Partnering for Better Outcomes
Supporting the Thriving Kids initiative through primary health care nursing
A joint submission from the Australian Primary Health Care Nurses Association and the Maternal, Child & Family Health Nurses Australia
Acknowledgement of Country.
APNA and MCaFHNA acknowledge Aboriginal and Torres Strait Islander peoples as the Traditional Custodians of the lands and waters on which we live, work and learn.
Executive summary
The use of developmental and autism screening tools across Australia’s states and territories is inconsistent, leading to significant variability in how early childhood developmental concerns are identified and managed. This inconsistency means that a child’s access to early identification and intervention services is impacted by where they live - it is in effect a post-code lottery for access to assessment and supports during a critical period in a child’s life.
Primary health care nurses (which includes practice nurses, maternal child and family health nurses, community First Nations nurses and others), are uniquely positioned across the Australian health care sector to support parents with questions or concerns about their child’s development.
Primary health care nurses have a critical role to play in supporting the early identification of developmental delay and autism in children, as they frequently care1 for families across both metropolitan and rural areas. Government can strengthen and expand the role of primary health care nurses as frontline professionals who can provide early identification, support, and referrals for children with developmental needs.
Providing these nurses with training in evidence-based screening tools - delivered by respected and established organisations such as the Australian Primary Health Care Nurses Association (APNA) and Maternal Child and Family Health Nurses Australia M (MCaFHNA) - promotes consistent, high-quality, and credible practice across the sector.
Supporting primary health care nurses as the first point of contact for parents and families will help ensure that children receive timely, appropriate care within the community.
Recommendation 1: No child should lose support until an evidence based, affordable and accessible alternative is in place.
Recommendation 2: The Commonwealth to support child assessment and screenings to be completed at 18 months of age, using a standardised national tool.
Recommendation 3: Potential new MBS items for child assessment to be accessible by nurse practitioners and appropriately qualified primary health care registered nurses.
Recommendation 4: Nurse practitioners and appropriately qualified registered nurses with specific training are able to make referrals to relevant specialists, reducing waiting times for care.
Recommendation 5: The Commonwealth to fund a national organisation with demonstrated expertise in primary health care nursing to develop and deliver a program to train primary health care nurses on the use and benefits of assessment tools.
Recommendation 6: The Commonwealth to fund an advertising campaign to highlight to parents the benefits of assessment tools and early assessment.
1 A profile of primary health care nurses , About - Australian Institute of Health and Welfare
About APNA
The Australian Primary Health Care Nurses Association (APNA) is the peak body and professional membership association for the 98,000+ nurses working outside of a hospital setting in Australia. APNA champions the role of primary health care nurses; to advance professional recognition, ensure workforce sustainability, nurture leadership in health, and optimise the role of nurses in patient-centred care.
APNA is bold, vibrant and future-focused. We reflect the views of our membership and the broader profession by bringing together nurses from across Australia to represent, advocate, promote and celebrate the achievements of nurses in primary health care.
About MCaFHNA
The Maternal, Child and Family Health Nurses Australia (MCaFHNA) serve as the leading professional body representing nurses who specialise in maternal, child, and family health. The organisation is committed to promoting and advocating for the best possible health and wellbeing of young children and their families within their communities, focusing on the specialty of maternal, child, and family health nursing.
Maternal, child and family health nursing is recognised as a primary health care service, with practice locations ranging from urban to regional and remote areas. Maternal, child and family health nurses provide care across primary, secondary, and tertiary health services and may be employed in a variety of settings, including community health services, hospitals, specialist day stay and residential family care centres, women’s and children’s refuges, specialised residential recovery facilities, medical practices, and pharmacies.
About primary health care nurses
Australia’s 98,000+ primary health care nurses play a critical role in disease prevention and control to keep people healthy. They provide proactive care and health promotion to keep Australians well.
Primary health care is a whole of society approach to health care that occurs outside a hospital setting. It includes primary care, which is the first level of contact that individuals, families and communities have with the healthcare system.2 In Australia, this:
- Incorporates personal care with health promotion, the prevention of illness and community development;
- Includes the interconnecting principles of equity, access, empowerment, community self-determination and inter-sectoral collaboration, and;
- Encompasses an understanding of the social, economic, cultural and political determinants of health.
Primary health care nurses work in diverse settings such as general practices, maternal, child and family health services, community health centres, and aged care facilities, focusing on health promotion, disease prevention, chronic disease management, and treatment of common illnesses. Their role is crucial in improving health outcomes and reducing pressure on hospitals by providing person-centered, proactive care within the community.
2 The role of Primary Health Care, primary care and hospitals in advancing Universal Health Coverage - PMC 3 About primary care | Australian Government Department of Health, Disability and Ageing
What nurses are currently doing
APNA’s annual Workforce Survey has been running for over two decades, providing APNA, government and the broader health sector with critical insights informing policy, practice, research, and advocacy, leading to meaningful improvements in primary health care nursing across Australia.4 It is an in-depth survey that captures a wide range of information, including scope of practice, intentions to remain in the profession, pay and conditions, and nearly 100 nursing activities - highlighting the breadth of primary health care nursing roles.
APNA’s 2024 Workforce Survey data shows that the top activity undertaken by nurses in maternal and child health services was children’s health assessments, with 83% regularly undertaking that activity, followed by 75% regularly undertaking postnatal and infant checks.
59% of nurses in maternal, child and family health services regularly undertook home visits. This is an important activity, as it enables nurses to interact with children in the home, providing important insights in to the child’s behaviour, development, and their family environment (including potential risk factors for developmental delays such as family and domestic violence).
64% of nurses in maternal, child and family health services regularly undertook referrals to external practitioners and services, as did 68% of nurse practitioners, highlighting the important role of nurses in supporting parents to access further care.
It is evident that nurses value the opportunity to engage with and support children and their families. The intention to remain in the primary health care workforce amongst nurses working in maternal, child and family health services was very high (93% likely or very likely to remain in the primary health care workforce over 12 months, and 83% over 2-5 years), and in fact substantially higher than the broader primary health care nursing workforce (82% likely or very likely to remain in primary health care workforce over 12 months, and 66% over 2-5 years).
We would be happy to provide further data and information to the Committee via the Secretariat if there are specific activities or figures from APNA’s annual Workforce Survey which are of interest to the Committee.
The current state of screening and assessment for developmental delays
The use of developmental and autism screening tools across Australia’s states and territories is inconsistent, leading to significant variability in how early childhood developmental concerns are identified and managed. This inconsistency means that a child’s access to early identification and intervention services is impacted by where they live - it is in effect a post-code lottery for access to assessment and supports during a critical period in a child’s life.
- For children and their parents, this can result in confusion, delayed diagnoses, or missed opportunities for early support - especially for those in under-resourced or rural areas.
- For nurses and other professionals, the lack of a nationally standardised approach creates challenges in training, confidence, and consistency of care, making it harder to ensure equitable developmental surveillance and timely referrals across the country.
As set out in detail further below, a more unified national strategy would help reduce these disparities and strengthen early intervention efforts.
Attachment A to this submission sets out our understanding of the current context in terms of different early assessment tools, and the jurisdictions in which they are used.
4 K Moore, The APNA Workforce Survey, Primary Times, 2025.
No-gap protections
The Thriving Kids initiative has been announced in the context of Commonwealth-state negotiations and public discussion over the costs associated with the National Disability Insurance Scheme. As Minister Butler noted in his National Press Club Address: “Families looking for additional supports in mainstream services can’t find them, because they largely don’t exist anymore. And, in that, governments have failed them.”5
In response, families and advocates have raised concerns about what the proposed changes may mean in terms of their access to existing support (including via the NDIS), and potential loss of services for their children.6
We recognise and value the contribution of advocacy organisations such as the Australian Autism Alliance and others in highlighting the impact of policy changes on NDIS participants. We support the positioned by the Australian Autism Alliance, that “No child should lose support until suitable, affordable, and accessible alternatives are in place and proven to work.”7 We believe this principle should inform the Commonwealth in its discussions with state and territory governments over health system reform, hospital funding, and interactions with NDIS funding and supports.
Recommendation 1: No child should lose support until an evidence based, affordable and accessible alternative is in place.
The importance of early identification
Neuroplasticity is a vital contributor to early intervention success rates and refers to the brain’s innate response to new information or experiences that allows it to restructure neural connections and pathways. Younger children’s increased neuroplasticity makes them more likely to demonstrate significant gains from intervention compared with those who receive similar services later in development.
Standardised and systematic developmental screening significantly enhances early diagnosis rates and ensures timely access to early intervention services for children showing signs of Developmental Delay and Autism.
Despite growing awareness, research shows a considerable delay often exists between the time parents first express concerns and when a formal diagnosis is made. To close this gap, regular national screening for early signs of developmental delay and autism is essential.
Primary health care nurses are at the frontline of developmental surveillance and play a crucial role in promoting equitable access to early intervention.8 Through routine assessments - particularly the 18-month health check (tied in with 18-month immunisation) - these primary health care nurses are well-positioned to identify early signs of developmental delay and autism / neurodiverse conditions and facilitate timely referrals for further evaluation and support.
Importantly, primary health care nurses can also provide support in diverse contexts, particularly for children from First Nations communities and culturally and linguistically diverse (CALD) backgrounds. These groups often face additional barriers to timely diagnosis and support, making culturally sensitive, community-informed care models essential. Nurses are uniquely placed to advocate for and
implement these inclusive approaches within local health systems, providing a clear pathway to addressing some of the systemic equity and intersectional issues that impact CALD and First Nations children.
The benefits of early screening
Recent research9 examining the characteristics of toddlers with early versus later diagnosis of Autism highlights the importance of early assessment:
- Early Intervention: Early diagnosis of autism can lead to earlier treatment, which improves developmental outcomes and allows children to receive necessary support.
- Missed Diagnoses: Many children are diagnosed later in life, missing the crucial period for early intervention, making 18-month screening a key opportunity for early detection.
- Milder Symptoms: Screening at 18 months can identify toddlers with milder symptoms who are more receptive to intervention.
The American Academy of Pediatrics10 recommends that all children should be screened for autism at both 18 and 24 months, in addition to ongoing developmental monitoring. This recommendation supports global best practice and aligns with evidence showing that early intervention during periods of heightened neuroplasticity can lead to significant gains in social communication and cognitive functioning.
The Australian National Guidelines for including mental health and wellbeing in early childhood checks (2025) evidence indicates that the first 2,000 days of life are a critical period and providing support during this time can significantly improve a child’s early life experiences, health and development.11
Ongoing training and workforce support can strengthen the role that primary health care nurses play in early assessment and intervention.
Initiatives like Thriving Kids, implemented through APNA models of care, can provide structured pathways and professional development that enable nurses to deliver high-quality, evidence-based developmental screening and early intervention services. Furthermore, it is essential to identify mechanisms that allow for a seamless transition through mainstream systems, especially for children with mild to moderate support needs.
Primary health care nurses can help bridge service gaps by coordinating care across sectors and advocating for flexible, responsive systems that meet children and families where they are - regardless of background or need.
By leveraging their ongoing relationships with families, cultural competence, and community insight, nurses in primary health care settings are optimally positioned to advance early identification, reduce disparities, and facilitate equitable access to intervention services for all children. This provides a clear pathway and framework, as set out in the Committee’s terms of reference, to “identify children with development delay, autism or both, with mild to moderate support needs and support them and their families”.
Recommendation 2: The Commonwealth supports health assessment and screenings to be completed at 18 months of age, using a standardised national tool.
9 Characteristics of Toddlers with Early Versus Later Diagnosis of Autism Spectrum Disorder - PMC 10 Identification, Evaluation, and Management of Children With Autism Spectrum Disorder | Pediatrics | American Academy of Pediatrics 11 National Guidelines for including mental health and wellbeing in early childhood health checks
The workforce to provide parents with early assessment
To support parents to access early assessments and referrals, nurses can play a critical role in early detection and intervention. This can make it easier and more accessible for parents to get the early assessment that can be so critical, and the referrals and support that they need, by broadening the pool of practitioners who can provide support (there are almost five times as many primary health care nurses in general practice as there are pediatricians in Australia). This requires support for the nursing workforce, including training in the use of a standardised assessment tool.
While in the short term there are temporary instances of imbalance between hospital needs and graduate numbers,12 the Department of Health and Aged Care (in material prepared prior to portfolio changes) has projected a growing shortfall in the national nursing workforce, increasing until at least 2035.13
Programs like APNA’s Nursing in Primary Health Care Program can support strengthening the capacity, role and utilisation of the Australian primary health care nursing workforce to address the community’s health care needs, including through improving employment opportunities, recruitment, and retention of nurses in primary health care settings.14
Programs such as these can support the workforce needed to ensure parents can access early assessment and intervention, which can make a critical difference in the early years of a child’s life.
Ensuring nurses are funded to provide support
Currently, primary health care nurses working in general practice and other primary health care settings do not have a Medicare Billing Schedule (MBS) item to enable funding for early assessment and referrals.
A number of reviews and reports have highlighted gaps and structural challenges in the current MBS structure.15 If government is considering adding an MBS item for early identification checks,16 then ensuring that nurse practitioners and appropriately qualified registered nurses are able to access the MBS item will create a clear funding signal to primary health care nurses, and the general practices and other primary health care workplaces in which they provide care, of the importance of early assessment. This will address a clear gap in workforce support, to provide greater support for nurses to undertake assessments.
Recommendation 3: Potential new MBS items for child assessment to be accessible by nurse practitioners and appropriately qualified primary health care registered nurses.
The need for referral pathways
One of the central issues identified in the Scope of Practice Review was the need for improvements to referral pathways. The report outlined in detail the constraints that health practitioners can encounter when making referrals and interacting with the Medicare Billing Schedule:
“Payment rules about which health professions can provide referrals to non-GP medical specialists are tightly defined under the Health Insurance Act 1973 (Health Insurance Act) and associated regulations.
Under these rules, consumers referred to as non-GP medical specialists including imaging or pathology, cannot receive MBS benefits for that service unless the referral was provided by a defined health professional under specified circumstances. In most instances, the referring health professional is required to direct the consumer to a GP who then makes the referral to the non-GP medical specialists.
Outside of referrals provided by specific named professions, these regulations prevent the consumer from being eligible for MBS benefits for the referred service, resulting in out-of-pocket costs by default. For consumers, this creates both cost and time barriers to accessing primary care because, despite receiving care and referral advice from a health professional of their choice, they are often required to undertake a secondary consultation (typically with a GP) to access the required referral.“
For primary health care nurses, this means that even where within their scope of practice they can identify the need for referral to a specialist, they cannot make that referral in a way that enables the parent to access the Medicare rebate.
The Scope of Practice review recommended structural changes to address this issue. It specifically recommended that:
The Australian Government implement new direct referral pathways for consumer access to specified non-General Practitioner (GP) specialist Medicare Benefits Schedule (MBS) items which meet the following criteria:
A. The direct referral made by the health professional is within their scope of practice
B. The referral is accompanied by appropriate, timely notification of the consultation to relevant treating team members including the patient’s GP, and registered practice via digital mechanisms as available.18
Where nurse practitioners and appropriately qualified registered nurses are able to undertake an early assessment, enabling direct referral within the nurses’ scope of practice can support earlier intervention, with significant benefits for children and their families. This will enable smoother transitions for children with mild to moderate support needs in accessing support services.
Recommendation 4: Nurse practitioners and appropriately qualified registered nurses with specific training are able to make referrals to relevant specialists, reducing waiting times for care.
Need for training for the workforce
We need to leverage the critical primary health care nursing workforce to support early identification of developmental delay and autism in children, as they are often the first point of contact for families in both urban and rural settings.
Training these nurses in evidence-based screening tools through well-recognised and trusted organisations like APNA and MCaFHNA ensures consistency, quality, and credibility in practice.
By equipping primary health care nurses with the right skills and resources, we can facilitate earlier detection and intervention, reduce delays in diagnosis, and ease the burden on the NDIS System by streamlining access to appropriate services. This proactive approach not only strengthens the role of primary health care nurses in child development but also helps ensure that children receive timely support, improving long-term outcomes and reducing system strain.
The model below demonstrates this capability through APNA and MCaFHNA. This will address a clear opportunity in supporting the workforces needed to deliver the Thriving Kids initiative.
Recommendation 5: The Commonwealth to fund national organisations with demonstrated expertise in primary health care nursing to develop and deliver a program to train primary health care nurses on the use and benefits of assessment tools.
Parental awareness and engagement
Primary health care nurses occupy a unique position - they conduct routine developmental surveillance, apply validated screening tools, and observe early warning signs, often before children start school.
Their accessibility and close connection to the community make them a valuable first point of contact for discussing developmental milestones, including screening for autism and developmental delay.
- It is often easy for parents to seek out a nurse, whether in a general practice clinic or in rural and remote areas, to make an appointment - helping to reduce parental anxiety and provide reassurance and screening early.
- Parental awareness of the early signs of mild to moderate autism and developmental delays is essential for timely intervention and improved outcomes in a child’s development.
- Early signs - such as limited eye contact, delayed speech, repetitive behaviours, or lack of interest in social interactions - can sometimes be subtle and easily overlooked, especially in milder cases.
- When parents are knowledgeable about these indicators, they are more likely to seek early assessment and support, which can lead to earlier diagnoses and access to crucial therapeutic services.
Early intervention is widely recognised to significantly enhance a child’s cognitive, social, and emotional development, potentially reducing the long-term impact of autism or developmental delays.
A substantial delay often exists between the time parents first notice early developmental concerns (typically between ages 1-2) and when a formal autism diagnosis is made (around ages 3-5), undermining timely intervention.19
Primary health care nurses play a critical role in supporting families through this process by offering both emotional reassurance and educational guidance. They are often the first point of contact for parents concerned about their child’s development and can help normalise parental concerns while also validating them.
Nurses can provide accurate information about developmental milestones, facilitate timely referrals to specialists, and connect families with community resources and support groups.20
Additionally, by fostering trusting relationships and providing empathetic, nonjudgmental communication, nurses can help reduce the stigma and anxiety parents may feel, empowering them to take proactive steps in their child’s care journey.
Recommendation 6: The Commonwealth to fund an advertising campaign (through Primary Health Networks or other appropriate bodies) to highlight to parents the benefits of assessment tools and early assessment.
19 Parents’ Early Concerns about Their Child with Autism: Relation to Age of Diagnosis - PubMed 20 Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening - PubMed
Conclusion
The use of developmental and autism screening tools across Australia’s states and territories is inconsistent, leading to significant variability in how early childhood developmental concerns are identified and managed. This inconsistency means that a child’s access to early identification and intervention services is impacted by where they live - it is in effect a post-code lottery for access to assessment and supports a critical period in a child’s life.
Primary health care nurses have a critical role to play in supporting the early identification of developmental delay and autism in children, as they frequently21 for families across both metropolitan and rural areas. Government can strengthen and expand the role of primary health care nurses as frontline professionals who can provide early identification, support, and referrals for children with developmental needs.
Providing these nurses with training in evidence-based screening tools - delivered by respected and established organisations such as the APNA and MCaFHNA - promotes consistent, high-quality, and credible practice across the sector.
Supporting primary health care nurses as the first point of contact for parents and families will help ensure that children receive timely, appropriate care within the community.
21 A profile of primary health care nurses , About - Australian Institute of Health and Welfare
Glossary
Autism is a neurodevelopmental condition that primarily affects social communication and behaviour.
Developmental delay refers to a delay in reaching one or more developmental milestones (e.g., motor skills, speech, cognitive abilities, social-emotional development). Children may have mild to moderate delays but can still develop with the right interventions and support.
Maternal, child and family health nurse: In Australia, a maternal, child and family health nurse is a registered nurse and/or midwife with additional postgraduate qualifications in child and family health, providing primary health care to families with children from birth to school entry (around age six).
Neurodiversity: Neurodiversity is the concept that human brains vary naturally in how they function and perceive the world, with neurodivergent being the term for individuals whose brains differ from the typical (neurotypical) brain, including those with autism, ADHD, and dyslexia. Therefore, autism is one example of neurodivergence, fitting within the broader framework of neurodiversity.
Neuroplasticity: Early childhood is a period of intense brain development. When delays or autism are identified early, interventions can capitalise on the brain’s plasticity to help children develop skills more effectively
Nurse practitioner: a Nurse practitioner is a registered nurse with additional master’s level education and extensive clinical experience, who is endorsed by the Nursing and Midwifery Board of Australia (NMBA) to provide advanced and independent nursing care.
Practice nurse: a practice nurse is a registered nurse or enrolled nurse who works within a general practice to support patient care by providing a range of nursing services.
Primary health care nurse: a qualified nurse who provides accessible, coordinated care outside of a hospital setting. They work in diverse settings such as general practices, maternal, child and family health services, community health centres, and aged care facilities, focusing on health promotion, disease prevention, chronic disease management, and treatment of common illnesses. Their role is crucial in improving health outcomes and reducing pressure on hospitals by providing person-centered, proactive care within the community.
Attachment A: Assessment tools
This summary is not definitive but represents our understanding of the current context in terms of different early assessment tools, and the ways they are used in different states and territories.
ASQ-3
- A parent- completed developmental screening questionnaire (assesses gross motor, fine motor, communication and person/social skills - also ASQ- SE (social- emotional).
- Used in WA, QLD, ACT, TAS, SA, and NSW as a secondary assessment.
- 1 month - 5 years.
- Can be used by primary health care nurses (requires training);
Learn the signs act early
- A validated child development screening tool to be completed by parents to detect early developmental delays;
- Used in NSW, Qld, ACT, NT;
- 0-5 years;
- Replaces PEDS;
- Can be used by primary health care nurses;
Parents’ Evaluation of Developmental Status (PEDS-R)
- 10 items - Parent Questionnaire that highlight parental concerns across multiple developmental domains
- Used in VIC and SA, and available in QLD
- 0-8 years;
- Can be used by primary health care nurses;
Brigance Screening Tool
- A developmental screening and assessment tool designed to identify potential delays in young children and inform early intervention.
- Used in SA, and in VIC as a secondary screening tool;
- 1 month - 5 years;
- Administered by primary health care nurses (requires training);
SACS-R (Social Attention and Communication Surveillance)
- SACS-R (Social Attention and Communication Surveillance - Revised) screening tool is primarily designed to detect early signs of autism, but research has shown that it can also identify children with broader developmental delays, particularly in communication and social-emotional domains.
- This is a Tailored Screening tool and validated globally - best for Autism-specific early signs;
- Used in VIC, TAS, with some training available in NSW, SA, QLD and WA
- 12-24 months;
- Can be used by primary health care nurses (requires training);