Almost always, children with developmental delays or disabilities need the support of more than one health professional.
Health and education professionals should always work as a team with the family to support the child.
This requires a lot of communication and teamwork.
If no one coordinates services, you end up with different professionals working on different goals without reference to each other, potentially creating service gaps and duplication.
A “siloed” approach is challenging for families, and inefficient for everyone.
In Australia, the key worker model is viewed as a best practice approach:
- for early childhood intervention services (ECIS); and
- under the Early Childhood Early Intervention Framework of the National Disability Insurance Scheme (NDIS).
The multimillion dollar question
Does the key worker model deliver better outcomes for children with developmental delays or disabilities?
Spoiler alert: The evidence (so far) is less convincing than expected!
But, first, we’ll outline an example of a Key Worker model used currently in Australia.
Key Workers and the NDIS early childhood approach (current system)*
- In Australia, if a family has concerns about their young child’s development or disability, they usually have a chat with the child’s GP, child health nurse, or early childhood educator.
- If, after those discussions, the family remains concerned, they can contact the NDIS or an “early childhood partner” – often large organisations funded by the NDIS to deliver early childhood support to families in particular areas.
- If the child has a developmental delay or disability, early childhood partners can support families to apply for NDIS funding.
- Under current pricing arrangements, NDIS Plans can include Key Worker funding (under Capacity Building supports) for early childhood supports to assist a child (younger than 9) with developmental delay or disability and their family or carers in home, community, and early childhood education settings, to work towards increased functional independence and social participation.
- The Key Worker – usually an allied health professional (e.g. a speech pathologist, occupational therapist, physiotherapist) or early childhood educator – is appointed and funded both as the main service provider and as the main point of contact for the family and the team.
- In theory, families can nominate a Key Worker of their choice. In practice, Key Workers often work for the early childhood partner.
- Based on the child’s needs, a transdisciplinary team is assembled to support the child (e.g. a team might include a speech pathologist, occupational therapist, physiotherapist, and one or more educators). In theory, families can choose their own therapists. In practice, team therapists often also work for the early childhood partner.
- Coordinated by the Key Worker, and in partnership with the family, the team delivers services to the family and/or the child – usually in natural environments, like homes and preschools, using family-centred practices.
Examples of Real World Challenges
- Lots of factors affect how well the model works in practice, including:
- each child’s support needs;
- each family’s circumstances, needs, priorities, and language and cultural backgrounds;
- where the family lives, and whether early childhood partners and experienced key workers and therapists are available (a significant challenge in some rural and remote areas);
- the workplace cultures, policies, and capacities of the organisation(s) involved (including how they manage potential conflicts of interest);
- each key worker’s experience, training, and skills to coordinate and deliver supports;
- each team member’s experience, supervision, discipline-specific and transdisciplinary training, access to resources, and overall work loads;
- specifics of the place(s) in which the services are delivered (e.g. including access arrangements); and
- funding models, regulatory settings and announced reforms – including incentives to support high quality transdisciplinary care.
- Under this model, it’s unclear how many families have real choice and control over the individual professionals who work with them to support their child.
Crucial Research Gaps
A recent systematic review found significant limitations in the research base underpinning the key worker model for children with developmental delay or disability (see link below).
- Just six studies qualified for inclusion in the review (including two Australian studies).
- There is no single definition or description of exactly what is meant by “family-centred practices”.
- It’s difficult to identify “active ingredients” of the model that lead to positive outcomes for children.
- Based on the review findings, the key worker model appears to:
- be significantly correlated with better family outcomes (like family satisfaction, and quality of life); BUT
- have no significant relationship with improved child developmental outcomes! This is potentially a big problem.
Bottom line
In light of the review’s findings, and the current speed and direction of NDIS and Thriving Kids reforms, we need urgent research – including experimental group comparison studies – to ensure key worker models actually improve developmental and functional outcomes for children with delays or disabilities.
Further reading
Park, K. K., & Carta, J. J. (2025). Defining the Characteristics and Outcomes Associated With the Primary Service Provider Teaming Approach: A Systematic Review. Journal of Early Intervention. (Unfortunately paywalled – abstract only.)
The early childhood approach for children younger than 9 | NDIS
Supplementary module: Early childhood supports | NDIS Quality and Safeguards Commission
*If (as announced), Thriving Kids is rolled out and replaces the current early intervention pathway for children with “mild and moderate” developmental delay or autism, things may change, although there still appears to be significant political support for Key Worker models in early intervention (read more here).
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