A new scheme for kids with mild to moderate needs, but how will it work? | Insiders On Background

Insiders on Background: Thriving Kids – Reforming Early Childhood Support in Australia

Key Concepts:

• NDIS (National Disability Insurance Scheme): Australia’s scheme providing funding for individuals with permanent and significant disabilities.
• Thriving Kids: A proposed new framework for supporting children (aged 0-9) with low to moderate needs, aiming to shift focus from diagnosis-driven funding to early intervention and parent support.
• Early Intervention: Providing support to children and families as soon as developmental concerns are identified, maximizing positive outcomes.
• Continuum of Support: Recognizing that all children and families require varying levels of support, ranging from basic health advice to intensive interventions.
• Bilaterals: Negotiations between the Commonwealth (federal) government and state/territory governments regarding funding and implementation of the Thriving Kids model.

1. The Current Issues with NDIS for Children

The discussion centers on perceived shortcomings of the NDIS when applied to children, particularly those with low to moderate needs. Professor Frank Overlaid highlights growing frustration among professionals and parents with the existing system. Key issues include:

• Diagnosis Requirement: Access to NDIS funding necessitates a formal diagnosis, which can be a lengthy (up to a year or longer) and expensive process (thousands of dollars). This creates barriers to timely support.
• Distorted Clinical Practice: Professionals, particularly pediatricians, report being approached primarily for diagnostic assessments to facilitate NDIS access, rather than comprehensive evaluations focused on a child’s strengths and weaknesses and tailored recommendations. This shifts the focus from holistic development to obtaining a label for funding.
• Funding Model Issues: Receiving a lump sum of money requires parents to independently source and manage therapists, leading to potential conflicts of interest (e.g., believing more therapy is always better) and a focus on therapy hours rather than developmental progress.
• Child-Centric vs. Family-Centric Approach: The NDIS, as currently implemented for children, is criticized for focusing on “what’s wrong with the child” rather than supporting the entire family unit and creating a supportive environment. Research indicates that family confidence and environment are stronger predictors of positive outcomes than therapy alone.

2. Introducing Thriving Kids: A New Framework

Thriving Kids is presented as a fundamental reform of early childhood support, aiming to address the issues with the NDIS. The core principles of the model are:

• Reconceptualization of Child Development: Moving away from a deficit-based model (focused on diagnosis) to a continuum of support, recognizing that all children and families need assistance at different stages. This ranges from basic health advice (immunizations, injury prevention) to more intensive interventions.
• Parent Support & Prevention: Prioritizing support for parents, providing them with evidence-based information and guidance on child development, and empowering them to identify and address concerns early.
• Early Identification & Intervention: Focusing on identifying developmental delays or concerns as early as possible, rather than waiting for a formal diagnosis.
• Service-Specific Referrals: Instead of providing a funding package, children will be referred to specific services (e.g., speech therapy, occupational therapy) based on their individual needs, with the duration of support determined by clinical assessment, not a pre-defined funding limit.
• Upskilling the Workforce: Increasing the expertise of professionals in settings where children are regularly seen (childcare, maternal and child health nurses, GPs) to enable them to identify potential issues and provide appropriate guidance.

3. The Child’s Journey Under Thriving Kids

Professor Overlaid outlines the proposed process:

1. Parent Access to Information: Parents are provided with credible, evidence-based information on child development.
2. Early Detection in Settings: Childcare workers, teachers, maternal and child health nurses, and GPs are trained to identify potential developmental concerns.
3. Targeted Referrals: If a professional identifies a potential issue, they make a targeted referral to a specific service (e.g., speech therapy for delayed language).
4. Service Provision: Children receive the necessary support (e.g., one or two speech therapy sessions) based on clinical need, without a predetermined funding limit.
5. State-Funded Services: The model relies on states rebuilding and funding community-based public services that were previously reduced when the NDIS was introduced.

4. Addressing Concerns and Potential Challenges

Several concerns are raised and addressed:

• Role of Non-Clinical Workforce: The Australian Association of Psychologists expressed concern about placing early identification in the hands of non-health professionals (parents, childcare workers). Professor Overlaid clarifies that these individuals are not expected to make diagnoses but to identify potential concerns and refer children to qualified professionals.
• Risk of Children Slipping Through the Cracks: The potential for children to be overlooked in settings where advice is to “wait and see” is acknowledged. The solution lies in ensuring adequate training and expertise among professionals in all settings.
• State-Level Variation: The model is expected to be implemented differently in each state and territory, potentially leading to inequities in access to support. Professor Overlaid acknowledges this but emphasizes that all programs will adhere to the core guidelines established in the Thriving Kids report.
• Workforce Shortages: Significant workforce challenges (both in number and expertise) exist in relevant fields (psychology, speech therapy, etc.). Addressing these shortages will require long-term investment in training and recruitment.
• Parental Anxiety & Control: Concerns that parents may lose control over their child’s care by not receiving a funding package are addressed by emphasizing that the model aims to provide parents with better guidance and access to appropriate services, rather than restricting their choices.

5. Financial Considerations & Driving Forces

Professor Overlaid explicitly states that financial considerations were not part of the advisory group’s deliberations. The focus was solely on developing the best possible model for improving outcomes for children. However, the interviewer notes that the initiative is likely driven, in part, by the desire to control the growing costs of the NDIS. Statistics cited indicate that 11% of 5-7 year olds were on the NDIS in the previous year, with 40% receiving a diagnosis of autism.

Quote: “David, we did not discuss finances for one second in our deliberations. We ignored that…The expert advisory group…focused only on better outcomes.” – Professor Frank Overlaid.

6. Implementation Timeline & Future Outlook

The Thriving Kids model has been approved by cabinet and is now in the negotiation phase with states regarding funding and rollout. While full implementation is expected to take more than a couple of years, the model will be operational in some form within that timeframe. The emphasis is on a phased approach, with ongoing evolution based on workforce development, training programs, and addressing identified gaps.

Quote: “This is not going to be finished in a year. I think what's important from our point of view is there's now an evidence-based framework that'll guide training, that'll guide expertise, that'll guide the child's journey.” – Professor Frank Overlaid.

Conclusion:

The Thriving Kids model represents a significant shift in approach to early childhood support in Australia. By prioritizing early intervention, parent support, and a continuum of care, it aims to address the shortcomings of the current NDIS system for children with low to moderate needs. While challenges related to workforce shortages, state-level variation, and potential parental anxiety remain, the framework offers a promising path towards improved outcomes for children and families. The success of the model will depend on effective collaboration between the Commonwealth and state governments, robust investment in workforce development, and a commitment to ensuring equitable access to support for all children, regardless of their location or socioeconomic background.