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SUBMISSION TO THE HOUSE STANDING COMMITTEE ON HEALTH, AGED CARE AND DISABILITY INQUIRY INTO THE THRIVING KIDS INITIATIVE
Triple P International Pty Ltd (TPI) welcomes the opportunity to provide this submission to the House Standing Committee on Health, Aged Care and Disability’s Inquiry into the Thriving Kids initiative. The Triple P - Positive Parenting Program® (Triple P) is one of the most effective and well-known parenting support programs in the world. Developed at the University of Queensland, TPI has an exclusive licence to disseminate Triple P worldwide. The Australian Government through the Department of Health, Disability and Ageing provides accessible support to all parents and carers of children in Australia through the Parenting Education and Support Program (PESP), which provides free access to Triple P’s suite of online parenting support programs. More than half a million families in Australia have accessed support through this initiative since it began in 2022. For the purpose of this submission, the term ‘parents’ refers to parents and other caregivers. TPI would be happy to appear before the committee to address any part of our submission or provide further information or support to the inquiry.
Triple P Contact Information contact@triplep.net
SUBMISSION OVERVIEW
Parents are the most influential teachers and role models for their children- and it is within the context of the family that children develop. Parenting is crucial to a child’s development, health, wellbeing and indeed early childhood, adolescent and lifetime outcomes. Early supports, such as evidence-based parenting programs, that assist families and guide them to address child socioemotional and developmental concerns, can be vital to improved outcomes for both children and their families.
The Triple P - Positive Parenting Program® (Triple P) is one of the most effective and well-known parenting support programs in the world. Triple P’s range of programs give parents and families simple, practical strategies to build strong, healthy relationships, confidently manage children’s behaviour and prevent problems from developing.
More than 870 trials, studies and published papers have shown Triple P is effective across cultures, socioeconomic groups and in many different family structures. This includes 207 randomised controlled trials, 432 evaluations, and 169 reviews including Triple P programs.
Ranked by the United Nations as the world’s most extensively researched parenting program 1, more than 1,940 different researchers from over 593 institutions in 43 countries have been involved globally in Triple P research and publications. A range of Triple P resources have been translated into over 20 languages.
The World Health Organisation reports that Triple P is one of only two programs with the strongest evidence-base demonstrating a parenting program’s ability to prevent child maltreatment 2.
A recent Australian report on Childhood Adversity and Mental Health named Triple P as one of only two programs to be given a “very high” evidence rating in review of 26 interventions designed to prevent or reduce the negative effects of Adverse Childhood Experiences (ACEs 3). The report concluded that Triple P is “effective across different settings including schools, community-settings or households” and “there is evidence of cost-effectiveness at reducing child behavioural and emotional problems and promoting effective parenting.” (Page 103).
Developed by experts and practitioners at the Parenting and Family Support Centre at the University of Queensland, Triple P has been researched and rigorously evaluated for over 40 years. Triple P includes a suite of evidence-based programs designed to support families, from light-touch parenting support to intensive interventions for varying challenges, including targeted support for families of children with developmental disability or delay (Stepping Stones Triple P). Stepping Stones Triple P is more than just parenting advice. Stepping Stones Triple P is a suite of interventions of increasing intensity, developed and rigorously evaluated by a team of clinical psychologists specifically designed to support parents of children with development disabilities or delay. More than 11,000 practitioners across 35 countries have been trained to deliver Stepping Stones, providing support to over 75,000 families worldwide.
From 2012 to 2017, The National Health and Medical Research Council (NHMRC) funded a large rollout of Stepping Stones Triple P in New South Wales, Victoria and Queensland. The project delivered training to practitioners working with children with developmental disabilities.
However, the trial coincided with the establishment of the NDIS and the gradual decline/loss of State support programs. Despite demand for training exceeding available supply, and promising outcomes from practitioners and families, the trial was not continued or expanded to ongoing and more widespread implementation and availability to families.
Stepping Stones Triple P Online (SSTPOL) was added to Triple P’s suite of programs available under the Australian Government’s Parenting Education and Support Program (PESP) at the end of last year. Since then, more than 12,000 families have accessed the program and benefited from this free support.
Across all programs included in the PESP, which providers universal access to Triple P’s online programs to all parents and carers in Australia, parents report significant improvement in their parenting self-efficacy (confidence) in responding to their children’s behavioural and emotional difficulties. In SSTPOL, they also report statistically significant reductions in family challenges related to their child’s learning and development, behaviours and in their family’s adjustment, stress and coping.
Importantly, families from diverse cultures and backgrounds are registering for PESP at rates relative to their proportion of the population, while vulnerable and at-risk groups are registering at rates, similar to, or above those observed in the general population.
TPI’s marketing and communications helps to ensure programs each and are accessible to all families nationwide.
The Australian and State Governments can also leverage the availability of SSTPOL’s trusted support and advice by communicating its availability to families through government agencies and promoting its availability through a range of sectors such as education and maternal and child health, allied health providers, and other child development services.
TPI recommends parents self-refer or are referred to SSTPOL by their child’s health or disability practitioner when they identify or suspect developmental delays or neurodivergence. It can also be utilised by families waiting for clinical services or as an adjunct to in-person services.
Program access is currently funded under the PESP, and with ongoing governmental support can form a central support pillar within a Thriving Kids model. The Australian and State Governments should also consider implementing the model proven though the NHMRC trial, to provide workforce training to practitioners in practitioner-delivered Stepping Stones Triple P programs.
As the Australian and State Governments now negotiate to establish foundational supports outside the NDIS for families with children with developmental disability or delay - TPI urges the committee that it recommend Stepping Stones Triple P practitioner training and online programs should form part of those supports.
The quality of support provided early in life has a direct impact on the amount of care and support a person with developmental disabilities will require in adolescence and adulthood.
A lack of clarity around the availability of parenting support services means that fewer families are offered and accessing evidence based parenting support and the substantive benefits that support provides to children and their parents 4.
Parenting programs for families of children with developmental disability, including autism, can save more than they cost in the long-term, in large part due to parents having increased capacity to return to the workforce 5 and reductions in child emotional and behavioural challenges 10,11 .
RECOMMENDATIONS
TPI’s recommends the following is considered as part of the Thriving Kids initiative framework:
- Stepping Stones Triple P Online is promoted through the Thriving Kids initiative as an accessible, flexible universal early intervention for all families in Australia with concerns related to the child’s development
- Fund practitioner training for a multi-disciplinary workforce across services for children with developmental disability or delay, to support and enhance knowledge, parent consultation skills and confidence, collaborative practice, neuro-affirming care.
- Ensure equity of access via proportionate universalism and public health approach to support, including through universal screening, culturally responsive care, offering light touch through to targeted auxiliary support as needed.
- Reduce the bottleneck preventing early intervention due to delayed assessment and diagnosis, by offering services based on family and child functional needs, thereby helping to prevent the development of greater challenges. This could be through the utilisation of and referral into programs like SSTPOL where there is identified or suspected developmental delays or neurodivergence .
RESPONSE TO THE TERMS OF REFERENCE
TOR 1: EXAMINE EVIDENCE-BASED INFORMATION AND RESOURCES THAT COULD ASSIST PARENTS TO IDENTIFY IF THEIR CHILD HAS MILD TO MODERATE DEVELOPMENT DELAY, AND SUPPORT PARENTS TO PROVIDE SUPPORT TO THESE CHILDREN.
PARENTS FACE CHALLENGES ACCESSING EVIDENCE-BASED RESOURCES AND DIAGNOSTIC SERVICES
Australian families with concerns about their child’s development can spend years waiting for their child’s first assessment and diagnosis, during which families often require ongoing, multidisciplinary support 6.
Developmental screening and support for children at risk of developmental delay are most effective in the first three years of life 7,8. However, many children with developmental delay or additional needs are not identified before beginning school, missing important opportunities for early intervention. Understanding the barriers to screening and intervention to increase access and improve referral pathways is crucial.
Parents commonly identify developmental concerns when their child is around two to three years of age, however the average age of diagnosis for children with developmental disability or delay is between five to seven years old 6,9,10. Providing support for parents to acquire the extra parenting skills to increase their understanding of their developing child’s unique needs, offers a key critical point of intervention, and beneficial family support.
Families accessing both publicly and privately funded developmental and diagnostic services wait on average two to three years for diagnosis 6,9,10.
In 2024, 1 in 5 Australian children started school with undiagnosed health and development needs, an increase from 1 in 10 in 2009 11.
When developmental delays are detected later in a child’s life or go undetected, children can experience behavioural, emotional, and social problems, learning difficulties and functional impairment 12.
Among families accessing services through the Children’s Hospital Westmead in Sydney, only 46.6% of children had received assessment by aged five — despite 80% of parents having concerns about their child’s development at that age 6.
Access to early intervention supports plays a crucial role in identifying developmental needs at an earlier age, and early identification can enhance the effectiveness supports provided to families.
Families engaged with allied health supports for their child are more likely to have identified developmental concerns and accessed diagnostic assessment at a younger child age and were more likely to access diagnostic assessment overall 13.
One Australian study found that children whose parents had accessed support services in early childhood were 1.9 times more likely to receive a diagnostic assessment by 5 years old 13.
Australian parents face significant challenges during the process of getting a diagnosis for their child, including a lack of evidence-based information and support whilst on long waitlists 14.
This lack of support negatively impacts their mental health and wellbeing, as they lack the necessary guidance to best understand and respond to their child’s behaviour 14.
Research suggests that approaches to care should use a clinical staging approach, where supports are provided on functional needs without the need for diagnosis, reducing pressures to provide diagnosis while still delivering appropriate services 10.
EQUIPPING PARENTS WITH THE RIGHT TOOLS TO SUPPORT CHILDREN
The quality of support received early in life influences the amount of care and support a person with developmental disability or delay will require in adolescence and adulthood.
Parents and caregivers face unique challenges when raising a child with developmental disability, including navigating social difficulties, delayed adaptive behaviour and additional support needs, financial stress, limited social support, and increased need for specialised services 15.
Children and adolescents with disability report high rates of comorbid mental and physical health issues 16 and insufficient access to necessary support services 17. Parents and caregivers commonly identify high stress around parenting 18, high levels of depression and anxiety 19, low relationship satisfaction 20, and increased use of dysfunctional parenting practices 21.
Research with Australian parents accessing the specialist services for their neurodivergent children suggests that parenting skills and parent wellbeing should be priorities for support 22.
Parents identify needing support to better understand their child’s behavioural cues, model self-regulation, engage in co-regulation, developing child independence, responding to child behaviour and strengthening the parent-child relationship 22.
Evidence-based parenting interventions equip caregivers with valuable skills, tools and strategies to better understand and respond to their child’s needs 23. These can help parents to negotiate the challenges and complexities of raising a child with development disability or delay.
Evidence-based parenting programs can provide parents with support, education, and practical strategies to manage stress and enhance their own well-being 24. By improving parental self-care and reducing parental stress levels, parents can better cope with the demands of parenting a child with additional needs, leading to a more positive family environment 25.
Providing evidence-based parenting supports during the critical periods of development can positively influence prosocial child development (including child social, emotional and physical wellbeing) 26, by supporting changes in the family environment related to the development of children’s behaviour and capabilities 23.
Parent access to support and resources should not depend on identification of level of support need or formal diagnosis. Universal, trusted support and resources should be promoted and available to families at any point the parent has concerns.
Parents must also know that support is available. Promotion through government and non-government channels is critical to ensure that resources are reaching families in need.
Guiding families to create structured and consistent routines within the home environment can promote a sense of predictability and security for the child, positively impacting their behaviour and wellbeing. Supporting ongoing development, encompassing social communication, language, emotional and behavioural regulation, cognitive, and adaptive skills, aids in addressing specific challenges and fostering growth 23.
Evidence-based parenting support must be at the core of early developmental screening and intervention which aims to improve and promote the wellbeing of children and families in Australia.
TOR 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.
Parents of children with developmental delay or disability report experiencing significant stigma and negative stereotypes within their communities, leading to feelings of isolation and disengagement from social activities 14. In one Australian survey, 25% of the participating parents did not feel part of a community and reported withdrawing from public interactions to avoid judgment about their child’s behaviour 14.
Expanding opportunities for children with disability and their families to be meaningfully involved in their communities is essential. Embedding appropriate supports within familiar community spaces, such as childcare, schools and community health centres, can help increase service visibility, normalise access to these supports, and create environments wherein families can share experiences and build relationships.
Parents of children with developmental disability identify diverse support preferences, including accessible support groups, parent education and financial assistance 14. They emphasise the importance of connecting with other parents to share experiences, practical support to respond to challenging child behaviours, and education to the broader community to reduce stigma and create a more receptive social environment for their child 14.
In Australia, families of children with developmental disability access a range of multi-disciplinary supports across healthcare and educational settings, including primary care professionals, speech and language therapy, occupational therapy, social skills training, developmental approaches and tailored educational supports 27.
A high proportion of families accessing publicly funded services for child’s assessment and diagnosis report that behavioural therapists and psychologists are their most desired, but inaccessible, child supports - due to long waitlists, high cost and limited knowledge of available supports 13. Half of these parents also identified a preference for parenting support if it were available, with only 7% of parents having been able to access parenting support previously 13.
Government funding under the NDIS has expanded access to support for families but may not adequately reflect the scope of support parents require. Parents and caregivers receiving support under the NDIS received more services (one study reporting an increase of approximately 3 to 5 different services), but this support was limited to disability specific support services 13.
Family-focused interventions have been found to have a range of positive impacts for children with developmental disability, including autism, and their families. Research suggests that active parent involvement can strengthen the positive impacts for children to interventions delivered by practitioners or educators alone 27.
In a comprehensive meta-analysis of 150 studies evaluating early intervention programs for autistic children under six years, programs which integrate behavioural strategies with developmental principles and emphasise caregiver involvement consistently produced positive outcomes in social communication and adaptive behaviour 28.
Importantly, the study highlighted that interventions involving parents or caregivers were especially effective, reinforcing the value of family-centred approaches in early autism support.
With respect to parenting programs, there are multiple potential entry points in the provision of early intervention and support:
- Perinatal period - introducing parents to evidence-based support.
- From birth to age five - at well-child health checks and in Early Childhood Education and Care/Schools - helping parents to identify developmental issues and seek advice and support.
- In services - as a waitlist intervention to provide families with support while they wait for targeted or intensive services, or as an intervention for families with existing complex needs.
STEPPING STONES TRIPLE P
There are a number of examples of evidence-based parenting interventions for children with developmental disability or delay available in Australia, such as Stepping Stones Triple P.
Stepping Stones Triple P forms part of the Triple P — Positive Parenting Program® system of evidence-based programs.
Stepping Stones Triple P is more than just parenting advice. It has been developed and rigorously evaluated by a team of clinical psychologists and is a targeted intervention designed to support parents of children with developmental disabilities or delay.
Stepping Stones Triple P aims to increase parenting skills and parenting confidence. Parents who access the program are empowered and supported with ideas to engage and encourage their child to develop functional adaptive skills that promote wellbeing.
Parents learn ways to help children self-regulate emotions and behaviours and to participate in home and community experiences.
Stepping Stones uses the Triple P multi-level framework that tailors information, advice and professional support to the needs of individual families.
All Stepping Stones programs can be adapted and built to reach either a targeted group or the whole parent population by providing varying intensities of support through a range of delivery formats (e.g. one-to-one, small group, large group, web-based, self-help).
Stepping Stones programs have been evaluated with families of children with a range of disabilities (e.g., autism spectrum disorders, developmental delay, intellectual disabilities, cerebral palsy) and high levels of behaviour challenges.
Studies evaluating Stepping Stones Triple P have demonstrated significant benefits for both parents and children across varying program intensities (e.g. Primary Care, Standard, Group, Triple P Online with Stepping Stones) 29, including:
- Reduction in child emotional and/or behavioural problems 29-32
- Reduction in the use of dysfunctional parenting practices 29-32
- Reduction in conflict between parents 29,30,32
- Improved parental confidence and satisfaction 30,32,33
- Reduction in parent stress 30,31
- Reduction in parent depression
- Improvement in the quality of family relationships 30,32,34
- Change in parental attributions of child behaviour.
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CASE STUDY 1: THE NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC) - IS STATEWIDE DELIVERY OF STEPPING STONES TRIPLE P EFFECTIVE?
Successful delivery of evidence-based parenting programs at scale has been previously demonstrated within an Australian context. An National Health and Medical Research Council-funded grant supported a large rollout of Stepping Stones Triple P in Queensland, New South Wales and Victoria (Australia), from 2012 to 2015 5.
Stepping Stones was chosen in part due to its strong evidence-base and flexibility, offering varied options for delivery (from a communications strategy to destigmatise parenting support, to large-scale seminars, group-based and one-to-one delivery).
This project delivered training to practitioners working with children with developmental disabilities across three states, with Stepping Stones programs being offered to families of children with developmental disabilities aged from 2 to 12 years, at no cost to the parent.
Researchers conducted a survey of over 1400 parents and 2500 practitioners, revealing high levels of mental health challenges, isolation, financial hardship and stress for parents. Responses indicated that their child’s emotional and behavioural difficulties were their biggest challenge in parenting
Nearly 3000 parents participated in a Stepping Stones programs, with the majority of parents being referred to Stepping Stones by a trusted practitioner, including teachers, early child workers, health professionals or disability support worker.
- Significant reduction in parent stress
- Significant improvement in quality of parenting
- Significant improvement in child behaviour
The evaluation found that parents who participated in a Stepping Stones program reported significant improvements in stress, the quality of their parenting, and their child’s behaviour. These improvements were maintained 12 months following program completion.
Other benefits of this community rollout included:
- Participation in Stepping Stones Triple P helped families financially as they were able to take less time off work.
- Organisations and professionals adopted the program enthusiastically.
- High demand for training, with more applications for training than available places. Those trained under the project came from education, early intervention, disability services and private practice.
- There was a relatively high level of participation—approximately 38% of the population targeted—compared with the 10% who have been shown to access expert help through usual clinical sources.
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CASE STUDY 2: STEPPING STONES TRIPLE P ONLINE PESP UPTAKE AND OUTCOMES
In December 2024, Stepping Stones Triple P Online was added to Triple P’s online suite of programs and made available to all parents and caregivers in Australia as part of the Australian Government’s Parenting Education and Support Program. Over 7000 parents registered for access within the first 6 months of availability. Of these parents, parents mostly commonly nominated Autism Spectrum Disorder (41.2%) and Attention Deficit/Hyperactivity Disorder (50.6%) as their child’s condition or diagnosis at registration. Just under 43% of all registrations nominated two or more conditions or diagnoses (n=3,015).
Internal evaluation of the program data across the first 6 months indicates that parents are benefiting from the skills and strategies provided in the program, with improved confidence in responding to children’s behavioural and emotional difficulties.
Significant increase in parental confidence in relation to child behaviour, family adjustment, and learning and development.
Significant decreases in how difficult parents found challenges related to behaviour, adjustment and learning and development.
When registering for access, parents tended to report low to moderate levels of confidence and also appraised the issues they experienced as very challenging. Following participation, parents experienced significant improvements in their confidence in their child’s learning and development, dealing with challenging behaviours and in their family’s adjustment, stress and coping.
At registration, parents were also asked to rate how challenging they found these issues. Challenges at registration tended to be rated towards the higher end of the scale, meaning that parents and carers viewed the issues as being very difficult and challenging. Following participation, parents reported statistically significant reductions in how challenging they found these issues.
Feedback from parents and carers in open comments highlighted several recurring themes. These include parents feeling calmer and more confident, having learned new parenting strategies, as well as enhanced communication, improved child behaviour and reductions in stress for both parents and children.
- Sole Parent of 3-year-old child, Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder
“Positive approach to parenting by complimenting what they did well, not what they didn’t do well. Staying calm and not reactive. Teaching and guiding rather than coaching from a distance.”
- Sole parent of 8-year-old child, Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder
“Was able to deescalate a situation that would usually result in a meltdown from my child.”
- First Nations kinship carer of 4-year-old child, Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder, Global Development Delay, and Fetal Alcohol Syndrome
“Not letting the behaviours take over the household. Using the plan to reflect and help was great.”
- Parent of 7-year-old child, Autism Spectrum Disorder, Global Developmental Delay, Speech and Communication Disorder and Sensory Disorder
“Getting down to his level and explaining what I want done and the consequences for not listening. Continue with the plan using all the skills I’ve learnt.”
TOR 3: IDENTIFY EQUITY AND INTERSECTIONAL ISSUES, IN PARTICULAR, CHILDREN WHO IDENTIFY AS FIRST NATIONS AND CULTURALLY AND LINGUISTICALLY DIVERSE.
All families should have access to resources that promote healthy early child development; however, a significant number of families are currently under-served due to a variety of factors. Vulnerable families such as those with low-income and living in rural areas are often limited in what they can access due to time, cost, transportation, and lack of social resources35. Research indicates that when parenting programs target under-served populations, outcomes are substantial and positive36.
Children from First Nations, culturally and linguistically diverse, low income, and rural backgrounds are all at increased risk of developmental vulnerability at school entry11. Children in very remote areas and from low-socio-economic backgrounds are twice as likely to be developmentally vulnerable than children in urban or high-income families37.
WORKING WITH CULTURALLY AND LINGUISTICALLY DIVERSE FAMILIES
Children from culturally and linguistically diverse backgrounds are more likely to be diagnosed with developmental disability, developmental delay or intellectual disability38. In spite of this, families are less likely to receive multi-disciplinary early support and more likely to need help to secure funding for services38. Research with diverse families highlights significant barriers to accessing support, including limited awareness of available services, language barriers, stigma around disability and help-seeking, and lack of options for culturally specific care39,40.
Parents report feeling like they lack control over the supports they receive and often rely on informal referrals within their communities to find appropriate services. Despite high levels of stigma, families are often proactive in seeking supports, reporting preferences for goal-oriented, intensive behavioural early interventions and additional supports for parent stress and wellbeing39,40.
THE NEED FOR HOLISTIC, TRAUMA-INFORMED SERVICES FOR ALL FAMILIES
Children and adolescents with developmental disability are at increased risk for experiencing multiple adverse childhood experiences (ACEs), with the most common factors being related to household dysfunction, poverty, and peer issues (including parental separation, parental mental health challenges and substance misuse, bullying, neglect)41,42, and are over-represented in out-of-home care43.
Many vulnerable families share common risk factors that disrupt parenting capacity, including limited ability to self-regulate their own behaviour and emotions and low self-efficacy. Poor self-regulation and low self-efficacy make parenting more challenging and stressful.
Parenting programs like Triple P help develop self-regulation in parents and children by teaching strategies that promote parental self-efficacy, self-management, personal agency, and problem-solving skills44,45. Building a parent’s ability to self-regulate decreases parental stress and depression, as well as children’s vulnerability to emotional and behavioural problems46. Higher parental self-efficacy is associated with lower parent distress, better coping and lower levels of stress, enabling parents to more effectively balance their parenting demands with their own wellbeing47,48.
WORKING WITH VULNERABLE COMMUNITIES
An approach that leverages existing community networks and provides professional development for practitioners working with target families can strengthen the capacity of organisations and staff to provide evidence-based, culturally responsive support and build trust with parents, caregivers and children.
Parents should have access to a range of programs, and choose the delivery format that suits them (online, face to face, etc). Triple P programs are designed to be delivered in a variety of ways, across sectors of parental engagement to promote availability to all parents who are seeking support. While the foundational messages and strategies are consistent, the ways in which parents experience the program is intended to match their own needs and goals. This flexibility and adaptability promotes skill development that is tailored to family needs, generalises across family environments and is responsive to child development.
WORKING WITH FIRST NATIONS FAMILIES
There are significant challenges in the diagnosis and support of First Nations children, including lower reported rates of diagnosis due to limited access to services49. First Nations families face many of the same barriers to service access as other Australian families, including confusion around funding schemes like the NDIS, compounded by racism, culturally inappropriate practices, and systemic disadvantage49,50. Initiatives in First Nations communities highlight the need for increased investment in training and retaining First Nations practitioners51.
Both parents and service providers working in First Nations communities advocate for culturally safe, community-led models of care, more transparency and flexibility from services, and greater Indigenous involvement in implementation and policy49,50.
Triple P’s self-regulatory model aligns with and supports self-determination for families and communities, with communities supported to determine the most appropriate programs, locations and practitioners. This approach was implemented in the Jandu Yani U (meaning ‘for all families’) program52,53. As part this project, practitioners and community leaders have been actively involved in the development of resources for parents using pictures and local dialect52.
Triple P International has also partnered with Cherbourg Regional Aboriginal & Islander Community Controlled Health Service (CRAICCHS) to implement the Dar’in Djanum (Strong Together)54 project.
The project was co-designed following extensive community consultations and a review of Cherbourg community protocols and co-facilitated by community staff. It uses a whole-of-community approach to promote family and child wellbeing. Positive outcomes for the community included overall high ratings of parent wellbeing as well as items associated with parent wellbeing such as school attendance and education.
Culturally-responsive delivery of Stepping Stones Triple P has also been well-received by First Nations families of children with developmental disability and additional needs, with interviewed parents reporting high program satisfaction and positive benefits to their parenting, wellbeing and child behaviour55.
Also included in the Triple P system is the Triple P for First Nations Families program. This program is responsive to Aboriginal and Torres Strait Islander peoples’ cultural values, traditions, needs and aspirations to reduce barriers53. Training for practitioners is delivered by a First Nations Triple P Trainer, or Triple P Trainer supported by First Nations Cultural Consultant, as per community preferences, which allows for an understanding of the past and present community context and culture53.
Throughout their training, Triple P practitioners discuss, observe, and rehearse a number of parent consultation skills attached to cultural competence, and introduced to various considerations or practices and are demonstrated appropriate communication skills and methods to facilitate trust and safety within the community.
Triple P research demonstrates that cultural adaptations of Triple P can significantly reduce the use of dysfunctional parenting practices and improve child behaviour53. Importantly, First Nations parents who have completed Triple P report feeling empowered to make changes in their family and community52.
Evaluation of Triple P for First Nations Families has also found that parents who have a positive experience when involved with the program experience reduced barriers to accessing mainstream services for individual assistance, for example with personal coping skills or mood management53.
TOR 4: IDENTIFY GAPS IN WORKFORCE SUPPORT AND TRAINING REQUIRED TO DELIVER THRIVING KIDS
A skilled workforce will be foundational to the success of the Thriving Kids program, one that can deliver these services in everyday settings - homes, schools, and communities - and ensure they are accessible and culturally safe for all families.
A study based on a Victorian cohort identified a number of barriers that impede early developmental screening and interventions. These include:
- Lack of available appointments.
- Time restraints to apply screening tests.
- Low knowledge and confidence using screening tools.
- Long wait times for referrals.
- Language and cultural differences56.
These barriers were also reflected in a pilot study to implement Parents’ Evaluation of Development Status (PEDS) screening tool in general practice (GP) in Victoria57. When interviewed GPs identified time restraints as the most common barrier57.
Key issues identified in the Review of Health Services for Children, Young People and Families Within the New South Wales (NSW) Health System58 included concern over waiting times for assessment and management of children with behaviour disorders, waiting times for developmental screening, and a shortage of allied health staff across local health departments.
General practitioners and other health professionals play an important role in identifying developmental disorders such as autism, yet their knowledge and confidence in providing this support varies widely across settings59,60.
One survey with Australian parents of autistic children found that they typically sought professional advice when their child was around 29 months of age, most commonly raising concerns with a general practitioner, paediatrician, or maternal and child health nurse61. Common responses to parental concerns included referrals to other professionals, acknowledgment of parental concerns, or to “wait and see” or “not to worry” about their child’s development61.
Professional response significantly predicted wait time for diagnosis, with referral at first professional contact predicting earlier diagnosis and being advised to “wait and see” significantly delaying diagnosis61.
Concerningly, a survey of Australian practitioners showed over 50% of practitioners reported having a preference for a “wait and watch” approach rather than diagnosis for children under three years old, despite parent concern62. Practitioners also reported reluctance to diagnose due to stigma, inability to see children earlier due to wait lists, and perceived limitations of assessment and diagnostic tools62.
Strengthening practitioner autism-specific knowledge, confidence and competence using screening tools, and referral pathways could better help early identification and multi-disciplinary care for families.
Current gaps in workforce support and training reflect a lack of available ongoing professional development, a need for programs which are responsive to the needs of their community (including options for flexible delivery and early intervention), and systematic barriers to multidisciplinary collaboration. These barriers can contribute to high practitioner stress, low confidence working with families and poor staff retention.
By leveraging existing community networks and providing professional development for practitioners working with diverse families, Triple P International aims to strengthen the capacity of organisations and staff to provide evidence-based, sustainable support and build trust with parents, caregivers and children.
Practitioners trained to deliver parenting support can be from a range of professions including social workers, teachers and teaching support staff, nurses, health support workers, family support practitioners, psychologists, counsellors, engaging families through common community access points like schools and health care.
A recently published large-scale evaluation63 examined changes in practitioner self-efficacy following participation in a Triple P training course. The study included a multidisciplinary sample of health, education and welfare practitioners (N=37,235) from 30 countries.
Practitioners of all disciplines reported significant improvements in their consultation skills self-efficacy, with improvements being the largest among allied professionals and medical personnel. Positive impacts to self-efficacy were also reported by practitioners who completed video-based training and accreditation63.
These results indicate that investing in workforce training and accreditation supports practitioners to confidently provide support to families as part of their routine service delivery.
TOR 5: DRAW ON DOMESTIC AND INTERNATIONAL POLICY EXPERIENCE AND BEST PRACTICE.
Government policy can have a powerful impact on families and services. Investing in policies, programs and initiatives is required to improve outcomes for families with more complex needs. Policy solutions should be based on existing evidence of what works, evaluated to ensure effectiveness, and sustained outside of government cycles to ensure both continuity of services for families and cost-effectiveness.
There are a number of important opportunities to strengthen policy and practice to better support autistic children and their families. While inclusion is the overarching goal of current approaches, families often encounter barriers that reflect deficit-based framing and fragmented service systems64,65.
Enhancing collaboration across sectors, shifting policy language to a neurodiversity-affirming lens, and ensuring targeted, culturally responsive supports will help improve outcomes for children with diverse needs64,65.
Support needs to be available in a variety of delivery modalities, including face-to-face individual and group programs as well as self-directed and/or online, and available at common community touchpoints (e.g. community health, early education, schools).
Waiting lists for developmental screening create considerable challenges for early intervention and treatment, and can negatively impact family functioning. To reduce bottlenecks in accessing early intervention services for developmental disabilities and delay, all families should have access to timely developmental screening and appropriate supports.
This requires a systematic approach, including increasing public and professional awareness of the varied ways in which developmental disorders can present. For professionals working with families, this needs to include increased awareness of children more at risk of developmental disability (such as those from diverse or vulnerable backgrounds) and culturally responsive assessment66,67.
There is a need for standardised assessment tools that are accessible, timely, flexible and appropriate for use with children from diverse backgrounds65.
Practitioners working in early childhood education and allied health services need training and support to effectively use standardised screening and diagnostic tools9. Initial evaluation for early intervention should also more frequently include appropriately trained mental health professionals and multi-disciplinary teams to identify social-emotional delays and challenges in the broader family system66,67.
It is important to increase access and referral to early intervention services on the basis of functional need, rather than tied to diagnosis.
Support services should align with the individual needs of families, prioritise services based on family preferences, and use ongoing evaluation to ensure that support needs are being met67.
An evaluation of delivery of evidence-based parenting programs shows that parents are typically referred by people they know (i.e. word of mouth) or by a professional68. Improving pathways and referral processes and providing funding for a trained workforce to deliver programs can assist in making sure all families know how to access the help they need.
Innovative solutions, such as the use of digital interventions like Stepping Stones Triple P Online, can be complementary to in-person services, reduce waiting times and support families experiencing challenges in a timely, evidence-based way.
TOR 6: IDENTIFY MECHANISMS THAT WOULD ALLOW A SEAMLESS TRANSITION THROUGH MAINSTREAM SYSTEMS FOR ALL CHILDREN WITH MILD TO MODERATE SUPPORT NEEDS
Families all around Australia interact with a range of multi-disciplinary supports across government, health care (GPs and primary care professionals, speech and language, occupational therapy, child and family health services), education (early childhood education and care services, schools), community and other organisations and services. This offers an opportunity to readily integrate parenting support into routine service provision.
From a public health perspective, integrating parenting programs into primary care services provides an important opportunity to offer parenting support as a part of stepped care strategy - engaging parents with varying support needs in a brief, low-level intervention with the option to refer to more intensive auxiliary treatment if required.
Families require the knowledge and skills to understand and navigate their support needs. This includes making informed decisions about evidence-based services that align with their needs, appraising service quality, advocating for desired services through a local area planner, and ultimately accessing those services4.
Strengthening parents’ ability to offer consistent support and fostering independence skills in their children is anticipated to contribute to addressing the lasting viability of evidence-based services4.
Australian and State Governments must work together to promote availability of services to families and to enhance availability of information around relevant referral pathways.
SCHOOL READINESS AND THE TRANSITION TO SCHOOL
Children with developmental disability are at increased risk of school refusal and academic disengagement, with bullying being a key influencing factor69. Children who are disengaged from school are increasingly vulnerable, being at higher risk of developing mental health issues, becoming socially isolated, and having poor academic outcomes70.
The transitions to school for children with developmental disability requires a coordinated, collaborative approach between parents, teachers and practitioners working with families. Practitioners working in early intervention, such as educators and allied health professionals, play a vital role in developing foundational skills, including communication, emotional and behavioural regulation and self-care, and in guiding parents through tailored transition planning71.
Research suggests that additional resources and training are needed to support educators to implement inclusive strategies and assist families, particularly those from culturally and linguistically diverse backgrounds71.
Stepping Stones Triple P is designed for practitioners in different sectors, including education settings to deliver parenting support as part of their professional practice. Providing evidence-based parenting programs like Stepping Stones Triple P programs in schools for parents of children with disability gives parents easy access to evidence-based support when and where they need it.
Stepping Stones has been found to be effective when delivered in schools, with educators reporting significant improvements in behavioural and emotional adjustment including less disruptive/antisocial behaviours, improved communication, reduced anxiety and enhanced social interactions72.
EXPANDING ACCESS WITH ONLINE PROGRAMS - THE PARENTING EDUCATION AND SUPPORT PROGRAM (PESP)
Making evidence-based programs available online means that families who may otherwise be unable to access a practitioner, such as those living in regional and remote locations, or those unable to access childcare and transport, are not denied access to effective supports.
At the end of 2022, supported by funding from the Australian Government Department of Health and Aged Care, the PESP commenced a nationwide rollout of the Triple P Online System (TPOS), giving all families with children under-12 across Australia access to free, online parenting support 24/7.
The PESP has provided evidence-based parenting support to more than 580,000 families around Australia to date.
Stepping Stones Triple P Online was added to Triple P’s suite of programs available under PESP at the end of last year. More than 12,000 families have now accessed the program.
Demographic data shows that a diverse range of families are benefitting from program access, including low-income families, single parents, First Nations parents and carers, regional and remote and those identifying as LGBTQIA+.
Raising awareness of the availability of this support at a national level is crucial to normalise and destigmatise participation. A national communications campaign, created by Triple P International as part of the PESP, has centred around the judgement-free normalisation of parenting programs. The campaign has demonstrated recall with 48% of parents nationally, including with diverse and remote groups.
June 2024 market research shows the campaign has decreased negative stigma associated with parenting programs since the campaign began. Parents agree that parenting programs are designed ‘for all families’, not just those experiencing challenges.
The PESP represents the first initiative of its kind around the world. By providing universal support to parents through the PESP to support their child’s mental health and wellbeing, the Australian Government is investing in enhancing parenting support, reducing stigma, and improving parental confidence in handling the challenging moments as they arise.
The PESP is providing immediately accessible, evidence-based support to families across Australia. This initiative should form part of a comprehensive suite of interventions and services as part of the Thriving Kids initiative. The PESP is currently funded until 30 June 2026. Future funding for the PESP is critical to ensure that the support provided through Stepping Stones TPOL and other Triple P online programs remain available to families.
The availability of digital supports should be complemented by additional workforce training and professional development for practitioners in programs that are responsive to community needs.
REFERENCES
1 United Nations Office on Drugs and Crime. (2009). Compilation of evidence-based family skills training programmes. https://www.unodc.org/documents/prevention/Family_Compilation_Update_2025.pdf 2 World Health Organisation. (2010). Violence prevention: The evidence - WHO violence prevention briefings. https://www.who.int/publications/i/item/violence-prevention-the-evidence 3 Sahle, B. W., Reavley, N. J., Morgan, A. J., Yap, M. B. H., Reupert, A., & Jorm, A. F. (2022). Delphi study to identify intervention priorities to prevent the occurrence and reduce the impact of adverse childhood experiences. Australian and New Zealand Journal of Psychiatry, 56(6), 686-694. https://doi.org/10.1177/00048674211025717 4 Mazzucchelli, T. G., Tonge, B. J., Brereton, A. V., Wade, C., Baird-Bate, K., & Dawe, S. (2023). The National Disability Insurance Scheme and parenting support for families of children with developmental disability: A need for policy reform. Australian & New Zealand Journal of Psychiatry, 0(0), 00048674231192369. https://doi.org/10.1177/00048674231192369 5 Einfeld, S., Sanders, M., Tonge, B. J., Gray, K. M., Sofronoff, K., & The MHYPEDD Team. (2018). Is statewide delivery of Stepping Stones Triple P effective? Research program findings at a glance. The University of Sydney. https://pfsc.psychology.uq.edu.au/files/2129/The%20Stepping%20Stones%20Triple%20P%20Research%20Project%20Report1.pdf 6 Boulton, K. A., Hodge, M. A., Jewell, A., Ong, N., Silove, N., & Guastella, A. J. (2023). Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: Findings from the Sydney Child Neurodevelopment Research Registry. BMJ Open, 13(2), e069500. https://doi.org/10.1136/bmjopen-2022-069500 7 Sheeran, L., Zhao, L., Buchanan, K., & Xenos, S. (2021). Enablers and barriers to identifying children at risk of developmental delay: A pilot study of Australian maternal and child health services. Maternal and Child Health Journal, 25(6), 967-979. https://doi.org/10.1007/s10995-020-03077-0 8 Whitehouse, A. J. O. (2017). Elizabeth Usher Memorial Lecture: Rethinking the clinical pathway for autism spectrum disorder and challenging the status quo. International Journal of Speech-Language Pathology, 19(3), 208-217. https://doi.org/10.1080/17549507.2016.1276963 9 Gibbs, V., Aldridge, F., Sburlati, E., Chandler, F., Smith, K., & Cheng, L. (2019). Missed opportunities: An investigation of pathways to autism diagnosis in Australia. Research in Autism Spectrum Disorders, 57, 55-62. https://doi.org/10.1016/j.rasd.2018.10.007 10 Knott, R., Mellahn, O. J., Tiego, J., Kallady, K., Brown, L. E., Coghill, D., Williams, K., Bellgrove, M. A., & Johnson, B. P. (2024). Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums. Australian & New Zealand Journal of Psychiatry, 58(2), 142-151. https://doi.org/10.1177/00048674231206997 11 Australian Government. (2025). Australian Early Development Census National Report 2024. Department for Education. https://www.aedc.gov.au/docs/default-source/default-document-library/aedc_national-report-2024_da7-409a37b9d-95ce-43e7-af00-51aa604cf0b3.pdf?sfvrsn=b56015ba_1 12 Whitehouse, A. J., Varcin, K. J., Pillar, S., Billingham, W., Alvares, G. A., Barbaro, J., Bent, C. A., Blenkley, D., Boutrus, M., & Chee, A. (2021). Effect of preemptive intervention on developmental outcomes among infants showing early signs of autism: A randomized clinical trial of outcomes to diagnosis. JAMA Pediatrics, 175(11), e213298-e213298. 13 Boulton, K. A., Hodge, A., Levu, K., Ong, N., Silove, N., & Guastella, A. J. (2024). Access and barriers to supports for children and caregivers attending public child developmental assessment services: Findings from the Sydney child neurodevelopment research registry. Autism Res, 17(3), 555-567. https://doi.org/10.1002/aur.3064 14 D’Arcy, E., Burnett, T., Capstick, E., Elder, C., Slee, O., Girdler, S., Scott, M., & Milbourn, B. (2024). The well-being and support needs of Australian caregivers of neurodiverse children. Journal of Autism and Developmental Disorders, 54(5), 1857-1869. https://doi.org/10.1007/s10803-023-05910-1 15 Smith, L. E., & Anderson, K. A. (2014). The roles and needs of families of adolescents with ASD. Remedial and Special Education, 35(2), 114-122. https://doi.org/10.1177/0741932513514616 16 Hoover, D. W., & Kaufman, J. (2018). Adverse childhood experiences in children with Autism Spectrum Disorder. Curr Opin Psychiatry, 31(2), 128-132. https://doi.org/10.1097/yco.0000000000000390 17 Masi, A., Mendoza Diaz, A., Tully, L., Azim, S. I., Woolfenden, S., Efron, D., & Eapen, V. (2021). Impact of the COVID-19 pandemic on the well-being of children with neurodevelopmental disabilities and their parents. Journal of Paediatrics and Child Health, 57(5), 631-636. https://doi.org/10.1111/jpc.15285 18 Patton, K. A., Ware, R., McPherson, L., Emerson, E., & Lennox, N. (2018). Parent-related stress of male and female carers of adolescents with intellectual disabilities and carers of children within the general population: A cross-sectional comparison. Journal of Applied Research in Intellectual Disabilities, 31(1), 51-61. https://doi.org/10.1111/jar.12292 19 Lanyi, J., Mannion, A., Chen, J. L., & Leader, G. (2022). Relationship between comorbid psychopathology in children and adolescents with Autism Spectrum Disorder and parental well-being. Developmental Neurorehabilitation, 25(3), 151-161. https://doi.org/10.1080/17518423.2021.1922529
20 Sim, A., Cordier, R., Vaz, S., & Falkmer, T. (2016). Relationship satisfaction in couples raising a child with autism spectrum disorder: A systematic review of the literature. Research in Autism Spectrum Disorders, 31, 30-52. https://doi.org/10.1016/j.rasd.2016.07.004 21 Hutchison, L., Feder, M., Abar, B., & Winsler, A. (2016). Relations between parenting stress, parenting style, and child executive functioning for children with ADHD or Autism. Journal of Child and Family Studies, 25(12), 3644-3656. https://doi.org/10.1007/s10826-016-0518-2 22 Kalisch, L. A., Lawrence, K. A., Howard, K., Basu, S., Gargaro, B., Kypriano, K., Spencer-Smith, M., & Ure, A. (2025). Recommendations provided to families of neurodivergent children with histories of interpersonal trauma across two clinical assessment services within a major Metropolitan Children’s Hospital in Melbourne, Australia. Journal of Child & Adolescent Trauma, 18(2), 467-480. https://doi.org/10.1007/s40653-024-00684-9 23 Ip, A., Zwaigenbaum, L., & Brian, J. A. (2019). Post-diagnostic management and follow-up care for Autism Spectrum Disorder. Paediatr Child Health, 24(7), 461-477. https://doi.org/10.1093/pch/pxz121 24 Ruane, A., & Carr, A. (2019). Systematic review and meta-analysis of Stepping Stones Triple P for parents of children with disabilities. Family Process, 58(1), 232-246. https://doi.org/10.1111/famp.12352 25 Ruane, A., Carr, A., & Moffat, V. (2019). A qualitative study of parents’ and facilitators’ experiences of Group Stepping Stones Triple P for parents of children with disabilities. Clin Child Psychol Psychiatry, 24(4), 694-711. https://doi.org/10.1177/1359104518807265 26 Sanders, M. R., & Prinz, R. (2017). Emergence of a population approach to evidence-based parenting support. In The Power of Positive Parenting: Transforming the lives of children, parents, and communities using the Triple P System (1st ed., pp. 32-62). Oxford University Press. https://doi.org/10.1093/med-psych/9780190629069.001.0001 27 Autism CRC. (2023). Interventions for children on the autism spectrum: A synthesis of research evidence. National Disability Insurance Agency. https://www.autismcrc.com.au/interventions-evidence 28 Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S., Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychol Bull, 146(1), 1-29. https://doi.org/10.1037/bul0000215 29 Sofronoff, K., Jahnel, D., & Sanders, M. (2011). Stepping Stones Triple P seminars for parents of a child with a disability: A randomized controlled trial. Research in Developmental Disabilities, 32(6), 2253-2262. https://doi.org/10.1016/j.ridd.2011.07.046 30 Tellegen, C. L., & Sanders, M. R. (2014). A randomized controlled trial evaluating a brief parenting program with children with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 82(6), 1193-1200. https://doi.org/10.1037/a0037246 31 Roberts, C., Mazzucchelli, T., Studman, L., & Sanders, M. R. (2006). Behavioral family intervention for children with developmental disabilities and behavioral problems. Journal of Clinical Child and Adolescent Psychology, 35(2), 180-193. https://core.ac.uk/download/15026839.pdf 32 Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Stepping Stones Triple P: An RCT of a parenting program with parents of a child diagnosed with an Autism Spectrum Disorder. Journal of Abnormal Child Psychology, 37(4), 469-480. 33 Hinton, S., Sheffield, J., Sanders, M. R., & Sofronoff, K. (2017). A randomized controlled trial of a telehealth parenting intervention: A mixed-disability trial. Research in Developmental Disabilities, 65, 74-85. https://doi.org/10.1016/j.ridd.2017.04.005 34 Shapiro, C. J., Kilburn, J., & Hardin, J. W. (2014). Prevention of behavior problems in a selected population: Stepping Stones Triple P for parents of young children with disabilities. Research in Developmental Disabilities, 35(11), 2958-2975. https://doi.org/10.1016/j.ridd.2014.07.036 35 Hansen, A., Broomfield, G., & Yap, M. B. H. (2019). A systematic review of technology-assisted parenting programs for mental health problems in youth aged 0-18 years: Applicability to underserved Australian communities. Australian Journal of Psychology, 71(4), 433-462. https://doi.org/10.1111/ajpy.12250 36 Finders, J. K., Diaz, G., Geldhof, G. J., Sektnan, M., & Rennekamp, D. (2016). The impact of parenting education on parent and child behaviors: Moderators by income and ethnicity. Children and Youth Services Review, 71, 199-209. https://doi.org/10.1016/j.childyouth.2016.11.006 37 Australian Institute of Health and Welfare. (2022, 25 February). Australia’s children: The transition to primary school. https://www.aihw.gov.au/reports/children-youth/australias-children/contents/education/transition-primary-school 38 Lewis, A. K. (2021). Cultural and linguistic diversity among children and families referred for diagnostic evaluation of developmental delay and disability: Implications for service delivery. Journal of Policy and Practice in Intellectual Disabilities, 18(2), 113-119. https://doi.org/10.1111/jppi.12358 39 Smith, J., Aulich, A., Bent, C. A., Constantine, C., Franks, K., Goonetilleke, N., Green, C. C., Lee, P., Ma, E., Said, H., Wang, R., Wood, S., & Hudry, K. (2023). “What is early intervention? I had no idea”: Chinese parents’ experiences of early supports for their autistic children in Australia. Research in Autism Spectrum Disorders, 108, 102227. https://doi.org/10.1016/j.rasd.2023.102227
40 Smith, J., Aulich, A., Bent, C., Constantine, C., Franks, K., Goonetilleke, N., Green, C., Ijaz, R., Patel, K., Said, H., Wood, S., & Hudry, K. (2024). “We go through trauma”: South Asian parents’ experiences of autism diagnosis and early supports for their autistic children in Australia. Research in Autism Spectrum Disorders, 114, 102408.
41 Morgart, K., Harrison, J. N., Hoon Jr, A. H., & Wilms Floet, A. M. (2021). Adverse Childhood Experiences and developmental disabilities: Risks, resiliency, and policy. Developmental Medicine & Child Neurology, 63(10), 1149-1154. https://doi.org/10.1111/dmcn.14911
42 Vervoort-Schel, J., Mercera, G., Wissink, I., Van der Helm, P., Lindauer, R., & Moonen, X. (2021). Prevalence of and relationship between Adverse Childhood Experiences and family context risk factors among children with intellectual disabilities and borderline intellectual functioning. Research in Developmental Disabilities, 113, 103935. https://doi.org/10.1016/j.ridd.2021.103935
43 Gatwiri, K., McPherson, L., & James, S. (2024). Experiences of Children and Young People with a Disability in Out-of-Home Care in Australia: A Scoping Review. Health & Social Care in the Community, 2024(1), 3456823. https://doi.org/10.1155/2024/3456823
44 Gagné, M.-H., Piché, G., Clément, M-E., & Villatte, A. (2021). Families in confinement: A pre-post COVID-19 study. Couple and Family Psychology: Research and Practice, 10(4), 260-270. https://doi.org/10.1037/cfp0000179
45 Day, J. J., Baker, S., Dittman, C. K., Franke, N., Hinton, S., Love, S., Sanders, M. R., & Turner, K. M. T. (2021). Predicting positive outcomes and successful completion in an online parenting program for parents of children with disruptive behavior: An integrated data analysis. Behaviour Research and Therapy, 146, 103951. https://doi.org/10.1016/j.brat.2021.103951
46 Sanders, M. R. (2008). Triple P-Positive Parenting Program as a public health approach to strengthening parenting. Journal of Family Psychology, 22(4), 506-517. https://doi.org/10.1037/0893-3200.22.3.506
47 Roberts, Y., Brophy, M., & Bacon, N. (2009). Parenting and wellbeing: Knitting families together. https://www.youngfoundation.org/wp-content/uploads/2013/01/Parenting-and-Wellbeing-knitting-families-together-September-2009.pdf
48 Fang, Y., Boelens, M., Windhorst, D. A., Raat, H., & van Grieken, A. (2021). Factors associated with parenting self-efficacy: A systematic review. Journal of Advanced Nursing, 77(6), 2641-2661. https://doi.org/10.1111/jan.14767
49 Bailey, B., & Arciuli, J. (2020). Indigenous Australians with autism: A scoping review. Autism, 24(5), 1031-1046. https://doi.org/10.1177/1362361319894829
50 D’Aprano, A., McRae, K., Dayton, S., Lloyd-Johnsen, C., & Gilroy, J. (2024). A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings. Aust J Rural Health, 32(5), 890-905. https://doi.org/10.1111/ajr.13164
51 Dossetor, P. J., Freeman, J. M., Thorburn, K., Oscar, J., Carter, M., Jeffery, H. E., Harley, D., Elliott, E. J., & Martiniuk, A. L. C. (2023). Health services for aboriginal and Torres Strait Islander children in remote Australia: A scoping review. PLOS Glob Public Health, 3(2), e0001140. https://doi.org/10.1371/journal.pgph.0001140
52 Andersson, E., McIlduff, C., Davies, J., Cox, E., Thomas, S., Hand, M., Carter, E., Oscar, J., Turner, K. M. T., Elliott, E., & Einfeld, S. (2020). Jandu Yani U (“For All Families”) project report.
53 Turner, K. M., Richards, M., & Sanders, M. R. (2007). Randomised clinical trial of a group parent education programme for Australian Indigenous families. Journal of Paediatrics and Child Health, 43(6), 429-437. https://doi.org/10.1111/j.1440-1754.2007.01053.x
54 Turner, K. M. T., Ponnapalli, A., Cliff, L., Forster, M., & Sanders, M. R. (2024). Darin Djanum (Strong together) Final Project Report.
55 Hoath, F. (2019). Stepping Stones Triple P: Acceptability and efficacy of a parenting programme with Indigenous families with a child with a disability [Doctoral thesis, The University of Queensland]. UQ eSpace. https://espace.library.uq.edu.au/view/UQ:f8bb6d5
56 Sheeran, L., Zhao, L., Buchanan, K., & Xenos, S. (2021). Enablers and barriers to identifying children at risk of developmental delay: A pilot study of australian maternal and child health services. Maternal and Child Health Journal, 25, 967-979.
57 Alexander, K., & Mazza, D. (2023). Routine developmental screening in Australian general practice: A pilot study. BMC Primary Care, 24(1), 143. https://doi.org/10.1186/s12875-023-02093-7
58 Henry, R. (2019). Review of health services for children, young people and families within the NSW Health system. NSW Health.
59 Coughlan, B., Duschinsky, R., O’Connor, M.-E., & Woolgar, M. (2020). Identifying and managing care for children with autism spectrum disorders in general practice: A systematic review and narrative synthesis. Health & Social Care in the Community, 28(6), 1928-1941. https://doi.org/10.1111/hsc.13098
60 Taylor, L. J., Eapen, V., Maybery, M. T., Midford, S., Paynter, J., Quarmby, L., Smith, T., Williams, K., & Whitehouse, A. J. O. (2016). Diagnostic evaluation for Autism Spectrum Disorder: a survey of health professionals in Australia. BMJ Open, 6(9), e012517. https://doi.org/10.1136/bmjopen-2016-012517
61 Bent, C. A., Barbaro, J., & Dissanayake, C. (2020). Parents’ experiences of the service pathway to an autism diagnosis for their child: What predicts an early diagnosis in Australia? Research in Developmental Disabilities, 103, 103689. https://doi.org/10.1016/j.ridd.2020.103689 62 Ward, S. L., Sullivan, K. A., & Gilmore, L. (2016). Practitioner perceptions of the assessment and diagnosis of Autism in Australia. Australian Psychologist, 51(4), 272-279. https://doi.org/10.1111/ap.12211 63 Sanders, M. R., Hoang, N.-P. T., Gerrish, R. J., Ralph, A., & McWilliam, J. (2023). The change of practitioner’s self-efficacy in Triple P professional training: Moderating role of practitioner characteristics, country, and delivery mode. Journal of Child and Family Studies, 32(5), 1470-1482. 64 Robyns, K. L. (2023). Experiences of families and professionals living/interacting with neurodivergent children while navigating the policy contexts of health, education and social services: The fight for accessible and suitable support (The University of Waikato). https://researchcommons.waikato.ac.nz/entities/publication/8aeab5e3-0721-41ef-8458-e5f86505f660 65 Rasheed, Z. (2023). Autism in Australia: Understanding, challenges, and support. Int J Health Sci (Qassim), 17(5), 1-4. 66 Stein, R., & Steed, E. (2023). Initial evaluation practices to identify young children with delays and disabilities. Contemp Sch Psychol, 1-12. https://doi.org/10.1007/s40688-023-00467-3 67 Evans, K., Whitehouse, A. J. O., D’Arcy, E., Hayden-Evans, M., Wallace, K., Kuzminski, R., Thorpe, R., Girdler, S., Milbourn, B., Bolte, S., & Chamberlain, A. (2022). Perceived support needs of school-aged young people on the Autism Spectrum and their caregivers. International Journal of Environmental Research and Public Health, 19(23). 68 Delach, T. B. (2020). Parent perceptions of the acceptability, effectiveness, and experience of engaging in the Group Stepping Stones Triple P intervention for parents of children with disabilities [PhD Thesis, University of South Florida]. South Florida. https://digitalcommons.usf.edu/etd/ 69 Di Vincenzo, C., Pontillo, M., Bellantoni, D., Di Luzio, M., Lala, M. R., Villa, M., Demaria, F., & Vicari, S. (2024). School refusal behavior in children and adolescents: A five-year narrative review of clinical significance and psychopathological profiles. Italian Journal of Pediatrics, 50(1), 107. https://doi.org/10.1186/s13052-024-01667-0 70 McKay-Brown, L., McGrath, R., Dalton, L., Graham, L., Smith, A., Ring, J., & Eyre, K. (2019). Reengagement with education: A multidisciplinary home-school-clinic approach developed in Australia for school-refusing youth. Cognitive and Behavioral Practice, 26(1), 92-106. https://doi.org/10.1016/j.cbpra.2018.08.003 71 Chen, N., Miller, S., Milbourn, B., Black, M. H., Fordyce, K., Van Der Watt, G., Alach, T., Masi, A., Frost, G., Tucker, M., Eapen, V., & Girdler, S. (2020). “The big wide world of school”: Supporting children on the autism spectrum to successfully transition to primary school: Perspectives from parents and early intervention professionals. Scand J Child Adolesc Psychiatr Psychol, 8, 91-100. https://doi.org/10.21307/sjcapp-2020-009 72 Ray, P., Dossetor, D., Caruana, J., Gomes, L., Saleh, H., & Whatson, L. (2019). Group Stepping Stones Triple P in Schools: An Evaluation of a Parenting Program for Children with Developmental Disabilities in the School Setting. Journal of Mental Health of Children and Adolescents with IDD, 10(1), 30-39.