Tag: Additional Needs

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Statements on Improving the Quality of Early Years Education: 21 January 2014

I welcome the Minister (Minster for Education Jan O’Sullivan TD) to the Seanad. She is particularly welcome as she is dealing with the issue of early years education. I know her personal commitment to and experience of the issue. The steps she made in the early days in terms of examining the early years and setting up the work she will do in this area are welcome. We have had many excellent debates in this House on the importance of the early years and I do not need to rehearse them. My colleagues have articulated the importance of early years education.

I should start with a declaration of interest. I am chair of Early Childhood Ireland, but it is a governance role. In speaking here today, I am not speaking in that role. I chair the board in the organisation in a governance role.

In her speech the Minister mentioned inspections and the importance of the inspectors she will appoint, which I welcome. It is an excellent decision. She said the inspectors will complement, not duplicate, the type of inspections carried out by the Child and Family Agency. At the moment early childhood care and education settings are inspected by Pobal and the Child and Family Agency, and will now be inspected by the Department of Education and Skills. I do not see why we need all of these inspections and different types of people doing the inspecting. It represents a mentality we have, namely, a silo effect of Government. We need to be much wider and broader.

I would welcome the Department of Education taking the lead in inspections. Would we accept multiple agencies and public health nurses inspecting the work being done in our primary and secondary schools? How many of us would say that makes sense? It does not make sense in terms of the use of public health nurses or the education and care of our children and young people.

In my experience, the Department of Education and Skills has built up a recognised and approved inspectorate. The Minister receives a lot of criticism, but it is rare that I hear criticism levelled at the inspection system. There is scope for us to examine how we develop an inspection system for early childhood care and education settings that is led by the Department of Education and Skills., and not have other Departments involved in the inspection process. The Department of Children and Youth Affairs can play an important part in the delivery and provision of settings, but we have to consider a much more co-ordinated approach. It is something I would urge the Government to reconsider.

I take the Minister at her word when she says this will complement inspections, but the reality is that I meet owners of child care settings who tell me two different inspectors will arrive, coincidentally, on the same day who are looking at slightly different things within their settings. They do not have extra staff to allocate to these inspectors. We need to be careful about what we are trying to achieve with the inspections. Are we really trying to ensure that the quality and standards improve? Are we trying to ensure that Síolta and Aistear are implemented in our child care settings or are we trying to make sure that a sink is in the right place? What are we trying to achieve with the inspections? What is the primary consideration for the inspections? I ask the Minister to go back to her colleagues in Government and ask whether we can re-examine this and find a better way.

I am greatly concerned about the investment by Government in child care settings. It is not adequate. We have to consider how we will increase it. Everybody agrees on the importance of the period from birth to six years of age, but early child care settings are only open for 39 weeks of the year. I would like to see the number of weeks provided for children in early child care and educations settings greatly extended. I would like to ensure that the staff are qualified. We will hear more in February about those who are on low and minimum wages, part-time contracts and go on the dole for the summer. One does not get paid for any non-access hours or child-free time. Teachers will get non-contact time, but those working in early child care settings do not, yet we are asking them to drive for quality while paying them the minimum wage or lower.

We have to examine how we can raise the quality bar and encourage teachers in early child care settings to get further education to be able to deliver the type of services we want to have. It is important that we build this up.

The other area of concern is children with special needs. This is not within the scope of the Minister’s Department, but the current system does not allow flexibility for children with special needs. Everybody agrees that we should extend the amount of time special needs children receive and that they would at least get a second year, as all children should get. The Department said it will have flexibility in regard to such children, but the ratios operate at a local level. A parent might know that a child with special needs can attend two or three days in a week. Nobody knows on a Monday the two or three days that will be used, so the setting has to provide the necessary staff. The State will only pay the service for the days the child attends. It does not compute.

We have to re-examine this issue because we need to ensure such children are in the system. We know early identification of special needs issues can often equip children to develop their full potential and be much more able to deal with and be part of life. We need to determine how to provide a facility whereby children with special needs and parents can feel they do not have to say they are fully in or out of the special needs early education system.

There is an issue in that the State is engaged in providing the free preschool year. I have had major debates on the issue of rates in this House, which the State sets in every county. I acknowledge that this does not come within the scope of the Minister’s Department, but it is a cost for child care facilities. In different services in different areas of the country, charges, be they rates, water charges or other charges, differ by area, yet the State decides how much a child care facility gets paid per child, the space required per child and the number of early years educators per child. It sets all these parameters and specifies that child care facilities cannot charge parents anything extra, which I support and with which I am in agreement. Different child care facilities, depending on where they are based in the country, are viable or not viable because of external costs such as rates or other charges related to the premises. This is an issue in that the State cannot say it is responsible for all these pieces, but it is responsible for the setting of rates. It is an area we need we need to revisit and in respect of which we need to look forward.

We need to ensure that we treat all children equally, and that is why I am a big supporter of the free preschool year. I would like it extended and for the State to invest more in services. As I said when we debated the Social Welfare and Pensions (No. 2) Bill, at the start of the recession we were lectured, and I use that word wisely, to the effect that it was not about cash transfers and that the way we could improve outcomes for children was by investing directly in the services and in the infrastructure to support such better outcomes. I hope, as we see an upturn in the economy, that those words will be acted on and that we will start investing in children’s health care and education and not go back to a system of cash transfers, which we know do not necessarily deliver better outcomes for children. I would encourage the Minister to say that we need a co-ordinated approach and a single system of inspection in order that it is clear both to parents and to those running child care facilities that our intention is to improve outcomes for children. I encourage the Minister in what she is trying to do and I welcome this debate.

 

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04 March 2014: Quarterly Meeting of the Joint Committee on Health and Children, The Minister for Health, James Reilly TD, and The HSE.

Questions submitted in advance by Senator Jillian van Turnhout and response received:

Question 9: Work undertaken by the HSE’s National Oversight group

Question 10: Allowing Pronouncement of death by advance Paramedics

Question 11: Poor performance in Children’s rights alliance report card 2014

 

Question 9: Work undertaken by the HSE’s National Oversight group

To ask the Minister to outline the work undertaken thus far by the HSE’s National Oversight Group that was set up to coordinate a response to requests for day service or rehabilitative training places for young adults with a disability, and to detail particularly the work undertaken in engaging with young people who require these services and their family members.

Revised Process to support School Leavers and those exiting Rehabilitative Training 2014

In line with the Social Care Division Operational Plan 2014, a revised process is being implemented this year to ensure a more streamlined approach to the assignment of places to School Leavers and those exiting RT places. A summary of key elements of the process is outlined below:

 

  • Providing for the emerging needs of the estimated 1,200 additional young people leaving school and rehabilitative training programmes using a newly developed streamlined approach (€7m and 35 WTE) and for emergency cases (€3m and 15 WTE).

Implement a standardised process to:

  • Identify, in conjunction with the Dept of Education and service providers the young people who will be leaving school or exiting a RT Programme who have a requirement for ongoing HSE-funded supports by 1st February, 2014.
  • In respect of those identified as having a requirement for ongoing support, identify and agree the supports required, with a specific focus on responses to those who have complex service needs.
  • Identify the service providers with capacity to respond to the individuals who require support by 1st April, 2014 and agree the allocation of additional resources in respect of individual placements as required.
  • Advise the school leaver and their families of the placement location and service they will be receiving in September, 2014.  Notification of placement will commence in May and all families will be advised no later than the 30th of June.
  • Implement a communications process with all stakeholders.
  • Building on the learning from 2014 review and refine the process for engagement and implementation in 2015.

 

An important aspect of the new process has been the establishment of a National Oversight Group, consisting of representatives of umbrella organisations, representing the Disability Service Providers, service user representation and senior staff from the health service. In addition, the health service has assigned a full-time Project Lead to work to co-ordinate the implementation of the Project in 2014.

Work has been ongoing on the 2014 process since October/November 2013. The Oversight group met and agreed the timelines. A template was agreed for collection of information regarding each individual seeking to access health funded services. A letter was circulated by the National Council for Special Education to all mainstream schools to ensure that individuals with disabilities and their families would be aware of the revised process. The Health Service Guidance officers engaged with the special schools directly. The National Disability Governance Group, which includes Lead Area managers and disability specialists meets monthly and receives updates on progress.

Following the meetings of the Oversight group the Regional Disability Specialists/Disability Managers engaged with local service providers to ensure a complete profile of each individual seeking to access service was submitted.

Each application is being reviewed to establish if the applicant is appropriate to specialist disability services, has the capacity to attend rehabilitative training programme or attend day services.

In relation to engagement with service users and their families the position is that in Dublin for example Individual meetings have occurred with the following:

a) School Leavers

b) Parents/Guardians

c) Teachers/Principals

d) Clinicians/Health Care Professionals (as appropriate)

 

Continuous communication with school leavers and parents/guardians on any issues or concerns arising regarding transition from school are ongoing with the Guidance service.

I am pleased to report that the deadlines set in the Operational Plan have been met in that in excess of 1400 applicants were received by February 1st 2014. The next milestone is 31st March and Disability Services are online to meet that target date where a review of service users’ needs and current service provision will be completed.

Tbe process commenced on October / November 2013

  • We achieved an agreed approach across the disability sector.
  • We will identify and implement a prioritisation process by the end of April 2014
  • We will consider appropriate placement options by end of May 2014
  • We will advise Individuals/Parents/Guardians of placement no later than 30th June 2014

A summary of the current position is that:

A total of 1407 number has been identified, 905 school leavers, 427 RT exits work is continuing on a further 75 who have been classified as other or no category.

Throughout the engagement a range of challenges continue to arise as the process is streamlined. The process is flexible enough to address many of these however a consistent theme that is emerging relates to some locations where the physical infrastructure is at maximum capacity and alternative accommodation will need to be identified. The health service is committed to appropriately supporting this group of young people to ensure that optimum outcomes are achieved

 

Question 10: Allowing Pronouncement of death by advance Paramedics

To ask the Minister for Health/HSE to give an update on progress regarding allowing pronouncement of death by advanced paramedics (as is allowed in other jurisdictions but currently not in Ireland) as recommended by the Pre-Hospital Emergency Care Council, and on allowing pronouncement of death by senior nurses. 

 The Pre-Hospital Emergency Care Council (PHECC) is responsible for clinical practice in pre-hospital care. PHECC approves clinical practice guidelines (CPGs) for all aspects of the clinical work of registered paramedic practitioners in Ireland.

There are two key PHECC CPGs in relation to the death of a patient – for recognition of death and for cessation of resuscitation. The procedures set out in these guidelines allow practitioners to cease treatment and resuscitation where a patient cannot be revived.

Currently, Irish paramedics, unlike paramedics in other jurisdictions, do not pronounce death. After a paramedic makes a clinical decision to cease treatment, a medical practitioner is required for pronouncement of death.  I am advised that PHECC is examining this issue through the Forum on End of Life in Ireland, with a view to engaging in broader consultation on this matter and developing appropriate and recognised clinical and legal procedures to resolve it.
The Nursing and Midwifery Board of Ireland (NMBI) is responsible for specifying standards of practice for registered nurses and midwives. NMBI has developed a Scope of Practice framework to enable decision making and development of practice for all aspects of a nurses’ clinical practice in Ireland. In addition NMBI provides guidance to nurses and midwives on their scope of practice and has published professional guidance to nurses regarding their scope of practice for pronouncement, verification or certification of death. The guidance outlined the processes required to develop an organisational policy to include the appropriate clinical governance supports and the professional responsibilities and authority for nurses to be involved with the pronouncement of death in a care setting. The HSE is consulting with the Directors of Nursing Reference Group on this matter.

 

Question 11: Poor performance in Children’s rights alliance report card 2014

To ask the Minister to give an update on the worrying E Grade his Department received for Mental Health in the Children’s Rights Alliance Report Card 2014, with emphasis on a number of key areas including the need to ensure all children under 18 receive age-appropriate and timely mental health services and treatment and can the Minister advise when the Child and Adolescent Community Mental Health teams will have the appropriate provision of in-patient beds and the 150 staffing posts filled to achieve this end. 

 

The Government has prioritised reform of all aspects of mental health services in line with A Vision for Change, including additional and improved quality care for children in both residential and community based settings. Total HSE Mental Health funding in 2014 is significant at around €766m. In this context, additional funding of €90 million, and around 1,100 new posts, has been provided over the last three Budgets. This has been primarily directed to strengthen Community Mental Health Teams for adults and children; specialist community mental health services for older people with a mental illness, improving services for those with an intellectual disability and mental illness, and enhancing Forensic Mental Health services.

Key to developing Child and Adolescent Mental Health Services (CAMHS), as per A Vision for Change, is the establishment of 99 multi-disciplinary CAMHS Teams providing acute secondary mental health care in the community, including hospital liaison and Day Hospital services. In 2008, there were 54 CAMHS Teams. There are now 66 Teams in place – 60 Community, 3 Adolescent, and 3 hospital liaison mental health teams.

The additional €90m provided for mental health over 2012–14 is being used, in part, to expand and enhance the skill mix of CAMHS Teams.  Around 230 new posts were allocated to CAMHS Teams over 2012-13, and recruitment of these is well advanced.  Of the 150 posts approved in 2012, 136 or 91% are complete with 8 further posts at an advanced stage in the recruitment process.  Of the 80 posts approved in 2013, 35 or 43% are complete, with a further 18.5 or 23% at an advanced stage of the recruitment process.  In summary, of the 230 new posts approved to CAMHS in 2012 and 2013, 197 or about 85% have been filled or are well advanced in the recruitment process.  Outstanding CAMHS posts will be filled as quickly as possible.

There are a number of posts for which there are difficulties in identifying suitable candidates due to various factors including availability of qualified candidates and geographic location. Alternative approaches being considered for posts not fillable in the normal way.

Just over 14,000 referrals were received by the Child & Adolescent Mental Health Teams in 2013.  This represents nearly 1,000, or 8% more, than projected in the HSE National Service Plan 2013, while the target of 70% of referrals being seen within 3 months was maintained.

A Vision for Change recommends the provision of 80 Child and Adolescent psychiatric in-patient beds nationally.  In 2008, there were 16 such beds and at present there are 51 beds operational country-wide, with more planned.   Capacity will be enhanced also, with the completion of the CAMHS Forensic Unit as part of capital developments now underway for the National Forensic Mental Health Service, and the National Children’s Hospital. In addition, improved community based services, coupled with increasing bed capacity, are all aimed at discontinuing the practice of placing children and adolescents in adult acute in-patient units, except in exceptional circumstances.  Admissions of children to adult units have decreased by almost 60% from 2008, when there were 247 reported, to a provisional figure of 106 in 2012.

The review of the Mental Health Act 2001, already well progressed, is a key step in providing a revised and more modern mental health legislation in this country. The Programme for Government contains a commitment to review the Act, informed by human rights standards and consultation with service users, carers and other stakeholders.

The review has been delayed due to a number of factors, including the wishes of members of the Expert Group to first see details of the Assisted Decision Making (Capacity) legislation, which was published in June 2013. Due to the high level of inter-connectivity between both sets of legislation, members of the Expert Group reviewing the Mental Health Act felt it would be necessary that the Capacity Bill should be finalised before they completed their own review.

Work is continuing on the completion of the report of the Expert Group, and members are carefully deliberating, re-examining and refining their recommendations on key central issues such as consent to treatment, capacity, criteria for detention, and treatment of children under the Act. It is expected that the final report will be completed in the near future, after which its recommendations will be considered at Ministerial level.

While noting the contents of the recent report by the Children’s Rights Alliance on Mental Health services, real and significant improvements have taken place on implementing A Vision for Change and modernising mental health services across the country over the last three years.  Nonetheless, historic deficiencies remain to be addressed.  The aim is to strive for equity in providing high quality services, while balancing residential and community-based provision.  This approach has already been proven in many areas at local level. The Government will retain its commitment to mental health, and focus on up-grading all aspects of mental health care, in line with evolving service demands and resources available overall for the Health sector, for 2014 and beyond.

to move to the following access targets:

–          6 month target inpatient / day care

–          9 month target for outpatient

–          again with hospitals effecting full compliance with performance targets in the first half of the year and subsequent maintenance for the remainder of the year

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Special Olympics Ireland: Motion

Wednesday, 17th July 2013

I welcome the Minister of State, Deputy Kathleen Lynch. I also welcome the publication of the Assisted Decision-Making (Capacity) Bill because it is historic in more ways than one, but I know we will discuss it on another day.

I wholeheartedly support the motion put forward by Senator Mary Moran and her colleagues in the Labour Party. Special Olympics Ireland is a tremendous organisation and I welcome people from the organisation who are in the Visitors Gallery. I read its mission, which I am surprised nobody mentioned yet. It states: “The mission of Special Olympics is to provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community.” That is wonderful. We often read the lofty missions of organisations but Special Olympics Ireland lives that mission in its work every day and it achieves exactly what it says.
There are 26,449 people with an intellectual disability in Ireland. Just shy of 9,000 are registered athletes with Special Olympics Ireland, which clearly demonstrates its reach and the huge range of activities. I read about Alpine skiing, gymnastics and football, which put any of my sporting attempts to shame. I thought I did well at hockey in school but I may have to revise my assessment, especially given athletes like James and Cillian who achieve so much, and that is multiplied throughout Ireland.
June 2003 was mentioned. I am so proud, as an Irish citizen, that we hosted what were the most successful games in Special Olympics history which reached into every community in Ireland. One only needs to mention it and it put smiles on all our faces.

I also take the opportunity to mention another organisation which shares many similarities with Special Olympics Ireland in its pursuit to enhance the quality of life for people with intellectual disabilities. The organisation is called HeadsARTS. It is a very young organisation and its mission is to empower and enable people with intellectual disabilities through the arts. I also welcome people from that organisation who are in the Visitors Gallery. I have been privileged to see its work as a start-up social entrepreneurial organisation. It wants to become Ireland’s leading service provider of arts for people with intellectual disabilities and wants to create a trustworthy and creative environment which encourages and enables its members. It has very much learned from and is borne out of experiences with Special Olympics Ireland. It is asking if there are other options it can offer young people and adults with intellectual disabilities who may not necessarily be sports-minded.

Where are the opportunities with which we can provide them? Both organisations rely very much on volunteers, carers and parents. People with intellectual disabilities are entitled to the same opportunities as all of us in society. They should have an equal opportunity to engage in the arts as well as sports, both of which are proven to enrich our lives. I want to commend the vision of HeadstARTS. It involves three young students in DCU who could choose to do other things. If one believed everything one read in the newspapers, one would think that students were doing other things. Instead, these students have given up their time to set up an organisation. They are funded through UStart, DCU, and many others are trying to support them. It is great to see students and young people showing this initiative.

I note the Sinn Féin amendment, but this is a positive day. I want to keep it positive. We must question, however, the type of society we wish to have. That society must include organisations like Special Olympics Ireland and HeadstARTS. Their values should be our values. The State must support these organisations. Senator Moran has set out the financial case for Special Olympics Ireland. I have no doubt that HeadstARTS also has needs. Support for them would demonstrate our values as a society. While I join with Senator Moran and her Labour Party colleagues and say “Well done” to Special Olympics Ireland, we will also have to put our hands in our pockets, not just applaud them.

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Order of Business, 21 June 2011

21st June 2011

My first question is on special needs assistants because the lack of clarity is deeply worrying. We know the important role special needs assistants play. If we looked at it in a purely fiscal way we would see that we save money in the long term by supporting children in the early years to mainstream education. Special needs assistance was an indication of a major move from an old Ireland where we hid our problems behind closed doors but instead we have become a society of which we all wish to be a part. It is very important that we get clarity around special needs assistants and that children are allowed to be educated together as we would hope them to grow up in society together.

Second, I ask that the Minister for Children and Youth Affairs would update us on the national vetting bureau Bill and her intention to put the Children First guidelines on a statutory basis. That is often talked about but as we know reports will be forthcoming, not least the Cloyne report. It is a serious discussion because we make the statement that we should put the Children First guidelines on a statutory basis but in terms of the way we will do that this House could play a role in framing that.

My third question is on youth mental health. There are many actions in this area but they are not often co-ordinated among Departments. We should consider a debate to examine the various aspects of youth mental health, not just in terms of hospital beds but in schools also and the long waiting lists for children to be seen after a teacher has identified a need.