3. Equity and Inclusion
   1. This chapter reflects the commentary the Committee heard about key areas of concern in relation to equity and inclusion for children with developmental delay and their families.
   2. Evidence received by the Committee consistently raised issues faced by First Nations and CALD families, and families in rural and remote areas, particularly that these groups ‘report limited availability of services or a lack of cultural safety.’[1]
   3. The chapter also reflects on evidence received about other challenges relating to equity and inclusion, including socio-economic factors and school and community integration.
   4. The Committee acknowledges the regular intersection and overlap between these issues and how this compounding can impact barriers to children and their carers accessing critical services and support.
   5. Ms Nicole Avery, Chief Executive Officer of South-West Autism Network (SWAN), drew attention to the compounded barriers that CALD families, regional and remote families and low-income households face. She reported that in a recent national survey conducted by SWAN, 90 per cent of the 360 respondents said that it was ‘critical that Thriving Kids address the unique needs of these groups with embedded, locally delivered and culturally safe supports.’[2]
   6. Various submitters and witnesses emphasised the view that equity and inclusion must be central to the design and implementation of Thriving Kids.
   7. A submission from the Australian Council of State School Organisations (ACSSO) summarised:

Equity must sit at the heart of the Thriving Kids initiative. Developmental vulnerability is not evenly distributed across the population: Aboriginal and Torres Strait Islander children, children from culturally and linguistically diverse (CALD) backgrounds, and those living in rural and remote areas are more likely to face barriers in access, affordability, and cultural safety. Without deliberate action, Thriving Kids risks reproducing the same inequities that have long plagued early childhood and disability systems.[3]

3.8Ms Katherine Utry, General Manager, Policy and Government Relations, Australian Physiotherapy Association explained:

Outside the NDIS, access to all allied health is certainly inconsistent, and those inconsistencies are greatest for people in rural settings, Aboriginal and Torres Strait Islander communities, and culturally and linguistically diverse communities. This is why we really need equity focused measures within Thriving Kids to make sure that it doesn't widen those existing gaps and to make sure that it fills those gaps really thoroughly.[4]

3.9Mr Ross Joyce, Chief Executive Officer, Australian Federation of Disability Organisations advised the Committee:

Thriving Kids must be culturally safe and responsive. It must work for First Nations families, for children in out-of-home care, and for those from culturally and linguistically diverse backgrounds, inclusive of our deaf community. Community controlled and grassroots organisations should be central partners in that delivery. AFDO and our member organisations are ready to stand with the government and work on this—and with the committee—to ensure that Thriving Kids becomes what it should be: a strong, equitable and inclusive system of foundational supports.[5]

Aboriginal and Torres Strait Islander children and communities

3.10Aboriginal and Torres Strait Islander Australians experience higher rates of disability compared to Australia’s general population. After factoring in age differences between the Indigenous and non-Indigenous populations, the rate of disability among Aboriginal and Torres Strait Islander Australians is almost double the rate among non-Indigenous people. However, the National Disability Insurance Scheme (NDIS) reports that the total proportion of First Nations participants in the NDIS is 8.2 per cent as of 30 June 2025.[6] Of this, half of First Nations participants on the scheme are aged 14 and below.[7]

3.11The National Aboriginal Community Controlled Health Organisations (NACCHO) commented on the importance of early intervention programs for Aboriginal and Torres Strait Islander children noting that they ‘in the 2021 Australian Early Development Census were 20 per cent more developmentally vulnerable on one or more domains, compared to non-Indigenous children (42 per cent compared with 22 per cent).’[8] They added:

Aboriginal and Torres Strait Islander people are twice as likely to experience disability than other Australians. Aboriginal children are twice as likely to be developmentally vulnerable at school entry.[9]

3.12The Committee received evidence about the lived experience of First Nations children with a disability and their carers, including the issues faced by First Nations communities accessing disability services and support, and reflections about the experiences and priorities of First Nations communities inputting into program design.

3.13A lack of cultural safety in program design, diagnostic tools and disability services was an issue that was raised frequently by stakeholders.

Lived experience of First Nations people with disability

3.14Mr Damian Griffis, Chief Executive Officer at the First Peoples Disability Network, highlighted it is ‘difficult to think of any more disadvantaged Australians than First Nations people with disabilities … because we often experience discrimination based upon indigeneity and disability.’[10] He added:

Right now, only 33.9 per cent of Aboriginal and Torres Strait Islander children start school developmentally on track—far short of the 2031 target of 55 per cent.[11]

3.15Associate Professor Clinton Schultz, Director of First Nations Strategy and Partnerships at the Black Dog Institute, suggested that the Aboriginal and Torres Strait Islander young people who experience autism—and their families—could be one of the most marginalised groups in Australian schools.[12] He stated:

…when we're looking at groups in that school based age. They face all the same challenges with the systems—access et cetera—that we have just spoken about, but we can't deny that there is also that overlay and that intersectionality of discrimination that exists within systems within Australia in the experiences of Aboriginal and Torres Strait Islander people.[13]

3.16SNAICC – National Voice for Our Children highlighted the ongoing impacts of colonisation, noting that it results in:

Aboriginal and Torres Strait Islander people with disability experiencing different forms of discrimination such as racism, ableism and intersectional and structural discrimination, significantly impacting on their rights, health, safety and wellbeing. Aboriginal and Torres Islander people with disability, after experiencing these different forms of discrimination, can often respond with what is known as ‘apprehended discrimination’; a fear of encountering prejudice that causes social avoidance and makes them reluctant to access disability supports and participate in the broader community. This intersectional disadvantage and ‘double discrimination’ leads to major barriers to access in ECEC settings, barriers that results in poorer treatment and outcomes for Aboriginal and Torres Strait Islander children with disability.[14]

Distrust of institutional care

3.17Several organisations noted a lack of trust in institutional care among Aboriginal and Torres Strait Islander peoples, identifying this as a significant barrier to accessing services.

3.18Children’s Healthcare Australasia commented on the overall distrust of the healthcare system:

The distrust that many First Nations families have for healthcare services is understandable given that as many as 1 in 10 Aboriginal babies are still being removed at or soon after birth in our maternity hospitals. At the very least, all services that come within the Thriving Kids initiative, whether Child and Family Hubs, Early Childhood Education Centres, or Child Development Services, need to be trained and required to provide culturally safe screening and/or support services.[15]

3.19NACCHO noted that Aboriginal and Torres Strait Islander people do not access disability services or early intervention supports at a rate commensurate with their level of need. NACCHO said that one of the multiple factors contributing to lower access and utilisation rates for Aboriginal and Torres Strait Islander people was distrust of institutional care as a result of both personal and historical experiences.[16]

3.20Karitane, a not-for-profit organisation that supports families and children agreed that ‘some Aboriginal families avoid mainstream services due to intergenerational experiences of racism, discrimination and judgement about parenting.’[17]

3.21The Brotherhood of St Laurence and the Australian Institute of Family Studies also commented on intergenerational trauma and general mistrust of government, health, disability services and providers, education, and other systems and ‘fear of child removal if formal supports are sought or accessed.’[18]

3.22The South West Autism Network and Uniting NSW/ACT, the social services and advocacy arm of the Synod of the Uniting Church in NSW and Australian Capital Territory, both advocated for the work to be led by First Nations communities, adding:

It is essential that services which deliver supports to First Nations families and communities are aware of systemic failings in mainstream systems such as the overrepresentation of First Nations children in out of home care. Some First Nations families and communities choose not to access mainstream services for children with indicators disability and developmental delay out of a fear of child protection involvement and judgement of their parenting capacity.[19]

Experience with diagnosis

3.23Several stakeholders raised that identification of disability, neurodiversity, and developmental delays can often occur later than is ideal for First Nations people, for a number of reasons.

3.24Every Australian Counts highlighted Closing the Gap data that only 34 per cent of First Nations children are developmentally on track at school start, dropping to just 16 per cent in very remote areas.[20]

3.25One reason is a lack of service availability in First Nations communities. Physical Disability Australia raised that late diagnosis of neurodiversity can occur ‘much later than would benefit the child and family, particularly if you’re First Nations and particularly if you’re living in rural or remote areas…where there is a lack of specialists who can actually make diagnoses.’[21]

3.26Triple P International agreed that there were ‘significant challenges in the diagnosis and support of First Nations children, including lower reported rates of diagnosis due to limited access to services.’[22]

3.27The NACCHO highlighted that there were ‘multiple factors contributing to lower access and utilisation rates for Aboriginal and Torres Strait Islander people’[23] including:

• Limited or no availability of disability services in Aboriginal communities (thin markets)
• The need to provide evidence of disability and the burden on health systems to supply this
• Difficulty navigating the system
• A lack of culturally appropriate and/or trauma informed mainstream disability service provision (culturally thin markets)
• Experiences of systemic and interpersonal racism
• Distrust of institutional care as a result of both personal and historical experiences.[24]
  28. NACCHO commented that while there is an increase in Aboriginal and Torres Strait Islander people participating in the scheme, overall utilisation of plans was poor:

While up-take of the NDIS by Aboriginal and Torres Strait Islander people is increasing – NDIS Quarterly reports for 2022-23 show that Aboriginal and Torres Strait Islander people consistently make up more than 9% of new participants to the Scheme - plan utilisation is poor with many Aboriginal and Torres Strait Islander people unable to access vital services and/or culturally safe services.[25]

3.29Mr Rhys Howard, National Policy Manager, at the First Peoples Disability Network highlighted the gaps between the prevalence of disability with rates of diagnosis and access to service:

…at the moment, for so many First Nations kids with disability, there is no service, because their diagnosis is made at such a lower rate. And yet, despite that, we know that the prevalence of disability is almost twice that of the mainstream population. So I think that, for kids who fall into this gap where they can't access the NDIS, because they don't have a diagnosis and there aren't mainstream supports available in their local region, especially if they're rural and remote.[26]

3.30In contrast to this, Associate Professor Schultz from the Black Dog Institute warned that Aboriginal and Torres Strait Islander people across the spectrum of social and emotional wellbeing are actually more likely to receive diagnoses, but far less likely to receive treatment and intervention.[27]

3.31Cultural differences in how disability is defined may also contribute to delayed diagnosis. Associate Professor Schultz from the Black Dog Institute raised that ‘for Aboriginal and Torres Strait Islander peoples, the understandings of neurodiversity may not always align with Western diagnostic frameworks,’ meaning programs may not be capturing individuals from these groups.[28]

3.32Speaking on assessment and developmental screening tools, Gayaa Dhuwi (Proud Spirit) Australia (Gayaa Dhuwi) said that ‘current Western assessment tools marginalise our children and lead to misidentification, under identification and the pathologising of cultural differences. Cultural validation must be a design requirement.’[29]

3.33A lack of cultural safety in diagnostic processes was also raised as an issue by stakeholders. First Peoples Disability Network highlighted that the assessment process required for gaining support services for those with a disability continues to be a barrier for many First Nations individuals, families, and community members, and created an enormous amount of fear.[30] He elaborated:

There's a real reluctance for parents to come forward and get support for their young child with disability, because they fear removal of the child or being judged as bad parents, for example. These are the bigger picture—understanding that needs to be well established in this system so that we can have the success that we want to see here. There is a greater risk of this becoming more and more medicalised, which will mean that our families, our communities will less engage with that sort of approach. So the critical thing is that our families, our parents, our communities are the ones that drive the program.[31]

3.34This point was also raised by SNAICC – National Voice for our Children (SNAICC), who told the Committee

We know that often our families don't look for support because of the intersection with the child protection system. We know that they are misrepresented, we know that they are over analysed, we know that they suffer from oversurveillance, and we know that those things that could have been solved in early childhood are often disregarded and left in tatters.[32]

3.35SNAICC also commented on the impacts of delayed diagnosis on First Nations people. On the experience of First Nations children with disability or developmental delays, SNAICC said:

What we know is that our children too often enter our school systems with undetected or misidentified developmental challenges and vulnerabilities. Those vulnerabilities persist throughout their lives. We know all too well that, if children start school with a learning gap, that gap gets bigger throughout their entire life journey. We also know that often the first time our children are picked up as needing a little bit of extra support is when they hit the juvenile justice system.[33]

3.36SNAICC reflected further on the interactions between development delays and the justice system, telling the Committee that in the Northern Territory in 2021, 77 per cent of children in juvenile detention needed cognitive or developmental supports. They said:

None of them had been identified as needing those supports despite having contact with several systems by the time they hit the child protection system, and there they are, locked up in cells.[34]

Developmental screening

3.37Several organisations emphasised the value of ensuring that Aboriginal and Torres Strait Islander people be provided culturally appropriate developmental screening tools. Miwatj Health Aboriginal Corporation stated that ‘existing measures of developmental milestones are largely based on Western concepts of progress and fail to recognise First Nations frameworks of child development.’[35]

3.38SNAICC also noted that ‘definitions of disability and developmental delay varies greatly between mainstream ‘Western’ perspectives and Aboriginal and Torres Strait Islander culture, knowledge and perspectives.’[36] They added:

This is reflected in the fact that many Aboriginal and Torres Strait Islander languages do not have direct equivalents for the word ‘disability’ and by extension, ‘developmental delay’. This highlights the importance of understanding Aboriginal and Torres Strait Islander definitions of health and wellbeing, anchored in culture and community. This is distinct from the Western perspective that frames disability as a deficit or as a condition to be fixed, rehabilitated, or prevented.[37]

3.39This view that the current system is premised on Western perspectives was echoed by South Burnett CTC and Uniting NSW/ACT.[38]

3.40Indigenous Allied Health Australia emphasised that the approach should avoid rigid, Western biomedical models and instead reflect holistic, culturally grounded perspectives; that the Thriving Kids initiative must be flexible and culturally responsive. Services should be delivered on Country, draw on culture as a strength for healthy development, and embed social and emotional wellbeing.[39]

3.41Indigenous Allied Health noted the challenges with current assessment tools for Aboriginal and Torres Strait Islander people:

Currently assessment tools being used lack cultural responsiveness, they are often prescriptive, deficit-based and developed through a non-Indigenous worldview. The assessment for Aboriginal and Torres Strait Islander children to go on the Thriving Kids Initiative needs to be culturally appropriate, strengths-based and localised. It can’t be a ‘one fits all approach’.[40]

3.42South Burnett CTC agreed that ‘interventions for the First Nations need to be presented in a way that suits their beliefs and are communicated appropriately.’[41]

3.43Submitters put forward two main examples of culturally appropriate assessment tools for Aboriginal and Torres Strait Islander children: ASQ-TRAK (Ages and Stages Questionnaire – Talking about Raising Aboriginal Kids) and the Tracking Cube.[42]

ASQ-TRAK

3.44ASQ-TRAK was developed by Dr Anita D’Aprano, now Principal Research Fellow in Indigenous Health at the University of Melbourne. To develop the tool Dr D’Aprano worked with remote Aboriginal communities in Arnhem Land.[43]

3.45Organisations were of the view that ASQ-TRAK was strength-based, family centred and develops the skills of caregivers. The Murdoch Children’s Research Institute put forward the view that the program was culturally appropriate and could be adopted broadly across the sector:

ASQ-TRAK is the only culturally adapted developmental screening tool designed specifically for Aboriginal and Torres Strait Islander children aged 2 months to 5.5 years. Co-designed with First Nations communities, it offers a strengths-based, family-centred approach that actively involves caregivers, supporting both early identification and caregiver confidence. ASQ-TRAK enables timely, equitable access to early intervention and is ready for national scale, with training and implementation supports in place. Broader adoption across early childhood services presents a key opportunity for Thriving Kids to embed culturally safe developmental care into universal platforms and support First Nations children to thrive.[44]

3.46Lifestart Disability Services agreed that ASQ-TRAK was a culturally safe screening tool, elaborating that it could:

…guide conversations with First Nations families around developmental milestones. This tool uses visuals, flipcharts, and simple language, which is more accessible for families, and ensures they are supported to clearly identify where their child may need support.[45]

3.47NACCHO commented on how ASQ-TRAK supported caregivers as part of the process:

It is designed to be administered by interview, and made to be easy-to-use, family centred. It is focussed on highlighting a child’s strengths as well as screening for delays. Caregivers are co-observers in the process, and as part of the process they can be supported and taught them about child development and their own child’s skills.[46]

3.48Maternal, Child and Family Health Nurses Australia also spoke of the success of ASQ-TRAK, and raised it as a potential tool to roll out across all of Australia, while acknowledging the challenge of collecting data on its use:

It makes it translatable to any non-English-speaking family of a non-English-speaking background, because it's full of pictures and plain English. It's brilliant, and it's so easy to use —and yet we've got no way to collect that data… How do you know that your bucket of money is being put to good use when we don't have any common way of collecting that result?[47]

3.49Several submitters did however express some concerns about the challenges in people accessing culturally appropriate screen tools such as ASQ-TRAK, due to high demand and limited availability of training sessions. NACCHO in particular, stated:

…the demand for training outpaces NACCHO’s current ability to facilitate training – with more than 700 applications for just 200 training places. There remains an urgent need to scale training in child development screening and assessment in the ACCHO sector in a culturally appropriate manner.[48]

3.50NACCHO recommended extension of funding to enable the continued roll-out of ASQ-TRAK training to meet the demand from the ACCHO sector.[49]

3.51Miwatj Health Aboriginal Corporation also raised concerns about the availability of culturally appropriate developmental screening tools including ASQ-TRAK:

At present, there is a lack of culturally safe screening tools for developmental delay. While tools such as ASQ-TRAK and the Vanderbilt Assessment exist, they are not widely accessible, nor are there enough qualified professionals to administer them consistently. The ASQ-TRAK training is delivered in Victoria via a 2-day face-to-face workshop that is a significant cost to the organisation, and not a culturally safe or inclusive pathway for First Nations professionals. This makes supporting staff to become qualified ASQ-TRAK Assessors unattainable for many ACCHOs, especially considering the recruitment and retention challenges in remote regions. Parents are also not provided with adequate education or support to understand these tools, nor how to contribute their own observations of their child's development.

The Tracking Cube

3.52Another developmental screening tool that was mentioned by several organisations as a ‘culturally responsive approach to screening, diagnosing and monitoring neurodevelopment that helps identify disorders such as FASD, ADHD, [and] Autism in primary healthcare and non-health settings’[50] is the Tracking Cube. NACCHO elaborated on the program stating:

The Tracking Cube can be used to assess children up to 17 years old. The ASQ-TRAK screening tool can be used as part of the assessment process (limited to 0 to 5 years of age).

Through the Yapatjarrathati Project, a bespoke version of the Tracking Cube was co-created for use by the Kalkadoon nation in the Mount Isa region. This ensures it is culturally safe and appropriate.

The Tracking Cube links evidence-based neurodevelopmental screening with risk and protective factors as well as parent/teacher concerns to provide a holistic understanding of at-risk children.

Its digital infrastructure summarises patient data from multiple sources and provides auto-generated referral and report templates to assist triage and support decisions.

It is split into 6 tiers – 5 of which can be carried out by primary health workers such as Aboriginal Health Workers (or workers in schools, childcare and other settings), and the 6th by a specialist. This in effect is able to lower patient wait times and get children the necessary referrals more rapidly.[51]

3.53Griffith University endorsed the Tracking Cube as a model for Thriving Kids which could be ‘translated into a secure, nationally-scaled platform’[52], highlighting:

In remote Aboriginal communities, the model has resulted in the identification of 7 times more children with developmental concerns and increased access to local support six-fold. Referrals to specialists stayed the same, because rather than referring all children with a concern (current care model), the right children were referred. The majority of identified children were supported in community and primary care. Staff confidence in supporting children improved and family trust in health care services improved.[53]

3.54They noted that the Tracking Cube was codesigned with community Elders who ‘shaped the Cube’s symbols and processes, ensuring cultural resonance and trust’[54] adding that:

Communities choose the tools they trust based on local expertise, evidence relevant to their region and cultural preferences, ensuring equity but providing a unified national framework for interpretation and outcome.[55]

Culturally safe services and community-led design

3.55The Committee heard evidence about the importance of cultural safety and community-led models in the design of Thriving Kids.

3.56The NDIA told the Committee that in their experience, ‘when First Nations people experience cultural safety, they're more likely to come back and use the service, and there are more likely to be more First Nations people employed in the service.’[66]

3.57The Miwatj Health Aboriginal Corporation told the Committee that there are currently very few culturally safe screening tools that are used in Australia.[67] They explained how their organisation has made these tools work for First Nations children:

In our model we use Aboriginal health practitioners and community workers—or, in our case, remote community connectors—to support those screening pathways. From our perspective…it's having the ACCHO model and that wraparound team supporting that process that makes it work. There are so many different screening tools around, and so many different screening tools that need to be used with respective disabilities or age demographics, that it is really challenging to make them all accessible and adaptable within language contexts around Australia. The key here is that ACCHO model and having a team to support the implementation of that screening tool, rather than potentially adapting that to all our very complex regions.[68]

3.58Stakeholders made recommendations on how cultural safety can be more closely embedded into disability services.

3.59Mr Rhys Howard of the First Peoples Disability Network warned against previous culturally unsafe government programs meant to assist First Nations people.[69] Mr Howard cautioned:

With a $2 billion investment from July 2026, we cannot afford to repeat the past failures of culturally unsafe and mainstream programs. We urge the committee to hardwire co-design, community controlled delivery and cultural safety into Thriving Kids. This will ensure early identification, family led supports and seamless transitions so that no child falls through the cracks.

3.60The First Peoples Disability Network emphasised to the Committee that ‘Thriving Kids can absolutely close gaps for our children only if it partners with First Nations community at every single stage.’[70] The Early Learning and Care Council of Australia echoed this, speaking of the importance of ‘co-design with First Nations people that is led by First Nations controlled organisations.’[71]

3.61They also reflected on the authority behind their recommendations, stating:

Our practical recommendations—from mandatory, culturally adapted screening to a First Nations workforce pipeline—are aligned with the disability royal commission's call for structural reform, as well as the national agreement on Closing the Gap.[72]

3.62The Executive Director of NACCHO, Dr Sarah Hayton, described why awareness and understanding of cultural safety in a local setting was so important to gain the trust of First Nations people needing support services.[73]

I think the criticality of this is that it is very important that this is identified as place based. That’s because cultural safety is locally placed and oriented towards their own community members. This is why the community-controlled sector is best placed to look after their own people, particularly within this space.[74]

3.63Ms Lewis from Indigenous Allied Health Australia emphasised First Nations families want services ‘on country because country and the environment are healing’[75]. She also emphasised that First Nations families want services provided by First Nations peoples or to be designed with awareness of First Nations issues, and spoke of the need for education and a co-design model:

They've also said that they want more Aboriginal and Torres Strait Islander workers as well. So they want investment in health and schools and communities. We know that, when the workforce shares culture and history, families feel understood and supported. Our families are saying that the way to do that is by having community co-design—not just the co-design that we talk about in the Western sense; it has to be that proper community co-design. That's to make sure services reflect local priorities and needs.[76]

3.64Various witnesses spoke about the importance of building connections and trust as an essential part of program design.

3.65First Nations families want services and professionals to show empathy, genuine care and to share something of themselves, according to Indigenous Allied Health Australia.[77] She stated:

They want to see and feel that relational accountability to their care and not a transactional account of their health journey. One parent has said to us: 'Professionals need to use story sharing, storytelling, and tell me who you are. It's not just about me giving. You have to tell me about yourself. What's your story. What's going to make me trust you to tell you these things?'[78]

3.66Dr Hayton of NACCHO commented:

It does require a lot of trust. I think that one of the core elements around that is the ability to have a trusting relationship where the Aboriginal family will actually speak openly with you. The reason why those connector roles are so critical…is that, even if they're bringing in clinical teams who are not Aboriginal and may not have deep knowledge of that local community, it is that local person who actually provides that cultural safety for the Aboriginal people and their family when they come into the clinics or if they're sitting in their family homes because they're doing an outreach visit.[79]

3.67Queenslanders with Disability Network spoke about the importance of continuing connections in the context of ensuring equitable access for First Nations communities, as well as families and communities with other diverse backgrounds:

I certainly think from our engagement and the families we've talked to that it is very much the importance of cultural safety, trust and engagement with those services on the ground… Families talked about, as different providers come in, having to start all over again. They lose half an hour of the appointment time having to go over everything and retell their story. Cultural safety in the services that are provided is critical.[80]

3.68Mr Pat Murphy, President of the Australian Government Primary Principals Association, told the Committee that there are often gaps between identification and timely follow-up services for First Nations children, children from remote, disadvantaged communities, and rural and low-SES communities. He called for dedicated funding for schools to employ cultural liaison officers and community connections, ‘to ensure families engage early, confidently and continually.’

3.69NACCHO also advocated support services being ‘very trauma informed to be able to work in this space’.[81] Similarly, Ms Lewis reflected that First Nations families want systems and services that retain information to avoid further trauma:[82]

Families spoke about having to retell their story and their lived experiences with each new health or educational professional, and they don't want that. They want a system that communicates so that they don't have to relive their trauma every time they see a new health professional or someone new in their schools.[83]

3.70The Committee heard of some initiatives that are aiming to embed community-led design into disability care.

3.71The NDIA has established a formal partnership with NACCHO and a First Nations sector policy advisory committee with representatives from SNAICC and FPDN. As well, they are working with Indigenous Allied Health Australia and the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners on growing and retaining a First Nations workforce.[84] The NDIA also started a cultural safety initiative in 2025, with the view to develop a cultural safety plan for the organisation following establishment of this baseline.[85]

3.72The Committee asked the NDIA whether the government should be doing more to improve the numbers of Aboriginal health and disability workers. NDIA said that there are policies in place to grow this workforce, and that through the actions of NACCHO and the NIAA numbers of Aboriginal health workers throughout the whole care economy are increasing.[86]

3.73NDIA is also growing an Aboriginal and Torres Strait Islander disability workforce, and placing Aboriginal Disability Liaison Officers (ADLOs) within Aboriginal Community Controlled Health Organisations (ACCHOs) to build trust.[87]

Culturally informed frameworks, initiatives and programs

3.74Submitters expressed strong support for several frameworks, initiatives and programs that they believe provide culturally informed and responsive approaches to early childhood intervention, particularly for Aboriginal and Torres Strait Islander families. These include the National Best Practice Framework for Early Childhood Intervention, the National Framework for Assessing Children’s Functional Strengths and Support in Australia, and ENVISAGE. The following section outlines the evidence received on these programs.

National Best Practice Framework for Early Childhood Intervention

3.75As discussed in Chapter 2, the National Best Practice Framework for Early Childhood Intervention is aimed at providing:

…advice on how to support children under 9 years of age who have developmental concerns, delays, or disabilities. It helps families and professionals understand what good support looks like and how to provide it.[88]

3.76The Framework ‘identifies cultural safety and diversity-affirming practice as universal principles of best practice, ensuring that services are rights-based and inclusive of Aboriginal and Torres Strait Islander families, CALD families, and neurodiverse children.’[89]

3.77The University of Melbourne noted that the Framework was ‘developed through a rigorous and comprehensive research collaboration which included consultation with key stakeholders and end-users: that is, young people with disability, their parents, carers and families, Aboriginal and Torres Strait Islander families and community-controlled organisations, and ECI service providers and researchers.’[90]

3.78Submitters who provided evidence to this inquiry supported the implementation of the Framework ‘as the foundational resource for the development of Thriving Kids’ believing that it would ‘address Aboriginal and Torres Strait Islander families’ fear that engaging with ECI practitioners will lead to unwarranted child protection notifications.’[91]

3.79A significant number of submitters, while not necessarily commenting on the synergy between the Framework and Aboriginal and Torres Strait Islander people, were very supportive of the Framework as a foundation for the Thriving Kids initiative.[92]

National Framework for assessing children’s functional strengths and support in Australia

3.80South Burnett CTC were supportive of the National Framework for assessing children’s functional strengths and support in Australia noting that it:

…has been researched and developed for First Nations people and considers their cultural needs and offers a comprehensive view of different strategies that can be used to assist First Nations families. The framework bases the assistance around body structure, activity, forming friendships, family and personal differences.[93]

3.81Not for-profit organisation Teach Speak Hear agreed that it offered ‘genuine partnership with Aboriginal and Torres Strait Islander children, families, and communities’[94] and:

…emphasises walking alongside families to facilitate culturally informed and responsive approaches to assessment and support. It involves listening, observing and engaging in ways that are developmentally appropriate and respectful. This Framework builds on foundational principles to guide a cyclical process of assessing functional strengths and support needs, differentiating levels of support and informing meaningful reporting.[95]

3.82When commenting on which frameworks provided guidance on best practice supports in early intervention more broadly, a significant number of submissions put forward the National Framework for assessing children’s functional strengths and support in Australia as an example.[96]

ENVISAGE First Peoples program

3.83The Australian Catholic University put forward the ENVISAGE–Families program and the dedicated ENVISAGE–First Peoples programs noting that they were ‘co-designed in partnership with Aboriginal and Torres Strait Islander communities to support families in ways that are culturally sensitive and relevant to context, community, culture and country.’[97]

3.84Similar to the previous framework, several submitters suggested the ENVISAGE program as an invaluable as starting support as they ‘provide evidence‑based information, empowerment, peer connection, and practical ideas to help families’.[98]

Additional suggested programs

3.85Examples of other programs referenced as a positive example of culturally appropriate service provision included:

• Waijungbah Jarjums (which means place of mother and child), ‘for mob by mob’ at Gold Coast Health ‘offers continuity of care by a known Aboriginal and Torres Strait Islander midwife and child health nurse from conception to 5 years.’[99]
• Victorian Aboriginal Child Care Agency’s Koorie Families as First Educators program ‘employs Koorie Educators to provide in-home support sessions with families or carers of Aboriginal children aged 0 to 5 years.’[100]
• The Victorian Aboriginal Child Care Agency’s Koorie Kids Supported Playgroups has delivered ‘supported playgroups to Aboriginal and Torres Strait Islander children and their families for over 15 years.’[101]
• Connected Beginnings program ‘provides a framework and funding to support the integration of early childhood, maternal and child health, and family support services with schools’ for Aboriginal and Torres Strait Islander children.[102]
• National Aboriginal and Torres Strait Islander Early Childhood Strategy ‘provides a community-informed and evidence-based pathway to achieve the National Agreement on Closing the Gap targets and outcomes for early childhood.’[103]
  86. The Minderoo Foundation + Thrive by Five put forward existing and developing parenting resources and programs ‘Baby Coming You Ready’, ‘Bubba Here What Now‘, ‘Maaman Baby Coming You Ready’ and ICARE. They elaborated on each noting:

Culturally appropriate parenting information and resources like ‘Baby Coming You Ready’ and ‘Bubba Here What Now’ have helped to close the equity gap for First Nations children and families.

Building on more than a decade of research, Murdoch University’s Professor Rhonda Marriott and her team at Ngangk Yira have brought stakeholders together to create healthcare supports that truly serve the needs of Aboriginal families they work with.

Their initiatives, such as perinatal assessment tool ‘Baby Coming You Ready’ and wrap-around maternal health program ICARE have had great success. They are now developing two new programs: ‘Bubba Here What Now’ to support families in the child’s first few years of life and ‘Maaman Baby Coming You Ready’, which is focussed on preparing First Nations men for fatherhood.[104]

3.87Miwatj Health Aboriginal Corporation spoke of their adaptation of the Maternal Early Childhood Sustained Home visiting program for the Northern Territory, a program they call Yothuw Mulka. On this program, they said that ‘taking the service to the people rather than expecting them to come into clinics’ has allowed them to ‘address some of the barriers for engagement within those assessments.’[105]

Experience with the NDIS

3.88The Committee heard from stakeholders that, in the past, the needs of First Nations people have not been considered in the design of reforms to disability schemes.

3.89Reflecting on previous reforms and the opportunity presented by the Thriving Kids initiative, Mr Griffis explained:

We are very anxious to ensure that the needs of our young people with disabilities are at the forefront of the Thriving Kids reform. Too often, major social reforms pass us by, or we are an afterthought, or we're not viewed as a priority. Our experience with the NDIS demonstrates this.[106]

3.90Mr Griffis described the 10-point plan for the successful implementation of the NDIS in its communities that the First Peoples Disability Network prepared in 2013.[107]

We did this because meeting the needs of our community members should always be a first-order priority. But, regrettably, and predictably, our 10-point plan was largely ignored and, as a result, our people remain at the margins of the NDIS. We cannot allow this to happen again with the Thriving Kids initiative. After all, if the needs of our young people with disability— particularly those living in regional and remote Australia—can be met, then this has the potential to mean greater success, under the Thriving Kids program, for all young Australians with disability.[108]

3.91The First Peoples Disability Network believed the current and proposed government policies needed to ‘better understand our worldview on disability’.[109]

In our traditional language, we have no comparable word for disability, and that's a wonderful thing; we've always recognised disability as part of the human experience. Yet the system is heavily labelled. Disability is heavily label ladened, be it autism, acquired brain injury, intellectual disability, cognitive impairment—whatever you want to call it. We are the thought leaders on inclusion, so we actually want to flip things over, if we may, and actually share with the rest of Australia the proper worldview on disability.[110]

3.92Drawing on its research and consultation, Ms Tara Lewis, Knowledge Translation Lead at Indigenous Allied Health Australia also drew attention to the lack of cultural safety within the current system for First Nations people:

…whilst we're talking about cultural safety, we have to understand that families are not struggling because of a lack of themselves or because the system is broken; they're struggling to navigate a system that was created to work exactly as it was intended. We know that it was designed to control and marginalise our peoples, and that design still shapes how our children are seen, assessed and supported today.

These systems are built on racialised ideologies that too often see us as problems to be fixed, rather than as families and children with strengths and potential. [111]

3.93The NDIA, the organisation that administers the NDIS, also reported that, during the Disability Royal Commission and the NDIS review, First Nations communities told them that the system is complex and not culturally safe.[112]

3.94As was raised when describing the experience of First Nations families in having their children diagnosed, witnesses raised that the fear of child removal negatively impacts their interaction with the NDIS. Gayya Dhuwi said that for First Nations parents, ‘the fear of child removal [is] an ongoing fear and it’s a very real fear.’[113]

3.95The NDIA agreed that this is something they have witnessed, saying:

The historical experience of First Nations people, not just with the agency but with the system, leads First Nations people to be apprehensive, particularly where children are concerned, due to child removal.[114]

3.96Gayaa Dhuwi emphasised the link between a lack of cultural governance and cultural safety, stating that ‘we do not have cultural governance in the non-Aboriginal organisations at present, and we certainly don't have it in the mainstream clinical services.’[115]

Perspectives on Thriving Kids

3.97The Committee heard from some First Nations stakeholders that Thriving Kids represents an opportunity for reform that could prioritise First Nations individuals and lead to better results for them.

3.98Gayaa Dhuwi told the Committee that they see Thriving Kids as an opportunity to make the system work better for First Nations people, saying:

Thriving Kids represents a period of significant structural reform of early childhood developmental and disability support…Together, these reforms create a rare opportunity to build a culturally safe, integrated national system that supports Aboriginal and Torres Strait Islander children across developmental, psychosocial, health and social and emotional wellbeing pathways. These reforms cannot be developed in silos, as they must be culturally grounded and grounded in Aboriginal and Torres Strait Islander concepts of healing and social and emotional wellbeing.[116]

3.99SNAICC told the Committee that they see Thriving Kids as an opportunity to reverse the disproportionate representation of Aboriginal and Torres Strait Islander children in rates of vulnerability and disability, raising that they might ‘for the first time, [be] disproportionately helped by a reform like this one.’ They view Thriving Kids as an opportunity to ‘work through shared decision-making and in partnership with use and our communities.’[117]

3.100After telling the Committee about how First Nations families find the current system to be culturally unsafe, Indigenous Allied Health Australia described how Thriving Kids ‘represents a vital opportunity to change how we support our families and children, particularly those who have been left navigating fragmented, unsafe and disconnected systems.’[118]

3.101Miwatj Health Aboriginal Corporation hopes that Thriving Kids will mitigate long waitlists for diagnosis or assessment to support access to the NDIS, and fast-track access pathways.[119]

3.102Gayaa Dhuwi added that ‘Thriving Kids cannot sit as a standalone program; it needs to be embedded within the broader national reform architecture so that Aboriginal and Torres Strait Islander children are not pushed between disconnected systems.’ They stressed the importance of integrating the reforms with the National Mental Health and Suicide Prevention Agreement and Closing the Gap reforms, and avoiding fragmentation across portfolios and disconnected systems. They envisage that embedding Thriving Kids across these reforms will create ‘a single, connected pathway which ensures consistency in cultural safety, workforce, assessment, navigation and service design.’[120]

3.103Dr Catherine Wade, representing the Parenting and Family Research Alliance and the Parenting Research Centre, suggested incorporating lessons learned from other programs into Thriving Kids:

…there are lots of different parenting programs, and they're all valid, and many of them have very good evidence bases behind them. I think there is room for funding for more than one option, because each of those programs looks different, is delivered in a slightly different way, and meets the needs of different families. Some have been adapted to suit Aboriginal and Torres Strait Islander families, and some have been adapted specifically to suit parents with intellectual disability or parents of children with specific disabilities So I think Thriving Kids needs to think about how to keep that flexibility in the offerings that are available because no one size will fit all.[121]

Role of Aboriginal Community Controlled Health Organisations

3.104The Committee received evidence about the importance and success of ACCHOs in delivering integrated services, and the opportunity to leverage off that model and approach in the design of Thriving Kids.

3.105ACCHOs are community-run primary healthcare services that provide comprehensive, culturally informed care for Aboriginal and Torres Strait Islander people. These services address not only physical health but also the social, emotional, and cultural wellbeing of individuals, families, and communities.[122]

3.106Reflecting on the challenge of receiving support or accessing the NDIS without a diagnosis, First Peoples Disability Network’s National Policy Manager, Mr Rhys Howard noted the service provided by trusted, existing groups:

…having a tier in between mainstream services and NDIS is really a critical juncture, especially if those services don't require diagnosis to enter them…Largely, for those kids, there are no thresholds, there are no barriers to entry to those services. I think the services that already exist, where relationships and trust are built, are the first step to having people come in and having first contact with that system.[123]

3.107The Chief Executive Officer of Broome Regional Aboriginal Medical Services (BRAMS), Ms Cassie Atchison, explained why BRAMS needed to be directly involved in the proposed Thriving Kids program, as a large ACCHO delivering fully integrated services across primary health care, aged care, disability, family violence, and social and emotional wellbeing all under one coordinated model of care in Broome, Western Australia.[124] Ms Atchison explained:

We are not just seen as a service provider by our community; we are seen as their health service, their one-stop shop where people can come and access a service from us without having to navigate external agencies and services. We believe that the Thriving Kids program will only work if Aboriginal community-controlled organisations are involved as partners where we're designing, delivering and doing place based modelling.[125]

3.108The CEO of BRAMS Ms Cassie Atchison stressed the importance of taking a culturally safe, individual approach to clients, especially school children, as a large ACCHO supporting more than 7,000 people on a regular basis.

It's really important for us that we don’t treat people as numbers and that we identify and work with our families on an individual basis and have that cultural safety. I have lots of examples where cultural safety is lacking in some areas. For example, one for us in Broome is making sure we’ve got other services on board like the education system. We have lots of kids in our Broome schools with special needs, and the schools still don't seem to be equipped to understand around that person-centredness for children, and children are quite often judged as being naughty or other things when there are developmental delays happening. We do a lot of advocacy in schools and other early childhood providers to ensure that other people have a good understanding of how to look at kids as individuals and not label them with a diagnosis or a developmental...[126]

3.109When asked about the benefit of remote community connectors being in an ACCHO for identification and diagnosis, NACCHO’s Dr Sarah Hayton highlighted the issues faced in Far North Queensland:[127]

There are areas where, for example, a local council or a different organisation is looking after those workers, and it's not as coordinated, because they're not necessarily linking into the primary health care system that we manage. That is why we really do advocate that, if community connectors are in an ACCHO, they're much better utilised, they're working much better and it seems to be more of a seamless engagement with our sector. But, when they're sitting in isolation, there's still a disconnect with service delivery. It has had large impacts, for example in Far North Queensland, because they've really struggled to identify children that require some screening and early diagnostics with early intervention. It has been quite difficult to try coordinate that, because they're in a mainstream organisation, and it does make it difficult sometimes to find really good, culturally safe internal referral pathways.[128]

3.110The Kimberley Aboriginal Medical Services is the peak body for Aboriginal community-controlled health services in the Kimberley, Western Australia. KAMS operates under the auspices of the Kimberley Supports consortium, bringing together eight local Aboriginal community-controlled organisations to improve the outcomes of Aboriginal people living with disability or developmental delay. Senior Manager, Mr Oskar Stenseke explained:

One of the programs that we do deliver is the Remote Early Childhood Support Program, which is essentially a community designed and led program that leverages the existing relationships and trust of the local Aboriginal medical services to engage with families early, to identify developmental delays and to then provide short-term, culturally safe early intervention services while also providing linkages to longer-term supports where needed. It’s kind of like you're looking at the scope of the Thriving Kids program.[129]

3.111Mr Stenseke elaborated on the advantages of using locally-based consortiums or teams in the major Kimberley hubs of Broome and Kununurra to both address workforce shortages and to deliver culturally-safe outreach services to a rural and very remote area such as the Kimberley.He stated:

In those communities we have local Aboriginal family support workers as part of the program. They're employed by the local consortium member organisation. It's really key, having that local person on the ground making sure that the services are delivered.[130]

3.112Kimberley Aboriginal Medical Services described its Community Connector Program in the Kimberley as being very successful in finding and encouraging more people to access NDIS services. They explained:

I think about five years ago when the state of Western Australia transitioned over to the federal NDIS system. They only had the operational NDIS participants. There were only, I think, about a hundred of them in remote communities across the Kimberley—probably less than a hundred. But, since then, over these five years, that number has increased to about 750 participants in the Kimberley region. That just shows that the community can access it. Knowing the community and knowing who to reach out to, to build that awareness, has really worked. The organisations that represent have that trust from community to engage and to assist them with this process.[131]

3.113Miwatj Health Aboriginal Corporation described the role of ACCHOs in assisting First Nations people to engage with and use the NDIS:

ACCHOs support the lifespan of community and we've built innate trust within our respective regions…A key message from our remote community connectors is that the NDIS is difficult to explain and interpret in a way that our mob can understand. They've described their role within the NDIS landscape as [Yolngu language not transcribed], which translates to 'taking the weight off' participants, but also 'going home and feeling fulfilled', like they're having an impact on their community.[132]

3.114The First Peoples Disability Network detailed how Thriving Kids should use ACCHO to ‘empower First Nations communities to lead in design and delivery as well’ to help their ‘kids grow strong in culture and thrive’.[133] Mr Howard told the Committee:

…what we see as necessary for success for Thriving Kids: a dedicated First Nation stream, co-designed with peaks and delivered through ACCOs and ACCHOs; mandated culturally adapted screening—for example, the ASQ-TRAK tool; funded, parent-mediated, culturally safe, early interventions through ACCHOs; child and family centres with group home visiting and telepractice options; the building of a First Nations workforce pipeline, including scholarships, cadetships, supervised practice, allied health assistant roles with funded clinical supervision, embedded child development navigators, and a consent-based passport—so information follows a child from system to system, reducing the burden on families; a phased implementation with transition safeguards, so absolutely no child loses support during the transition from NDIS to Thriving Kids; a co-commissioned education program to deliver school and ECEC-based inclusion supports; and monitoring, which is aligned with the Closing the Gap priority reform, where published disaggregated results are available within the principles of Indigenous data sovereignty.[134]

3.115SNAICC were of the view that ACCOs ‘set the gold standard in early childhood service delivery’ adding that ‘integrated early childhood services provide crucial community-based, trusted, culturally appropriate, integrated services in ECEC settings.’[135] They elaborated on the importance of integrated services:

Aboriginal and Torres Strait Islander children with mild to moderate developmental delays, and their families, should be able to access the requisite developmental supports they need, delivered in a culturally appropriate manner, in an environment where they feel comfortable, surrounded by their own community. Though some Aboriginal and Torres Strait Islander children with more profound disability or developmental vulnerabilities may require specialised, evidence-based early childhood developmental supports, nevertheless screenings, referral and navigation supports, and allied health provision should be delivered in natural early years settings to the degree possible.[136]

3.116SNAICC noted that ‘in several communities, ACCOs/ACCHOs are already providing such integrated, child and family centred, culturally appropriate services.’[137]

3.117Brotherhood of St Laurence also highlighted the strengths of ACCOs to deliver integrated models.[138] Minderoo Foundation + Thrive by Five believed that ACCOs provided ‘holistic wraparound models of care that demonstrate[d] the success of integrated, family-centred care and are instructive for mainstream service design.’[139]

3.118Murdoch Children’s Research Institute were also supportive of First Nations led place-based initiatives commenting that:

These initiatives [such as Connected Beginnings, ACCOs, Child and Family Hubs] are demonstrating impact via inclusive, holistic, and culturally responsive models. Aboriginal and Torres Strait Islander integrated early years centres, embody these principles by serving as culturally safe community hubs which support early identification and improve access to both universal services and tiered interventions.[140]

Challenges for Aboriginal Community Controlled Health Organisations

3.119As noted above, submitters believed that ACCHOs play a critical role in delivering culturally safe, community-led health and disability services, but face significant systemic challenges. Short-term and inadequate funding arrangements undermine service continuity and workforce stability, while reliance on fly-in fly-out and agency staff erodes trust and cultural safety. Gaps in staffing expertise, transactional partnerships, and restrictive definitions of family further compound barriers to access and equity for Aboriginal and Torres Strait Islander children and families.

3.120NACCHO and Miwatj Health Aboriginal Corporation commented that ACCHOs were facing funding and resourcing challenges. NACCHO stated:

A number of ACCHOs already provide disability and related services, most without adequate funding. When funding is provided, it is often short-term contracts. One member service reported that their contract for the Remote Community Connector program (a program through which community members are employed by local ACCHOs to assist in connecting to services, support workers and the NDIA) was only renewed on the day of its expiry. This makes it very difficult for ACCHOs to retain staff and provide continuous service. ACCHOs also report issues with staff leaving to join mainstream services as they can offer more stability. Understandably, this has a negative impact on outcomes for ACCHOs and for the Aboriginal and Torres Strait Islander communities they support.

A research report from Deloitte, coming out of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability found that:

‘Community Controlled and Aboriginal Community Controlled Health Organisations frequently deliver disability services with inadequate funding and resourcing. Partnerships and shared service delivery arrangements between First Nations and non-Indigenous organisations are often transactional and usually favour the non-Indigenous organisation. Allied health providers often aren’t disability specialists and provide inadequate and culturally inappropriate services.’[141]

3.121NACCHO suggested directing funding to ‘ACCHOs for child-centred, family-focused and culturally safe approaches to: screening and referrals; assessment and diagnosis; and intervention and supports.’[142]

3.122Miwatj Health Aboriginal Corporation highlighted a gap in staffing and expertise:

In contrast, the MHAC child health program across six of the seven East Arnhem communities is primarily staffed by short-term agency nurses who are not trained in child health. These nurses cover the 0-17 age group and are also required to participate in acute care and on-call services. This model leaves a significant gap in the delivery of well child assessments and developmental screening. Families are left uncertain about where to access consistent, reliable well child services, creating inequities in early childhood health and development outcomes.[143]

3.123Several organisations expressed concerns about the reliance on fly-in fly-out (FIFO) and short-term practitioners in remote and regional communities.

3.124Queenslanders with Disability Network observed that families prefer providers who understand local contexts and maintain long-term relationships with communities. FIFO and locum models often require families to repeat their stories to new practitioners, eroding trust and continuity. First Nations families emphasised the importance of cultural safety, trust, and continuity in service delivery.[144]

3.125The Australian Clinical Neuropsychology Association (ACNA) reported that FIFO therapists frequently lack understanding of local cultural norms and community relationships, leading to interventions that do not suit local conditions and result in poor engagement. The ACNA stressed the need to build local capacity and co-design services with families and communities for sustainable outcomes.[145]

3.126NACCHO advocated for investment in ACCHOs to strengthen local economies, reduce reliance on FIFO services, and deliver services ‘with community, not to community.’

3.127Organisations who submitted to this inquiry also highlighted that Aboriginal and Torres Strait Islander families often face additional barriers when accessing disability supports due to restrictive definitions of family within service design and eligibility criteria.

3.128The Australian Institute of Family Studies reported that systems such as the NDIS frequently assume that parents are the primary navigators of disability supports. This creates difficulties for other family members—such as grandparents and kinship carers—who often play a significant role in caring for children with disability.[146]

3.129The Brotherhood of St Laurence noted that current service frameworks articulate family too narrowly, which can prevent Aboriginal and/or Torres Strait Islander kinship carers from accessing the supports they need.[147]

Culturally and linguistically diverse communities

3.130Stakeholders identified a range of intersecting barriers that prevent people with disability and their carers from CALD communities accessing the NDIS and other services, such as:

• language barriers
• lack of culturally safe response services
• barriers to accessing early support
• service affordability
• navigating complex NDIS systems and services
• lack of trust in government and other services
• citizenship and visa considerations.
  131. This section also discusses evidence received regarding the importance of enshrining a CALD informed design of the Thriving Kids initiative.

Language barriers

3.132Accessing NDIS services for people from culturally and linguistically diverse communities (CALD) can be challenging. More than 8 million people living in Australia were born overseas – these individuals speak 300 different languages. This language barrier can make it challenging for those families and individuals to navigate and access services and supports.[148]

3.133Mr Fioramonte of Settlement Services International (SSI), explained it was ‘very, very difficult for people to navigate and understand the systems’, and even harder for those from non-English speaking backgrounds in Australia.[149]

The NDIS is so complex and so difficult for anyone to manage and navigate. When you're looking at someone who is from a CALD background, where English is not their first language, where there are digital literacy issues, where they're from a lower socioeconomic background, as well as a range of other things, it makes you end up with a situation where there are layers of barriers.[150]

3.134Multiple stakeholders to this inquiry raised the importance of having accessible information about the NDIS available in their preferred language. Lifestart Disability Services highlighted this point in relation to accessing developmental supports.

Language barriers and limited access to interpreting services, …can hinder effective communication and erode trust.[151]

3.135WA Early Childhood Intervention Collaborative also emphasised that besides language barriers, consideration must be given to levels of literacy and dialects.

A family may not be able to access support in their dialect as resources are translated into a limited number of languages. Consideration of the parent or primary care giver’s level of literacy is also needed as they also may not be able to read in their own language.[152]

3.136Ms Rana Ebrahimi, National Manager, Multicultural Youth Advocacy Network Australia (MYAN) emphasised the need for children with disability to be heard and understood when accessing developmental services.

…children have the right to be heard in matters that affect their life; language accessibility through multilingual resources, bilingual workers and translated digital and phone based supports; and partnership with local community organisations, such as SSI, who can serve as trusted bridges between government systems and families.[153]

Lack of culturally safe and responsive services

3.137Some stakeholders told the Committee about difficulties faced when trying to find and access culturally safe and responsive services. SSI suggested that lower levels of access to these services were ‘not related to lower levels of need but rather due to difficulties in navigating and accessing services that are culturally responsive.’[154]

3.138Several submitters, including Marathon Heath, identified that even though children from CALD families are more likely to be diagnosed with a developmental disability, they are less likely to receive early intervention support and services such as allied health.[155]

Children from culturally and linguistically diverse backgrounds are more likely to be diagnosed with developmental disability, developmental delay or intellectual disability. In spite of this, families are less likely to receive multi-disciplinary early support and more likely to need help to secure funding for services. Research with diverse families highlights significant barriers to accessing support, including limited awareness of available services, language barriers, stigma around disability and help-seeking, and lack of options for culturally specific care. Parents report feeling like they lack control over the supports they receive and often rely on informal referrals within their communities to find appropriate services.[156]

3.139The Australian Institute of Family Studies noted that CALD communities found it challenging to engage with existing supports that did not align with cultural values––particularly for parents from culturally diverse backgrounds who care for children with developmental disability and autism.[157]

3.140Associate Professor Schultz from the Black Dog Institute discussed the need to acknowledge the wide range of cultural diversity for non-Indigenous peoples:

…you are Aboriginal or Torres Strait Islander, or you are non-Indigenous, and in that non-Indigenous bracket there is a whole bunch of cultural diversity that we tend to just glaze over and not attend to, as if it's not important in terms of how we engage with, respond to and work with families and communities.[158]

3.141Mr Fioramonte, General Manager, Children, Families and Disability Support at SSI, noted that Sydney has a higher uptake of the NDIS as a percentage due to support services having a more culturally diverse workforce than in other regions. He elaborated:

…the uptake of CALD people with disability into the NDIS is sitting at around that nine per cent mark, as it has roughly been since the implementation of NDIS. Within Sydney and south-west Sydney, the percentage of people with a CALD background with disability on the scheme sits at around 23 per cent, and we largely attribute that to having that diverse workforce—people that are based in and connected to the communities that we serve. That diverse workforce is definitely key.[159]

3.142Similarly, Ms Lynette Brodie, Chief Executive Officer at Speech Pathology Australia told the Committee that challenges with languages or cultural differences were being helped by its speech pathologists coming from diverse backgrounds themselves. Ms Brodie explained:

When we talk about language barriers, often you can still detect their language in their speech, even if you don't speak the language. But it is about really looking at criteria and where the allied health professionals are coming from. If we've got a good system, we can understand when we've got particular communities that have issues and perhaps find professionals that can meet their needs as well as their language. Of course, translation services alone are maybe not always ideal in this situation. There are speech pathologists who, as I'm sure do other professions, do a lot of play learning as well, and that really does break down a lot of the barriers. And it's not just CALD communities. We also work with very vulnerable Aboriginal and Torres Strait Islander communities.[160]

Barriers to accessing early support

3.143Multiple submitters gave evidence that CALD children are accessing early childhood education at lower rates.[161] SSI also reported that children from CALD backgrounds are ‘more likely to miss out on critical early intervention for children with developmental concerns.’[162] MYAN suggested ‘This disparity is not about the need; it's about access.’[163]

3.144A submission from the Murdoch Children’s Research Institute said that the lack of early support leads to reduced opportunities for CALD children to reach their potential:

Children and families from culturally and linguistically diverse backgrounds often miss out on early identification and support. This is due to current services and supports not designed or delivered for culturally safety or inclusiveness or parents not knowing where to get help or facing stigma in asking for help. This contributes to reduced opportunities for children to reach their potential and inequities in children’s outcomes.[164]

3.145SSI outlined the barriers that CALD children face in accessing early childhood education and early intervention support:

People with disability from CALD backgrounds may experience multiple barriers to access such as lack of accessible information in their preferred language; disability services not being culturally responsive; social isolation; lack of knowledge about complex service systems and lack of comparable systems in their home country; cultural stigma surrounding disability; and distrust of government agencies due to negative experiences in other countries. These issues are mirrored in part in research with children from CALD backgrounds.[165]

3.146Mrs Jo Johnson, from the Bathurst Early Childhood Intervention Service, discussed the barriers to early identification for CALD children and stated that it leads to a two-tiered system:

To be able to have that early identification is good, but we're really struggling to get counsellors within the school to do the work that's already there—having that navigator beforehand that would be there. The students that my special schools cater for are usually well identified beforehand, except for communities of culturally and linguistically but different backgrounds because they will shy away from that lens being cast on them. They won't know how to access. We end up with a two-tier system with the parents who can navigate, advocate for their child, get support and get NDIS packages and those who can't.[166]

3.147Community Hubs Australia explained how some of the challenges for CALD communities with accessing early childhood support services are exacerbated for newly arrived families to Australia with young children.

Accessing early childhood education is not always easy, for many culturally and linguistically diverse (CALD) families the Australian school system can be difficult to navigate, especially for those with limited English. For newly arrived families, the settlement process can be intensive and if they are focused on housing and employment, they might not have time to arrange early childhood learning. Additionally, these families are often navigating this without the support of extended family or friends and can be dealing with significant isolation or trauma.[167]

3.148Mrs Nicole Pates, Chair, National Paediatric, Australian Physiotherapy Association, highlighted the need for integrated systems to support vulnerable CALD communities. She explained: ‘that’s why it's tricky and why they fall through the cracks, there's no easy referral system for GPs into allied health in that very early phase.’[168]

Impact of delayed early support on school readiness

3.149Some stakeholders highlighted the consequences of delayed early identification for children from CALD families for their school readiness and education milestones later on, such as NAPLAN. For example, the Royal Australasian College of Physicians said:

In refugee communities, children are often not referred until 4-5 years of age, by which time moderate or significant developmental delays are affecting school readiness, representing a critical missed opportunity for early intervention.[169]

3.150Learning Links described similar issues:

Systemic inequities are well documented, particularly for First Nations children, culturally and linguistically diverse (CALD) families, and those living in rural and remote communities. These groups are disproportionately represented in both the AEDC data for children starting school, and in NAPLAN results in later years – reinforcing the barriers to early identification and access to developmental supports.[170]

Service affordability

3.151Some stakeholders discussed the affordability of services for CALD families.[171] The Brotherhood of St Laurence observed intersecting issues such as socio-economic disadvantage, and the cost of private assessments and services that led to potential barriers for CALD communities:

For some families on temporary visas they may not be eligible for Medicare or other related Government services, which can mean that some families do not access supports for their children due to costs associated with support.[172]

3.152Ms Sally Maddison, Acting Chief Executive Officer, Early Learning and Care Council of Australia, told the Committee about the importance of access to early childhood education and care, particularly for First Nations and CALD families. She stated:

We need to invest in greater access for ECEC [early childhood education and care] because many of the children, including those facing vulnerability and disadvantage who would benefit most from ECEC, do not attend. This includes children with additional needs, First Nations children and children from culturally and linguistically diverse backgrounds. We're hoping that the government's introduction of the three-day guarantee at the start of next year will help provide greater access to these children, but that is something we all need to work on.[173]

3.153Occupational Therapy Australia commented:

Thriving Kids must recognise and respond to the needs of families who are experiencing economic disadvantage and other complexities… Almost a third of children from CALD backgrounds living in the most disadvantaged socio-economic areas were developmentally vulnerable compared to 1 in 6 of their peers living in the most advantaged areas.[174]

Navigating complex NDIS systems and services

3.154On navigating the current care system, Ms Sally Maddison, Acting Chief Executive Officer, Early Learning and Care Council of Australia told the Committee:

When parents and carers seek help for a child with additional needs, they are often faced with a complex, disconnected network of services involving multiple agencies, application processes and funding streams.[175]

3.155Ms Maddison continued to discuss the benefit of 'navigation support' for families, stating:

I think navigation support [for families in the early childhood education and care system] is really important, particularly when we're dealing with really diverse cohorts. It's complicated enough for a mainstream family without additional needs or any additional—

…language support. It is really quite a fragmented system and it's highly bureaucratic. I think navigation support not only supports families and the child but supports the ECEC workforce, which we know is really dedicated to children and supporting children's participation, ensuring they get every support they can to participate fully in early learning and care.[176]

3.156Ms Angela Falkenberg, President, Australian Primary Principals Association, was of the view that there is sometimes a disconnect between the work being done at school and the family being excluded, particularly in CALD communities.

When it comes to building family capability, often, when the support is at school and in school time, that's exclusive of families. The child might be getting some gross motor skills support, but how does the connection with family work? It's left to the teacher. I think the navigator role is key also in keeping the family present for the support.[177]

3.157Mr Hermann, Policy and Advocacy, Allied Health Professions Australia discussed the importance of capacity building in CALD communities in order to provide better access to developmental services.

…we need to really be focusing on how we are building capacity in communities, and that's why I mentioned CALD communities. The reality is that it's families and perhaps communities, potentially informal playgroups and all those sorts of things that are seeing children constantly. If those families, if those playgroups and whatever else better understand how to identify potential needs that then trigger potentially accessing general practice or allied health services, that's how we do it. Universal approach is a part of the solution, but we need the people who are spending the time with children in the first instance to understand what to look for and how to actually get in and connect to those services.[178]

3.158MYAN also highlighted the challenge faced by new CALD migrants using the NDIS:

The people, especially those who are new arrivals, when they get to rural areas, it's really hard for them to navigate a complex system like NDIS or the general system. They have so many other priorities and health will be at the bottom of these priorities.[179]

3.159Mr Christopher Ouizeman, Director, ADHD Foundation, suggested the need for investment in the literature for CALD communities to support parents and build their health awareness and literacy.

The information that's provided is very sparse. There's not a lot of good information out there. I think investment needs to be made in literature for CALD communities as well as the English-speaking communities and, to some degree also, the First Nations communities. Tailored information needs to be provided; it's not currently available. The second part is GPs. They need to have access to information that they can provide to their patients. That's not happening at the moment because there isn't any information. The best we can do is refer people to the ADHD Foundation or ADHD Australia or the ADHD professionals association. We do our best to compile best practice information.[180]

Stigma associated with disability

3.160Children and families from CALD communities may also face cultural stigma around disability when accessing developmental supports. For example, a submission from Uniting NSW/ACT discussed the negative impact that cultural stigma has on seeking further advice and assistance, and described:

…an ongoing stigma associated with disability and developmental delay which can prevent some families from accessing support. Our staff report that this is particularly damaging for mothers from culturally and linguistically diverse backgrounds who fear that signs of disability and developmental delay are a reflection on their parenting skills and avoid disclosing their concerns outside the family. This stigma becomes a barrier to seeking help and further information.[181]

3.161Ms Judy Connell from the Victorian Catholic Education Authority pointed out that the stigma is very real for some cultures. She explained:

…in some culturally diverse communities there isn't a word for disability. In others, disability is seen as a punishment. We need to work with those families who are really reluctant and not trusting of systems.[182]

3.162Ms Nicole Rogerson, Chief Executive Officer at the Autism Association of Australia also commented on the issue of stigma being a barrier to accessing early developmental support services.

We know that for some families, from certain cultural backgrounds, disability is very difficult to talk about ... Often in a family not both parents are on the same page as to where their child is developmentally. One of them might be more prepared to investigate things than the other.[183]

Lack of trust in government and other services

3.163Trust and collaboration in service delivery is critical to engaging communities, especially for CALD children and families. The Committee heard that some communities have a fear or mistrust towards services, due to previous experiences and therefore are reluctant to engage around their child.[184]

3.164Ms Connell highlighted the need to invest in time to build trust with CALD children and families:

…there's a real role for multicultural education aides in supporting that process and engaging with culturally diverse families and building trust. There are soft entry points that we can manage in terms of starting to bring families along those journeys. Examples of where that might have worked previously are in supported play groups, where families attend together with their children. There might be a speech pathologist or an occupational therapist there who develops a conversational relationship with families around a coffee. They then start to work through, once that trust develops, the next stages of referral or support that might be required.[185]

3.165Mrs Nicole Pates, Chair, National Paediatric, Australian Physiotherapy Association, commented on the complexities for some communities accessing developmental services.

I think that core to accessing any service is your therapeutic relationship and common values. Given the way our systems are set up at the moment, there are very specific entry points and very specific knowledge needed to enter those systems. You need to know that there is a developmental divergence or difference and, potentially, if you're in a specific community, you might know that, to access services, you need to go outside of your safe and trusted community.[186]

Citizenship and visas considerations

3.166Some stakeholders discussed challenges regarding citizenship and visa status for children and families trying to access the NDIS and other services. For example, a submission from Uniting NSW/ACT highlighted:

…while some early connections are available to families living in Australia regardless of their citizenship or visa status, children must meet residency requirements to be eligible for the NDIS. Similarly, asylum seeker families are broadly ineligible for the Child Care Subsidy. They must therefore pay full fees to access early childhood education and care (ECEC).[187]

3.167The Brotherhood of St. Laurence described similar barriers:

Families who are seeking a visa renewal, extension or transfer, permanent residency or citizenship may not want to access services or support that might label their children as having a disability due to discrimination in Australia’s migration system.

…For some families on temporary visas they may not be eligible for Medicare or other related Government services, which can mean that some families do not access supports for their children due to costs associated with support. …

While there are some services available for families ineligible for the NDIS due to visa status, there can be substantial wait times which delay access to early intervention services.[188]

3.168Acknowledging the persistent gaps that exist for CALD families, National Disability Services recommended that Thriving Kids should ‘ensure that foundational supports are universally accessible regardless of visa status.’[189]

3.169Early Childhood Intervention Australia Victoria advocated for families to be able to access ‘the right supports, at the right time in the right place regardless of visa status or diagnosis.’[190] Its submission also recommended that Thriving Kids should ‘ensure residency and visa status does not deny access to supports.’[191]

CALD informed design

3.170Some stakeholders highlighted the need for better CALD-informed design of the Thriving Kids initiative.[192] For example, the national peak body representing young people from refugee and migrant backgrounds, MYAN highlighted the initiative’s importance and emphasised ‘for Thriving Kids to truly achieve its aims, it must be equitable, inclusive and culturally responsive.’[193]

3.171MYAN recommended ‘a strong commitment to equity and cultural intelligence, cultural competence, across all aspects of the program design and delivery’. MYAN expanded that the Australian Government needed to include comprehensive cultural awareness and intelligence training for all staff to ensure understanding of diverse family experiences and perceptions of disability and developmental delay; and meaningful participation of First Nations and CALD communities in the design, governance and evaluation of Thriving Kids.

3.172Mrs Nicole Smith, Head of Disability Supports at SSI, emphasised the importance of ensuring inclusion for the CALD community, given it represents a quarter of the Australian population, and explained:

With more than one in four children entering school in 2024 being from CALD backgrounds …it's imperative that the initiative reflects the true diversity of Australia and that it makes sure that we have equitable access for supports.[194]

3.173Mrs Smith also shared her personal experience as a mother of a child who is accessing the NDIS. She explained:

…the benefit for me is that reassurance that I'm not alone on this journey, and I know that many of the supports, and the families from CALD backgrounds that we support, feel the same. That intervention is critical but, as we've heard through this reform, the NDIS doesn't need to be that point of call for everything, and I think that's where Thriving Kids has a really key opportunity.[195]

3.174SSI advocated for a blend of universal and targeted place-based interventions with programs such as community hubs that demonstrate an effectiveness of being culturally responsive and relationships based, which helps ‘build trust and facilitate a warm referral process.’

Thriving Kids needs to incorporate tailored communication strategies to reach CALD families, including translated pictorial resources, and we need to understand the limited English proficiency and digital literacy of these communities, which often results in exclusion from essential information and increases isolation and stigma.[196]

3.175SSI suggested that an advantage of a national hubs model is that it facilitates an opportunity to connect individuals to a range of services, whether these be health services, settlement services, or disability supports. SSI explained:

Where families do have that point of contact, we need to remember that trust is very, very important. Trust is important to anyone, but it's especially important for CALD communities who may have recently migrated to Australia. They may be quite isolated, and sometimes they can even be isolated from their own community.[197]

3.176SSI’s general manager Mr Ben Fioramonte highlighted the effectiveness of their Ability Links program working with Vietnamese communities in the Liverpool area.

…we would find that they would connect with one of our Vietnamese workers and that worker would be the go-to for anything. They would give their number out to their families. That was really positive, but we also had to work quite hard to build their trust with other people, other places and other services so that they could connect and integrate more broadly.[198]

3.177The Executive Director of the Australian Multicultural Health Collaborative, Ms Priyanka Rai, also highlighted the importance of service providers being trusted and embedded in communities to achieve better outcomes.

When that information comes from someone who's already a part of that community and who the family trusts, as opposed to an NDIS brochure in a language they're not familiar with or calling a call centre—those barriers then just start piling up for these families.[199]

3.178Professor Sharon Goldfeld, Theme Director, Population Health, Murdoch Children's Research Institute, and Director, Centre for Community Child Health, Royal Children's Hospital, spoke about the importance of building community hubs for CALD families:

We talked about hubs for services, but the other really important thing about hubs is bringing families together. You've got amazing people sitting around the table here, including the people in the room with you, who have already talked about the importance of bringing families together. There are supported playgroups, for example, where families can get together, and they can be culturally appropriate and language specific. Again, that's about putting information in the hands of families.[200]

3.179Many stakeholders advised against a universal or one-size-fits-all approach to delivering services through Thriving Kids, due to the diversity amongst priority groups such as First Nations and CALD, advocating for a flexible and targeted approach. For example, Professor Goldfield summarised that:

Universal programs are important but cannot fully address complex and diverse needs. It is important for them to assist alongside individualised support delivered by trained health professionals especially for CALD communities.[201]

Rural and remote communities

3.180Evidence to the inquiry highlighted the vast and complex equity and inclusion challenges faced by children and their families in rural and remote communities, including:

• inconsistent service availability
• limited telehealth and outreach
• limited infrastructure and internet connectivity
• workforce shortages
• funding and costs.
  181. The Committee heard that children in rural and remote communities are more likely to experience developmental vulnerability and lower educational outcomes compared to those living in cities.[202] A submission from the Regional Education Commissioner reported that only half (around 50 per cent) of children in regional areas and 43 per cent of children in remote and very remote areas are developmentally on track on all five domains measured by the Australian Early Development Census [AEDC].’[203] More information about the AEDC is available in Box 3.2.

3.182Ms Susanne Tegen, Chief Executive at the National Rural Health Alliance (NRHA), also gave evidence regarding the AEDC domains, and highlighted that more than 20 per cent of children in rural and remote areas ‘are vulnerable in two or more domains.’[205] She elaborated:

This is not just a statistic. It is a signal that we are failing thousands of children at the very start of their lives purely because we rely on their parents to work in rural, remote and regional Australia, which brings in most of our economic income, brings in the food that Australians eat and also brings in the income from tourism. We must not allow this to continue. They're thwarted by the systemic barriers and the fact that they're out of sight and out of mind.[206]

3.183Ms Nicole Moran, Board Member at Regional Autistic Engagement Network, said that Thriving Kids, as currently proposed, ‘will disproportionately impact rural and regional communities.’[207]

3.184Many submitters and witnesses emphasised the importance of ensuring that Thriving Kids is fair to all children no matter their postcode. For example, Ms Tegen advocated:

Thriving Kids must be responsive, sustainable and equitable... Getting it right is not only a matter of fairness; it is a national imperative, and it will in fact impact our long-term productivity.[208]

3.185Similarly, speaking about her experience as a mother of a two-year old boy with a developmental delay living in a regional area, Ms Jessica Paoloni emphasised that ‘a postcode should never determine whether a child gets the support they desperately need during their most critical development years.’[209]

Inconsistent service availability

3.186One of the key challenges affecting children and families in rural and remote communities discussed in evidence to the inquiry was the inconsistent availability of health and disability services, such as paediatricians, allied health professionals, psychologists and psychiatrists.[210]

3.187A submission from Pop Family Pty Ltd, a national online speech pathology service, highlighted that ‘the success of the Thriving Kids initiative is entirely dependent on the availability of a skilled and sufficient workforce, which currently does not exist.’[211]

3.188Dr Sarah Chalmers, President-Elect of the Rural Doctors Association of Australia (RDAA), said that new programs are not designed for the health system in rural and very remote communities, and explained:[212]

Most people understand the health service as being public and private, that there are primary, secondary and tertiary providers, that there are hospitals with specialists in them, that GPs work out of buildings with all of the resources, and that many of the allied health providers are in private practices that GPs might be able to refer people to. We are in really remote places. We don't have those systems. Often…the system is designed around the urban health system. It simply doesn't work the further away you get from a major capital city.[213]

3.189In this context, Dr Chalmers warned that without taking ‘the differences in availability of resources into account in the initial design, you set particularly the remote communities, rolled into regional and rural communities, up for failure.’ She elaborated

That means they have no chance of any type of equity simply from the design. I would say that taking the remote and rural health system into account as part of designing what happens going forward may assist in equity of access for those children.[214]

3.190Ms Tegen from the NRHA expressed similar concerns, and added that design ‘needs to be covered in a way that takes into consideration the many kilometres that people have to travel and the many costs that rural people have to cover.’[215]

3.191Ms Carrie Clark, Chief Executive Officer at Kiind, a peer support organisation in Western Australia (WA), pointed out that the NDIS was ‘rolled out differently and later than in WA’, and shared concerns that Thriving Kids will:

…end up designed and working for children who live in metro areas and that it will really fail children in regional and remote areas, particularly in WA, where there are significant difficulties in delivering services and huge workforce issues that could potentially create equity problems for families.[216]

3.192Dr Garth Hargreaves, a General Paediatrician and Member of the Australian Paediatric Society, observed ‘a very stark difference in services’ between city, regional, rural and very remote areas.’ Dr Hargreaves also noted a lack of access to therapeutic services and suggested that existing funding models are insufficient to maintain face-to-face services.[217]

3.193Ms Nicole Avery, Chief Executive Officer at South West Autism Network, told the Committee about service gaps experienced in WA. She said that while:

…some allied health professionals [are] available through the WA Country Health Service and through primary health care… There might be two years where there is no speech pathologist servicing a community. That is a pretty big chunk of your child's early development. Other issues are that they might be geriatric trained rather than early childhood trained.’[218]

3.194WA Early Childhood Intervention (ECI) Collaborative noted ‘an insufficient number of ECI practitioners with appropriate ECI experience in rural and regional areas’[219] and explained:

…where rural / remote schools cannot spare the teaching capacity to accommodate children with higher needs, leading to children with more acute sensory or behavioural needs sometimes excluded from school because teachers are not trained or equipped to support them in line with best practice.[220]

3.195Allied Health Professions Australia suggested a ‘hub and spoke model’ may improve access to services, where specialised skills are based in metropolitan or regional centres or operate by fly-in models. While Allied Health Professions Australia recognised the importance of building local capacity in the health system, they raised that this may be challenging for highly specialised skills like orthotics or prosthetics.[221]

3.196However, Autism NT were of the view that you ‘can't just walk into any community’ but that ‘you have to collaborate with our services and people who understand that community.’[222] They also explained that providers in regional centres have expectations for how often clients are available, saying ‘If you go to Alice Springs, you have to come every three months. You don't just come when you can. If [you] have funding here and there.’[223]

The role for schools

3.197Given the limited services available in rural and remote areas, some stakeholders recommended that schools in rural and remote areas be leveraged to provide better support to children and their families. For example, the Regional Education Commissioner suggested consideration be given to:

…how regional, rural and remote schools could be utilised to provide vulnerable students and families with better access to allied health services, while ensuring that the school is not overburdened coordinating this access. For example, a community allied health services coordinator role could be funded within a school, or across a cluster of schools, to provide the vital linkage between students and allied health services.[224]

3.198A submission from South Burnett CTC shared an example from Kingaroy, a rural town in Queensland, where an Early Years Service provides in-home support to families with neurodivergent children to prepare them for school:

This service assists with navigating the pathways for pre and post diagnosis with families for neurodivergent children. The service also assists with behaviours of concern, routines, immunizations, transport to appointments, seeking mental health assistance for the adults. The Early Years Service provides a specialist program that also offers paediatricians, child development service, allied health professionals extensive information on children’s developmental differences... Early Years address any concerns parents may have with typical children as well such as toilet training, eating difficulties and many others. This service has been within our community for seven years and … has been very successful in assisting families to have a better understanding of children’s development and a bigger toolbox for behaviours of concern.[225]

3.199Conversely, Dr Hargreaves highlighted the benefits of making therapies available home or clinical settings, as opposed to school settings:

[O]ver time, we're seeing a lot of kids getting ongoing therapeutic services in school settings, which excludes the parents. I think you get a lot more bang for your buck if therapeutic services include parents—particularly for the conditions that therapists are often working with and the sorts of symptoms and problems that they're seeing. Any reform should be very mindful that … the system has slipped into this model in particular because we fly in and fly out services. It's a lot easier and more convenient to do therapy in school settings, but I don't think it's the most efficacious. So, moving forward, funding models that might allow for clinical spaces outside of schools or in the home really should be part of it.[226]

3.200South West Autism Network also pointed out equity issues associated with delivering services through schools, including the risk that:

…they are only available in specific schools rather than every school. That potentially increases segregation if you can't attend the same school as your siblings because you've got some developmental delays and instead you have to attend a school at a town two hours away.[227]

Long travel distances and waiting periods

3.201Inconsistent service availability means that families may be forced to travel long distances, or face long waiting periods, to access the support their children need.[228] For example, Mrs Law told the Committee ‘waitlists for autism assessments are often 1–3 years long. Even when funding is approved, families cannot find providers to deliver the supports.’[229]

3.202A submission from the Australian Paediatric Society reported ‘hospital and private paediatric services in rural areas often carry 6 to 18 month wait times; paediatricians advocate for timely, affordable, and sustainable pathways.’[230]

3.203South Burnett CTC also highlighted long waitlists for a range of health and disability services:

The wait list for Allied Health professionals, and Child Development Services are anywhere from 12 -18 months and up to 24 months for Paediatricians in rural areas. This is really limiting the assistance that children with differences are receiving. Even when you have a NDIS plan there is still a 12 month wait list for a speech therapist, and an Occupational Therapist can be longer with many refusing new referrals as their waitlists are full… The paediatrician is only available on certain days and comes from a larger town which isn’t enough to service the growing community.[231]

3.204Ms Tegen, from the NRHA, shared her personal experience travelling long distances from rural South Australia to access NDIS services:

I travelled 70,000 kilometres during my child's first year… It didn't include my flights. I was living in the south-east of South Australia on a farm. And I'm literate. There are many people that are not health system or health literate, and we are failing those communities. We are failing our children and we are failing those parents and carers. We must not fail rural Australia, because we need rural Australians for our economic wellbeing.[232]

3.205Services for Australian Rural and Remote Allied Health (SARRAH) expressed concerns that long waiting periods present ‘a missed opportunity to provide interventions that ensure children can start school having reached essential developmental milestones.’[233]

3.206Given the long travel distances travelled by some families in rural and remote communities, Physical Disability Australia recommended that implementation of Thriving Kids should cover all areas of Australia:

So that, if I live in a remote part of Queensland, I don't have to travel 500 or a thousand kilometres to get the diagnosis and support that I need. So it's not just about it being rolled out in major centres and major cities; it's about it being rolled out across the states, because otherwise kids are just going to continue to fall through the gaps.[234]

3.207Community Therapy recommended a system of travel compensation based on the Modified Monash Model (MMM) zones.[235]

3.208Succeed Healthcare Solutions Pty Ltd also commented on long waitlists for families, but suggested:

These waitlists are not necessary as there is provider capacity, but there are no consistent, nationally supported mechanisms to match families with available services. Small, responsive providers are ready to deliver, but families often cannot find them, especially in rural and remote areas where trust must be built over time.[236]

3.209Allied Health Professions Australia highlighted:

…consideration needs to be given to how support can be provided in natural settings without significantly increasing the costs of services to consumers or reducing significantly the volume of services that can be provided. This is particularly important for rural and remote settings where travel can be considerable.[237]

3.210Mrs Meredith Cox, Early Interventionist and Key Worker, Bathurst Early Childhood Intervention Service, told the Committee:

What works for the city doesn't necessarily work for families in regional and remote areas—for example, the recent changes in travel charges within the NDIS. Some families are travelling further to services, and some providers are now swallowing up those costs to service needs in rural and remote areas. Families need support when they first reach out. We are often the first port of call for families in our regional areas. These families are serviced by what we call Start Strong, and we currently are creating a playgroup to try and capture families when they first reach out for us. We are being supported by another like-minded organisation to fund these programs. Once the playgroup starts early next year, we will be inviting families to come and meet some of our team. We will work with the families to complete ages and stages, identifying areas of concern, and, if Thriving Kids were to be in place, we would happily be a pilot program for it.[238]

Limited telehealth and outreach

3.211Multiple stakeholders called for improved or expanded telehealth and outreach services as a means to improving access to services for children and families.[239] For example, Pop Family Pty Ltd recommended:

• Funding and regulation for ‘telehealth-based developmental screening services to provide timely and equitable access for families in rural, remote, and other isolated and undeserved communities, eliminating prohibitive wait times’.[240]
• Funding for ‘telehealth access packages, including subsidies for data and devices, to ensure digital inclusion for all families, particularly those in rural/remote and low-socioeconomic communities.’[241]
  212. The Australian College of Nurse Practitioners (ACNP) noted that ‘families in rural/remote areas … may also experience poverty, transport disadvantage, digital exclusion, or limited workforce availability’. Given this, the ACNP recommended:
• funding for telehealth services to ensure accessibility and affordability
• removing the face-to-face requirement for access to Medicare rebateable telehealth services.[242]
  213. Similarly, the NRHA recommended:

Telehealth and hybrid service models supported by local facilitators and outreach programs may complement (not replace) face-to-face contact and address the tyranny of distance, allow timely screening, and facilitate continuity of care, especially for workforce-scarce areas.[243]

3.214The Regional Education Commissioner suggested that community organisations should be supported ‘to provide allied health services through telehealth and outreach [as] another opportunity to extend access to allied health services to regional, rural and remote communities.’[244]

3.215Royal Far West described telehealth as ‘a very effective model of care’ that ‘doesn’t take children out of school.’ They shared the example of a student who had to travel to Dubbo to receive care, and, as a result, needed 36 days off school to attend sessions, while her mother had to take those days off work.[245]

3.216Other stakeholders expressed reservations about the utility of telehealth. For example, although Autism NT agreed that telehealth works for some individuals ‘because it takes away the anxiety of that social interaction,’ they also noted that healthcare delivered online does not always lead to best results.[246]

3.217Mrs Ashlee Law noted that ‘Telehealth is sometimes available but does not fully replace local, consistent access, and is often incompatible for supporting young children.[247]

3.218Services for Australian Rural and Remote Allied Health (SARRAH) similarly pointed out that the complexity of some supports mean that they are not suitable to virtual formats. For example:

Speech pathologists work with children with complex communication needs, supporting participants who have limited speech or are non-verbal to use customised assistive technology. Prescribing the right technology, customising it and training in its use requires face to face input and consistent follow-up to ensure learning sticks. These complexities make virtual modalities impractical. The situation is compounded by poor bandwidth and connectivity issues routinely faced by rural and remote Australians.[248]

3.219The National Organisation for Fetal Alcohol Spectrum Disorder submitted that telehealth ‘functions best as a supplementary model rather than a replacement, as it relies on already overstretched clinic staff and digital infrastructure…’[249]

3.220Associate Professor David McDonald, Senior Member of the Australian Paediatric Society, said that ‘Telehealth has a place but should not replace face-to-face assessment,’ highlighting ‘very significant limitations in terms of the clinician-to-client interaction.’[250]

3.221Beyond telehealth, some stakeholders called for improved outreach and digital tools. For example, Succeed Healthcare Solutions Pty Ltd recommended investment in pathways to link families with providers, ‘prioritising long-term relationship-building and cultural safety’ and ‘long-term strategies for rural access, including outreach and relationship-building.’[251]

3.222Succeed Healthcare Solution’s submission explained its own experience trying to reach rural and remote areas:

We are willing and able to service rural and remote areas, including through place-based allied health assistant groups and telehealth. However, trust is the first barrier. Families are reluctant to engage when they don’t know us, and there are no effective, nationally maintained systems to connect families with providers who have capacity. As a result, support remains unavailable even when services exist.[252]

3.223Ms Kylie Irvin, Portfolio Manager, NDIS Western at Marathon Health highlighted the need for continued investment in allied health services operating in regional and rural communities:

…there are already some excellent allied health services who just need continued investment to be able to deliver more of the services that they're already doing a really great job at doing. We typically travel 400 kilometres to 500 kilometres to provide face-to-face services to children in our patch. We would travel into those communities roughly once a month or sometimes once a fortnight—around about 300 kilometres there and home—and then back again that day or the next day. I think we would view telehealth as something that complements this face-to-face service delivery. And, as I mentioned, adding in those enabling roles, like paediatric linkers and allied health assistance, can really complement that service as well, where families who aren't able to access telehealth—who might live on a remote station an hour from Bourke, which is about 500 kilometres from Dubbo—could have a person in the home, working with them, and then be supported through telehealth as well.[253]

3.224Colman Education Foundation: Our Place also commented on some of the limitations of digital outreach:

While digital tools such as apps and websites can extend access, particularly in rural and remote areas, they are not enough on their own. Families experiencing disadvantage are the least likely to engage through these channels, and digital resources cannot provide the reassurance or professional judgement that parents often need when concerns arise.[254]

3.225Mrs Rachel Green, from SANE Australia, outlined a project funded by the Department of Health on designing digital solutions to improve navigation of the mental health system, and also the role of people helping others navigate the system.[255]

Those principles from our navigation report are to find me where I am; make it easy to get more help, because no single path works for everyone; help me choose based on what's important to me; value, build and maintain my trust; help others help me; make it easy to move between services; and provide support and resources while I'm waiting—this one is particularly relevant considering the fact that it's not always clear, and it's not always possible, to diagnose certain developmental delays or types of neurodivergence when a kid is simply too young and there could be a lot of factors.[256]

Limited infrastructure and internet connectivity

3.226Multiple stakeholders identified poor infrastructure and internet connectivity as a barrier affecting children and families in rural and regional communities. For example, MYAN highlighted that poor infrastructure (such as telecommunications, broadband, or electricity) can compound challenges for people with disability living in regional and rural areas.[257]

3.227A submission from South West Autism Network described poor internet connectivity in parts of regional WA, which can be a barrier to using telehealth.[258]

3.228Ms Catherine Maloney, Chief Executive Officer, SARRAH, described poor access to high-speed internet in regional, rural and remote Australia as ‘an equity issue for children with disability’. She stated:

That means you must have all of these options available to families living in rural and remote areas. The evidence tells us that the use of screening models of care with multidisciplinary teams and role substitution methods seems to improve screening, assessment and diagnostic processes, leading to the appropriate identification of children who do require services. But solutions can't rely solely on digital modalities, as there are often reports of technology difficulties, such as not having appropriate equipment or inadequate internet connections.

3.229In this context, Ms Maloney recommended that consideration be ‘given to ensuring all remote Australians have access to high-speed internet as an essential part of health and education infrastructure.’[259]

Workforce challenges

3.230The Committee heard about a ‘health workforce crisis’ in rural Australia, where many communities have limited or no access to services and support. Ms Jacqueline Emery, Chief Executive Officer at Royal Far West explained:

GP access and the availability of allied health, particularly in MMM5, is declining. Bulk-billing rates are falling and locum contracts are unsustainable. Paediatric waitlists can stretch from 18 months to six years, and private assessments cost up to $3,000. We receive consistent reports of a two-year waitlist for allied health. Teachers are managing complex needs without support. Families are under financial and emotional strain. Our rural communities are losing young families because services simply aren't there. Families in thin markets are not getting the help they need at the time when it makes the most difference. This is structural, not situational.[260]

3.231Stakeholders generally agreed that for Thriving Kids to be delivered successfully, rural and remote communities need more health and disability service workers.[261]

3.232For example, the National Organisation for Fetal Alcohol Spectrum Disorder (NO FASD) described ‘disproportionate shortfalls in the healthcare workforce’, especially in rural towns. Its submission also highlighted that many communities rely on fly-in fly-out ‘clinicians whose services are prioritised for children with acute or medically complex needs.’ Ultimately, NO FASD concluded: ‘The assumption that Thriving Kids can “scale up” existing services ignores the reality that in many communities, no baseline FASD-informed services currently exist.’[262]

3.233Contemplating funding of Thriving Kids with a focus on workforce, Ms Susanne Tegen, Chief Executive at the NRHA said:

…clinicians on the ground should be celebrated rather than being made to run through more hoops. We need to build the local workforce and we need to support the local workforce, not treat them as if they are criminals because they're asking for more. They're not even receiving the equitable funding in the first place. That is a really important thing.[263]

3.234Submitters and witnesses discussed a broad range of sector-specific workforce challenges in rural and regional communities, such as:

• high costs and safety risks for staff driving long distances.[264]
• people studying allied health degrees typically need to relocate to cities, and often don’t move back to rural and remote areas after graduation.[265]
• secondary teacher demand is expected to exceed supply, enrolments are rising and workloads are increasing.[266]
• educators do not always have ‘the time or the confidence’ to make decisions about identifying at-risk children.[267]
• short-term contracts do not incentivise new medical and allied health graduates to relocate or return to rural areas.[268]
• caps on travel limits make it difficult for allied health professionals to provide services.[269]
• pay discrepancies exist between nurses working for a local health district versus in communities.[270]
• rural accommodation shortages.[271]
  235. Ms Samantha Hunter, Chief Executive Officer at Occupational Therapy Australia, described occupational therapy as ‘the fastest-growing allied health profession’, and suggested that the increasing number of graduates should assist the availability of supply in rural and remote areas. She also highlighted that ‘a number of programs are being started up over the coming two to three years and will be delivered in regional and remote areas.’[272]
  236. Mrs Amanda Curran, Chief Psychologist at the Australian Association of Psychologists suggested:

…a model that we proposed to government where provisional psychologists could be doing placements in those settings if the supervisors were trained and there was some paid work for those provisional psychologists to be out in rural and remote settings. We found that, if people complete their training in those settings, they're more likely to stay in those areas as well. A system like that, where we're getting people there and completing their training, might ease up the burden for those families living in those locations for many more years.[273]

3.237Additionally, the ACNP argued that nurse practitioners be integrated into the Thriving Kids model to support ‘a sustainable, system-wide approach to supporting children to thrive outside of the NDIS.’ The ANCP explained:

Nurse Practitioners are a vital part of the primary care workforce, and are embedded across maternal and child health, general practice, and community health services. With appropriate funding, NPs can strengthen early identification and intervention, ease service demand on specialised behavioral pediatricians, and improve equity of access across metropolitan, rural, and remote settings.[274]

3.238The Australian Primary Health Care Nurses Association agreed, saying that the 98,000 nurses working in primary care represent a workforce that is embedded in communities and could be trained in screening, early intervention, coaching and supporting parents, which could ease challenges in MM6 and MM7 areas.[275]

3.239Ms Janice Finlayson from Maternal, Child and Family Health Nurses Australia, echoed this and said that nurses are a mobile workforce which are currently being underutilised.[276]

Relocation and retention incentives

3.240Many submitters and witnesses advocated for workforce incentives as a means to increase the health and disability service workforce in rural and remote communities.[277] Specifically, stakeholders recommended incentives and other supports to attract and retain educators,[278] allied health professionals,[279] and psychologists.[280]

3.241While stakeholders proposed a range of different incentives, most described financially-based incentives. For example, Ms Louise Ingall, Manager Research and Partnerships at HealthWISE suggested discounting student debt as an incentive for people to relocate to rural areas.[281] She elaborated:

…we are not expecting people to give up their lives; we would like them to come and have a rural experience for 12 to 18 months. It would make a difference to all our children.[282]

3.242Similarly, ACSSO recommended ‘Relocation and retention incentives should be provided for allied health professionals in rural and remote areas, including housing, travel subsidies, and professional development opportunities.’[283]

3.243However, the Australian Physiotherapy Association highlighted the need for non-financial incentives:[284]

Generic incentives have not fully addressed shortages of paediatric physiotherapists in rural and remote locations. Discipline-specific incentives, career development, mentoring and professional learning opportunities are essential to build local workforce capacity.[285]

Funding and costs

3.244Multiple stakeholders throughout the inquiry referred to the Modified Monash Model / MMM 2019, which is used by the NDIS to determine the location of a participant and cost of a provider. More information about the Modified Monash Model is available in Box 3.3.[286]

3.245Throughout the inquiry, the Committee was fortunate to hear from support services active in MMM remote locations. For example, in 2024–25, Royal Far West supported more than 30 000 people across 387 communities, with 42 per cent of its services being delivered in MMM 5 locations (small rural towns).[288]

3.246A submission from SARRAH discussed NDIS funding and pricing in MMM 4-6 areas, and warned that ‘NDIS participants in these areas are at risk of losing access to therapy supports essential for maintaining quality of life.’[289] SARRAH explained:

The 2025 NDIS Pricing Arrangements which came into effect from 1 July 2025 saw significant changes limiting therapy provider travel, and for many providers will make delivering services into rural and remote communities unsustainable... Recommendations arising from the 2023 NDIS Review have not been implemented, leaving participants with no back-up plan should their current provider withdraw services.[290]

3.247The National Regional, Rural, Remote and Very Remote Community Legal Network said that children were being let down by current supports, particularly in Regional, Rural, Remote and Very Remote (4R) areas:

Currently the NDIS Act and swathes of Commonwealth legislation fail to visibly support geographic inclusion of children, people and groups in 4Rs areas. This portrays that no major challenges for inclusion, intersectionality and implementation exist, when the reverse is true. The invisibility fails to provide leadership and vision to promote momentum and solutions.

The problems which are letting down children with disability in 4Rs areas – and the complex of failures affecting children and others in 4Rs areas across so many policy and program areas and dimensions – mean that the task must now include establishing a culture of geographic success and inclusion. That is, establishing an enabling, educative and self-improving environment for large scale cultural change which expects and achieves full geographic inclusion of children, people and peoples in 4Rs areas.[291]

Block funding

3.248Some stakeholders suggested that block funding arrangements (see Box 3.4) could potentially help to address workforce challenges in rural and remote communities. However, other stakeholders raised concerns that this model would unduly impact local providers and subsequently the supports available in those communities.

3.249The Royal Australian College of General Practitioners discussed the ‘tremendous potential’ of block funding in areas where there are limited specialists available. For example, if ‘multiple general practices pool their block funding to employ…suitable early intervention providers that are community centric.’[295]

3.250Ms Clark, Kiind, believed that block funding could potentially be one of several alternative models for reaching regional and remote communities, particularly in Western Australia.[296]

3.251Pop Family Pty Ltd suggested the ‘government could consider funding models such as block funding or national contracts for telehealth-enabled services, which would secure a baseline of access nationally and particularly benefit families in regional and remote communities’[297] as well as enabling ‘providers to invest in the workforce development required to meet demand.’[298]

3.252The National Rural Health Commissioner noted that block funding could be an option that ‘could support the delivery of services that are no or low cost to clients in rural and remote communities.’[299]

3.253In contrast, Ms Heidi La Paglia, a Steering Committee Member from Every Australian Counts, said that regional communities are concerned that large block funding contracts will exclude communities that are not serviced by major providers, since local providers may not be NDIS registered, leading to potential collapse or changes to the market in these areas. She also warned that this could lead to workers losing their jobs.[300]

3.254The Nobody Worse Off Coalition was of the view that if ‘services are block funded small First Nations-led or regional providers may not be eligible, risking service loss.’[301]

3.255Ms Nicole Moran, Board Member of the Regional Autistic Engagement Network, agreed that block funding ‘will logically disproportionately impact marginalised and intersectional communities, families and children, who cannot afford gap service fees, which we know will remain in rural communities due to the lack of available services and providers.’ She said that her personal experience of block funded disability supports in Tasmania ‘never provided us with adequate support and always fell short of our needs…my family and I were left with out-of-pocket expenses that we could not afford.’ She told the Committee that research supports self-directed, individualised funding packages, such as those currently provided through the NDIS.[302]

Funding and contracting

3.256The National Rural Health Alliance emphasised the need for adequate and targeted block funding from government as an equitable solution for meeting the higher costs of service delivery of Thriving Kids to participants in regional, rural and remote areas.[303]

Block funding is one; isolating the funding for rural and remote communities; and,…really investing in your rural workforce. If you’ve already got people there, it’s business 101: if you've got a customer, hang on to them, because it is much more difficult to get new ones. The next thing is rural training: picking rural students, training them in rural—that’s a longer-term one. But, at the very beginning, let's start looking at place based solutions for those communities. Let’s start looking at ways we can, in the interim, support those people who are on the ground to grow. We’ve got plenty of communities where the communities have had to raise the funding, and they’re expanding, and they’re doing it on their own because nobody is willing to help them. In fact, if anything, they have barriers there from the state and federal system, because it’s not flexible enough for them to deliver. So work with communities that are doing that. Work with those clinicians that have solutions.[304]

3.257The Chair of the APA’s National Paediatric, Mrs Nicole Pates, outlined that the block funded model had some ‘fantastic points, but it was also less accessible’[305].

There were very long wait lists in Western Australia, where I'm from, for different services, and there continue to be very long waitlists for our child development service. There needs to be an element of choice and control and options. There is not a one-size-fits-all approach. I think we all agree that being able to be funded to have those and not having a family have to choose between professions, because we work so well together in hospitals—in all the hospital systems you see the multidisciplinary teams are together. We want the same in the community as well.[306]

3.258Occupational Therapy Australia agreed with the APA and saw an opportunity for blending various funded models.

There is also a great opportunity for us to really invest in our allied health workforce to ensure we are embedded in schools, we are embedded in community health, we are embedded in disability services and we also have a thriving private practice area…but there is absolutely some gaps. This is a great opportunity for us to reset the scene and create systems and services that enable us to thrive, which will enable the young people and families that we work with to thrive.[307]

3.259Outside the NDIS, access to allied health services is inconsistent. According to the Australian Physiotherapy Association, those ‘inconsistencies are greatest for people in rural settings, Aboriginal and Torres Strait Islander communities, and culturally and linguistically diverse communities’[308].

This is why we really need equity focused measures within Thriving Kids to make sure that it doesn't widen those existing gaps and to make sure that it fills those gaps really thoroughly.[309]

3.260Services for Australian Rural and Remote Allied Health Ltd outlined how recent changes made by the NDIS to allied health professionals claiming for travel impacted on their clients in regional areas.[310]

This is why we looked at the driving distance to an occupational therapist as a marker of that. The travel caps meant that, if you had an hour’s round trip to visit a child and their family in their home, you were only going to be able to claim for half of that time. So immediately, if you are a small provider located in a Modified Monash Model 4 or 5 town, that's going to limit your capacity to travel to see some of these children in their home context.[311]

3.261The Department of Social Services highlighted how its financial support for playgroups and toy libraries created opportunities for mutual support as well as ‘conversation that might lead to a referral to a more intensive or targeted service and so forth’.

Probably the key service offerings are Children and Parenting Support Program—CAPS for short… The other one I'd probably draw attention to is Communities for Children Facilitating Partners, which is a place based initiative where the facilitating partner establishes a committee and a strategic plan based on the needs of the community in respect of children aged nought to 12…complemented by what's needed—reach into the important consultation and engagement with the local schools, preschools, childcare facilities and so forth.[312]

3.262NACCHO claimed only some of their member services seek to access the Department of Social Services’ Communities for Children funding and other financial support, due to the complexity of application processes onerous reporting requirements.

Some of them have got up to 72 funding streams that they need to report to. I think Thriving Kids, for it to be incredibly successful, has got this great opportunity at a system level to bring that all together and consider how one funding model could actually integrate a number of different areas. It puts a huge burden on our sector, and they're not funded to manage all the grant guidelines and the constant things that they have to do to receive those pockets of money.[313]

Footnotes

[1]Australian Council of State School Organisations, Submission 46, p. 6.

[2]Ms Nicole Avery, Chief Executive Officer, South West Autism Network, Committee Hansard, 3 October 2025, p. 34.

[3]Australian Council of State School Organisations, Submission 46, p. 7.

[4]Ms Katherine Utry, General Manager, Policy and Government Relations, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 18.

[5]Mr Ross Joyce, Chief Executive Officer, Australian Federation of Disability Organisations, Committee Hansard, 20 October 2025, p. 44.

[6]NDIS website, Quarterly report to disability ministers, Quarter 2024-25 Full report, p. 21, www.ndis.gov.au/publications/quarterly-reports (accessed 2 October 2025).

[7]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 2.

[8]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 6.

[9]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 6.

[10]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[11]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[12]Associate Professor Clinton Schultz, Director, First Nations Strategy and Partnerships, Black Dog Institute, Committee Hansard, 10 October 2025, p. 43.

[13]Associate Professor Clinton Schultz, Director, First Nations Strategy and Partnerships, Black Dog Institute, Committee Hansard, 10 October 2025, p. 43.

[14]SNAICC – National Voice for Our Children, Submission 327, p. 15.

[15]Children’s Healthcare Australasia, Submission 290, p. 9.

[16]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 6.

[17]Karitane, Submission 282, p. 15.

[18]Brotherhood of St Laurence, Submission 254, p. 24; Australian Institute of Family Studies, Submission 370, p. 5.

[19]Uniting NSW/ACT, Submission 258, pp. 10–11.

[20]Every Australian Counts, Submission 273, p. 9.

[21]Mr Jeremy Muir, Chief Executive Officer, Physical Disability Australia, Committee Hansard, 3 October 2025, p. 11.

[22]Triple P International, Submission 310, p. 13.

[23]National Aboriginal Community Controlled Health Organisations, Submission 154, pp. 6–7.

[24]National Aboriginal Community Controlled Health Organisations, Submission 154, pp. 6–7.

[25]National Aboriginal Community Controlled Health Organisations, Submission 154, pp. 6–7.

[26]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 11.

[27]Associate Professor Clinton Schultz, Director, First Nations Strategy and Partnerships, Black Dog Institute, Committee Hansard, 10 October 2025, p. 43.

[28]Associate Professor Clinton Schultz, Director, First Nations Strategy and Partnerships, Black Dog Institute, Committee Hansard, 10 October 2025, p. 41.

[29]Ms Rachel Fishlock, Chief Executive Officer, Gayaa Dhuwi (Proud Spirit) Australia, Committee Hansard, 17 November 2025, p. 30.

[30]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 11.

[31]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 11.

[32]Ms Catherine Liddle, Chief Executive Officer, SNAICC – National Voice for our Children, Committee Hansard, 17 November 2025, p. 28.

[33]Ms Catherine Liddle, Chief Executive Officer, SNAICC – National Voice for our Children, Committee Hansard, 17 November 2025, p. 28.

[34]Ms Catherine Liddle, Chief Executive Officer, SNAICC – National Voice for our Children, Committee Hansard, 17 November 2025, p. 28.

[35]Miwatj Health Aboriginal Corporation, Submission 288, p. 1.

[36]SNAICC – National Voice for Our Children, Submission 327, p. 15.

[37]SNAICC – National Voice for Our Children, Submission 327, p. 15.

[38]South Burnett CTC, Submission 41, p. 5; Uniting NSW/ACT, Submission 258, pp. 10–11.

[39]Indigenous Allied Health Australia, Submission 271, p. 3.

[40]Indigenous Allied Health Australia, Submission 271, p. 2.

[41]South Burnett CTC, Submission 41, p. 5.

[42]See, for example: Lifestart Disability Services, Submission 245, p. 10; Children’s Healthcare Australasia, Submission 290, p. 9; Monash University, Submission 291, p. 7; Occupational Therapy Australia, Submission 304, pp. 26–27; University of Melbourne, Submission 319, p. 23.

[43]Ms Janice Finlayson, Director, Maternal, Child and Family Health Nurses Australia, Committee Hansard, 21 October 2025, p. 26.

[44]Murdoch Children’s Research Institute, Submission 234, p. 18.

[45]Lifestart Disability Services, Submission 245, pp. 19–20.

[46]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 17.

[47]Ms Janice Finlayson, Director, Maternal, Child and Family Health Nurses Australia, Committee Hansard, 21 October 2025, pp. 26–27.

[48]National Aboriginal Community Controlled Health Organisations, Submission 154, pp. 12–13.

[49]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 3.

[50]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 18.

[51]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 18.

[52]Griffith University, Submission 222, p. 2.

[53]Griffith University, Submission 222, pp. 2, 6.

[54]Griffith University, Submission 222, p. 2.

[55]Griffith University, Submission 222, p. 3.

[56]Australian Health Practitioner Regulation Agency, The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025, p. 9

[57]Australian Institute of Health and Welfare, Cultural safety in health care for Indigenous Australians: monitoring framework, 7 July 2023, www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/background-material (accessed 3 December 2025).

[58]Australian Health Practitioner Regulation Agency, The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025, p. 9

[59]Department of Health and Human Services, Aboriginal and Torres Strait Islander cultural safety framework: Part 1, 2019, p. 7.

[60]National Aboriginal and Torres Strait Islander Health Worker Association, Aboriginal and Torres Strait IslanderCultural Safety Framework, p. 4.

[61]Department of Health and Human Services, Aboriginal and Torres Strait Islander cultural safety framework: Part 1, 2019, p. 7.

[62]Australian Institute of Health and Welfare, Cultural safety in health care for Indigenous Australians: monitoring framework, 7 July 2023, www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/background-material (accessed 3 December 2025).

[63]Department of Health and Human Services, Aboriginal and Torres Strait Islander cultural safety framework: Part 1, 2019, p. 7.

[64]Australian Institute of Health and Welfare, Cultural safety in health care for Indigenous Australians: monitoring framework, 7 July 2023, www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/background-material (accessed 3 December 2025).

[65]Australian Health Practitioner Regulation Agency, The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025, p. 9

[66]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 5.

[67]Mrs Emily Osborne, NDIS Operations Manager, Miwatj Health Aboriginal Corporation, Committee Hansard, 17 November 2025, p. 29.

[68]Mrs Emily Osborne, NDIS Operations Manager, Miwatj Health Aboriginal Corporation, Committee Hansard, 17 November 2025, p. 28.

[69]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[70]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[71]Ms Sally Maddison, Acting Chief Executive Officer, Early Learning and Care Council of Australia, Committee Hansard, 28 November 2025, p. 6.

[72]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[73]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 13.

[74]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 13.

[75]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 14.

[76]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 14.

[77]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 14.

[78]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 14.

[79]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 13.

[80]Ms Michelle Moss, Chief Executive Officer, Queenslanders with Disability Network, Committee Hansard, 3 October 2025, p. 10.

[81]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 13.

[82]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 14.

[83]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 14.

[84]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 5.

[85]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 3.

[86]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 9.

[87]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 5.

[88]Department of Health, Disability and Ageing, About the National Best Practice Framework for Early Childhood Intervention, www.health.gov.au/our-work/national-best-practice-framework-for-early-childhood-intervention/about?language=en (accessed 3 December 2025).

[89]Queenslanders with Disability Network, Submission 279, p. 19.

[90]University of Melbourne, Submission 261, p. 5.

[91]University of Melbourne, Submission 261, pp. 1 and 6; SNAICC – National Voice for Our Children, Submission 327, p. 26.

[92]See for example: Child and Family Disability Alliance, Submission 117, p. 3; Early Childhood Intervention Australia Victoria, Submission 199, p. 7; Murdoch Children’s Research Institute, Submission 234, p. 4; Queenslanders with Disability Network, Submission 279, p. 5; Occupational Therapy Australia, Submission 304, pp. 7, 31; Australian Child and Family Services Alliance, Submission 316, p. 4; University of Melbourne, Submission 319, p. 17; The Australian and Family Supports Alliance, Submission 357, p. 4.

[93]South Burnett CTC, Submission 41, p. 1.

[94]Teach Speak Hear, Submission 89, p. 5.

[95]Teach Speak Hear, Submission 89, p. 5.

[96]See for example: Australian Psychological Society, Submission 160, p. 11; Australian Physiotherapy Association, Submission 171, p. 47; Connectability Australia, Submission 225, p. 2; Family Services Alliance, Submission 316, p. 6; National Rural and Health Alliance, Submission 379, p. 2; Divergent Psychology, Submission 337, p. 1; Australian Council for Educational Research, Submission 394, p. 2; Autism CRC, Submission 403, p. 1.

[97]Australian Catholic University, Submission 385, p. 4.

[98]Australian Physiotherapy Association, Submission 171, p. 9; Name Withheld, Submission 393, p. 5; Connected Kiddos, Submission 206, p. 4; Occupational Therapy Australia, Submission 304, p. 16; Royal Children’s Hospital, Submission 272, p. 5.

[99]Children’s Healthcare Australasia, Submission 290, p. 9; Queensland Government, Gold Coast Health, Waijungbah Jarjums, www.goldcoast.health.qld.gov.au/aboriginal-and-torres-strait-islander-service/services/mums-and-bubs (accessed 3 December 2025).

[100]Brotherhood of St Laurence, Submission 254, p. 11; Victorian Aboriginal Child Care Agency, Koorie Families as First Educators, www.vacca.org/content/Document/KFFE%20Flyer%20for%20Professionals%20-%20Jan2020.pdf (accessed 3 December 2025).

[101]Gayaa Dhuwi (Proud Spirit) Australia, Submission 99, p. 5; Victorian Aboriginal Child Care Agency, Koorie Kids Supported Playgroups, www.snaicc.org.au/wp-content/uploads/2023/09/220201_7_Early-Intervention-Profile-VACCA-KK-1.pdf (accessed 3 December 2025).

[102]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 15; Australian Council of State School Organisations, Submission 46, p. 3; National Aboriginal Community Controlled Health Organisations, Submission 154, p. 7; Department of Education, Submission 363, pp. 9-10; University of Melbourne, Submission 319, p. 26; Autistic Self Advocacy Network of Australia and New Zealand, Submission 181, p. 30.

[103]Occupational Therapy Australia, Submission 304, p. 31; Australian Music Therapy Association, Submission 274, p. 3; National Indigenous Australians Agency, National Aboriginal and Torres Strait Islander Early Childhood Strategy – Summary, www.niaa.gov.au/sites/default/files/documents/publications/niaa-early-years-summary.pdf (accessed 4 December 2025).

[104]Minderoo Foundation + Thrive by Five, Submission 342, p. 6.

[105]Mrs Emily Osborne, NDIS Operations Manager, Miwatj Health Aboriginal Corporation, Committee Hansard, 17 November 2025, p. 34

[106]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[107]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[108]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[109]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 11.

[110]Mr Damian Griffis, CEO, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 11.

[111]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 13.

[112]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 3.

[113]Professor Helen Milroy, Board Chair, Gayaa Dhuwi (Proud Spirit Australia), Committee Hansard, 17 November 2025, p. 35.

[114]Ms Janine Mohamed, Deputy Chief Executive Officer, First Nations, National Disability Insurance Agency, Committee Hansard, 21 October 2025, p. 9.

[115]Professor Helen Milroy, Board Chair, Gayaa Dhuwi (Proud Spirit Australia), Committee Hansard, 17 November 2025, p. 35.

[116]Ms Rachel Fishlock, Chief Executive Officer, Gayaa Dhuwi (Proud Spirit) Australia, Committee Hansard, 17 November 2025, p. 28.

[117]Ms Catherine Liddle, Chief Executive Officer, SNAICC – National Voice for our Children, Committee Hansard, 17 November 2025, p. 28.

[118]Ms Tara Lewis, Knowledge Translation Lead, Indigenous Allied Health Australia, Committee Hansard, 10 October 2025, p. 13.

[119]Mrs Emily Osborne, NDIS Operations Manager, Miwatj Health Aboriginal Corporation, Committee Hansard, 17 November 2025, p. 28.

[120]Ms Rachel Fishlock, Chief Executive Officer, Gayaa Dhuwi (Proud Spirit) Australia, Committee Hansard, 17 November 2025, p. 30.

[121]Dr Catherine Wade, Member, Parenting and Family Research Alliance; and Principal, Parenting Research Centre, Committee Hansard, 28 November 2025, pp. 36–37

[122]Aboriginal CommunityControlled Health Organisations - NACCHO, www.naccho.org.au/aboriginal-community-controlled-health/ (accessed 3 December 2025).

[123]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 11.

[124]Ms Cassie Atchison, CEO, Broome Regional Aboriginal Medical Services, Committee Hansard, 10 October 2025, pp. 11–12.

[125]Ms Cassie Atchison, CEO, Broome Regional Aboriginal Medical Services, Committee Hansard, 10 October 2025, p. 12.

[126]Ms Cassie Atchison, CEO, Broome Regional Aboriginal Medical Services, Committee Hansard, 10 October 2025, p. 13.

[127]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 16.

[128]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 16.

[129]Mr Oskar Stenseke, Senior Manager, Kimberley Aboriginal Medical Services, Committee Hansard, 10 October 2025, p. 12.

[130]Mr Oskar Stenseke, Senior Manager, Kimberley Aboriginal Medical Services, Committee Hansard, 10 October 2025, p. 12.

[131]Mr Oskar Stenseke, Senior Manager, Kimberley Aboriginal Medical Services, Committee Hansard, 10 October 2025, p. 16.

[132]Mrs Emily Osborne, NDIS Operations Manager, Miwatj Health Aboriginal Corporation, Committee Hansard, 17 November 2025, p. 28

[133]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, p. 10.

[134]Mr Rhys Howard, National Policy Manager, First Peoples Disability Network, Committee Hansard, 10 October 2025, pp. 10–11.

[135]SNAICC – National Voice for Our Children, Submission 327, p. 5.

[136]SNAICC – National Voice for Our Children, Submission 327, p. 16.

[137]SNAICC – National Voice for Our Children, Submission 327, p. 16

[138]Brotherhood of St Laurence, Submission 254, p. 14.

[139]Minderoo Foundation + Thrive by Five, Submission 342, p. 9.

[140]Murdoch Children’s Research Institute, Submission 234, p. 18.

[141]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 8.

[142]National Aboriginal Community Controlled Health Organisations, Submission 154, p. 8.

[143]Miwatj Health Aboriginal Corporation, Submission 288, p. 3.

[144]Queenslanders with Disability Network, Submission 279, pp. 11, 15.

[145]Australian Clinical Neuropsychology Association, Submission 152, pp. 1–2.

[146]Australian Institute of Family Studies, Submission 370, pp. 5–6.

[147]Brotherhood of St Laurence, Submission 254, p. 24.

[148]National Disability Insurance Scheme, Cultural and Linguistic Diversity Strategy Summary 2024–2028, p. 7.

[149]Mr Ben Fioramonte, General Manager, Children, Families and Disability Support, Settlement Services International, Committee Hansard, 10 October 2025, p. 20.

[150]Mr Ben Fioramonte, General Manager, Children, Families and Disability Support, Settlement Services International, Committee Hansard, 10 October 2025, pp. 20–21.

[151]Lifestart Disability Services, Submission 245, p.18.

[152]WA Early Childhood Intervention Collaborative, Submission 128, p. 26.

[153]Ms Rana Ebrahimi, National Manager, Multicultural Youth Advocacy Network Australia, Committee Hansard, 10 October 2025, p. 20.

[154]Settlement Services International, Submission 73, p. 13.

[155]See, for example, Australian Council of State Schools, Submission 46, p. 8; Autism Spectrum Australia, Submission 67, pp. 7, 9; WA Early Childhood Intervention Collaborative, Submission 128, p. 26; Marathon Health, Submission 163, p. 9; Brotherhood of St Laurence, Submission 254, p. 24; Queenslanders with Disability Network, Submission 279, pp. 2, 11, 18; Karitane, Submission 282, p. 15; The Benevolent Society, Submission 309, p. 12; Triple P International Pty Ltd, Submission 310, p. 12; Outcomes Therapy, Submission 312, p. 3; Australian Institute of Family Studies, Submission 370, p. 5.

[156]See, for example, ADHD Australia, Submission 221, p. 1; Multicultural Youth Advocacy Network and 54 Reasons (Save the Children), Submission 228, p.1; Every Australian Counts, Submission 273, p. 8; Triple P International Pty Ltd, Submission 310, p. 12.

[157]Australian Institute of Family Studies, Submission 370, p. 5.

[158]Associate Professor Clinton Schultz, Director, First Nations Strategy and Partnerships, Black Dog Institute, Committee Hansard, 10 October 2025, p. 43.

[159]Mr Ben Fioramonte, General Manager, Children, Families and Disability Support, Settlement Services International, Committee Hansard, 10 October 2025, p. 22.

[160]Ms Lynette Brodie, Chief Executive Officer, Speech Pathology Australia, Committee Hansard, 20 October 2025, p. 22.

[161]See, for example, Settlement Services International, Submission 73, p. 13; The Occupational Therapy Society for Invisible and Hidden Disabilities (OTSi), Submission 365, p. 6; Marathon Health, Submission 163, p. 9; Multicultural Youth Advocacy Network and 54 Reasons (Save the Children), Submission 228, p. 1.

[162]Settlement Services International, Submission 73, p. 13.

[163]Ms Rana Ebrahimi, National Manager, Multicultural Youth Advocacy Network Australia, Committee Hansard, 10 October 2025, p. 20.

[164]Murdoch Children’s Research Institute, Submission 234, p. 17.

[165]Settlement Services International, Submission 73, p. 13.

[166]Mrs Jo Johnson, Early Interventionist and Key Worker, Bathurst Early Childhood Intervention Service, Committee Hansard, 17 November 2025, p. 6.

[167]Community Hubs Australia, Submission 364, p. 6.

[168]Mrs Nicole Pates, Chair, National Paediatric, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 23.

[169]The Royal Australasian College of Physicians, Submission 243, p. 9.

[170]Learning Links, Submission 103, p. 22.

[171]See, for example: Karitane, Submission 282, p. 15.

[172]Brotherhood of St Laurence, Submission 254, p. 24.

[173]Ms Sally Maddison, Acting Chief Executive Officer, Early Learning and Care Council of Australia, Committee Hansard, 28 November 2025, p. 2.

[174]Occupational Therapy Australia, Submission 304, p.28.

[175]Ms Sally Maddison, Acting Chief Executive Officer, Early Learning and Care Council of Australia, Committee Hansard, 28 November 2025, p. 3.

[176]Ms Sally Maddison, Acting Chief Executive Officer, Early Learning and Care Council of Australia, Committee Hansard, 28 November 2025, p. 4.

[177]Ms Angela Falkenberg, President, Australian Primary Principals Association, Committee Hansard, 17 November 2025, p. 3.

[178]Mr Philipp Herrmann, Policy and Advocacy, Allied Health Professions Australia, Committee Hansard, 20 October 2025, p. 33.

[179]Ms Rana Ebrahimi, National Manager, Multicultural Youth Advocacy Network Australia, Committee Hansard, 10 October 2025, p. 21.

[180]Mr Christopher Ouizeman, Director, ADHD Foundation, Committee Hansard, 21 October 2025, p. 23.

[181]Uniting NSW ACT, Submission 258, p.3.

[182]Ms Judy Connell, Manager, Education Programs and Support, Victorian Catholic Education Authority, Committee Hansard, 28 November 2025, p. 14.

[183]Ms Nicole Rogerson, Chief Executive Officer, Autism Association of Australia, Committee Hansard, 21 October 2025, p. 38.

[184]WA Early Childhood Intervention Collaborative, Submission 128, p. 26.

[185]Ms Judy Connell, Manager, Education Programs and Support, Victorian Catholic Education Authority, Committee Hansard, 28 November 2025, p. 15.

[186]Mrs Nicole Pates, Chair, National Paediatric, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 22.

[187]Uniting NSW ACT, Submission 258, p.11

[188]Brotherhood of St. Laurence, Submission 254, pp. 24–25.

[189]National Disability Services, Submission 200, p. 20.

[190]Early Childhood Intervention Australia Victoria, Submission 199, p. 10.

[191]Early Childhood Intervention Australia Victoria, Submission 199, p. 10.

[192]See, for example: Mrs Nicole Smith, Head of Disability Supports, Settlement Services International, Committee Hansard, 10 October 2025, p. 19.

[193]Ms Rana Ebrahimi, National Manager, Multicultural Youth Advocacy Network Australia, Committee Hansard, 10 October 2025, p. 20.

[194]Mrs Nicole Smith, Head of Disability Supports, Settlement Services International, Committee Hansard, 10 October 2025, p. 19.

[195]Mrs Nicole Smith, Head of Disability Supports, Settlement Services International, Committee Hansard, 10 October 2025, p. 22.

[196]Mrs Nicole Smith, Head of Disability Supports, Settlement Services International, Committee Hansard, 10 October 2025, p. 19.

[197]Mr Ben Fioramonte, General Manager, Children, Families and Disability Support, Settlement Services International, Committee Hansard, 10 October 2025, p. 20.

[198]Mr Ben Fioramonte, General Manager, Children, Families and Disability Support, Settlement Services International, Committee Hansard, 10 October 2025, p. 20.

[199]Ms Priyanka Rai, Executive Director, Australian Multicultural Health Collaborative, Committee Hansard, 10 October 2025, p. 21.

[200]Professor Sharon Goldfeld, Theme Director, Population Health, Murdoch Children's Research Institute; and Director, Centre for Community Child Health, Royal Children's Hospital, Committee Hansard, 28 November 2025, pp. 52–53.

[201]Mr Kai Reuben Seah, Submission 130, p.3.

[202]See, for example: Australian Multicultural Action Network, Submission 17, p. 2; Regional Education Commissioner, Submission 42, p. 1; Royal Far West, Submission 60, p. 8; Office of the National Rural Health Commissioner, Submission 195, p. 3; Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 33.

[203]Regional Education Commissioner, Submission 42, p. 1. See also: Noah’s Ark Inc, Submission 311, p. 11; Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 33.

[204]Australian Early Development Census, AEDC National Report 2024, July 2025, www.aedc.gov.au/resources/detail/2024-aedc-national-report (accessed 4 December 2025).

[205]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 33. See also: Royal Far West, Submission 60, p. 8.

[206]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 33.

[207]Ms Nicole Moran, Board Member, Regional Autistic Engagement Network, Committee Hansard, 17 November 2025, p. 26.

[208]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 33.

[209]Ms Jessica Paoloni, private capacity, Committee Hansard, 7 November 2025, pp. 18–19.

[210]See, for example: Mrs Ashlee Law, Submission 14, p. 2; Australian Multicultural Action Network, Submission 17, p. 5; Nest Culture Pty Ltd, Submission 192, p. 3; Mr Michael Perusco, Chief Executive Officer, National Disability Services, Committee Hansard, 20 October 2025, p. 50.

[211]Pop Family Pty Ltd, Submission 15, p. 6.

[212]Dr Sarah Chalmers, President Elect, Rural Doctors Association of Australia, Committee Hansard, 10 October 2025, p. 35. See also: Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 35.

[213]Dr Sarah Chalmers, President Elect, Rural Doctors Association of Australia, Committee Hansard, 10 October 2025, p. 35.

[214]Dr Sarah Chalmers, President Elect, Rural Doctors Association of Australia, Committee Hansard, 10 October 2025, p. 35.

[215]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 35.

[216]Ms Carrie Clark, Chief Executive Officer, Kiind, Committee Hansard, 3 October 2025, p. 32.

[217]Dr Garth Hargreaves, Member and General Paediatrician, Australian Paediatric Society, Committee Hansard, 17 November 2025, p. 51.

[218]Ms Nicole Avery, Chief Executive Officer, South West Autism Network, Committee Hansard, 3 October 2025,p. 36.

[219]WA Early Childhood Intervention Collaborative, Submission 128, p. 2.

[220]WA Early Childhood Intervention Collaborative, Submission 128, Attachment, p. 25.

[221]Mr Philipp Herrmann, Policy and Advocacy, Allied Health Professions Australia, Committee Hansard, 20 October 2025, p. 32. See also: Associate Professor David McDonald, Senior Member, Australian Paediatric Society, Committee Hansard, 17 November 2025, p. 50.

[222]Mrs Niki Lehmann, Executive Officer, Autism NT, Committee Hansard, 3 October 2025, p. 17.

[223]Mrs Niki Lehmann, Executive Officer, Autism NT, Committee Hansard, 3 October 2025, p. 17.

[224]Regional Education Commissioner, Submission 42, p. 1.

[225]South Burnett CTC, Submission 41, p. 3.

[226]Dr Garth Hargreaves, Member and General Paediatrician, Australian Paediatric Society, Committee Hansard, 17 November 2025, p. 58.

[227]Ms Nicole Avery, Chief Executive Officer, South West Autism Network, Committee Hansard, 3 October 2025, p. 37.

[228]See, for example: Regional Education Commissioner, Submission 42, p. 1; Kids I Can, Submission 51, p. 6; Municipal Association of Victoria, Submission 102, p. 1; Mrs Michelle Oliver, Chief Occupational Therapist, Occupational Therapy Australia, Committee Hansard, 20 October 2025, p. 21.

[229]Mrs Ashlee Law, Submission 14, p. 2.

[230]Australian Paediatric Society, Submission 344, p. 1.

[231]South Burnett CTC, Submission 41, p. 5. See also: Outcomes Therapy, Submission 312, p. 2.

[232]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 35.

[233]Services for Australian Rural and Remote Allied Health, Submission 295, p. 3.

[234]Mr Jeremy Muir, Chief Executive Officer, Physical Disability Australia, Committee Hansard, 3 October 2025, p. 11.

[235]Mrs Kate Southward, Paediatric Speech Pathologist and Clinical Manager, Community Therapy, Committee Hansard, 17 November 2025, p. 9.

[236]Succeed Healthcare Solutions Pty Ltd, Submission 150, p. 2.

[237]Allied Health Professions Australia, Submission 176, p. 10.

[238]Mrs Meredith Cox, Early Interventionist and Key Worker, Bathurst Early Childhood Intervention Service, Committee Hansard, 17 November 2025, p. 45.

[239]See, for example: Australian Multicultural Action Network, Submission 17, p. 4; Aruma, Submission 113, p. 9; NursePrac Australia, Submission 173, p. 3; Allied Health Professions Australia, Submission 176, p. 8; Autistic Self Advocacy Network of Australia & New Zealand, Submission 181, p. 17; Australian Orthotic Prosthetic Association, Submission 189, p. 2; Nest Culture Pty Ltd, Submission 192, p. 3; Believe and Become Pty Ltd, Submission 381, p. 5.

[240]Pop Family Pty Ltd, Submission 15, p. 3; Australian Physiotherapy Association, Submission 171, p. 19.

[241]Pop Family Pty Ltd, Submission 15, p. 6.

[242]Australian College of Nurse Practitioners, Submission 30, pp. 7–8.

[243]National Rural Health Alliance, Submission 379, p. 4.

[244]Regional Education Commissioner, Submission 42, p. 1. See also: Australian Council of State School Organisations, Submission 46, p. 8.

[245]Ms Jacqueline Emery, Chief Executive Officer, Royal Far West, Committee Hansard, 7 November 2025, pp. 3-4.

[246]Mrs Niki Lehmann, Executive Officer, Autism NT, Committee Hansard, 3 October 2025, p. 20.

[247]Mrs Ashlee Law, Submission 14, p. 2. See also: South Burnett CTC, Submission 41, p. 5; Ms Nicole Avery, Chief Executive Officer, South West Autism Network, Committee Hansard, 3 October 2025, p. 37.

[248]Services for Australian Rural and Remote Allied Health, Submission 295, pp. 3–4.

[249]National Organisation for Fetal Alcohol Spectrum Disorder, Submission 106, p. 7.

[250]Associate Professor David McDonald, Senior Member, Australian Paediatric Society, Committee Hansard, 17 November 2025, p. 50. See also: Square Peg Round Whole, Submission 318, p. 9.

[251]Succeed Healthcare Solutions Pty Ltd, Submission 150, pp. 4-5.

[252]Succeed Healthcare Solutions Pty Ltd, Submission 150, p. 4.

[253]Ms Kylie Irvin, Portfolio Manager, NDIS Western, Marathon Health, Committee Hansard, 7 November 2025, p. 4.

[254]Colman Education Foundation: Our Place, Submission 193, p. 4.

[255]Mrs Rachel Green, Chief Executive Officer, SANE Australia, Committee Hansard, 10 October 2025, pp. 41-42.

[256]Mrs Rachel Green, Chief Executive Officer, SANE Australia, Committee Hansard, 10 October 2025, pp. 41-42.

[257]Ms Rana Ebrahimi, National Manager, Multicultural Youth Advocacy Network Australia, Committee Hansard, 10 October 2025, p. 21. See also: Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 35.

[258]Ms Nicole Avery, Chief Executive Officer, South West Autism Network, Committee Hansard, 3 October 2025, p. 37.

[259]Ms Catherine Maloney, Chief Executive Officer, Services for Australian Rural and Remote Allied Health Ltd, Committee Hansard, 10 October 2025, p. 34.

[260]Ms Jacqueline Emery, Chief Executive Officer, Royal Far West, Committee Hansard, 7 November 2025, p. 1.

[261]See, for example: South Burnett CTC, Submission 41, p. 6; The Benevolent Society, Submission 309, p. 14.

[262]National Organisation for Fetal Alcohol Spectrum Disorders, Submission 106, p. 7.

[263]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, pp. 35–36.

[264]Mrs Niki Lehmann, Executive Officer, Autism NT, Committee Hansard, 3 October 2025, p. 16.

[265]Ms Nicole Avery, Chief Executive Officer, South West Autism Network, Committee Hansard, 3 October 2025, p. 35.

[266]Inclusive Educators Australia, Submission 132, p. 10.

[267]Ms Kylie Irvin, Portfolio Manager, Marathon Health, Committee Hansard, 7 November 2025, p. 3.

[268]Ms Sally Urquhart, Executive Manager of Strategy, HealthWISE, Committee Hansard, 7 November 2025, p. 13.

[269]Dr Alexandra Murray, Head, Policy and Research, Australian Psychological Society, Committee Hansard, 20 October 2025, pp. 14–15.

[270]Mrs Denise Lyons, President, Australian Primary Health Care Nurses Association, Committee Hansard, 21 October 2025, p. 29.

[271]Dr Sarah Chalmers, President Elect, Rural Doctors Association of Australia, Committee Hansard, 10 October 2025, p. 38; Australian Council of State School Organisations, Submission 46, p. 10; South West Autism Network, Submission 131, p. 20;

[272]Ms Samantha Hunter, Chief Executive Officer, Occupational Therapy Australia, Committee Hansard, 20 October 2025, p. 21.

[273]Mrs Amanda Curran, Chief Psychologist, Australian Association of Psychologists Inc; Committee Hansard, 20 October 2025, p. 14.

[274]Australian College of Nurse Practitioners, Submission 30, p. 3.

[275]Mrs Denise Lyons, President, Australian Primary Health Care Nurses Association, Committee Hansard, 21 October 2025, p. 26.

[276]Ms Janice Finlayson, Director, Maternal, Child and Family Health Nurses Australia, Committee Hansard, 21 October 2025, p. 29.

[277]See, for example: Australian Multicultural Action Network, Submission 17, p. 4; Australian College of Nurse Practitioners, Submission 30, p. 8; Aruma, Submission 113, p. 7; Pop Family Pty Ltd, Submission 156, p. 7; Australian Physiotherapy Association, Submission 171, p. 19; NursePrac Australia, Submission 173, p. 4; Allied Health Professions Australia, Submission 176, p. 8; Murrumbidgee Primary Health Network and Murrumbidgee Local Health District, Submission 191, p. 7; Dr Jacqui Barfoot, Submission 194, p. 1; Australian Paediatric Society, Submission 344, p. 3; Queensland Council of Social Service (QCOSS), Submission 358, p. 3.

[278]Inclusive Educators Australia, Submission 132, p. 11.

[279]South Burnett CTC, Submission 41, p. 6; Australian Youth Affairs Coalition, Submission 334, p. 3.

[280]Australian Association of Psychologists, Submission 157, p. 5; Dr Alexandra Murray, Head, Policy and Research, Australian Psychological Society, Committee Hansard, 20 October 2025, pp. 14–15.

[281]Ms Louise Ingall, Manager Research and Partnerships, HealthWISE, Committee Hansard, 17 November 2025, p. 13. See also: PRECI (Professionals & Researchers in Early Childhood Intervention), Submission 203, p. 5; Australian Paediatric Society, Submission 344, p. 3.

[282]Ms Louise Ingall, Manager Research and Partnerships, HealthWISE, Committee Hansard, 17 November 2025, p. 13.

[283]Australian Council of State School Organisations, Submission 46, p. 10.

[284]Australian Physiotherapy Association, Submission 171, p. 21.

[285]Australian Physiotherapy Association, Submission 171, p. 21 (citation omitted).

[286]See, for example: Royal Far West, Submission 60, p. 4; National Regional, Rural, Remote and Very Remote Community Legal Network, Submission 264, p. 2; Developing Ur Life, Submission 238, p. 5; Services for Australian Rural and Remote Allied Health, Submission 295, p. 2. See also: MyCareSpace, How to understand the NDIS MMM Pricing, https://mycarespace.com.au/resources/how-to-understand-the-ndis-mmm-pricing (accessed 29 October 2025).

[287]MyCareSpace, How to understand the NDIS MMM Pricing, https://mycarespace.com.au/resources/how-to-understand-the-ndis-mmm-pricing (accessed 29 October 2025).

[288]Royal Far West, Submission 60, p. 4.

[289]Services for Australian Rural and Remote Allied Health, Submission 295, p. 2. See also: Mrs Niki Lehmann, Executive Officer, Autism NT, Committee Hansard, 3 October 2025, p. 16.

[290]Services for Australian Rural and Remote Allied Health, Submission 295, p. 2.

[291]National Regional, Rural, Remote and Very Remote Community Legal Network, Submission 264, pp. 7-8.

[292]National Health Funding Body, Funding types, www.publichospitalfunding.gov.au/public-hospital-funding/funding-types (accessed 3 December 2025).

[293]The Front Project, Funding Models and Levers for Early Childhood Education and Care, www.thefrontproject.org.au/media/attachments/2022/08/30/ecec-funding-models-and-levers.pdf (accessed 3 December 2025).

[294]National Disability Insurance Scheme, How the NDIS works, 2 April 2024, www.ndis.gov.au/understanding/how-ndis-works (accessed 3 December 2025).

[295]Dr Timothy Jones, Chair, Specific Interests Group, Child and Young Person's Health, Royal

Australian College of General Practitioners, Committee Hansard, 20 October 2025, p. 25.

[296]Ms Carrie Clark, Chief Executive Officer, Kiind, Committee Hansard, 3 October 2025, p. 33.

[297]Pop Family Pty Ltd, Submission 156, p. 8.

[298]Pop Family Pty Ltd, Submission 156, p. 8.

[299]National Rural Health Commissioner, Submission 195, p. 4.

[300]Ms Heidi La Paglia, Steering Committee Member, Every Australian Counts, Committee Hansard, 20 October 2025, p. 48.

[301]Nobody Worse Off Coalition, Submission 242, p. 8.

[302]Ms Nicole Moran, Board Member, Regional Autistic Engagement Network, Committee Hansard, 17 November 2025, p. 17.

[303]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 36.

[304]Ms Susanne Tegen, Chief Executive, National Rural Health Alliance, Committee Hansard, 10 October 2025, p. 36.

[305]Mrs Nicole Pates, Chair, National Paediatric, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 20.

[306]Mrs Nicole Pates, Chair, National Paediatric, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 20.

[307]Mrs Michelle Oliver, Chief Occupational Therapist, Occupational Therapy Australia, Committee Hansard, 20 October 2025, p. 20.

[308]Ms Katherine Utry, General Manager, Policy and Government Relations, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 21.

[309]Ms Katherine Utry, General Manager, Policy and Government Relations, Australian Physiotherapy Association, Committee Hansard, 20 October 2025, p. 21.

[310]Ms Catherine Maloney, Chief Executive Officer, Services for Australian Rural and Remote Allied Health Ltd, Committee Hansard, 10 October 2025, p. 36.

[311]Ms Catherine Maloney, Chief Executive Officer, Services for Australian Rural and Remote Allied Health Ltd, Committee Hansard, 10 October 2025, p. 36.

[312]Mr John Riley, Family Wellbeing Group, Department of Social Services, Committee Hansard, 10 October 2025, p. 2.

[313]Dr Sarah Hayton, Executive Director, Policy and Programs, National Aboriginal Community Controlled Health Organisation, Committee Hansard, 10 October 2025, p. 18.