NDIA Accountability Project

Submission 359 — Australian Nursing & Midwifery Federation (ANMF) — Inquiry into the Thriving Kids initiative

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Submission by the Australian Nursing and Midwifery Federation

Parliamentary Inquiry into the Thriving Kids Initiative

3 October 2025

Annie Butler
Federal Secretary

Australian Nursing and Midwifery Federation
Level 1, 365 Queen Street, Melbourne VIC 3000
E: anmffederal@anmf.org.au
W: www.anmf.org.au

Introduction

  1. The Australian Nursing and Midwifery Federation (ANMF) is Australia’s largest national union and professional nursing and midwifery organisation. In collaboration with the ANMF’s eight state and territory branches, we represent the professional, industrial and political interests of more than 345,000 nurses, midwives and care-workers across the country.

  2. Our members work in the public and private health, aged care and disability sectors across a wide variety of urban, rural and remote locations. We work with them to improve their ability to deliver safe and best practice care in each and every one of these settings, fulfil their professional goals and achieve a healthy work/life balance.

  3. Our strong and growing membership and integrated role as both a trade union and professional organisation provides us with a complete understanding of all aspects of the nursing and midwifery professions and see us uniquely placed to defend and advance our professions.

  4. Through our work with members, we aim to strengthen the contribution of nursing and midwifery to improving Australia’s health and aged care systems, and the health of our national and global communities.

  5. The ANMF thanks the House Standing Committee on Health, Aged Care and Disability for the opportunity to provide feedback on the Thriving Kids Initiative.

  6. Nurses and midwives provide care to children and families across the life span and many contexts of practice including acute care, early childhood services, general practice and schools and contribute significantly to the early identification, referral, and support of children and families experiencing developmental concerns within universal and targeted services. The ANMF commends the Hon Mark Butler, MP, for his vision to increase supports to children and families with developmental health needs. It is critical that new initiatives meet the needs of the target population and are resourced to achieve their aims.

Overview

  1. The ANMF is very concerned by several overarching misconceptions of the Thriving Kids Initiative.

  2. The program is listed for children aged 0-8 years of age with “mild to moderate” autism spectrum disorder (ASD) and states “children with permanent and significant disability will continue to be supported through the NDIS”. ASD is not a transient condition that children grow out of, nor does a presentation of mild-to-moderate ASD reflect the daily struggles or care needs of the individual. The levels of ASD described by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) serve to act as a clinical guide for broadly defining the differences in social and communication skills under the neurodevelopmental umbrella. However, they are often applied as functional labels which inaccurately reflect the support needs of the individual and their family. The failing of the NDIS to provide funding to support individuals with a level 1 ASD diagnosis despite their need for multiple layers of intervention not dissimilar to those with a level 2 ASD diagnosis, is an example of this.

  3. The language used in the Thriving Kids initiative appears to have a single worldview that ASD is its own diagnosis with its own struggles that can be managed with early intervention. What it does not seem to address is that ASD falls under a wider umbrella of neurodevelopmental disorders, which encompasses Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Obsessive Compulsive Disorder, Rett’s Syndrome and more. There are also higher risks of poor mental health in neurodivergent individuals. These conditions typically overlap, and it is more common than not to have several diagnoses alongside each other^12^

  4. In designing and implementing the Thriving Kids Initiative it is critical policy makers act on the understanding that children with ASD are not homogenous in their presentation. Regardless of the assessed “level”, individuals often have other neurodivergent or mental

health diagnoses, they will likely always require support, and this support may change over time with potential periods of greater support needs. Supporting children and their families to access early identification, early intervention and care, must be viewed through an individualised lens, on a case-by-case basis, and in the broader health care context of ongoing care into adolescence and adulthood.

Response to the Terms of Reference

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

  1. The phenomenon of self-diagnosis via internet information is increasingly common in the digital age and, often, increased by barriers to accessing professional care. The identification of mild to moderate developmental delay is nuanced and complex; child development cannot be viewed in isolation from the physical, mental and social elements of health and wellbeing. Information and resources that could assist parents in identifying if their child has mild to moderate developmental delay without the input of a health practitioner must be promoted with caution. Such tools should ensure they target awareness building, early help seeking and resourced pathways for timely support and formal assessment.

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

  1. The ANMF supports the Thriving Kids Initiative aim to scale up and build on existing mainstream and community services in principle to support access to professional care, assessment and early intervention.

  2. Nurses and midwives provide comprehensive health and development assessments via Maternal Child and Family Health (MCFH) services and school nursing programs. They also provide support to families to manage complex health care needs. However, it should be noted that ASD often requires a specialised and multi-disciplinary team care approach.

  1. To leverage existing MCFH and school nursing services to meet the needs of people with ASD, the current deficits in these programs need to be acknowledged and acted on.

  2. There is currently no national approach to developmental screening nor equitable access to MCFH or school nursing services in Australia. In many jurisdictions MCFH services and school nurse programs are under resourced, understaffed or non-existent and nurses and midwives are under increasing time constraints to deliver more complex care.

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

  1. The Australian Early Development Census (AEDC) National Report 2021 evidenced that language and cognitive skill developmental vulnerabilities in children increase concurrently with remoteness. These vulnerabilities are exacerbated by the systemic barriers and structural disadvantage already endured in regional, rural and remote communities including a lower socioeconomic demographic and poor access to health care through health workforce deficits and severely limited referral pathways.

  2. Language and cognitive skill developmental vulnerabilities in children are also exacerbated by the ongoing impacts of intergenerational trauma in First Nations populations. The ANMF acknowledges the profound connection to land and Country in First Nations culture. This connection not only shapes identity but also encompasses responsibilities, spirituality, social kinship, and emotional well-being. Culturally safe healthcare is imperative in improving access and addressing the gaps in health outcomes for First Nations children and families in rural and remote NSW communities.

  3. The complexities of geographical location in accessing healthcare for First Nations people must also not be overlooked. Approximately 6.0% of First Nations people live in remote areas, whilst 9.4% live very remotely. Moreover, the proportion of the total population who identify as being Aboriginal and/or Torres Strait Islander increases with remoteness. Due to this, reliance on westernised models of care, travelling to nearby towns or implementing

telehealth services for early childhood health and development assessments is not always conducive with Cultural Safety in rural and remote communities.

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

  1. The inference of the term “mild to moderate support needs” downplays the extensive support a child presenting with level 1 or 2 ASD may require. A child with ASD, of any level, likely requires, at minimum, multidisciplinary input from a general practitioner, paediatrician, psychologist, speech therapist and occupational therapist.

  2. Whilst MCFH and school nurse programs may be able to provide initial identification and support for children experiencing developmental delay and ongoing support for parents to meet their children’s needs, it is inappropriate to divert specialist input to mainstream systems in the absence of robustly scrutinised evidence that demonstrates best practice.

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.

  1. There are several examples of effective programs and initiatives that identify children with developmental delay. Such as:

    • The Bellies and New Life Program, New South Wales (NSW)

    Upon the identification of significant MCFH service disengagement in Warren in Western NSW, the Bellies and New Life program was established through collaboration with Warraan Widji Arts, a local Wayilwan language and cultural community group. Funded by the NSW Department of Aboriginal Affairs, Bellies and New Life utilises cultural dance, language, and music to encourage First Nation’s pregnant women to paint belly castings and yarn with Elders, whilst simultaneously being linked into MCFH services with the

support of an Aboriginal Health Worker (AHW). The program highlights the importance of MCFH services working in partnership with AHWs to address service gaps.

*   The implementation of the Monitoring of Social Attention, Interaction and Communication (MoSAIC) tool in Victorian maternal and child health services provides evidence of integration of a validated developmental assessment tool in MCFH services.

22. It must be noted that these programs are embedded in universal access to early childhood health and wellbeing care, not a specialised service for supporting children with ASD. Furthermore, the success of these programs is dependent on providing a workforce that has the time, skills and competence to engage with children and families to assess, manage and support holistic health and wellbeing, not provide developmental screening in isolation

Recommendations

  1. The ANMF requests the Committee considers the feasibility of the current Thriving Kids initiative proposal to meet the needs of young children with developmental delay and their families.

  2. If the Thriving Kids initiative is to deliver its aims, significant reform and governance of early childhood services to all children and their families must occur. Furthermore, specialised care to support people with ASD to thrive, must not be underestimated or compromised.

  3. The ANMF recommends the Thriving Kids Initiative develop a suite of actions to build on and strengthen existing services and whilst enabling continued access to specialist services. These actions must include:

    • increased funding for universal MCFH nursing care and school nursing programs to enable early detection of developmental delay in young children, embedded in holistic health assessments

    • improved access to universal MCFH nursing care and school nursing programs, including all geographical locations, targeting regional, rural and remote communities, families

  • with or at risk of low health literacy, Aboriginal and Torres Strait Islander peoples, and culturally and linguistically diverse populations

  • introduction of a national framework for MCFH nursing care that articulates core elements of service delivery, including minimum service delivery standards and evidence-based assessment of developmental delay

  • career pathways for MCFH nurses to develop and specialise in neurodevelopmental support

  • workforce education relating to holistic developmental delay assessment and referral such as family centred approaches to care, perinatal mental health, trauma-informed care, culturally safe practice and use of neuro-affirming language

  • robust referral pathways including removal of system inefficiencies that prevent nurses and midwives referring to specialist services following the use of evidence-based assessment and validated tools

  • development and funding of programs to support families who are waiting for access to further assessment and intervention programs including integration of specialised services

  • implementation of culturally safe, Aboriginal and Torres Strait Islander-led models of primary health care and pathways to specialised services

  • address the underrepresentation of Aboriginal and Torres Strait Islander participation in the healthcare workforce across all disciplines

  • fast-tracked access to a National Disability Insurance Scheme (NDIS) Plan in the event that consumers within the Thriving Kids Initiative are determined to need a higher level of care, thus ensuring continuity of supportive care and equity of access to this scheme.

Conclusion

  1. Thank you for the opportunity to provide feedback on the Thriving Kids Initiative. Nurses and midwives play a critical role in the identification and support of children and families experiencing developmental delay. The limitations of existing services must be addressed to create a strong foundation for future growth. It is imperative the Thriving Kids Initiative is underpinned by specialist knowledge of ASD and endeavours to support young children with ASD in mainstream systems does not compromise access to specialist services.