A Scoping Review of Therapy Provision Under the National Disability Insurance Scheme: Provider-Identified Barriers and Facilitators.
M D Marveggio, D S Dorstyn, D Turnbull and 1 others
NDIS administrative complexity is the most common barrier to therapy for children with cognitive disabilities, followed by family circumstances.
Tailoring the intervention to the individual child is the most common facilitator. Across 55 studies, providers reported 171 barriers against 122 facilitators.
Key findings
1The most frequently reported barrier was NDIS policies and processes (33 of 171 barriers), followed by family circumstances (28). Systemic and environmental factors accounted for 125 of the 171 barriers overall, ahead of intervention-related (30) and provider-related (16) barriers.
2The most frequently reported facilitator was flexibility of approach and personalised support (25 of 122 facilitators). Intervention characteristics overall accounted for 51 of the 122 facilitators, with provider characteristics (41) emphasising relationship-building with families.
3The evidence base is predominantly qualitative: 37 of 55 studies (67%) used qualitative designs, and only 4 studies included validated outcome measures as part of their intervention evaluation.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The evidence base is overwhelmingly qualitative (67% of studies), and only 4 studies used validated outcome measures, so the barriers and facilitators are provider-reported perceptions rather than independently verified effects. Occupational therapists, speech pathologists, and psychologists are overrepresented; without NDIA data on actual service usage, it is unclear whether this reflects real-world patterns. Adolescents (aged 13–19) are underrepresented: only 2 of 55 studies focused exclusively on this age group. The disability mix is skewed toward neurodivergent conditions, particularly autism (35 studies); low-incidence conditions such as Fragile X syndrome are barely represented. The findings are specific to the Australian NDIS funding and reporting structure, which does not exist in most other countries, so the barriers and facilitators may not transfer to other funding models. As a scoping review, the synthesis is descriptive (mapping and counting) rather than analytical; it cannot determine which barriers or facilitators actually change outcomes.
Declared interests
The first author and the research were supported by an Australian Government Research Training Program Scholarship. No industry funding, no conflicts of interest, and no sponsor involvement in design or writing were declared.
The easy way to misread this
Do not read the barriers and facilitators as evidence that specific therapies are or are not effective for children with cognitive disabilities. This review maps what providers say makes their work harder or easier within the Australian NDIS; it does not evaluate whether any intervention produces better outcomes for children. The findings are also specific to the NDIS funding and reporting structure, which does not exist in most other countries, so the barriers identified may not apply to your funding context.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →