Dáil Éireann debate -
Wednesday, 5 Apr 2000

Vol. 517 No. 4

Priority Questions. - Autism Services.

Alan Shatter

Question:

52 Mr. Shatter asked the Minister for Health and Children his views on whether the Outreach units have the number of therapists and psychologists necessary to provide a proper service for autistic children and whether the current level of respite and home support is adequate; if he will arrange for a speech and language therapist and an occupational therapist to be assigned to each two class unit so that each child can have the daily intensive speech and language therapy and occupational therapy required; and if he will further arrange for the appointment of a psychologist to each of the teams within the Eastern Health Board area with sole responsibility for each of the Outreach units and make available the respite care and home support required by each family on a regular basis. [9948/00]

Mr. Martin

As the Deputy is aware, health-related support services for children with autism and their families have been greatly enhanced and expanded since 1998. The health boards have established a number of multidisciplinary teams comprising speech and language therapists, occupational therapists, psychologists, nurses and social workers to provide health-related support services to children with autism and, in particular, to the special classes for children with autism being developed by the Department of Education and Science. A sum of £4.6 million has been provided for the development and enhancement of these services since 1998 increasing to a full year cost of £5.1 million in 2001.

In the eastern region, two multidisciplinary Outreach teams were established in 1998 and 1999, each consisting of a psychologist, speech and language therapist, occupational therapist, nurse, social worker and secretarial support. This year a further £500,000 with a full year cost of £600,000 in 2001 has been provided for the expansion of the Outreach and respite services, bringing the total additional funding provided for these services since 1998 to £1.2 million in 2000. A third multidisciplinary Outreach team is being established to cover the western part of the region which will have a similar composition to the two existing teams.

The establishment of this team will relieve some of the pressure on the existing personnel, thus enabling them to spend more time with the children within their designated areas. The question of the overall level of input from any particular therapist will vary in each case depending on the individual needs of each child. My Department will continue to endeavour to assist the authority to meet the health-related needs of these children.

With reference to the provision of respite services, I understand from the Eastern Regional Health Authority that a social worker has been recruited and is to take up duty next month specifically to develop home support services for families of children with autism. The role of the social worker is to recruit and train home support workers, including families, to provide home-based respite services. The authority is also actively seeking a suitable property to expand the residential respite service. As an interim measure, the authority has made arrangements with a voluntary agency to provide respite services every second weekend.

I understand that, in addition to recruiting the additional staff already mentioned, the authority is also seeking to fill two existing psychology posts which are vacant in the services. I am aware of the difficulties being experienced within the health services generally as regards the recruitment of health professionals. Following a Labour Court recommendation in 1997, an expert group was established to examine and report on various issues, including recruitment and retention of staff, relating to paramedical grades. The group is in the process of finalising its report which is expected to be published in the next few weeks. A review of psychology services is under way with manpower planning as one of its terms of reference.

My Department is also working closely with other Departments, the health boards, voluntary service providers and the various professional representative bodies to facilitate in any way it can issues related to the short-term recruitment of additional nursing and paramedical staff to work in various areas of the health services.

Mr. Shatter

Does the Minister acknowledge that, based on the manner in which these teams are working, each child in the units to which he refers receives only ten minutes speech and language and occupational therapy per week? Does he accept that children who suffer from autism require much more intensive therapy, both in the speech and language area and in the occupational therapy area, than is provided? Will he agree to the recruitment of additional speech and language and occupational therapists to ensure these children receive the daily therapy of an intensive nature they require for their personal advancement?

Mr. Martin

I have no difficulty agreeing that children with autism and children with special needs in general should receive all the educational facilities and health-related services they require. Tremendous progress has been made in the area of autism in the past two to three years which has highlighted a historical deficit in the provision of services to children with autism. Until 1998 children with autism were not defined as a special category in terms of the receipt of educational facilities, which is hard to credit but that was the position. I agree we need more language therapists. I am concerned about the availability of such therapists and related paramedical grades such as occupational therapists. An issue exists in that regard which I am keen to address. While committing ourselves to increased services, and there has been an increase in services, there is a parallel issue of the supply of the requisite qualified personnel to take up these positions. That is an issue the report I mentioned will address and we can move on that agenda following its completion.

Mr. Shatter

In the context of the children in these units, is the Minister saying there is a supply problem and is he seeking to recruit additional therapists for each of these units now? If he is, perhaps he would indicate when advertisements were placed in the papers seeking additional therapists for these units. Does he accept the ratio of one speech and language therapist and one occupational therapist to 90 children is grossly inadequate? Does he agree a psychologist should be attached to each of these teams and that one psychologist serving the totality of the teams—

Mr. Martin

Each multidisciplinary team?

Mr. Shatter

Yes, within the autism area. One psychologist serving the totality of the teams is inadequate to meet the real needs?

Mr. Martin

Each multidisciplinary team would have a psychologist. I indicated in my reply that the authority is seeking to fill two vacant positions for psychologists. As regards autism, we must also look at the context of the provision of education. Particular methodologies have been employed to deal with autism, such as the Teach method, which use direct personnel. There is a ratio in classes in the eastern region of six pupils to one teacher and one classroom assistant and they adhere to a specific behavioural programme. A psychologist may not necessarily be needed in every group of six. What is required is a multidisciplinary team providing a service to the education context as appropriate. I do not know in what manner the Deputy is dividing the time, but stating the number of pupils per psychologist is not appropriate.

Mr. Shatter

The parents of these children are grossly unhappy.