Maurice Quinlivan (Limerick City, Sinn Fein)
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Apologies have been received from Deputy Liam Quaide and Senators Nikki Bradley and Laura Harmon.

The purpose of today's meeting is to continue discussion on inclusive education for persons with disabilities. On behalf of the committee, I extend a warm welcome to Ms Anne O'Rourke, educational psychologist; Ms Áine Lawlor, chairperson of the Irish Association of Speech and Language Therapists; Ms Claire Mortell of the IASLT professional standards standing committee; Ms Caroline Walker-Strong, chief operations officer of the Irish Association of Social Workers; and Ms Aisling McGrory, senior social worker and IASW member.

Before we begin, I will read a note on privilege and housekeeping matters, as I always do. I remind all witnesses of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, I will direct them to discontinue their remarks. It is imperative they comply with any such direction. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege. I remind members of the constitutional requirements that, in order to participate in public meetings, members must be physically present within the confines of the Leinster House complex. Members of the committee attending remotely must do so from within the precincts of Leinster House.

I am aware that a wide range of issues will be the subject of discussion today. If necessary, witnesses and members can send further and more detailed information on certain issues raised to the clerk of the committee for circulation to members.

I call Ms Anne O'Rourke to make her opening statement. She has five minutes.

Ms Anne O'Rourke:

I thank the Chairperson, Deputies and Senators for inviting me to meet them to discuss inclusive education. I am an educational psychologist working part-time in private practice in Galway, offering consultation and educational psychology services. I am also a family caregiver and am here in a private capacity. Prior to working in private practice, I worked as a senior psychologist with NEPS for the best part of 20 years. I also spent 17 years as a teacher in mainstream and special education settings in Ireland and the UK. There is a broad range of topics for consideration by the committee. I will do my best to touch on as many as I can within the time allowed.

I welcome the commitment made by the Department of Education and Youth as part of the National Human Rights Strategy for Disabled People to develop a roadmap for inclusive education underpinned by the vision incorporated in Article 24 of the UNCRPD. Understanding the broad system of support is complicated due to the different models used to identify need for intervention and to allocate resources. A medical model identifying disability with a focus on deficit and within child factors seems to be the model that underpins services and resources in the HSE and the Department of Social Protection. It also comes into play when applying for special class or school placements and, currently, for funding for assistive technology in education. In these instances, the criteria outlined in Department of education circulars based on the disability categories in the SERC report from 1993 must be met.

In contrast, for access to all other supports and resources within education, a holistic and biopsychosocial model is used whereby the strengths and needs of learners are identified and schools are front-loaded with SET and SNA support to meet the children’s identified needs without the need to have a professional report or diagnosis. The continuum of support is the educational framework used by schools to identify, plan for and respond to the needs of learners with SEN. This model is needs-led, flexible and responsive and does not put the burden on parents to have a professional report or diagnosis to access support.

In my view, a needs-led approach should be extended to all aspects of supports for children with additional needs, including education settings. Parents frequently mention the difficulty in finding information about services, the ongoing struggle to access assessments and supports and the extensive paperwork required. Many feel that an AON is the only way to secure supports, but there is no guarantee as to when an AON will take place or when the supports will be provided. Recently, parents have asked me to do assessments to secure special class placements at junior infant level, fearing limited availability at post primary. Others, whose children are doing well in mainstream, are concerned about future access to SET, SNA, SLT, OT or other supports, and believe special schools may offer better access when the NCSE in-school therapy initiative begins. It is essential that this scheme also provides in-reach services to special classes in mainstream schools and is rapidly extended to all schools. It could be possible to identify some children who require a special class setting or a special school placement using a needs-led approach based on their response to intervention and the continuum of support. This might result in a more flexible approach to special classes where children have opportunities to be included in mainstream classes from time to time if that is appropriate. Also, if special schools were co-located with mainstream schools, children in special schools would have better opportunities to be included in the mainstream setting, again, subject to their needs and strengths.

While in NEPS, I worked at primary and post-primary levels in urban and rural settings with responsibility for the provision of educational psychology support to between 30 and 46 schools in any given year. In my experience, schools value NEPS as a school-based service that, in addition to casework with individual learners, provides support and development work, consultation, and evidence-based training programmes for teachers, in areas such as trauma-informed practice and managing anxiety. They are also valued for facilitating the sharing of best practice and the rapid response to critical incidents. NEPS has a broad remit and supports the well-being, inclusion and participation of all learners, but the pupil to psychologist ratio in Ireland is much higher than in other countries. There is an obvious need to increase the number of educational psychologists in NEPS to align with the numbers in other countries so that service delivery can be optimised for schools, learners and their families. NEPS would also be supported through the introduction of an assistant educational psychologist role.

There is a huge need for dedicated time for special education-related administrative tasks, for continuous professional learning opportunities for all teachers to support inclusion and a higher level of training on SEN in pre-service teacher training at both primary and post-primary levels. In summary, we need a model that appreciates the unique strengths of every learner, a clearer definition of inclusion, better family support, early and responsive interventions, enhanced NEPS resources, enhanced teacher professional learning, expanded in-school therapy and skilled support staff. These measures will help ensure all learners experience true, meaningful inclusion in our educational settings. I look forward to contributing to the debate.

Ms Áine Lawlor:

The Irish Association of Speech and Language Therapists welcomes the opportunity to contribute to the national dialogue on inclusive education for people with disabilities. We strongly advocate for a system that upholds the rights enshrined in Article 24 of the UNCRPD and advances the targets of ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all. Genuine inclusion is more than just placing children with disabilities in mainstream classrooms. It demands meaningful engagement, tailored supports and a deep understanding of each child’s unique strengths and support needs. Inclusion that is merely surface level falls short. What truly matters is whether the child can actively participate, learn, and flourish within their educational environment and that they have the right supports to achieve this.

The EPSEN Act has yet to be fully commenced and recommendations from the Disability Act 2005 have also yet to be enacted. It is important that we move away from a system that requires diagnostic labels before children can access support, and yet critical that supports are tailored and available for individual needs. We urge the committee to advocate for legislative and policy alignment to ensure that inclusive education is not only aspirational but actionable. Accurate and timely identification of disability is critical to ensuring that children receive the supports necessary to thrive both educationally and developmentally. Disability services have been under considerable pressure, with long waiting lists, limited resources and fragmented access to supports, with families often facing prolonged delays in receiving essential therapeutic supports. This results in many children commencing school without their needs having been recognised, leading to systemic obstacles in accessing appropriate placements, therapeutic supports and sustained interventions. To uphold the rights of children with disabilities and meet statutory obligations, a co-ordinated, well-resourced and integrated approach to appropriate therapeutic support is imperative.

IASLT welcomes the development of therapy in schools, which represents a shift from the previous service delivery frameworks under the NCSE. Embedding therapy provision within the school environment makes supports more accessible, responsive and inclusive for children who need them most. It is important that there is a commitment to appropriate multi-annual funding to ensure this service can move beyond special schools and into special classes and mainstream schools. While IASLT recognises that the implementation of a new model will bring operational and strategic challenges, we have been encouraged by early engagement and are committed to working collaboratively with stakeholders, including the Department of education.

In order to ensure sustainability and impact, speech therapists and all clinicians linked with a child must operate within an interconnected framework that transcends sectoral boundaries. This requires collaboration between the Departments of Health and education, creating a system where joined-up thinking is the norm, and every child’s communication needs are met through seamless co-operation across sectors.

This includes transition planning. A child’s identified needs and supports must remain consistent and responsive throughout their educational journey. Every child deserves supports during transitions to new schools and into post education or employment. Transition planning should be a continuous process with adequate resources, from early childhood to post-school life. I now hand over to Ms Mortell.

Ms Claire Mortell:

With regard to assistive technology, Article 21 of the UNCRPD protects the right of all people with disabilities to communicate by whatever means, modes or formats they choose. Yet, lack of access to appropriate augmentative and alternative communication, AAC, pathways and speech and language therapy expertise means this right is not being upheld. Providing an AAC system is only the start. Each child requires individualised SLT interventions to ensure their device grows with them, and to support their communication partners. Without this, AAC systems may be abandoned, which is financially costly, but ultimately costly in terms of lost opportunities for communication, leaving inclusion unrealised and communicative potential unfulfilled.

Universal design is also critical. Inclusive education requires intentionally designing environments, curricula, instruction and communication systems that are accessible to all learners. Speech and language therapists play a vital role by integrating communication supports including visuals, multimodal strategies and inclusive classroom environments. By collaborating with educators SLTs have embedded communication accessibility into everyday classroom practice. When communication supports are embedded within universal design for learning frameworks, all learners benefit, fostering authentic inclusion, promoting communication equity and affirming the diverse ways pupils express and understand language.

Ireland's current education system remains misaligned with the principles of inclusive education, where access to supports is often contingent on clinical categorisation rather than individual need. Every child, regardless of communication profile, sensory processing difficulties or support requirements, has the right to an education that is inclusive, affirming and developmentally responsive. This means recognising and valuing diverse ways of communicating, engaging and learning. Inclusive education requires resourcing, training and accountability. Appropriate funding is essential to expand therapy services in education, extending beyond special schools. Robust service models, governance and evaluation alongside an interconnected framework between the Departments of education and Health are required. Specialist AAC pathways must be fully funded and implemented aligned with UNCRPD commitments.

Maurice Quinlivan (Limerick City, Sinn Fein)
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As Ms Mortell is running out of time, I ask her to wrap up. The rest of her statement will be on the website.

Ms Claire Mortell:

The allocation of special needs assistants in primary and post primary must reflect inclusive education principles, providing support for communication, regulation and participation to ensure the provision of inclusive education for children with disabilities.

Ms Aisling McGrory:

I thank the Chair and members of the committee for the opportunity to address them on behalf of the Irish Association of Social Workers and to contribute to the discussion on Article 24 of the UNCRPD, specifically as it relates to inclusive education. I am speaking in my capacity as a senior social worker with a children’s disability network team. I am on a special schools team. I am joined by Ms Caroline Walker-Strong, chief operations officer of the IASW. Social workers witness first-hand the critical role that parents and carers play in ensuring children and young people with disabilities can access their constitutional right to education. Positioned on the front lines in homes, communities, respite, residential services and schools, we are uniquely placed to support families, and to recognise and advocate for the services they need.

Social workers play a vital role in helping families navigate complex systems across health, education and social care. We provide a clinical assessment of family needs. We support families to understand their rights, accessing services and advocating for their needs. Through a consent-led, strengths-based, collaborative approach, we provide support across all stages of care - prevention, intervention and outcome management. Social workers recognise there is a family behind the child.

We want to highlight the significant challenges faced by families caring for children with complex disabilities. There are hundreds of children with disabilities who do not have access to full-time school placements. These children are often excluded due to behavioural, sensory or medical needs that schools are unable to accommodate. We are aware of increased numbers of children with disabilities who have been expelled due to the complexity of their needs, including children who have been suspended and expelled from special schools. When this happens, families and carers are left to manage alone without adequate support from either the education support services or health system. There is no integrated system to wrap around the child and the family.

Families report feeling isolated and overwhelmed and are unsure of where to turn. The lack of co-ordination between education and health services means that when a child is out of school, there is no automatic pathway for clinical support, respite or structured alternatives. Parents are left to manage complex behavioural, sensory and medical needs without guidance or relief. In these situations, the children are often seen as the problem, not the system. While progress has been made, including an increase in SNA supports, special schools and special classes, significant challenges remain. When a child is excluded from school, whether formally or through reduced timetables, the impact extends far beyond the classroom. Parents become full-time caregivers, educators and advocates. Often, parents have a number of children with additional needs who require support. Many parents are forced to leave employment, reduce working hours or rearrange their entire lives to meet their child’s needs. In many families, siblings often take on caregiving roles, becoming young carers, which can affect their own well-being and development. These situations can result in long-term consequences for financial stability, mental health and family cohesion, the risk of which cannot be underestimated and has had detrimental consequences and impact on the child and the child's family and siblings.

Home tuition is often presented as a solution for children out of school, but for children with complex needs, it is rarely viable. Many children require structured environments, therapeutic input and peer interaction, none of which can be replicated in a home setting. Parents report lengthy delays in accessing home tuition, inconsistent provision and tutors who are not trained to manage complex behaviours. This is not in keeping with Article 24.

While mainstream guidelines for transport suggest a maximum travel time, no such standard exists for children with disabilities. Some travel over an hour each way to attend their existing school, while others are forced to change schools or face delays in securing any school placement at all. We are aware of cases where children are required to travel long distances, for example, Athlone to Dublin, to maintain a school placement, which is over 250 km a day. These disruptions are especially difficult for children who rely on routine, familiar environments and consistent support.

The deadline to apply for a special school class or special school place was brought forward this year from February to October. The advancement of the submission deadline to 1 October for notifying the NCSE about the need for special classes or school places put additional pressure on the relevant services to complete assessments on time. It has also increased stress and confusion for parents, caregivers and educators. Additionally, they must engage in emotionally difficult conversations without adequate time to process often unexpected and overwhelming diagnoses. Notably, this deadline applies only to children with disabilities.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Ms McGrory's time is up. In fairness, she finished rapidly.

I invite members of the committee to put their questions. When I call members to speak, they should adhere to the agenda and items scheduled for discussion. Each member has seven minutes. There is a rota in place. If there is any extra time, we will have a second round. The first member up is Deputy Toole.

Gillian Toole (Meath East, Independent)
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I thank the witnesses for being our guests and for the work they and their members do across the full continuum, with older people as well as with children. I come from a healthcare background, so I am familiar with their different disciplines. I thank them for the information they provided in advance. It was highly informative. I would nearly go so far as to say that we nearly have the blueprint, but I have some questions.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The clock is not working. I will do the time.

Gillian Toole (Meath East, Independent)
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I apologise, as I may have to nip out in a little bit.

The common thread is the interconnected framework. How do the witnesses see that playing out? Were they consulted by the NCSE in advance of the change of the enrolment deadline? I appreciate these are probably random questions, so I apologise.

On assistive technology and communicating by whatever means, I first came across spelling to communicate or rapid prompting method, RPM, about three years ago and have spoken with the HSE about the possible trialling of same. Are the witnesses aware of that? Are they aware of any studies that may be available in relation to providing an evidence base for that methodology?

On recruitment and robust retention strategies, that matter is a common theme across the witnesses' different professional roles. How do the witnesses see robust retention apart from pay parity for section 39 workers? Do they have other ideas in relation to retention, for example, a two-to-three-year retention period post graduation before possible emigration for experience?

Respite is an area of particular interest. How much co-ordination and collaboration takes place? The HSE is the common denominator in all of this and now more recently the Department of education, in particular special education. What co-ordination currently takes place and how can that be improved?

Ms Caroline Walker-Strong:

I will answer the last question on respite care. The assistive technology aspect might be answered by my colleagues from IASLT.

On respite care, what our members are saying to us very clearly is that, by the time a respite care placement is sought by a family, they are usually in crisis. The collaboration that happens is happening in an emergency situation where a family are completely on their knees and exhausted and are reaching out for services. It needs to be done in a more planned and thought-through way for equal access to respite services across the country. We are finding that there are pockets where it is quite well serviced and there are pockets where it is difficult to get a placement. Those respite places need to be tailored for the needs of the children who are going into them because sometimes we find that a child may need a placement on his or her own, which is referred to as "bed blocking". This is not helpful because the child is not the issue there. It is the system around the child that needs to be addressed. We have had communication with the HSE about respite care. We will welcome an engagement with it about respite care in the coming weeks. We have been raising this as an issue going back as far as when Senator Rabbitte was Minister of State to address the respite care piece.

On recruitment and retention, particularly in the area of social work, there is a lot of work being done at Department level to try to address that. There are new educational streams that have come on board, notably the apprenticeship scheme in UCC. Most of the Departments now support bursaries and other types of mechanism to encourage people to engage in social work. In the IASW, we are working on improving the profile of social work and why it is a worthwhile profession to get into.

Ms Claire Mortell:

I am going to take the issue of recruitment and retention and link that with the interconnected framework because they go hand in hand. We need to acknowledge that there is a shortage of health and social care professionals nationally, not only within disability services. While CDNTs are facing recruitment challenges, we know that is not the case for every team. There is some strategic planning that needs to happen for specific CDNTs where retention or recruitment appears to be a significant challenge while we have other teams that are able to recruit quite successfully.

There is definitely space to do more investigation into the challenges and why they might arise.

We absolutely welcome the opening of more university placements in order to have more recruitment of SLTs, but we also need to acknowledge that we need to make the disability services sector an attractive one in which to work. To do that, we need to take the learning from what we have seen to date, and feedback from our members who have experienced difficulties working within disability services, particularly children’s disability services, that highlights that robust clinical governance structures were not in place from the outset. They felt unsupported in their work and that they were carrying additional risk, and that led to a lot of burnout and poor retention. Moving forward into a therapy support service in education, we need to take the learning from the feedback.

Additionally, our members continually highlight that they want to do the work that they were trained to do, and that is to work directly with the children and families. It entails considering the model of service and ensuring we are getting down to where we want to be, working directly with the children and families. That leads to the matter of the interconnected framework. If we have two systems, with therapists working with schools and therapists working on our CDNTs, it is already a very confusing system for families to navigate. They ask whether they now have two speech and language therapists and who does what. There needs to be very clear direction for the therapists working in education and those working on CDNTs. We need to examine our resources because we know that recruitment and retention comprise a challenge. We need to make the best use we can of the resources we have, and that is going to take a lot of work. This means examining what the schools and CDNTs are providing and asking whether, if there are children accessing therapy in school, it means the CDNTs can put more emphasis on early intervention services and children who are not able to access school. There is just a lot of work that needs to be teased out. We very much welcome it. We have been involved in the early stages of the discussion, which was most welcome, but we need clarity on the roles and responsibilities. A very specific framework for working between health and education is critical.

Ms Áine Lawlor:

We should have some examples of joint working and how we do it. It is important to take the learnings because it is not necessarily novel to build around a child a team that can appropriately intervene and share the roles. It is a matter of the clarity.

We were asked about AAC and a specific approach in terms of Spelling to Communicate. It is particularly important to note that one specific approach is rarely appropriate for all children. As a professional organisation, we would be advocating clinically for access to robust assessment, appropriate support and equitable access to services. It is about more than just giving a child an AAC device; it is about giving them access to communication support for them and their communication system, but also support for their language development. That is an ongoing process that requires development.

Margaret Murphy O'Mahony (Fianna Fail)
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Ms Walker-Strong, Ms McGrory, Ms Lawlor, Ms Mortell and Ms O’Rourke are very welcome here this morning. I echo my colleagues’ comments in thanking them for the great work they do. Fair play to them. I have just a few questions.

With regard to speech and language therapy, therapy done in school is obviously the way forward and the plan. This is being rolled out in some schools on a trial basis. Could Ms Lawlor and Ms Mortell recommend anything before it is rolled out everywhere?

Ms Áine Lawlor:

We have met officials from the Department of education on the recommendations. Certainly, our learning from the roll-out of PDS has been important in terms of an appropriate governance structure and the consideration of the model of service delivery. A key recommendation concerns how we are going to joint-work children. There are children for whom it is appropriate that their needs are met in an education setting with the team, and there will be children who have health needs that transcend the school setting. It is a case of ensuring the joint-working protocol is very clear and that we are not hampered by two Departments saying they cannot communicate with each other, the result being families not knowing how to proceed. Those are probably our key recommendations.

Margaret Murphy O'Mahony (Fianna Fail)
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A joined-up approach.

My next question, on social work, is for Ms Walker-Strong and Ms McGrory. I am delighted to hear that they involve the families of children with additional needs. They are often forgotten. There will be siblings and parents of children whose lives have turned out much differently than what they had hoped for or expected. How early do social workers get in touch with a family? If a child is in for an assessment, do the social workers get involved straight away? Do they see the child and family through the whole education system, or is there a cut-off point?

Ms Aisling McGrory:

I can take this because I have been involved in CDNTs and I worked through the PDS when it was about early intervention. I have also worked in adult disability services. Referrals to me might come from a school or parent or from the CDNT team. Irrespective of whether a referral is from a parent, PHN, doctor or school, it might contain something that triggers me or my manager to say the family concerned could do with social work support – a wraparound service that involves going to the house, seeing what is happening, what services can be applied for and how to make the family’s life that bit easier.

As has been said, when families get these diagnoses, they are often not prepared. They are unsure about the future and what it is going to look like. They wonder what will happen when the child turns 18. It is about what the various transitions, initially at birth and then when starting school, moving to secondary school and moving to third-level education, look like for them. Our involvement depends on capacity. My role is within the special schools team. Anybody eligible for the two special schools where I come from in Donegal could have access to the team. I am the social worker on that team. Regarding the other children in respect of the CDNT, it depends on the social worker on the team. We also have social care workers, and they are very involved and might also pick up cases. When they feel there is a higher level of need, the social workers can get involved with the families.

We have been doing very specific piece work, and that is why I advocate for social workers for the teams on the new pilot projects. Initially, it will involve OTs, SLTs and behavioural therapists, which are 100% needed.

I too echo what my colleagues are saying about the communication issue. We find that if you have therapists within the Department of education and therapists in the HSE, or whatever service they are employed in, you have issues around sharing information and data protection systems. In CDNTs, we have an online system being rolled out. It is an information management system, which means your manager can go on and that psychology and social work can go on, and then you can actually talk to a family about the services, what is happening, the referrals, who the family has seen, the relevant therapies and the plan in place.

Often families find this very overwhelming. We know the system, the HSE, the schools, and the various systems we are involved in, but families do not and struggle to navigate. There is a changing population, too. There are many newcomers in Ireland and our schools, which means working with interpreters. A lot of the families concerned are not familiar with our systems and where to go.

Margaret Murphy O'Mahony (Fianna Fail)
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Could Ms O’Rourke state how long an assessment takes ordinarily? Are there long queues?

Ms Anne O'Rourke:

A lot of schools already do very robust screening and assessment of children in schools, at both primary and post-primary levels. There is already a lot of data on children gathered in schools so schools can put resources and programmes in place. Is the Senator talking about psychology?

Margaret Murphy O'Mahony (Fianna Fail)
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Yes.

Ms Anne O'Rourke:

When I worked in NEPS, we were given the broad guideline that one assessment would take about a day and a half of a NEPS psychologist’s time. This is a huge investment of time when a psychologist might cover 30 or more schools. In my private practice, it is generally a parent-led assessment. When I meet a child, the actual assessment part takes roughly two hours, and then I may spend up to an hour and a half talking to the parents about it. Before I see a child, I will have gathered a lot of data and information from both the parents and teachers. If I were to say one thing, it would be that we need to include the voice of the child where possible.

One simple thing I thought of last night was that we do a census every year and we could put a question into the census for children to give their opinion or view on some aspect of education and how they think it could be improved. That would be a simple thing.

Another simple thing to get the voice of the child and to get a wonderful record of a child's development, in primary school in particular, is if in addition to the end of year school report card, there was a one-page document the child filled in where they drew a picture of themselves, you would have a sample of their handwriting, what they like, what they do not like, how a teacher could help them and what they would like to learn. That piece of data is missing sometimes from the assessment process.

The assessment of need, AON, is a different ball game, generally speaking, for a NEPS psychologist. Then you would have more complex cases that could take days and days of their time if they were doing an assessment for an individual child, because they will always put in the time required.

Margaret Murphy O'Mahony (Fianna Fail)
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Thank you.

Maurice Quinlivan (Limerick City, Sinn Fein)
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We now move on to Senator Clonan, who has seven minutes.

Tom Clonan (Independent)
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I apologise, because I had to attend the health committee meeting this morning and I have to return. Apologies, I do not mean to be rude and in that context, forgive me if my questions are redundant because I am at a disadvantage in not having heard either the presentations or the questions and answers previously.

Taking up the question of assessment of need because it is great to have members of the multidisciplinary team here in front of the committee. In other jurisdictions an assessment of need is routinely carried out for all disabled citizens. In fact, in other jurisdictions in the European Union and places like Australia, an assessment of need will be repeated every two or five years, depending on the developmental stage of a child or young adult. Since this Government has come into power, I have heard interviews given by the Minister of State, Deputy Naughton, for example, on Virgin Media's morning programme where she suggested the right to an assessment of need in the Disability Act is causing all the problems in providing services for disabled children. She asserted in her interview that it was so time consuming and using up so many resources that the assessment of need was the problem and was getting in the way of providing services.

I also heard the Minister, Deputy Foley, in her remarks, state the Government in this term will revisit the right to an assessment of need. My own view on this is every child should have the right to an assessment of need but they should also have a right to everything set out in that assessment of need within the therapeutic timeframe. That is my question for the witnesses. Do they believe we should revoke the right to an assessment of need or would they be of the view that it is routine? It is best practice in other jurisdictions so why are we not doing it here?

Having the therapies on site in an inclusive educational setting is consistent with the social model, but regarding the basic medical model, I have been informed that, at present, there are no speech and language therapy services or therapists in the Central Remedial Clinic, CRC - none. Is that reflective of the general situation regarding recruitment and retention, and do the witnesses have any observations as to why that might be the case?

Ms Áine Lawlor:

I might start with the Senator's assessment of need piece. Currently, we have a bottleneck in the system. We have not matched funding and resourcing with the needs of children who need to be assessed. We advocate, and I think that is in our statement and is certainly shared by a lot of our health profession colleagues, that children should get an assessment when they need it. Creating a system that assesses children just at set times continues to create bottlenecks for children. There needs to be access to assessment in a timely manner, perhaps at their transition to or when things become difficult in school, and certainly earlier access to assessments.

There is a continued issue for families and clinicians on the ground trying to navigate long waiting lists, access to services and trying to utilise assessment of need to do that. In many areas, this has become a way to at least identify their need and that they are there in the system. That continues to apply but we do not have a matching resource for it, which continues to be a problem. While we have reduced and removed many diagnostic barriers to access it, because people are on a waiting list and cannot get access to a speech therapist, an occupational therapist, a psychologist or a diagnosis to identify their needs, they are going to use assessment of need to do that because of these vast waiting lists and the inability of access. This is not only their assessment but also the consequent intervention the child should have access to.

It is a continued problem that is only increasing and will do so until we can manage waiting lists to intervention. That requires resourcing and ties into the Senator's question on therapists within the CRC. We continue to see an issue with access to health and social care professionals. It is not the sole issue. There is a retention issue, but also a significant barrier to recruitment that has been the implementation of a pay and numbers strategy which has significantly impacted employment, certainly in primary care and CDNTs. A significant timeline to get a therapist in post is also what we see and hear from our members all the time.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Did Ms O'Rourke want to come in there?

Ms Anne O'Rourke:

I was watching Cara Darmody recently in the debate here. There are 15,000 children, I gather, on waiting lists and potentially 25,000 by the end of the year. If the resources were there to have all those assessments done privately, that would cost something in the region of €625 million. What could we do with that amount of money to put in resources for intervention to support families, children, parents and schools? There are potentially many children on the AON waiting list who are there for the very reason Ms Lawlor said, because parents think it may be the only way to get supports.

With regard to the Department of education and NEPS, the continuum of support is a very robust process for supporting children. I remember back in the day in NEPS when the whole thing of IAP versus continued support was being put in place. Since then, NEPS has had the time to put in a strong framework which is, in effect, the same as an IAP process except it is not under legislation. Most children will have a review in school of their continuous support plan at least once if not twice a year.

We need to look at the systems we have and what can be done better. There is a Japanese saying that if you get on the wrong train, the sooner you get off the better because the longer you stay on it, the farther back you have to go and the more expensive it is. I think that is where we are potentially with the AON process and the review of the legislation.

We also need to bring the language we use in line because we use "disability" and we use "additional educational needs". We need a conversation around what is most appropriate in an evolving society for the language we are using.

Tom Clonan (Independent)
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Thank you very much. I will just say as a parent of a now adult with a disability, he has never had meaningful speech and language therapy intervention. He has never had meaningful physiotherapy. He has never had any proper interventions and, as a consequence, it has had suboptimal outcomes for him.

I was in Germany last week in Mannheim meeting our counterparts there, and at a federal, state and municipal level, German citizens enjoy full access to assessment of need and all the supports and therapies they need because it is based upon rights put into their constitution in 1974. We are 51 years behind and it is my view that it is back to first principles. The only reason people get an assessment of need is because they have a legal right to it, and I would say we need to have the legal right to all the therapies and supports. The Government will then be led by the nose and will resource it.

I thank the witnesses and apologies for my having to leave.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The next person to speak is Sinn Féin's Deputy Ó Murchú with seven minutes.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Gabhaim buíochas leis an gCathaoirleach. Tá fáilte roimh na finnéithe go léir anseo. One of the reasons for this meeting was on the basis that the autism committee would have met with a number of the organisations before. We had the issue where the State had attempted its alternative to assessment of need which did not work out very well, and I was taken by the fact that somebody said that what many of the experts had said was there would have been no conversation with the witnesses' organisations on that. It is fair enough to have a conversation on everything from assessment to therapies and best practice. I think we are all won over on in-school therapies. My fear is that, for those in special schools, applications to those schools will go through the roof.

I also get that we have not had the real conversation. Sometimes there is a fear around whether these therapies will be based completely in the school setting and will not involve parents. None of that particularly works.

I will ask a straightforward question. What would best practice look like with regard to assessments and therapies, when we are starting from here and not from the perfect place where we have a whole set of in-school therapies?

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Deputy. Who would like to take that?

Ruairí Ó Murchú (Louth, Sinn Fein)
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We are all afraid of moving from the AON and removing that one right. I would back Senator Clonan up on that. What we need is a real conversation. What is the best we can offer now and how can we improve it into the future?

Ms Áine Lawlor:

Absolutely, removing a right does not make sense at this point. Our system is hampered in every way for families. Removing a right to something is not the way to do that when the system is not functioning for them. People need to have an appropriate assessment when they need it but now there are massive waiting lists for assessment. We also see the impact of recruitment challenges from the pay and numbers strategy. Children are missing out. Assessment of need is not the only time. As Ms O'Rourke said, we have children who should be seen by a public health nurse for a developmental check and should then get early access into speech and language therapy or an appropriate pre-school setting. They should then have an assessment at an appropriate time and move into education. Those pieces are missed all the way along with long waiting lists for absent services. Then they get to school, where the school is left trying to put that together. I think members have heard that as a committee multiple times. We need to actually resource our services so they can meet children and their families at a time when they need to be met. That assessment, for some children, is at two years of age while for other children, it is more appropriately done in a school-based setting with a team around them. Having such a rigid system-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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While they are still getting therapies.

Ms Áine Lawlor:

While they are still getting therapies, absolutely. Funding and resourcing only one section of that system is leading to an inequity and imbalance as people fight to get across the system. As the Deputy said, that comes back to the NCSE piece. If we put this resource into special schools only, that is a concern we had. It needs to move beyond special schools. We also have children with needs in our mainstream classrooms who require support and would benefit from support in that robust way, so it can meet their needs, so they can fulfil their potential and so it can transport them outside of that meeting their needs.

Ms Aisling McGrory:

Often, parents are unsure. When you have got a young child, you do not where your child is going to go. Some parents might want to try different schools and they have a right to do that too to see how their child manages and gets on. The schools may not have the supports or resources to support that child. Then the parents might have to look for alternatives. That might mean looking for an education psychology assessment or an assessment around getting a diagnosis so they can apply for a special class or school.

This comes back to the deadline coming forward. We do not have the resources nationally to fulfil this deadline for today, 1 October. I understand pre-planning. I really do. I think it is great and if we had numbers, we could pre-plan for the future for special schools, SNAs, therapy teams and all the services our children will need, even going into adulthood as well.

Senator Clonan talked about adults. I used to work with adults with ID and it is severely lacking therapies for adults. We all know it is great to have an early intervention and have that model, bringing the child as far as you can so they can reach their potential. We just do not have the resources to do that at the minute.

Ruairí Ó Murchú (Louth, Sinn Fein)
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What would a perfect assessment of need system look like?

Ms Anne O'Rourke:

It would be easily accessed. It would be quite a seamless process whereby information from parents, concerns and so on was gathered without having to fill in the CDNT form, which, I think, is seven pages with ten additional pages. Then if you look for domiciliary care allowance, it is another whatever. I would love to see a one-stop shop or an online toolkit. Deputy Toole mentioned recently that there was an online access point. I asked ChatGPT to do a flowchart for me on how to access supports for children in Ireland with additional needs and in five minutes I had a flowchart. There was Welsh spelling in it but the flowchart was not bad. It then offered to give me a whole handbook on how to access it and I am still waiting for that to happen. It is not rocket science for the experts we have in IT in Ireland to develop a system whereby parents could say, "Okay, I'm concerned about my child's speech and language issues. Where do I go?" Parents get a lot of support. The public health nurses are just incredible in the work they do on identifying children early on.

A seamless process would start from a very early age, particularly if there was a concern. There would be data gathered with parents' information. The question I always ask parents is, "What is the story?" Within five minutes I would have more information than I would have from a 20-page form from the parents about where their child is at and similarly from teachers.

Ruairí Ó Murchú (Louth, Sinn Fein)
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And their main worries.

Ms Anne O'Rourke:

It is cutting to the chase.

Is a psychological assessment needed in all instances? Currently, under the system we have for allocating children places in special schools or classes, it is. It is a requirement to have an IQ score. That is a number but we have limited resources and resources are allocated according to needs. A certain percentage of the population will have an IQ of 69 or lower and they fit into the mild range. We may need to rethink the categories, particularly for special classes, and think of a more flexible approach. As I mentioned earlier, a lot of data is being collected in schools and there could be a better way of allocating places in classes for children who need special class placements.

The SERC report categories are still the designated names of the special classes in Ireland even though some of those have been changed by the Department of Education and Youth. I am thinking of specific speech and language disorders. The name of that class has been changed but it is still on the NCSE special classes list. I would love to know how many new classes were set up for children with specific developmental language disorders, reading difficulties and mild and moderate general learning difficulties in mainstream schools.

To answer the Deputy's question, although I do not know if I can in a very short period, I do not know that a formal psychological assessment and IQ score should really be a requirement. It can be very helpful and tell us a lot about how our children learn, their strengths and where they need support and so on.

Keira Keogh (Mayo, Fine Gael)
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I wish the witnesses a good morning and thank them for their fantastic opening statements. I have four questions and seven minutes. Let us see how we do.

I have a thought to start with. I loved Ms O'Rourke's description of including the voice of a child through pictures and other ways. It struck me that, yes, we need the disability voices but another piece of this puzzle might also be including the neurotypical voices of children, especially in mainstream classes, which have become so diverse. They might also have a good opinion as to what a great system would look like and how to integrate. They are often the best experts because they are growing up with this.

Ms Lawlor and Ms Mortell both spoke about embedding therapists within the school environment and the classroom routines. I think all the witnesses spoke about that. If I was to give them a magic wand, with no budgetary or resource constraints, what would the perfect roll-out of this pilot programme of therapies in schools look like? It is great to hear that the witnesses had that early engagement. I do not think some of the principals have had that yet. I am conscious that we are currently hiring, or trying to hire, therapists but we do not necessarily have the policy or the job description down yet. As a behavioural consultant who was in and out of schools, I would see it as a support in the classroom, assisting at maths time, circle time or PE time but then also at one-to-one sessions outside the classroom, and being in the schoolyard trying to support socialisation. We often see a drop in support at lunchtime when staff have to eat. I refer to prioritisation of classroom and one-to-one rather than socialisation, which is sometimes key to surviving, especially when kids often get reduced hours or suspensions because a lot of difficulties happen at break times. I would also see it as supporting our bus escorts, who are sometimes acting on a wing and a prayer to get kids to and from school on long journeys without distressed behaviours. There is also the home liaison piece, which is so important for wrapping around the parents and, of course, liaising with the HSE and the CDNT.

I am happy to hear the witnesses have had the engagement but I am not yet confident we have a good format for this pilot programme.

I would hate to see it start to roll out, fail and then not be delivered to more than 45 special schools and into mainstream schools. If the witnesses had a magic wand, what would they do? Perhaps we will start with Dr. O'Rourke and move along.

Ms Anne O'Rourke:

If I had a magic wand, I would have a whole team report for the speech and language therapists and OTs and, ideally, further down the line physiotherapy and other professions such as behaviour support specialists. There would be a whole team and a whole-of-school approach whereby there is training and upskilling for the whole school staff and it is not just seen as, "Johnny can't pronounce his R's so he just goes to whoever". It is a vision that looks at the needs of staff in terms of upskilling and training, collaboration and co-operation and then, as Deputy Keogh said, some classroom-based supports and support in the playground.

I would also love to see parents being brought in. There may be occasions where children need small group support outside of the classroom setting and we could bring in parents to upskill them. It is wonderful to see those supports will be put in place in schools.

During my 20 years at NEPS, I only ever had parents not turn up to meet me twice. HSE colleagues just could not believe it. If a parent or child was not in school - I think maybe twice a child was not in school when I went to see them - the school would always have something else for me to do. I never arrived at a school and was told I could go home. I was always asked to do this or that. That is one of the fantastic benefits of this. There needs to be time for training for the staff.

Keira Keogh (Mayo, Fine Gael)
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What will that team look like? Is that a team in that school, if it is a school with 300 children, or will it be a team that moves between three schools? What does it look like?

Ms Anne O'Rourke:

I think it would depend on the size of the school. In a larger school, it would be hoped that, ideally, it would have its own dedicated multidisciplinary team. There are also smaller rural areas and we have not mentioned children in the Gaeltacht or in Gaelscoileanna. There are many very small schools along the western seaboard so they could be clustered into an administrative cluster where they would have a team that was dedicated to a number of schools.

Keira Keogh (Mayo, Fine Gael)
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We have two and a half minutes left so I might give the other witnesses a minute each so I can get all of their answers.

Ms Claire Mortell:

In terms of the allocation, it definitely needs to be based on the needs of children within that school. What is critical is both the training aspect and that individualised therapy happening within a child's everyday environment. For example, there are children who are using alternative or augmentative communication, AC, systems, be it Lámh signing, the use of visual aids or their own specific AC device. It would be having therapists in the class supporting the teacher with that. It would be very naïve to think that if we are really serious about inclusive education and all children are attending their community school, one teacher at the top of the room will be able to facilitate and support the needs of all pupils. It will take a team that includes SNAs and therapists, ranging from psychologists and speech and language therapists to OTs to support regulation. It is a collaborative approach with everybody working together looking at individual need. There is also scope, as Deputy Keogh was saying, in that children in mainstream schools have such good acceptance now of children with additional needs. They are sometimes better teachers for us than anybody else. It is really important that we are using whole-school approaches, such as Lámh within a classroom. It does not necessarily have to be directed at the child with additional needs. It is the same with the use of visual supports. They will benefit all learners, not necessarily just the child who is identified as needing to use visual supports. It is about looking at really reforming the classroom to be inclusive. We cannot just expect that having a child in a class will be meaningful inclusion. It takes having a support team around them.

Keira Keogh (Mayo, Fine Gael)
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That is really well put. If we have an OT providing regulation supports to a child with a disability, it will help to regulate the whole classroom. We have 30 seconds left for this question.

Ms Aisling McGrory:

Our submission came about because the two schools I work with in Donegal never had special school therapy teams, so we set those up. We have had to navigate some different pathways for children who are open to CDNTs and for those who are open to primary care. It is a really good model. We are working with the OTs, SLT, social work such as myself, and physiotherapists. With the new pilot that is coming in, Donegal does not have one of the pilot schools The physiotherapists, the social workers on the team and I are not sure where we will be when the model is rolled out across the country so we are watching that space.

I will go back to Deputy Keogh's point about the home school liaison. Special schools are not DEIS schools. They do not actually get home school liaisons. They do not have that. Social workers in these schools are meeting families at home and doing the communication piece, particularly for families who may have literacy issues themselves, issues navigating systems or do not speak English as their first language. We spoke earlier about completing forms, whether for special education placements or the domiciliary care allowance. We and others have a role in helping parents to navigate the system.

Ms Caroline Walker-Strong:

Can I just add one thing that leads back into what Deputy Ó Murchú was saying? It is one of the things we called for but did not get to it during our opening remarks. It concerns the collection of data. There is a lot "we do not know" because we are not capturing the data properly, such as how many places we need and where the children are, where they are living and what the level of need is. I know that this week the Ombudsman for Children has been calling for data to be collected at maternity hospital level, which would be helpful but it does not capture everybody because things emerge as children grow. There is an important piece around having accurate data and being able to plan properly for the future so we get to a stage where two years in advance, we know what is coming and can see it coming.

Maria Byrne (Fine Gael)
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I thank the witnesses and apologies for not being present for their opening statements, but I have read them. I was attending the health committee meeting, which is on at the same time. In regard to alternative therapies and how they can assist in classroom settings, is their use good practice and how can they be better utilised?

Assistive technology is sometimes used in isolation. Should it be integrated more into the teaching system? Would that be a good idea? Some children with disabilities may have issues with using assistive technology. Is there a way of introducing it or bringing it into mainstream teaching?

There is also the issue of the shortage of speech and language therapists in schools. How can we address that? I will start with those questions.

Ms Áine Lawlor:

In terms of an AC device, as Ms Mortell said, it is not just about giving a device to somebody and we cannot just expect a teacher to be able to support all of the different children with all of their different needs without appropriate support. That is the joy of having a speech therapist and wider team around a child who can support implementation and move from individual sessions that assess and prescribe a device and build on it, to supporting a child to use that in the playground, on the bus to school or wherever they might need it in their home or school environment. That is required and I hope this therapy in schools will allow that movement so there can be truly meaningful communication for a child. That requires a societal approach as well whereby we are accepting of different ways of communicating.

On the shortage of speech and language therapists, there have been announcements of an increase in college places for speech and language therapists. We are very supportive of that. However, as Ms Mortell said, which the Senator may have missed, there is a pipeline issue with speech and language therapists but there is also an issue around how we attract and retain them in our system. There have been issues, in particular the size of caseloads and working conditions, that we hear about from our members which are impacting retention of therapists in our health system, never mind attracting them into the education system. It is important that we get some of those structures right so that it is a safe place to work, for therapists as well as for users who are accessing our services.

Ms Anne O'Rourke:

Assistive technology is in all of our hands and our phones. There is so much stuff there. It can be such a useful educational tool for children in the classroom setting. For a child who might be slow at handwriting, if he or she can take a photo of the work from the board and start writing, they would still have the photo when they go home to do homework. There is so much low-level stuff such as reading pens, calculators and spell checkers. That low-level stuff should be normalised. I would love to see the normalising of the use of that type of low-level technology because for the child who is slow at handwriting, using an iPad to take a photo of their work from the board is as essential as another child wearing a pair of glasses. If every classroom had half a dozen reading pens on the teacher's desk, all the children could go up to the desk and use them if and when they needed to or wanted to.

Again, a lot of assistive technology for schools has been funded by the Department of education for individual students, but schools do not have the time or the training to actually set the kids up to use it as effectively and efficiently as they could. Sometimes there is an issue where a child cannot use an iPad now because if he uses an iPad then he will not be able to type his exams in the junior certificate or leaving certificate or they are afraid to use it. When kids go from sixth class into first year, they do not want to be different.

Inclusion is not about fitting in; it is about a sense of connectedness and belonging and if everybody could use whatever technology they need. You would never tell a child in a wheelchair that they could not use a wheelchair, yet children are very self-conscious about using assistive technology in the shape of iPads or tablets in secondary school. Phones, for obvious reasons, are pretty much a non-starter. As an educational tool, assistive technology has a huge role, particularly for dyslexic children who tend not to get the same attention in relation to that.

Ms Caroline Walker-Strong:

Alternative therapies in the classrooms were mentioned. What we are hearing from our members from a social work perspective is that alternative therapies are a great idea. Everybody would welcome the idea that you could bring in equine therapy and have these lovely alternatives. However, when families are really struggling with their day-to-day managing of a child with a special need who is perhaps on a reduced timetable and cannot access respite care, if you were to suggest bringing a horse in and having equine therapy, the families would welcome something but they would question it and say what they really need is a night of respite, assistance in the day-to-day and more help. They may have three other children at home and have to manage the child who has just travelled an hour and a half on the bus to school and an hour and a half back. The child is completely emotionally deregulated in the evenings and the parents are trying to manage GAA, ballet and swimming for the other children in the family. The idea of alternative therapies is great and would certainly be welcome, but let us fix the things that are already an issue. Let us get that sorted as well. Not instead of - alongside would be great.

Maria Byrne (Fine Gael)
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There are examples to do with multidisciplinary teams and how they can work effectively. I know there are many of them in other countries. What should we be doing here in Ireland?

Ms Caroline Walker-Strong:

Ms McGrory works in a special school in Donegal. They have a wonderful model up there. It is not across the country. I suppose that is why Ms McGrory is down with us today. They have a wonderful multidisciplinary team in operation at the moment, but it is unclear if that model is going to remain. It would be great to see that model being replicated, not only in special schools but in mainstream schools, so that children stop having to pass their schools at the end of the road to go to the special school because that is where they are getting their therapies. This type of model could be rolled out and have those multidisciplinary supports, including the liaison between home and school, which, as Ms McGrory has pointed out already, is only really available in DEIS schools. That is where the social work role is really important because they are supporting the family. There is a family behind every child. It is having that support there that is minding the family to mind the child, to maintain the placement and prevent them getting to a crisis stage.

Maurice Quinlivan (Limerick City, Sinn Fein)
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If Ms McGrory has the document about what her school has, could she forward it on to the committee? We now move on to Fianna Fáil's Deputy Martin Daly. He has seven minutes.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the witnesses for coming in today. I too apologise for being absent earlier. I was at a meeting of the health committee, of which I am a member, but I have read the witnesses' statements.

A lot of the questions coming at the witnesses are probably rehashed, but one of the things that caught my eye is the problem of expulsion and suspension from school, which is a situation that is often complicated by poverty associated with disability. Impoverished families often have people with complex needs in their own homes. Are there solutions to this? It seems to be a very final event. It also puts enormous pressure on services outside the school. I am not expecting teachers to carry everything within the school but there must be another way to do this. I was taken by the idea for rural schools and the clustering of schools for the provision of therapies within the school setting. I think that is a good idea because we have that in the management of schools, where there is a clustering of small schools that share managers. It is one of the things that the INTO has been asking for in its pre-budget assessment. It is a really good idea and it makes sense. The special schools are not DEIS schools by nature. Is that because they already receive enhanced funding and support?

Respite care is a massive issue for me as I worked as a GP in my past life. It is the difference between making and breaking families and parents who are under enormous pressure. I know there has been a commitment in the budget to increase respite places, but it should be something that is enshrined by right for parents, certainly with children with very significant additional and special needs.

I raise the competition among the various services, including the HSE, the CDNTs and now education for allied health professionals, speech and language therapists, physiotherapists, psychologists and all the full panoply. How can that be addressed? What are the witnesses' views on that? One of the issues we are having in the primary care sector is looking at the model of primary care and whether it is attractive or not for young people coming out of college, highly trained allied health professionals, to go into single, isolated places, often working on their own and not working in very creative teams. It would appear we cannot attract people into those positions. How are the witnesses finding that in their own settings?

Ms Caroline Walker-Strong:

I might respond to the question on school exclusion, reduced timetables and expulsion. Our members would be really concerned about that. One of the things we called for was better strategies and supports to protect families and be able to work through it. That is an approach that the school needs to take because the supports are not there. This is no blame - schools are working under incredible pressure and do not have the supports at times, but the impact of that is on the family at home because the child is then at home for longer times.

We will engage with the HSE in the coming weeks regarding respite. We have sent our position statement to it looking for a tiered approach to respite. People think respite is often residential. It may not be. It could be weekend access, evening access, homework clubs and those types of things. If a child has to go on a reduced timetable or there is an expulsion, there should be another option. It should not just be one and done. There should be another option available to families to access if they get that dreaded call from the school about reducing the timetable. Parents have to agree to the reduced timetable, which, from listening to members, a lot of them do not really understand and feel as if it is foisted on them. We would welcome an expansion of respite care. We are meeting with the chief social worker and some of the disability team in the HSE in the coming weeks regarding tiered access. We will be looking at those pieces that are day to day, the weekends, evening clubs and summertime access for children to maintain some kind of structure over the summer.

There are some children who will need residential care because the complexity of their needs are such that it is very difficult to manage in the community in any kind of wraparound way. I know we are moving away from the decongregated, which is correct and right, but there are still some children who require that. We need a suite of care for those children. We also need there to be that step-down piece. It may be for a period that a family requires their child to go into residential care, but there is very little oversight in terms of bringing a child back home. Their needs will change as they grow and mature. There may be an option to bring a child back home, but it is a different system to the Tusla system where there is a statutory obligation for that to happen. We will be looking for more of an expansion for that in order that there is a statutory mechanism and an allocated social worker to review those cases. Things may have changed at home and other children in the house may have gone to college. It is about looking at this and seeing what can happen there and what supports can be put in. I am aware there is a piece today on RTÉ about ageing parents.

Martin Daly (Roscommon-Galway, Fianna Fail)
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It is a huge issue around the country. I know we are dealing with education today, but it is a massive issue.

Ms Caroline Walker-Strong:

That is the lifelong planning piece. Social work operates cradle to grave.

Martin Daly (Roscommon-Galway, Fianna Fail)
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It is a cause of great distress to parents who are getting older in terms of knowing what is going to happen. Ms Walker-Strong made a good point about having the option to come back into the community, but one of my patients took someone back into the community. It was not working out as they got older but there was no way back in.

I have used the line before that an issue will be solved when the person dies. It was solved within ten days in this case because the poor woman fell and broke her hip and died in surgery. The family came to me and I told them to stand back because if they did so they would have ten days' residential care sorted and everyone would be happy.

Ms Caroline Walker-Strong:

That is a genuine fear we hear about through our network and our members. Often when a residential placement is accessed it is very far from the person's home community. Parents are afraid to complain about it because it is the only thing they have.

Martin Daly (Roscommon-Galway, Fianna Fail)
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It is the only option.

Ms Caroline Walker-Strong:

Their children are then travelling, as Ms McGrory said in our opening statement, from places such as Athlone to Dublin to access their local school because parents are trying to cling onto the community. We have engagement with the HSE coming up. Deputy Daly had other questions but I have completely forgotten them.

Ms Aisling McGrory:

Home school liaison officers are only in DEIS schools. Special schools do not have home school liaison officers. They do brilliant work but there is a gap, particularly with the needs of pupils and families in special schools.

Ms Anne O'Rourke:

I want to say something on the expulsion of children who are out of school. There are children who are out of school or on shortened days. There are children not attending school because of emotionally based school avoidance. I would love to see a situation where we had a rapid response multidisciplinary team, made up of psychology, speech and language therapy and whoever we need to be able to call on, to support families with their concerns. There could be an underlying medical issue. There could be some issue that could be resolved at home with the aim of getting the kids back into school as soon as possible. We have pathways for those aged over 65, which is an incredible service, I have to say. We should have something similar as a rapid response for kids who are out of school.

Martin Daly (Roscommon-Galway, Fianna Fail)
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As we know, the longer the hiatus grows when they go out of school, and I have found the same with adults who come out of day services, the more there is a resistance to go back in again.

Ms Anne O'Rourke:

My understanding with regard to students receiving home tuition because of anxiety is that it is very hard to get those kids back into school.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Ms O'Rourke mentioned there are 15,000 people waiting for an assessment of need and potentially up to 25,000 people. How much did she say 25,000 people would cost the State?

Ms Anne O'Rourke:

My understanding is it would be €625 million. My understanding is that a private assessment of need done by service providers funded by the HSE typically costs €2,500.

Maurice Quinlivan (Limerick City, Sinn Fein)
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If we divide €625 million by 25,000 it would be €26,000. This is my concern.

Ms Anne O'Rourke:

I apologise, my calculations must have been out.

Maurice Quinlivan (Limerick City, Sinn Fein)
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That is all right. It jumped out at me that 25,000 assessments would be €26,000 each.

Ms Anne O'Rourke:

I apologise.

Maurice Quinlivan (Limerick City, Sinn Fein)
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It is €2,500.

Ms Anne O'Rourke:

Yes. My apologies and I thank the Cathaoirleach for the correction.

Maurice Quinlivan (Limerick City, Sinn Fein)
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That is a lot more credible. I was wondering what was going on and I thank Ms O'Rourke for clarifying it.

Gillian Toole (Meath East, Independent)
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We have had fantastic interaction with the questions of all of the members and the information the witnesses have given us. What jurisdiction do the witnesses think is a model of best practice? Canada is sometimes cited as a model of best practice of integrated support. I apologise if I am duplicating my questions, as I stepped out of the meeting. In order of priority, what are the highest priorities for families? If we were to say that in the next six months a plan could be put in place, and then reviewed and tweaked, what do the witnesses think this might look like in their professional disciplines?

Ms Caroline Walker-Strong:

The priority is planning. It is to know where a child is going to school and what therapies they can access when they are there. It comes back to the assessment of need with regard to what does a child need. When a child with a disability comes into a family, the family is not expert at the start. Families require the expertise of the professionals around them to guide them and navigate them. Particularly for those families where there are complex needs and there are challenges in the household, it is knowing there are supports available for them. If we had a magic wand, we would have that lovely wraparound care where mum and dad can continue working, the siblings can continue with their activities, and the child with a disability has their own particular wraparound service that is specific to them and the needs they have. It would not be based on what is available and there would be a proper plan around it. Midway through primary school is when the secondary school situation would be considered, so there would not be the anxiety in the run-up to sixth class as to what is next, and the same with regard to sixth year. There would be a properly laid out plan with a multidisciplinary team that would slot in and out as the child needs it.

Ms Aisling McGrory:

Many families speak to us about financial issues. They are concerned about going into poverty, the cost of living and the cost of rent. Carers receive carer's allowance and, perhaps, domiciliary care allowance. They might be able to work up to 18.5 hours a week. Families are really struggling financially.

Ms Claire Mortell:

From a speech and language therapy perspective, what families are really asking for is support for their child's communication. Training for parents and educators is very important. It is about working directly with the child and the family. This is what we want as therapists and it is what families want also. It is only when we get to build a relationship with a child and a family that we can see what is important to them, perhaps in terms of an appropriate AAC system that works for the child and their family and where they are attending school. What needs to be prioritised is that we remove some of the barriers to access AAC supports. Funding to be able to access an AAC device, for example, is coming through resource allocation groups better but we do not have the resources to match this from an expertise perspective, to support children to be able to develop their communication skills and be able to be included in the classroom and the community now that they have this excellent tool. We also need to look at support for the communication partners. There are also the people who are on the other side of the communication tool, and they need to understand how the children are communicating and how they can support them to develop their communication further. It is about the resourcing to allow for a therapist to really get to work closely with the children and families to meet their needs.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I have a follow-up question to what I asked earlier. The witnesses have all laid it out. Ms Walker-Strong spoke about the idea that first we need to make sure we have data. Then we are talking about a proper screening system. This is not just for kids with disabilities; it is also something we definitely need from a child protection view. Then we need a responsive system with regard to assessments and therapies. Everyone has been won over on in-school therapies but without a timeline we will have everybody running towards the 45 special schools and this will create its own difficulty. It is also about knowing what the plan is and how much engagement there will be with parents.

We have had a considerable conversation on the assessments. The witnesses have dealt with some of the issues regarding therapies. I know from when we took our Turlough for speech and language therapy we were getting photocopies. Some of the therapy was very good and sometimes the fall-down was my fault. My wife generally did most of the heavy lifting. If we had had an AAC device that could have been shared with the school and everyone, from the SNA to the teacher to the principal, alongside whatever other training was there, we would all be in a very different place. It is a case of how best we can put it in play. I used to use the terrible line about getting the best bang for our buck. I ask the witnesses to try to answer this in three and a half minutes and give us the perfect system.

Ms Claire Mortell:

That is the optimum and that is what we are aiming for. An AAC system is a child's voice. The children should not just have that voice at home; that voice has to go with them to school.

Ruairí Ó Murchú (Louth, Sinn Fein)
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The question I did not ask earlier was whether there has been sufficient engagement with the witnesses on the best means of delivering the system. The answer previously was "No". I apologise for interrupting Ms Mortell.

Ms Áine Lawlor:

To an extent, it is recognised that children should have access, and there has been improvement in enabling funding being provided to children. As Ms Mortell said, it is about backing up the resource because there is not just one piece. If we give somebody a device or we give them a programme and tell them to do these activities in any of our disciplines, this is not enough for all families.

Sometimes that is enough if it is a low level need. When we are thinking about a disability, however, families often need more support. Their whole system needs a level of support. We need to think about using technology and different ways of translating that. For example, we still give out paper pieces but perhaps there are other service models where we might have videos. There are parent support groups doing some of those things.

It is also about having access to more than one of those supports. We see parents say that they just had education support or were told to go to a support group. A wrap-around system is needed that meets the person's and family’s needs where they are at. It is that whole system that includes environments such as the home, school, playground or wherever it may be.

Ms Claire Mortell:

Due to the logistics with special school placements, special classes and autism classes, we have situations currently where the distance between a child’s school and a CDNT can be quite significant.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It is a logistical disaster.

Ms Claire Mortell:

Even where a child has access to a CDNT speech and language therapist and has been supported with an AAC device, there is a logistical element in getting that integrated into the school system. In terms of utilising resources, the speech and language therapist would lose a day travelling to another school to support it. That often becomes a phone or Teams call as a result. If there were an in-school therapist, however, there would be ongoing communication from the outset and that assessment piece would be looked at within the whole home and school environments.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It would be constantly reviewed.

Ms Claire Mortell:

It would be constantly reviewed. The in-school therapist would be able to provide feedback about what is working well, how the vocabulary within the device could be developed and what is useful both in a home and school setting. Families are so keen. Children are not just in their home; they are out in their communities. If we really want to be progressive towards inclusion, the more people in the community see AAC devices, whether it is a child in the library or at the playground, the better. It creates interest. As we said earlier, their peers are interested in technology. Sometimes, it is the adults who might be a little bit more unsure about AAC.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It is an easy sell to the kid.

Ms Claire Mortell:

Other children are intrigued by it. It is about being positive about it, making it part and parcel of how certain people communicate using AAC supports and making it as inclusive as possible.

Ruairí Ó Murchú (Louth, Sinn Fein)
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We must make it as easy as possible and put the resources where the needs are. We just need a timeline in that regard and to ensure there is enough engagement with the likes of the witnesses who know how to do it. Mr. Bernard Gloster said that the people who had the best outcomes from CDNTs, or at least those who said they had, were those who had a contact person. That is a vital piece that is lacking in a lot of areas.

Ms Aisling McGrory:

Looking at some of the reports, such as Jack’s case, one of the recommendations and outcomes is the need for collaboration between services. Deputy Ó Murchú spoke earlier on that safeguarding piece. That is always a concern of mine. We are talking about Article 24 of the UNCRPD and disability. I know of children in Donegal who have been moved into some accommodation, some in rural parts, who do not have school placements at all. They are receiving home tuition instead. It is just because of the numbers coming in. They are seeking any type of school placement, not necessarily a special school.

Ruairí Ó Murchú (Louth, Sinn Fein)
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There are highly challenging needs and real difficulty in that regard, and that is before you talk about respite and residential services. None of it is done in a planned way.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank Deputy Ó Murchú.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I could make 400 more points but I will let it go.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the Cathaoirleach. I did not realise I would get a second bite of the cherry. We can take up where we left off the last time when the witnesses were answering questions on the competition between primary care, CDNTs and education for scarce allied health professionals. What are the witnesses’ views on that? How can we increase the number of allied health professionals available for all of these services? How do we increase the numbers in Ireland, because this is an expanding need?

Ms Caroline Walker-Strong:

A lot of Government Departments are working hard with respect to health and social care professionals by increasing education pathways and the attractiveness of the roles. CORU is trying to streamline its services so that international qualifications are recognised to the same quality that we have in Ireland. There is work being done in the background.

One of the things the Deputy mentioned was that recruitment is one thing and retention is another. It is about making those working conditions conducive to making people want to stay, so it is ensuring there are salary levels and career progression. People need to know that if they do a couple of years in the role, they can progress upwards and that there is a pathway and appropriate CPD available to them.

We have spoken a lot today about interagency work. With regard to a lot of those primary care posts that the Deputy is talking about that kind of sit in a lonely place, if we work on that interagency work and work in collaboration, that will not happen as much. The primary care social worker would interact much more with the local school, for example. They would not be on their own but rather part of a multidisciplinary team in the community.

Deputy Ó Murchú mentioned earlier about interagency collaboration working as a method of safeguarding, not just for children but for adults. If there are proper protocols and mechanisms available to professionals working in the community in those isolated posts, as Deputy Daly called them, they are free to communicate better, with consent where necessary. In the case of children, it allows for the free flowing of information to ensure we are making milestones, spotting things coming down the road, and doing that planning piece. Often, professionals in the community can see something coming. They can see it for miles away, but there is no mechanism to react to it because they do not feed directly into the next service the child will need, such as the Department of education. Work must be done on that interagency collaboration piece.

Martin Daly (Roscommon-Galway, Fianna Fail)
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We seem to have gone from a time when people could only get a physiotherapy appointment in a hospital in the community - I am taking physiotherapy as an example, but it is interchangeable with speech and language therapy, not as a profession but rather as a group of professions that are hugely sought after, highly valuable and hugely skilled – to a point where there are physiotherapists divested into a small health centre in east Galway where they do not have the requisite resources and are working essentially on their own. While they may have some contact with their manager, that is not an attractive role. We might need to look at finding a model that is somewhere intermediate where there are clusters of three or four physiotherapists together in a bigger centre. People may have to travel a little further, but at least they will be guaranteed a service. If someone goes on maternity leave now, for example, the post cannot be backfilled and there is a two-year waitlist for community physiotherapy. It is mad stuff.

Ms Áine Lawlor:

There has definitely been a bringing together of services in some areas in primary care. What we can hear and see that is significantly affecting this area is the impact of the pay and numbers strategy. That has impacted on recruitment, which in turns impacts on a team working together. You never quite get a team going because there is either no speech and language therapist or, where there is a speech and language therapist, the social worker is gone and it will take nine months to get a replacement or they may not be replaced at that point. It is very challenging to build those services and attract staff because why would people want to leave to go to a post where they do not have any colleagues, may not get them and are left covering all the areas?

Martin Daly (Roscommon-Galway, Fianna Fail)
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That is exactly the point I am making.

Ms Áine Lawlor:

However, we support the development of posts into education because that is going to enhance recruitment into Ireland. People can come and see that they can work in a school or health system. That is a positive development for us. It is important that it is incremental. While we want to see it move quite quickly outside of special schools, it is important that it is incremental because we cannot take all our health service staff into education either. It is an incremental development. A commitment is needed in this regard to ensure there are a certain number of posts going in this year and next year which coincides with the development of additional places from the universities.

Martin Daly (Roscommon-Galway, Fianna Fail)
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Any interruption in recruitment and retention takes years to put right again. It is amazing.

Keira Keogh (Mayo, Fine Gael)
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I am wondering about the idea of caseload when we look at these in-school therapies. While I am a TD now and probably should not say this, I avoided working in public service because I wanted to manage my caseload. I kept it at approximately 50 clients. That meant some could come maybe once a month, others once a fortnight and some I saw a couple of times a week, depending on the need. Ms O’Rourke mentioned, as a NEPS psychologist, that she might have 30 schools. To break that down, there are 36 or 37 weeks in the school year and it takes a day and a half to do an assessment. If we say there are four assessments per school, that means there are 120 assessments per year. That is probably the best-case scenario. What does an ideal caseload look like for a speech and language therapist, a psychologist or even a social worker within a school? How many children or families can they support? While I know that is a one-size-fits-all question and it depends on need, the witnesses have some sense of it.

Ms Áine Lawlor:

In terms of a caseload, there is no easy or specific answer. We have old data on caseloads, but our services and what people need has changed.

It is hard to say what we can deliver any more because there are so many gaps in that. People have come without having had services and then our teams are not resourced. Ideal becomes harder in that context.

There is also a gap in data for what the actual need is out there that we can resource. Some special schools will have a different profile of needs within them that will require a different staffing level. There has been some work to look at caseloads and to look internationally at what caseloads are challenging. There is still no clear information on that. There is a gap in caseload data and workforce planning that goes with that. That is something that is really necessary for our health service to develop, along with education.

Ms Anne O'Rourke:

We need double the number of educational psychologists to provide a good service similar to other countries. I reiterate that casework, or individual assessment-type work, is only one part of the role of an EP. Educational psychologists have a huge remit. The development of an assistant educational psychologist post would be very helpful. A lot of people who graduate with a degree in psychology from any of the universities in Ireland can spend three to five years on a path or trajectory where they are trying to get a masters in something related to psychology. Whether it is applied behaviour analysis, ABA, or organisational psychology, they are looking for psychologist posts in the universities and CDNTs and so on. If there were assistant educational psychologist posts in NEPS, then there would be a clear pathway for a lot of students to get on the road. It can take five or six years before a student gets a place on the doctorate programme in Mary Immaculate College or Dublin.

Keira Keogh (Mayo, Fine Gael)
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That earn and learn-----

Ms Anne O'Rourke:

Earn and learn, yes.

Keira Keogh (Mayo, Fine Gael)
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-----approach. From the social work perspective-----

Ms Aisling McGrory:

As my colleagues said, it is very hard to define. It depends on the family, the case, the child and the need. In the two schools I am working with, not everybody would be open to a CDNT. There might be more children who are primary care, but it might be different. There might be issues, and I meet children individually, with bullying or relationships and things like that. It is very hard to say what the caseload is and what a safe caseload is. We talk about that and about prioritisation. CDNTs are doing a lot of work nationally on prioritisation and wait-listing. The Irish Association of Social Workers has a progressing disability subgroup as well. We have done a prioritisation tool. Tusla has a model on this as well. We developed our own model and trialled it as well in a pilot project around prioritising. We look at the complexity of the disability, whether there are any safeguarding issues, how many children are at home or whether they are homeless. There are lots of different social and medical factors that we take into consideration in what we are doing.

There could be a case, and I am thinking about some of the cases I am very invested in, where there could be multiple meetings. It may concern a child in foster care and there could be service input from Tusla, schools, the CRC, which was mentioned, and CDNT therapists. You could go to a family where there are literally lists of different people involved. I have done that. I have done a print-out of who is involved - like a who's who for the family. This is because people are picking up the phone to ask me whether somebody is under social work or SLT. People get confused because so many people are involved. I want to make life as simple and easy for everybody as I can. That is hard when you have a high number of cases because, sometimes, you are over-committed. Some of the things are quite short. Somebody might need a bit of support with a domiciliary care allowance, DCA, application, or a letter or something, or a phone call to the council about accommodation or homelessness or whatever it is. There are then other ones that take a lot of time, investment and eyes-on talking to the child, the school, Tusla and whoever is at home. It is very difficult to manage that.

We are always working around prioritisation, wait-list and what is safe, but also advocating for more of our own disciplines, the other disciplines we recognise working together and how that can benefit the child, and his or her family and future.

Micheál Carrigy (Longford-Westmeath, Fine Gael)
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I welcome the witnesses. I apologise, but I was listening in for most of the morning. I am a parent of a young autistic son. I was also the Chairperson of the Joint Committee on Autism. I met some of the witnesses previously, when they were before that committee. It is good to hear there is engagement with the Department. I remember at the time that there was no engagement with any of the relevant organisations when PDS was being set up. That is something that is positive.

The school inclusion model is the model we all want to get to, but the reality is I do not know how many years it would take to have enough qualified professionals in the country to fill the roles to actually do it. We need to be realistic about it and say it will not happen in the short term. That is a question. I know additional places were opened up in some of the colleges here and in Northern Ireland. Have we enough places in speech and language therapy in third level colleges in the country at the minute? I would like a short answer on that one.

We have seen the CDNTs, which are fully funded by the Government. Comments were made about the Government not resourcing things. The Government is resourcing. The reality is we do not have enough professionals to fill the roles to carry out what we need to carry out. There are hundreds of positions in the various CDNTs and primary care teams across the country. In my county of Longford, down the years, we had vacant roles that nobody even applied for, when roles within the CDNT were advertised. Significant investment has been put in privately by the Government for additional assessments of need. I have my own opinion on that, and different comments were made with regard to the assessment of need. I fully believe it is a service and support that is required. That should be the priority. If someone has a speech and language issue, they do not need an assessment to tell them they need therapy and support. That is the point we need to get to.

Every child should have a right to a service. The unfortunate part is when children do not get that support, they regress and there are more difficulties as they get older. A number of courses have been opened in the ETBs for speech and language assistant positions. What are the witnesses' thoughts and views on them? Should there be an assistant position in every single school in the country that will work with a qualified speech and language therapist that would take on 30, 40, 50 or whatever number of schools? Is that something they believe in?

Deputy Toole mentioned alternative therapies. Speaking as a parent, we used equine therapy, which was brilliant. It was the best thing we have ever done to bring on our son and open up his mind. We use music therapy through the LiFT programme, which the witnesses might be aware of, with a speech and language therapist based in Galway. We went from our son probably starting in a special school to being able to start in mainstream school with support. He is now in a special class and getting on brilliantly, but not being able to communicate raised his frustration levels and his meltdowns. That is what causes significant issues for kids.

There are other alternatives. I am still on a committee here that meets every month, which met yesterday. It includes members of all parties and none. We leave politics at the door. We are looking to implement all 109 recommendations we made in the joint report. That is what we are committed to doing. We are sticking together to make sure we do. I would like the witnesses' views on RPM, which was raised. People have not been favourable towards it, but if it works it works, even if it works for only one or two or three children. It is work to be proven. We had a meeting with parents yesterday. We met with children and we also met with Fiacre Ryan, who gave evidence to our committee previously. What are the witnesses' views on those alternative therapies that work?

Ms Áine Lawlor:

I think that is for me.

Micheál Carrigy (Longford-Westmeath, Fine Gael)
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I am not looking at anyone in particular. I will leave it to yourself.

Ms Áine Lawlor:

I will start at the beginning. Are there enough places? No. There is a commitment from the Government for new places. One course in speech therapy had additional places this year and more are due to come in over a number of years. That will need to continue to be developed. It is not just about places. There is also infrastructure and there needs to be a commitment to student places so they can actually train across all our professions. It is a bigger piece than just allocating places to universities.

The Deputy mentioned that we do not have enough therapists to fill posts. That is certainly part of the issue.

Ms Mortell and I sit here as managers of services that have vacant posts. We cannot find therapists even if we are allowed to hire them. There are certain pockets of our health service that need support to find and access therapies. There is a retention issue and there is also a places issue. It is not the sole piece of the narrative. I can find therapists for certain services if I was allowed to hire them. There is also an issue with hiring that we see consistently throughout pockets of our health service too, which is related to the pay and numbers strategy.

In terms of assistants, the Deputy asked how we feel about that. We absolutely support the implementation of assistants. They allow us to look at our therapy delivery models, be more effective and utilise time more efficiently but they cannot replace the therapist. That is our concern with the introduction of assistants in disability services because they were going in where there were huge vacancies and into unsafe roles. We can see in the NCSE model, in the context of education in schools, that assistants are going to be part of that, with the appropriate supports in order that they can be part of a team delivering therapy. That is definitely welcome.

The Deputy also asked about alternative therapies. There are lots of ways that we can intervene for children and access supports for them. We often talk about alternatives. Horse riding is useful for people. We call it equine therapy sometimes. We need access to activities that are suitable for children and interesting to them. We need to be able to adapt those for children, however that might be.

Marie Sherlock (Dublin Central, Labour)
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I am not a member of this committee but take a very serious interest in the matters being discussed here today. I apologise if the questions I ask have already been answered but I have literally come from a meeting of the health committee. We heard from the Minister for Health today that there is going to be a new special initiative taken to try to work through the waiting lists for speech and language therapy, occupational therapy and physiotherapy in the health service. Specifically with regard to speech and language therapy, the Minister wants to reduce the waiting list to ten months or less. What information, if any, have our guests been given on this special initiative?

I also want to move to the suppressed posts part of the conversation. There is an awful lot of talk about vacant posts but there is also the situation, as referred to by Ms Lawlor, of suppressed posts. I ask them out outline in more detail the experience around the country in that regard. Have they mapped out the number of suppressed posts across the sector? If so, it would be useful to hear more.

Ms Áine Lawlor:

We can see on the ground and we hear from our members that since 2023 there has been a suppression of posts and a removal of posts. There is a reduction in front-line clinical staff working in primary care in particular but also in HSE CDNTs as well. We see that in those two areas in particular and where there is recruitment, the timelines are significant. What we hear from members is that there are posts that they either are not able to fill or that posts predating a certain timeframe are now gone from the system. That experience is mirrored across large swathes of the country among all health and social care professions. It is unclear exactly what posts are gone, what posts remain and what posts can or cannot be recruited. As managers or staff change, it becomes even less clear what is or is not there. There has certainly been a reduction in front-line clinical staff for speech therapy and for our colleagues across other health and social care professions.

Marie Sherlock (Dublin Central, Labour)
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On the funded positions that are currently vacant, is it Ms Lawlor's view that it the issue is pay or a lack of flexible working hours? What are the issues that our guests believe are the reasons for the posts remaining vacant? I am interested in their perspective on why there are unfilled posts out there.

Ms Áine Lawlor:

In some of the teams there have been challenges around governance, caseloads and working conditions. There are also issues around pay and career advancement. We also have staff coming into situations where there are no supports around them. There are huge waiting lists and fewer staff members and that all makes it more challenging. If staff can go somewhere else where there is a full team around them and a more manageable service, they will do so.

Ms Claire Mortell:

We need to take the learning from teams that have full capacity, in terms of their recruitment. We see that a lot in our section 38 and section 39 teams which, historically, have strong clinical governance structures already in place. That is attractive to new therapists coming in, knowing that they have access to clinical supervision, CPD and somebody who will support them with their career development. What Ms Lawlor alluded to in the HSE has raised a lot of challenges and our members have communicated that to us. In terms of retention, they feel that there is not that support network there from a clinical governance perspective. That is definitely an issue but there are learnings to be taken from teams that are functioning at capacity as to how they are retaining staff and the reasons for staff wanting to work in those particular teams.

Marie Sherlock (Dublin Central, Labour)
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That is really helpful. The multidisciplinary team operating in the north-east inner city for the past five years has been a great pilot project, for want of a better description. I am conscious that we are talking about an inclusive education model today and I have not had a chance to read the opening statements, for which I apologise. In terms of that multidisciplinary team, MDT, experience, what are the lessons that our guests believe arise from that in terms of applying it to other parts of the country? What is the appetite, as they see it, for introducing that kind of multidisciplinary team across a number of schools in other parts of the country?

Maurice Quinlivan (Limerick City, Sinn Fein)
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As that was not on the agenda, if our guests do not have an answer, that is fine but they are welcome to answer it if they can.

Ms Áine Lawlor:

Our members are hugely engaged in the development of multidisciplinary team services. Everybody who has come here today is keen to see that. The important piece is that there are a number of those projects across the country that have good outcomes and good learnings, both in Ireland and internationally and we need to take the learnings from those and implement them. How do we share that? We see a lot of little pilots or little pockets of excellent work. We need to come together, share those and take the learnings from them to build something really successful for families and children.

Ms Caroline Walker-Strong:

Just to add to that, Ms McGrory comes from a special school in Donegal that has a multidisciplinary team and is happy to share what that model looks like. She has it here today and will make it available to members.

Séamus Healy (Tipperary South, Independent)
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I was here earlier but had to leave to speak in the Chamber, for which I apologise. I thank all of our guests for coming and for their opening statements. A number of my questions have already been asked. The issue of the assessment of needs was dealt with earlier and the issue of recruitment and retention was dealt with by a number of speakers. I ask our guests to talk some more about therapies in schools. I recall that therapies were available in special schools a number of years ago but they were withdrawn. Now the policy seems to have changed again. What was the thinking behind that? I obviously believe that the new situation is the better one. We actually opposed the withdrawal of the therapies from schools previously. What was the background to that?

On a daily basis, when we deal with families who are caring for somebody with an additional need, one of the main things they say to us is that they have to fight for everything. I believe that to be true, as do most people. Is there some way that families can be helped in that situation? Is there a one-stop-shop that can be set up or is there one in place already? Is there some practical intervention that can be made on behalf of parents who are absolutely frustrated on a daily basis?

Ms Caroline Walker-Strong:

We are advocating that a social worker be attached to those special schools to act in that role. Ms McGrory can speak a little bit more about it because she is actively working in that role, as a contact person. That is true of the CDNT network as well, where parents have one person that they can phone if they cannot remember the name of the lady who is providing speech and language, for example. If they only have to remember one name, it just reduces the battle a little bit for them. Ms McGrory spoke earlier about producing a list for parents comprised of the names of the professionals, what they are doing and the day their child is going to see them.

In terms of bringing it back into schools, that is part of the UN model for inclusive education so that a child is not seen to be taken off somewhere else to go do something but is in the classroom.

We have spoken today around how some of those interventions will not just help the child at whom they are targeted, but will help the whole class to learn around a new way of communicating, around accepting diversity and around accepting that there are different ways to communicate. One of the challenges we have spoken about at length today is around the resourcing of things. Part of the reason things are a battle for parents is because the resources are scant and are scattered. It is about bringing those multidisciplinary teams back into schools so that parents know, if their child has additional needs, they are sending them off to school in the morning and they are getting what they require within their school day, which then reduces the stresses at home. Ideally, it would be in their local community so they are not having big long bus journeys to somewhere else outside the community and then they do not have friends within their community as they are all based in the school that is far away. Bringing all of that back into the local school environment really is the ideal; not just for the students, but also for their families.

I will pass over to Ms McGrory who may talk more around the model in which she is working in the special schools in Donegal where there is a multidisciplinary team in place and it works really well for the families. They have Ms McGrory as a resource available to them. She links them in with her multidisciplinary team within the school. The child is accessing their education. It is that one-stop shop type model. It would be great to see that being rolled out on a wider scale.

Ms Aisling McGrory:

I am in a special schools team and in our team there is a speech and language therapist, occupational therapists and physiotherapists. We have two vacant posts for a speech and language therapist and a psychologist. It is quite unique because the two special schools in Donegal have never before had a CDNT schools team available to them. Nationally, there were therapists in school previously, until that model was withdrawn, but it was not the model that is in the two schools in Donegal. This is brand new so there is lots of learning for us in it. We are actually quite lucky in the team we have because we have developed pathways, universal strategies, and training for both teachers and parents. By working together we are sharing all our knowledge to best support the pupil, the teachers and the families. The social workers who are embedded in that model can bridge the gap between home and school. We spoke already about the lack of respite and the lack of residential places. That is so stressful for families. We are helping to try to prevent crises, family breakdowns and separations that can end in very expensive emergency placements which do not necessarily happen to be in somebody's locality. I know CDNTs across the country have different models around key contacts. Sometimes, somebody may be identified to be that liaison person for the family. The family might pick up the phone to that person who will review how things are going. They will have one person as a key contact who they can contact and ask about physiotherapy, incontinence wear, the assessment for an AAC device or education psychology and psychology support. As we are all working together, if those therapies are in the teams, I, or the key contact, can then report that parent A is looking for physiotherapy and can ask about what is happening. They can pass on that parent A may be looking for some psychological report, maybe some support with applying for carer's allowance, or, when the child turns 16, for disability allowance and what that looks like for them. The parents know they have one person identified who they can contact. This helps. It is a really good model. All people sometimes want to do is to talk to one person and ask them how they can help them to get all these other therapies. I am conscious I am taking up time. Is there anything else?

Maurice Quinlivan (Limerick City, Sinn Fein)
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Very briefly.

Ms Áine Lawlor:

I think that covers everything.

Maurice Quinlivan (Limerick City, Sinn Fein)
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We will now move on to Fianna Fáil's Deputy Michael Cahill who has five minutes.

Michael Cahill (Kerry, Fianna Fail)
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I acknowledge and thank the committee for the opportunity to raise a most important and urgent matter in my own county of Kerry. We have a huge issue with respite beds. Many families are waiting several months-----

Maurice Quinlivan (Limerick City, Sinn Fein)
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Sorry Deputy. The witnesses will not able to be answer that question. These people are here for us.

Michael Cahill (Kerry, Fianna Fail)
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Okay so.

Maurice Quinlivan (Limerick City, Sinn Fein)
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If you have any other questions, feel free to ask them but as per the agenda we are talking about education and access to education.

Michael Cahill (Kerry, Fianna Fail)
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I wish to raise the proposed sale of St. Mary of the Angels in Beaufort, which is a fabulous facility.

Maurice Quinlivan (Limerick City, Sinn Fein)
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No-----

Michael Cahill (Kerry, Fianna Fail)
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Is that not appropriate? That is fine. No problem.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The Deputy cannot expect these witnesses to answer that question.

That concludes our first round. If anybody wants to come in again, and I think everybody does, they have one minute. We will begin with Deputy Carrigy.

Micheál Carrigy (Longford-Westmeath, Fine Gael)
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I am looking for an answer to the question about RPM that I asked earlier.

Ms Áine Lawlor:

In terms of RPM, I said earlier that we think about a whole-school approach, or the whole approach we are looking to fund. As a professional organisation, what we recommend clinically is not one specific approach but utilising an approach that is tailored to a child. This means a child would have access to an appropriate assessment, planning and intervention that provides a tailored approach that is appropriate to them, rather than one whole approach that may not be the best approach for any child. It is wider than that because, particularly when it comes to AAC, it is about building communication support, building language development and building literacy support. It is much broader than that. Each child requires an individualised approach to that which is evidence-based and robust. That would be our recommendation.

Ms Claire Mortell:

We really advocate for a total communication support and that often moves between different approaches. A child may, in those very earlier years, be using Lámh or a sign approach using photographs and visuals. That will progress through their lifetime. It does not mean that is the approach they will have forever. When we are looking at investment in particular approaches, we need to know that we have invested in AAC as a whole in looking at communication needs across the board for multiple children. Like that, one size does not fit all. Children have a range of communication profiles and we need to be able to accommodate those. It is about looking at investment across the board rather than focusing on one specific approach.

Micheál Carrigy (Longford-Westmeath, Fine Gael)
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I totally agree. I am not focusing on one. We have used AAC devices to help speech. However, where a proven, internationally used method works, we should be supporting it. I feel IASLT as an organisation should be supporting it. We have had witnesses in this Chamber who actually gave testimony to the NCSE only a number of weeks ago that-----

Maurice Quinlivan (Limerick City, Sinn Fein)
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Deputy, you are well over your time.

Micheál Carrigy (Longford-Westmeath, Fine Gael)
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-----it works. I am disappointed that the organisation cannot come out more strongly to support it.

Gillian Toole (Meath East, Independent)
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Apologies that I had to run out. I am on the same page as Deputy Carrigy having worked with families in my other role and seeing the benefit. I absolutely agree. The ask is that RPM becomes part of the suite. There is no denying the need for the evidence base. Now, I am a dinosaur. I qualified from an institute down the road 38 years ago and anecdotal evidence was what came before the clinical trials. If anecdotal evidence provided enough of a measured, positive outcome, that was then the stimulus to set up a clinical trial or a scoping programme. The ask is that this would be included. It will work for some children and teens and it will not work for others. Therefore, they have options.

Ms Áine Lawlor:

I previously submitted a piece back in 2023 to the committee. We can submit it again. It looked at what was available across the professional bodies internationally from an evidence-based point of view. There is anecdotal evidence. It is important to think about what ingredients of therapy are working for the child. Is the specific approach that is RPM working, or are other pieces of intervention working? The evidence base has not necessarily shown this yet. That does not mean it is the end of the conversation. This needs to be continued to be worked on. However, internationally, at this point, that is where things stand on a full basis. There are pieces that are working for individuals and that is definitely what we are seeing and hearing. It is important we take that forward into the narrative for how we develop therapies.

Gillian Toole (Meath East, Independent)
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ABA began in that format.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Sorry Deputy, your time is up.

The document Ms. Lawlor referenced would be useful. Could she forward it to us again? We would really appreciate that.

Ms Áine Lawlor:

No problem.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Deputy Ó Murchú has one minute.

Ruairí Ó Murchú (Louth, Sinn Fein)
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On the RPM, it is whatever pieces work. We do not want children not getting what will make a difference.

We have all had the silo piece. The issue for an awful lot of parents and schools is about strategies for de-escalation from moments.

Therapies will play a part, but at times we also need to find a way to provide them with that. We keep talking about a one-stop shop and no wrong door but it is about delivering that. The liaison person needs to be provided as quickly as possible.

According to the most recent reply I got to a parliamentary question, the CDNTs are missing 445.3 positions. I assume there are suppressed posts on top of that. Are there difficulties with getting those people employed?

Ms Claire Mortell:

It is a matter of looking at the breakdown of where those posts are. Where I am working, we have two children's disability network teams and no vacancies. There probably needs to be a more strategic evaluation of where these vacancies are and whether they are within specific disciplines, rather than saying there are all these vacant posts. Identifying what are the disciplines will also inform where we need to put more investment in terms of education and bringing people through universities and so on to fill posts. I do not relate to that number because in our teams we do not have that issue. It must be looked at in a broader context than just the numbers to filter down and identify whether there are pockets geographically around the country that need more specific recruitment strategies and whether there are specific disciplines within a team that are vacant as opposed to vacancies across the board. It is important to break that down.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank Ms Mortell. Does Deputy Keogh want one minute?

Keira Keogh (Mayo, Fine Gael)
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One minute is not a lot. I want to go back to something Ms Walker-Strong said about the Ombudsman for Children's comment on potentially collecting data on disability at a hospital. I always welcome the Ombudsman for Children's comments and I look forward to engaging with him on this issue. I can see the benefit of data collection facilitating forward planning for timely, equitable, co-ordinated supports but I am conscious of potential risks of data breaches. We are in an AI world now and I am conscious of the risks of giving people a permanent label that they may not be able to consent to so early in life. Although it should not happen, sometimes disabled people can be influenced in a bad way by employers' institutions. We are working through equality legislation to try to prevent that. When we look at what happened in America this week in relation to autism and the US President trying to row back on rights and things like that, I wonder what are the witnesses' thoughts on the benefits of such a register as well as the potential risks in relation to privacy and confidentiality for people with disabilities?

Ms Caroline Walker-Strong:

It is not around names on a list; it is about numbers. It is about where are the people geographically. The idea of a register would not sit well with any of my members, particularly for all the reasons the Deputy outlined around data and privacy. There are lots of other elements that can be impacted if there are names on a list but we do not even have the numbers. We do not know where geographically in the country people who have needs are. We have a rough idea at local level and a lot of the local networks would be able to tell us what their waiting lists look like. We keep talking about this future planning but how are going to do that when we do not know? We need to get to a point where we can geographically say, for example, that this number of children were born in 2025 in Galway. They may not all stay in Galway of course. As Ms McGrory said, we have a lot of people coming into the country as well and that needs to be taken into account too. We are currently not counting, however, and we need to start counting.

Marie Sherlock (Dublin Central, Labour)
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Most of the focus, when we talk about education, is on children aged five years and upwards. What we do not talk about as much as we should are the early years. There is a glaring gap there in terms of the targeting of resources. I would like to hear quickly what the witnesses believe needs to happen for children aged between three and five years in the education system. AIM support is available in most mainstream early years education at present but that is it. If the witnesses' have any comments on that, I would like to hear them in the time we have - I am sure a book could be written on the subject.

Ms Áine Lawlor:

There are models of services being delivered into early years settings. We know that getting in earlier, providing a whole-school approach and targeted interventions in those early years settings will be important, particularly for children with certain disabilities or who have additional needs and families where there may be more complexities. Getting in early, supporting that development and providing support to teachers so that they can deliver their education curriculum are important, but we can also, through therapies, support that differentiation and inclusion in that setting too. That is really important.

Maurice Quinlivan (Limerick City, Sinn Fein)
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That concludes our discussion. I propose that we publish all the opening statements on the committee's website. Is that agreed? Agreed.

I thank everybody for attending today, especially the witnesses, Ms O'Rourke, Ms Lawlor, Ms Mortell, Ms Walker-Strong and Ms McGrory. It is great to see, and it is one of the first times it has happened, all-female representation among the witnesses. It is positive power. I thank the witnesses for their good and insightful contributions on the issue of inclusive education.

The committee will adjourn until our meeting with the National Disability Authority at 9.30 a.m. on 8 October.