On 1 June 2007, Part Two of the Disability Act 2005 became effective for children less than five years of age. Disabled children within this age group now have a right to:
- An independent Assessment of Need (AON)—health and educational—arising from their disability An assessment report
- A statement of the services they will receive
- The entitlement to make a complaint if they are not happy with any part of the process.
Under the Act, the HSE appointed Assessment Officers (AOs) in each Local Health Office (LHO). The AO is independent of services provision and will commission and complete an assessment report ‘without regard to the cost or the capacity to provide any services’. The AO determines the scope of assessment required for the person concerned and arranges that the appropriate professionals carry out the assessment in the specified timeframe as outlined in the Act.
An assessment report is then completed and forwarded to the Liaison Officer who draws up a service statement. The Liaison Officer employed by the HSE in each LHO area is responsible for arranging appropriate service provision for the person with a disability, in accordance with the assessment of needs and having regard to available resources. The Liaison Officer provides the services statement and he/she ensures that the services committed to in the services statement are delivered within the timeframes specified. The Liaison Officer is the key link with the person with a disability (or their parent/care giver) and the service provider.
Impact of the legislation from the service provider perspective
The Brothers of Charity (BOC) Southern Services worked with the HSE South and other agencies in the former Southern Health Board region to develop a model of Health Support Services for Children with disabilities in the Cork and Kerry area. The model was developed having regard to the Disability Act 2005. The key developments under the model were:
- Establishment of an Intake Forum in each Catchment (LHO) Area
- Timeframe for Assessment of Need
- Recognition of existing and newly post-assessment intervention caseloads
- Inappropriate referrals to be routed back through Intake Forum
- Gap analysis and resources requested to be flagged by Intake Forum.
There have been many challenges for the BOC Services in the region in the roll-out of a new Model of Services and the implementation of Part Two of the Disability Act 2005. Some of these are detailed below:
Intake Forums which have been set up in two of the five LHO areas are working well, with all services providers agreeing the distribution of referrals based on standardised referral documentation. Assessment Officers attend the Forum meetings informing service providers of Assessment of Need requests. As this system is working well, we are now actively advocating for Intake Forms to be established in the remaining LHO areas.
Assessment of Need
Like anything else, preparation is the key to ensuring success, but many delays in the roll-out of the Act have caused much concern. Some of the issues that arose are:
Parents did not fully grasp that while the assessment process was independent of services provision, the same services provider could actually be carrying out the assessment of need process. This was disappointing to some parents; while they may be very happy with their current service provider, they did consider the assessment under the Act as a form of ‘second opinion’.
The AON process was rolled out a year ago and training of assessors is only happening now. This has created a lot of uncertainty and misunderstanding for assessment staff, in particular around the language used in the Summary Report Forms. Unfortunately, the language is based on the Act and on ‘adult language’. Terms such as ‘lifelong disability’ or ‘substantial restriction’ are not user-friendly considering the specified age group and sensitivities for parents on delivery of diagnosis. Forms have been amended during the process, but these should have been reviewed prior to commencement of the assessment process.
Meeting timeframes have been a huge challenge when there are a number of AONs to complete within the same timeframe. Multidisciplinary teams are not fully resourced and we are now finding that with limited resources in each team, the time taken in assessment work leaves no scope for intervention services themselves—the key to our services delivery. We are also finding that from January onwards there are a lot of full team reviews required for children moving onto primary education for the following September. These reviews, coupled with AON requests, have put a huge strain on delivery of intervention services.
The recognition of only four core disciplines—psychology, occupational therapy, psychology, and speech and language therapy—under the roll-out of the Act has caused huge concerns for other professionals on the ground who have worked as part of the early intervention teams for years. For instance, social workers may be the first point of contact for families and they would have a key role in supporting families throughout their involvement with the early intervention services. Clinic nurse specialists, pre-school therapists, child development workers, family support workers—all assisting children with disabilities and their families from the onset in their homes and in specialist settings—are key members of the multidisciplinary teams, although they have not been recognised under the Act.
The Assessment of Need report is now provided to parents by the Assessment Officer. This is a change of practice in that parents always received a copy of reports following a verbal feedback by the services. The service provider is no longer allowed to provide the written report to the family as the Act determines that this is the role of the AO. This has been a challenge for professionals, as teams feel that parents are unable to retain the level of verbal feedback as it can be very distressing informing families of their children’s disabilities. Also we would be concerned on the merits of the AO providing the final written reports as not all AOs are clinically trained professionals.
There is a need to develop an open relationship with AO/Liaison Officers who are new in post and are not familiar with the model of services.
There has been a marked reduction in intervention services due to AON requests. Our teams have advised that they are spending on average 80% of their time on assessments, leaving individuals little time for intervention work and other functions. Services such as individual therapies, attendance at team meetings, IPPs, programmes for parents and staff training have all been affected. Frontline staff, who have always relied on the expertise of multidisciplinary support staff in delivery and implementation of child-centred plans, do not have these supports available to the same degree, due to time demands of assessment work. They find that this impacts on the service delivery to the child.
In summary, the problems identified under the above headings have been very challenging for us as a service provider. The establishment of Intake Forums in all LHO areas is key to the success of the Assessment and Intervention Services. It is essential that the Assessment Officer and Liaison Officer/Case Manager are part of this model, liaising with the Chair of the Forum in between meetings.
To enable us as a service to continue to respond under the Act, it is essential that the Intake Forum is aware of our current caseloads, our capacity to address assessment of needs, and that they ensure that the core principles of a teamwork approach are present with full information flowing between team members.
As a service, we are currently working on defining caseloads and our capacity to address the assessment of need and will continue to advance this issue with the HSE Manager of the Disability Services to ensure that we can work the model painstakingly identified as best practice for the child and family under the Act. We hope that this will lead to the development of protocols to protect intervention services as much as possible where assessments of need requests are significant.