OT Unplugged: Community of Practice Insights

A major shift in early childhood supports

The long-anticipated Thriving Kids rollout is beginning to take shape in New South Wales, offering the clearest indication yet of how early childhood supports may operate from October 2026.

Children already on the NDIS are not expected to be removed immediately. However, children aged eight and under who may previously have entered the NDIS under mild to moderate autism categories are expected to be redirected into Thriving Kids instead.

This marks a significant shift for OTs, families and private providers.

While the program includes many evidence-based early intervention ideas, it is also arriving alongside tighter NDIS eligibility. For many clinicians, the concern is not the existence of Thriving Kids itself, but what families may lose access to in the process.

What the Thriving Kids model includes

The current draft specifications outline a system focused on short-term, early intervention supports for children, families and carers.

Proposed services include supported playgroups, parenting programs, peer support and allied health intervention delivered individually or in groups. There is also a strong focus on family navigation and coordination.

Importantly, the model appears focused on functional support rather than diagnosis.

General supports and early intervention

The general supports stream includes playgroups, parenting programs, peer support and referral services.

The draft also includes allied health “in-reach” within these programs, allowing clinicians to observe children in play-based settings, provide developmental guidance and support referrals into targeted services.

For many OTs, this resembles community outreach models already operating within some health services.

Targeted allied health supports

The targeted support stream includes time-limited, goal-focused allied health intervention.

Services may be delivered individually, in groups or through multidisciplinary collaboration across clinics, homes and community settings.

Although exact limits have not yet been released, the wording strongly suggests therapy caps around intensity and duration.

Group intervention also appears likely to play a larger role. While groups can work well for some children, clinicians are concerned they may become the primary pathway for children who require more individualised support.

Why providers are concerned

One of the biggest challenges for providers is the proposed commissioning structure.

The New South Wales expression of interest documentation strongly prioritises not-for-profit organisations as preferred providers. This has created widespread concern across private practice, particularly for regional and rural clinicians who are already filling workforce gaps.

However, the draft specifications also reference a pre-qualified allied health panel that may allow private practitioners, sole traders and small businesses to deliver fee-for-service supports where service gaps exist.

This pathway appears especially relevant in thin-market and regional locations where NGOs or public services may not have enough workforce capacity.

The practical reality in regional areas

For many regional communities, private practitioners are already the only available providers.

Long waitlists, recruitment difficulties and workforce shortages remain significant issues. As a result, practices operating in these locations may have stronger opportunities to demonstrate why private allied health involvement remains essential.

The expression of interest process allows providers to outline:

Existing early childhood experience

Regional or multicultural service delivery

Telehealth and in-person capacity

Partnership arrangements

Workforce capability and organisational structure

There is also a strong emphasis on collaboration between providers, including partnerships with Aboriginal community-controlled organisations and allied health services.

For some smaller practices, consortium-style partnerships may become an important pathway moving forward.

The return of capped intervention models

Many clinicians recognise similarities between Thriving Kids and pre-NDIS systems where intervention was often short-term and group-based.

The concern is not necessarily that group programs exist, but whether children who need ongoing support will still have access to consistent therapy.

Families of children with ADHD, anxiety and developmental concerns have already struggled to access support under the current system. Many providers worry more children may now fall into those same gaps.

At the same time, parts of the model are genuinely promising.

The focus on peer support, family navigation, early touchpoints and community-based intervention aligns strongly with best-practice early childhood approaches. If these services were being introduced alongside existing NDIS access, many clinicians would likely welcome the program enthusiastically.

Questions around assistive technology and coordination

The draft specifications also include low-cost assistive technology funding for communication, mobility, sensory regulation and daily functioning.

However, clinicians have raised concerns about how equipment provision will work in practice.

Mobility and sensory supports rarely succeed through equipment alone. Effective implementation usually requires assessment, training and follow-up support. There is still little detail about funding caps, approved product pathways or how therapy input will integrate alongside equipment provision.

The program also introduces a family support coordination role designed to help families navigate services and systems.

Rather than a traditional NDIS key worker model, this role appears more focused on care coordination and oversight. For families navigating multiple systems, this could become an important source of continuity.

Preparing your practice for what comes next

Despite ongoing uncertainty, one message is becoming increasingly clear.

Private practices will need to think strategically about diversification.

Many providers are already exploring private fee-paying pathways, school-based supports, community partnerships and collaborative service models. Others are considering consortium arrangements to strengthen future tender opportunities.

There is still substantial uncertainty around pricing, therapy caps and implementation. However, waiting for complete clarity may leave practices unprepared.

For OTs, this is likely to be a period of recalibration rather than business as usual.

Key takeaways for OTs

• Thriving Kids is expected to begin in New South Wales from October 2026.
• Children already on the NDIS are not expected to lose access immediately, but new children may enter Thriving Kids instead.
• The model appears focused on short-term, goal-based and group-oriented intervention.
• Current documentation strongly favours NGO-led delivery.
• Regional and rural providers may still play a significant role where workforce shortages exist.
• Collaboration and partnership models are likely to become increasingly important.
• Practices should begin considering diversification strategies now.
• Significant uncertainty remains around funding, therapy caps and implementation.

Links

Communities and Justice: Thriving Kids
https://dcj.nsw.gov.au/community-inclusion/disability-and-inclusion/thriving-kids.html

OT Unplugged - Brisbane Friends of the Podcast Event - 20 May 2026: https://www.trybooking.com/events/landing/1576072

Balmoral Burn Fundraiser Event - Support Sarah here: https://raceroster.com/events/2026/109219/humpty-dumpty-balmoral-burn/pledge/participant/46083634

The Occupational Therapy sector is moving through another period of uncertainty, with ongoing discussions around NDIS pricing, registration and funding changes continuing to dominate conversations across the profession. At the same time, conference and expo season is underway, giving OTs a valuable opportunity to reconnect, learn from one another and strengthen professional networks.

In recent conversations across the OT community, one thing has become increasingly clear – while there is still a lot we don’t know about upcoming NDIS changes, there is enormous value in staying informed, avoiding misinformation and leaning into community support.

Understanding the current NDIS funding discussion

One of the biggest concerns circulating at the moment is the discussion around NDIS plan reductions. There has been widespread confusion, with some providers and coordinators hearing claims that all plans will be reduced to a fixed amount.

What has actually been communicated so far is that the government intends to gradually reduce overall plan spending back toward average funding levels seen around 2023. Reports suggest this may involve reductions somewhere in the range of approximately 22% to 30% overall, but the exact implementation process remains unclear.

Importantly, this does not mean every participant will suddenly receive the same funding amount. The details of how any reductions may occur have not yet been released, and there is still uncertainty around whether changes will happen during scheduled plan reviews or through broader administrative adjustments.

For OTs supporting participants through this period, caution around misinformation is critical. Many conversations currently happening online and within services are based on speculation rather than confirmed policy.

Why the annual pricing review matters

A key document many providers are waiting for is the annual pricing review report. This report is expected to provide further clarity around pricing recommendations, registration pathways and possible future pricing structures.

The annual pricing review is separate from the final NDIS price guide. The review outlines recommendations and findings gathered through consultation, while the price guide confirms the actual operational changes providers will need to follow.

This distinction matters because many OTs are currently feeling pressure to begin registration processes immediately, despite not yet knowing what future registration requirements or pricing models may look like.

For many providers, particularly sole traders and small practices, the most practical approach right now may simply be to stay informed, monitor updates closely and avoid making rushed decisions before the full details are released.

NDIS worker screening checks for unregistered providers

Another area creating confusion for many therapists is the NDIS worker screening check process for sole traders and unregistered providers.

While requirements vary slightly between states, the process generally involves applying through the relevant state authority before linking the screening clearance through the NDIS Commission’s unregistered provider portal.

For sole traders, this can feel unnecessarily complicated because providers are often required to effectively link themselves to their own unregistered provider account.

The worker screening process itself is relatively straightforward once the systems are set up correctly. Most therapists will need to provide identification documents such as a Medicare card, passport and driver’s licence, complete an online application and attend an in-person identity check.

One positive development is that NDIS worker screening checks are now increasingly being recognised within aged care settings, reducing the need for duplicate police checks in some circumstances.

For OTs considering future registration, obtaining a worker screening check may be one practical step worth completing early while waiting for further policy announcements.

Conference season brings connection and perspective

Alongside all the uncertainty, conference and expo season has arrived, bringing much-needed opportunities for connection within the OT profession.

Large events such as ATSA and OTX require significant preparation from exhibitors, educators and providers. Behind every stand is a huge amount of planning, logistics, freight coordination and setup work that many attendees never see.

For therapists attending these events, expos can provide far more than just product displays or CPD opportunities. They create space for relationship building, idea sharing and genuine community connection at a time when many clinicians are feeling professionally isolated or overwhelmed.

Why networking matters for OTs

Professional networking is often misunderstood as formal or transactional, but for many OTs, it becomes one of the most valuable long-term career investments.

Strong professional networks help therapists build referral pathways, identify trusted service providers and create collaborative support systems that ultimately benefit clients.

For clinicians running private practices, these relationships can become particularly important during periods of transition or uncertainty. Having established connections with other providers makes it easier to coordinate care, refer appropriately and support participants when service needs change.

Networking also creates emotional support within a profession that can sometimes feel isolating. Simply being around other OTs who understand the pressures of clinical work, business ownership and the evolving NDIS landscape can make a significant difference.

Importantly, networking does not need to feel forced or performative. Often, the most meaningful professional relationships begin through simple conversations over coffee, shared experiences at conferences or casual introductions at industry events.

Making the most of conferences and expos

Many OTs feel intimidated by networking events or unsure how to approach large exhibitions. The reality is that there is no single right way to participate.

Some clinicians enjoy speaking to every exhibitor they encounter, while others prefer to quietly explore before choosing who they want to engage with more deeply. Both approaches are completely valid.

The most valuable conference experiences often come from approaching events with intention. Rather than collecting endless flyers or free merchandise, it can help to think ahead about what you actually want to gain from the experience.

For some therapists, this may mean exploring referral pathways or learning more about local services. For others, it may involve discovering new equipment, asking questions about complex clinical areas or connecting with peers facing similar challenges.

Students can particularly benefit from attending expos when they approach them with curiosity. Asking thoughtful questions about workplace culture, career pathways, client groups and clinical roles often leads to far more meaningful conversations than simply collecting brochures or promotional material.

Approaching conferences with a clear sense of purpose can help therapists feel less overwhelmed and more confident engaging with exhibitors, educators and peers.

Balancing innovation with practicality at expos

Exhibitors are increasingly looking for creative ways to stand out at conferences, but there is growing awareness that practical value matters more than novelty.

Many attendees no longer want to carry large amounts of printed material home from events, leading providers to experiment with QR codes, digital resources and more streamlined information sharing.

At the same time, there is still value in creating memorable experiences that reflect a brand’s personality and values. The challenge for exhibitors is finding the balance between engaging attendees and ensuring resources remain genuinely useful.

For OTs considering future exhibiting opportunities, clear planning around goals, budget and intended outcomes can make a significant difference. Understanding whether the focus is on education, visibility, networking or referral growth helps shape a far more effective conference strategy.

Building community during uncertain times

The OT profession is currently navigating significant change, and uncertainty within the NDIS space continues to create understandable stress for providers and participants alike.

But amid the complexity, one thing remains incredibly valuable – connection.

Whether through conferences, networking events, online communities or informal peer support, staying connected with other therapists creates opportunities for shared learning, collaboration and reassurance.

At a time when many OTs are searching for clarity, community may be one of the most important professional resources we have.

Key takeaways for OTs

• Current NDIS funding discussions do not mean every participant’s plan will be reduced to the same amount.
• The annual pricing review and upcoming price guide are expected to provide further clarity on registration and pricing changes.
• Sole traders and unregistered providers may still complete NDIS worker screening checks through the unregistered provider portal.
• Conference season offers valuable opportunities for networking, learning and professional connection.
• Attending expos with clear goals can make the experience far more meaningful and manageable.
• Strong professional networks support referral pathways, collaboration and long-term career resilience.
• Community connection remains essential during periods of industry uncertainty.

Sydney Friends of the Podcast: Wednesday 13 May 2026 @ 5:30pm
https://www.trybooking.com/events/landing/1560836

Brisbane Friends of the Podcast: Wednesday 20 May 2026 @ 5:30pm
https://www.trybooking.com/events/landing/1576072

The current NDIS landscape is shifting quickly, and many Occupational Therapists are being asked to make decisions without having all the information. Between proposed funding changes, evolving reporting expectations and ongoing uncertainty around registration, it’s easy to feel overwhelmed.

Rather than trying to predict every outcome, the focus right now is on understanding what’s changing, what it means in practice and how to respond in a way that is both clinically sound and sustainable for your business.



Preparing for changes to social and community participation funding

One of the biggest concerns is the proposed reduction in social and community participation funding. While details are still emerging, early indications suggest a significant cut for many participants.

What’s important to recognise is that this funding is often not just used for social outings. It supports essential daily activities such as attending medical appointments, grocery shopping and accessing community services.

If funding is reduced, the need for support does not disappear. In many cases, it simply shifts. Participants may still require assistance at home, which can increase pressure on families and create new risks if appropriate supports are not in place.



Adapting your reporting approach

These changes highlight the need to be far more explicit in reporting.

Rather than broadly referencing social participation, reports should clearly outline how funding is currently being used, why those supports are essential for daily functioning and what risks may arise if they are reduced.

It is also important to articulate what alternative supports would be required if funding is changed. This ensures that reports reflect the real-world impact on the participant, rather than abstract recommendations.

Clarity, specificity and clinical reasoning are more important than ever.



Functional assessments on file: necessary or not?

There has also been an increase in requests for updated functional assessments “just in case”. While this may feel like a protective strategy, it is not always the best use of funding.

If a participant has had a recent assessment and there have been no meaningful changes, completing another report may not provide additional value. In contrast, if circumstances have changed, eligibility is unclear or documentation is outdated, an updated assessment may be justified.

The key is shared decision-making. Presenting the pros and cons allows participants and their families to make informed choices, rather than defaulting to unnecessary reporting.



Should you register as an NDIS provider?

With all of these changes, it is no surprise that the question of registration is coming up again.

There is ongoing discussion around mandatory registration and potential pricing differences between registered and non-registered providers. However, there is still no clear timeline or confirmed model for what this will look like.

Registration is not a simple decision. It depends on your service type, business structure and financial position. Therapists providing therapeutic supports may access the verification pathway, while those in early childhood or behaviour support may face significantly higher costs through certification.

Adding to the complexity is the likelihood that the system will change again. Investing in registration now may not mean avoiding future requirements.



Understanding the true cost of registration

Registration involves far more than the initial fee.

Beyond upfront costs, there is a significant time investment in preparing documentation, undergoing audits and maintaining compliance. This includes systems for staff checks, professional development, incident management and infection control.

Importantly, it is not enough to have policies in place. You must demonstrate how they are implemented in practice. Audits often include staff interviews and evidence of real-world application.

While these systems become easier to maintain over time, the initial setup can be substantial, particularly for smaller practices.



Making a business decision, not an emotional one

Given the uncertainty, registration decisions need to be grounded in business strategy rather than fear.

This includes considering how long you plan to remain in the NDIS space, whether you have the financial capacity to absorb costs and whether your client base will require registration in the future.

For some areas of practice, particularly paediatrics, the future demand within the NDIS is still unclear. This makes it even more important to carefully weigh the return on investment.

There is no universally correct answer, only what makes sense for your individual context.



Staying grounded in uncertainty

The lack of clear direction is one of the biggest challenges right now. With multiple changes pending, it is easy to feel like every decision carries significant risk.

This is where intentional decision-making becomes critical. Focusing on what you know, what you can control and what aligns with your values will lead to more sustainable outcomes.

Small, considered actions will always be more effective than reactive decisions driven by uncertainty.



Key takeaways for OTs

• Start with what is changing in funding and how it impacts your clients
• Be explicit in reports about how supports are used and why they are essential
• Only complete functional assessments when there is clear clinical value
• Use shared decision-making with participants when considering reports
• Registration is a business decision, not a reactive one
• Consider both upfront and ongoing costs of becoming registered
• Wait for further NDIS updates where possible before committing
• Stay intentional and focus on what is within your control



Links

Life Skills Training for NDIS OTs with Nikki Cousins: https://www.verveotlearning.com.au/Life-Skills-Training-for-NDIS-OT-Providers

A Coregulation Approach to Emotional Regulation in Paediatric OT with Alyce Svensk: https://www.verveotlearning.com.au/Supporting-Children-with-Emotional-Regulation-Challenges

The National Disability Insurance Scheme is entering a major reform phase, with sweeping changes designed to improve long-term sustainability. These updates will reshape how people access the scheme, how funding is allocated and how services are delivered.

While some reforms aim to strengthen consistency and reduce misuse, others introduce significant shifts that will directly impact participants and the clinicians who support them. For Occupational Therapists, understanding the direction of these changes is essential for navigating what comes next.



A system under pressure

The driving force behind this reset is cost growth. The scheme has expanded rapidly, both in participant numbers and overall expenditure, prompting concerns about its long-term viability.

In response, the government has outlined a four-year reform plan focused on reducing fraud, slowing spending, clarifying eligibility and improving service quality. A new legislative package is expected to be introduced and passed quickly to enable these changes.



A fundamental shift to functional capacity

At the centre of the reform is a move away from diagnosis-based access towards functional capacity. Eligibility will increasingly depend on whether a person has substantially reduced functional ability, rather than the presence of a specific condition.

This change will be supported by a new standardised assessment tool, although key details remain unclear, including who will complete these assessments and how they will be implemented in practice.

Over time, this approach is expected to apply not only to new applicants but also to existing participants as their plans are reviewed.



Fewer participants, tighter entry

Alongside changes to eligibility, the government is aiming to significantly reduce the number of people on the scheme compared to current projections.

This will likely occur through stricter access criteria, reassessment of existing participants and a greater reliance on supports outside the NDIS. While funding has been allocated to strengthen these alternative systems, there is limited clarity about how they will function or whether they will meet demand.



Funding changes that will impact daily life

One of the most immediate and tangible changes is the reduction in social and community participation funding. Budgets will be reset to align with earlier averages, resulting in an estimated 30 per cent decrease for many participants.

These reductions are expected to begin from October 2026 and may occur regardless of where a participant is in their plan cycle. This represents a significant departure from previous approaches and may create uncertainty for participants who rely on this funding for everyday activities.

Although a national fund has been proposed to support community-based alternatives, questions remain about whether this will adequately replace individualised supports.



Reduced flexibility in plan management

Changes to plan reassessment processes will also affect how participants respond to changing needs. Stricter criteria for unscheduled reviews are expected to limit access to additional funding within a plan period.

While intended to reduce overspending, this may also reduce responsiveness when circumstances change, placing greater pressure on initial planning accuracy.



Provider reforms and market shifts

The reform package includes several changes that will reshape the provider landscape.

Mandatory registration will apply to providers delivering higher-risk supports, particularly those involving personal care or restrictive practices. In addition, a new system will require basic identification or enrolment for most providers, improving visibility across the sector.

Plan management will also undergo significant restructuring, with a move towards an approved panel system. This is likely to reduce the number of providers and may disproportionately impact smaller businesses.

There are also early indications of differentiated pricing, potentially favouring registered providers, although details are still emerging.



A move towards commissioned supports

A notable structural change is the potential introduction of commissioning for home and living supports. This would involve funding a select group of providers directly, rather than allowing participants to choose freely from the market.

While this approach may improve consistency and cost control, it represents a shift away from participant choice and could reduce the diversity of available options.



Strengthening compliance and oversight

Fraud prevention and compliance remain key priorities within the reform. Planned changes include improved payment systems, increased evidence requirements and expanded regulatory powers.

These measures are designed to protect participants and ensure funds are used appropriately, addressing ongoing concerns about misuse within the scheme.



What this means for Occupational Therapists

Although many of the changes do not directly target allied health, the flow-on effects will be significant.

Occupational Therapists will need to support participants through funding reductions, changing eligibility criteria and increased uncertainty. Clear, functional evidence will become even more important in demonstrating need and justifying supports.

There will also be a growing role in helping participants adapt to reduced flexibility and navigate alternative support systems outside the NDIS.



What to watch next

Many elements of the reform are still evolving, with further detail expected as legislation is introduced and implementation plans are released.

Key areas to monitor include the development of the functional assessment tool, the rollout of support needs assessments from 2027 and updates to pricing and provider regulation.

Staying informed and adaptable will be critical as the scheme continues to shift.



Key takeaways for OTs
• Expect a stronger focus on functional capacity in both access and funding decisions
• Prepare for future changes to assessment processes, including support needs assessments
• Be aware of reductions in social and community participation funding and how this affects clients
• Anticipate tighter rules around plan reassessments and reduced flexibility
• Monitor provider reforms, including registration and pricing changes
• Strengthen reporting to clearly demonstrate functional impact and support needs
• Support participants to navigate both NDIS changes and alternative support pathways

Links
Speech Transcript made by Mark Butler at National Press Club on 22/04/2026: https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-butler-speech-at-the-national-press-club-22-april-2026?language=en&fbclid=IwY2xjawRVYFdleHRuA2FlbQIxMABicmlkETFzVm1kUkFuUVJGMDBvbEN4c3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHsmjiG7yqVQOEl0d_2wkkwEh2weHvl2Xra9wg4zmbTRx95bkZNBb_MJFWhbq_aem_YgrkLacZXUDHpufvM0KOZA

Securing the NDIS for future generations fact sheet: https://www.health.gov.au/sites/default/files/2026-04/securing-the-ndis-for-future-generations_0.pdf

Taking time away from work sounds simple in theory. In practice, many OT business owners know it can feel anything but simple.

Whether it’s a short holiday, a family trip or parental leave, stepping away often raises the same questions. Who makes decisions while you’re gone? What happens to client care? How much should you stay across emails? And how do you protect your team, your clients and your own wellbeing at the same time?

For OTs in private practice, these questions sit within a broader reality. Many businesses are already operating under pressure, with tight margins and ongoing uncertainty. That means leave planning is not just personal — it is a business systems decision.



Start with a clear leave plan

Most people do not accidentally take proper leave. It takes planning, boundaries and a willingness to let go of control.

One of the biggest traps is leaving everything until the last minute and hoping it will work itself out. In reality, leave works best when it is treated like a business process.

That means planning ahead for supervision, approvals, emails, scheduling and client communication — as well as deciding who will hold responsibility in your absence.

There may never be a perfect time to step away. But if you do not create the conditions to do so, the business can become so dependent on you that leave feels impossible.



Build a structure your team can rely on

Once the plan is in place, the next step is making sure your team can actually carry it.

Taking leave is not only about rest. It is also an opportunity to build a more sustainable business.

When owners stay across every detail, teams miss the chance to develop confidence and decision-making skills. With the right structures in place, most teams are far more capable than expected.

Many practices benefit from having a temporary caretaker or second-in-charge who can triage emails, support the team and escalate only what truly needs attention.

A clear structure reduces pressure for everyone. The team knows where to go, small issues do not escalate, and the owner is not constantly pulled back into the business.



Match your plan to the type of leave

Not all leave requires the same approach.

A short break may only need light daily check-ins. A longer holiday requires clearer delegation and escalation pathways. Parental leave adds another layer — particularly for sole traders and small practices where one person may be managing clinical work, admin and business operations.

This is where many therapists underestimate what is involved. Hiring another clinician does not replace the full scope of what a business owner does. Much of that work sits behind the scenes and still needs to be covered.



Use leave planning as a systems check

Once you start preparing to step away, gaps in your business become much more visible.

Leave planning often highlights inefficiencies that go unnoticed during busy periods — whether that’s unclear processes, over-reliance on the owner, or systems that don’t quite work.

It is also a chance to look at how your business is operating day to day. Are your workflows clear? Are your systems supporting your team? Or are things more manual and reactive than they need to be?



Review costs with intention — not reaction

This naturally leads into reviewing where your money is going.

Many OT businesses are paying for overlapping platforms, underusing features or sticking with workflows that no longer make sense. This might include double-handling invoices, paying for duplicate software or not fully utilising existing tools.

But not every cost should be cut.

Some systems significantly reduce admin time and improve workflow. Removing them may save money in the short term but create more work and inefficiency.

The goal is not to reduce spending blindly. It is to understand what each expense enables. A system that saves hours each week may be worth far more than its monthly cost.



Keep therapist experience front of mind

Efficiency on paper does not always translate to efficiency in practice.

A cheaper system is not necessarily better if it adds extra steps, reduces usability or increases daily frustration for therapists. Over time, this affects productivity, morale and service quality.

Therapist-led businesses often navigate this well because they understand the realities of clinical work. Cost matters — but so does how systems function in real life.

Understand the added complexity of parental leave
For small OT businesses, parental leave brings an added layer of complexity.

Unlike larger organisations, there is often limited capacity to backfill roles or absorb the financial impact. Even when owners want to offer paid leave, tight margins can make this difficult.

This creates a tension many business owners face — wanting to support their team, while working within the constraints of a small business model.



Understand where the money actually goes

Part of navigating this is having a clear understanding of business finances.

Service rates do not just reflect therapist wages. They also fund supervision, admin, CPD, parental leave, software, compliance and all the behind-the-scenes work required to deliver quality care.

When margins tighten, these supports are often the first at risk. Profit is not separate from care — it is what allows businesses to operate sustainably and continue supporting clients well.



Create space for strategic thinking

One of the biggest challenges for OT business owners is time.

Many spend most of their time delivering services and supporting their team, leaving little space to step back and assess the business objectively.

That makes it harder to review systems, analyse spending or plan for change. In some cases, external support can help bring clarity when decisions feel complex or emotionally loaded.

This is not about being less caring. It is about making decisions that allow the business to continue.



Sustainable businesses support better outcomes

At the centre of all of this is a simple truth.

Sustainable businesses are what enable consistent, high-quality care.

Better leave planning, stronger systems and clearer decision-making are not just business strategies — they are what allow OT services to remain stable, accessible and effective over time.

When practices are well run and supported, everyone benefits — especially the people receiving care.



Key takeaways for OTs
• Treat leave as a business process, not an afterthought
• Build clear structures so your team can operate without you
• Match your leave plan to the type and length of time away
• Use leave planning as an opportunity to review systems and efficiency
• Review costs strategically, not reactively
• Prioritise systems that support therapist workflow and efficiency
• Recognise the added complexity of parental leave in small practice
• Understand that profit enables sustainability and quality care