New assessment for children with disabilities not a ‘box-ticking exercise’, HSE official says

HSE officials have rebutted claims from public representatives that a new system for assessing a child’s needs is simply a “box-ticking exercise”.

The HSE’s head of operations, Dr Cathal Morgan, said the new standard operating procedures, which have been used since for the past year, facilitates the timely assessment of a child’s needs and the provision of ongoing intervention based on the clinician’s evaluation.

In some parts of the country children with disabilities had been waiting years for assessment and in many cases had no access to specialist services in the interim period. he said . He referenced an internal agency review conducted in 2016 which found the approach to assessment was not consistent across the country. While guidance notes had been issued as far back as 2007, there was no nationally standardised approach until last year, he said.

Some deputies on the Joint Committee on Children, Disability, Equality and Integration raised concerns that the new assessment system, which aims to assess a child’s needs within a 90-minute session, might not be sufficient in picking up on all of the additional requirements.

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Sinn Féin deputy Mark Ward said some parents are worried that the new assessments will not pick up on all of the challenges faced by their child. Mr Ward also said he has “serious concerns” that the new system simply moves children from one waiting list to another without providing them with the developmental treatment they require. He said he fears the standard operating procedure does not speed up the time children wait for meaningful intervention.

Fianna Fáil’s Jennifer Murnane O’Connor TD said she fears the preliminary assessment is a “box-ticking exercise”.

“I don’t believe it is providing the children with the help they need to access supports,” she said.

Social Democrat TD Jennifer Whitmore flagged concerns that there could be an “extreme difference” in the level of analysis children get under the new system compared to previously when assessments could take up to 100 hours. She cited the Children’s Ombudsman as someone who believes it would be difficult to do a comprehensive assessment of need within an hour-and-a-half session.

However, the HSE’s national disability specialist with responsibility for the assessment process, Angela O’Neill, said 100 hours was at the “upper limit” of past assessment durations and said the HSE “certainly cannot stand over that length of time”.

“Our goal in trying to streamline the assessment is to ensure that we are reaching as many children as possible,” she said, adding that there cannot be a system where a small number of children are receiving a ‘Rolls Royce service’ while others are languishing for years on waiting lists. Ms O’Neill also said that the Disability Act 2005, which stipulates that a child is entitled to an assessment of their need within six months, does not require a diagnosis.

Professor Malcolm MacLachlan, clinical lead at the National Clinical Programme for People with Disabilities, stressed that assessments are tiered to cater to the complexity of the challenges a child presents with. Young people with more easily identified needs will be assessed quickly to enable swift intervention, while others presenting with more complicated needs will undergo a broader range of assessments.

“The standard operating procedure has been specifically introduced to prioritise the importance of intervention and to have it informed by prior assessment,” he said.

Dr Morgan said the HSE is moving towards a system that provides services based on need rather than diagnosis, which would bring it more into line with the UN Convention on the Rights of Persons with Disabilities. Dr Morgan said the HSE aims to ensure that people with disabilities can have access to both an assessment and interventions.

He also noted that the Disability Act 2005, with its focus on assessment rather than intervention, can create barriers for children trying to gain access to “equitable and timely intervention”. He said the HSE welcomes the Ombudsman for Children’s recommendation that this section of the act be reviewed.