NDIA Accountability Project

Submission 315 — Sydney Local Health District — Inquiry into the Thriving Kids initiative

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OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

Sydney Local Health District

Submission from Child and Family Health Services

September 2025

NSW Inquiry into the Thriving Kids initiative

Acknowledgement of Country Artwork: Ngurang Dali Mana Burudi – a place to get better. The map was created by our Aboriginal health staff telling the story of a cultural pathway for our community to gain better access to healthcare. Artwork by Aboriginal artist Lee Hampton utilising our story.

OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

About the SLHD Child and Family Health Services

Sydney Local Health District’s Child and Family Health Services provide free, community-based health and developmental support for children and families residing in the district. Services are delivered through Child and Family Health Centres and tailored to family needs via individual appointments, group sessions, or outreach to homes, schools, and community hubs.

We offer a mix of universal, targeted, and specialist services, such as but not limited to:

Child and Family Health Nursing (0–5 years): No eligibility restrictions; care packages are tailored and prioritised using Sustaining Families NSW criteria.

Allied Health Services (0–12 years): Prioritise children within the first 2000 days of life. Children with moderate to severe Global Developmental Delay or ASD Level 2–3 are referred to NDIS.

Community Paediatric Services (0–18 years): Developmental paediatric services, including the Disability Specialist Unit for comprehensive developmental assessments.

A summary of available services is available here: Child Health & Development | Sydney Local Health District

Summary of Key Recommendations

  1. Strengthen universal and tiered early intervention across state and primary care systems.
  2. Integrate services via community hubs with service navigation and co-designed models of care.
  3. Deliver support based on functional needs, not only diagnosis, and embed parent/carer capacity-building.
  4. Ensure access for children and families ineligible for Medicare or NDIS due to residency status.
  5. Partner with Aboriginal communities and Aboriginal Controlled Community Health Organisations (ACCHOs) to deliver culturally safe, community-led pathways.
  6. Build workforce capability to work in the autism and developmental delay space (allied heath, nursing, interpreting services, cultural support workers, Aboriginal Health Workers), and in integrated, evidence based, trauma-informed, developmentally appropriate and strengths-based approaches.

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OFFICIAL: Sensitive — NSW Government

OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

Response to Terms of Reference

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

Key Issue:

Parents need accessible, evidence-based tools to identify and support children with mild to moderate developmental delay.

Evidence / Research:

  • Over 63,000 children start school each year with or at risk of disability (15).
  • Early intervention is critical but often inaccessible to those most in need (6).
  • Late intervention costs Australia $15.2 billion annually (22).
  • Community hubs with co-located services significantly increase engagement and developmental surveillance uptake, especially amongst culturally and linguistically diverse communities (CALD) (8, 9, 10).

Recommendations:

  • Strengthen surveillance and early intervention across primary care and strengthening access to child and family health nursing services, as part of Tier 1 programs of services (14; 32)
  • Establish community hubs with service navigation and co-designed care models.

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.

Key Issue: Effectiveness of existing programs varies across sectors and populations.

Evidence / Research:

  • For Paediatric Speech Pathology - Naturalistic Developmental Behavioural Interventions (NDBIs) show strong evidence for improving social communication and language in children with autism (28, 30).
  • Clinician-led or collaborative interventions outperform caregiver-only models (27).
  • Programs like DIR/Floortime and Hanen also show positive outcomes (31).

Recommendations:

  • Expand access to evidence-based interventions.
  • Increase disability-specific training for mainstream and community-based professionals.

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OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

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

Key Issue: Children from First Nations and CALD backgrounds face disproportionate barriers to care.

Evidence / Research:

  • Aboriginal and Torres Strait Islander children have 1.5–2 times higher prevalence of disability (12, 13).
  • CALD families show rates of low engagement with routine health checks due to systemic barriers (20, 21).
  • School-based integrated care models (e.g., Ngaramadhi Space) demonstrate improved access and outcomes (1, 2, 3).

Recommendations:

  • Co-design culturally safe services with communities through evidenced based approaches.
  • Identify pathways for families ineligible for Medicare / NDIS to access disability supports.
  • Embed services in trusted settings like ACCHOs, education settings (preschool / schools), and multi-service hubs with dedicated hub coordinators.

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

Key Issue:

Workforce shortages and training gaps may hinder development, implementation and sustained delivery of Thriving Kids.

Evidence / Research:

  • Allied Health and paediatric sectors face critical shortages (6, 23).
  • Training in integrated, trauma-informed, and strengths-based care is limited (24, 25).
  • Programs like Family Partnership and NEST Wellbeing Framework (ARACY) offer scalable models (7).

Recommendations:

  • Fund workforce development and training, that includes clinical and non-clinical programs to enable effective and sustainable clinical, operational, professional and strategic governance.
  • Identify opportunities for education and training providers to develop tiered programs of qualifications to meet what will be an increasingly diverse disability service environment.
  • Support hub coordinators and care navigators.
  • Expand cultural support and interpreter services, including review of current industrial award provisions to optimise workforce attraction and retention.

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OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

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

Key Issue:

Australia can adapt successful domestic and international models.

Evidence / Research:

  • Sure Start (UK), National Child and Family Hub Network, and CRC Autism guidelines offer scalable frameworks (6, 26).
  • ACI developmental guidelines and First 2000 Days strategy provide local alignment (14, 16).

Recommendations:

  • Pilot and adapt best practice models with improved mechanisms for collaboration and sharing of data across Australia.
  • Create seamless pathways across health, education, and social systems to reflect and enable the eco-system that families and communities most effectively thrive in.
  • Ensure service user and service provider experience is captured as part of quality improvement, research and evaluation frameworks to support accountability and governance of program delivery.

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

Key Issue: Families struggle to navigate complex systems from screening to diagnosis and intervention.

Evidence / Research:

  • Act Early Autism Project shows promise with integrated screening and coaching (26).
  • Two-thirds of families face adverse social determinants of health, impacting service engagement (23, 24).

Recommendations:

  • Deliver services informed by an individual’s / family’s functional and psychosocial needs, that strengthens the focus on enabling parent / carer wellbeing, knowledge and connection to support groups and related communities.
  • Implement social prescribing and navigation models from the point of referral and intake to support early identification and formulation of care plans that acknowledge and respond to the unique needs of each family — this could include a tiered approach integrating e-navigation, peer navigation and professional navigation models.
  • Fund Allied Health services adequately across all disciplines, and continue to recognise the importance of key supporting professions such as allied health assistants, and nursing roles.
  • Improve accessibility through transport, interpreters, flexible operating hours, virtual care, and disability-friendly facilities e.g. that are suitable for neuro-diverse consumers.

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OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

Conclusion

This submission outlines a comprehensive, evidence-informed recommendations to support children with mild to moderate developmental delay and autism. Drawing on the expertise of existing workforce, and harnessing the voice of consumers, will be necessary to maximise the opportunity that this revision to disability supports offers.

We encourage the committee to consider these recommendations and welcome further engagement to ensure Thriving Kids delivers on its promise for all families.

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OFFICIAL: Sensitive — NSW Government

OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

References

  1. Rungan S, Gardner S, Liu HM, Woolfenden S, Smith-Merry J, Eastwood J. Ngaramadhi Space: An Integrated, Multisector Model of Care for Students Experiencing Problematic Externalising Behaviour. Int J Integrated Care. 2023;23(4).

  2. Rungan S, Montgomery A, Smith-Merry J, Liu HM, Eastwood J. Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour. J Paediatr Child Health. 2023;59(12):1311-8.

  3. Rungan S, Liu HM, Smith-Merry J, Eastwood J. School-based integrated care within Sydney Local Health District: a qualitative study about partnerships between the education and health sectors. Int J Integrated Care. 2024;24(2):13.

  4. Woolfenden S, Galea C, Badland H, et al. Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law. J Epidemiol Community Health. 2020;74(6):495–501.

  5. Woolfenden S, Eapen V, Jalaludin B, et al. Parental concerns about development detected by PEDS at well-child checks. BMJ Open. 2016;6(9):e012144.

  6. Teager W, Fox S, Stafford N. How Australia can invest early and return more: A new look at the $15b cost and opportunity. Early Intervention Foundation, The Front Project and CoLab at the Telethon Kids Institute. 2019.

  7. Edwards K, Fernandez R, Rimes T, et al. Happy, healthy, ready — working with early childhood NGOs for developmental surveillance. Aust J Adv Nurs. 2020;37(4):37–46.

  8. Montgomery A, Honniset S, Hall T, et al. Co-designing integrated child and family hubs for families experiencing adversity. Med J Aust. 2024;221(10):S41-S47.

  9. Hodgins M, Ostojic K, Hu N, et al. Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women. BMJ Open. 2022;12(8):e061002.

  10. Hodgins M, Ostojic K, Rimes T, et al. Building Blocks for Successful Hub Implementation for Migrant and Refugee Families. Health Expectations. 2025;28(1):e70082.

  11. Ostojic K, Hu N, Hodgins M, Woolfenden S. Integrated Health-Social Hubs for Migrant Women and Infants. Pediatrics. In press. 2025.

  12. Chando S, Craig JC, Burgess L, et al. Developmental risk among Aboriginal children in urban Australia: SEARCH study. BMC Pediatrics. 2020;20(13).

  13. Woolfenden S, Galea C, Smithers-Sheedy H, et al. Impact of social disadvantage on cerebral palsy severity. Dev Med Child Neurol. 2019;61(5):586–592.

  14. NSW Health. The First 2000 Days Framework. 2019. The first 2000 days of life

  15. AEDC. Australian Early Development Census. https://www.aedc.gov.au/data/data-explorer?id=135216. 2020.

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OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

  1. Brinkman S, et al. Associations between the early development instrument and later outcomes. Child Indicators Research. 2013.

  2. Goldfeld S, et al. Impact of multidimensional disadvantage over childhood. Int J Epidemiol. 2018.

  3. Rogers H, et al. Responding to the health needs of migrant women. Health Soc Care Community. 2020.

  4. Ostojic K, Hu N, Hodgins M, et al. Integrated Health-Social Hubs for Migrant Women and Infants. Pediatrics. 2025;156(Suppl 1).

  5. Woolfenden S, et al. Equitable access to developmental surveillance. Health Expectations. 2015.

  6. Mendoza Diaz A, et al. Adapting the First 2000 Days framework for CALD families. Aust Health Rev. 2023.

  7. Minderoo Foundation. 15.2 billion reasons to rethink late intervention. https://www.minderoo.org/thrive-by-five/news/15-2-billion-reasons-why-we-must-change-our-way-of-thinking-on-late-intervention/

  8. Ostojic K, Karem I, Paget SP, et al. Social determinants of health for children with cerebral palsy. Dev Med Child Neurol. 2024;66(1):32–40.

  9. Yeoh A, Ostojic K, Berg A, et al. Unmet social needs in children with cerebral palsy. Dev Med Child Neurol. 2024.

  10. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff. 2002;21(2):78-93.

  11. Gaines R, Korneluk Y, Quigley D, Delehanty AD, Vismara LA. Act Early Autism Project: Feasibility of an early pathway to care. Can J Speech-Language Pathol Audiol. 2021;45(2).

  12. Hampton LH, Kaiser A. Intervention effects on spoken language outcomes for children with autism. J Intellect Disabil Res. 2016;60(5):444–463.

  13. Sandbank M, Bottema-Beutel K, Crowley S, et al. Project AIM: Autism intervention meta-analysis. Psychol Bull. 2020;146(1):1.

  14. Steinbrenner JR, McIntyre N, Rentschler LF, et al. Race and ethnicity in autism intervention literature. Autism. 2022;26(8):2026–2040.

  15. Tiede G, Walton KM. Meta-analysis of naturalistic developmental behavioral interventions. Autism. 2019;23(8):2080–2095.

  16. Liu S, Zhu M, Yi C, Zeng D. Early rehabilitation interventions for global developmental delay. Front Pediatr. 2025;13:1576324.

  17. ACI Clinical Practice guide- Children 0-5: ACI-Children-0-5-years-presenting-with-developmental-concerns-clinical-practice-guide.pdf

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OFFICIAL: Sensitive — NSW Government
Sydney Local Health District

Our recommendations are informed and alignmened with the below NSW Health and Local Policies, Guidelines and Strategic Plans

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OFFICIAL: Sensitive — NSW Government