on educational outcomes. This can be a very narrow view of the support needs of children and families from an early childhood early intervention perspective. With support occurring within school hours and school terms, it may not be effective for engaging with families, particularly those who work full time.

Consideration may also need to be given to how inclusivity is provided in some educational settings. Research shows that not all parents find inclusive settings are providing the supports their children with complex needs require.28

Approaches that increase access to occupational therapy and allied health support to identify and accommodate different needs have been identified by occupational therapists with expertise working in the early childhood educational sector. These examples should be considered as programs to build on to provide effective ways to improve services for children across mainstream settings.

Student Support Services

SA Department of Education Student Support Service29, provides preschools and schools with professional learning and coaching support for educators, as well as more intensive services to develop

26 Occupational Therapy Australia. (2025). Advice to governments on the development of foundational supports for children with developmental delay and disability. Occupational Therapy Australia.

27 Occupational Therapy Australia. (2025). Understanding occupational therapy in education. https://www.otaus.com.au/resources/ot-school-flyer

28 Ashburner, J., Tomkins, V., Taylor, J., Saggers, B., & Bobir, N. (2025). Mainstream or special education or somewhere in-between? What do parents of autistic students want and why? Journal of Research in Special Educational Needs, 25(1), Article e70032. https://doi.org/10.1111/1471-3802.70032

29 Department for Education (South Australia). (2025, 22 September) https://www.education.sa.gov.au/parents-and-families/student-health-and-disability-support/support-services-for-students/student-support-services

support strategies as part of a team around the child approach. It includes access to occupational therapy through its Self-Regulation Service and the Service’s School Buy-In Service.

Victorian Department of Education programs also fund occupational therapy roles in Student Support Services as well as in mental health roles. Employment of Occupational therapists in specialist schools and by private schools is also common.

Queensland Education Department provides funding to approved organisations to deliver services to support students with a disability through the Specialist Disability Support in Schools (SDSS) program. Therapy teams work collaboratively with schools, therapists and other agencies to support students, and integrating therapy into the classroom.

However, other jurisdictions such as Western Australia, may have no occupational therapists employed within the Departments of Education and have only a few occupational therapists employed directly by individual schools.

These examples show the current variation in the state and territory occupational therapy programs for children. A focus on increasing consistency of access and making programs more widely available nationally and across jurisdictions is critical.

Recommendation 7: Develop an early identification and access process for early childhood supports based on best practice that ensures streamlined and coordinated access to all appropriate mainstream and foundational supports, and NDIS supports if required.

Recommendation 8: Occupational therapists and other allied health professionals must be involved in the design and delivery of early identification, and delivery of tiered, interdisciplinary assessments that support access to programs and supports.

Recommendation 9: Supports should be delivered by occupational therapists and other allied health professionals as part of an embedded, interdisciplinary team approach that emphasises working closely with educators, caregivers and students.

Recommendation 10: Supports in educational settings should be made available in an equitable manner regardless of whether they are in government, religious or independent systems.

It is important to note that some of the examples identified above provide consultancy to schools and teachers, rather than on the ground support to students and teachers in the classroom. It is vital to also consider including programs in Thriving Kids where occupational therapists work together with teachers in classrooms to support outcomes for all children.

OTA highlights a number of research projects being undertaken to investigate models that effectively work in classrooms to deliver interventions that support outcomes for the individual as well as the class.30 31

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

There is a risk that Thriving Kids may create or exacerbate inequalities by further reducing access for children and families who are already experiencing the highest barriers to accessing services and supports. This includes (CALD) communities, Aboriginal and Torres Strait Islander communities, rural and remote communities, and those with complex family dynamics. While we speak to some of these issues below, we advise the Standing Committee to seek direct input from those communities. It is crucial to co-design Thriving Kids with CALD, Aboriginal and Torres Strait Islander, and rural and remote communities.

Culturally and Linguistically Diverse Communities

It is important for Thriving Kids to appropriately identify and respond to the specific needs of CALD children and families. Up to a quarter (26%) of all children entering their first year of schooling now come from a CALD background, according to the Australian Early Development Census. Recent research from Uni SA and Settlement Services International32 has found that children from CALD backgrounds are more likely to be developmentally vulnerable at school entry than other children and much less likely to attend most types of early childhood education.

It is essential that Thriving Kids is designed to include, and that funding is provided for, the delivery of programs and services in settings that enable or improve access for children and families experiencing these difficulties. Engagement and co-design with CALD communities will be important to ensure that services and setting are accessible, culturally safe and respond to diverse family and community needs.

Recommendation 11: Services should be designed in collaboration with CALD communities to ensure they are accessible, culturally safe and respond to diverse family and community needs.

30 Ray, K., Dally, K., Colyvas, K., & Lane, A. E. (2021). The effects of a whole-class kindergarten handwriting intervention on early reading skills. Reading Research Quarterly, 56(4), 607–627. https://doi.org/10.1002/rrq.365

31 Southall, A., Philpott-Robinson, K., Lane, A., & Leonard, C. (2025). Australian teachers’ perceptions of a co-taught self-regulation program. International Journal of Educational Research, 122, 102242. https://doi.org/10.1016/j.ijer.2025.102242

32 Lam, B., McMahon, T., Beauchamp, T., Badu, E. & Brinkman, S. (2024). Stronger Starts, Brighter Futures II: Exploring trends to promote the early development of children from culturally and linguistically diverse backgrounds in Australia. Occasional Paper – Number 5. © SSI/ Education Futures University of South Australia 2024

Recommendation 12: Funding must be provided to enable access to culturally appropriate and responsive programs and services. For example, enabling access to interpreters, translation of materials, etc.

Aboriginal and Torres Strait Islander Peoples

Aboriginal and Torres Strait Islander children are disproportionately affected by developmental delay, yet remain underserved by mainstream systems. This is in part due to structural racism and a lack of cultural safety in those systems. As identified by Indigenous Allied Health Australia (IAHA), in their submission to this Inquiry, Thriving Kids must commit to addressing structural racism and systemic barriers, and embedding cultural safety and anti-racism as legislative and program requirements. International models of early childhood support, such as those in Canada33 and New Zealand34 demonstrate the importance of culturally safe early intervention and community-led service design.

As stated by IAHA, to realise Thriving Kids’ potential, the initiative must be grounded in cultural safety, a strong and diversified workforce, system integration, and genuine co-design with Aboriginal and Torres Strait Islander families and communities. IAHA’s Cultural Responsiveness Framework35 provides sound guidance on cultural safety and cultural responsiveness.

Equity also requires addressing rural and remote workforce shortages and ensuring service access is not contingent on geography or socioeconomic status.

Recommendation 13: OTA recommends the adoption of IAHA’s recommendations to this Inquiry which include:

• Prioritise an interdisciplinary workforce that is culturally safe, to ensure success of Thriving Kids.
• Recruit and train Aboriginal and Torres Strait Islander allied health professionals across disciplines (speech pathology, occupational therapy, audiology, social work, psychology, etc.).
• Introduce mandatory cultural safety and anti-racism training for all Thriving Kids workforce members.
• Implement a clear national workforce strategy to avoid shortages that would undermine rollout.

33 Employment and Social Development Canada. (2018). Indigenous Early Learning and Child Care Framework. Government of Canada. Retrieved September 29, 2025, from https://www.canada.ca/en/employment-social-development/programs/indigenous-early-learning/2018-framework.html

34 Ministry of Social Development. (2024). The Child and Youth Strategy 2024-27. New Zealand Government. Retrieved September 29, 2025, from https://www.msd.govt.nz/about-msd-and-our-work/child-wellbeing-and-poverty-reduction/child-youth-strategy/index.html

35 Indigenous Allied Health Australia. (2020). Cultural Responsiveness in Action: An IAHA Framework. Retrieved October 30, 2025, from https://iaha.com.au/wp-content/uploads/2020/10/IAHA_Cultural-Responsiveness_2020_v6-1.pdf

• Link workforce development to government commitments in the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework & Implementation Plan 2021–2031.

• Adopt international best practice by embedding First Nations co-design, leadership, and governance at every stage of Thriving Kids.

• The provision of culturally safe case coordination and navigation services.

• Implement strong accountability measures that include:

  • Disaggregated data (including by Indigeneity, gender, geography) to monitor equity.
  • Independent oversight and evaluation, with Aboriginal and Torres Strait Islander leadership.
  • Outcomes frameworks that track cultural safety, workforce quality, and child and family wellbeing.

OTA draws the Committee’s attention to ASQ-TRAK36 as the only culturally tailored developmental assessment for Aboriginal and Torres Strait Islander children and communities. It is a family centred tool which highlights a child’s strengths as well as catching delays early. This will be an important tool to incorporate into Thriving Kids.

Regional and remote needs and access

A key challenge for Thriving Kids will be to ensure there is equity regarding access to services for children located in regional and remote areas. Children in remote and very remote areas have much lower preschool enrolment rates, and when they are enrolled, they attend for fewer hours each week than children in cities or regional areas.37 The design, funding and delivery of Thriving Kids must recognise that, similarly to CALD communities, remote and regional communities may require additional supports to ensure that children and families can access services. To maximise access to appropriately skilled practitioners, Thriving Kids should look to commission services in regional areas that utilise existing allied health providers. Solutions must offer face to face service options that link in with existing services and supports that families are accessing. As noted above, there cannot be an overreliance on digital or telehealth services in isolation.

Recommendation 14: The design, delivery and funding of Thriving Kids must deliver equitable access for children and families in regional and remote communities through place based and commissioned services that meet children and families’ needs in everyday settings and their communities.

36 Strong Kids, Strong Future. (n.d.). About. University of Melbourne. Retrieved September 29, 2025, from https://www.strongkidsstrongfuture.com.au/about/

37 Early Learning: Everyone Benefits. (2019). State of early learning in Australia 2019. Early Childhood Australia. http://www.earlychildhoodaustralia.org.au/our-work/submissionsstatements/state-early-learning-australia-report-2019

Complex family dynamics and needs

Thriving Kids must recognise and respond to the needs of families who are experiencing economic disadvantage and other complexities.

Low socioeconomic families are less engaged in health and education services and more at risk of isolation and failure to recognise developmental needs of children. Analysis of the Australian Early Development Census38 has found that socio-economic disadvantage is the largest driver of developmental vulnerability for all children. Almost a third of children from CALD backgrounds living in the most disadvantaged socio-economic areas were developmentally vulnerable compared to 1 in 6 of their peers living in the most advantaged areas.

Parents with disabilities should also be supported in their parenting role. Consideration needs to be given to the complex interplay between children’s and adult services, and the collaborative efforts required to support these families.

For these reasons, Thriving Kids must ensure that services are designed, funded and commissioned in a way that will enable flexible and responsive access to families that are experiencing a range of barriers to engagement in health, education and community settings, and ensure they provide tailored support for families to understand, access and navigate services.

The initial consultation documents from the Department of Social Services on foundational supports outlined a potential targeted foundational supports model in which the potential need for extra support where children have concerns across several developmental areas was acknowledged.39 The recognition that this role would involve a focus on the family, including capacity building and emotional support to facilitate parental and caregiver wellbeing, was positive. Parents can only influence positive developmental outcomes for their child when they are also supported appropriately.

However, available information about Thriving Kids does not refer to children and families with more complex needs. Minimum capabilities in key areas such as developmental science, relationship-based approaches, reflective practice and parent engagement are essential for Thriving Kids to meet the needs of families.

Recommendation 15: Services provided under Thriving Kids must be designed, delivered, commissioned and funded in a way that enables flexible and responsive access for families that experience barriers to

38 Commonwealth of Australia. (2025, August 13). 2024 AEDC results. Australian Early Development Census. Retrieved September 29, 2025, from https://www.aedc.gov.au/data-hub/public-data/2024-aedc-results

39 Australian Government Department of Social Services. (2024, October). Foundational supports for children with developmental concern, delay and/or disability and their families, carers and kin: Consultation paper. Retrieved September 29, 2025, from https://engage.dss.gov.au/wp-content/uploads/2024/10/Foundational-Supports-Consultation-Paper.pdf

engagement in health, education and community settings. This should include provision of tailored support for families to understand, access and navigate services.

Recommendation 16: Minimum capabilities in key areas such as developmental science, relationship-based approaches, reflective practice and parent and caregiver engagement must be mandated for Thriving Kids to meet the needs of families.

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

Defined Scope and Competencies

A key issue in terms of the early childhood workforce is the divide between those with clearly defined scopes, competencies, and discipline boundaries, which is a key foundation for interdisciplinary practice. This includes differences in terms of clearly defined capabilities and experiential or training requirements associated with paediatric and early childhood practice.

Educators are a key workforce in early childhood but often have little specific training or experience in developmental delay and disability. Training and professional development will be required for early childhood educators, and other health professionals to build this capability and understanding. Occupational therapists can have a role in working with workers in mainstream settings to support this capacity building.

Work should be undertaken to determine the skills and scope of practice required to provide safe and effective interventions in different areas of early childhood intervention across early childhood workforces. This should assist in identifying where role substitution can occur and where services should only be delivered by occupational therapists or allied health professionals.

Workforce development and support should be a key consideration for the development and implementation of Thriving Kids and other foundational supports for children. Attention will need to be given in particular to the support required by recent graduates and early career OTs and other AHPs, who may be required to take up roles to meet the demand under this new initiative. Mentoring and supervision should be built into service frameworks to support this workforce.

OTA’s capability framework for working with children, young people and families

OTA’s capability framework for occupational therapists working with children, young people and families outlines the capabilities (skills, knowledge and values) required for safe, effective and ethical occupational therapy practice in the early childhood space. The framework is supported by OTA’s Practice Essentials: Working with children, young people and families, a comprehensive, evidence-based learning and development program. The Practice Essentials were developed in collaboration between OTA and leading universities to provide the foundational knowledge and skills required to meet the paediatric occupational therapy capabilities as outlined in the framework.

Together, these initiatives provide clear guidance on the scope of practice for occupational therapists in paediatrics by setting nationally consistent expectations of what safe and competent practice entails. They guide occupational therapists to recognise the boundaries of their role, apply evidence-based approaches, and uphold professional and ethical standards in complex practice settings. In doing so, they safeguard quality of care, build professional confidence and support accountability, ensuring children and families receive occupational therapy that is both effective and aligned with contemporary best practice.

There is a clear need for other early childhood workforces to develop and maintain similar standards for their own professions when working in early childhood roles. To achieve this, the Government should work with professional bodies of these workforces to establish workforce quality standards and specific professional training requirements, including on-the-job support and supervision, as the foundation for key roles in Thriving Kids and other early childhood models of supports.

Recommendation 17: Establish the skills, scope and experience required by the early childhood workforce to deliver early childhood supports across a range of settings, and identify how they relate to evidence-based practice and the ability to successfully deliver different services and supports.

5. Draw on domestic and international policy experience and best practice.

We identify domestic and international policy experience and best practice below and encourage the Standing Committee to consider this evidence in their final report.

Australian examples

Thriving Kids can and should build on and complement current government frameworks, strategies, reviews and policy documents. The newly endorsed and released National Best Practice Framework, highlighted in the Introduction above,40 should guide the design and delivery of future early childhood practice, services and supports.

The evidence review and consultation undertaken for the development of the Best Practice Framework endorsed and supported occupational therapy practice, referring extensively to evidence and examples from occupational therapy practice and the key principles that underpin the work of the profession.

40 Australian Government Department of Health. (2025, September 29). National Best Practice Framework for Early Childhood Intervention. https://www.health.gov.au/our-work/national-best-practice-framework-for-early-childhood-intervention (Retrieved September 29, 2025)

Recommendation 18: Adopt and actively implement the National Best Practice Framework as the National Framework for Thriving Kids.

Other key policy documents and strategies relevant to the implementation of Thriving Kids include:

• The National Early Years Strategy 2024-203441 – This Strategy sets out the Australian Government’s vision to best support Australia’s children and their families in the early years, to the age of five years. It is a whole of government approach that connects major reviews and reform activities across the early years system in areas such as health, early childhood education and care, disability and family support.

  The Early Years Strategy may provide a valuable platform for the development of Thriving Kids, as it monitors and assesses key reforms and outcomes across relevant sectors. Importantly the new National Best Practice Framework for Early Intervention aligns with this strategy.

• The National Aboriginal and Torres Strait Islander Early Childhood Strategy42 – this strategy will be vital for consideration in developing the services framework, goals and outcomes to be achieved by Thriving Kids. Thriving Kids should support the Close the Gap goals and contribute to their achievement.

• The Nest Wellbeing Framework – developed by ARACY (Australian Research Alliance for Children and Youth) is Australia’s first evidence-based framework for national child and youth wellbeing with six interconnected domains that support young people to thrive43.

• The National Framework for assessing children’s functional strengths and supports needs in Australia44 – This Framework provides a consistent, evidence-based and culturally responsive approach for assessing, differentiating, and reporting children’s functional strengths and support needs. It focuses on professional practice when working with children aged 0-12 years and their families. It can be used across relevant health, education, disability and community services to support all children, irrespective of whether they have a diagnosed condition or may receive a diagnosis in the future.

41 Australian Government Department of Social Services. (2024, May 7). Early Years Strategy 2024–2034. Retrieved September 29, 2025, from https://www.dss.gov.au/early-years-strategy

42 National Indigenous Australians Agency. (2021, December 7). National Aboriginal and Torres Strait Islander Early Childhood Strategy. Retrieved September 29, 2025, from https://www.niaa.gov.au/resource-centre/national-aboriginal-and-torres-strait-islander-early-childhood-strategy

43 ARACY. (n.d.). The Nest wellbeing framework. [Review of The Nest wellbeing framework.]. Australian Research Alliance for Children and Youth. Retrieved September 29, 2025, from https://www.aracy.org.au/the-nest-wellbeing-framework/

44 Autism CRC. (n.d.). Strength and Supports Framework. Retrieved September 29, 2025, from https://www.autismcrc.com.au/best-practice/strengths-and-supports

• The National Autism Strategy 2025-2031 and First Action Plan45 – This Strategy focuses on improving life outcomes for Autistic Australians of all ages, genders and cultural backgrounds. To deliver on this intent, this Strategy covers key reform areas including improving social connections, and improved access to services, healthcare, education and employment. Connected to the National Strategy is the National Roadmap to Improve the Health and Mental Health of Autistic People 2025–203546
• NDIS Independent Review Final Report47 and supplementary analysis48 – The NDIS Review recommended (Final Report, Action 6.5) that early intervention supports are based on best practice principles. The Commonwealth has indicated its intention to support that recommendation by requiring future early childhood services funded by government to build upon this policy foundation.

Recommendation 19 – The Government should draw on the range of Strategies and Frameworks already in place to ensure that Thriving Kids provides evidence-based best practice supports for children with developmental delay and disability and their families.

International examples

There are several good international examples of early years support and wellbeing strategies and programs, that could be considered by the Standing Committee as providing best practice approaches:

• Partnering for Change (Canada)49 – Partnering for Change (PC4) was initially developed for occupational therapists working in the Ontario school system with children with motor coordination challenges. Since 2008, P4C has been developed, refined and continually evaluated through both qualitative and quantitative research involving key representatives from government, health care decision-makers, service provider organizations, clinicians, schools, and families working with the researchers.

45 Australian Government Department of Health. (2025, January 14). National Autism Strategy 2025–2031. https://www.health.gov.au/resources/publications/national-autism-strategy-2025-2031

46 Australian Government Department of Health. (2025, February 25). National Roadmap to Improve the Health and Mental Health of Autistic People 2025–2035. https://www.health.gov.au/resources/publications/national-roadmap-to-improve-the-health-and-mental-health-of-autistic-people-2025-2035

47 Australian Government Department of Social Services. (2023, October). Working together to deliver the NDIS: Independent Review into the National Disability Insurance Scheme – Final Report. https://www.ndisreview.gov.au/sites/default/files/resource/download/working-together-ndis-review-final-report.pdf

48 Australian Government Department of Social Services. (2023, October). Working together to deliver the NDIS: Supporting analysis. https://www.ndisreview.gov.au/sites/default/files/resource/download/NDIS-Review-Supporting-Analysis.pdf

49 CanChild. (n.d.). Partnering for Change. McMaster University. Retrieved September 29, 2025, from https://canchild.ca/discover-canchild/current-studies/partnering-for-change/

• The Child and Youth Strategy 2024-2750 (NZ) – This Strategy has a focus on supporting children and their families and whānau in the first 2,000 days.
• He Pikorua51 (NZ) – is the practice framework for Ministry and learning support practitioners. Both these key documents provide valuable pointers to working with indigenous communities to address early childhood support needs.
• Getting it right for every child in Scotland52 – (GIRFEC) GIRFEC is both an approach and framework used by services across Scotland to improve and uphold the wellbeing of children and their families.
• Eurlyaid.53 – The European Association on Early Childhood Intervention (EAECI). EAECI was implemented in Portugal under a legal framework that requires health, education and social services to collaborate in the design and delivery of best practice for young children with developmental concerns, delay or disability in the early years.
• UNICEF Global Report on Children with Developmental Disabilities – This report proposes priority actions to accelerate individual-, family-, community-, and society-level changes to achieve inclusion and health equity. The report makes the case for greater investment and accountability to build inclusive and responsive multisectoral care systems for children and young people with developmental disabilities.
• Head Start54 (US) – Head Start programs support children’s growth from birth to age of five through services centered around early learning and development, health, and family well-being. It is a free program for families that meet low- income eligibility guidelines.

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

Coordination and Collaboration

50 Ministry of Social Development. (2024, November). The Child and Youth Strategy 2024–27. New Zealand Government. https://www.msd.govt.nz/about-msd-and-our-work/child-wellbeing-and-poverty-reduction/child-youth-strategy/

51 Ministry of Education. (n.d.). Our Story. He Pikorua. Retrieved September 29, 2025, from https://hepikorua.education.govt.nz/our-story/

52 Scottish Government. (2022, September 30). Getting it right for every child (GIRFEC): Policy statement. https://www.gov.scot/publications/getting-right-child-girfec-policy-statement/

53 EURLYAID – European Association on Early Childhood Intervention (EAECI). (n.d.). EURLYAID – European Association on Early Childhood Intervention. Retrieved September 29, 2025, from https://www.eurlyaid.eu/

54 Administration for Children and Families. (n.d.). Head Start. U.S. Department of Health & Human Services. Retrieved September 29, 2025, from https://www.acf.hhs.gov/ohs/about/head-start

Collaborative, child- and family-centred practice is recognised as an important foundation for helping children and young people to thrive. Evidence shows that families benefit from professionals working together and empowering families to understand their child’s developmental characteristics and their own role in supporting the child’s development. This approach should be prioritised under Thriving Kids to ensure families and children to achieve the best outcomes.

To facilitate this, collaborative teams should be embedded in mainstream settings. This would have the additional benefit of uplifting the capacity of mainstream workers and communities as well as providing a continuum of care for all children with developmental concerns, delay or disability.

Collaboration is a key component of occupational therapy training and practice. Therefore, occupational therapy can help to lead the way in this area.

Recommendation 20: Coordination of services and collaboration should be a key area of focus under Thriving Kids. This requires a commitment to supporting collaboration between different providers and services working across different funding programs and settings.

Recommendation 21: Funding must be available across all programs to support collaboration and coordination and must be flexible enough to accommodate for different combinations of service delivery; funding individual coordination roles will not create collaboration without enabling participation by all providers.

Early Identification and Assessment

Early identification of developmental delay and disability has been clearly established in evidence and in policy reviews, frameworks and strategies as a foundation for maximising outcomes for children and families. Early identification and the approach to assessment will be critical to Thriving Kids and should incorporate best-evidence practice as identified in the Best Practice Framework.

Mainstream health services are likely to be the key point of contact for families during this early period but consideration of how to provide access to occupational therapy and allied health assessments to formalise understanding of developmental needs and support families to make decisions about accessing supports is needed.

Early intervention and how assessment is undertaken should be a priority focus for Thriving Kids. Many of the programs we have highlighted focus on a ‘light touch’ to assessment, with it being undertaken primarily to identify goals and concerns, and enable the right support to be provided.

Early intervention, support and access to assessment should be implemented across a wide range of settings, particularly mainstream settings in an integrated and consistent approach. This needs to be supported by training health professionals, educators and other key workers to develop the skills and knowledge to monitor for potential signs of developmental delay or disability. This should be

complemented by access to more specialised occupational therapy expertise to support verification and assessment.

Recommendation 22: Implement evidence-based best practice as identified in the Best Practice Framework to ensure effective early identification and assessment is provided under Thriving Kids.

Recommendation 23: Skilled and qualified health professionals such as occupational therapists, should be recruited for assessment roles to ensure Thriving Kids effectively meets the needs of the children and families who require its services.

Recommendation 24: Ensure health professionals and other key workers including early childhood educators, teachers, and maternal and child health nurses are trained and supported to monitor for potential signs of developmental delay or disability and have access to more specialised occupational therapy expertise to support verification and assessment.

OTA’s proposal for implementing Thriving Kids

To address the support needs of children with developmental delay and disability, and their families, a whole of government approach is required to ensure supports are delivered when they are needed and in line with the principles outlined above, and that access to occupational therapists and other allied health professionals is prioritised across all sectors.

Recommendation 25: Thriving Kids should be incorporated into the National Early Years Strategy ensuring a coordinated and strategic approach across Disability, Health, Education and Social Services.

Key actions to support the implementation of Thriving Kids through this mechanism should include:

1. Address access to supports, including OTs, in educational settings by
   • establishing senior OT roles in Departments of Education to support the provision of embedded allied health supports in early childhood settings, preschools and schools, in line with the quality improvement goals of the school, and to meet the needs of the school community and individuals;
   • develop embedded roles in educational settings which include discipline specific supervision and the possibility of career progression.
2. Address early identification and assessment issues by
   • ensuring early childhood workers across all sectors are trained and supported to monitor for potential signs of developmental delay or disability and have access to more specialised occupational therapy expertise to support verification and assessment;
   • defining and implementing an integrated and consistent approach to early identification and assessment of children and young people across early childhood settings and funding programs. This approach should minimise duplication, recognise the role of multidisciplinary assessments, and enable streamlined access to the most appropriate early intervention and support services and funding programs.

3. Coordinated and collaborative approaches be implemented by
   • making funding available to support collaboration and coordination between different providers and services working across different funding programs and settings, and
   • ensuring that funding is flexible enough to accommodate for different combinations of service delivery; funding individual coordination roles will not create collaboration without enabling participation by all providers.
   • Implement universal 3-year-old health and development screening programs across all jurisdictions to check progress across a range of domains as per the Brighter Beginnings program.
   • Implement the National Framework with flexibility at local level.

Additional Key Considerations for the Standing Committee

Regulatory Framework

A regulatory framework is required to support the implementation of Thriving Kids to ensure high quality services are delivered by an appropriately qualified and skilled workforce.

The workforce delivering foundational supports must be subject to quality standards that ensure:

• appropriate levels of experience and knowledge,
• that they are working within their scope of practice, and
• that development and support for less experienced staff is provided by all providers.

Quality standards must be developed and applied across early childhood workforces to establish clear scopes of practice, disciplinary boundaries and areas of overlap, the training and experience needed for a discipline to practice in particular models of collaborative practice, and the ongoing support and development needed to protect consumers and practitioners.

Supporting the transition to new services

Any moves to amend the NDIS Act to remove access to any cohort of children must ensure there is adequate time for Thriving Kids programs and services to be fully established, evaluated and found to be operating appropriately to meet the needs of this cohort. this must be achieved before any changes are made to NDIS legislation to remove access. Government must avoid making legislative amendments to meet budgetary constraints; doing so risks increased flow on costs if children do not receive the supports they need to access services, education and employment in future. Failure to plan for an adequate transition time may result in children experiencing delays in access OT services at crucial stages, and place families at risk of significant stress and disruption.

Preserving and supporting NDIS access

Engagement with early childhood experts, sector, families and caregivers in the design and funding a contiuum of supports that address the needs of all children in their everyday settings will be critical to ensuring that Thriving Kids and other foundational supports are integrated with NDIS. This will ensure that children who require ongoing supports during or after participation in Thriving Kids do not experience service silos, delays or roadblocks. Children with mild and moderate developmental delay may also have other forms of disability including physical disabilities and psychosocial disability. Common co-occuring disability types include Down Syndrome and Cerebral Palsy.

Thriving Kids must be established in a way that ensures that these children can continue to access reasonable and necessary supports required for non-ASD related disabilities through the NDIS, which may include Assistive Technology, Home Modifications, and capacity building supports. For those children not yet on the NDIS or Thriving Kids, that require dual access to both programs, the evidence gathering and assessments

used to establish evidence for one should be accepted by the other to ensure that families do not need to undergo dual screening and assessment pathways.

For children who are assessed as meeting the threshold for Thriving Kids, and still require ongoing disability supports once they age out of the program at the age of nine, there must be an integrated way for these children to continue to access the NDIS where their disability requires ongoing supports. Documents and evidence from Thriving Kids must be accepted by the NDIS to streamline access.

In the case of families and children who have current NDIS access revoked, and are transferred to Thriving Kids, this must be undertaken in a trauma-informed and supportive way, that enables them to have a supported transition to appropriate services in their area, with warm referrals, appropriate handover of existing information and assessments (with permission from families).

Pathways to support for children aged nine and above

Since Thriving Kids is for children aged eight and under, it is important to consider how children nine and above can access or continue to access supports.

Children over the age of nine with developmental delay and disability may continue to need supports even if they are not eligible for NDIS. These supports may be even more critical as they age and progress through school, and seek to participate in their communities. The transition to secondary school is a particularly vulnerable time for many children; and children living with developmental delay or disability may develop more significant mental health and wellbeing issues if they are unable to access timely supports.

The Thriving Kids Advisory Group will need to consider how Thriving Kids contributes and connects to an eco-system of supports for children, that incorporates Thriving Kids, general and other targeted foundational supports and NDIS.

Recommendation 26: The Committee should recommend that the Thriving Kids Advisory Group consider how Thriving Kids contributes and connects to an eco-system of supports for children, that incorporates Thriving Kids, general and other targeted foundational supports and NDIS.

Access to assistive technology and home modifications

OTA members identified that one of the benefits gained under NDIS was greater access to home modifications and assistive technology.

People with disability who are unable to access the NDIS do not have access to the assistive technology they need. They are commonly required to wait more than 12 months to access funding, self-fund some or all of the assistive technology they need or simply go without. Families of children with disability who are deemed ineligible for NDIS supports, or may be in the future, face the same difficulties.

Access to assistive technology will enable children to:

• Increase their independence and participation in everyday activities;
• Reduce reliance on families and carers, improving family relationships and reduce carer stress;

• Reduce the risk of accidents and falls.

The importance of these supports for children aged eight and under with ‘mild and moderate’ developmental delay must be recognised. As highlighted above, ‘mild’ or ‘moderate’ developmental delay or disability does not directly correlate to level of function.

Recommendation 27: Thriving Kids should include funding for assistive technology and home modifications.

Key Worker models and coordination of services

Key worker models are seen by many early childhood providers as best practice, and may be utilised as a default method of providing early childhood services. However, there is evidence to suggest that overreliance on these may jeapordise outcomes. In practice, the programs being delivered do not always align with the evidence underpinning a key worker approach. This may be due to several factors.

It may be that providers do not understand when and how to implement key worker models based on the needs and preferences of the child and family; or that staff working in key worker roles may lack the scope, training and professional characteristics to work effectively in interdisciplinary key worker roles, or similar roles. Perhaps most critically, key worker models may be offered as independent services rather than as part of a team; which is contrary to the intent underlying the model.

The Desktop Review of Best Practice in Early Childhood Intervention noted the scarcity of vigorous research about collaborative practice, including key worker models55. The report identified that none of the randomised control trials they reviewed examined outcomes of collaborative teamwork, or specific team-based approaches including key worker models, and that this remains a gap in the evidence.

Effective teams can be established using a range of models. Evidence-based decision making should guide teams in their approach to collaborative practice. The Decision-Making Guide56 and Practice Guidance on the Teamwork Key Principle57 developed as part of the National Best Practice Framework will be important resources to support this.

Recommendation 28: Lead Practitioner or key worker models should be recognised as a means of providing coordinated supports for children and families that is sometimes appropriate but may not best align with

55 Luscombe, D. (2024). Review of best practice in early childhood intervention: Desktop review full report (Deliverable 1). The University of Melbourne

56 Australian Government Department of Health. (2025, May 23). The National Best Practice Framework for Early Childhood Intervention – Decision-making guide. https://www.health.gov.au/resources/publications/the-national-best-practice-framework-for-early-childhood-intervention-decision-making-guide?language=en

57 Australian Government Department of Health. (2025, May 22). The National Best Practice Framework for Early Childhood Intervention – Practice guidance – Teamwork key principle. https://www.health.gov.au/resources/publications/the-national-best-practice-framework-for-early-childhood-intervention-practice-guidance-teamwork-key-principle?language=en

evidence and needs. This model of delivery should be an option available for practitioners and families to consider rather than a default approach.

Recommendation 29: Evidence-based decision-making (such as the guide developed under the National Best Practice Framework) should be utilised to support collaborative processes and team development.

Funding of services and programs

OTA argues that there is a need to prioritise co-design of commissioning processes with the clinical and NGO sector that ensures the involvement of allied health professionals, including occupational therapists.

Commissioning processes must be designed appropriately to ensure that services can be established that meet the goals of government and the needs of consumers. This must be based on an understanding of who will undertake commissioning and what services will be commissioned. A key priority in the design will be ensuring that commissioning processes enable and strengthen existing local service capacity rather than overlaying new services with no local footprint. Allied health professionals, including occupational therapists, must be seen as a key part of Thriving Kids and any commissioning process must recognise that a majority of occupational therapists with the necessary skill and expertise now work in the private sector.

Commissioning arrangements will be critical to workforce recruitment and retention. The scope of occupational therapy practice is not well understood by some commissioners of health services and individual clinicians, leading to their exclusion, or low utilisation, in certain settings.

Primary Health Networks (PHNs)

OTA is concerned that the governance of PHNs appears to be medically driven by the GP profession. As a result, PHN commissioning processes do not take into account the occupational therapy and allied health workforce, particularly the high proportion who are now in private practice. This results in a highly qualified and capable workforce effectively being excluded from the provision of these services, and is a missed opportunity for those who access PHN commissioned services.

Inclusion of a dedicated role for allied health representation would ensure that allied health service delivery and scope is included in the leadership of PHNs, and their commissioning processes.

There are some good examples of effective commissioning of services to respond to local community need, that could be the basis of future models. One such example is the Thriving on Track (ToTs) Initiative, which is a collaborative initiative between Children’s Health Queensland, Griffith University, Logan Together, Brisbane South PHN and other community partners58.

58 Brisbane South PHN. (2024, July 11). Thriving and On Track (TOTs). https://bsphn.org.au/community-health/child-youth-and-families/thriving-and-on-track-tots

This initiative is delivered in ECECs and community hubs across Logan and Inala, with the goal of providing early developmental support to children, families and ECEC educators.

Delivery of early childhood disability supports via Medicare

Minister Butler has identified that government will look to establish new Medicare items to enable access to allied health disability supports including those delivered by an occupational therapist.

However, without additional detail OTA is concerned that this approach will not adequately meet the needs of vulnerable families and children.

CDM items show that 100% of providers charged a gap fee due to inadequate reimbursement. This is likely to result in the cost associated with accessing services under Medicare being prohibitive for many families to access the services they require.

If the real cost of services is not included in the reimbursements available to occupational therapists and other allied health professionals this situation will be perpetuated.

In terms of disability specific Medicare supports, the Complex Neurodevelopmental Disorders and eligible disabilities program provides access to both assessment and/or treatment items provided by allied health professions including occupational therapists. While these Medicare programs recognise the importance of allied health supports they are impacted by annual and lifetime limits, as well as low rebates.

Bulk-billing incentives need to be put in place to support access for people who will be unable to access the appropriate health professional due to economic issues. Barriers to collaborative care and case conferencing, number of sessions available and ineffective referral pathways will also need to be addressed.

A range of current and recent reviews have identified access barriers and are seeking to provide advice to government to help improve the accessibility of Medicare-funded allied health services. Accessibility will be critical if Medicare-funded allied health services developed as part of Thriving Kids

Recommendation 30: Fund Thriving Kids and other targeted foundational supports for children with developmental delay and disability at a level that reflects evidence and supports access to an appropriately skilled and trained workforce.

Recommendation 31: Undertake formal, ongoing engagement with occupational therapists and other key allied health and early childhood professions to design and implement commissioning models for Thriving Kids. These models should enable participation by private sector allied health organisations of all sizes with demonstrated early childhood expertise, as well as public sector organisations.

Recommendation 32: New early childhood intervention service models, such as Thriving Kids, should allow for a range of different employment and contracting models, in order to:

• account for the differences in how individual states and territories, as well as rural and regional localities, provide support in mainstream settings;

• recognise that the workforce with the necessary skills and experience are spread across both public and private sectors, with the higher percentage now predominantly situated in private practice.

Recommendation 33: The design of new allied health Medicare items, including for Thriving Kids, should be based on the real cost of services, and not limited by arbitrary annual limits or inefficient referral requirements, and support collaborative team-based approaches.

Evaluation, data collection and reporting

Comprehensive evaluation and monitoring at program and system levels will enable refinement and expansion of the program as it matures and as future needs are identified. This means that data collection, monitoring and evaluation – done in a transparent and independent way – is integral to the design and implementation of Thriving Kids.

Research in the disability space is already inadequate, with funding prioritisation primarily going to medical research. This needs to be addressed to ensure there is capacity for development of innovative programs, implementation of trials and evaluation of outcomes.

The lack of evaluation of programs that were in place prior to NDIS is also a significant evidence gap, with evaluation not being conducted in many cases due to funding constraints or not completed as programs ceased or rolled into the NDIS. It is important that there is funding available at the program level to ensure that programs can be monitored and evaluated.

Monitoring, evaluation and reporting will also be necessary at the system level to ensure that Thriving Kids is achieving its aims and operating efficiently and effectively. This will be a complex task, and should include a focus on system integration, and coordination across jurisdictions. Sufficient resources will need to be dedicated to this.

To complement the above, clear measures of success should be developed, including identification of aims and outcomes that Thriving Kids is hoping to achieve, and related indicators. These should be co-designed with families and experts in the early childhood sector to ensure that they align with the aims of Thriving Kids and are also grounded in lived experience, expertise and community expectation. Co-design with the groups who may experience equity and intersectional issues identified under Term of Reference Three will also be important to develop indicators around equity and intersectionality.

The principles and components outlined under Term of Reference Two above will be useful in determining measures of success. Evaluation and reporting should pivot from solely clinical or impairment-based goals to prioritising participation, inclusion, and community engagement. Furthermore, the evaluation must incorporate family and child satisfaction (PROM) and the achievement of their personal goals (PREM).

Recommendation 34: Robust monitoring and evaluation processes be developed and funded, for the Thriving Kids system of supports, and for individual programs that will be delivered at State and Territory levels to support continuous improvement of Thriving Kids.

Conclusion

OTA welcomes the opportunity to provide input to the Committee’s inquiry into Thriving Kids. We look forward to working with the Government and Department of Health, Disability and Ageing to support the implementation of an effective Thriving Kids system of supports.

If you would like to discuss our submission please contact OTA on policy@otaus.com.au

Appendix 1

Exemplary models identified by OTA members

scope and purpose of project | education across Burnie, Smithton and Devonport, funded by the Tasmanian Government until April 2026. Parents, carers and professionals will help create and test resources focused on children’s critical first two years, building on Burnie’s earlier work around connection, nutrition, caring and movement. The project will also develop a roadmap to guide other communities in creating place-based parent resources.

| Good Start in Life | Contains Link to brochure providing proposed research study’s objective and methods, and brochure on benefits of project implementation (including quotes). Study looks at role of Family and Community Liaison Coordinator in EC development. Another study looks at critical role of OT in EC settings, and importance of collaborative partnership to tailor interventions (both studies sit behind paywall) | Research project (Uni Canberra), delivering multi-sectoral service integration. Provides student-led OT/SP to support families & educators to facilitate child (0 – 5 years) development & participation in ECEC centres, pre schools and community. | MRFF grant | ACT | Data from the most recent national Australian Early Development Census (AEDC) in 2018 show significant increases in the percentages of children who are developmentally vulnerable | | | | | SA Dept Education Student Support Services, incl School Buy in | SA DoE Brochure provides high level summary of models under which Occupational therapistsdeliver services in schools Vic gov website on school readiness funding provides info on access to allied health services in schools under school readiness funding | Allied health professionals work in collaboration with educators and families, with the goal of improving outcomes for children in one or more of the three School Readiness Funding priority areas. | State Department of Education –school readiness funding. | State-based scheme across Australia | Victoria: Services that receive over $10,000 over a 2-year cycle in School Readiness Funding will have a portion of their funding allocated to pre-purchased allied health sessions. | | | | | Australian Rural Health Education Network | Not a specific program as such – links to organisation website. Contains some studies. | National association for 19 university depts. of rural health. Promotes health and wellbeing of Australians in rural/remotes areas through delivery of health education, research and advocacy. | | | | | | |

Supports 15,000 nursing, midwifery, allied health students to work/study outside metro regions.

| Partnering for Change | Links to website which provides overview of project’s aim, methods, implementation, findings and recommendations | Model which delivers rehabilitation services to children with special needs. Partnership between educators, health professionals, community care access centres, families. Deliver in school settings, allowing therapists to coach educators and families about the needs of children, thus increasing | | Canada | | | | |

intensity of their services.

| RCOT Unlocking Potential | Royal College of OT Website provides evidence for service design which utilises universal, targeted and specialist interventions to improve access to OT for children with additional learning and support needs. | Brochure provides examples of applying a universal approach to service desin, and the impact. | | UK | | | | | | 2 programs in NSW which provide examples of coordinated response and service integration: JGOS SAFESTART | These examples could be applied to strengthen and coordinate EI and coordinated response via a MD team. JGOS website provides background on Agreement, partners and agreement participants as well as objectives, guiding principals and supporting frameworks. | JGOS: Health and Housing Joint Guarantee of Service (JGOS) for People with Mental Illness Partnership to achieve access housing and mental health supports. Signatory partners inc govt and community housing providers. SAFESTART: Implemented 2000 Hunter region. | JGOS: NSW Health and the Department of Communities and Justice | NSW | | | | |

SAFESTART document outlining rationale and overview of model and strategic action plan. | Establishes coordinated response pathway via flagging system within electronic records and enabling coordinated response planning. Universal, preventative screening for MH and PS risks and coordinated support for women and their families. Utilizes MD team based approach to develop comprehensive care plan and improve outcomes for

infants and families in first 1000 days.

Occupational o © Therapy

o °o Australia 5 / 340 Gore St. Fitzroy VIC 3065 1300 682 878 OTAUS.COM.AU

Structuring mainstream, foundational and NDIS disability supports to ensure access to high quality occupational therapy services for children and young people with developmental delay and disability

Advice and actions for government

May 2025

Introduction

More than 12 months ago, the National Disability Insurance Scheme (NDIS) Review Final Report made a compelling case for a more integrated, multi-tiered system of early childhood services focused on meeting the needs of children and young people with developmental delay and disability, and their families. The proposals outlined for early childhood in Recommendation 6 of the Review provide a positive vision of an integrated system of supports funded and maintained by all governments to support all children aged 9 and under with disability and developmental concerns based not on diagnosis but rather on need.

Since then, changes to NDIS legislation and associated policy changes implemented by the National Disability Insurance Agency (NDIA) have led to plan reductions, higher rates of reassessment, and slower decisions about access resulting in many children and young people losing or missing out on access to services. While the Commonwealth government made a commitment to ensure that NDIS reforms would not disadvantage children and young people, many children and families with ongoing support needs have now found themselves outside of the NDIS without the promised expansions to mainstream access or development of foundational support services. The impacts of these delays are significant. With no supports to transition to, and no idea when they may be able to access supports in the future, children with developmental delay and disability face missed opportunities for early intervention that may have long-term consequences and result in higher costs to our disability and health systems.

In light of the rapid changes occurring within the NDIS and ongoing uncertainty about how new services outside the NDIS would be developed, Occupational Therapy Australia (OTA) established an expert advisory group of more than 40 experienced occupational therapists working across government, non-government, education, and private practice early childhood settings in late 2024 to guide policy development and understanding of the on-the-ground impact of these changes. That group has spent more than six months supporting engagement with Commonwealth and New South Wales consultations on foundational supports, contributing to consultation on the development of the Department of Social Services-funded Best Practice Framework for Early Childhood Intervention and providing advice and input to guide the development of this paper. Their input underpins the recommended actions for government and policy guidance outlined here.

Recommended actions for Australian governments

The increasing delays in designing and establishing foundational supports must be addressed as a key priority for all governments. The Commonwealth, in conjunction with the states and territories must develop and communicate a coordinated roadmap for how and when new disability supports will be established across mainstream and foundational supports. Children, families, and providers of early childhood intervention across health, education, and disability sectors must be engaged in developing plans for an integrated system of supports for children and young people with developmental delay or disability. To address the significant impact being experienced by children and families as a result of NDIS changes, transitional funding arrangements are urgently needed to ensure early intervention programs can be completed and that families do not experience a complete withdrawal of supports.

Workforce planning will be critical to ensure that new models of service delivery provide access to experienced providers with the scope and experience to deliver outcomes associated with their roles. With the shift to private practice that has arisen due to the closure of state and territory disability programs and the market-based approach of the NDIS, service models must ensure that private allied health practices of all sizes are able to participate in delivering supports.

Occupational therapists are a crucial early childhood workforce, providing supports and services across the gamut of early childhood services and settings. Occupational therapists work closely with children and families, carrying out comprehensive developmental and functional assessments, facilitating capacity building of children and their family, and delivering specific and targeted interventions and supports at the individual and system levels. Occupational therapists also provide education and knowledge to children, families and their broader informal and formal support networks. Occupational therapists draw on a focused skillset and therapeutic frameworks that align with, and are the basis of, best practice early childhood intervention and supports delivered in collaboration with the child, family and other providers. Their role must be retained and expanded if we are to build a more effective system that delivers outcomes for children, young people and their families.

Immediate actions

OTA calls on governments to commit to the following actions:

1. Pause the implementation of NDIS reforms, including the increase in plan reassessments, to align with the introduction of targeted foundational supports and more accessible mainstream services. Until accessible systems are in place, and tested, participants must have access to NDIS or transitional funding that supports continued access to targeted Early Childhood Intervention supports and services such as occupational therapy.
2. Establish new and expanded mainstream and foundational support programs that provide access to occupational therapy and other supports. Mainstream, general and targeted foundational support programs are complementary but separate programs that require careful consideration of the roles of occupational therapists in each. Outcomes for children, young people and families will only be achieved by investing in increased inclusion and capacity building within mainstream settings, alongside a comprehensive model of general and targeted foundational supports that can support children and families with information, guidance, capacity building, and the more complex and targeted early intervention support needs that many children will require.
3. Commission an early childhood workforce review to substantiate the scope, skills and expertise needed by the workforces delivering early childhood services. This should focus on the scope and skills underpinning key roles such as early identification and assessment, education and capacity building, coordination and support in the form of key worker or lead practitioner models, and targeted therapeutic supports. The review should seek to identify minimum qualification and experience standards for all professions providing early childhood supports along with workforce development needs to ensure future access to an experienced workforce.
4. Ensure that registration requirements across early childhood settings are proportionate and recognise existing Australian Health Practitioner Registration Authority (Ahpra) registration requirements. Current NDIS registration requirements are financially prohibitive and administratively onerous and there is little evidence to suggest they increase the safety or quality of the services provided by Ahpra-registered occupational therapists. Governments must commit to ensuring registration processes are fit for purpose, and balance participant safety with access to quality service provision in all geographic settings through the development of requirements that are proportionate and complementary to existing regulatory requirements. In addition to imposing registration requirements, governments must ensure that early childhood supports are delivered by suitability qualified and experienced professionals (see Action 3).

Short and medium-term actions

OTA calls on governments to commit to the following actions:

5. Fund targeted foundational supports for children and young people with developmental delay and disability at a level that reflects evidence and supports access to an appropriately skilled and trained workforce. OTA notes that occasional or one-off services do not align with current evidence and are unlikely to reduce demand on the NDIS. Evidence is available that can guide decisions about dosage for some disabilities, aspects of developmental delay and types of child, family and environmental need but clinicians must be able to guide dosage decisions. The funding and structure of foundational support programs must also prioritise access to appropriately experienced clinicians by providing funding at a level commensurate with that experience. Robust evaluation mechanisms will be needed to ensure that children and family needs are being met by foundational support programs, and that services are delivered by appropriately qualified and supported workforces.
6. Establish a rigorous early identification and assessment process for early childhood supports that ensures streamlined and coordinated access to mainstream, foundational and NDIS supports. Early identification must be optimised at the earliest points of contact within hospitals, mainstream maternal and child health services, GP settings, as well as ECEC settings, with accessible and timely pathways to appropriately skilled and experienced professionals who can identify indicators of potential developmental delay, differences or disability. Timely and comprehensive identification is essential to ensure early intervention can commence during critical developmental windows. The development of assessment processes for foundational supports should be undertaken in conjunction with the NDIS, in order to ensure that a coordinated multidisciplinary model of assessment and access is developed for all early childhood disability programs.
7. Recognise the role and expertise of occupational therapists in delivering mainstream, foundational, and NDIS supports for children and young people with developmental delay and disability by establishing and funding clearly defined roles for occupational therapists across future services models in all three systems. This document provides guidance about how and where occupational therapists fit into a range of different models. We note that occupational therapy roles are needed across all three systems and that appropriate, evidence-based supports will require both mainstream and foundational or NDIS supports working collaboratively to achieve outcomes for children, young people and their families. This should draw on the work undertaken in immediate Action 3 (see above).
8. Undertake formal engagement with occupational therapists and other private sector allied health organisations of all sizes to design and implement service models that enable participation in mainstream and foundational support programs. A key principle in the design of new systems must be that new and expanded services will strengthen existing services and the effective working relationships that many communities have established, prioritising access to in-person services for rural and remote communities. Given the majority of state and territory services have closed and been replaced by private NDIS services, careful consideration is needed to consider where the most experienced early childhood workforce is now situated. Failure to harness the expertise of the existing workforce will lead to knowledge loss, workforce shortages, and lower quality services.

By implementing these actions, governments will ensure that early childhood reforms align with current evidence, meet the stated needs of children, young people and families, and support a more sustainable and outcome-focused system of supports.

Important note about defining mainstream supports

The guidance included in this document is primarily focused on mainstream education and early childhood education and care (ECEC) programs, and the role of occupational therapists in those programs and settings, to reflect current discussions by governments and the NDIS Review about how to develop and structure early childhood foundational supports. OTA recognises that mainstream services comprise a broad ecosystem of supports including health, mental health, welfare, youth justice, child protection, and housing. Occupational therapists work in and play an important role across all of these mainstream systems. We welcome any opportunity to provide additional guidance and input to support improved collaboration across these systems and services for children and young people with developmental delay and disability.

Background

This document has been developed by Occupational Therapy Australia (OTA) in close collaboration with the occupational therapy community. Australia’s over 30,000 occupational therapists are key providers of therapy and other supports, working across mainstream health and education programs as well as state, territory and Commonwealth-funded programs for children experiencing developmental delay and disability. We particularly acknowledge the work of our NDIS National Reference Group, our Expert Advisory Group for Early Childhood Foundational Supports, as well as individual members that have provided advice and input.

The intention of this paper is to provide practical guidance for all governments as they design and deliver an expanded system of early childhood and early childhood intervention services for children and young people with developmental delay and disability. The document proposes a series of actions that should be undertaken in the short and medium term to ensure a safe and effective transition to a new support system that continues to prioritise access to high quality occupational therapy.

That new system should comprise:

1. An inclusive and responsive mainstream system of education-based supports in both early childhood education and care (ECEC) and school settings that delivers consistent access to occupational therapy mainstream supports in all states and territories.

2. A new system of foundational supports that provides general supports such as information and peer support guided by qualified and experienced early childhood professionals, and targeted interventions by occupational therapists and other appropriately qualified early childhood professionals.

3. A strong National Disability Insurance Scheme (NDIS) that remains accessible to the children and families that need more intensive and individualised early intervention and ongoing supports.

While this document emphasises and provides expert advice on the role of occupational therapists in early childhood intervention, OTA recognises that best practice involves a multidisciplinary team of allied health professionals and educators working in close collaboration. Recommendations about the inclusion of occupational therapists across mainstream and foundational support programs should not be seen as excluding or diminishing the important role of other early childhood professions.

This document is intended to build on, respond to, and complement current government frameworks, strategies, reviews and policy documents to provide the concrete guidance needed to support the development of new and updated policies and programs for early childhood services.

These include:

• Consultation and Desktop Review Reports – Review of Best Practice in Early Childhood Intervention
• The Commonwealth Early Years Strategy 2024-2034
• The National Children’s Education and Care Workforce Strategy 2022-2031
• Improving Outcomes for All: The Report of the Independent Expert Panel’s Review to Inform a Better and Fairer Education System (Department of Education, 2023)
• The Department of Social Services (DSS) General Supports Consultation Paper

• The DSS Foundational Supports for children with developmental delay or disability, families, carers and kin Consultation Paper
• The National Autism Strategy 2025-2031 and First Action Plan
• National Roadmap to Improve the Health and Mental Health of Autistic People 2025–2035 (Department of Health, Disability and Ageing, 2025)
• The National Framework for assessing children’s functional strengths and supports needs in Australia
• NDIS Independent Review Final Report and supplementary analysis

OTA particularly notes the importance of the NDIS Review recommendations and the DSS-funded Best Practice Framework for Early Childhood Intervention project in guiding future early childhood practice and service design. The NDIS Review recommended (Final Report, Action 6.5) that early intervention supports are based on best practice principles and the Commonwealth has indicated its intention to support that recommendation by requiring future early childhood services funded by government to build upon this policy foundation. While the framework is not yet finalised, OTA has drawn on all available reports including the consultation reports and desktop review, and our participation in the consultation processes to develop our proposed actions in close alignment with this policy framework. This document will be updated as needed when further guidance becomes available from governments about the disability reform roadmap.

Principles, concepts, and practices underpinning best practice early childhood intervention for children and young people with developmental delay or disability

OTA commends the Australian government for commissioning a formal review of best practice in early childhood intervention and developing a Best Practice Framework. The importance of an agreed policy framework based on the advice and input of experts in the field, and extensive input from children and families, cannot be understated.

Current early childhood practice under the NDIS allows supports or services based on models or approaches that may not best meet the needs of the child and their family. Services may also be delivered by professionals without the necessary capabilities, scope of practice and experience to deliver effective early childhood interventions. Key worker and transdisciplinary approaches are often referenced as best practice without considering the experience and qualifications required to successfully implement these approaches or whether they meet the needs of the child and family. For example, high quality evidence clearly shows that children with brain injuries are best supported by a highly skilled, multidisciplinary team of allied health clinicians. OTA recognises the need to recalibrate what is funded and how, based on the most up-to-date evidence and the input of children and families, professionals such as occupational therapists, and the broader early childhood sector.

There is also a clear need to better define the skills and experience required for effective and safe early childhood practice and for governments to establish mechanisms to ensure these requirements are met by service providers. OTA has undertaken extensive work to develop a paediatric capability frameworki that provides an important foundation for establishing how and when paediatric occupational therapists can work in paediatric practice. OTA continues to modify this as new best practice evidence becomes available, ensuring the profession is supported to deliver high-quality, contemporary supports. Similar quality standards must be developed and applied across other early childhood workforces to establish clear scopes of practice, disciplinary boundaries and areas of overlap, the training and experience needed for a discipline to practice in particular models of collaborative practice, and the ongoing support and development needed to protect consumers and practitioners.

When developing and implementing foundational support models, governments must draw on these standards and work with professional bodies to ensure professions are enabled to work within their full scope of practice. We note in this context the 2024 Unleashing the Potential of our Health Workforce - Scope of Practice Review identified a wide range of examples where government funding programs limited the scope of allied health and other professions with consequences for the cost and effectiveness of services.ii This should be linked into the workforce and commissioning actions recommended above (Immediate Action 3 and Short/Medium Term Action 8).

The evidence review and consultation findings emerging from the development of the best practice frameworkiii to date heavily endorse and support occupational therapy practice, referring extensively to evidence and examples from occupational therapy practice and the key principles that underpin the work of the profession. Occupational therapy practice is rooted in occupational models such as the Model of Human Occupation (MOHO)iv, the Person Environment Occupation (PEO)v model, and Canadian Model of Occupational Participation (CanMOP)vi. These models emphasise the important need to understand the child, their environment (physical, sensory, social, cultural, relational environments), and their occupations, with occupations representing everyday activities and routines. Occupational therapists draw on these models to work with children and families to develop collaborative goals, develop contextualised interventions that fit into the child’s everyday environments, and ensure that areas of developmental

need are practiced and reinforced where they are needed most. This approach and focus is unique to occupational therapy practice and training.

While the candidate principles and practices in the January 2025 Review Reportvii developed by the Best Practice Framework consortium align directly with the work of occupational therapists, OTA notes that there are key areas that require additional clarification and guidance:

1. Workforce requirements – guidance is needed to define the skills and scope required for different intervention types and roles, with consideration of professional practice frameworks, professional development and quality requirements for all early childhood professions, and the association of evidence-based models with particular professions.

2. Collaborative practice models – clearer guidance is needed to support decisions about when to apply models such as key worker or lead practitioner models, based on the needs of the child and family. Those approaches should be understood as service delivery models supported by a multidisciplinary team rather than stand-alone roles or separate professional positions. Clear and detailed decision-making tools should be developed to guide families and providers, which outline the skills and knowledge required to work within these models, and the environmental and broader contextual factors that must be considered when applying them.

3. Early identification and assessment services – there is an urgent need to define and implement an integrated approach to early identification and assessment of children and young people across early childhood settings and funding programs. This must include defined roles for the different early childhood professions that recognise their scopes of practice and skills. This approach should minimise duplication, recognise the role of multidisciplinary assessments, and enable streamlined access to the most appropriate disability services and funding programs.

4. Natural or everyday settings – clearer guidance is needed about the role of natural settings, and the importance of focusing activities and outcomes on their relevance to natural settings rather than mandating intervention in non-clinical settings when this potentially contradicts best practice approaches and the individual needs of children and families.

5. Dosage – establishing clearer guidelines to support evidence-based decision-making processes about the frequency, duration and intensity of services based on different areas of developmental delay and disability, allowing for consideration of child, family, and environmental factors.

Each of these key areas is outlined in more detail below with key takeaways and considerations for policy makers identified.

Workforce requirements

The early childhood workforce consists of a broad range of professions with varying levels of training, scope, experience, and regulatory requirements. These qualifications range from Australian Qualifications Framework (AQF) 3 and 4 certificate or diploma level training for the majority of Early Childhood Education and Care workforceviii to allied health professions such as occupational therapy with training at AQF 7 (bachelor’s degree) or higher. A key division in early childhood workforces is between those with clearly defined scopes, competencies, and discipline boundaries (a key foundation for transdisciplinary practice), as well as clearly defined capabilities and experiential or training requirements associated with paediatric and early childhood practice, and those without.

Educators are a key workforce in early childhood but may have little specific training or experience in developmental delay and disability. Parents and other caregivers are rightly recognised as an important informal workforce in early

childhood but there is a need to recognise the different levels of capacity that parents and caregivers may have, including differences in home, educational, financial and relationship contexts that may impact their role in supporting developmental outcomes.

Current work being undertaken on behalf of government to develop frameworks and resources to guide early childhood practice has so far avoided reference to specific workforces or professions when describing evidence-based approaches and providing guidance. This has the consequence of positioning specific tools, approaches, or models as the basis for outcomes rather than recognising the role of the skills, training, and experience of the person using the tool or approach. As well as undermining the role, skills and experience of occupational therapists who have often led development of new models and approaches, this creates risks for children and families. If governments are to provide a framework for more effective, consistent and high-quality early childhood intervention, guidance needs to cover both the tools and approaches, and the workforce needs associated with those. We note that in other areas of clinical and medical practice, intervention types or approaches cannot be separated from the specific professional credentials and capabilities required to deliver them.

In practice, those differences can be subtle but impact longer term outcomes significantly. An example of how occupational therapy practice better supports long-term capacity building can be seen in the different possible approaches to addressing the risk of a child’s absconding behaviour. Where a profession with less specific training and expertise may implement mechanical solutions such as approved child locks, alarms or harnesses, an occupational therapist will seek to assess and understand the child’s needs that are reflected in these behaviours. They will then develop supports in conjunction with the child, their caregivers and family, adapting environments and activities where indicated, and developing the capacity of the child and caregivers, drawing on neurodevelopmental and relational approaches. Both approaches may create the same short-term outcome, but the mechanical approach masks the issue, while the occupational therapist’s deeper understanding of the child’s individual needs and how they are reflected in these behaviours not only minimises behaviour and risk but also enables the positive developmental outcomes and capacity building needed for long-term change.

OTA also argues that all early childhood workforces must be subject to minimum standards associated with experience and ongoing development of early childhood knowledge and expertise. These requirements apply particularly when early childhood professionals step into transdisciplinary roles such as key worker or lead practitioner roles. OTA recognises that despite the rigorous nature of occupational therapy training, and that early childhood practice is within the standard scope of all occupational therapists, there is a need to support ongoing development of knowledge, skills and capabilities associated with high quality practice. The previously mentioned OTA paediatric capability framework has been developed for that purpose, guiding occupational therapists and those that may employ them to understand the capabilities they require, and how to develop those capabilities at different levels of career progression. The profession considers the use of this framework an important foundation for practice and argues strongly that similar capability standards and quality frameworks are needed across other early childhood professions.

We note the evidence review undertaken to support the development of the Best Practice Framework specifically states that in order to support the ‘…implementation of evidence-based strategies and best practice, on-the-job support, coaching, and continuous learning strategies are needed.’ix

Key takeaways:

1. Understanding one’s own scope of practice and professional boundaries is an essential foundation for transdisciplinary and collaborative practice. This is especially relevant when core professional training does not involve training in these areas or multidisciplinary practice.

2. Tools and models that may be identified as best practice and evidence-based have been developed by particular professions in particular settings and with particular levels of experience and professional capabilities. It is not possible to separate the outcomes and evidence from those foundations. Yet role substitution is occurring regularly where funders, employers and those delivering services are making decisions based on the availability or cost of a workforce rather than with an understanding of the capabilities needed to deliver services.

3. All professions working in early childhood should be supported by clear and appropriate quality frameworks and be subject to minimum skill and capability requirements. These should also be used to support employers and those delivering early childhood programs to recruit appropriately and put in place appropriate service delivery and workforce development structures.

Collaborative practice

Collaborative, child- and family-centred practice is recognised as an important foundation for helping children and young people to thrive. Evidence shows that families benefit from professionals working together and empowering families to understand their child’s developmental characteristics and their own role in supporting the child’s development. Collaboration is as a key component of occupational therapy training and practice and the profession must be recognised as a leader in this area.

Where parents or caregivers can act as active partners, parent coaching and relationship focussed interventions are well-established by evidence and a core component of occupational therapy practice. Occupational Performance Coaching (OPC) is an example of an approach commonly used by the profession that draws on both family- and occupation centred approaches and a focus on collaboration and parent-initiated solution finding.x xi Evidence also shows that occupational therapists are skilled at drawing on other areas such as sensory-based approaches as part of parental coaching.xii xiii Caregiver roles, including those of educators or childcare staff in ECEC or school settings, can often enhance their knowledge and practice through coaching, such as that provided by occupational therapists. There is evidence to show that coaching provided by occupational therapists to childcare providers enhances early childhood mental wellness by equipping providers with essential skills in responsive caregiving to facilitate adult and child coregulation and trauma-informed interactions. xiv

OTA was pleased to see that initial consultation documents from DSS outlining a potential targeted foundational supports model noted the potential need for extra support where children have concerns across several developmental areas.xv We welcomed the recognition that this role would involve a focus on the family, including capacity building and emotional support to facilitate parental and caregiver wellbeing. Parents can only influence positive developmental outcomes for their child when they are also supported appropriately. However, we are concerned about the lack of specificity about the model of service delivery for children and families with more complex needs as well as the lack of reference to the qualifications of the workforce providing that support. It is our strong view that minimum capabilities in key areas such as developmental science, relationship-based approaches, reflective practice and parent engagement are essential. The description provided by DSS also fails to account for multidisciplinary ‘team around the child’ allied health teams that are needed when a child requires support across multiple developmental domains. There is a clear need to better define how and when collaborative models should be applied, and the skills and experience needed to effect early childhood intervention outcomes.

Models of collaborative practice

Key worker models, based around concepts of transdisciplinary practice and collaboration, are often referred to by early childhood providers as best practice and may be seen as a default method of providing early childhood services. However, there is evidence to suggest that current models do not align with the evidence that underpins a lead practitioner approach. Providers may not understand when and how to implement key worker models based on the needs and preferences of the child and family, and staff working in key worker roles may lack the scope, training and professional characteristics to work effectively in transdisciplinary key worker roles or equivalent roles. Perhaps most critically, key worker models may be offered as independent services rather than as part of a team. While solo practitioners with the necessary skills, scope and experience can work as lead practitioners, the funding and delivery model must support collaboration with a child’s multidisciplinary team.

The Desktop Review of Best Practice in Early Childhood Intervention noted the scarcity of vigorous research about collaborative practice.xvi The report states ‘none of the included RCTs examined outcomes of collaborative teamwork, or specific team-based approaches (e.g., interdisciplinary, key worker, team-around-the-child models), and this remains a gap in the evidence… while collaboration and team-based approaches to supporting children and families are understood to be an element of best practice, the success of implementation and outcomes of specific models of collaboration did not appear to be a key focus of the included studies and could be an area which requires further examination’. Given this gap in evidence, key worker approaches cannot be categorised as best practice.

In some areas of early childhood intervention, such as for children with brain injuries and cerebral palsy, there is no evidence supporting key worker models. Instead, there is very strong evidence from randomised control trials for specialised occupational therapy.xvii xviii Transdisciplinary key workers have reported workplace issues due to the complex and high family needs they encounter, including having inadequate time to fully support each family, the lack of a clearly defined role and its boundaries, recognised gaps in knowledge and skills, and the systemic lack of information and accessibility to other support services for families.xix

Evidence also suggest that those working in key worker roles may not be confident working outside of their professional boundaries.xx Where transdisciplinary practice works more effectively, it is typically associated with a strong understanding of the worker’s own discipline, support from peers in other disciplines, and an alignment between the worker’s disciplinary background and the child’s needs.xxi Key workers should always be working in close collaboration with the relevant professions and have extensive experience working alongside other professions. Collaborative models should be based around lead practitioner approaches where a practitioner from within a multidisciplinary team takes on a lead role based on the key needs and priorities of the child and family, and their own skills and experience. Those in lead roles must collaborate with the broader team through regular case reviews and discussion about the effectiveness of interventions, progress in achieving outcomes, and changes in child or family needs.

Key takeaways:

1. There is a strong evidence base showing that occupational therapists have expertise in building family and caregiver capacity to support children and young people with developmental delay or disability. This expertise must be recognised in new and expanded models.

2. Some children and families will benefit from a lead practitioner (or key worker) approach. From an OTA perspective, the term lead practitioner, and the model that underpins it, is considered more appropriate due to its better alignment with evidence-based practice. We were pleased to see the use of lead practitioner by the NDIS Review team and note that the two terms are not necessarily interchangeable. The decision to use any model of this sort should be based on:

   a. Consideration of the child and family’s needs and capacity, noting that lead practitioner models will generally be more appropriate when multiple domains of developmental delay are identified or where there may be a particular focus on family support. For many children and families with less complex needs and single domain developmental issues, a single profession such as an occupational therapist, speech pathologist or physiotherapist delivering targeted therapeutic interventions aimed at areas such as improving fine motor skills, managing behaviours or sensory processing issues, or developing communication skills is preferred by families and most appropriate.

   b. Assessments and consideration of family need and capacity by a multidisciplinary team that consider the role of transdisciplinary models and the team member with the most relevant professional background to act as the lead practitioner. The lead practitioner approach should be a response to a specific need identified in conjunction with children and families, generally where a higher level of complexity and multiple domains of developmental need or disability are identified.

   c. An understanding that lead practitioner roles cannot be standalone roles but must instead be situated within multidisciplinary teams with ongoing access to input from the other members of that team.

   d. Understanding of the need to address parental mental wellbeing. While a lead practitioner should have the necessary foundation in mental health and wellbeing needed to recognise mental health needs and provide some support, there may be a need to recognise more focused mental health interventions as a separate area of support that parents and caregivers may need to be referred to.

Early identification and assessment

Early identification of developmental delay and disability has been clearly established in evidence and in policy reviews, frameworks and strategies as a foundation for maximising outcomes for children and families. Early identification of developmental delays is critical for optimising outcomes, as the brain exhibits heightened neuroplasticity during early childhood, making this period a crucial window for intervention.xxii For some areas of disability such as cerebral palsy, early identification has been shown as critical in order to allow interventions at a stage when the brain is most capable of adapting, improving outcomes across the lifespan.xxiii Early intervention is also crucial to supporting relationship development and secure attachments between children and those around them, leading to better outcomes across a range of domains such as health, education, social cohesion and justice.xxiv

The Early Childhood Targeted Action Plan, which forms part of the implementation of Australia’s Disability Strategy 2021-2031 identified the need to enable ‘early identification of disability or developmental concerns and develop clearer pathways and timely access to appropriate supports.’xxv The NDIS Review also acknowledged the need to improve capacity, recommending the establishment of universal health checks in mainstream services working with children including both health and education.

Some states and territories have commenced programs with examples including the New South Wales Health and Department of Education partnership to deliver the Brighter Beginnings program in ECEC settings across all NSW Health local health districts.xxvi This program is providing a 4-year-old health and development screening program to check progress across a range of domains. Despite positives, there are several issues with the current approach. Senior early childhood practitioners have noted that, at least in some areas, checks are being carried out by early career staff with limited knowledge and experience, who are spending too little time with children and with ECEC staff, leading to potential misdiagnosis and over-referral. This causes stress for families and places additional demand on services without increasing outcomes.

As the Desktop Review of Early Childhood Evidencexxvii notes ‘Improved screening is desirable both because it offers opportunities for intervention at earlier ages and because it can drive innovation and new knowledge. However, knowing how to intervene effectively with very young children is challenging – they are at their most developmentally plastic stage and their disabilities are still in a relatively undifferentiated state and have not yet evolved into a more distinct form for which proven interventions exist.’xxviii

Consideration of how and when to increase access to early identification supports will need to focus on periods of development where the child may have limited exposure to health professionals. Practitioners note significant gaps in identification services for children aged between 18 months and 4 years due to the lack of mandated developmental checks during the period as well as decreasing take-up of childhood immunisation appointment opportunities, and reductions in nurse check-ins. Mainstream health services are likely to be the key point of contact for families during this period but consideration of how to provide access to occupational therapy and allied health assessments to formalise understanding of developmental needs and support families to make decisions about accessing supports is needed.

New approaches should also carefully consider how access to ECEC settings can be increased and how ECEC and school educators can be supported to build capacity to identify potential concerns. Occupational therapists employed in mainstream education settings are ideally placed to support educators in this role as well as to provide more formal assessment once potential delays are identified so that informed decision making about potential support needs and interventions can take place. Further information about occupational therapy roles in mainstream services is provided in the section on mainstream settings below. This includes examples of existing programs that draw on occupational therapists in mainstream settings.

The South Australian 2023 Royal Commission into Early Education and Care recognised the importance of families receiving supports via integrated service hubs where multiple services including occupational therapy and other allied health are co-located and work collaboratively. An example of this is the Department for Education (SA) Children’s Centres for Early Childhood and Parenting. South Australia will also be the first Australian state to introduce 30 hours of 3-year-old preschool from 2026, recognising that there are “a growing number of children who are developmentally vulnerable in families from all walks of life in South Australia, so traditional targeting of particular cohorts for assistance will not reach every child who needs it.” The Royal Commission also proposed expanding the existing definition of preschool beyond a program of teacher-led learning to the following:

• “Each individual child receives a learning entitlement (including any adjustments required) from an early childhood teacher operating with support from allied health and other professionals as required.

• There is early identification of a child’s developmental needs on site … and organised pathways to funded interventions, including providing those on site as appropriate.

• There are organised pathways to broader parental and community supports, including those provided on site as appropriate.”xxix

A key strength of this program will be that it provides not only access to early identification and assessment but also access to allied health and other supports to support the child in that setting.

Approaches like this that increase access to occupational therapy and allied health support to identify and accommodate different needs provide an example of potential ways to improve services for children across mainstream settings.

Key takeaways:

• Occupational therapists are experts in early identification and assessment and must be recognised as a key workforce in the delivery of new and expanded early identification and assessment pathways.

• Early identification and assessment is a key foundation for early intervention and should be enabled throughout the early years of a child’s development.

• Early intervention and assessment needs to be a priority focus across a wide range of settings, particularly mainstream settings. For this to occur, early childhood educators, teachers, and maternal and child health nurses, need the skills and knowledge to monitor for potential signs of developmental delay or disability and have access to more specialised occupational therapy expertise to support verification and assessment. Occupational therapists and allied health professionals should play a key role in supporting the development of tools and training as well as referral pathways.

• Referral pathways need to be available and funded across government and private sector services to avoid a return to the bottlenecks and lengthy waitlists that have too often compromised timely access to early intervention.

• Knowledge and experience is essential for those supporting early screening and assessment to avoid over-diagnosis as well as to avoid missing subtle or nuanced indicators of potential delay or disability.

• Identification and assessment must occur in collaboration with families, educators and others, and ideally in multiple natural settings.

• Assessment processes should be evidence informed. The Autism CRC’s National Guideline for the Assessment and Diagnosis of Autism in Australiaxxx provides clear guidance for policymakers. OTA endorses the Autism CRC’s national assessment framework as the foundation for further development of identification and assessment pathways.

• Assessment processes should integrate seamlessly with different tiers of new and existing disability services, reducing the need for duplicated assessment.

Natural and everyday settings

Natural settings (also referred to as everyday settings) are the settings in which children and young people live and interact with their families and peers. Where children and young people experience developmental delay or disability, their ability to participate in activities within those settings is impacted.

Occupational therapy practice prioritises natural settings when designing and delivering interventions and setting outcome goals. Occupational therapists work with children and families in their everyday environments to embed capacity building approaches into daily routines, relationships, and environments. Distributed practice models embed supports and interventions within natural settings so that they can be carried on outside of therapy sessions with practitioners and are an evidence-based approach frequently used by practitioners. Occupational therapists also focus on considering and addressing familial and cultural factors, observing and assessing everyday environments and activities, developing and implementing environmental modifications and task adaptations, and building therapeutic approaches into daily routines.

While occupational therapy practice is heavily based on the delivery of services in natural settings, the profession has significant concerns about potentially mandating service delivery in natural settings as inferred by the DSS consultation paper on targeted foundational supports.xxxi For children with physical disabilities such as cerebral palsy, or for children with significant sensory-motor based difficulties, clinicians require access to specialist equipment, intentionally designed settings, and standardised assessment kits that cannot just be made available in home or school settings, especially in the early stages of therapy. Many standardised developmental assessments require not only training, but also precise application and the use of particular resources. Using these in some environments can compromise the standardisation of assessment criteria. Mandating natural settings for these client groups would adversely impact practice and outcomes.

Occupational therapists have also noted that while a home, school, or ECEC settings may be considered a natural setting, interventions may actually occur in a way that negates the benefit of that natural setting. For example, if services are delivered in separate rooms and through activities that aren’t part of the child’s normal routines and activities, then they may not achieve the outcomes associated with natural setting-focused approaches. Education settings may also be either inaccessible to practitioners providing supports, or inappropriate for particular interventions due to the disruption for the child and their peers. Some state and territory education departments or providers have implemented blanket bans on external therapists entering their sites in response to concerns about disruption to the delivery of educational programs, even if access to employed therapists may be limited. Others impose costs on practitioners seeking to deliver services in the form of a fee. While this may reflect real world challenges for education providers, it does not result in better outcomes for children and families.

Importantly, for education settings to be a safe and effective space for interventions, consideration must be given to how state and territory education programs can ensure appropriate staffing ratios within centres and schools that support educators to engage with the needs of children and young people with developmental delay. Educators must be supported to engage with, and be supported by, occupational therapists whether they are working within mainstream roles or delivering developmental supports to children and families outside of schools. Improving collaboration between educators and those delivering interventions in both mainstream and foundational roles is crucial to improving outcomes in natural settings. The focused section below on mainstream supports provides an overview of the role of education-based occupational therapists and how they can support outcomes in education settings as well as reduce the load on educators.

We note in this context that parents are also increasingly in full-time employment which can limit opportunities for practitioners to engage in vital face-to-face parent collaboration. Providing essential supports just where children live and not engaging directly with the family does not achieve the benefits of interventions focused on natural settings. Home environments for some children may also be unsafe or have factors that make it difficult for the child or young person to meaningfully engage in early intervention approaches.

As a final note, OTA argues that best practice approaches may not always align with the real-world challenges associated with delivering services sustainably. Prioritising service delivery in natural settings is important where appropriate but needs to consider the cost implications and impact on service availability if early childhood practitioners are required to travel to deliver services in natural settings. Controlled environments such as those in clinics can allow strategies and tools to be trialled more quickly than if they are delivered in natural settings. In a metropolitan environment, in-clinic capacity is significantly higher than when services are provided in-home due to the time required to travel to, and set up a space, with commensurate increases in costs for the family. This is exacerbated further still when looking at rural and remote settings where a combination of clinic settings (requiring the family to travel), and tele-support, have been shown to provide the most effective outcomes and increase options and supports for families.

Given these factors, it is impossible to determine a blanket approach that will ensure optimal outcomes for all providers and all children, and their families. To avoid an ineffective and arbitrary approach, governments must provide decision-making frameworks to support early childhood providers, children and families to decide collaboratively on the most appropriate settings in which to deliver supports and interventions for their specific situations. OTA notes that the March consultation update from the team leading work on the development of the Best Practice Framework for Early Childhood Intervention recognises the need for flexibility around where services are delivered.xxxii

Key takeaways:

1. Occupational therapists use and value home-based supports, routines and prescribed programs as well as education-based programs, recognising these as a key means of supporting developmental outcomes.

2. The decision to use natural settings needs to be based on their role in achieving outcomes rather than as a mandated setting for service.

3. Decisions about how and where to situate services should be based on the individual needs of the child and their family, as well as the appropriateness and accessibility of ECEC and school settings.

4. Funding programs should consider the cost of providing services in natural settings and balance the importance of funding travel to allow appropriate home- or community-based care as well as considering the range of intervention models available to provide cost-effective and sustainable services.

5. Achieving outcomes in ECEC and school settings requires appropriately trained and resourced educators, supported by occupational therapists in mainstream roles. Those mainstream occupational therapists and educators need to be authorised and supported to engage with foundational supports delivered through the health and disability sector to ensure that interventions and supports are developed and implemented collaboratively and consistently across all natural settings where children live, learn and play.

Dosage (or frequency and intensity of supports)

The decision about how to resource a new system of foundational supports will be critical to determining the extent to which they can meet the needs of children and families and reduce demand on the NDIS. Governments will need to make careful decisions about the level of resourcing provided for targeted foundational supports in order to ensure that children and families can access occupational therapy and other allied health supports outside of the NDIS and realise opportunities for early intervention aimed at maximising outcomes and reducing the longer-term impacts of developmental delay.

While governments have yet to release information about the about the likely levels of funding available to families, consultation undertaken on behalf of DSS late in 2024 indicated that targeted supports for this cohort would comprise low intensity or periodic allied health services. Where a child has greater complexity, the consultation paper suggests that the model of service would involve additional coordination support in what appears to be a key worker model with no suggestion that access to allied health services would scale with higher levels of need. The proposals appear to displace well-established and effective approaches such as team around the child models, evidence of the need for key worker models to be integrated into multidisciplinary teams, and evidence for the need for comprehensive and targeted early intervention delivered by skilled and experienced occupational therapists to positively affect developmental trajectory. They also ignore evidence that limiting access to low intensity supports can impact developmental outcomes.xxxiii

OTA has welcomed consultation discussions in relation to dosage as part of the development of the Best Practice Framework for Early Childhood. Determining appropriate resourcing for foundational support programs that enable evidence-based practice and appropriate dosage levels for early childhood programs is highly complex and will need to balance available evidence, budgetary considerations and the goal of establishing genuine alternatives to the NDIS.

Some evidence is available to guide governments. Examples of evidence include previous work to develop guidelines for frequency of servicesxxxiv, current evidence for children with cerebral palsyxxxv xxxvi, and guidance for collaborative, parent or care led occupational therapy home programsxxxvii. We note that work undertaken as part of the desktop review supporting the best practice project provides guidance about a wide range of existing early childhood intervention programs including the dosage of services. However, this will need to be balanced against a recognition that dosage decisions in existing and previous programs have too often been based on funding parameters and the accessibility of services rather than best practice. For example, practitioners in rural and remote areas or geographic settings where services are limited may reduce dosage to better manage wait lists. Similarly, a program may arbitrarily prescribe a set number of hours for a client or a maximum period of time during which services can be provided that does not align with individual need. Subsequent consultation undertaken as part of the development of the Frameworkxxxviii identified the issue of service systems or models inappropriately guiding dosage and the need for funding programs to recognise the dynamic nature of dosage decisions due to changing needs, priorities and circumstances of children and families.

It is imperative that funding levels recognise that more intensive interventions based on higher dosages of services will be required by many children and families. Providers should have flexibility in the level of funding available for targeted foundational supports, and the ability to align service dosage with the needs of more and less complex presentations. The development of tools to help guide providers and families when making decisions about the frequency, intensity and duration of early childhood supports is welcomed but will need funding to be flexible enough to align with need.

In making decisions about dosage, consideration must be given to the importance of therapeutic alliances in supporting therapeutic outcomes. While there are a range of factors contributing to the quality of the therapeutic

alliance, establishing a trusting relationship requires time and consistent engagement with the person, in turn requiring sufficient funding to support regular engagement over an extended period of time.xxxix A range of family factors may also impact how and for how long supports are provided and will need to be identified by dosage tools and in foundational support funding. The overall complexity of a child’s needs is impacted not only by their own presentation and needs, but also family factors such as domestic and family violence or child protection issues, custody arrangements, unstable housing, or where caregivers are impacted by their own disability or mental ill-health or that of the child’s siblings.

Key takeaways:

1. Low-intensity and periodic supports provided by occupational therapists and other allied health professionals will not meet the dosage needs of many children and families needing support outside of the NDIS.

2. Decisions about dosage and frequency of supports delivered by occupational therapists and other allied health professionals across foundational supports and other programs must draw on contemporary evidence of what is most likely to achieve outcomes for children and support clinical decision-making about the volume of support needed to effect change.

3. Occupational therapy and allied health services are a crucial component of all targeted foundational supports for children, particularly where there are multiple developmental domains of concern or higher levels of need, but funding must scale with need to ensure appropriate levels of service at appropriate dosage levels can be delivered.

4. Funding for occupational therapy services must support not only direct work with children and families, but also capacity-building with educators or other formal caregivers, assessment and program development, and collaborative work with lead practitioners or key workers.

5. Family factors that increase the complexity of overall support needs must be considered when making decisions about funding models outside of the NDIS.

Occupational therapy roles and service delivery models across mainstream and foundational supports for children and young people with developmental delay and disability

A reformed disability system that increases access for all children and young people with developmental delay or disability, and supports their families and caregivers, will only succeed if there is investment in consistent, integrated, and appropriately funded models of early childhood intervention across mainstream, foundational and NDIS supports. New models underpinning programs outside the NDIS must continue to recognise the role and value of occupational therapists within early childhood programs. The guidance below is intended to support governments as they design and establish supports outside the NDIS.

While this document focuses on mainstream and foundational supports, the role of occupational therapy within the NDIS must continue to be recognised and funded. Similarly, access to NDIS funding must continue to be available to children and families whose needs are more complex than those that can be accommodated by a future foundational support system. Occupational therapists provide high-quality, individualised supports for children and families with complex needs and will need to continue doing so even as NDIS and other disability reforms are implemented. Occupational therapists play a vital role as providers of individualised assessment, planning, coordination and therapeutic support services for children and young people across NDIS-funded early childhood intervention programs and for NDIS participants.

Mainstream education supports

The NDIS Review clearly established the need for more inclusive and accessible mainstream services for children and young people with disability within ECEC and school settings. Being able to access mainstream services is a human right under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) but many people with disability still face major obstacles to participating in mainstream education programs due to a lack of available supports. Occupational therapists engaged as part of the development of this paper provided multiple examples of families who were home schooling their children due to the inadequacy of supports within schools as well as children and young people who were failing to achieve educational outcomes due to inadequate accommodation of their needs.

Despite those barriers, mainstream education settings are common to almost all children, including those with developmental delay and disability. As such, mainstream settings should not only be made more inclusive but also recognised for their role in supporting early identification of developmental delay and disability, and as a setting in which children and young people can be supported to achieve developmental outcomes. xl

Occupational therapists are well established in many mainstream education settings and there is significant capacity to build more consistent access to occupational therapists across jurisdictions and settings. Occupational therapists work successfully within education departments at a strategic level, as therapists employed by education programs to provide in-reach support to ECEC and school services, and as part of ECEC and school teams. Occupational therapy training and practice is highly relevant to mainstream education settings, thanks to training and experience in community approaches that translate well into mainstream education settings. Many occupational therapy theoretical models can be interpreted through both an individual and community lens.xli The Community-Centred Practice Framework outlines how occupational therapists can work at the community level to address issues and barriers and create goals and strategies that benefit all children in those settings. xlii

Current occupational therapy roles in mainstream education settings

While occupational therapists are well-represented in many mainstream settings, service structures and capacity vary greatly between states and territories. Queensland has a well-established model where occupational therapists are employed in therapy teams within a school region to deliver supports focused access and participation in learning and school activities. Unfortunately, capacity issues can mean that therapists are working across many schools with significant waitlists, which results in a focus on assessment and report-writing and limited opportunities for support and intervention. South Australia (SA) has several programs that employ occupational therapists to work in different school settings. These include occupational therapy roles in 33 statewide children’s centres, who support children aged between 0 and school age (5-6). The focus is on building the capacity of families, children’s centre staff, and other service providers to enrich developmental outcomes for children and address key areas of risk and disadvantage.

SA also has a statewide Self-Regulation Service, which provides preschools and schools with professional learning and coaching support for educators as well more intensive services to develop support strategies as part of a team around the child approach. SA schools can purchase occupational therapy services through the Student Support Service’s School Buy-In Service and employ occupational therapists as mental health practitioners within the School Mental Health Service in secondary schools.

Victorian department of education programs fund occupational therapy roles in Student Support Services as well as in mental health roles. Employment of occupational therapists in specialist schools and by private schools is also common. Other jurisdictions such as Western Australia, may have no occupational therapists employed within the Departments of Education and have only a few occupational therapists employed directly by individual schools.

These examples show the wide variation in the state and territory occupational therapy programs for children. A focus on increasing consistency of access and making programs more widely available nationally and across jurisdictions is critical. There is emerging evidence from current mainstream education programs that embedding occupational therapists within education systems leads to positive outcomes and is required to support children with developmental delay and disability. We note in this context that mainstream occupational therapy roles, such as those in early childhood and school settings or in departments of education, are complementary to the roles of occupational therapists and early childhood services outside of those settings. Mainstream occupational therapy may have a different scope, which predominantly focuses on system-based or whole-of-site supports and supporting educators and staff rather than working directly with children or families. Access to occupational therapy and other supports across both mainstream and foundational or NDIS support systems are not duplicative but rather different areas of focus. This is because children and families need appropriately focused and situated supports across multiple systems and settings to thrive.

Importantly, both mainstream education services and those provided outside them whether through foundational supports, the NDIS or other programs need to coordinate more effectively to ensure more consistent and integrated supports for children and young people.

Multi-tiered approaches

Structuring mainstream education services delivered by occupational therapists and other allied health professional may be most effective using a multi-tiered approach. These approaches are a well-established means of promoting

inclusion and participation in early childhood settings and research. A common approach involves three tiers of support: tier 1 – universal supports; tier 2 – targeted supports; and, tier 3 – specialised and/or intensive supports.

In Victoria for example, tier 2 supports may include professional learning for school-based staff, funding education and other workforces to support inclusive education and, supporting the purchase of resources and equipment. Tier 3 supports are available where a student has severe limited functional capacity and requires extensive adjustments to facilitate specialised approaches, such as differentiated teaching and support to manage behaviour regulation and safety.

Occupational therapists already work in many mainstream settings at all three tiers of support though approaches vary widely across Australian states and territories. Inconsistency across the states and territories, and within different programs, impacts the availability of supports for inclusion as well as the role of occupational therapists in supporting early identification and assessment. The most effective approaches involve occupational therapists working across multiple tiers, providing opportunities to build systemic capacity and effect broader changes while also working to address the individual needs of a child and their educators and caregivers.

Occupational therapy roles are needed in all states and territories at all three tiers, but we note that there is likely to be overlap between tier 3 supports and supports that are funded as targeted foundational supports or as NDIS supports. Any future models should be informed by a co-design process with mainstream educators and occupational therapists in both education and community roles to ensure that new approaches and models facilitate collaboration between educators, education-based occupational therapists, and those delivering early childhood interventions outside of education settings. Increasing the confidence and capacity of education systems to support children with a variety of needs will allow for external community-based providers to focus their support on other complementary goals and, over time, enable positive outcomes across a range of key domains and areas.

When developing a more inclusive mainstream system that draws on the skills of occupational therapists to support early childhood staff, educators, and children, and works alongside a new system of general and targeted foundational supports, governments must consider ways in which different employment, contracting, and commissioned service models can enable participation by a skilled workforce, which requires careful consideration of how to also harness the expertise of private practice occupational therapists. There are clear examples of current programs that allow private providers to be contracted in or to be part of provider panels that allow experienced providers with local knowledge and experience to support mainstream education providers. This approach can be particularly beneficial in rural and remote settings where there may not be sufficient demand for mainstream services to support employment of an occupational therapist.

Occupational therapists are currently underutilised in many mainstream education settings, but the current reform agenda provides an important opportunity to address that. Appendix A provides additional guidance about the roles and activities that occupational therapists in mainstream settings may undertake and OTA encourages governments to work with OTA and the sector to build more inclusive education systems.

Key takeaways

1. Expansion and reform of mainstream education services for children and young people with disability provides an opportunity for more inclusive settings that provide better outcomes for children.

2. Occupational therapists have an important and demonstrated role in mainstream education that should be expanded in jurisdictions and settings with no access to occupational therapists to ensure greater national consistency.

3. Occupational therapy roles in mainstream education settings are a crucial support for educators and the inclusiveness of those mainstream settings for children and young people with developmental delay and disability, providing education, support and guidance to educators and supporting environmental and task adaptations.

4. Appropriate therapeutic input in mainstream education settings can reduce educator workloads allowing them to work more effectively with all students and improving educational outcomes.

5. Mainstream education-based occupational therapy supports, and the supports provided by occupational therapists and other early childhood professionals funded by the NDIS or as part of foundational supports are complementary and should work collaboratively to maximise outcomes for children and families.

Foundational Supports for children and young people with developmental delay and disability

Occupational therapists are well recognised as a key workforce in early childhood practice, providing family-centred supports within the NDIS, in other disability programs, and across general paediatric practice. This role and experience across multiple systems means that occupational therapists are well placed to support both general and targeted foundational supports.

Family-centred practice is a well-established and accepted framework for working with children with developmental delays and disabilities and acknowledges that effective care not only focuses on the cause of the stressor but also identifies and builds on the family strengths to support family functioning.xliii General foundational supports will need to draw on this evidence base to support parental capacity building focused on embedding supports into daily routines and settings while also supporting parent and caregiver wellbeing. Family-centred practice that builds family capacity draws heavily on the specific skills and training of occupational therapists to achieve outcomes and occupational therapists should be recognised as a key workforce. Capacity building approaches can support parents, as well as educators in ECEC or school settings and staff in community services and locations such as libraries and playgroups. An example of the role of occupational therapists in supporting education and early identification is the Medical Research Future Fund (MRFF) Good Start in Life for Young Children research project undertaken by the University of Canberra, which showed the value of allied health education and support across a range of programs in Canberra.xliv

Peer support approaches can play an important role in supporting family-centred practice, providing an important complement to general information and referral support. Peer groups have been shown to support wellbeing in parents and caregivers, as well as helping to build capacity for parents in relation to supporting their children’s needs and longer-term developmental outcomes. While evidence is still varied about how programs should be structuredxlv, research also shows that peer support approaches can deliver lasting impact.xlvi

While peer support programs are based around peer leadership, occupational therapists have a long history of supporting the development of peer support programs, leading research into their effectiveness and role, and providing practical support for peer groups. For example, an occupational therapist might support peer group leaders to develop group leadership and facilitation skills, as well as providing direct support such as education to a group of parents in established peer-led groups in areas such as understanding sensory processing differences, supporting play skills, development of secure attachments, and understanding of children’s needs that may lead to behaviours of concern.

Targeted foundational supports for many children and their families will involve focused therapeutic interventions across one or more developmental domains. These interventions will need to be delivered by an appropriately skilled occupational therapy and allied health workforce, resourced to provide an appropriate level of support based on the needs of children and families. Evidence of current changes to how the NDIA is determining NDIS eligibility suggests that a proportion of children and young people with relatively complex needs will not receive NDIS support and will instead rely on targeted foundational supports from a team of allied health professionals. In some cases, this may best involve a team around the child approach, in others a lead practitioner approach will be more appropriate. However, crucial to both is that funding will support the multidisciplinary team to collaborate and deliver supports to the child and family in the way that best suits their goals, capacity, and overall needs.

Importantly, these supports will not be one-off or episodic for many children and young people accessing supports. Instead, funding decisions will need to draw on evidence and clinical guidance about appropriate dosage and provide flexible funding approaches that recognise the significant variation in support needs that different children and families will have. The workforce delivering foundational supports must be subject to quality standards that ensure appropriate levels of experience and knowledge, that they are working within their scope of practice, and that development and support for less experienced staff is provided by all providers.

A more detailed overview of the roles of occupational therapists across general and foundational supports is provided in Appendix B and OTA strongly encourages all governments to consider the roles and outline provided. We also encourage governments to engage with OTA and the occupational therapy workforce as new foundational support programs are established.

Key takeaways:

1. Occupational therapists and other allied health professionals will need to be involved in early identification and tiered, multidisciplinary assessments that support access to programs and supports, as well as the design and delivery of those supports.

2. New early childhood intervention service models will need to allow for a range of different employment and contracting models, in order to account for the differences in how individual states and territories, as well as rural and regional localities, will establish and consolidate an ecosystem of early childhood supports, and to ensure that the high proportion of the workforce with the necessary skills and experience now situated within private provider organisations remains accessible to children and families.

3. Coordination of services will be key and will require a commitment to support collaboration between different providers and services working across different funding programs and settings. Funding must be available across all programs to support collaboration and coordination and must be flexible enough to accommodate for different combinations of service delivery —funding individual coordination roles will not create collaboration without also enabling participation by all providers.

4. Access barriers that limit access to occupational therapists in early childhood settings such as early childhood education and care settings, as well as schools, are reducing opportunities to realise developmental outcomes. Access to occupational therapists based in mainstream settings and supported to work collaboratively with community-based occupational therapists delivering foundational supports should be considered best practice but models in some areas such as rural and remote settings may need to enable access to community-based occupational therapists that can provide mainstream system and staff-focused interventions as well as supports focused on the child or young person.

Conclusion

The current disability support reform agenda presents a critical opportunity for governments to create a more inclusive, integrated, and evidence-based system of early childhood supports. This document has outlined practical steps for government to take to ensure that disability reforms and the establishment of new programs and systems meet the needs of, and achieve outcomes for, children and young people with developmental delay and disability. Recognition of the essential role and expertise of occupational therapists in early identification, assessment, intervention, and capacity building must be at the centre of these reforms.

Achieving better outcomes will require a coordinated approach across all levels of government that includes much-needed policy alignment, adequate and flexible funding models, rigorous establishment of workforce requirements and standards, and a strengthened focus on enabling collaborative practice across systems and settings. Governments must ensure transitional arrangements prevent service gaps, draw on the expertise of the existing occupational therapy workforce, and implement workforce and service quality standards that reflect best practice. Without these measures, the system risks failing the very children it is intended to support.

Governments must also recognise that foundational supports cannot be delivered without also considering how to strengthen mainstream education and other supports. Occupational therapists have a critical role within both foundational supports and within mainstream programs and are a crucial support for more inclusive mainstream education programs.

Finally, governments must acknowledge and address the changes that have occurred in our disability system since the establishment of the NDIS. The shift to a market model based on choice and control has had many positive outcomes that should be acknowledged and retained in a new and evolved system of supports. Foundational support programs and service models must have the capacity and flexibility to address varying levels of individual need and to draw on the expertise and experience of private occupational therapy early childhood providers.

By committing to the actions and principles outlined in this advice, governments can uphold their promise to deliver a more accessible, responsive, and outcome-focused early childhood support system—one that empowers children and families, supports long-term development, and sustains a capable, collaborative, and high-quality service eco-system.

Appendix A: Roles and approaches for occupational therapists in mainstream education programs

The list below provides examples of the different areas that occupational therapists can achieve outcomes to support children and educators in mainstream education settings. This list should be considered as examples of key areas of current practice rather than a complete list. Additional guidance is available from OTA about occupational therapy roles in schools and education settings.

1. Tier 1: Employment of occupational therapists by departments of education to provide strategic guidance to state and territory education programs aimed at improving inclusion and access across education programs.

2. Tier 1: Employment and contracting of occupational therapists by departments of education to provide ongoing access within schools. The focus areas for these practitioners would include:

   a. Conduct school access audits which may consider environmental sensory demands (e.g. lighting, noise, classroom set up) and physical barriers (e.g. stairs, furniture selection, playground equipment)

   b. Design and deliver professional development for staff on topics such as self-regulation, relationship-based and trauma-informed developmental and learning approaches, motor development

   c. Contribute to whole school reviews of student inclusion policy

3. Tier 1: Employment or contracting of occupational therapists by departments of health or social services to provide support to mainstream services such as those delivered by councils for children and young people to:

   a. Assess and adapt environments to make them more accessible to children and young people with developmental delay or disability.

   b. Adapt tasks and activities offered by mainstream library, playgroup, or other programs for children with developmental delay or disability in conjunction with program staff.

4. Tier 2: Employment and contracting of occupational therapists by ECEC providers, schools and education systems to support occupational therapists to:

   a. Work with children and educators to assess needs, modify environments and adapt tasks to support the participation of all children in school environments

   b. Provide professional learning for educators and staff in areas such as Responsive Caregiving in order to improve understanding of attachment theory and trauma-informed support

   c. Develop and deliver group programs to address specific skill areas such as fine motor programs, handwriting intervention or social skills programs

   d. Support participation in school excursions and camps by collaboratively planning with student, school and family.

5. Tier 3: Employment and contracting of occupational therapists by ECEC providers, schools and education systems to:

a. Deliver targeted, one on one interventions that address more complex needs within education settings. Occupational therapists operating at tier 3 are likely to work closely with a multidisciplinary team of educators and supports outside of the school setting.

b. Design individual student programs to support development in an identified area of need e.g. to improve recording of schoolwork or to increase independence in organising belongings.

c. Identify and recommend environmental modifications or accommodations to ensure buildings, outdoor areas, and specific areas such as bathrooms are accessible and safe and support the use of assistive technology and specialist equipment such as seating, hoists and transfer equipment.

d. Support transition to new schools and classrooms through environmental assessment and recommendations to meet individual needs.

Appendix B: Occupational therapy roles in general and foundational supports

General foundational supports

Current descriptions of general foundational supports exclude the well-established role of occupational therapists shown in contemporary evidence and case studies. This oversight will detrimentally impact on the efficacy of general foundational support. The following roles for the profession under general foundational supports must be retained and expanded:

1. Occupational therapists are involved in co-design of resources for families, alongside consumer representatives and other allied health professions. These resources should support people with disability to access high quality information and advice and make decisions about their lives (Actions 1.3 and 5.4 from the NDIS Review).

2. Occupational therapists are employed or contracted to assist with the development and running of peer group activities such as playgroups, parent groups and equivalent, supporting the development of capacity within the group and providing advice and guidance on general approaches to supporting the needs of children.

3. Occupational therapists are employed or contracted to provide navigation services, particularly where Specialist Navigation services (Action 4.2 from the NDIS Review) are required. Navigation supports will need to sit within the NDIS but should also form part of general foundational supports for those that are not eligible for NDIS funding. Access to navigation should be available on referral from the NDIA, from an educator or health professional, as well as through self-referral.

• Occupational therapists are employed or contracted to provide assessments as part of an integrated multidisciplinary assessment model that identifies support needs and establishes eligibility and access to mainstream, foundational and NDIS supports. This should include supporting playgroups and other ECEC programs through training to develop capacity in areas such as early identification.

• Occupational therapists are employed to support the development and delivery of parent and peer programs, providing guidance and support around key skills such as group facilitation and assisting to provide group education.

Targeted foundational supports

Occupational therapists have been recognised as providers of targeted foundational supports in early descriptions provided by the Commonwealth. Occupational therapy practice is closely aligned with the principles and practices described in evidence reviews and draft proposals for the Best Practice Framework for Early Childhood Intervention. However, there is still little detail about how targeted supports will be developed and implemented and how access to occupational therapy will be prioritised.

OTA notes the following roles must be retained and expanded to align with evidence and need:

1. Occupational therapists are funded to provide more comprehensive developmental needs assessments and to work with children and families to identify domains of developmental and support need. This would likely occur after referral from a navigator or equivalent role and after initial assessment by an occupational therapist or other qualified early childhood professional has identified the need for targeted foundational.

2. Occupational therapists work with children and families to identify goals, discuss recommended approaches to supporting the child’s development. Determining suitable interventions involves considering settings, parental roles, the most appropriate team and model of support, and appropriate dosage based on the child’s needs and family’s capacity.

3. Where single domain support needs can be delivered by an occupational therapist or other allied health professional, those supports are funded at a level that ensures dosage aligns with evidence and family need. Outcomes of interventions should be measured and reported against.

4. Where assessment identifies the need to address multiple developmental domains, the occupational therapist is funded to work as part of a multidisciplinary team. The occupational therapist may working within a team around the child model, as a lead practitioner working in close collaboration with other allied health professionals, or as a support for a lead practitioner providing guidance to plan therapeutic interventions, assess progress and adjust approaches based on child and family needs.

5. The occupational therapist, working in the above roles, also works with caregivers and educators in ECEC or school settings, or with occupational therapists in those settings, to collaborate on the development and delivery of developmental programs and adaptation of environments and activities to support inclusion in the environment, developmental progression and ability to engage in social participation.

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