Thriving Kids (Part 2): Why Small Providers Like Enable Me Are Worried

Reform within the NDIS landscape is both necessary and important if the system is to become easier to navigate, more sustainable, and focused on outcomes that genuinely matter for children and their families.

While the vision behind Thriving Kids speaks to many of these aims, there is also a growing sense of unease across the Occupational Therapy community - particularly among small, independent practices like ours. This is not because therapists are resistant to change. Rather, it reflects our concern about what could be lost if services become too centralised, too standardised, or increasingly concentrated within large-scale providers.

Earlier this week I wrote a blog about my concerns for the families accessing Thriving Kids, and today I am writing about it from the perspective of a small, allied health provider and business owner.

Enable Me OT clinic

A shift towards large, multidisciplinary organisations

From what can be understood from the report, Thriving Kids will favour large, multidisciplinary organisations that can provide multiple services under one roof, rather than small-scale providers.

For some families, that may feel convenient. However, this structure can unintentionally make it harder for smaller practices, like ours, to survive. For example, smaller single or dual discipline practices typically don’t have the built in referral pathways that large multidisciplinary providers have where they can be a one-stop shop for all needs. Instead, we rely on families being free to choose a provider based on relationship, approach, and fit, and then making word of mouth referrals because they like our service.

Additionally, larger providers can take on a higher volume of clients, have their own compliance teams, and absorb funding delays that small businesses like our, can’t afford to do.

And when small providers disappear, diversity in how and where therapy is delivered disappears with them.  Leaving us concerned that if the delivery of allied health services for Thriving Kids is limited to large organisations, families may face reduced choice, longer travel distances, and less culturally or contextually responsive care.

Will there still be choice and control?

Choice and control are central principles in disability services – and this is especially meant to be so in the world of NDIS.Yet choice becomes complicated if families are primarily offered options within one organisation, or if moving outside that all-in-one system feels difficult or disruptive to them.

From my point of view, a parent should be able to say my child’s therapist: understands our family, uses an approach which suits my child, and the service model used aligns with our values. However, I’m concerned whether families will get a say in any of these principles under Thriving Kids.

Children don’t fit into templates

Occupational Therapy is built on clinical reasoning. It asks therapists to constantly adjust what they do and how they do it based on: the child in front of them, the environments in which they live, learn, play, and participate in, what matters most to the family, and how regulation, relationships, and daily life are interacting.

Larger-scale organisations often depend on structured programs, packages, and standardised assessment and intervention pathways in order to operate efficiently. But children aren’t linear, and they certainly aren’t static. They are dynamic, constantly developing, and their progress rarely follows a neat, predictable path. For example, an approach that is effective one month may not meet a child’s needs the next, and strategies that succeed in the classroom may not translate easily to home or community environments.

Additionally, we know from what our families tell us, that their priorities are harder to quantify. They want their child to: feel safe and understood, participate in everyday life to the best of their ability, and build confidence and identity. These type of goals take time, nuance, and partnership, and those types of outcomes are not easily measurable.

As a result, good OT requires flexibility. And flexibility is harder to maintain in highly standardised models compared to smaller, community-based practices that are more likely to implement collaborative goal-directed care.

Will Thriving Kids be neuroaffirming and trauma-informed?

Another concern I worry about is that system frameworks, like what is proposed in Thriving Kids, can gravitate toward more cookie cutter interventions and outcomes that are easier to quantify — such as behaviour change or performance metrics — which may not always align with neuroaffirming or trauma-informed practice.

Small providers have often been leaders in embedding neurodiversity-affirming and trauma-informed approaches. We want to ensure that any reforms made will continue to prioritise and make space for this work, rather than squeezing it out so that the Government can look good through biased statistics and carefully selected outcomes.

What will happen to workforce sustainability?

For children with developmental delay and autism, continuity and trust are fundamental to engagement, regulation, and the development of skills. Disruptions to therapeutic relationships - often associated with higher workforce turnover in large-scale service models - can negatively affect outcomes and increase stress for families.

The allied health sector is already experiencing significant workforce shortages. When clinicians experience reduced autonomy or are required to practise in ways that conflict with their professional judgement, ethics, or values, burnout and attrition are more likely.

Small providers, like us, commonly create practice environments where occupational therapists are able to: maintain sustainable pacing and caseloads, develop deep, long-term relationships with families, and deliver care that aligns with professional standards and neuroaffirming, trauma-informed principles.

These conditions matter not only for clinicians, but for the children and families who rely on stable, trusted supports. If small, values-driven workplaces become less viable, the system risks losing experienced practitioners, ultimately reducing the quality and availability of care.

Small providers are also particularly well placed to deliver the things that matter to families including: consistent therapists across time, strong, enduring partnerships and

flexible and responsive models of service delivery.

Furthermore, Thriving Kids requires rapid expansion of early supports to ensure success. This scale cannot be achieved without drawing on the existing provider ecosystem, which includes thousands of small providers like Enable Me, that already delivering early childhood allied health services within their communities.

Where Enable Me Occupational Therapy stands

I want to make it clear that I support reform that improves outcomes for our neurodivergent kiddos, but these reforms need to also improve children and family’s lives through the provision of:

• genuine family choice,

• individualised child and family-led therapy,

• professional autonomy, and

• care that recognises the whole child within their real environments.

As such, I believe that for kids to thrive, they need access to a range of service models, including small, relationship-based practices like ours.

Our hope is that as Thriving Kids continues to develop, it safeguards the diversity, expertise, and humanity that families value most and deserve to receive.