Dr. Aoibhinn Walsh:

I will address the issue of children with disabilities because it is something I see and work with every day. I want to be careful about disability because I know children born in Ireland have been waiting a long time. This is about equitable access for all children. However, there is a very different need for access and escalation of care for a three-year-old child who may be in the process of receiving a diagnosis of autism spectrum disorder who has family with an income and has housing, be it rented or supported in the system. I will give the example of the case of an eight-year-old girl I came across recently. She has come to Ireland through the international protection service. She is severely impaired with what looks to me as autism spectrum disorder with an underlying moderate to severe intellectual disability. The forms to access the community disability network team, CDNT, are very long and the mother does not speak English. We completed these for her. They moved three times to various CHOs. The mother informed us through text when she moved and gave us permission to inform the new CDNT and pass on the referral. That is a large amount of work in itself. They were in accommodation where the child performed significant self-injurious behaviour, including banging her head against the wall late into the night. There were people thumping on the ceiling and the walls to quiet her down. The mother was afraid to leave the hotel room because she was afraid people would be verbally abusive and aggressive towards her child. She could not take her outside because she had no safety awareness. One of the hotels they stayed in was on a busy national route so the child could not be brought outside. Being outside was what used to regulate her. Her behaviour escalated.

We have put together a national pathway through the HSE, signed off by the national clinical lead, to try to identify those children who need priority and would come under progressing disability services priority one access because of severe neurological impairment or significant needs. Families in hotels who do not have knowledgeable support workers in place very much rely on word-of-mouth awareness to understand how they can access disability services. There are also children who are not in appropriate schooling because their needs are not recognised.

To access other services people often need a diagnosis. This can take a long time. People are referred for an assessment. There are many members in a multidisciplinary team. To speak frankly, someone does not need to be a medical professional to identify there is the clear and significant medical or developmental need for some children. Each child having to go through the same process is transparent but there are some children who should very much be a priority with regard to being identified and at least linked with services that can prevent a crisis in care. This might involve getting a wheelchair or having an appropriate seat. I know of a case of a three-year-old child who could not support her own head to feed. She was choking and aspirating because she did not have an appropriate chair. Highlighting needs such as these should very clearly be within the remit of the CDNTs.

We frequently email the various heads and administrators trying to advocate. I have an excellent contact who has been mandated with the care of Ukrainian beneficiaries of temporary protection. I do not have a similar contact person for international protection applicants so that I can flag cases as high need. There is disparity in the care given, which means international protection children are not afforded the same level of care or recognition as Ukrainian refugees or other children born in the State. That impacts on their education and wellbeing. We cannot underestimate the effect on the mental health of care givers of living with these children with no resources, respite or even social support.