Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2025
Summary
To create culturally safe, community-led early childhood services that improve access and deliver seamless care in remote Torres and Cape communities
Dates: Jul 2023 - Ongoing
Implementation sites: Kubin Primary Health Centre, Torres and Cape HHS
Partnerships: National Disability Insurance Scheme Remote Partnership Branch
This project was presented as a Poster at CEQ Showcase 2026 (PDF 311KB).
Aim
To establish integrated, community-led early childhood support pathways that enable seamless care journeys for children and families in remote Torres and Cape communities.
Outcomes
- The program has significantly improved access to early childhood supports across NPA and Torres Strait.
- Families feel relief, reassurance, and increased confidence when engaging with developmental supports through the Program.
- Cultural safety is a defining strength of the program, built through Aboriginal and Torres Strait Islander staff and their leadership.
- The program is recognised for strong partnerships across health, education, and community.
Background
The Torres and Cape Hospital and Health Service (TCHHS) commenced conversations with the National Disability Insurance Agency (NDIA) to explore how best to support young children with developmental concerns and disability across the Torres Strait and Northern Peninsula Area (NPA).
At the time, access to early childhood supports in the region was extremely limited. There were very few locally based therapy or developmental services, and many children were starting school with developmental challenges that may have been mitigated through earlier identification and intervention. Workforce shortages meant that therapy provision was sporadic, outreach-based, or unavailable, resulting in low engagement with the NDIS despite high levels of need.
The scale and complexity of the region further compounded access barriers. Located more than 2,100 kilometres north of Brisbane and spanning 48,000 square kilometres, the Torres Strait and NPA include 17 island and five mainland communities. Accessing services often requires travel by plane, ferry or helicopter, making consistent early intervention difficult for families.
Developmental data reinforced the need for early intervention. The Australian Early Development Census (AEDC 2024) showed that:
- 40% of children were developmentally vulnerable on at least one domain
- 25.5% were vulnerable on two or more domains
In response to these challenges, TCHHS and the NDIA partnered to design and implement the Early Childhood Approach (ECA) Program — a culturally responsive, community-led model aimed at improving early identification, access to early childhood supports, and developmental outcomes through locally delivered, integrated care pathways.
Methods
The Torres and Cape Hospital and Health Service (TCHHS) implemented the National Disability Insurance Scheme (NDIS) Early Childhood Approach (ECA) across 21 remote Torres Strait and Northern Peninsula Area (NPA) communities to improve access to culturally safe early childhood supports for children aged birth to nine years.
The program was designed to address geographic isolation, limited local therapy availability, and fragmented service pathways. A place-based, culturally grounded service model was developed and implemented using transdisciplinary practice, local First Nations leadership, and flexible delivery mechanisms.
Initiatives Developed and Implemented
The ECA model comprises three core intervention streams:
- Early Connections - Community-based early identification of developmental concerns and navigation support to connect families with health, education, community services and the NDIS.
- Early Intervention - Delivery of play-based, best-practice therapy and developmental supports.
- Family and Community Capacity Building - Strengthening local capability through parent education, mentoring, knowledge sharing, and workforce development.
Principles of co-production with First Nations people and communities supported implementation:
- Engagement with Elders and community leaders to ensure cultural responsiveness and local relevance.
- Development of culturally adapted materials and assessment approaches (e.g., eco-mapping, local language use).
- Community awareness activities including presentations, parenting sessions and outreach.
- Local partnerships with schools, early learning centres and community organisations to co-deliver services.
- Flexible service delivery via outreach clinics, home visits, primary health centres, community spaces and telehealth.
- Transdisciplinary clinical practice across allied health and early childhood educators to maximise workforce efficiency.
- Strengthening referral pathways and care coordination across NDIS, Queensland Health and community services to ensure connected care.
This approach ensured children received the right support, at the right time, close to home.
Implementation Approach
Implementation was staged and adaptive. Services were co-designed with each community to ensure cultural integrity and responsiveness to local priorities. A place-based workforce model embedded identified Aboriginal and Torres Strait Islander roles to strengthen trust and engagement. Visiting Allied Health clinicians and Early Childhood Educators provided specialist input. Connection to community, cultural knowledge and continuity of care in service delivery was provided through a stable local team.
Continuous quality improvement principles were applied, including iterative refinement of the model of care, referral pathways, workforce configuration and service delivery mechanisms in response to community feedback and operational data.
Evaluation and Improvement Methodology
An independent First Nations–led organisation, Kowa Collaboration, was engaged to support Understanding, Monitoring, Evaluation and Learning (UMEL). The evaluation methodology included:
- Desktop analysis of program administrative data.
- Co-creation workshops with ECA staff and stakeholders to revise the Program Logic and develop a culturally appropriate UMEL Plan.
- Sense-making processes ("Impact Yarns") to inform refinement of the Model of Care.
This structured improvement methodology has provided key findings that are being implemented to ensured the continued evolution of the program in response to data, lived experience and community voice.
Discussion
The success of the ECA Program was highly dependent on context and environment. Operating within remote Torres Strait and NPA communities required a model grounded in cultural responsiveness, trust and long-term relationship building rather than transactional service delivery. Embedding Aboriginal and Torres Strait Islander staff and leadership within the workforce was essential to creating safe spaces for families to engage. Local language use, shared cultural understanding and visible First Nations leadership built confidence and legitimacy.
Queensland Health hosting provided governance stability, workforce continuity and system integration capacity in a 'thin market' environment where private providers are scarce. Transdisciplinary practice and flexible delivery (outreach, co-location, telehealth) were necessary to overcome geographic dispersion and workforce constraints. Finally, structured evaluation and iterative refinement through UMEL processes ensured continuous improvement rather than static implementation.
Lessons learned and limitations
The Evaluation Review confirmed that the ECA Program significantly improved access to early childhood supports and strengthened family confidence, reassurance and navigation capability. Families described relief in having services close to home and greater understanding of their child's developmental needs. Partnerships across health, education and community were recognised as a defining strength.
However, several lessons emerged:
- Access structures alone are insufficient; relational trust is central to inclusion.
- Communication strategies must adapt to frequent staffing and sector changes.
- Workforce constraints (e.g. limited Allied Health, early childhood educator capacity) affect scalability.
- Cultural responsiveness must extend beyond representation to leadership influence and decision-making authority.
Desktop data captured activity and outputs effectively but did not fully reflect lived experience. Impact Yarns added critical insight into relational and emotional outcomes, reinforcing the importance of mixed-method evaluation approaches.
Where else in Queensland Health could this succeed?
The model has strong applicability across rural and remote Queensland, particularly in regions with:
- Limited private therapy markets
- High Aboriginal and Torres Strait Islander populations
- Workforce instability
- Fragmented early childhood pathways
Because it has been implemented successfully in one of Queensland's most geographically complex and disadvantaged regions, the model is likely to be even more efficient in rural areas with fewer logistical constraints. The transdisciplinary, place-based workforce design offers a scalable solution for other Hospital and Health Services seeking to improve early childhood access under Thriving Kids.
Next steps
Future priorities include:
- Strengthening First Nations leadership pathways within the program structure.
- Enhancing cross-sector communication to reduce service navigation confusion.
- Expanding workforce capability to meet growing demand.
- Embedding UMEL practice to track long-term developmental and family outcomes.
- Supporting adaptation of the model to inform Thriving Kids statewide implementation.
Overall, the ECA Program demonstrates that culturally grounded, locally embedded and system-connected approaches can create meaningful improvements in access, trust and developmental outcomes - even in the most remote contexts.
References
Kowa Collaboration 2025, Early Childhood Approach Program (Torres Strait & Northern Peninsula Area): Final Review Report – Emerging Themes, Critical Lens and Key Insights, report prepared for Torres and Cape Hospital and Health Service, Queensland.
Australian Government Department of Education 2025, Australian Early Development Census (AEDC) National Report 2024, Australian Government Department of Education, Canberra
Key contact
Rita Kaitap
Senior Early Childhood Coordinator
Torres and Cape Hospital and Health Service