Psychologists are critical to supporting young children and their families who are accessing the NDIS.
For some families of children living with developmental differences, it's not until they're seeking out NDIS support for their child that they get to talk about their concerns for the first time.
If the person they're speaking with isn't educated about the important role of psychologists as part of an NDIS participant’s care team, that child can miss out on critical support to enhance their functional capacity, agency, learning abilities and more.
This is reflected in APS’s 2023 submission to the NDIS Review, which cited research from its member base outlining that only 34% of NDIS providers believe the NDIS is effective in promoting early childhood support.
That’s why Caroline Keating MAPS, an educational and developmental psychologist and convenor of the APS Psychology and Early Childhood Intervention (ECI) Interest Group, says more information is needed to educate the pipeline of stakeholders that come into contact with a family’s case – "from the management of the NDIA and the policymakers to the people on the ground talking to families."
Dr Susana Gavidia-Payne MAPS, who is an Adjunct Associate Professor, Educational and Developmental Psychology with the School of Education at RMIT University, agrees.
"Psychologists who work in early childhood intervention perform a significant role in the provision of services under the NDIS and [perform] a significant range of tasks according to the individual needs and characteristics of children and their families."
These tasks can involve using observations and assessment tools to determine whether a child presents with a developmental concern, delay or disability, and provide a diagnosis if necessary, says Dr Gavidia-Payne.
"In conjunction with team members from other allied health professions, this information can, in turn, form a critical part of goal-setting, planning and design of intervention supports for children and those in their specific contexts.
"Psychologists can also perform a ‘skill-build’/coaching role about competencies to colleagues from other disciplines, as well as engaging in coordination and advocacy efforts to support families and communities.
"Psychologists’ numerous competencies allow them to play roles that extend well beyond those of treatment and intervention."
Keating adds that psychologists are an essential part of what the NDIS calls the 'Early Childhood Approach'.
"Parents are experts in their own children. [Families and caregivers] don’t necessarily have a framework or language to articulate their concerns when seeking supports. They might not know what best practice is or what the options look like, as there is a lot to get your head around in understanding early childhood supports.
"Their child’s development is changing and growing all the time, and they might be unsure of what they need. So, I’d really like to see a system where families are supported to access [psychological] supports that we already have evidence for and know are best practice in this space."
However, misconceptions about the role of psychologists mean their contributions can sometimes be overlooked.
"[Some] people perceive a psychologist as someone who asks in-depth questions about thoughts and feelings. Many don’t understand what psychology could look like for a child who’s not yet talking or can’t engage in traditional talk therapy.
"I’ve heard reports of families being told, 'You don’t need a psychologist until your child is older and can talk. You’ll be best supported by a speech or occupational therapist; psychologists don’t work in that space.' That’s a real barrier.
"The skill set of psychologists is broad. We have training in learning, behaviour, emotions, development, improving relationships and supporting participation. There are lots of different ways we can offer this support that is very family and child friendly."
Working with families and other health professionals
A unique aspect of working with young children in the NDIS as a psychologist is engaging with a wide range of stakeholders, from families and educators to speech pathologists and occupational therapists.
A transdisciplinary team approach is best practice for early childhood support, says Keating, as is the key worker model.
"[This model] is where you have a team of therapists, and one is the main contact for that family. They get to know the child and family, their goals, needs, strengths and challenges. The team back at the office can then be pulled in when needed.
"It might be that a speech pathologist is working regularly with a family, and they ask me to consult on difficulties with transitioning into kindergarten or a behaviour problem. They’d ask me to join for a visit, so the family doesn’t have to explain their situation all over again. There’s already someone who knows their circumstances and can help integrate suggestions into what’s already known about the family’s goals and strengths.
"It brings the team’s expertise to the family, rather than each member sharing their individual ideas."
Dr Gavidia-Payne shares an example of a psychologist working alongside a key worker in a team-based approach with a young child whom, for the purposes of this example, we will call Peggy*.
Peggy presented with language and communication delays, as well as behavioural concerns. At preschool, Peggy’s teacher reported that she had started hitting other children and being disruptive. The clinic where she received speech therapy support made a referral to a psychologist.
"The psychologist worked closely with Peggy’s parents, family key worker, speech pathologist from this clinic and the preschool educator. They conducted various observations at Peggy’s preschool and home."
As a result of this process, the team established that:
- Peggy lost interest in activities quickly
- Her behaviour was communicating a desire to interact with other children, but perhaps did not have the skills and tools to do so effectively
- Little was known of Peggy’s specific interests and strengths, particularly within the preschool routine.
Following further data collection, the team planned a support approach involving augmentative communication and behavioural strategies.
"Peggy’s preschool teacher then implemented the strategies, with coaching, which Peggy’s speech therapist and the psychologist provided. The psychologist also worked with Peggy’s family on their own concerns, which… included parental wellbeing and unsettled family routine.
“Approximately one month later, Peggy’s interactions with peers increased, behavioural concerns in the classroom and in the playground had virtually disappeared, and her family’s quality of life and community connections had improved. A positive result for all."
Family and child-based goals
Taking a family-centred approach to developmental assessment and care is also important.
"Delivering interventions and supports under a family-centred lens, implies psychologists adopt [specific] knowledge, skills, behaviours, and dispositions," says Dr Gavidia-Payne.
She says they can be summarised as:
- Conceptualising the child’s family as a powerful influence on a child’s early years
- Listening and validating family’s concerns, priorities, choices and hopes
- Learning about family’s unique values, routine and supports
- Working in partnership with families
- Focussing on promoting parent and family capacity, decision-making, wellbeing, and self-efficacy
- Facilitating access to tools and resources in the local community
"Family-centred practice is one of eight key practices in the current National guidelines for Best Practice in Early Childhood Intervention," she adds.
Early childhood support under the NDIS should always be based on family and child goals, says Keating.
"We often talk to families about their daily routines, what’s challenging for them and their child, and then look at how we can support the child’s inclusion and learning opportunities."
When working in early childhood support – whether within or outside of the NDIS – Keating highlights the importance of engaging in spaces where young children naturally gravitate.
"We’re not trying to pull a child out to learn a skill with us for an hour a fortnight. We know children learn through repeated experiences in their everyday environments, so we look at optimising that for children with developmental differences or delays."
To illustrate how a psychologist might work with a family within the NDIS, Keating shares the example of a parent whose child with developmental delays often runs away in public, causing stress for the parent.
"We explore that challenge because there are many great learning opportunities at the playground, but the child’s developmental differences might be making it harder for the family to enjoy the space.
"The child might find new environments confronting, making it hard to relax and enjoy the park. These feelings could manifest as aggression. So, we examine the underlying skills and supports the child needs to engage in that environment."
A psychologist might work with the parents to modify the environment or partner with a speech pathologist to support the child’s communication and social opportunities with peers.
Ethical considerations
Dr Gavidia-Payne notes that there are important ethical considerations to keep in mind when working with children within the NDIS. These are covered in the NDIS code of conduct.
"The APS also has its own code of [ethics], as well as ethical guidelines related to working with children, privacy, confidentiality, and informed consent.
"It's also possible that psychologists could experience everyday dilemmas in their practice in dealing with families or other professionals, including differing appraisals in assessment, intervention, supports and standards of care.
"This will require putting in place ethical problem-solving strategies, including the consideration of children’s rights, inclusion, equity, and respect for the autonomy, self-determination and culture of families in making decisions for their young children with developmental concerns, delays, or disability.
"Important ethical considerations also include respect and collaboration for colleagues in the field and demonstrating the highest standards of practice, as well as personal integrity.
NDIS challenges
Alongside public misconceptions, Keating highlights the lack of access to psychological services.
"There’s some fabulous work being done with NDIS funding, but, at the moment, I think it’s the minority of children and families accessing support.
"It’s frustrating because when I encourage families to see a psychologist, there’s limited availability, making it hard to find a psychologist who specialises in this space."
Keating also emphasises the importance of training pathways for early-career psychologists.
"I’m passionate about supporting early-career psychologists with professional development, mentoring and supervision. The mentoring I received early in my career was invaluable. This work is so flexible and fluid, you need support from someone who’s been there."
Dr Gavidia-Payne agrees that current psychological training practice is limited and says it's sometimes "at odds with good practice in ECI".
"For example, the concept of transdisciplinary teamwork and the use of a key worker model is unknown to most new psychology graduates. Unfortunately, this has resulted in an unintended consequence of how psychologists working in the ECI field are often viewed – that is, only in terms of doing IQ assessments and providing a diagnosis, where we have much more to offer."
Another challenge for psychologists, she says, will be responding to the evolving systemic issues associated with the delivery of ECI services.
"Up until now, [these] have often promoted service models that tend to preclude the execution of evidence-based practices with children and their families," she says.
Looking ahead, Keating is hopeful about the implementation of key recommendations from the NDIS Review regarding early childhood support.
"The NDIS Review highlighted the need for more foundational support in early childhood, and I’m looking forward to seeing what that might look like."
Dr Gavidia-Payne says the NDIS Review and the current review and development of a National Early Childhood Intervention Framework are "two very exciting developments for all psychologists, particularly considering that about one half of NDIS participants are children".
"In time, as new service models are likely to be developed, the role of psychologists will be front and centre, as we bring in a range of skills regardless of our specialisations.
"In addition to working with children and families, we count on our expertise and knowledge of service systems, policy development, advocacy and community support. These will be instrumental in enabling the design and implementation of an NDIS that is responsive to all young children and their families."
Further reading
During the current period of NDIS reforms, the APS continues to advocate for the role of psychologists within the NDIS. Some of our recent advocacy wins include:
APS would like to thank all members of our NDIS working group for their contributions to our ongoing advocacy about psychologists’ role within the NDIS.
*Not her real name.