Enable Ireland currently provides early intervention services in Counties Cavan, Monaghan and Meath. Services are provided in partnership with the Health Service Executive North East, from whom we are funded. Services are provided to children from birth to six years of age with a wide range of needs including developmental delay, physical disability, sensory disability, learning disability, specific language impairment, autism or features of autism who meet the criteria for acceptance into the service.
Services commenced in 2001 and a single point of entry to service was established at that time. The aim of the service is to facilitate the development of the child and to provide support to parents and families through a mix of group- and individually-based sessions. Services are delivered in a family-centred, integrated and holistic manner based around individual needs. This includes assessment, therapy and support which is provided mainly in centres, but also in homes, schools and other locations.
’No infant or child needs physical, occupational, or speech therapy twice per week in order to grow and develop. What young children need is exposure to communication, mobility, play, gradual independence in activities of daily living, and nurturing interaction with family members, everyday, in their usual places and situations. Therapists, using their therapeutic expertise as the means to this end, can help young children and family members achieve their desired outcomes’
(Hanft and Pilkington 2000).
The team concur with the sentiments of Hanft and Pilkington above and we aim to empower parents to be involved as partners in service delivery. Together with them teams aspire to identify a child’s individual abilities, strengths and needs. Services are delivered within a social model context, in partnership with the children and families. We actively involve families to contribute to various service-related initiatives. Examples include the development of a Parent Information Booklet on Enable Ireland services in the North East, and a booklet to support families whose child has received a diagnosis of autism.
Model of team work
The team work within an inter/trans-disciplinary model of service, enabling and empowering parents to be active participants in their child’s plan. Team members are committed to teach, learn and work across discipline boundaries in both planning and providing integrated services. Parents/family are always full members of the team and are encouraged to take a joint role (or a lead role) with team members in planning and delivering services to their children.
Every child and family in the service has a nominated key worker who acts as the link person between the family and team members and other professionals/services, where appropriate. Any member of the team can be a nominated as key worker for a family. The key worker is responsible for providing the family with regular, long-term contact and continuity of support and information.
All children and families in the service are offered a family meeting following their initial assessment period. The aim of this planning meeting is to determine with families what their priorities are for their child and to make a plan on how to meet the needs and concerns of the family as a whole. Families choose who they would like to attend the meeting and the frequency of such meetings. Regular reviews of the plan take place with each family, often with a focus on the major transition periods in a child’s life. Our planning process is based on the feedback we received from families, following a research project funded through the National Disability Authority (NDA) in 2007. This research project highlighted the importance of determining the needs of the child and of the family, and that the planning process itself should be flexible to meet the differing needs of all concerned.
On 1 June 2007, Part 2 of the Disability Act 2005 became law, where all children with a disability under 5 years of age are entitled to apply for an ‘assessment of need’ (AON). The roll-out of the disability legislation had a significant impact on service delivery in Cavan, Monaghan and Meath as the assessment officer was determined to be the single point of entry to intervention services. This brought a change to the previous practice where the single point of entry was a referral forum. The HSE and Enable Ireland have been working together to ensure children and their families access services in a timely manner. At present all children under one year of age can be referred directly into services so that intervention can commence and the assessment of need follows when appropriate. A change in the process of single point of referral is currently being piloted in Meath with a referral forum now in place again—attended by the HSE and Enable Ireland, and including the assessment officer.
Impact of AON on service delivery
The introduction of the assessment of need provided an opportunity to relook at the assessment process and streamline this in line with the national guidelines. This has had a positive impact in relation to developing a standard approach to assessment. In order to meet legislative time frames around the assessment of need process, resources have had to focus on assessment rather than intervention. This has impacted on service delivery for those children and families already accessing the services, as well as new referrals. The changes have resulted in:
- A delay in children getting access to service from initial point of referral
- Resources sometimes being used to complete the AON process for children who do not then meet the eligibility criteria for the service
Early intervention staff spend considerable time trying to explain the process of assessment of need to families
- A large volume of referrals leads to a bottleneck with assessments.
- A total of 273 referrals were received in Meath during 2008 and 195 of these were assessment of need. A total of 130 referrals were received for Cavan-Monaghan, 75 of which were for assessment of need. As at April 2009 a total of 94 referrals have been received in Meath and 12 have been received in Cavan Monaghan for early services.
- A waitlist has developed due to the bottleneck of assessments
Managing now and looking to the future
Enable Ireland North East are committed to providing a range of high quality services to meet the needs of children and families accessing our services. The commitment to continued quality improvements has been demonstrated by our success in achieving the Recognised for Excellence Level 4 EFQM Quality award and, more recently, being recognised by the ‘Excellence Through People’ standard award. Families of children accessing our services have the opportunity to provide feedback on service delivery through many different ways. Enable Ireland’s aim is to continue to put the needs of children with disabilities and their families first to ensure a child’s disability does not block their access to play, education, building friendships and participating in the community at large.
New initiatives are in place, including improved Person-centred planning, reduction of waiting list, introduction of individual care pathways for children, information groups for parents, increased parent training groups (e.g. Early Bird, Parents Plus, Lamh training etc.). With these initiatives caseloads are being managed more effectively and waiting lists have been significantly reduced and in some cases eliminated. In Meath waiting time is now down to a maximum of six weeks down from 18 months less than a year ago. We have recently commenced using MPOC as a tool to collect feedback from parents and look forward to using the information from this to continue to improve our services.
MPOC – Measure of Processes of Care. This is a standardised questionnaire which is analysed externally to help us understand and measure the experiences of parents who have a child with a disability within our organisation. Feedback from these questionnaires will help us improve our services.