Accessing speech and language therapy has become a real problem, writes Laura Slattery
After months of being entranced by simple gurgling sounds, a baby's first word will often be an emotional landmark for parents. Spurred into teacher mode, mothers and fathers will mouth words, point at particular objects and wait until a first word eventually becomes a first sentence and their babies spurt into chattering toddlers.
But for many children, learning to talk isn't always so easy or so pleasurable.
Parents of children born with a wide variety of medical conditions including autism, hearing impairments, cleft lip and palate and learning disabilities may need to seek help from a qualified speech and language therapist while their children are at a very early, pre-school age.
These parents, as well as those who notice that their child has an unexplained difficulty with fluency or making certain sounds, will then be obliged to get on what one parent calls the "merry-go-round" of securing access to speech and language therapy services in Ireland.
Caint, a support group for the parents of speech and language impaired children, says it frequently receives calls from parents who have difficulty accessing services.
"The pressure on the system is enormous," says Geraldine Graydon, a Caint committee member. "What happens sometimes is that there is one therapist doing the job of three, so nobody is getting the service they need."
Following the initial assessment, children are often not given the treatment time allotted to them, she says. "They might get 20 minutes once a week, once a fortnight or once a month for four to five months, then they're off the books."
Therapists often move on after short periods, she says, so children who need ongoing speech therapy often do not have the continuity they need.
Ms Graydon, whose 13-year-old son is autistic, is a fan of a recent trend towards more group therapy. "Someone might only be able to do one to two-word sentences, so the aim would be to build that up to three or four or five or six-word sentences, and they would do that with the teacher in a group," she says.
But in educational units for people with a range of special needs, the approach requires smaller classes and extra resources such as teaching assistants for it to work, she cautions.
Parents who despair of the public system and seek out private therapists also face waiting lists of up to two years, Ms Graydon says.
In recent years, parents have been forced to protest outside the Dáil in order to get speech therapy for their children, while parents of autistic children have taken the Government to court in order to secure their rights.
Meanwhile, the Cleft Lip and Palate Association of Ireland (CLAPAI) is also concerned by the limited speech therapy services available for children with a cleft palate.
In some health board areas, it is not uncommon for a child with a cleft to receive only five hours (10 30-minute sessions) of therapy in a year despite being recognised as needing more therapy with shorter gaps between sessions, according to Eddie Byrne, chairman of CLAPAI.
Mr Byrne, whose son has a cleft palate, says he had expected the gaps between sessions for participants to be reduced following the introduction of group therapy techniques, which help manage waiting list numbers.
"But there are still five to six- month gaps. It's even worse than it was before." When several months go by without seeing a therapist, parents have little or no guidance as to whether their efforts at home are helping or hindering, Mr Byrne argues.
Children with speech difficulties referred by their GP to the health board service are prioritised according to need.
"There are long waiting lists in every health board area and in certain areas there are huge gaps in resources," says Anne Geraghty, chairwoman of the Irish Association of Speech and Language Therapists (IASLT).
Adults who acquire speech difficulties may find it hard to gain access to treatment, according to Ms Geraghty. "Let's say if you had a stroke and you needed speech and language therapy, it would be very difficult to get it outside the acute hospital areas. The same would apply if you had a head injury following an accident or if you were an adult with a stammer," she says.
There are about 300 therapists working in the health service. One report, by economist Dr Peter Bacon, said 1,285 speech and language therapists would be needed by 2015 to provide an adequate service. However, IASLT said financial cutbacks last year led to a freeze on filling some vacant health board posts.
The Bacon Report identified 88 vacancies in the health service at the end of 2000. Since then, employment levels in speech and language therapy have increased by 28 per cent, according to the Department of Health.
Speech and language therapy services are going through something of a transformation at the moment. "In the short term, the situation is probably going to get worse rather than better," says Martine Smith, head of the School of Clinical Speech and Language Studies at Trinity College, Dublin.
Until the current academic year, Trinity was the only university where people could train as speech and language therapists in Ireland. This meant that just 25 therapists qualified each year.
But following recommendations contained in the Bacon Report, a further 75 training places became available this year: 25 each on degree courses at UCC and NUI Galway and a postgraduate degree at the University of Limerick.
The first batch of Limerick students will graduate in 2005, but the effect of the Cork and Galway places won't be seen until 2007.