When Systems Change: Moral Distress, Thriving Kids and the Impact

Earlier this week, I was in tears.

I have been watching, waiting and learning more about the changing funding context for children with disabilities and their families in Australia. Changes to the NDIS. The design of Thriving Kids as the first phase of Foundational Supports. Ongoing conversations about which children will continue to access the NDIS, which children will be supported through other systems, and what that will actually look like in practice.

Alongside this, families are already experiencing increased cost of living, long waitlists, thin markets, limited access to child-informed services, and the emotional load of navigating systems that can be confusing, fragmented and exhausting.

All of this has had an impact on where I am at with the therapy side of the support I offer to families (as well as a personal side - activating all of those thoughts, feelings and beliefs I felt in a past life when I was made to feel like I was a problem).

I was in tears because I had been feeling such deep conflict with my values and an enormous amount of guilt that I was beginning to feel distressed.

I have done a lot of personal and professional work over the last 18 months to understand what my values are. For me, my personal values and professional values are not separate. They are one and the same.  Through this process, I had landed on fairness, integrity and being of service.

Recently, I felt as though everything I was doing, everything I was responding to, and everything I was having to navigate was pressing against those values.

I felt powerless.

The current NDIS reform landscape and the emerging design of Thriving Kids raise significant questions for those of us working with children and families. Thriving Kids has been described as a national system of supports for children aged 8 and under with developmental delay and/or autism with low to moderate support needs, with rollout expected from October 2026 and full rollout by January 2028. Children with permanent and significant disability, including those with high support needs, are expected to remain eligible for the NDIS, subject to usual arrangements. (Health, Disability and Ageing Dept)

On paper, a system that identifies children’s developmental needs earlier and supports families in the places children live, learn and play could be deeply valuable.  But in practice, there is still so much uncertainty.

What will these supports actually look like?

Who will deliver them?

How will children’s developmental, relational and mental health needs be understood?

How will families have choice and control?

How will children with complex trauma histories, attachment disruptions, neurodevelopmental differences, family stress, safeguarding concerns or multiple intersecting needs be supported?

And what happens when a child’s needs are considered “low to moderate” by a system, but feel significant and daily for the child, parent or carer living them?

These questions matter.

They matter because behind every policy phrase, there is a child.  Behind every access change, there is a family trying to make the best decision they can.  Behind every funding reform, there are practitioners trying to work ethically within systems that are shifting underneath them.

When systems change, children and families feel it

When we talk about NDIS changes, service design and foundational supports, the language can become very abstract.

We talk about eligibility. Access pathways. Foundational supports. System sustainability. Service models. Mainstream interfaces. Low to moderate support needs. High support needs. Cost containment. Workforce transition.

Children and families do not experience these changes as abstract policy.  They experience them as uncertainty.

A parent may wonder whether their child will still be able to access therapy.

A carer may worry about whether their child’s trauma history will be understood within a developmental support model.

A child may lose a trusted therapist because the funding pathway no longer supports that relationship.

A family may be told that support will exist elsewhere, but not yet know where, when, how, or whether it will meet their child’s needs.

For many families, especially those who have already had to fight to be heard, this uncertainty can be deeply destabilising.

For practitioners, it can be heartbreaking to sit alongside families in that uncertainty while also navigating the viability of our own services.

Many small therapy practices were built around the current NDIS landscape. Many practitioners have shaped their work around children and families who needed responsive, relational and developmentally informed support. When that landscape changes, practitioners are not simply making business decisions. We are making decisions that affect therapeutic relationships, continuity of care, access, safety and trust.

That is where moral distress can begin to emerge.

Why we do the work we do

Many of us come into the helping professions because we care deeply.

We want to help.

We want children to have spaces where they can express themselves, process their experiences and feel deeply understood.

We want parents and carers to feel more confident, supported and capable, so they can keep meeting the needs of their children long after therapy has ended.

We want to advocate for families when they feel voiceless in complex systems.

We want to bring kindness, safety and thoughtfulness into spaces that can sometimes feel rushed, under-resourced or overwhelming.

For many practitioners, this work is not just a job. It is connected to our values, our histories, our hopes for children, and the kind of world we want to contribute to.

What happens when our work conflicts with our values?

When we are unable to act in line with our values, or when we feel forced into decisions that conflict with what we believe is right, we can experience moral distress.

Moral distress can occur when we know, or strongly sense, what the ethical or morally right action would be, but institutional limitations, funding constraints, resource shortages, policies, power imbalances or systemic barriers prevent us from doing it.

For child and family practitioners, this might sound like:

“I know this child needs more support, but the funding is not there.”

“I know this family needs a more flexible response, but the system does not allow for it.”

“I know this parent is exhausted from navigating services, but I do not know where to send them next.”

“I know this child needs relational safety and continuity, but the funding model does not protect that.”

“I know this family needs help now, but the new system is not yet built.”

“I entered this work to help, but I feel like I am participating in a system that is excluding or failing people.”

In the NDIS and Thriving Kids context, moral distress may show up when we are trying to balance:

the child’s needs, the family’s financial reality, the limits of available funding, our professional obligations, our own business sustainability, and the uncertainty of what comes next.

It may also show up when language used in reform does not match the complexity we see in practice.

A child may be described as having “low to moderate support needs,” but that child may still experience intense distress, school refusal, communication differences, sensory overwhelm, developmental vulnerability, family stress, trauma impacts, or significant relational needs.

A family may be told that support will be available through everyday settings, but those everyday settings may already be under-resourced, stretched and unsure how to respond.

A practitioner may believe strongly in inclusion, early support and family-centred practice, while also worrying that the implementation of reform may leave children and families without the depth, consistency or relational care they need.

That tension is not just administrative.

It is ethical.

And over time, it can become distressing.

Moral distress and moral injury

Moral distress can show up emotionally, physically, psychologically and spiritually.

It may feel like anger, frustration or helplessness.It may feel like guilt or shame.It may feel like grief.It may feel like deep sadness about what children and families are being asked to carry.It may feel like hopelessness about systems that do not seem to honour the complexity of people’s lives.

Physically, it may show up as fatigue, ongoing exhaustion, sleep difficulties, tension, pain in the body, nausea, a racing heart, or a sense of being constantly braced.

And when moral distress is prolonged, repeated or unresolved, it can contribute to moral injury.

Moral injury refers to the deeper and more enduring psychological, social and spiritual impact that can occur when we are involved in, witness, fail to prevent, or feel subject to actions that violate our deeply held moral beliefs or ethical values. Moral injury is increasingly discussed in healthcare and helping professions, particularly where workers are repeatedly exposed to ethically distressing situations within constrained systems. (Preci)

This is not the same as burnout, although the two can overlap.

Burnout often asks, “How long have I been carrying too much?”

Moral distress asks, “What am I being asked to participate in that conflicts with what I believe is right?”

Moral injury asks, “What has this done to my sense of self, meaning, trust, integrity or hope?”

That distinction matters, because many practitioners are not simply tired. They are ethically distressed.

Moral distress, the NDIS and Thriving Kids

I believe that therapists working in the NDIS space may be at higher risk of experiencing moral distress during this period of reform.

The proposed changes sit at the intersection of disability rights, children’s rights, children’s development, family wellbeing, service access, practitioner sustainability and government cost management.

Thriving Kids is intended to provide earlier support for children aged 8 and under with developmental delay and/or autism with low to moderate support needs, including supports for families, carers and kin. The Australian Government has stated that services will be designed to help children access support earlier in everyday settings and that further details about specific services and access pathways will be released closer to rollout. (Health, Disability and Ageing Dept)

There are parts of this vision that many child and family practitioners may agree with.

Children should not have to wait until difficulties become severe before receiving support.

Families should be able to access trusted information, guidance and practical help earlier.

Support should be available in the environments where children live, learn and play.

Parents and carers should not have to navigate complex systems alone.

But the distress comes from the gap between the vision and the current uncertainty.

A system can use words like child-centred, family-centred, strengths-based and evidence-informed, but those words need to be lived in the design.

They need to be visible in funding.In workforce planning.In access pathways.In rural and regional availability.In cultural safety.In trauma-informed practice.In parent choice.In the recognition that children’s needs are relational, developmental, sensory, emotional, social and systemic.

For me, the current landscape has led me to ask:

Where are children’s rights in these decisions?

Where is the child’s voice?

Where is the recognition that families need time, trust, consistency and support?

Where is the understanding that therapy is not just a “service item,” but often a relationship that has taken time to build?

Where is the recognition that parents and carers are already carrying so much?

Where does this leave children who do not fit neatly into categories?

And where does this leave practitioners who have built ethical, relational and responsive services around the needs of children and families?

These are not easy questions. And there may not be neat answers.

But I do think we need to name the emotional and ethical weight of this moment.

Three ways to support ourselves when experiencing moral distress

There is no simple three-step solution to moral distress or moral injury.

I also do not want to suggest that individual self-care can resolve what it is that we’re feeling and the systemic harm. It cannot.

But I do believe there are ways we can support ourselves to stay grounded, reflective and values-aligned while we navigate difficult terrain.

1. Focus on what you can do and how you are practising in alignment with your values

When the wider system feels overwhelming, it can be helpful to return to your circle of control and circle of influence.

What can I control?What can I influence?What decisions are mine to make?What values can still guide me here?What is the most ethical, fair and compassionate option available within the constraints I am facing?

For me, my values of fairness, integrity and being of service have become anchors.

They did not make the decisions easy, but they shaped how I wanted to approach them.

When I needed to make changes to my therapy availability, I felt I needed to balance fairness to the children and families I work with, as well as towards myself as well.

I wanted to communicate with families in a way that was fair and done with integrity. I was able to give families 2-3 months notice that I intended to take a pause and shift my focus and attention elsewhere. This allowed time to offer closure to some children and support referrals to other services where needed.

Was it perfect? No.

Did it remove the grief or discomfort? No.

But it allowed me to act in a way that was more aligned with my values, even within circumstances I could not fully control.

For the time being, I have chosen to move into a hybrid space, working part-time in private practice and part-time employment. I have moved into a role where I can transfer my skills, develop new ones and continue practising in a way that aligns with my values as much as possible.  I’m moving back into a space that desperately needs fairness and integrity.

Sometimes values-aligned practice does not look like staying exactly where we are.

Sometimes it looks like adapting.Sometimes it looks like grieving.Sometimes it looks like communicating clearly.Sometimes it looks like advocating where we can.Sometimes it looks like being honest about what we can and cannot hold.

2. Keep children and families at the centre of decision-making

When systems are changing quickly, it can be easy for practitioners to get pulled into survival mode.

We think about policy updates. Business viability. Referral pathways. Funding rules. Service agreements. Waitlists. Capacity. Income. Sustainability.

All of those things matter.

But one way to stay connected to our values is to keep returning to the child and family in front of us.

What does this child need to understand about the changes happening around them?How can I support this parent or carer to feel less alone?What information can I provide clearly and compassionately?What choices are still available to this family?What transition planning is needed?What relationships, routines or supports can be protected?Where might advocacy be appropriate?How can I communicate uncertainty without adding fear?

In a changing NDIS and Thriving Kids landscape, children and families need more than information.

They need transparency, warmth, time to process, practitioners who can be honest without being hopeless and they need support to make sense of what is changing and what it may mean for them.

This is where values-led practice matters.

We may not be able to control the policy environment, but we can still choose how we communicate, how we transition, how we advocate, how we document, how we collaborate, and how we hold the dignity of children and families in the process.

3. Use supervision as a safeguard

Supervision can be an important safeguard when we are experiencing moral distress.

Not because supervision removes systemic pressure, but because it gives us a space to think, feel, reflect and make meaning with another person.

A good supervision space can help us notice signs of moral distress before they become more entrenched.

It can help us ask:

What is this situation bringing up in me?Where do I feel caught or compromised?What values feel threatened here?What is within my responsibility, and what is not mine to carry alone?How can I respond ethically within the limits of this system?What does this child or family need from me right now?Where might I need to advocate, consult, document or pause?

Supervision can also offer perspective, reassurance and much needed co-regulation.

When we are distressed, our nervous system can narrow our view. We may move into urgency, self-doubt, shame or helplessness. Having a reflective space where someone can slow down with us, help us breathe, and support us to think clearly can be deeply protective.

For practitioners working with children and families, supervision is not only about case direction.

It is also about sustainability. Ethical practice.Values alignment.System navigation.Professional identity. And staying connected to ourselves in the work.

When seeking professional help when needed

Sometimes moral distress becomes long-lasting and begins to move into moral injury.  The impact is not something that supervision alone can hold.

If you are noticing ongoing distress, intrusive thoughts, deep shame, persistent grief, emotional numbness, sleep disruption, physical symptoms, hopelessness, or a sense that you are no longer yourself, it may be important to seek professional mental health support.

Therapies such as Acceptance and Commitment Therapy may be helpful because they support people to reconnect with values, make space for painful internal experiences, and take committed action in ways that matter.

There may also be other therapeutic approaches that are useful depending on your experiences, history and current symptoms.

Seeking support is not a sign that you are not coping.

It may be a sign that you have been carrying too much, for too long, in systems that have not adequately supported you.

A final reflection

If you are a therapist, practitioner, supervisor or service provider feeling the weight of the current NDIS and Thriving Kids landscape, I want to say this gently:

Your distress may be telling you something important.

It may be pointing to your values.It may be pointing to the limits of the system. It may be pointing to your care for children and families.It may be pointing to the places where advocacy is still needed.It may be pointing to where you need support, rest, clarity or change.

Moral distress is not something we need to dismiss or push through.

It is something we can listen to.  Not so it consumes us, but so it helps us return to the questions that matter:

How do we keep children and families at the centre?

How do we practise with fairness, integrity and service, even within uncertainty?

How do we make ethical decisions when the system around us is changing?

And how do we make sure we are not trying to hold those questions alone?

If you’re feeling like this too or would like to support navigating this season of change with these questions in mind, please reach out and connect.  I offer heart centred and values-based 1:1 and group supervision to practitioners working with children and families, as well as clinical consultation.

Ashleigh