We Can Do Better

August 29 2022

As part of my third year of occupational therapy (OT) studies, I spent 6 weeks on placement at Monash Health Community. I was part of the Child and Family Team which was a lucky result for me, as someone who wants to go into paediatric practice after graduating. The placement was overall an enjoyable, engaging and meaningful learning experience. Not only was my confidence boosted, but my passion for paediatric OT was emphasised and I was reassured by the unwavering feeling that I was taking my life in the right direction.

However, my experience was also an eye-opening one. Being involved in a government-funded, short-term community health service, I was exposed to families from varying ethnic backgrounds, low socio-economic statuses, poor health literacy and even some cases of strained family relations and child protection involvement. I was suddenly truly able to acknowledge the privileges of the community in which I have grown up and still reside.

I knew that many families in my community were accessing ongoing private OT (and other therapies too) for their children, either through NDIS funds or by paying out of pocket. Yet, I was ignorant to the reality that there are many families whose children require the same long-term support and are unable to access services.

Being a government-funded, community health service, the Child and Family Team at Monash Health is therefore a short-term service. For OT specifically, they provide children aged 0-12 – who have developmental delays – with a block of 3-6 therapy sessions to work on small goals that can be achieved in this timeframe. This is similar to the other disciplines, such as speech and physio. Funding for community speech therapy also stops once a child reaches school age.

For those children who have more complex needs and require more long-term intervention than what community therapy can offer, their families can apply to the Early Childhood Early Intervention (ECEI) stream of the NDIS. The NDIS funds are extremely beneficial to families who cannot otherwise afford long-term, private therapy.

However, I became frustrated and saddened by the realisation that there are some children whose needs cannot be fixed by the short-term nature of community health, but would not qualify for NDIS funding either, based on the ECEI criteria for developmental delay. In particular, one of the criteria for determining developmental delay and eligibility for fundings is that “the child needs specialist services from more than one professional working as a team to support the child and for longer than 12 months.”

But what about the children who have a severe delay that requires just OT or just speech or physiotherapy? The short-term nature of community health won’t be able to address all of their needs, but they also won’t be eligible for ECEI funding. That means the family’s only other option is to pay out of pocket for private therapy. And most of the families accessing community health just can’t afford to do this. So where does this leave them?

I know that the NDIS does not have unlimited funding to give to everyone. And I do acknowledge the positive impact they bring to so many families. But to me it just seems that there is still a worrying abundance of young children from vulnerable families falling through the cracks because of a rigid ‘system’.

I’m not saying I have all of the knowledge or an easy solution. I just want to point out that even initiatives that seek to bridge gaps within society can always do better.