Dr. Cathal Morgan:

I thank the Deputy. I will address her really good queries. I will include my colleague, Ms Breda Crehan-Roche, because she specifically mentioned the ASD element of the challenge in the system. On the matter of why it has taken so long, the development of the progressing disability services policy, based on what we were talking about earlier, has been about consulting and bringing together children and staff to understand what is needed, examine models in other jurisdictions and agree on how best to provide child- and family-centred supports. It took time to get people to coalesce around what would be the best model for Ireland. We often look to models overseas but we need to think about how they work in an Irish context so we can contextualise them. We placed very heavy emphasis on trying the initiative out. Several regions piloted it. The mid-west and Kerry, in particular, went through a reconfiguration process. We wanted to see how the initiative worked and to refine it as we were going along. The significant changes we have been making involved multiple organisations and agencies, including the HSE, that were delivering supports in their own way, not a joined-up way. Bringing together all the entities, including the State, to agree on whether the system could be organised to make it simpler for the child and family to access one team rather than multiple organisations required a significant level of negotiation and mediation with the trade unions and other organisations on the question of how, if the child and family were to be put up front, the service could be delivered in a manner that was seamless for the children. I am delighted that we have done that. It is not perfect. I am not saying it is all rosy in the garden; it is not at all but we are absolutely on track to have the 91 networks in place by the end of quarter 2. The Deputy should note that there are over 40 in place, as distinct from 31. We will clarify where they are so she will have sight of them for herself.

I will ask Ms O'Neill to address the waiting lists initiative. The Deputy should keep in mind that an additional resource of 100 posts was given to us last year. There are another 100 posts for this year. It is not enough so we will be relying on the capacity review report to build the competency of the teams, as in having more staff come in.

The Deputy mentioned the connectivity between CAMHS, primary care services, education services, NEPS and so on. I will provide the committee with a copy of our national access policy, which I referred to before. The policy helps to determine how we assess children and stream them into the right service. That includes how children can access CAMHS because that is a key concern for us, particularly regarding behavioural supports.

The Deputy rightly identified this matter as being a significant concern for families. Behavioural management supports will be a key part of what the networks will do. Children will have access to psychology services.

ASD is a significant concern for us. We have an improvement programme that includes parents as well as people with autism. It will determine how we will develop more and better supports. It will align and dovetail well with the work being done by Ms Crehan-Roche, the chair of the initiative and the chief officer in the west. She might talk us through what that initiative is about.

There is an old phrase: "Culture eats strategy for breakfast." We can pour in all the resources we want, but if there is not a fundamental change in how clinicians work, there are no standardised norms in how we perform interventions and our system is one of assessments only, then we create a waiting list for assessment and then another for intervention. That has to stop. We must move to a scenario where children are on an intervention pathway from the get-go. Assessment is ongoing. Professor MacLachlan has a great deal to say about this matter because he will be leading an initiative on how we might work with clinicians on doing things differently with children and families.

To summarise, there are two elements: the autism programme board and capacity building among clinicians. Ms O'Neill might discuss the assessment of need element.