Post on 30-Dec-2019
transcript
Children’s Disability Services Reform Programme
Ann Bourke, National Disability Specialist, HSE
Irish Learning Support Association Spring ConferenceLimerick, March 9th 2018
Today’s Objectives
• Background on children’s disability services – Why need for change?
• Progressing Disability Services for Children & Young People
• Current Status of Reform Programme
• National Access Policy
• Disability Act & new AON Standard Operating Procedures
• Health Service role in new DES Resource Allocation Model
Historical development of Disability Services
Delivered by HSE and voluntary organisations, developed over decades for specific cohorts of children with disability
Outcome: Different access criteria for each service
Significant gaps and inequities in access to services – extremes where some children receiving excellent access and others little/no service
Lack of clarity for referrers and families
Mainstream schools varied access to multidisciplinary services depending on service providers in that area
Some service providers are patrons of special schools and provide MDT supports
Children’s Disability Services Reform Programme
Context
• Legislation: Disability Act 2005
• Report of National Reference Group for Multidisciplinary Disability Services for Children aged 5 – 18 (2009)
• National Policy: Transforming Lives – Value for Money and Policy Review 2012
Progressing Disability Services for
Children and Young People (PDS)
Nat Reference Group Report 2009 – 24 recommendations incl
Services as close to child’s home as possible
Clear referral pathways & Skilling up of Primary Care
Restructuring of children’s services into interdisciplinary teams, EI & SA co-located and aligned to Primary Care Networks
Joint working with Education
Access to Specialist Supports
CORE OBJECTIVES OF PDS:
• One clear pathway and equity of access to health services for all children with disabilities according to their need
• Resources used to the greatest benefit for all children and families
• Effective teams working in partnership with parents and Education to support children in achieving their outcomes
Implementation of PDS
What does this require?
Reconfiguration of all children’s disability services staff into Children’s Disability Network Teams (CDNTs) and Specialist support services
An integrated access pathway with Primary Care to provide clear signposting to and through the appropriate services for parents (National Access Policy 2016)
Strong collaborative working between Health and Education & Health to support child and family centred model with focus on transition planning, staff and family training and information sharing.
Establishing CDNTs
Enable Ireland
(P&S)
HSE(Community
SLT)
Brothers of
Charity (ID/Autism)
Children’s Disability Network Teams (CDNT)
Children’s Disability Network Teams
One CDNT providing for all children & young people with complex needs in a defined geographic area, regardless of
the nature of their disability
where they live or
where they go to school.
May be Early Intervention & School Age Teams or 1 CDNT for birth to 18 years with sub-teams 0-6 & 6-18
Establishment of CDNTs - Current Status
PDS Model of Service
Bio psychosocial model
Child and family centred Building on strengths, capacity, existing & new skills Empowering and coaching parents (proven better outcomes for
children) incl. accessing community supports Involving families in goal planning and setting specific to their
child/developing IFSP
Needs led, not diagnosis led
Outcomes focused
Interdisciplinary CDNT working in partnership with families & in close collaboration with schools, communities and other service providers
PDS Model of Service
Move from: traditional model of 1:1 block therapy sessions
Evidence indicates limited skills retention and transfer from ‘clinic’ environment into child’s everyday life
Move to: Supporting & empowering families to learn strategies to work
with their child in their natural environment (3 times more effective)
‘Child/young person is not reliant on intense 1:1 input from “specialists” rather those who surround him/her day to day are empowered to maximise opportunities for growth and development in their everyday environments….. this approach is effective in producing better outcomes’ (Moore, 2011).
PDS Sustainability Depends On…
• Close collaboration with all partners HSE: Disability / Primary Care / CAMHS & Vol Org Service
Providers
Parents/carers of children and young people
DOH
DES & schools, NCSE, NEPS
• Implementation of Framework for Collaborative Working between Ed. & Health incl: Local Ed Health Fora
• Planning for local needs
• Transitions planning for children
• Training for teachers/CDNTs, parents/siblings/carers
Progress to Date• 56 CDNTs established & remaining 82 CDNTs in development
• Communication Strategy: PDS Webpage
Regular PDS Bulletin
Formal Communication Pathways
• Policy Framework for Service Delivery of CDNTs to support consistent implementation of policy
• HSE TUSLA Joint Working Protocol
• AIM implemented in Early Intervention – Disability & Primary Care AIM KPIs introduction Jan 2018 AIM Training Programme in partnership with Early Years Specialists nationally
Progress to Date (2)
• Extensive Suite of National Policy and Guidance documents incl
National Policy on Access to Services for Children with disability or developmental delay
National Prioritisation and Discharge/Transfer policies
Interim Standards for CDNTs & Self Audit Tool
National Guidance on Specialist Supports
Framework for Collaborative Working between Education and Health Professionals
• National Access Policy Training Prog for Disability & Primary Care
• National AON Standard Operating Procedures
• National Conference Working together to support Children and Young People with Disabilities and their Families
National Access Policy
National Access Policy
• Key foundation stone of PDS
• Equity of access for all children with disability or developmental delay
• Primary Care services if needs can be met there: non complex difficulties in functional skills and/or applied skill
sets required for ADLs, learning new skills and social interactions
• CDNT where interdisciplinary team approach required complex difficulties …
• Specialist supports when required for Primary Care & Disability Network Teams
National Access Policy
Primary
CareTeams
Primary Care Teams
Children’s Disability Network
Teams
Child with non-complex needs
Specialist support as needed by Primary Care and Children’s Disability Network Teams
Child with complex needs
Transfer between
services if and when
child’s needs change
Children with disability or developmental delay and their families
Disability ActAON Standard Operating Procedures
AON Standard Operating Procedures
Why change?
What is new?
Disability as defined in the Act:
“A substantial restriction which
Is permanent or likely to be permanent, results in significant difficulty in communication,
learning or mobility or in significantly disordered cognitive processes
And
Gives rise to services to be provided continually to the person, or if the person is a
child, to the need for services to be provided early in life to ameliorate the disability”
Linked to National Access Policy: If a child meets the level of complexity for a CDNT, he/she meets eligibility for AON – there will be some exceptions
Complete Children’s Services Referral Form & age specific Additional Information Form
AON Standard Operating Procedures
Preliminary Team Assessment
2 members of CDNT
60 – 90 mins
Case history discussion
Informal observation
Play based assessment
Screening tools
Formal and informal assessment tools
Discussion with child/young person, identify next steps
AON Standard Operating Procedures
Outcome of Assessment: Identify care pathway - to be included in Service Statement
May include:
Diagnostic Assessment
Interventions
Additional referrals to other services
Disability or no disability?
Nature of Disability Learning
Communication
Mobility
Disordered Cognitive Processes
Extent of Disability
No requirement to provide diagnosis at this point
DES Resource Allocation ModelRole of Health Service
Health provided (Sept 2017)/will provide (Sept 2018) number of children entering mainstream school & who are in/waitlisted for CDNT (or disability services where CDNT not yet established)
From 2019 onwards, Health will provide every Oct the number of children who entered mainstream school that year & who are in/waitlisted for CDNT (or disability service where CDNT not yet in place)
For children with SEN in all other classes, their needs will already be known by the school to inform their school profiling
Health will continue to provide as much support and information as possible to teachers, including reports for SNA process
Thank YouQuestions?
Ann.bourke4@hse.ie
www.hse.ie/childdisability