Ms Rosalind No?l:

We propose a framework for achieving change in how services and supports provided by the State for autistic people are delivered based on the following points: equality, mainstreaming, neuroaffirmative approaches, and a lifespan perspective.

Beginning with equality, the autistic community should have equal access to all aspects of health services in the same way neurotypical people do. Barriers to accessing services based on a diagnosis of autism need to be removed. It is not uncommon for a service to refuse a referral because a person has a diagnosis of autism. This contravenes the principle of equality in the provision of services and supports by the State. There is a wealth of evidence showing autistic people can have other health needs for which they seek to access services. The current practice of excluding citizens on the basis of an autistic diagnosis is discriminatory and hard to justify within a human rights context.

Moving to the area of mainstreaming, most health services are built and delivered with a neurotypical person in mind. The term "neurotypical" describes individuals who display typical intellectual and cognitive development. Individuals who are neurotypical develop skills, such as social or organisational skills, at around the same rate as others their age and in their culture. The term "neurodivergent" describes people whose brain differences affect how their brain works and includes autistic people and others such as those with attention deficit hyperactivity disorder, ADHD, dyslexia and dyspraxia. Our health services, and indeed all public services, need to be reoriented so they become inclusive of the needs of neurodivergent people.

We advocate for this mainstreaming approach whereby all health services become autism-friendly and inclusive of autistic and other neurodivergent people. An example of mainstreaming in action is the town of Clonakilty, which has become an autism-friendly town. Staff in businesses, shops and public services are trained to be accepting of autism and deliver their services in a way that caters for autistic people.

An example in our health services where mainstreaming would make a real difference is in acute services and emergency departments. The way emergency departments currently operate means that they are highly challenging environments for autistic people to be in at a time when they need those services most. Current overcrowding and other service pressures further exacerbate this problem. An example of where the health services have taken a mainstreaming approach that works for a particular group of people is dementia-friendly emergency services. From the point of access to an emergency department, the service is tailored to the specific needs of someone with dementia and therefore provides for better health outcomes and a much better experience of using the service. Occupational therapy is at the forefront of developing and delivering dementia-friendly services. With this experience and collaboration with the autistic community, the occupational therapy profession is well positioned to assist the State in delivering health and other public services in an autistic-friendly way.

I turn to neuro-affirmative approaches. The medical model focuses on finding a cure for disease and disorders. This approach assumes that a person is broken in some way that needs to be fixed. The aim is to improve functioning, so doctors focus on making someone more whole or giving them a normal life. The medical model has historically shaped the way health services were designed and delivered in Ireland, as well as the way we understand human nature itself.

Using a neuro-affirmative approach means that we do not view autism as something that is wrong with a person or that something is broken or needs fixing. Instead, autism is accepted as a different neurotype - the way your brain works - that is a part of human diversity. AOTI advocates for a neuro-affirmative approach to the design and delivery of all health and public services in Ireland. A neuro-affirmative approach to health and disability services works on the assumption that autistic people have an innate potential and identity that can best be actualised by providing person-centred, neuro-affirmative services and supports.

The world is designed for neurotypical people, which, in turn, disables autistic and other neurodivergent people. A neuro-affirmative approach requires us to re-orient how we design and deliver public services and restructure our communities so they enable, rather than disable, autistic people and support their full participation in everyday community life.

I refer to the lifespan perspective and cradle-to-grave health services. Early intervention and assessment is essential in order for autistic children and their families to get the supports and intervention that will best enable the autistic child to reach their potential. Occupational therapy is one of essential services delivered at this crucial stage. Autistic people may continue to benefit from occupational therapy and other health and social care professional services throughout the lifespan. These essential support services must be provided by the State.

I turn to play and leisure. Play is an essential component of childhood and child development. Occupational therapists understand the importance of play and leisure participation in people's lives. It is a priority for the occupational therapy profession that autistic citizens have equal access to play and leisure opportunities. Play for autistic children can look different from neurotypical children’s play and we need to move to accepting and supporting this. Autistic children can be excluded and marginalised in mainstream leisure and play facilities and clubs through lack of acceptance, poor infrastructure and availability of supports and services.

Given the importance of play, we need a recognition of the right to play in the home, in the community and in school. We need to develop inclusive play and leisure spaces so autistic children and young people are not excluded in their communities.

At an individual level, supporting autistic sensory processing and regulation can be a key factor to enable participation and engagement, and this is something occupational therapists are experts at. AOTI also calls for an urgent review of Ready, Steady, Play, the national play policy, as this policy was published in 2004.

Supporting autistic students in education to ensure they reach their potential and thrive within the educational system is a key role for occupational therapists. A lack of supports within the education system poses significant challenges for autistic students. They often experience environmental barriers to social participation in education, such as lack of acceptance and negative attitudes among peers and staff. In addition, inadequate support across the school system, as well as support in managing educational transitions, such as from primary to secondary, further limit the educational potential of autistic students.

Progress is being achieved by the National Council for Special Education, NCSE. We know the committee is aware of the NCSE and its work. Being able to expand and further develop the NCSE's supports in schools is essential so that autistic students can benefit from occupational therapy intervention as well as other HSCP services. This will help create a more inclusive and enabling school environment for autistic children. An expansion of the occupational therapy role is advocated to address educational environments, especially the social, physical and policy aspects, to promote social participation and inclusion of autistic students. Occupational therapy can help reduce the segregation of autistic students throughout their educational journey.

Occupational therapy is now recognised as a key support service for students in higher education and many Irish universities now directly employ occupational therapists on campus to deliver services when needed by students including autistic and other neurodivergent students as well as those with physical and sensory disabilities and mental health difficulties.

Work and employment are very important parts of autistic people's lives, and occupational therapists work with both autistic individuals and employers to support active participation in the workplace. On an individual level, autistic people may benefit from support with managing disclosure, accessing reasonable accommodations and developing strategies to manage their worker role and responsibilities. Workplaces can benefit from a universal design approach to support participation for autistic employees.

Occupational therapists are skilled in universal and inclusive design and are at the forefront of driving efforts to re-orient work environments, including physical and virtual spaces, so they accommodate the needs of autistic employees. Occupational therapists use adaptive strategies, tools and technologies across the lifespan to help autistic people enter and remain in the workplace. Our workforce can be greatly enhanced through the inclusion of autistic people in workplaces.

In the area of health management, occupational therapists play an essential role in supporting autistic individuals to manage their health and well-being across the lifespan. As dual-trained health professionals, occupational therapists can also help autistic people with the psychosocial and mental health impacts of living with autism. Occupational therapy can help autistic adults meet their long-term mental and physical health needs, maintain a good quality of life and achieve a state of well-being and satisfaction with everyday life.

In conclusion, our statement was informed by occupational therapists working in different practice areas with autistic individuals across the lifespan, as well as occupational therapists working in education and research. We have set out some of the key values and principles that AOTI believes must be central to the analysis of services and supports provided by the State for autistic people. We have also set out a framework we believe is necessary to achieve change in how services and supports provided by the State are delivered to autistic people. This framework focuses on: equality in all service delivery; re-orienting mainstream services so they become inclusive of the needs of autistic and neurodivergent people; taking a neuro-affirmative approach in the provision of health services and other public services; and taking a lifespan perspective.

We thank members for the opportunity to meet them today and value their detailed consideration of this important matter for Irish society. We look forward to discussing this further with them today and welcome any questions they may have.