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Disabilities Assessments

Dáil Éireann Debate, Thursday - 10 December 2020

Thursday, 10 December 2020

Ceisteanna (84)

Richard Bruton

Ceist:

84. Deputy Richard Bruton asked the Minister for Health if he has undertaken a review of the system for early assessment and prioritisation of therapies for children with special needs, which despite extra resources seems to continue to struggle to provide time supports; his views on whether the success on the pilot integrating therapies into the school provided model offers an opportunity of a different approach; and if he will make a statement on the matter. [41603/20]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte)

First I wish to congratulate the Minister of State, Deputy Rabbitte, on her appointment. An earlier question noted parents' frustration with long waiting lists for both assessments and therapeutic intervention. They are waiting for admission to services like Beechpark Services. Frustratingly, the transfer from infant services to school-going services creates another blockage. These are sources of stress, uncertainty and fear of irretrievable loss of time. Can a different model be considered to better deliver for parents?

I thank Deputy Bruton for raising this vital question. As I said in my earlier contribution, one of my key priorities is finding a model that actually works. Let us have one list so that when a child reaches early years education or school and needs an assessment, it is done in a timely way and an intervention can be accessed. The intervention should follow all the way through. Children should not age into and then age out of the catchment of early years intervention without ever accessing a service. That is what I hope to achieve. The €7.8 million package was intended to form a basis for timely intervention.

A pilot scheme was set up in community healthcare organisation, CHO, 7 as part of the school inclusion model, which envisages the provision of a certain number of therapists. That proved very successful. The pilot was not completed because of the Covid-19 pandemic but funding has been secured by the Department of Education to ensure that therapists are part of the education system. When children are diagnosed and given therapy and a further follow-up is needed, services can continue until all therapy has been completed. No child would end up on a list.

The network disability teams have been reconfigured under the HSE. Some 91 of these teams will be geographically spread throughout the country. They will be fully populated. As of my most recent information, only seven team lead positions remained to be filled. A lot of reconfiguration is going on to put speech and language therapy, occupational therapy and physiotherapy services in place.

The model is coming together really well. We now have the opportunity to work through the school inclusion model. The network disability teams and the school and modular teams can work together so children can get the intervention they need in the appropriate setting and no appointments are missed. This is all about intervention. A new model is in place to allow for collaboration between education and disability services.

I would like to draw the Minister of State's attention to some of the features of the school-led model. It is far less reliant on assessment. The Minister of State mentioned the development of an assessment industry and the avoidance of the loss of a lot of very valuable time in those assessments. Parents previously had to spend €500 or €600 on private assessments, which serve only as a gateway to further treatment.

Perhaps there should be less reliance on assessment and more collective delivery of service, whereby both the resource teacher and the SNA within the school could supplement the professional therapies in order that, even between intermittent therapeutic interventions, there might be continuity for the child and less withdrawal of him or her from the group in the way these needs are handled. I think there are in that model the seeds of a better approach than the one embedded in the HSE. I worry that while huge money is being put into attempts to improve the HSE model, it might in its structure have elements that are not best practice and some of that money will not deliver the opportunities we hope it will.

Deputy Bruton has pulled together in his comments where we want to get to. The child should at all times get the necessary intervention. We should also equip the people who spend eight hours per day in classrooms in developing the skill sets they need to support the child in his or her pathway through education. We need to crack this nut - I used that phrase earlier - for the simple reason that there are too many lists and too many people responsible for them. We need a clear pathway. I see the value in the school inclusion model because we have the therapists who are dedicated to supporting the children all the way through their education as long as they need that support. Nobody should need to time out after six weeks of speech and language therapy while waiting again and wondering whether he or she needs another assessment to continue when he or she is part of the education system. I do not wish to speak on behalf of the education sector but I see completely the value in this.

I also see the value in the 91 network disability teams, which are geographically spaced and which work in collaboration. If children in schools need further intervention at a more complex level, the network disability teams will be able to support them. It is all about using the resources collaboratively and together, cutting out the assessment and getting to the intervention at whatever level the child and the family need it. The frustration of families at present is that they get letters back telling them it could be two years before their child will have his or her initial therapy. Then the child has to get further therapy and is put on another waiting list for that. These children are ageing out of their early years and going to secondary school without having got the other intervention they needed in the beginning. That is where we need to get to.

The frustration I think people feel is a little like when Secretary of State Kissinger asked, "Who do I call if I want to call Europe?" One does not know who to ring. I think parents have the same experience. Who do they ring when they want to find out from one of these 91 teams where their child stands? This is a very frustrating element and it needs to be sorted out.

I welcome the Minister of State's commitment to meet the Minister of State, Deputy Madigan, and her work with the Oireachtas committee. For those of us Deputies who do not have the privilege of attending those meetings or being on the Oireachtas committee, could the Minister of State, Deputy Rabbitte, perhaps include at least me in some of this work in order that I might get an insight into the way in which the Department sees this developing? I would like to contribute in some way.

Absolutely. I would welcome more involvement of people with experience for the simple reason that I think we all want the one thing: we want the families to get their interventions. We do not want lists upon lists. I look forward to working with the Minister of State, Deputy Madigan, on this. I believe in the network disability teams, coupled with the school inclusion model so we can have just one list so that families know when their children have gone on a list. The reason I need the school inclusion model, and I hope it will work, together with the network disability teams, is that schools operate for 38 weeks per year and that for the other weeks of the year children need to continue with their therapies in order that the network disability teams are able to support them through term time as well.

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