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(Ireland) Kids waiting years for assessment; "significant increase" in demand

Oct 15, 2020, Irish Examiner: Assessment of Need system leaves children with disabilities waiting years for essential services, report says The country's Assessment of Need system is leaving many children with a disability waiting years for the services they require and is marked by a lack of resources and inconsistencies between different HSE areas, according to a new report by the Children's Ombudsman. In the 'Unmet Needs' report, published today, on the challenges faced by children who require an assessment of their needs, the Office of the Ombudsman for Children says the system needs to be revamped, along with a possible ten-fold increase in resources to make it work as less than 10% of AONs are typically delivered within the statutory timeframe. Under the 2005 Disability Act, the Assessment of Need (AON) is undertaken or arranged by the HSE to determine the health or educational services needed by a person with a disability. The AON must begin within three months of the application and must be carried out in accordance with standards determined by HIQA and without regard to the cost of any service identified. However, the AON system has been beset by problems in recent years, with High Court actions brought by families seeking timely delivery and opposition to the introduction of a new Standard Operating Procedure. In the report foreword the Children's Ombudsman Dr Niall Muldoon writes of "many complaints from distraught parents whose children have been on a waiting list for years to access an assessment of need for their child", adding: "Many have found that once their child is assessed, they struggle to get any or all of the services recommended to help their child talk, move, learn and grow." The number of AON-related complaints lodged with the OCO has almost tripled in recent years, with some children waiting years to access an AON via early intervention services for children aged 0-5, only to have aged out while on the waiting list, plunging them to the bottom of a new AON waiting list for school-aged children. "The HSE informed the OCO that there has been a significant increase in the number of applications for AONs over the last 10 years, exceeding the capacity of services to meet this demand," the report said. "Indeed, the number of applications for AONs has risen steadily over the past 11 years, from 1,138 applications in 2007 to 5,060 in 2018. The statutory timeframes for the completion of AONs are also routinely not met by the HSE. In 2018, the number of assessments completed on time was 8.8%. The HSE National Service Plans for 2019 and 2020 gave a projected outturn of 9% of AONs completed within the timeframes provided for in the 2007 Regulations. Regarding those resources, the report said: "This would suggest a tenfold increase in expenditure requirement (not accounting for potential economies)."… "At the same time, long assessment waiting times is impacting greatly on children achieving their fullest potential. For example, 10,455 children are currently waiting more than 12 months for access to occupational therapy assessments.” The HSE informed Andrew’s mother that her son would need to wait approximately one year to access a psychological assessment. She made a complaint to the HSE with respect to this delay. She was told that her complaint would not be heard for approximately seven months. Lucy is non-verbal and has a diagnosis of ASD combined with Mild General Learning Difficulties. In 2015, when Lucy was six-years-old, she had an AON, which recommended SLT and physiotherapy and that she be seen by a multidisciplinary team for intervention as soon as possible. Lucy was placed on a waiting list for clinical services and in 2018, Lucy’s mother was informed by the HSE that Lucy would need to wait a further two years for clinical services. Lucy was also referred by her school to the HSE Early Intervention Team, but that referral was declined because she was already waitlisted for another service. Lucy, who is now 11 years of age, is still not receiving any of the clinical services assessed to meet her needs as a six-year-old. Michael is non-verbal and has suspected ASD. When he was two years old, his mother wrote to their local CHO requesting an AON. Michael was referred to the HSE Early Intervention Team and they referred him on to one of their voluntary providers for an ASD assessment. His mother was informed that there would be a significant delay in accessing an ASD assessment, but that she could make a complaint to the Complaints Officer about this. After 10 months, Michael’s mother was informed that her complaint was upheld. The Complaint’s Officer recommended that the HSE provide Michael with his Assessment Report within 10 weeks and his Service Statement four weeks later. When this did not happen, Michael’s mother was informed by the Complaints Officer that she could go to the Circuit Court to force the HSE to implement their recommendations. By the time she contacted the OCO, Michael had been waiting 19 months for his AON. Sarah has been privately assessed as having ASD. She also has sensory issues, is unable to wash or dress herself, and her co-ordination is poor. When she was four years old, her mother applied to her local HSE Early Intervention Team for an AON. She was informed that Sarah would have to wait at least 27 months for an AON and that, when she turned five, she would be transferred to the School Aged Team waiting list. Sarah would not receive any priority on that list, despite ‘aging out’ of the Early Intervention Team waiting list. Sarah’s mother complained to the HSE regarding the delay. Her complaint was upheld but Sarah has still not received an AON.


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