Assessment of Need for our most vulnerable children (June 2020)
19th June 2020
Drs Anna Beug, Kieran Harkin, Fiona, Monahan, Edel Mc Ginnity and Susan Smith For Deep End Ireland
We are a group of GPs working in disadvantaged areas in Ireland. We are witnessing the disproportionate effect impact of Covid19 on patients living in disadvantaged areas. There is one particular area of concern for us relating to closures in Assessment of Need services in primary care. These services assess children with developmental delay in order to establish an underlying diagnosis and identify an appropriate management plan. This is the pathway through which conditions like autism are identified. Without an assessment no action can follow and children and their parents are left completely unsupported by these statutory services. This has essentially brought a situation that was barely functional to a complete halt endangering the welfare of the most vulnerable children. While there have been massive delays in accessing Assessment of Need for years, this has always been worse in areas of deprivation, as services are not distributed based on need. Parents of children in more affluent areas can afford to get assessments done privately, which also releases the pressure on public services in these areas further compounding the inequality.
This situation is leading to lost opportunities for early intervention, support and special education. In addition, there continues to be no meaningful access to psychiatry services for children with autism and other disabilities, although they have a huge need as they very frequently have associated mental health problems. There is generally a lack of therapies and interventions once a diagnosis is actually made but the inability to even access an assessment is leading to extreme distress for very vulnerable children and their families. The situation has been greatly exacerbated by COVID.
The following is a typical case example highlighting this problem:
“Three year old girl, one of 4 children, and father removed from family home in late 2019 due to allegations of domestic abuse. The Gardai, Tusla, Courts were all involved. Tusla have now closed the case. Mother has history of significant mental illness – currently relatively stable. This three year old girl has no language, and significant motor delay, not toilet trained and worsening behavioural issues including kicking, headbanging etc. Does not sleep and pulled a pot of boiling water down on herself some months ago – significant scarring.
She was referred for Assessment of Need in early 2020. GP was advised in March 2020 of likely 20 month waiting list, which, due to Covid-19 is now indefinitely delayed. The child was seen by Speech and Language Therapy (SLT) in early March 2020, following a referral made previously. GP was phoned by SLT to say likely moderate to severe autism and GP would agree.
None of the children in this family are school due to Covid-19 closures, so there is no afterschool care, no preschool. Mum is struggling hugely. No prospect of any support, or alternative pathways for diagnosis and Intervention.
This will likely lead to huge loss of potential and is placing an enormous strain on an already vulnerable single parent.”
GPs in Deep End Ireland are calling for emergency measures to address this crisis in Assessment of Need, which is undoubtedly leading to life-long problems for these vulnerable children, their siblings and parents and will have knock-on societal and economic effects. While this is a national issue, it particularly affects children in the most disadvantaged communities as there is limited economic capacity to use alternative private services.
We have identified a range of potential solutions:
Review all AON waiting lists and prioritise urgent cases, based on clinical need
See which discipline is most needed by each child and introduce more flexibility with direct access to that speciality – ie Speech and Language Therapy, Occuaptional Therapy and Psychology
Consider liaising by phone with GP’s to help prioritise the most needy.
Innovate around novel ways of doing assessments do they don’t require as much face to face time.
Consider in severe cases uncoupling the need for a diagnosis from access to services.
Prioritise opening of schools and childcare facilities for vulnerable children.
Consider extra resources for assessments and interventions according to means. In areas of deprivation parents have no ability to seek private assessments or interventions. This leads to even longer waiting lists in the areas where care is most needed.