APM enabling better lives
Thriving Kids
APM Submission to the House Standing Committee Parliamentary Inquiry
3 October 2025
Classification: Confidential
Acknowledgement of Traditional Owners and Custodians
APM acknowledges the traditional custodians of the lands on which we live and work. We pay our respects to elders past and present of all Aboriginal and Torres Strait Islander nations. Globally, APM recognises the significance of indigenous communities and the important role they play within our own workforce and the world, underpinning our efforts to build a culture that embraces diversity, equity and inclusion.
Photographs used in this document are for illustration only and should not be interpreted to mean that any person or organisation whose assets are shown in them endorses this document.
Classification: Confidential
APM Contact
Communications regarding this document should be forwarded to:
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Executive Chair – Therapy
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Executive Summary
Thriving Kids is a pivotal opportunity to create a joined-up, stepped-care system that identifies developmental needs consistently, and gets support to children and families early and closer to home – where they live, learn and play. Designed, funded and implemented well, it reduces unmet need, smooths pathways and narrows equity gaps; done poorly, it entrenches missed care, inconsistent experiences and widening disparity.
APM recommends system design anchored in:
- Universal, nationally consistent screening and closed-loop referrals,
- a genuine stepped-care model that includes adequate funding for both identification and information, and for targeted evidence-based early intervention supports including 1:1 allied health therapy interventions where needed,
- system infrastructure and governance (national and local) that ensure integrated and easy to navigate care, and
- data-driven and measured outcomes-based performance and embedded continuous improvement.
Thriving Kids must be a national framework, locally integrated and delivered at scale. To achieve this, it needs adequate funding, a workforce that is capable, credentialed and supported, and a system that bridges program, policy and jurisdictional silos.
Innovative models like APM’s established Key Worker and Habit Coach approach demonstrate how extending the reach and intensity of naturalistic, family centred supports in homes, childcare and community settings can easily be achieved – improving family empowerment, goal attainment and service efficiency, while freeing senior clinicians to focus on complexity and secondary consultation.
Measurement must be built in from day one: a system-level performance framework to track implementation, impact and experience; and routine individual-level outcome measurement (developmental, social, quality of life) to inform case planning, service adjustments and provide deidentified data that can be aggregated at the population level so we can better understand and evidence what works, where, when and for whom as the system matures.
APM brings proven evidence-based models, including the Early Start Denver Model (ESDM) and transdisciplinary approaches - already operating across natural settings (homes, early childhood education and care, schools, community) and scalable via parent coaching, group programs and remote delivery as examples of what good service delivery models look like. These approaches align strongly with Thriving Kids and demonstrate how evidence, workforce and place-tailored delivery can work together to deliver outcomes.
Contents
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APM’s evidence-based approaches to supporting children and families thrive
About APM
APM Group is a team of 16,500 people in 11 countries with a global purpose - to enable better lives.
APM started in 1994 as an allied health and vocational rehabilitation provider based in Perth, Western Australia, looking to provide better access to vocational rehabilitation services for injured workers so they could recover their health and return to work.
Today we’re an international human services provider with more than 1,500 locations across Australia, the United Kingdom, Canada, the United States of America, New Zealand, Germany, Switzerland, Spain, Sweden, Singapore, and South Korea
Each year, globally, APM supports more than 2.4 million people of all ages to live a better quality of life.
In Australia, our more than 6000 strong team deliver key services across the social services and care economy, including early intervention and employment, allied health and therapy, training, aged and disability care, community and assessment, and health and wellbeing services, from 618 locations across the country.
Our breadth of both services and footprint provides a unique vantage point in the ecosystem. We understand the power of access to the right supports at the right time in the early years in positively influencing a child’s development and their pathway right through to adulthood, supporting and developing a child’s sense of identity, health and wellbeing, learning, safety, and happiness; and supporting long-term outcomes, including future economic, social and civic participation.
APM’s skilled, multi-disciplinary workforce (professional and paraprofessional) works with children and young people with neurodevelopmental diagnosis (including autism), developmental difference, delay and/or disability and their families to achieve outcomes in the areas of behaviour, social participation, life skills, communication, emotional development and school success. Our evidence-based service approach includes both developmental-behavioural and social-routines model delivery - including 1:1 and group therapy, key worker supports, parent coaching and supported play groups.
Our approach is grounded in family-centred practice, embedding support delivery into natural routines and environments to make development meaningful and lasting. We support capacity and capability development within the sector, delivering training and support to early learning centres and education facilities on identifying and supporting developmental difference and delay. In the last 12 months we worked with more than 28,000 children and young people and their families nationally.
We also have deep expertise in working with governments globally to design, pilot and transform social services programs and systems, improving service delivery, capability and outcomes, and system coordination and management.
Classification: Confidential
About our submission
APM welcomes the opportunity to make a submission to the House Standing Committee on Health, Aged Care and Disability on the Thriving Kids initiative.
APM has been actively involved in the review and consultation processes that have led to the Thriving Kids announcement, through workshop and consultation session attendance and formal submissions to the NDIS Review, the Early Years Strategy,1 the National Autism Strategy,2 General Foundational Supports and Targeted Foundational Supports for children with developmental delay or disability, families, carers and kin.3
Our submission draws on our experience as a provider of evidence-based early intervention and allied health supports and resources for children and families delivering services across Australia, and our interactions with community and mainstream services and systems including health, education and early childhood care in each state and territory and builds on our previous submissions.
We also recognise the depth and breadth of information and evidence the government has received to date, and acknowledge broader work being undertaken through the independent review of early childhood intervention (ECI) best practice commissioned by the Department of Social Services (DSS) under the Early Childhood Targeted Action Plan,4 5 which is part of the implementation of Australia’s Disability Strategy 2021-2031.
Underpinning system design principles
Guiding our response are the principles we believe should underpin the development of any system of foundational disability supports in Australia:
- Universal accessibility: foundational supports are available to all people with disability regardless of NDIS eligibility and geographic location.
- Integration with the existing ecosystem: system complexity is reduced by adding to existing fit for purpose, established mechanisms and infrastructure where appropriate; and when creating new solutions, complement and enhance mainstream and specialist services within the disability ecosystem to deliver a comprehensive, connected system of support.
- Inclusivity and cultural responsiveness: design supports the diverse needs of communities and intersectional nature of disability – including First Nations peoples, culturally and linguistically diverse groups, LGBTQIA+SB individuals, and those residing in rural and remote areas.
- Sustainability and reliability: as system stewards, government provides a consistent and dependable approach to foundational supports that ensures long term availability, market viability and responsiveness to evolving community needs. Trust is rebuilt through reliable decision making.
- Consistency: foundational supports are underpinned by a national approach that ensures consistency in quality, workforce competence, data, funding and scalability of supports, while fostering localised solutions based on population needs.
1 APM Submission to the Early Years Strategy (2023) 2 APM Submission to the National Autism Strategy (2023) 3 Department of Social Services Consultation on Foundational Supports 4 Department of Social Services (2024) Developing a framework for early childhood intervention 5 Department of Social Services (2021) Early Childhood Targeted Action Plan
- Outcome measurement and continuous improvement: mechanisms to evaluate the effectiveness of foundational supports are embedded in the system at design, and a continuous improvement and evidence-based approach is taken to guide service delivery and investment.
- Viability and diversity: participant choice, market viability and value to the Australian economy is supported by a diverse provider mix including small, medium, large, not-for-profit and profit for purpose organisations delivering foundational supports.
Alongside specific principles which should underpin the design and development of the supports for children, young people, families, carers and kin:
- Child-centred and strength-based: targeted supports prioritise the child’s needs, strengths and aspirations while fostering their developmental potential and inclusion. Systems recognise that the needs of children differ significantly from adults with disability and services are conceptualised and implemented differently.
- Family and kin empowerment: recognises families, carers and kin as experts in the lives of the child, primary supporters and decision makers. Provide them with the skills, knowledge and resources they need, improving their capacity to make informed decisions about supports, and provide safe, nurturing and supportive environments in which a child can thrive. Parent, carer and kin are empowered to raise concerns about development, concerns are taken seriously and support provided without the need for ‘formal’ diagnosis.
- Early and universal screening: supports are underpinned by a nationally consistent screening program (social-emotional, physical and cognitive development) to support early detection and intervention of developmental concerns.
- Evidence-informed practice: supports are based on contemporary evidence and best practice (linked to continuous improvement) to confirm effective, efficient and responsive services that achieve measurable outcomes and provide a return on investment.
- Skilled and competent workforce: all professionals are qualified and equipped to provide neuro-affirming, trauma informed, safe and disability competent services through nationally consistent support and training. This includes GPs, child health nurses, childcare workers, allied health and other professionals and paraprofessionals involved in a child’s care. Organisations delivering supports must be committed to implementing best practice frameworks and delivering ongoing professional development and training.
- Clear pathways to support: consistent, reliable and well-articulated pathways to support ensure families do not fall through the gaps, understand the full ecosystem of supports available (mainstream, foundational supports like Thriving Kids and NDIS), and can access all necessary services.
While we have clarity on these design principles, and they are the lens through which APM considers our feedback, it is important to acknowledge the lack of detailed information and data about what Thriving Kids actually is and who exactly it will serve, and the difficultly in providing a fully considered response to the terms of reference (ToR) in the absence of important contextual information. We recognise that a design process is required, and that the inquiry forms part of this process, however it is hard to provide additional information beyond what has been already put forward through the key consultations which has brought us to this point.
As a result, this submission provides background and context which has been critical in shaping our thinking, and that APM believe needs to be front of mind for all stakeholders as the Thriving Kids is taken from idea to implementation.
Background and context
On face value, Thriving Kids is a pivotal chance to replace fragmented, ad-hoc supports with a joined-up, stepped-care system that gets children and families help earlier, and closer to home - in the places their children live, learn and play. Implemented well – universal screening and closed-loop referrals, local system management, shared outcomes and workforce capability, we reduce unmet need, smooth pathways and narrow equity gaps. However, implemented poorly, we continue to entrench missed care, inconsistent experiences, services that don’t match real family needs, and widening disparity.
The importance of intervening early
Research and experience demonstrate that intervening as early as possible in a child’s development enables interventions to have the greatest impact.6 7 The most effective interventions for ensuring a child’s health and development occur as early in life as possible, particularly during the first 1000 days,8 as during this time there is the greatest potential to shape outcomes and optimise the effects of interventions. If a gap in development emerges by age 5 and is not addressed, it is likely to remain, particularly for those children who are vulnerable or disadvantaged, impacting life trajectories and embedding disability across the life course.9
In his speech to the National Press Club on 20 August 2025, Minister Butler spoke to the original intent of the scheme being to support those with ‘significant and permanent care and support needs’, and the fiscal impact of more children entering the scheme than originally intended.10 It is critical recognise that if the funding and support delivered under Thriving Kids doesn’t effectively provide for the right interventions at the right intensity, at the right time, children with developmental delay are more likely to end up facing a profound disability impact and needing significant and/or lifelong care and support as a result.
Why are there more children on the scheme than originally projected?
The removal of previously existing programs targeted at early intervention for children with disability and developmental delay has driven an increase in the number of children accessing the NDIS. But it is not the only factor to be considered. The impact of changes to the definition and diagnosis autism spectrum disorder (ASD) under the DSM-5 in 2013 (moving from the conceptualisation of autism from a multi-categorical diagnostic system to a single diagnosis based on multiple dimensions)11 alongside the rise in awareness and information on neuro-developmental difference, delay and disability must also be factored in.
When the Productivity Commission made its initial projection of the number of NDIS participants in 2011, they utilised data from the 2009 Survey of Disability, Ageing and Carers (SDAC).12 In the 2009 SDAC, the data suggested around 64,600 Australians had autism,13 in 2018 this figure had increased to 205,200, and in 2022
6 Black, M., et al (2017). Early childhood development coming of age: science through the life course. The Lancet, 389(10064), 77-90. 7 Nelson, C. A., & Gabard-Durnam, L. J. (2020). Early adversity and critical periods: neurodevelopmental consequences of violating the expectable environment. Trends in neurosciences, 43(3), 133-143. 8 Berry, D. (2017). Early childhood health disparities, biological embedding, and life‑course health. In E. Votruba-Drzal & E. Dearing (Eds.), The Wiley Handbook of Early Childhood Development Programs, Practices, and Policies (pp. 35-65). Hoboken, NJ: Wiley-Blackwell. 9 National Scientific Council on the Developing Child. (2020). Connecting the brain to the rest of the body: Early childhood development and lifelong health are deeply intertwined. Cambridge, MA: Centre on the Developing Child, Harvard University. 10 The Hon Mark Butler MP (2025) National Press Club Address Transcript 11 Rosen, N. E., Lord, C., & Volkmar, F. R. (2021). The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond. Journal of autism and developmental disorders, 51(12), 4253–4270. 12 Productivity Commission (2011) Inquiry into Disability Care and Support – Final Report 13 Australian Bureau of Statistics (2009) Autism in Australia
the number was estimated to be 290,900, including 4.3% of all children aged 5-14.14 Of those 290,900, 73% had profound or severe limitation, only 9.3% had a moderate to mild limitation, and 97.3% had an educational restriction - meaning they need help or have difficulty at school indicating a need for targeted supports.15
Further, data around developmental delay has also changed significantly over time. In 2005, it was estimated that developmental delay occurs in up to 5% of children aged under 516 however, recent data in Australia from the Australian Early Development Census indicates that more than one in five (22%) of children are developmentally vulnerable (meaning they are facing some significant challenges in their development) on one or more developmental domains, and 11.4% were developmentally vulnerable in two or more domains in 2021.17 This aligns to international data including the reported rates of developmental disability amoung children in the United States (17% in 2017).18
In June 2022, there were an estimated 1.82 million children aged 0 to 5 years living in Australia. Based on the figures outlined above, it is easier to see how the original projections of the Productivity Commission were off base – and why one in ten 6-year-old boys, for example, might need an NDIS plan to meet their developmental support needs.
Clarifying what Thriving Kids is…and isn’t
Given the number of children estimated to experience development delay, to make sure the funding allocated to Thriving Kids has the most impact, clarity around what Thriving Kids is, and isn’t, is vital. While $1 billion per annum (arrived at by matching the Commonwealth $2 billion with $2 billion from the states and territories over the forward estimates) may seem like a significant amount of money, when the pool of potential children needing support is (conservatively) more than 300,000 (and could be up to 600,000)19, it becomes a significantly smaller sum when we are talking about identification, information and the delivery of evidence-based early intervention supports including allied health.
Based on the publicly available information, Thriving Kids will focus on identifying developmental concerns earlier and establishing a national system of supports for children aged 8 and under with mild to moderate developmental delay and autism and their families.20 Both the Minister and the Thriving Kids fact sheets note that the initiative intends to ‘build off existing mainstream supports’. While we agree that identification of developmental concerns and/or delay through nationally consistent screening and surveillance, and the provision of quality information to support parents and carers, should be embedded in existing infrastructure, many of the evidence-based supports required to address developmental concerns require a response that integrates targeted, individualised supports, alongside parent and family coaching and in naturalistic settings.
Of most concern is the risk that in focussing on existing service infrastructure and gap filling, we further fragment the early intervention support system, increasing complexity for families, and further embedding inequity in a system that is not fit for purpose. Many of the issues identified with the current system which have led to the announcement of Thriving Kids mirror those raised in 2010/11 when the NDIS was being
14 Australian Bureau of Statistics (2022) Autism in Australia 15 Ibid 16 Oberklaid, F & Efron, D. (2005). Developmental delay: Identification and management. Australian family physician. 34. 739-42. 17 Department of Education, Skills and Employment (2022), Australian Early Development Census: National Report 2021 18 US Centres for Disease Control and Prevention (2025) Data and Statistics Autism Spectrum Disorder 19 Based on 20 per cent of total population of children 0-9 (3,123,034) as at June 2024 – ABS Population Data 20 Department of Health, Disability and Ageing (2025 Thriving Kids Factsheet
conceived – fragmentation, inequitable access and servicing, extensive waitlists, limited funding, difficult navigation, a lack of data and poor outcomes.
Realising the full potential of Thriving Kids requires more than the existing services and systems – it requires a universal joined-up approach that brings together a national framework (universal screening and stepped-care, digital infrastructure, data and outcomes measurement) cross government stewardship (co-governance by Commonwealth, state and territory governments that brings together and drives key policy and strategy) and system management that understands needs at the community level and can fully integrate local delivery. Without this, we risk having the same conversation about the same issues in another decade, while children continue to miss out on critical early interventions.
Thriving Kids - what would good look like?
A fully funded, nationally consistent universal screening framework
At present, Australia lacks a consistent national population-based screening program to identify developmental delays, which, as detailed in the Early Years Strategy (2024) and NDIS Review (2023) results in missed opportunities to establish a strong foundation for success in all children.
While systems exist across the states and territories, for example national hearing screening at birth or free vision screening for pre-schoolers, there are no nationally consistent programs or approaches dedicated to speech, communication, and motor functioning. This is not only out of step with other OECD nations but also misses key opportunities to consistently identify children with developmental delays or disabilities early in life when we know interventions are most effective.
The foundation of Thriving Kids should be a population-level developmental surveillance and screening framework (social-emotional, physical and cognitive development) to support early detection and intervention for developmental concerns. APM agrees that the introduction of universal Medicare funded three-year-old screening is an important addition to the current screening framework, however it still leaves each state and territory with differing approaches to developmental screening across the early years. Formal screening services should be delivered (alongside the delivery of general developmental surveillance by families, carers and key professionals) at regular points across the early years (for example the Victorian model includes scheduled checks at birth, 2, 4 & 8 weeks, 4, 8, 12 & 18 months, 2 & 3.5 years),21 and be free and easily accessible for all children and families.
A fully funded, nationally consistent approach to screening would not only positively impact access and equity to interventions, helping to ensure that all children are screened consistently, regardless of where they live or their socioeconomic status, but allow, at the population level for robust data collection to better identify trends in developmental delay and/or disabilities across populations and geographic areas. This information can be used to target interventions and resources where they are most needed, and to better evaluate the effectiveness of early intervention programs.
A genuine stepped-care model
A genuine stepped-care model means the system delivers the right supports at the right time, at the right intensity, matched to the child’s needs, and adjusted as those needs change.
21 Mclean, K. et al (2014) Screening and surveillance in early childhood health: Rapid review of evidence for effectiveness and efficiency of models. Murdoch Children’s Research Institute
Supports progress across steps/rungs from least restrictive to most intensive — starting with universal supports for all families. Progress is closely monitored. If there is insufficient improvement, the child or family “steps up” to more intensive services. Conversely, where a child or family is thriving, they can/may “step down” once needs are met.
Step Three — Targeted (Intensive) Transdisciplinary supports, Lead Clinician/Practitioner, warm handover to/from NDIS
Step Two - Targeted (Moderate) Multidisciplinary early intervention, embedded supports, care navigation, goal-based reviews
Step One - Targeted (Light) Parent coaching, group programs, short blocks in natural settings
Ground floor —- Universal Inclusive ECEC/schools, MCH/GP, health promotion, parenting info, routine developmental screening
This approach prioritises least-intrusive, effective help first, builds caregiver capability, reduces wait times and duplication and focuses effort where it has the greatest impact, ultimately improving equity, outcomes and system efficiency.
The current outline of Thriving Kids speaks to the ground floor and Step One of a stepped care approach, and to a degree Step Two. Step Three, where more intensive targeted, individualised support is delivered is an important component of the stepped care model and is essential in preventing lifelong dependence on NDIS funded supports.
For children who plateau at Step Two or present with multi-domain complexity, Thriving Kids requires funding for secondary consultation capacity and the tailored, individualised transdisciplinary supports needed at Step Three, and to provide a warm pathway to the NDIS should more intensive supports be required over the longer term. Without this, we continue to risk an influx of older children and adults into the scheme as developmental delay that hasn’t been addressed and now has a greater impact on life outcomes. This approach would include defined escalation criteria and outcomes-linked reviews.
Note: if Thriving Kids is not intended to deliver Steps Two and Three in a stepped-care model - it is critical that a national program is fully funded to deliver these more intensive targeted specialist supports outside of the NDIS. Relying on Medicare funded allied health supports for this group risks driving greater waitlists and increasing disparity for families without the means to pay out of pocket.
A well-integrated and managed system
As mentioned earlier, and aligned to recommendations made by the NDIS Review, to be effective the ‘system’ needs to work at both the national and place/community level to ensure optimal delivery of supports regardless of where a child/family is located, and to manage the flow of information and data across service and jurisdictional silos.
Given the variability of existing infrastructure within communities across Australia, and our experience of the breadth of differences in community needs at the local level, a nationally consistent, place-based
management function should underpin Thriving Kids. This would enable the undertaking of regional level assessment of current infrastructure, and ensure that the system for mainstream, general and targeted supports is working in concert to meet the needs of children and families and deliver effective support. This would also enhance the focus on establishing integrated, community-centred solutions at the local level.
Benefit (quality, efficiency and effectiveness) could be achieved through a system manager with both national infrastructure and a localised, community-embedded approach to delivery. Such models offer significant economies of scale, while also enabling consistency in quality, data capture, workforce development and performance management.
A well-integrated, managed system should also provide navigation supports anchored to the child and family journey (critical for complex needs, families at risk), including a funded navigator/lead professional that tracks a family through systems including the maternal/child and family health (MCH/CFH), early childhood education and care (ECEC) to school entry using consented, parent -held digital records and closed-loop referrals (referrals sent, appointment booked, outcome returned). Ideally, this is supported by commissioned pathway maps and shared handover templates across health, education and community,
Data-driven decision making and outcomes-based measurement
Knowing what is working, for whom and where is fundamental to building an effective, evidence-based system of services and supports. It is also critically missing from the current system. Thriving Kids must include the ability to measure outcomes, and the impact supports are having on the lives of children, their families, carers and kin. A performance management system needs to be designed, and data collected to monitor implementation, impact and the experience of those accessing services to ensure that policy objectives are achieved. This in turn will allow a process of continuous improvement to be established to strengthen the role that supports under the initiative have as part of the wider system available to people with disability and their families.
At an individual level, data should be regularly collected, analysed to measure outcomes (developmental, social, quality of life), identify gaps and inform service adjustments, ensuring supports are effective, efficient and responding to evolving needs.
A skilled, credentialed and accountable workforce
Effective delivery is underpinned by an appropriately skilled, credentialed and accountable workforce. A nationally consistent workforce registration/credentialling approach for child-development practitioners (including allied health and paraprofessionals) delivering early intervention supports should be considered. This would be tied to minimum capabilities, a structured continuing professional development (CPD) approach (neurodevelopment, family coaching, cultural safety, trauma informed practice) and audit pathways to prevent low-evidence interventions.
Embedding these expectations in funding contracts and supervision requirements would support increased service quality and reduced variability.
APM’s evidence-based approaches to supporting children and families thrive
APM delivers two key models of evidence-based support through our early childhood intervention and therapy services which we believe are highly relevant to the Thriving Kids initiative, building the capability and capacity of children, families and communities through delivery in naturalistic settings.
The Key Worker Transdisciplinary Approach
Everyday Independence (EI) uses the Key Worker Transdisciplinary Approach22 to deliver our social-routines model of supports.
Under this approach one lead professional (the key worker) partners closely with the family and the transdisciplinary team (Occupational Therapists [OT], Speech Pathologist [SP], Physiotherapist, Psychologist, etc.) shares knowledge and planning in partnership with the family so the family experiences one coherent plan rather than multiple disconnected therapists.
In the EI model, the Key Worker (KW) approach goes one step further and pairs a lead worker with a Habit Coach (HC) (allied health assistant). While the KW partners closely with the family and the transdisciplinary team, the HC provides longer, practical sessions and may work through an entire routine with the child and family to embed strategies in natural settings in a variety of contexts.
The focus of the model is on natural environments (home, childcare, community), coaching parents and caregivers in everyday routines to build the child’s participation and family capacity.
Evidence shows this approach improves family empowerment, goal attainment, and service efficiency particularly for children with multi-domain or complex developmental needs.
The Everyday Independence model also uses “F-words for Child Development” which is a family-friendly framework created by CanChild23 to help professionals and families assess, plan, and report on children’s development in a holistic, strengths-based way, and embeds progress measurement into practice using both the Canadian Occupational Performance Measure (COPM)24 which maps to the Australian Early Development Census (AEDC) domains25 and Goal Attainment Scaling (GAS).
COPM is a client-centred, self-rated tool. Children and/or caregivers identify the priority activities then rate Performance and Satisfaction on a 1-10 scale. Therapists facilitate the interview, but the scores themselves reflect the child’s or family’s own perception of change. For each goal we calculated the individual change score (post-intervention minus pre-intervention) for Performance (participation) and Satisfaction on the 10-point COPM scale, then averaged those change scores across all goals and children to obtain a service-level mean change.
The Early Start Denver Model
Early Start Australia (ESA) delivers the Early Start Denver Model (ESDM) as part of their evidence-based developmental-behavioural approach to early intervention. As one of the most effective early intervention therapies for children on the autism spectrum and with developmental delays, ESDM therapy is a fun and flexible intervention that follows a play-based approach to improve communication, social and cognitive skills. The ESDM is multi-disciplinary and works across all areas of development.
Importantly, the ESDM approach is child-led, allowing them to make the choices. In general terms, a family might find that the ESDM approach starts with a generalised and naturalist approach that focuses on individual motivation and what the child wants to do and enjoys. If the child doesn’t make progress, more structure might be brought in, but ESDM is always about learning through play-based activities. Fun activities are created to address a child’s goals and teaching needs.
22 CanChild Centre (n.d) The Key Worker Model 23 CanChild Centre (n.d) F-Words Resources 24 The Canadian Occupational Performance Measure 25 Australian Early Development Census (2025) About the AEDC Domains
ESDM is designed for toddlers and pre-schoolers but can help children from 12 months to 6 years of age. There are a variety of different service models, each shaped by the evidence-base, and this supports service delivery where children and families are in their developmental journey and the varying level of supports that they may need. For example, ESA delivers ESDM through:
- targeted early intervention playgroups
- childcare and kindergarten settings
- in home/in community
- group parent coaching groups (online)
- individual parent coaching, at homes, in clinic and online. This also provides remote supports.
In the context of Thriving Kids, the ESDM delivery can be scaled with studies indicating the benefits of light touch community embedded interventions26 for those with less significant support needs, while more intensive ESDM interventions can be delivered as and when needed.
The model has a strong focus on early parent/carer capacity building (P-ESDM) which has been shown to improve intervention/support delivery and child/family outcomes.27
ESA also supports broader workforce development, delivering ESDM coaching and training to early childhood educators and carers, further supporting the embedding of interventions in the places children spend the most time.
Responding to the Terms of Reference
In responding to the ToR our focus is on the current mainstream entry points to information and supports our services interact with regularly including maternal and child health (MCH/CFH), primary care (GPs), early childhood education and care (ECEC), playgroups and schools, and draws on the direct experience of our frontline staff with current state/territory programs.
TOR 1 – Evidence‑based identification & parent resources
What the evidence and practice show:
- Universal developmental surveillance works best when delivered in familiar settings (ECEC, school entry, MCH/CFH) using structured tools and prompts (e.g., personal health records).
- Parent‑facing tools that are simple, visual and strengths‑based increase help‑seeking and reduce stigma; culturally co‑designed materials improve uptake for First Nations and CALD families – e.g. Raising Children Network28
Persistent gaps:
- Uneven uptake of checks prior to school; families still carry the burden of navigation.
- Inconsistent language access (interpreters, translated resources) and limited culturally‑grounded materials.
- Limited digital integration between parent-held records and service data systems.
26 Vismara, L., et al. (2023). Abbreviating the Early Start Denver Model for community-based family-centered care. Frontiers in Psychology, 14. 27 Edilici R.,et al. (2021) The effectiveness of early parental coaching in the autism spectrum disorder. Jornal de Pediatria, 97, 4, 453-458. 28 Raising Children Network Parenting Website
Ideas to address:
- Commission a national ‘Learn‑the‑Signs’ style toolkit aligned to personal health records and ECEC educator guidance, co‑designed with First Nations and CALD communities.
- Alongside 3-year-old GP checks, fund national delivery of 4‑year‑old health & development checks in ECEC (opt‑out model) and strengthen school‑entry checks, with consented feedback to families and GPs.
- Publish simple pathway maps with localised referral points and expected timeframes.
TOR 2 – Effectiveness of programs across mainstream settings
What the evidence and practice show:
- Programs embedded in ECEC/schools and place‑based hubs (Children’s/Child & Parent/Family Learning Centres) consistently show better reach and warmer referrals than siloed clinic‑only models.
- Allied‑health coaching for educators (e.g., speech‑language, social‑emotional) lifts capability to support mild–moderate needs without over‑medicalising.
- First Nations‑led initiatives that pair comprehensive health checks with kindy enrolment and follow‑up demonstrate ‘closed‑loop’ effectiveness.
Persistent gaps:
- Fidelity varies across sites; outcomes are not consistently monitored beyond activity counts.
- Allied‑health waitlists and workforce churn reduce timeliness of supports, especially rural/remote.
- Fragmented commissioning across health, education and community services dilutes accountability.
Ideas to address:
- Scale evidence‑backed models: ECEC‑embedded checks, school‑entry assessments and hub‑based service integration.
- Commission allied‑health coaching packages for ECEC at scale (speech, OT, behaviour) tied to simple outcome indicators.
- Use outcome‑based, relational commissioning (shared metrics, joint governance) to align health, education and community providers.
TOR 3 – Equity & intersectionality (First Nations, CALD, rural/remote)
What the evidence and practice show:
- Culturally safe, community‑led approaches increase participation and follow‑through, trusted navigators and bilingual staff matter.
- Targeted ear and eye‑health programs address high‑burden conditions that impact language and learning.
- Transport, cost, and digital access are persistent barriers for rural/remote families.
Persistent gaps:
- Gaps in funded interpreting and translated materials in everyday delivery, not just policy.
- Limited scaling of First Nations‑designed models beyond specific regions.
- Data rarely disaggregated to track equity outcomes at service level.
Ideas to address:
- Commission First Nations‑led models (with ACCOs) and embed paid cultural liaison roles and bilingual workers in mainstream settings.
- Guarantee interpreting and translation as a funded line item across programs; support outreach/transport solutions.
- Require equity‑disaggregated reporting (First Nations, CALD, remoteness, socio‑economic) with targets to close gaps.
TOR 4 – Workforce support & training to deliver Thriving Kids
What the evidence and practice show:
- The binding constraint is allied‑health availability (notably speech pathology) and ECEC workforce capability.
- Coaching-in-place and micro‑credentials, paired with supervision communities, lift educator practice at scale.
- Remote models combining on‑site intensives with tele‑allied‑health extend reach.
Persistent gaps:
- Limited time and funding for backfill reduces access to PD/coaching.
- Complex referral guidance leads to variable educator confidence to act early.
- Recruitment/retention challenges in rural/remote areas.
Ideas to address:
- Fund national educator coaching (speech/OT/behaviour) with paid backfill and micro‑credentials; build supervision hubs.
- Publish ‘gold standard’ referral guidance and educator toolkits (decision trees, consent templates, scripts).
- Create pooled rural rotations and scholarships; blend telehealth with periodic on‑site clinics.
- Increase options for learning while earning through higher apprenticeships.
- Build a paraprofessional pipeline (allied health assistants) to help extend workforce reach.
TOR 5 – Domestic & international best practice
What the evidence and practice show:
- Common elements: universal surveillance with proportionate targeting; multidisciplinary hubs; strong school links; closed‑loop referral; family‑centred practice; and simple pathway maps.
- OECD‑aligned systems use shared outcomes across sectors rather than siloed KPIs.
- Countries with strong ‘preschool readiness’ checks and school‑entry assessments show higher early intervention coverage.
Persistent gaps:
- Australia’s strengths are unevenly distributed across jurisdictions; scale is patchy.
- Lack of a shared outcomes set across health–education–community limits system learning.
Ideas to address:
- Adopt a national outcomes set (access, timeliness, participation, family‑reported outcomes) applied locally.
- Publish a national pathway map and commissioning playbook modelled on high‑performing jurisdictions.
- Invest in evaluation for scaling: rapid cycle testing, common measures, learning collaboratives.
TOR 6 – Seamless transition through mainstream systems
What the evidence and practice show:
- Closed‑loop mechanisms—recall systems, co‑location, shared records, and proactive follow‑up—reduce drop‑off at handovers (ECEC↔MCH/CFH↔school).
- A designated ‘lead professional’ or navigator for higher‑risk families improves continuity.
- Transition statements and case conferencing support smooth handovers.
Persistent gaps:
- Information sharing is inconsistent; consent and privacy processes vary by provider/system.
- No single accountable owner for ensuring completed referrals and attended appointments.
Ideas to address:
- Mandate consented feedback loops (referral sent, appointment booked, outcome returned) for funded programs.
- Enable shared, parent‑held digital records that auto‑notify relevant providers at transitions.
- Fund navigators/liaison roles for vulnerable cohorts and set accountable transition metrics
Conclusion
Thriving Kids can be the bridge between universal mainstream supports and the NDIS, catching need early, matching support to complexity and building family capability in everyday contexts, but only if it is well designed, adequately funded and actively stewarded.
A national consistent, locally integrated system; universal screening; a complete stepped care model (including secondary referral and tailored individual interventions); a skilled, capable workforce that blends professional, para-professional and specialised consultation; equitable, mixed modality delivery; and embedded measurement are the critical ingredients. Together they create a coherent pathway that improves outcomes for children and families, reduces duplication and wait times and strengthens system efficiency and equity.
APM would welcome the opportunity to continue to work with government on the design, testing and implementation of Thriving Kids, leveraging demonstrated practice models, data capability, global knowledge and a national footprint, to help ensure Thriving Kids delivers on its promise: earlier support, better outcomes and a system that truly enables children and families to thrive.