Squeezed out or set free? Thriving Kids will transform Australian paediatric allied health care and our workforce

After reading the Thriving Kids Advisory Group’s Final Report released 3 February 2026, as well as the Ministerial media release and press conference transcript from Minister Mark Butler and Professor Frank Oberklaid AM, it’s clear that Australian governments are working together to:

• give states direct control over the delivery of publicly-funded paediatric allied health services for children 0-8 years with developmental delays and/or autism with low and moderate support needs; and
• reorganise the allied health workforce, so that more of us work across different parts of the care economy (e.g. public hospitals, aged care, veterans’ affairs) and/or in other sectors. 

Thriving Kids poses significant challenges for small paediatric allied health providers and professionals who support children with developmental delays and/or autism through the NDIS. But it will also create new opportunities to improve access and services for children and families – both within and outside the new system – and to grow as professionals and providers. 

Let me explain what’s happening, and why it matters:

A. Thriving Kids will transform paediatric allied health care

What’s happening? The Federal Government is giving states $1.4 billion – to add to their own $2 billion – to deliver Thriving Kids services. Service delivery and/or commissioning will be controlled by the states. According to Minister Butler,Thriving Kids is about “getting back to a system that existed before the NDIS but has largely been dismantled because of the NDIS covering the field”, including by leveraging existing state-delivered programs. 

Different states will take different approaches, based on what they are doing now. Keep an eye on what’s happening in the state(s) in which you work. For example, I’ve been following the latest round of NSW Foundational Support consultations closely.

Timing: Thriving Kids will roll-out from 1 October this year. If things go to plan, it will be fully operational by 1 January 2028.

Key components:

• Settings-based (not child-based): Thriving Kids will be delivered in places like homes, early childhood settings, schools, community-based child and family hubs “and similar settings” (not clinics). 
• Universal Parenting Supports will include information, peer-support and supported playgroups, programs to build family capacity, and family advocacy training.
• Targeted Supportswill include:.
  • Allied health therapies:
    • Kids identified as needing extra help by GPs/family health nurses, or Thriving Kids providers may get referred to allied health.
    • May include a “child development plan” similar to a Chronic Condition Management plan under the MBS. 
    • Diagnosis won’t be needed for access.
    • Treatment will be based on a ‘light-touch’ needs assessment.
    • Therapy will be time-limited and focused on specific goals. 
    • Therapy may be provided by a single discipline or transdisciplinary team based on a Key Worker model, depending on needs.
    • Therapy will be delivered “through a mix of 1:1, in person and/or virtually”.
    • May include intensive family capacity building (beyond Universal Parenting Supports)   
  • Low cost (<$1,000) assistive tech may also be loaned or provided. 

For kids affected, Thriving Kids will replace:

• early intervention NDIS access;
• individualised plans and NDIS funding; 
• choice and control of provider; and
• clinic-based care models.

What happens to kids during the roll out? Children aged under 9 with developmental delay and/or autism with low to moderate support needs who are or become NDIS participants before 1 January 2028 will “be subject to the usual reassessment criteria in place prior to 1 January 2028”.

Zoom in: For more detail, read the Report – especially pages 9 and 63, which summarises the model and the “theory of change” that will inform service design and implementation.

B. Thriving Kids – and other factors – will transform our workforce

Thriving Kids will cut across the early childcare, education, disability, and health systems, and will affect them all. Those systems, in turn, will affect Thriving Kids. Big workforce changes are flagged several times in the report (e.g. pp 38-48), including the work that will be needed to “enable a smooth transition for providers and practitioners who are currently providing services through the NDIS and who may transition towards Thriving Kids delivery” (p 40). It’s a huge project.  

Priority-check: Before we get into some business and workforce implications for allied health providers and professionals, we must make three important points:

• Good intentions: A lot of work has gone into Thriving Kids. The Government, and the Report authors are very pleased about the model, with Oberklaid claiming that “it’s very hard to argue with any of it”. Despite our reservations, we know the current system needs an overhaul, and that Thriving Kids has the potential to help thousands of families with children with developmental delay and autism who cannot currently access the help they need. 
• Many families are stressed and need us to stay calm: We want Thriving Kids to succeed for the sake of the families and children we serve. Many families are worried by all the changes. Despite our own fears, we must remain rational, stick to the facts, and acknowledge we don’t have all the answers. During the roll-out, we have an important role to explain and co-navigate the new system with families looking for help (p 39.), as well as to advocate for better services when needed. 
• Yes, no one owes us a living. But we are not powerless pawns either. If our business and service delivery models stop working because of events outside our control, it’s up to us to change things within our control to adapt to new conditions. Of course, this is much easier said than done! 

Zoom out: The workforce and business implications of Thriving Kids make more sense if you consider the bigger picture: 

• Macroeconomic constraints: Right now, aggregate demand is above the aggregate supply, increasing inflation. This is why the RBA put up interest rates last week. Government spending on things like the NDIS (and Thriving Kids) contributes to aggregate demand. Federal and state government spending continues to increase, and most NDIS reforms to date are about slowing rates of spending growth, not decreasing the overall spend.   
• Governments are under pressure to increase productivity: Australia needs to increase overall productivity to increase our standards of living.
• The care economy is a big and growing part of the Australian economy: According to the Productivity Commission, Health, aged care, disability, veteran’s affairs and early childhood education and care (ECEC) contributed about 8% of GDP and 12% of our workforce in 2022-2022. Both shares are expected to rise over the next 40 years. A large care sector is a mixed blessing for productivity and the Australian economy:
  • Blessings: It frees up lots of otherwise unpaid careers (mostly women) to take on paid work. It improves outcomes for people who receive care.
  • Drawback: It intensifies competition for labour across the economy, potentially pulling workers out of other sectors – especially if people can earn more money in the NDIS than in a “more productive” private sector job. (Some sections of the media have been focusing on this point as part of the NDIS reform debate, arguing that too many NDIS workers are a “drag” on the economy.)   
• Productivity gains in the care economy are hard to achieve: Most care is labour-intensive and we don’t want to reduce care quality. The Productivity Commission thinks the government should intervene to “shape” the care economy, including by:
  • aligning regulation across care sectors, and making it easier for workers to work across different parts of the care sector;
  • embedding place-based “collaborative commissioning”, including between Local Hospital Networks and Primary Health Networks, to break down silos between organisations and types of care; and
  • implementing a national prevention and early intervention framework.  

So, all this means…: Federal and state governments are working to try to change demand, supply and distribution of allied health services across disability, aged care, social care, health, and education settings. Through regulation, pricing limits, de-privatisation, funding arrangements, and other incentives, governments are seeking to reorganise our allied health workforce to meet their policy objectives. For example:

• as the Independent Pricing Committee observed last year, NDIS pricing limits are already forcing the allied health market to restructure itself, with current settings advantaging large providers (who can survive periods of low profitability and losses and achieve economies of scale) and sole practitioners (who have low overheads and no staff to train or supervise) over smaller providers that train and supervise staff. 
• even before Thriving Kids, most small clinic owners were aware that their business models must change, and many of us are working hard to diversify and reduce reliance on NDIS funding; and
• in his Thriiving Kids press conference of 3 February 2026, Minister Butler explained that one of his aims is “[g]etting a little bit more of an even spread of that [allied health] capability into veteran’s care, into aged care, into public hospitals…of that allied health capability as it’s moved into the private sector to participate in NDIS.” 

Things are worse for small clinic owners: 

• the small businesses sector is struggling. Across the economy, business conditions are tough for small businesses, with rising overheads, inflation and interest rates challenging cashflows. In the 2025 financial year, we saw a record number of insolvencies (up 33% from the previous year [paywalled]). 
• NDIS risks and costs are increasing: NDIS pricing caps, new definitions of NDIS supports, increasing regulatory risks, new compliance requirements, and additional red tape make things harder.
• many allied health providers manage clinics, which grew in response to surging demand from families of NDIS-funded children, and as state services dismantled services. Individualised funding models incentivised professionals to go into private practice and to offer clinic-based services. As policy settings have reversed to discourage clinical models of care, many clinic owners are at a crossroads. 

Why this matters: Private paediatric allied health clinic owners and professionals have some big decisions to make in the near future. And the clock’s ticking. 

Key challenges: 

• For providers: What’s already happening with the NDIS – and what is likely to happen with Thriving Kids – is that providers will feel pressured to allow governments to change their services to match government-dictated service delivery models, including assessment and therapy services. During the transition, providers may experience a “regulatory squeeze”, trapped between diminishing revenues, rising costs, limited autonomy over service design and delivery, and difficulties recruiting, supervising, training, and retaining staff. 
• For professionals/workers: Some allied health professionals may find themselves stranded in systems and workplaces that deliver limited, low-quality, and/ or non-evidence-based services and programs. Others may experience difficulties accessing sufficient supervision, training, and other opportunities for professional growth. Of course, these are issues that exist in the current system, too. (The Report authors recognise that investment in supervision, training, and governance will be essential for Thriving Kids workforce development, see p 8). 

With changes, come opportunities: 

• The overall demand for high quality paediatric allied healthcare remains high.
• We have valuable skills and an overall worker shortage. Few of us will struggle to find work.
• Some will relish the opportunities presented by Thriving Kids, either through employment within the public sector, or through lead provider and/or subcontractor roles in services commissioned by states. Across systems, there will be an urgent need for skilled professionals with years of experience supporting children with developmental delay and/or autism to train and supervise others.  
• Others may choose to move to a different part of the care economy, as is expected by the governments.
• Some clinic owners may shutter their clinics, take a job, or leave the sector altogether (again outcomes expected by governments). 
• Regardless of funding models, I remain committed to delivering high quality paediatric services to improve functional outcomes for children – both directly, and by supporting my team and other professionals to help clients and their families. 
• Thriving Kids and a smaller NDIS may improve access and outcomes for many children and families – and I hope it does! But Thriving Kids cannot and will not suit everyone, everywhere, all at once. 
• I expect there will be lots of “on the ground” access and service gaps for families, e.g. in schools. Some families will want more than what Thriving Kids can deliver. Others may want something different. 

Bottom line:

Now we know what’s coming – and the risks of inaction – we should spend less time worrying and more time focused on identifying opportunities – ways to use our knowledge, skills, talents, and interests to:

• help more children and families achieve good outcomes; 
• keep learning and growing professionally; 
• support our colleagues, including early career allied health professionals; and 
• pursue our professional goals with people we respect, and people who respect us.

For those of us committed to paediatric allied health care for children with developmental delay and/or autism, let’s keep sight of our North Star: to deliver excellent services to the children and families – regardless of sector, setting, system, program, or funding model. 

As Thriving Kids rolls out, we’ll explore emerging challenges and opportunities in Banter Boosters.

Further reading:

• Thriving Kids Advisory Group’s Final Report
• Ministerial media release: Advice on national model for Thriving Kids
• Transcript: Press conference with Minister Butler, Canberra – 3 February 2026

Related articles:

• Small NDIS allied health providers: keep moving, and don’t give up
• Allied health providers and pricing controls: independent providers that employ, train, and supervise staff are caught in the middle, and might not survive (and the NDIA knows it)
• Thriving Kids in Schools: Will it Work?
• The Key Worker Model for young children with developmental delay or disability: does it actually improve child outcomes?
• Allied Health Providers: The NDIA Just Told Us the Truth (Again)

This article also appears in a recent issue of Banter Booster, our free newsletter navigating problems for busy speech pathologists, one week at a time.

Sign up to receive Banter Booster in your inbox each week: