Michael McKeon compares the roles of the Special Needs Assistant and the Health Care Assistant.


A review of the literature on special needs assistants in education found a small amount of research in this area. Described in a Department of Education and Science circular, special needs assistants (SNA) are considered appropriate where a pupil has significant medical need, a significant impairment of physical or sensory function, or where their behaviour is a danger to themselves or to other pupils. It would be expected that very often this level of care might diminish as the child matures.

In certain circumstances principals may, where appropriate, deploy individual SNA resources to support several pupils with special needs. This may involve the deployment of an individual SNA in more than one classroom. The Department of Education is of the view that SNAs should only be allocated duties of a non-teaching nature (DOE 2003).

An English study by Leigh (1999) of SNAs in education found that they lacked clear ideas about expectations and reported poor classroom communication, where the assistants were attached to one subject area rather than to specific pupils. However, the overall results found the SNAs felt happy in their work and were accepted as members of the team (Leigh 1999). In looking at the development of the SNA, a picture of the potential road to travel can be obtained from viewing the development of the care staff already in intellectual disability services. A greater amount of studies were found under the title of care staff, which is a broader term used to describe staff with no professional qualification who work in intellectual disability in educational, community and health care settings.

Traditionally, there have been unqualified care staff working in intellectual disability care settings since the formalisation of education, health, and community services. In health acts as early as 1919, unqualified people were engaged in duties that could be defined as ancillary or auxiliary. Presently, there are various terms attached to the role of the non-qualified care staff—health care assistant, care staff, assistant nurse, special needs assistants, to name a few (Thornley 2000). In nursing the grade of nursing auxiliary or nursing assistant was first recognised in 1955. A study by Philip and Nancy Hall (2002) reports that since the 1950s recruiting direct-care staff to work with people with intellectual disabilities has not been successful. However, they have identified practices that can reduce care staff turnover, such as articulating the mission of an organisation and improving working practices as a way of retaining care staff.

A recent employment advertisement in a Irish Sunday newspaper looked for applicants to apply for the position of ‘Care Staff – Residential Services’ within a large organisation providing services to people with intellectual disability in the Dublin area. The applicants were required to have attended a recognised FETAC programme or equivalent, and completed of a first aid course and/or a manual-handling course. It looked on a successful candidate as organised, motivated, having good interpersonal and communication skills and to be client-focused (Sunday Independent 03). This advertisement appears to view care staff as people who walk in off the street with no qualifications, no previous experience of work in services for people with intellectual disability—a view that is truly out-dated.

In the past, no major courses or awards were available for care staff to develop a career. The principal change in Ireland now influencing the modern view of care staff is the introduction of qualifications and awards by FETAC. The Minister for Education and Science set up the Further Education and Training Awards Council (FETAC) as a statutory body on June 2001. Under the Qualifications (Education & Training) Act 1999, FETAC was given responsibility for making awards previously made by BIM, CERT, FÁS, NCVA and Teagasc. The awards—e.g. the (pilot) Health Care Assistants courses—are recognised by service providers in intellectual disability as a requirement necessary for a care staff post- Awards provide the potential for formal recognition of care staff’s experiential learning and provide a means by which they may progress into a career in education, health or community care (FETAC 2003).

The relationship between qualified and non-qualified staff is difficult to portray and can be described by the perception of nurses working alongside care staff and how care staff perceive their role working alongside the nursing staff. A comparison of the perception a nurse has of care staff in the United Kingdom and the United States point towards standardised training for care workers as the key to a positive nurse/care-staff relationship. UK nurses were more satisfied with care staff owing to the greater clarity in the scope of the nurse’s role and the standardised training and duties of care staff. A greater level of dissatisfaction of the US nurses indicated a need for a standardised training requirement. (McLaughlin et al. 2000).

Workman (1996) found that the perceived role of care staff has shown that they support the nurse by acting as a link in the communication chain between the client and carers, and by providing time for the nurse to engage in therapeutic activities. In certain areas care staff notice little difference between their roles and those of nurses and they experience ambiguity as to the proper care-staff role. Thornley (2000) suggested that the extent to which care staff perceive themselves as substituting for a qualified staff can be recognised by the maturity, experience, competencies, roles and responsibilities of the work they carry out.

In intellectual disability, the nurse, teacher and other professionals may perceive care staff as a threat to their own roles, in that they may be seen as depriving them of their ‘real’ nursing, teaching, caring or therapeutic role. With the idea of a standardised training requirement in mind, the introduction of courses and awards by FETAC for care staff in Ireland should help provide a positive relationship between all types of staff and a high standard of caring for people with intellectual disability in both an educational, community, and health care setting.

Nurses, teachers and other health professionals need to understand the formal training now offered to care staff and appreciate the limitations of the care staff role as stated in the training criteria, in order to work in partnership with them for persons with intellectual disability. Care staff need to understand the nurse, teacher and other professional’s knowledge and to be aware of the accountability in delegation and supervision of care staff and work in partnership with them. The development of care staff provides a clear road for the promising development of the SNA, given that support, education and training is provided so that people with no experience or qualifications are no longer employed in services for people with intellectual disability.


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