Early intervention: The experiences of staff of the assessment of need in early intervention services

by Charmaine Payne, Clinical Psychologist in Placement, Brothers of Charity Services, Limerick & Dr Barry Coughlan, Senior Lecturer and Assistant Director, Doctoral Programme in Clinical Psychology, University of Limerick

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Introduction

Due to the heightened awareness of the importance of early intervention and its benefits, Part 2 of the Disability Act 2005 (the Assessment of Need process for children aged 0-5 years) came into effect in Ireland on 1June 2007. The Assessment of Need was introduced as a means of providing timeous access to an independent assessment of children’s health and educational needs arising from their disability. To the researcher’s knowledge, this is the first study to be conducted on the Assessment of Need from a multidisciplinary staff perspective. This is important because professionals on the ground attempt to bridge the gap between policy and practice. This article follows on from an article published in Issue 77 of Frontline, ‘Early intervention services: A survey of parental attitudes toward service provision and impact of the Disability Act (2005’) by Brian Muldoon and Dr. Barry Coughlan (2009).

Aims

The aims of the research were to explore the experiences of multidisciplinary staff on the Assessment of Need in early intervention services in the HSE mid-West Region; to explore staff experiences of referrals for the Assessment of Need compared to the traditional referral route; and to explore staff perceptions of their team’s effectiveness in meeting the requirements of the Assessment of Need.

Method

Participants
The multidisciplinary staff members from three specialist early intervention teams in the HSE mid-West region were selected for participation. Staff names from each professional group were randomly drawn by a clinical psychologist who was independent of the research process. This ensured that each professional group was represented. 14 participants were selected in this way and were invited to participate in the study. The remaining 10 staff members, not drawn for interviews, were sent questionnaires.

Research Instruments
This study utilised two research instruments.

1. Semi-structured interviews: The semi-structured interview, designed by the researcher, consisted of seven open.ended questions aimed at gathering information on staff experiences of the Assessment of Need. The interview times varied from 15.50 minutes. The researcher offered staff the option of receiving a copy of the transcribed interview to validate that the transcription was a true representation of the information discussed during the interview.

2. Questionnaire: The questionnaires were posted to the remaining 10 staff members who were not drawn for interviews. Eight questionnaires were completed and returned to the researcher. The questionnaire was based on the interview schedule and was aimed at gathering qualitative information on staff experiences of the Assessment of Need.

Rationale for Methodology
Qualitative techniques elicit rich descriptions and quality information, and they have been advocated as the best strategy for exploring areas that have not been previously explored, or for developing hypotheses (Miles and Huberman 1994). The aim of using both semi-structured interviews and follow.on questionnaires was to gather a comprehensive account of all the staff’s experiences of the Assessment of Need and to employ the principle of triangulation to increase the validity of the research (Richardson 1996).

Data Management and Analysis

Coding
The identifying information obtained during interviews was coded numerically and was utilised when providing direct quotations within the text. To ensure confidentiality, no distinction in coding was made between various professions. The questionnaires were randomly assigned a numerical code, which enabled additional comments made on the questionnaires to be included in the data reduction process and in the completed research report.

Qualitative Analysis
Information obtained from the interviews was analysed utilising the ‘Flow Model’ proposed by Miles and Huberman (1994). The authors describe analysis as three simultaneous flows of activity, namely data reduction, data display, and conclusion drawing or verification. Initially, 16 themes were identified which were later condensed into 10 themes, using a circular procedure (Lieblich et al. 1998). These were further grouped into four core categories. The information obtained from the questionnaires was utilised, where appropriate, to support the information obtained from the interviews.

Results

Four core categories of themes emerged from the analysis of the data.

Professional Issues

Negative aspects of the Assessment of Need
Staff reported a number of negative aspects related to the Assessment of Need: inconsistencies in Assessment Officers’ expectations and requirements (this was reported by staff members who had dealt with different Assessment Officers during the course of their work); it is a time-consuming process and there is difficulty completing the assessment within the three.month deadline; and there is increased pressure on staff.

Impact of the Assessment of Need on the way staff work
Staff members reported that the introduction of the Assessment of Need had impacted on the way that they work. Additional time is spent on administration and writing reports; there is a move towards team assessments; staff take on additional roles such as coordination and monitoring; and staff members reported that they are forced to prioritise Assessment of Need applicants, often at the expense of other children waiting for intervention.

Early intervention

Inappropriate referrals
Staff reported an increase in inappropriate referrals for the Assessment of Need. Staff members are increasingly assessing children whose primary difficulty is mental health, and they feel these children should have access to more appropriate services.

Practical Issues

Positive aspects of the Assessment of Need
Staff reported four positive practical aspects arising from the Assessment of Need: children going through the Assessment of Need receive a comprehensive assessment; they receive a Statement of Need; there is improved consistency in report writing and assessments; and the Assessment of Need enables one point of contact for the duration of the process resulting in easier information sharing.

Negative aspects of the Assessment of Need
The Assessment of Need has impacted negatively on practical issues. Staff reported that unclear, ambiguous terminology was used and there was an increase in paperwork as a result of the Assessment of Need.

Accessibility of services
Mixed reactions were recorded regarding the Assessment of Need’s impact on the accessibility of services. The Assessment of Need increases accessibility to assessment, and is of particular benefit to children living in regions where there is limited access to early intervention services or where a team has a large caseload. It does not increase accessibility to interventions, and, because the Assessment of Need applications are prioritised, some staff felt it decreases the accessibility of services for other children waiting for intervention.

Efficacy of the team in meeting the requirement of the Assessment of Need
Staff members felt their teams were effective in meeting the requirements of the Assessment of Need, even though some reported that occasionally they would have to apply for extensions. Although this could be for reasons such as a staff member being on sick or maternity leave, the parents not engaging in the process or a child being sick or hospitalised, sometimes extensions were requested due to a heavy workload.

Assessment of Need compared to the traditional route of referral
Referrals for the Assessment of Need reach early intervention teams faster than the traditional referral route, and lines of communication are more direct and enable easier access to information. However, it was reported that the traditional route of referral resulted in fewer inappropriate referrals and included more detailed, relevant information about the child and his/her family.

Statistics and future planning
Staff members stated that they are interested in accessing national figures regarding Assessment of Need applications, the needs identified, services offered, and the gap in services.

Resource Issues

Need for Additional Resources
Staff reported that the Assessment of Need was not resource.led and that additional resources should accompany applications. Staff reported that they need more therapists on the teams and additional services such as respite, family support, home support, sibling groups, parent support and parent training.

Family Issues

Parents/Families’ understanding of the Assessment of Need
A number of staff members reported that parents or families do not fully understand what an application for an Assessment of Need entailed or what it entitled them to. Many families did not realise they would have increased access to an assessment, but would have to wait for intervention. Some families thought the process was a means to obtaining other benefits, such as a domiciliary care allowance.

Conclusion and implications for policy implementation

The research was useful in identifying the experiences of staff of the Assessment of Need. Although the staff had some positive experiences of the AON, there were a considerable number of negative themes, which are cause for concern. This may have implications for refining existing policies and guidelines and guiding future ones.

There is a need for policy makers to consult with the individuals who are charged with implementing the policy during the course of their work. Staff are under increased pressure as a result of the introduction of the Assessment of Need. The research highlighted that adequate resources should be available in order to comply with policy requirements effectively, and to prevent other children waiting for intervention from being negatively affected by prioritisation of Assessments of Need.

There is also the possibility that by enforcing statutory requirements and time limits, the quality and thoroughness of assessments may be affected. Furthermore, it may enforce a rigidity to the process that was not otherwise present, and staff may not feel that they have the flexibility to adapt the process to the requirements of the child as they emerge. Furthermore, where in the past clinicians’ judgments on the length of time and type of assessment may have been accepted, now they could potentially face difficulties in requesting extensions from Assessment Officers who are eager to meet policy-dictated deadlines.

This research focused on staff experiences of the Assessment of Need in one geographical area. A National review study with a focus on the implications of the Assessment of Need and the Disability Act (2005) is recommended, to allow collation of data and to enable geographic comparisons. Additional research recommendations include: to explore parents’ and families’ experience of the Assessment of Need, how the introduction of the Assessment of Need has impacted on the accessibility of intervention services and comparing what needs the Assessment of Need identifies and what services are actually accessible.

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