Unit brings childcare disciplines together to offer a holistic approach to encouraging children's skills. Éibhir Mulqueen reports
A building in Ennis once used as a residential unit for children with severe intellectual disabilities is now the centre for a new model of delivering child development services for Clare.
The transdisciplinary play-based assessment model for children aged up to six is as removed from the old institutional approach as it is possible to be.
"In a way we have gone full circle," says Patricia Dillon, HSE area manager for disability services in Clare. "We are supporting those children in being kept at home, trying as far as possible to have them integrated into the mainstream pre-school and mainstream school, and providing them with play-based therapy and therapeutic services."
The model, taking play to be the primary activity by which children learn, recognises parents as primary educators and the home as the main environment where the child develops.
"There is a significant move to get away from the notion that if your child needs speech and language therapy, that if they have an hour a week that meets their needs," says Dillon.
At a cost of €1.6 million, the new Child Development Centre, a listed building, was refurbished and an outdoor play area was built. At the centre, specialists who would previously have worked in isolation in the HSE or in voluntary agencies now form part of a team. The transdisciplinary therapy approach solves the problem of multiple agencies delivering specialised services by having a one-stop shop for parents to access with their children.
According to Dillon, the aim is to concentrate the "inputs" at as early a stage as possible. "The greater part of a child's developmental advances are between the age of zero and six. They learn to talk, walk, see, develop a sense of smell, and develop movement in that time. Nearly all their life skills are trapped into that short space of opportunity."
A team can include a new type of specialist - an early intervention specialist - along with a clinical psychologist, an occupational therapist, a physiotherapist and a speech and language therapist. "The concept is that each of the specialists would understand the requirements of each other so that when they are delivering their service to the child, each of those therapists knows what the other's goal for the child is, and they deliver that service on a team basis," says Dillon
The agencies now acting as one - the Clare Early Intervention Service - are the HSE, Enable Ireland, the Clare Federation and the Brothers of Charity. The new service is looking after more than 100 children with a range of disabilities in Clare.
"It involved a lot of change in practice in relation to traditional models of service. All of us as organisations had to look at what we were doing and how we were doing it, and there had to be a certain amount of letting go of what our traditional areas of ownership were in looking at the child," says Dillon.
Margaret Galvin, the project manager, has helped introduce service throughout the mid-west region, having developed centres in Nenagh and Limerick.
From New Zealand, she drew on experience of child development services there and best practice in other countries to come up with a model which would suit the Republic's particular requirements.
"I had to develop posts to meet the needs here. The early intervention specialist post was developed so we could bring that aspect into the model," she says. "Through listening to the families' stories this is what we came up with. It has broken down the competition and the barriers. We do not have agencies competing for funding or several different buildings. There is one place for families to go to now."
In addition, the specialists gain new insights into developmental issues through exposure to other disciplines. "You have professionals willing to share knowledge being released from their role and taking on more knowledge from other people.
"It is about sharing knowledge, not splitting a child into pieces. You see the child as a whole. You look holistically at the child and address the issues in the context of the whole child's life," Galvin says.
Initially, the child has a transdisciplinary, play-based assessment where a group of professionals observes him or her playing so they find out what the child's abilities and needs are. "The family is a key member of the assessment team. The model recognises the knowledge and expertise of the child's parents," says Galvin.
A key worker from the team is appointed to liase with the family and an individual plan is determined for the child that has up to three components.
In the first, the child attends a play-based intervention group with the family as part of a wider group of other children with their families, in the recognition that the family is the key provider for the child. Secondly, the family is given support in the home by the key worker, so that children can have their needs addressed in all of their environments. And thirdly, the service aims at including the child in a mainstream pre-school setting, so they can play alongside their peers and learn from them.
Galvin is now developing the service for over sixes so that children can continue to develop within the new model.
Aideen Taylor de Faoite is a play therapist and teacher by training but is now employed as an early intervention specialist. She describes the new role: "This job incorporates all of those skills. From both backgrounds I would see that play is the child's primary way of understanding the world."