Report on the Practice of Assessment of Need under Part 2 of the Disability Act 2005 - Appendices



Appendix 1: Schedule of interviews

ActivityDates
Meeting with Tipperary S.R personnel involved with statutory assessment of need process(Cashel)8June 2011
Meeting with Dublin South personnel involved with statutory assessment of need process13 June 2011
Meeting with Meath personnel involved with statutory assessment of need process14 June 2011
Meeting with Mayo personnel involved with statutory assessment of need process15June 2011
Meeting with North West Dublin personnel involved with statutory assessment of need process16 June 2011
Meeting with Kerry personnel involved with statutory assessment of need process (Tralee)21 June 2011
Meeting with Laois/Offaly personnel involved with statutory assessment of need process (Tullamore)23 June 2011
Meeting with Limerick personnel involved with statutory assessment of need process27 June 2011
Parent phone interviewsConducted over period June to mid September 2011



Appendix 2: National Disability Authority questionnaire

Priority Questions

1. Assessment officers

1.1 Background information on the assessment officer, i.e. do they have a clinical background, how long they have been an Assessment officer, etc.

1.2 Typically, how do children come to be assessed within or outside the statutory assessment of need process?

1.3 Are specific strategies (formal and informal) deployed to "manage" the numbers who apply for assessments under the statutory assessment of need process?

1.4 Is there a pattern to statutory assessment of need referrals that is different from other assessment referrals?

1.4.1 Are different professional involved in referring children via statutory assessment of need?

1.4.2 Are children with certain disabilities more likely to be referred via statutory assessment of need?

1.4.3 To what extent have referrals directly or indirectly from the education sector driven demand for statutory assessment of need?

1.4.4 Is there a difference in the level of information supporting the referral?

1.4.5 Other

1.5 When you initially meet parents are they generally well informed about what a statutory assessment of need can and cannot deliver?

1.5.1 If parents at these initial meetings do have misconceptions about the statutory assessment of need process, what do these misconceptions relate to?

1.5.2 What efforts do you make to inform parents of what to expect from a statutory assessment of need process (i.e. explain that it won't necessarily lead to a diagnosis)?

1.6 What information, if any, do you gather about the child and the family before you refer him to a clinician or service for an assessment?

1.6.1 Is there a structure to capture this information?

1.6.2 Do you make this information available to assessors?

1.6.3 Do you have a process / structure for providing assessors with this information?

1.7 How do you decide where you send a child to be assessed under the statutory assessment of need process?

1.8 Is there a referral forum [or some such structure] to support you in your decision?

1.8.1 What is the composition of the referral forum?

1.8.2 Has the development of a referral forum been useful to you in your role? If so, please explain?

1.9 How do you decide what needs of the child are to be assessed under the the statutory assessment of need process?

1.10 How do you communicate your opinion for what needs should to be assessed to relevant clinicians / services?

1.10.1 Do you have a sample / anonymised communication to relevant clinicians / services?

1.11 Do you feel that children going through the statutory assessment of need process are receiving assessments that are appropriate for initial assessments?

1.11.1 [If you think they are over-assessed, has anybody locally discussed this with clinicians?

1.11.2 What do you think could be done to address this?

1.12 What role does the level of cooperation between the Assessment officer and the team management / service management play in ensuring assessment resources are used efficiently?

1.13 What are the principal causes for the overdue assessment in your opinion?

1.13.1 Has anything been done to address this issue / these issues?

1.13.2 What do you feel could address this issue / these issues?

1.14 Has / would the integration of early intervention services made / make the operation of Part 2 easier or not?

1.14.1 (where there are integrated services): how has the statutory assessment of need been integrated with other business processes?

1.15 Do you find completing the assessment report difficult? If so please explain why?

2. Service manager / Team leads[1]

2.1 Background and context of service (integrated early intervention team, single disability specific service, etc.)

2.2 Background and context of referral model in operation (pre-statutory assessment of need process and for children who are currently referred outside statutory assessment of need process) [request copies of any relevant guidance, frameworks, templates]

2.2.1 Description of assessment model /approach deployed for children referred outside of the statutory assessment of need process

2.3 Background and context of assessment model used for statutory assessment of need process referrals [request copies of any relevant guidance, frameworks, templates]

2.3.1 [If there is significant difference between initial assessments for other assessment referrals and statutory assessment of need process] Why do you have different approaches to the statutory assessment of need process and initial assessments for other assessment referrals?

2.4 What is the approximate ratio of children being assessed under the statutory assessment of need process and those receiving services who did not receive an statutory assessment of need? (important to note that in LHO areas where there are multiple services or referral pathways, a manager may only have this information for their own services and/or differences in integrated services)

2.5 Is there a pattern to the statutory assessment of need process referrals that is different from other assessment referrals?

2.5.1 Are different professional involved in referring children via the statutory assessment of need process?

2.5.2 Are children with certain disabilities more likely to be referred via the statutory assessment of need process?

2.5.3 To what extent have referrals directly or indirectly from the education sector driven demand for the statutory assessment of need process?

2.5.4 Is there a difference in the level of information supporting the referral?

2.5.5 Other

2.6. How is it determined what needs of the child are to be assessed under the statutory assessment of need process?

2.6.1 How are the number of domains that a child will be assessed on identified?

2.7 To what extent do you influence how assessment of need process under Part 2 of the Disability Act is operated within your team / service?

For example, how much if any do you influence:

2.7.1 Which of the child's needs are assessed under the statutory assessment of need process [i.e. are strategies deployed to assess needs in areas where child is exhibiting greatest need]?

2.7.2 The number of domains that a child will be assessed on?

2.7.3 The intensity of the initial assessments that will be undertaken by clinicians on your team for children referred via the statutory assessment of need process?

2.8 What sort of strategies are used to gather information in advance of a team assessment, e.g. review of files; self assessment of parental needs / views; parent interviews; basic screening; conference with existing professionals (heath and non-health) in the child's life? If such techniques are used how do they shape subsequent team actions?

2.9 Have the protocols on the intensity of the initial statutory assessment of need process or the tools to be used by the teams been developed locally? Do you have locally developed protocols for the initial assessment of young children referred outside of the statutory assessment of need process?

2.10 How parents are included in the statutory assessment of need process under Part2? Is this any different from how parents are included in assessments outside of the statutory assessment of need process?

2.10.1 [If there is a difference of approach to parental inclusion between the statutory assessment of need process and other assessment processes]. Why do you think there is a difference in approaches to parental inclusion for the statutory assessment of need process and other assessment processes?

2.11 What role does the level of cooperation between the Assessment officer and the team management play / service management in ensuring assessment resources are used efficiently?

2.12 At a number of fora, where the statutory assessment of need process has been discussed, clinicians have indicated that they feel that language of Part 2 places a legal obligation on them to conduct a very comprehensive assessment akin to an assessment they might conduct where a child was party to legal proceeding.

2.12.1 Has this been an issue in your service?

2.12.2 Have efforts been made to establish clarity on what are the requirements under Part 2 for clinicians? If so, please describe these efforts?

2.13 What approximately is the clinical specialist time needed to complete a statutory assessment of need process under Part 2? (note this information needs to be captured by clinical specialism and, if possible, by disability type)

2.13.1 How would this compare to an assessment to determine eligibility (outside of the Part 2 framework) of a child for services?

2.13.2 What specifically about the legislative requirements of the statutory assessment of need process is driving the difference, if any?

2.13.3 Has your team / service developed protocols on the intensity of the initial Part 2 assessments or the tools to be used by the teams?

2.13.4 Approximately how much of this time is spent on

  1. Actual clinical work.
  2. Report writing.
  3. Summary report completion

2.14 An assessment under statutory assessment of need process requires that a child's needs are assessed not necessarily that a child or family be given a diagnosis. Does this distinction cause difficulties for your team?

2.14.1 If so, have efforts been made to address this issue?

2.15 What are the main challenges to operating Part 2 for your team / service in your opinion?

2.15.1 What action, if any, has your service / team taken to address these issues?

2.15.2 What do you think would be required to address these challenges?

2.16 Has / would the integration of early intervention services made / make the operation of Part 2 easier or not?

2.17 To what extent is the iHIQA Standards for statutory assessment of need process integrated in the team's work?

Assessors

3.1 Context and background - profession, years of professional experience, experience of assessment before introduction of the statutory assessment of need process currently conducting assessments from referrals other than the statutory assessment of need process.

3.2.1. Do you typically assess children as part of a team or by a uni-disciplinary assessment?

3.2.2 Is there a pattern that is different to the statutory assessment of need process referrals from other assessment referrals?

3.2.3 Are different professional involved in referring children via the statutory assessment of need process?

3.2.4. Are children with certain disabilities more likely to be referred via the statutory assessment of needs process?

3.2.5. To what extent have referrals directly or indirectly from the education sector driven demand for the statutory assessment of needs process?

3.2.6 Is there a difference in the level of information supporting the referral?

3.3 What sort of strategies are used to gather information in advance of a (team) assessment, e.g. review of files; self assessment of parental needs / views; parent interviews; basic screening; conference with existing professionals (heath and non-health) in child's life? If such techniques are used how do they shape your subsequent actions?

3.4 At a number of fora, where the statutory assessment of needs process has been discussed, clinicians have indicated that they feel the language of Part 2 places a legal obligation on them to conduct a very comprehensive assessment akin to an assessment they might conduct where a child was party to legal proceeding.

3.4.1 Has this been an issue in your service?

3.4.2 Would you assess two children presenting with broadly similar needs very differently if one was referred under Part 2 and the other was not?

3.4.3. What's your understanding of what constitutes an appropriate clinical assessment, for your clinical specialism, to comply with the statutory assessment of need process under the Disability Act?

3.4.4 Is it your understanding of Part 2 that you need to conduct a very comprehensive assessment on any child referred via Part 2?

3.4.5 Have efforts been made to establish clarity on what are the requirements under Part 2 for clinicians? If so, please describe these efforts?

3.5 The statutory assessment of need process under Part 2 requires that a child's needs are assessed not necessarily that a child / family be given a diagnosis.

3.5.1 Does this distinction cause difficulties for you?

3.5.2 If so, please explain why this distinction has caused you a difficulty?

3.6 Some stakeholders have argued that the requirement of assessment officers to provide a statement of the "nature and extent" of a disability means that in effect assessors must provide a diagnosis. Has this phrase in particular caused you particular difficulty?

3.7 Has your team / service management provided you with any guidance / fostered discussion around the difference between assessing need and establishing a diagnosis or around what the phrase "nature and extent" of disability means in the context of Part 2? If so please describe?

3.8 Do you have locally developed protocols or guidance for the initial assessment of young children referred via the statutory assessment of need process?

3.8.1 In particular, have the protocols on the intensity of the initial statutory assessment of need process or the tools to be used by the teams been developed locally?

3.9 What approximately is the clinical time you require to complete the statutory assessment of need process under Part 2?

3.9.1 How would this compare to an assessment to determine eligibility (outside of the Part 2 framework) of a child for services?

3.9.2 What specifically about the legislative requirements of the statutory assessment of need process is driving the difference?

3.9.3 Has your team / service developed protocols on the intensity of the initial Part 2 assessments or the tools to be used by the teams?

3.9.4 Approximately how much of this time is spent on

  1. actual clinical work
  2. report writing
  3. summary report completion

3.10 What are the main challenges to operating the statutory assessment of need process for you?

3.10.1 What actions, if any, has your service / team taken to address these issues?

3.10.2 What do you think would be required to address these challenges?

3.11 Has your professional body produced protocols / guidance specific to the statutory assessment of need process?

3.11.1 What extent has this guidance shaped your approach to how you conduct assessments as part of the statutory assessment of need process?

3.11.2 Does this guidance conflict with any guidance on conducting the statutory assessment of need process that you may have been given by your team / service manager/ or the HSE's National Disability Unit?

3.12 To what extent is the iHIQA Standards for Needs Assessment integrated into your work?

3.13 How are parents included in the assessment of need for the statutory assessment of need process? Is this any different from how parents are included in assessments outside of the statutory assessment of need process?

3.14 Has / would the integration of early intervention services or children's services made / make the operation of Part 2 easier or not? If you think so please say what this has / would make a difference

3.14.1. (Where there are integrated services): how has assessment of need been integrated with other business processes?

Appendix 3: Local Health Office area Sample Data

Anonymised

Local Health Office Area

Estimate of number of children with a disability aged 0 - 4ApplicationsStarted Stage 2Reports CompletedMilestone ActivityAssessments Overdue
7495121522941
2319231233842
364327227564
5657322513706
4374873180
84571495281
127719163380
63993237249322
Sample Average452.625   46.2514.5
National Average426   42.528.4


Source
: Estimates in column 1 were supplied by the Health Service Executive and are based on Census 2006 figures and assume a 4% disability prevalence rate. Other figures based on figures supplied by the Health Service Executive's Disability Information Unit and reflect activity to date in 2011

Appendix 4: Health Service Executive forms and guidance

Disability Act 2005 Guidance Note No: 29(A) 11th August 2010Section 1 - General guidance for assessors

Introduction

This document has been developed by the Assessment Process Working Group established by the National Project Team for the Implementation of the Disability Act. The Working Group brings together management and clinicians from both the HSE and voluntary sector service providers, NDA, NCSE, DoHC, and NEPS.

The aim of the document is to assist assessors when they are deciding on the level and extent of assessment(s) necessary in order for the Assessment officer to be able to provide the applicant with an Assessment Report that meets the requirements of the Act. The document also aims to assist in improving the consistency of interpretation among clinicians of the terms used in the definition of disability contained in the Act.

It is important to emphasise that these guidelines do not constitute a standard of practice and they are not intended to substitute for sound clinical judgment which is a matter for relevant professionals.

The members of the Working Group engaged with the various national professional representative bodies of the disciplines concerned and with practitioners providing assessments and services in a team setting. The guidance included in this document is based on those discussions.

Essential Points To Note

  • The Disability Act gives an individual with a disability the right to an assessment of their health and education needs.
  • In relation to health services, the intention of the Assessment of Need process is to identify the health needsresulting from the child's disability.
  • It is a matter for clinicians, based on their experience and qualifications, to decide how best to evaluate the needs at that time of the child being assessed. The Act does not give the right to a specific assessment at a particular point in time.
  • The Disability Act does not give a right to access to a diagnosis unless it is required at that time to identify the health needs occasioned by the disability.

General Principles Underpinning all Assessments of Need

  • Child and family centred - the Assessment of Need (AON) should be focussed around the child and family, recognising them as individuals and concentrating on outcomes important to them.Information and communication - information should be available in a timely manner throughout the process, and assessors should engage with the family on the process and arranging of assessments.
  • Co-ordination - where more than one assessor is involved assessors should co-ordinate their assessments, in consultation with the Assessment officer.
  • Outcome-focussed and strengths / needs-based - the purpose of the AON is to identify the needs of the child and family, and to set outcome-based goals which reflect the child's level of functioning in the different areas of development and his or her ability to participate.
  • Appropriateness of assessment - the assessment should be appropriate for each individual child and family at the time of assessment and include consideration of the age of the child, culture, presenting difficulties and readiness of the whole family.

Assessment Pathway

Once referred for an AON all children should follow a similar assessment pathway.

The pathway proposed involves three stages:

  1. The initial planning stage;
  2. The actual assessment process;
  3. Compilation of the report.

1. Initial Planning Stage

The Assessment officer should clarify with assessors the specific aim and purpose of assessing this child. The team / assessors should then identify what is required to give a picture of this particular child's health needs, including which disciplines will carry out the assessments and the level and depth of assessments to be carried out. Assessors should be guided by what is normally accepted as good practice in assessment when a child is coming into their service.

Children should be assessed in line with best practice to inform intervention, and assessors should not carry out assessments over and above those clinically indicated. Bearing this in mind, clinicians should judge what level of assessment/s are indicated and may recommend further assessment at a future, and more appropriate time.

In order to make these decisions, assessors whether working in a team or individually, should confer by meeting or by teleconference, using all the information received from parents, existing reports, clinical judgement and the Assessment officer's requests.

In some cases the outcome of these discussions may vary from the original requests made by the Assessment officer. The reasons for these decisions, the clinical judgment on which they are based and confirmation that the decision is not based on resource considerations, must be given to the Assessment officer in writing at the earliest possible opportunity and discussed with the parents and/or guardians.

Lack of resources is not a valid reason for refusing to carry out a specific assessment or choosing one form of assessment over another. If a member of a team is not available for any reason and their discipline is considered necessary for the assessment, alternative arrangements must be made and the Assessment officer should be consulted.

The Disability Act does not require a diagnosis to be made as part of AON. What is required is an assessment of the child's needs at the time.

The child, particularly an existing service user, may have had assessments within the last twelve months. If they were conducted in accordance with the HIQA Standards, these may be acceptable for the purposes of the Assessment of Need and new assessments may not be required. This should be discussed with the Assessment officer who has guidelines covering this issue.

A team should identify one of their members to be the link person to ensure communication with the family and with the Assessment officer throughout the assessment period. Individual assessors should maintain contact with each other and with the Assessment officer.

An assessment plan should be drawn up to include:

  • Settings for assessments and any supports required;
  • Sequence / co-ordination of assessments;
  • Possible times and dates to be agreed in consultation with the family.

2. Assessment Process

Parents should be actively engaged throughout the process and all steps clearly outlined to them. These steps may overlap depending on local service structures and practice.
Step 1: The Assessment officer will have passed on to assessors all relevant information he or she has obtained from the family. An initial clinical interview by one of the team / assessors with the family will gather further information, get the parents' understanding of their child's strengths and needs and answer questions they may have around the process.

Step 2: Assessors interact with the child using formal and/or informal assessments either jointly or individually to form an opinion of the child's strengths and needs. Formal procedures for assessment may include the use of assessment tools or checklists or medical / clinical tests and procedures (Appendix I provides suggested criteria for choosing assessment tools). Informal procedures include conversations with parents, informal observations of the child and other informal assessments as appropriate.
Clinicians are the best qualified and best placed to make the decisions, based on their clinical expertise, about the appropriate methods to use and the extent of assessment needed in order to identify the health needs of the child and the services required. The decision on the level and extent of assessment cannot be influenced by the resources available to the assessor.
At this stage additional assessments may be identified before the process can continue (e.g. Audiological assessment) and the Assessment officer should be informed as early as possible so that arrangements can be made.

Step 3:Assessors will agree whether a sufficient picture of the child's needs has been gathered at this time or if further assessment is required. All findings should be shared with parents as dictated by good practice. It may not be appropriate to carry out all assessments necessary to identify the child's needs at this stage (e.g. the child is too young). In such cases two options are available:
1. An extension to the timeline for the assessment process may be negotiated through the Assessment officer;
2. An appropriate date for a formal review of the Assessment Report may be specified.

Significant assessments which will identify needs should be conducted under the Act through the Review procedure rather than included in the Service Statement. Any assessments not necessary for identification of needs (e.g. diagnostic assessment in some cases) may be included in the Assessment Report and arranged as part of the Service Statement. However the reasons for including any recommendations for further assessments need to be carefully considered in terms of their value to the child's intervention programme.

3. Report Stage

All assessors involved in the assessment of need process share outcomes and agree joint recommendations and goals. This information will have been shared already with the parents throughout the process. Clinicians may wish to provide parents with a copy of their individual findings during the process. Reports given to parents should be headed, 'This report forms a part of the full Assessment Report under the Disability Act, which you will receive in due course.'
Parents will receive all reports so clinicians should take this into account when considering inclusion of information such as sensitive details about the wider family or matters which they have not discussed with the parents. Reports should not include extraneous material which is not relevant to identifying the child's needs arising from their disability.
Child protection concerns which arise during the assessment should be dealt with according to Children First Guidelines and usual practice within the employing organisation. Responsibility for reporting such concerns should not be delegated to the Assessment officer via the Assessment Report.
A joint final report for the Assessment officer is preferable. (Separate reports may also be attached.) Whether individual or joint reports are used the following guidelines should apply.
Reports should be written in easily understood language, and be concise, consistent and not repetitious. Technical information may be added in an appendix.

Include in report:

  • Reason for referral;
  • When child seen and by whom;
  • Assessment tools / process used;
  • Outcome of assessments;
  • Strengths and needs of child;
  • Summary and recommendations;
  • Appropriate review period.

The report should be written according to functional areas and should be goal and outcome focussed rather than discipline focussed.

The Assessment of Need process does not require a quantum of service to be specified. The final report should be signed off by the team, or an individual on behalf of the team, listing all those involved with their discipline / title.
An example of a joint report template that might be useful is attached in Appendix 3.
Appendix 2 outlines the entire assessment process.

Summary Report

The Summary Report is essential for the Assessment officer as it clearly captures the child's needs and the services required to address those needs. Assessors are asked to give their opinion as to whether the child has a disability or delay which is likely to last at least 12 months and which leads to the need for services. If there are points of disagreement within the team regarding the child's needs, majority opinion should be recorded along with an outline of concerns raised. These can be noted on the Summary Report.

Review of the Assessment Report

The Regulations accompanying the Disability Act state that the maximum period for a review of the Assessment Report to be carried out is 12 months from its completion or 12 months from the last review, but may be earlier if there is a significant change in health or education needs.
Please note that what is required is a review of the Assessment Report not a reassessment.
1. If a child is attending a service the review should be informed by the normal process of ongoing review of intervention. It is suggested that services should build the requirement for a review of the Assessment Report (AR) into their own review process, revisiting the AR to see if there should be any amendments when they conduct the child's service review. In most cases there should be no need for a separate process.
The clinicians who currently see the child should review the AR, not the original assessors if they are changed.
The Assessment officer (AO) will be in contact with the parents coming up to the review date to discuss any change in needs that they perceive. The AO will then write to the service provider asking them to review the AR, sending the original Summary Form and latest Service Statement. The service provider will be asked to amend the Summary Form as necessary and return it to the AO. Correspondence will be by email where possible, so that service providers can amend the Summary Form using tracked changes and minimising paperwork.

Changes to the AR that may be identified at review time include:

  • The child no longer meets the definition of disability under the Act
  • A service not identified in the original AR is now required
  • A service identified in the original AR is no longer required
  • There is a requirement for an additional assessment to identify health needs
  • There is a requirement for an assessment of educational needs (which the AO will refer to the local SENO)


Significant changes in circumstances should be discussed with the AO who will not normally attend review meetings with the team and parents, but may do so if seen as necessary.

  1. Where a child is being seen by individual clinicians rather than a team, they also should build review of the AR into their normal practice of regular review, with collaboration with other clinicians where appropriate by telephone, email or teleconference.
  2. If a child is on the service waiting list it is likely that the review will require some degree of reassessment to see if his or her needs remain the same or not.
  3. If a child is not receiving services and is not likely to in the next 12 months, the AO will discuss with the parents whether new assessments are warranted at this time, given that if a service does become available new assessments will most likely then be conducted.

Section 2: Interpretation Of The Terms Used In The Definition Of Disability

Introduction

This document forms a part of the overall guidance to assessors and is designed to assist clinicians who have been asked to carry out assessments under the Disability Act 2005. As with all legislation, the precise wording employed must be studied carefully when interpreting the meaning of the Act. While the Act is clear that it is the Assessment officer who is asked to make a determination as to whether or not an applicant meets the definition of disability contained in the Act, they would normally do so having received advice from clinicians. Consequently, it is important that assessors have as clear and consistent an interpretation of the terms used in the definition as can be achieved.
It is important to emphasise that the definition of disability under the Act has not been considered judicially. These guidelines do not constitute a standard of practice and they are not intended to substitute for sound clinical judgment which is a matter for relevant professionals. This document can only suggest how the terms might be interpreted. It is not intended to be prescriptive.

The Definition of Disability Contained in the Disability Act 2005

The following are extracts from the Disability Act 2005. Section 2 provides the fundamental definition of disability while section 7 (2) expands on the term, "substantial restriction" used in section 2.
Section 2: "Disability", in relation to a person, means a substantial restriction in the capacity of the person to carry on a profession, business or occupation in the State or to participate in social or cultural life in the State by reason of an enduring physical, sensory, mental health or intellectual impairment.
Section 7 (2): In the definition of "disability" in Section 2, "substantial restriction" shall be construed for the purposes of this Part as meaning a restriction which:

  • is permanent or likely to be permanent, results in a significant difficulty in communication, learning or mobility or in significantly disordered cognitive processes, and
  • gives rise to the need for services to be provided continually to the person whether or not a child or, if the person is a child, to the need for services to be provided early in life to ameliorate the disability.

Important Aspects of the Definition

It is particularly important to note that the term "substantial restriction" refers to a restriction in a person's capacity to participate. It does not refer to the impairment. This is important as it is this restriction in capacity to participate that must be "permanent or likely to be permanent" according to the definition in the Act.
Furthermore, when the definition refers to the substantial restriction resulting in significant difficulty, it is referring to significant difficulty in one of the four areas of functioning listed:

  • Significant difficulty in communication;
  • Significant difficulty in learning;
  • Significant difficulty in mobility;
  • Significantly disordered cognitive processes.


It is important to emphasise that the Act focuses on difficulties in particular areas of functioning. It is also important to emphasise that the definition of disability contained in the Act does not make any reference to a diagnosis. Consequently, assessors are not asked to provide a diagnosis. The Assessment officer is required to make a determination as to whether or not an applicant has a disability within the terms of the Act. The Assessment officer does this based on the information received from a variety of sources. Those carrying out the actual assessments are asked to provide their clinical opinion in relation to certain questions, given the information available to them.
Finally, an important characteristic of the definition is that all the criteria must be met. Careful attention must be paid to the Act's use of the words, "and" and "or".

Interpretation of Terms and Phrases

The following table highlights the various terms of importance. The terms in capitals in the left-hand column require definition and interpretation.

According to the Act, for a person to be defined as having a disability, there must be a physical, sensory, intellectual or mental health...

IMPAIRMENT

which is

ENDURING

and which results in a

SUBSTANTIAL RESTRICTION

in a person's

CAPACITY TO PARTICIPATE

in social or cultural life and which is

PERMANENT

or

LIKELY TO BE PERMANENT

and which, in turn, results in

SIGNIFICANT DIFFICULTY

in communication, learning or mobility or in

SIGNIFICANTLY DISORDERED

cognitive processes

AND

which gives rise to the

NEED FOR SERVICES

to be

PROVIDED CONTINUALLY

or, if the person is a child, to the need for services early in life to

AMELIORATE

the restriction in the capacity to participate.


Suggestions as to how some of these might be interpreted, have appeared either in the standard documentation developed during the implementation of the Act, or elsewhere. Thus, the World Health Organisation defines "impairment" as a problem in body function or structure. "Enduring" has been taken internationally to mean lasting for 12 months or more. Guidance issued by the HSE states that the term, "continually" used in respect of the provision of services, may also encompass the situation in which services are provided intermittently or in response to conditions of an episodic nature.

For the assessing clinician, the terms that are likely to give rise to the most debate are, "permanent or likely to be permanent", "significant difficulty" and "substantial restriction" used in respect of a person's capacity to participate in social or cultural life in the State.

The table on the following pages provides some guidelines for clinicians who are requested to carry out an assessment under the Disability Act. The Assessment officer is legally obliged to make a determination as to whether or not an applicant meets the definition of disability contained in the Act but would normally do so only following clinical input.

Assessors are asked to complete a section of the Summary Reportentitled, "Determination of Disability - Supporting Information". It is in this section that they are required to provide the answers to the questions that assist the Assessment officer in making his or her determination. If the Assessment officer relies solely on the answers provided by assessors, (bearing in mind what has already been stated above concerning how the Act demands that all criteria must be met), the answer to question 3 would have to be "yes" for the applicant to be deemed to meet the definition of disability.

Guiding Principles

Before moving on to provide more specific suggestions on the interpretation of the terms used in the definition illustrated with examples, the following are some overall guiding principles:

  1. carrying out the assessments must be suitably qualified, experienced and competent.
  2. issue of whether or not a child is experiencing, or may potentially experience, a substantial restriction in their capacity to participate must be judged on an individual basis.
  3. Children should be compared with their normative peers.
  4. Standardised assessment tools can be used if they are appropriate at the time. The results of these assessments may indicate deviations from the norm which are considered significant. This will be suggested in the guidance manuals for the standardised tests.
  5. Clinicians are asked to decide whether or not a child is experiencing a significant difficulty in an area of functioning which falls within their area of competence.
  6. Majority consensus among team members, on a child's level of needs, should be used in situations where there is a difference of opinion on the significance of difficulties.
  7. Diagnosis alone does not indicate level of need but will be a factor for consideration. However, the Disability Act does not necessarily require a diagnosis to be made.
  8. If a child requires frequent and/or ongoing physical assistance and/or supervision on a one-to-one basis in order to achieve reasonable outcomes they might be described as experiencing a significant difficulty. Where supervision is necessary at a distance or in a group, this may be taken to indicate that the difficulty is not significant. Requiring one-to-one attention may be regarded as an indication of a significant difficulty.

TermGuidance On Interpretation
Impairment

Impairment may be defined as being a problem in body function or structure.

Enduring

Enduring may be interpreted as meaning that the condition is likely to last for 12 months or more.

Substantial Restriction In Capacity To Participate

The Act refers to a "...substantial restriction in the capacity of the person to carry on a profession, business or occupation in the State or to participate in social or cultural life in the State...". Since the Act has only been implemented for children under five, this could be interpreted as referring to participation in age-appropriate activities or the potential to participate later in life.

The following are examples of where an impairment may be deemed to result in a substantial restriction to participate:

  • Alterations needed to child's physical living environment;
  • Assistive technologies required;
  • Personal assistance (not normally required by a child of the same age) required in order for the child to carry out activities of daily living and participate fully in age appropriate activities;
  • There is an inability to communicate needs in everyday environments;
  • The child has considerable difficulty engaging in educational activities at the level of his/her peers;
  • The child is limited in ability to integrate socially, including participation in age-appropriate play;
  • Presence of emotional distress in relation to communication and/or feeding difficulty.

Note: It is important to ensure that the child in question is being assessed in relation to the norms for any other child of their age and not in relation to the norms applying to the children normally seen by the assessing service.

Permanent Or Likely To Be Permanent

It is recognised that this part of the Act poses particular difficulties for assessors (especially in the case of young children) and necessarily involves a degree of judgement. Many clinicians have expressed a reluctance to label a child at such an early age and to commit such an opinion to paper. We have already stated that "enduring" might be taken to mean lasting 12 months or more. The term "permanent or likely to be permanent" could be interpreted in a similar way. The form provides space for the assessor to qualify his or her answer.

It should be remembered that the Assessment Report resulting from the assessments arranged must be reviewed at least within 12 months. Therefore, any opinion given in the first instance can be revised as necessary.

Significant Difficulty

The most important aspect of this section is that it refers to a significant difficulty in communication, learning or mobility or in significantly disordered cognitive processes. (Difficulty in one area only is sufficient). I.e. A significant difficulty in an area of functioning, not a significant difficulty as defined by a particular area of clinical expertise and not as defined by the existence of a large number of relatively minor difficulties. The ideal situation is for assessments not to be carried out in isolation from each other.

Once again, a staged approach to answering this question may prove useful:

  1. a diagnosis has already been made, it may be obvious that there are significant difficulties in particular areas of functioning. Similarly, the presentation may make this obvious.
  2. Informal assessment techniques and co-operation with other assessors may provide sufficient information to reach a decision.
  3. The following are examples of what might be regarded as being significant difficulties in each of the areas of functioning referred to in the Act:

Communication

  • Disordered rather than delayed pattern of communication.
  • A 4½ - 5 year old child more than 15 months behind chronological age in two or more areas on informal assessment. Or, proportionately according to age.
  • Inability to access environment communicatively to meet needs.
  • The child would often not be understood by people outside the family.
  • Inability to demonstrate attention and listening attention for formal assessment.
  • Problems in developing and using non-verbal communication skills.
  • Restriction in vision which significantly impacts on communication.
  • Restriction in hearing which significantly impacts on communication.

Learning

  • In multi-domain assessment, there is significant delay in two or more areas of development. I.e.
    • motor;
    • communication;
    • cognition (problem solving);
    • sensory;
    • adaptive and personal-social skills (affective, behavioural and interactive patterns).
  • Cognitive functioning on standardised assessment is at 2 SD or more below the mean.
  • Significant delay / disorder in performance tasks. E.g.
    • visuo-spatial awareness;
    • speed of performance and precision.
  • Adaptive functioning is significantly delayed or impaired, including:
    • levels of independence;
    • daily living / self-care skills.
  • There are significant delays or impairments in social skills development which are affecting socialisation and learning. I.e.
    • how the child interacts with family;
    • Peers, strangers.
  • Significant delays in the development of play skills.
  • Impact of delay on family functioning is high, including access to activities of daily living. This may be associated with severe emotional and/or behavioural difficulty / disorder / disturbance including:
    • injurious behaviour to self or others;
    • severe withdrawal - emotional withdrawal or inhibited pattern - doesn't seek comfort in distress, reduced social and emotional reciprocity;
    • tantrums (high in frequency and duration) 3+hrs a day - excessive levels of irritability, disturbed intensity of emotional expression.
  • Patterns of behaviour and levels of functioning observed occur across different contexts / settings / relationships.

Mobility

  • The child has a condition, (e.g. respiratory, cardiac, musculoskeletal, neurological, sensory or surgical), that affects endurance / ability to participate in skills such as walking, negotiating steps / stairs / playground equipment etc to such an extent that they require assistance / supports.
  • Child whose overall functional performance is impacted significantly as evidenced in results of standardised assessment tests. For example: Movement ABC, Peabody, Brunicks. (These are examples only. It is not a prescriptive list. Scores / levels / deviations in specific range of assessment tests which demonstrate significant difficulties to be agreed by clinicians).
  • Child unable to organise movements / negotiate environment on daily basis without high risk of injury or need for ongoing guidance / assistance.

Significantly Disordered Cognitive Processes

  • Disturbed affect and pattern of behaviour:
    • difficulty with regulation of affects including depressed mood, anxiety, fear, anger;
    • need to consider if pattern of emotional expression is generalised across settings and relationships.
  • Symptoms are pervasive and impair functioning. E.g. Participation in age appropriate activities.
  • Difficulty processing sensory input suggested by unusual and extreme responses to normal sensory stimuli in the environment.
  • Combination of difficulties with communication, learning, mobility and disordered cognitive processes which indicate need for assistance in daily activities.


Appendix 1 - Criteria for Selection of Assessment Tools

  1. Is the purpose of the assessment tool clearly stated?
  2. Is it considered good practice / what evidence supports its use?
  3. Who can administer and interpret the test?
  4. Are results quantifiable - can they be measured?
  5. Are there any comparison tools that can be used with it?
  6. Are there other tools, not currently in my possession, which would be more appropriate to use?
  7. Have I the necessary training and experience to use the tool?


Appendix 2 -

Flowchart outlining the Assessment Process


Appendix 3 - Sample Joint Report Template

Clinical Report

Name:

Address:

D.O.B:

Chronological Age:

Date of Assessment:

Date of Report:

Referred by:

Reason for Referral:

Other Agencies Involved:

Pre-school / School:

Assessment Tools Used:

Developmental History:

Presentation:

Social - Emotional - Behaviour:

Communication and Language:

Cognitive Development:

Gross Motor Development:

Fine Motor Development:

Sensory Motor Observations:

Strengths:

Needs:

Conclusions:

Recommendations:

Date for Review:

Signed on Behalf of the Team:

Print Name and Qualifications:

Team Members Carrying Out Assessment (with discipline and title):



HSE Disability Act 2005 Assessment Officer Process And Practice Guidelines

12th June 2009

Introduction.

This document has been drawn up by the Assessment officer Reference Group and approved by the Project Team for the Implementation of the Disability Act. It is designed to act as a guide to Assessment officers in the fulfilment of their role. It is also hoped that it will be of assistance to others involved in the assessment process such as General Managers, Disability Managers, Service Managers and health professionals involved in carrying out assessments under the provisions of the Disability Act.

The document has been divided into five main sections covering the five major phases of the Assessment officer's role:

  1. Application;
  2. Stage 1 - Desk-top assessment;
  3. Stage 2 - Professional assessments;
  4. The return of professional assessments;
  5. Issuing the Assessment Report;
  6. The Redress System.

The document should be read in conjunction with the similar document produced by the Case Manager Reference Group which guides the Liaison Officers in the fulfilment of their role, Liaison Officer - Process and Practice Guidelines (28th July 2008).

1. Application Received.

1.1. Checking the Application.
1.1.1. When an application for an assessment of need under the Disability Act 2005, (referred to in this document as "the Act"), is received in an LHO, it should be opened, date-stamped and checked for:

Eligibility in respect of age;

  • Appropriateness;
  • Completeness;
  • The existence of an Assessment Report for which the review date has not expired or of an active application in the assessment of need process. The latter would not be treated as a new application although a review may be required.

1.1.2. If the Assessment officer is not in the office, arrangements should be made for this procedure to be carried out on his/her behalf. This arrangement is in addition to any Assessment officer cross-cover arrangements made between LHOs.
1.1.3. If the Assessment officer is of the opinion that intervention is required as a matter of urgency, the Assessment officer should ensure that a referral is arranged to the relevant service provider. In any event, the Assessment officer should ensure that the assessment process does not unduly hinder or delay intervention.
1.1.4. In accordance with the Disability (Assessment of Needs, Service Statements and Redress) Regulations 2007 the Assessment officer will process applications for assessment in order of the date on which they are received. Where two or more applications are received on the same date then they shall be processed in alphabetical order of the surname of the applicant.

  • Ref. Application Form.
  • Ref. Guidance for Assessors.

1.2. Eligibility in Respect of Age.

1.2.1. When determining eligibility in respect of age, Guidance Note No. 1 should be followed.

  • Ref. Guidance Note No. 1. Age. Amended by the Interpretation of Age-Limit - September 2008.
  • Ref. Disability Act 2005 (Commencement) Order 2007.S.I. No. 234 of 2007.

1.3. Appropriateness of Applications.

1.3.1. "Appropriateness" refers to issues such as:

  • Is the application made by a person authorised to do so under section 9 (2)?
  • Is the applicant applying to the correct LHO? The correct LHO is the one in which the child lives.

1.3.2. Section 9 (2) (d) of the Act allows for application to be made by an advocate appointed by the Citizen's Information Board (CIB). (Formerly Comhairle). The CIB has yet to establish this service.

1.3.3. Section 9 (4) of the Act states that an employee of the HSE "may arrange for an application....to be made by or on behalf of the person". In practice, the employee will suggest to the person that they make an application and the actual application and the relevant consents are submitted by the person.

1.3.4. Where a child is in the care of the HSE, the Assessment officer should seek advice on consent issues from the relevant Social Worker.

1.3.5. Where it is clear that the application is not appropriate, one of the following actions should be taken:

  • If the application has not been made by an appropriate person authorised under section 9 (2), the person making the application should be contacted immediately and guidance given on how an appropriate application might be made;
  • If the application has not been made to the correct LHO, the application should be referred on to the appropriate LHO immediately and the applicant notified. The relevant Assessment officer should also be notified by e-mail.

1.3.6. In any event, the Assessment officer should ensure that appropriate referrals are made to other health services and that this is not left up to the applicant to pursue.

1.4. Completion of Applications.

1.4.1. If the application form is not complete, a letter requesting the missing information should be sent out within five working days.

1.4.2. When all information is received the application should be recorded as complete, along with the date, in the "For Office Use Only" section of the application form.

1.4.3. All complete applications should be recorded on the IT system regardless of whether or not they are deemed appropriate.

  • Ref. Standard Letter. Further Application Information.

1.5. Existing Assessment Report.

1.5.1. It may become evident that an assessment has already been carried out under the Act and the specified review period has not yet expired. In such circumstances, the HSE may decline an application for an assessment of need.

1.6. Consent Issues.

1.6.1. An application may be accepted with a signature from one of two parents or guardians. The additional consent of the second parent or guardian should only be sought when it becomes clear that there may be uncertainty as to whether or not the second parent or guardian would provide consent if asked. Such instances will be dealt with on a case-by-case basis.

1.6.2. Some general principles apply to the issues of data-protection and consent:

  • The individual concerned must understand what information is being collected and/or shared. It is an important part of the Assessment officer's role to explain the complete process to the applicant and to provide them with information to which they may later refer;
  • The information may only be used for the purpose for which consent was provided. In this case, for the purpose of assessment or service provision. Information legitimately held by the HSE may be circulated within the HSE for these purposes. This also applies to HSE funded agencies where they are involved in assessment or service provision;
  • A general, "need-to-know" principle applies. This means that only those who require the information should receive it and that they should receive only the information they require;
  • In particular, child protection reports would not normally be sought or circulated. If such a report is relevant at all, it is sufficient that potential assessors are aware that a family is in touch with HSE Social Services.
    • Ref. Memo on Consent Dated 12.12.08.

1.7. Application Acknowledged.

1.7.1. A letter of acknowledgement must be sent out within 14 days of receipt of a completed application form. This time-frame is stipulated in the Regulations accompanying the Act.

1.7.2. The date of receipt of the completed application form is the date on which the first period of three months (within which the assessment must commence), referred to in section 9 (5) of the Act, commences. "...the Executive shall cause an assessment of the applicant to be commenced within 3 months of the date of the receipt of the application..." (See also paragraph 3.1.2. below).

1.7.3. A file should be opened when the application is acknowledged.

  • Ref. Standard Letter. Acknowledgement.
  • Ref. Disability (Assessment of Need, Service Statements and Redress) Regulations. S.I. No. 263 of 2007.
  • Ref. Standard Letter. Ineligible-Existing Report.
  • Ref. Filing System Contents.

2. Desktop Examination of the Application. Stage 1.

2.1. Evidence of Disability.

2.1.1. If it is clear that the person does not meet the definition of disability, Guidance Note No. 24(a) should be followed.

2.1.2. In cases where uncertainty remains, clinical advice should be sought.

2.1.3. If uncertainty still remains having sought clinical advice, the child should be referred for assessment under the Act.

2.1.4. In order to facilitate forward planning, those likely to be involved in the assessment process may be e-mailed early in the process. It should be made clear that no action is required from them at this stage.

  • Appendix. Guidance Note No. 24(a). Treatment of those not meeting the Definition of Disability.

2.2. Ineligibility

2.2.1. If, having checked for appropriateness, eligibility in respect of age and completeness, and having acknowledged receipt of the completed application form, it subsequently becomes evident that an Assessment Report is in existence for which the review period has not expired, the relevant standard letter should be sent. NB. The existence of an active application in the assessment of need process would not be treated as a new application although a review may be required. (See paragraph 1.1.1.).

2.2.2. Where a child is deemed ineligible for an assessment under the Act, parents or guardians should be informed that their right to apply to the HSE for services is not affected by the fact that they do not qualify for an assessment under the Act.

2.3. Onward Referral

2.3.1. Reports accompanying the application may indicate the need for a referral to the NCSE under section 8 (3) or to another public body. Such an indication may become apparent at various stages of the process and referral should be made at the earliest possible opportunity.

2.3.2. Where a referral to the NCSE is indicated, the Guidance Note concerning referral for assessment of educational needs should be followed.

2.3.3. Where a referral to a housing authority is indicated, the protocols for such referrals drawn up by the DoHC should be followed.

2.3.4. In either case, the applicant should be contacted and made aware of the Assessment officer's intentions.

2.3.5. The Assessment officer should check that the applicant has provided the appropriate consent.

2.3.6. When referring on to a body outside the HSE, the Assessment officer should be mindful of the general principles applying to matters of consent noted in paragraph 1.6.

  • Ref. Guidance Note on. Referral for Assessment of Educational Needs.
  • Ref. Protocols for Referral to another Public Body.

2.4. Contacting Parents or Guardians.

2.4.1. Parents or guardians should be contacted in order to:

  • Clarify why they think the child needs an assessment;
  • Gather further relevant information which may be of benefit in identifying the child's health and education needs
  • Explore their expectations of the assessment of need process.

2.4.2. Contact with parents or guardians is important at all stages on the process so that they are kept informed of developments and queries can be dealt with as they arise.

2.4.3. The form of contact is at the discretion of the Assessment officer and should be informed by reference to the criteria for deciding the type of contact with parents.

2.4.4. Cognisance should also be taken of the Lone Worker Policy.

2.4.5. If the interview is to be by phone, a preliminary call should be made to agree a time and to provide an estimate of the potential duration.

2.4.6. The Additional Information About Your Child Form (also known as Application Form-Part 2) should be used consistently to guide the interview with the parents. This form, and any other information gathered from contact with parents or guardians, should be made available to potential assessors in order to minimise the overlap between Assessment officer and assessor contact with parents or guardians.

2.4.7. In cases where parents or guardians fail to agree an interview time or an appointment is missed, the following procedure should be followed:

  • Check the reasons for non-attendance with the family. (In particular, be aware of literacy or language issues.);
  • Attempt to negotiate a new appointment;
  • Enlist the assistance of service providers already involved;
  • If a third appointment is missed, a letter is issued informing the parent that their file has been closed and that they may re-apply in the future. The file is also closed on IT system.

2.4.8. NB: An important function of the early contact with parents of applicants is to ensure that the whole process from the time of application through to the provision of services and future review of Assessment Reports is explained in detail. This explanation should include:

  • Reference to the standards applying to the assessment of need process;
  • An explanation of the roles of those involved in the process;
  • An explanation of the independence of function afforded to the Assessment officer by the Act;
  • An explanation of "informed consent" and its application in this case;
  • Clarification of the important differences between the process governing the assessment of need and that governing the provision of the Service Statement;
  • In particular, the fact that assessments are carried out without regard to resources or capacity to deliver while Service Statements provide the detail of which services are going to be provided, given current resources;
  • Reference to the redress system;
  • Provision of the explanatory leaflet.

2.4.9. In addition to the above, the Assessment officer should take the opportunity to explore the expectations that parents or guardians have of the process with particular emphasis on the following:

  • The assessments may well be carried out by the service provider in which a child is receiving intervention and the process is not designed to provide a second opinion;
  • Assessing a child's health needs does not necessarily involve a diagnostic assessment;
  • The process will not necessarily result in a higher level of service provision than that which is already in place.

2.4.10. Where specific assessments are requested by parents, the Assessment officer should ascertain the reasons for the request and ensure that the request is based on a presenting need. It should also be clarified with parents, that the decision as to whether or not a particular assessment is clinically appropriate lies with the clinician at whom the request is directed.

2.4.11. Where the Assessment officer receives an application in respect of a newly diagnosed baby, it may be appropriate to introduce the family to the service required, (or arrange for that to happen), rather than process the application at that time.  This would provide the family with the opportunity to gradually build up a relationship with the service and the Therapists involved and to acclimatise themselves to their new situation.  In such circumstances, the child's application can be put on hold for a period of time, with the agreement of the parents or guardians.

  • Ref. Standard Letter. Client Interview.
  • Ref. Criteria for Deciding Type of Parental Contact.
  • Ref. Lone Worker Policy.
  • Ref. Additional Information Form.
  • Ref. HIQA Standards for the Assessment of Need.
  • Ref. Guidance Note No. 25. Independence of Assessment officers.
  • Ref. Explanatory Leaflet.

2.5. Accessing Existing Reports.

2.5.1. Using the information gleaned from the application form and the initial contact with parents or guardians, the Assessment officer should contact the relevant professionals to ask them to forward copies of existing, relevant reports. A standard letter is provided on the IT system for this purpose. Existing reports form an important part of the overall information available to potential future assessors and to the Assessment officer. Consequently, the Assessment officer should seek relevant existing reports at the earliest possible opportunity.

2.5.2. Assessment officers should be selective in seeking existing reports and should be clear that each will fulfil a necessary function. Reasons for obtaining an existing report are as follows:

  • It is necessary in order to provide the Assessment officer with sufficient evidence to warrant further assessment;
  • It is necessary to gain the information required to ascertain the health and education needs without requiring further assessments;
  • It is required by potential assessors in order to enable them to carry out their own assessments.

Please note that it may be sufficient for potential assessors to know that a report exists so that they can access it themselves if they deem it necessary.

2.5.3. It would normally be sufficient to obtain the most recent reports from current service providers.

2.5.4. Guidance has been issued concerning the criteria to be applied when deciding whether or not existing reports can be accepted as a part of the assessment of need process.

  • Ref. Standard Letter. Request for Reports.
  • Ref. Guidance Note No. 11. Previous Reports.

2.6. Following Contact with Parent(s) or Guardian(s).

2.6.1. If, following the interview with the parents or guardians, it is clear that there is evidence that the child may not meet the definition of disability, the process outlined in paragraph 2.1. should be followed.

2.6.2. If, following the interview, the need for a referral to the NCSE under section 8(3) or to another public body is indicated, the process outlined in paragraph 2.3. should be followed.

2.7. Arranging Assessments.

2.7.1. Before making arrangements for clinical assessments to be carried out, Assessment officers should be satisfied that there is sufficient evidence to suggest that the child may meet the definition of disability. In those cases where they are not satisfied, they should afford the parents an opportunity to provide that evidence.

2.7.2. It is the Assessment officer's role to arrange for assessments to be carried out. Decisions in this regard are based on information from the following sources:

  • The Application Form;
  • The interview with parents or guardians;
  • Existing reports received;
  • Clinical advice. This should be sought if deemed necessary.

2.7.3. The Assessment officer should ensure that they request assessments based on presenting needs rather than broadly requesting assessments from certain disciplines. If the Assessment officer is unsure of the need for a particular assessment, s/he should contact the relevant assessor or other relevant clinician and discuss the matter. Guidance has been developed to assist Assessment officers in deciding which assessments should be requested.

2.7.4. Assessment officers should be familiar with the documents, Guidance for Assessors and Guidance on Requesting Assessments.

2.7.5. Assessment officers may be in the position of arranging for assessments to be carried out either by a range of individual clinicians or by a team. When referring to a team for assessment, it is unnecessary, in most circumstances, to request individual assessments from certain clinicians. It is sufficient to request an assessment of health needs occasioned by the disability.

2.7.6. Where an assessment is requested of a team and the team is unable to carry it out as requested, they will inform the Assessment officer in writing of the clinical reasons for this and will confirm in writing that the decision was not based on resource considerations.

2.7.7. Assessment officers should use the forum provided by the Local Implementation Group (LIG) to ensure that good lines of communication are established with potential assessors and that the legislative obligations on Assessment officers and others involved in the process are understood.

2.7.8. A standard letter is sent to each potential assessor. This should include:

• A copy of the Application Form;

• A copy of the Additional Information Sheet;

• Reference to or copies of any relevant, previous reports;

• The HIQA Standards for the Assessment of Need. (Sent once and referred to thereafter);

• The Guidance for Assessors including the section on Interpreting the Definition of Disability Contained in the Act. (Sent once and referred to thereafter);

• A Summary Report form;

• Any other useful information.

2.7.9. All assessment requests should be logged on the IT system in order to facilitate tracking and targeting of issues arising.

2.7.10. The letter to the assessor must include the latest possible date on which the assessment must be returned to the Assessment officer. The date for return will be at least two weeks before the Assessment Report is due to be sent to the Liaison Officer.

2.7.11. If the time-frame is extended with the agreement of the parents / guardians, the date on which the Assessment Report is due, as entered on the IT system, must be changed by the Assessment officer.

2.7.12. The legislation allows for the assessment to be commenced within three months of the date of receipt of the completed application and completed "without undue delay" which is defined in the Regulations as meaning, within a further three months. Given the fact that non-adherence to the time lines is one of the potential grounds for complaint, it is essential that the beginning and end of each stage is clearly marked. The start of this second stage of the assessment process is defined by the date on the letter sent by the Assessment officer arranging the first professional assessment.

2.7.13. Assessment officers and potential assessors are expected to maintain contact in order to manage this process and ensure that assessors have adequate time to complete their assessments, that the assessments are completed within the time lines and that the process is completed without undue delay.

  • Ref. Guidance on Requesting Assessments.
  • Ref. Standard Letter - Request for Assessments.
  • Ref. HIQA Standards for Assessment of Need.
  • Ref. Guidance for Assessors.
  • Ref. Summary Report form.

2.8. Co-ordinating Assessments.

2.8.1. The letter used when requesting assessments allows for other assessments requested to be noted so that assessors may be in communication with each other, co-ordinate their assessments and discuss their findings.

2.8.2. It is the Assessment officer's role to ensure that all assessors are:

  • Informed of the names of all other assessors who have received requests to assess the child;
  • Are aware of their obligations under the HIQA Standard No. 5 to carry out the assessments in a co-ordinated manner in order to accurately identify the needs of the child and to achieve a comprehensive report and to agree prioritisation of health needs.

2.8.3. In particular, Assessment officers should be aware of the need to ensure co-ordination where further assessments are requested later in the process after initial letters requesting assessments have been sent.

2.8.4. Assessors also have an obligation to ensure that they co-ordinate their assessments with those of other clinicians.

2.8.5. Prior to sending out assessment requests, The Assessment officer should try to ascertain who is carrying them out in order to include contact details in the letter.

2.9. Assessor Qualifications.

2.9.1. It is the Assessment officer's role to ensure that potential assessors are suitably qualified, aware of the Guidance for Assessors and aware of the HIQA Standards for the Assessment of Need.

2.9.2. If assessment requests are channelled through a central administrator, the Assessment officer needs to make arrangements to ensure that they know the identity of the person carrying out the assessment.

2.9.3. In order to ensure that those requested to carry out assessments are suitably qualified and experienced, Assessment officers should request, on an annual basis, a letter from the employers of assessors stating that those who will be carrying out assessments under the Act in the coming year will be so qualified and experienced. In the case of assessors employed by the HSE, this letter should be signed by the General Manager. In the case of assessors employed in voluntary sector agencies, the letter may issue from the organisation's central office. (Assessors are also asked to state their qualification when completing the Summary Report form.)

2.10. Where an Assessor is Unable to Carry out an Assessment.

2.10.1. If an assessor is unable to carry out an assessment, the Assessment officer should be notified in writing and reasons provided.

2.10.2. Valid reasons may include the following:

  • A material mistake of fact is identified during an assessment. E.g. clinical content of a report has been misinterpreted;
  • The specific assessment requested by the parents or guardians is not age appropriate and/or not required;
  • The applicant/family has missed a number of appointments and/or is not engaging with an assessor. (See paragraph 3.2.3.).

2.10.3. Other issues may arise which may delay an assessment. These should be notified to the Assessment officer at the earliest opportunity.

2.10.4. If an assessor determines that an assessment which has been requested should not take place, they should explain their reasons to the Assessment officer in writing. This letter should also confirm that the decision was not based on resource considerations.

2.10.5. Invalid reasons for being unable to carry out an assessment may include the following:

  • There is a waiting list for assessments;
  • Staff shortages due to leave or non-recruitment;

2.10.6. In the event of an assessment not being obtainable from the normal assessors, Assessment officers should discuss the issue with their General Manager. Solutions might include:

  • GM requesting the service manager to complete the assessment;
  • A different agency;
  • A neighbouring LHO Area;
  • A private clinician.

2.10.7. In the event of an assessment being requested from a private assessor, Guidance Notes No. 15 and 16 should be followed.

  • Ref. Guidance Note No. 15. Private Assessors.
  • Ref. Guidance Note No 16. Private Assessors Agreement.

3. Assessment Stage - Stage 2.

3.1. When Stage 2 Commences and Finishes.

3.1.1. According to section 9 (5) of the Act: "...the Executive shall cause an assessment of the applicant to be commenced within 3 months of the date of the receipt of the application or request and to be completed without undue delay".

3.1.2. The term, "the assessment of the applicant" is taken to refer to the professional assessments. I.e. The Assessment Stage - Stage 2.

3.1.3. In order to vindicate the applicant's rights under the Act and to measure performance within the system, it is necessary to define the exact time that this stage commences.

3.1.4. The commencement of stage 2 is taken to be as detailed in paragraph 2.7.11. I.e: The start of this second stage of the assessment process is defined by the date on the letter sent by the Assessment officer arranging the first professional assessment.

3.1.5. Assessment officers and potential assessors are expected to maintain contact in order to manage this process and ensure that assessors have adequate time to complete their assessments, that the assessments are completed within the time lines and that the process is completed without undue delay.

3.1.6. According to paragraph 10 of the Regulations: "The Executive shall complete the assessment and forward the assessment report to the Liaison Officer within a further three months from the date on which the assessment commenced..." In other words, the term, "without undue delay" in section 9 (5) of the Act is interpreted to mean within a further three month period.

3.1.7. The date on the e-mail sent from the Assessment officer to the Liaison Officer attaching the Assessment Report, is taken to be the date on which stage 2 finishes and the one-month period within which the Service Statement should be produced, begins.

  • Ref. Guidance Note No 18. Issuing the Assessment Report and the Service Statement at the same time.

3.2. Inability to Comply with the Time-Frame.

3.2.1. If an assessor is unable to comply with the time-frame, s/he should notify the Assessment officer in writing as soon as possible stating the reason.

3.2.2. Paragraph 10 of S.I. 263 of 2007 (which refers to "exceptional circumstances" in which an assessment may be delayed), may be invoked where there are clinical reasons for the delay or pressing family issues affecting the applicant.

3.2.3. Where an assessment is delayed because the applicant was unable to attend an appointment, the process may be put on hold pending resolution of the issues. The following procedure should be followed:

  1. The particular service concerned may have a policy for handling non-attendance. In such a case, this policy should be implemented.
  2. In the absence of a particular policy relating to the service, the assessor should:
    • Check the reasons for non-attendance with the family. (In particular, be aware of literacy or language issues.);
    • Attempt to negotiate a new appointment;
    • Enlist the assistance of other service providers already involved;
  • If a third appointment is missed, the Assessment officer should be informed. The Assessment officer will then issue a letter informing the parents that the file has been closed and that they may re-apply in the future. The file is also closed on IT system.

3.3. Assessments Identified Late in the Process.

3.3.1. Where an assessor identifies the need for an assessment late in the process, the relevant Guidance Note should be followed.

  • Ref. Guidance Note on Assessments Identified During the Process - To be issued.

4. Assessments Returned.

4.1. Summary Report Form Returned Incomplete.

4.1.1. The Assessment officer requires all assessment documentation (Professional Report and Summary Report including the Determination of Disability - Supporting Information section), to be returned complete. However, ensuring that the child concerned receives intervention as soon as possible is the paramount consideration.

4.1.2. The Guidance for Assessors document has been developed to assist assessors in this regard. This document includes advice on interpreting the terms used in the definition of disability contained within the Act.

4.1.3. It should be remembered that it is the Assessment officer who makes the determination as to whether or not a child meets the definition of disability contained in the Act. This is done, taking into account, the information provided by clinicians and others.

4.1.4. The Assessment officer requires all clinicians involved in the assessment to return the Summary Report. However, the s/he may make a determination based on information contained in a form returned by one clinician.

4.1.5. Further, the Assessment officer may make a determination without information contained in the Determination of Disability - Supporting Information section, if s/he is of the opinion that there is sufficient other information upon which to base such a decision.

4.1.6. The information contained in sections 7 and 8 of the Summary Report is required to populate sections 6 and 7 of the Assessment Report.

4.1.7. The content of the Assessment Report is stipulated in the Act and Assessment officers require the assistance of clinicians to ensure that the HSE meets its statutory obligations.

4.1.8. Local Implementation Group meetings and/or other forums should be used to explain the necessity of this information to assessors. If it were not received, the Assessment officer would be placed in the position of having to interpret the professional reports of the clinicians involved.

4.1.9. The assistance of the General Manager and the Disability Manager should be sought in dealing with these issues.

  • Ref. Guidance for Assessors.

4.2. The Assessor has not completed / returned a full report.

4.2.1. Where an Assessment officer has requested a clinician to carry out an assessment under the Act, a full report is not returned and none of the reasons listed in paragraph 2.10.2. apply, the Assessment officer is not in a position to fulfil his/her obligations under the Act.

4.2.2. In these circumstances, the Assessment officer should contact the assessor concerned by e-mail or letter. This communication should explain the legislative position and request the reasons for not returning the report in writing.

4.2.3. The assistance of the General Manager or Disability Manager may be required to resolve the situation.

5. Issuing the Assessment Report.

5.1. Where the Determination is that the Child does not have a Disability.

5.1.1. In those cases where the information received leads the Assessment officer to determine that the child does not have a disability as defined in the Act, Guidance Note No. 24(a) should be followed.

5.1.2. This leads to the issuing, directly to the person concerned, an Assessment Report noting that the Assessment officer has determined that the person does not meet the definition of disability contained in the Act.

5.1.3. The Assessment officer should ensure that the person is referred on to any necessary health services as appropriate. It should be made clear that, a determination that a person does not meet the definition of disability under the Act does not affect access to any health services deemed necessary.

5.1.4. When the Assessment Report is complete, the Assessment officer should contact the parents with a view to clarifying the next steps in the process.

  • Ref. Guidance Note No. 24(a) Treatment of those not meeting the Definition of Disability.
  • Ref. Assessment Report - No Disability.

5.2. Where the Determination is that the Child has a Disability.

5.2.1. In those cases where the information received leads the Assessment officer to determine that the child has a disability as defined in the Act, the Assessment Report should be completed and sent to the Liaison Officer in accordance with Guidance Note No. 18 and the Liaison Officer - Process and Practice Guidelines.

5.2.2. When the Assessment Report is complete, the Assessment officer should contact the parents with a view to clarifying the next steps in the process.

  • Ref. Assessment Report - Disability.
  • Ref. Guidance Note No. 18. Issuing the Assessment Report and Service Statement.
  • Ref. Liaison Officer - Process and Practice Guidelines.

6. Redress System.

6.1. Protocols for Staff Handling Complaints and Appeals

6.1.1. The Disability Act makes provision for a separate redress system. Separate protocols have been developed to guide staff in handling complaints and appeals in this regard. This issue is not dealt with in these guidelines.

6.2. Grounds for Complaint.

6.2.1. An applicant may make a complaint in relation to one or more of the following:

a. a determination by the Assessment officer concerned that he or she does not have a disability;

b. the fact, if it be the case, that the assessment under section 9 was not commenced within the time specified in section 9(5) or was not completed without undue delay;

c. the fact, if it be the case, that the assessment under section 9 was not conducted in a manner that conforms to thestandards determined by a body referred to in section 10;

d. the contents of the Service Statement provided to the applicant;

e. the fact, if it be the case, that the Executive or the education service provider, as the case may be, failed to provide or to fully provide a service specified in the Service Statement.

6.2.2. Any complaints that an applicant may have which do not fall into the categories mentioned above should be dealt with in accordance with the provisions of part 9 of the Health Act 2004.

6.3. Redress System Structures.

6.3.1. Two dedicated Complaints Officers have been appointed and are based in the Consumer Affairs Division of the HSE. An independent Office of the Disability Appeals Officer has also been established.

Appendix 5: National Council for Education circular

Circular No. 0020/2011 Circular to the Management Authorities of National Schools on the Assessment of Need process under the Disability Act 2005

1. Background

As outlined in Circular 51/2007, the provisions of Part 2 of the Disability Act, 2005 came into operation in relation to persons under 5 years of age on 1 June 2007. Under its provisions, parents may apply for an assessment of need under the Act if they are of the opinion that the child may have a disability in terms of the Act.

Disability under the Act is defined as follows:
"Disability", in relation to a person, means a substantial restriction in the capacity of the person to carry on a profession, business or occupation in the State or to participate in social or cultural life in the State by reason of an enduring physical, sensory, mental health or intellectual impairment.
"Substantial restriction" is considered to mean a restriction which:
(a) is permanent or likely to be permanent, results in a significant difficulty in communication, learning or mobility or in significantly disordered cognitive processes, and
(b) gives rise to the need for services to be provided continually to the person whether or not a child or, if the person is a child, to the need for services to be provided early in life to ameliorate the disability.

2. The Assessment of Need under the Disability Act

Assessment Officers are charged with organising the assessment of need for the HSE. The Assessment Officer must organise an assessment of the child within tight statutory time frames. The assessment focuses on the child's needs and may not necessarily result in a diagnosis which meets the DES criteria for resource allocation. It is the statutory duty of the Assessment Officer, taking cognisance of available clinical evidence, to make a determination as to whether or not a child meets the definition of disability contained in the Act. It is this decision which determines whether or not the child is entitled to the benefits of the Act's provisions.

3. Education and the Disability Act

Under Section 8 (3) of the Disability Act, the Assessment Officer may request assistance from the NCSE in identifying the educational needs of the child. A process has been agreed for timely contact and response to the HSE by the NCSE to these requests.
The Assessment Officer (HSE) contacts the relevant SENO (NCSE) when an educational need is identified as part of the assessment process. The SENO informs the Assessment Officer of the education services which will be made available to the child. These services will be based on the relevant criteria applying at the time, with regard to provision for the education of pupils with special educational needs, including assessment and intervention and using the approach outlined in the NEPS Guidelines - A Continuum of Support - the General Allocation and resources allocated to schools by the NCSE, on the basis of criteria set out by the DES.
In order to ensure that parents have all the information and support they need, the contact details of the SENO will be made available to the Assessment Officer for parents' use, if required.

4. The School and the Disability Act Process

(i) What to do in terms of intervention prior to advising a parent about Assessment of Needs

Where a child under the age of 5 presents as having learning and or behavioural emotional or social difficulties in school, teachers should follow the approach to assessment and intervention outlined in the NEPS Continuum of Support Guidelines to address those needs in the first instance.

Applications for assessment of need under the Act should be made by the parent or guardian. In cases where a child under the age of 5 years appears to have a disability as set out above, and has not been assessed under the Act, the principal may inform the parents of the assessment of need process. Information leaflets for parents are available from HSE Local Health Offices, in GP clinics and HSE local health centres. Information is also available on the HSE website.

Principals should be aware that it is not appropriate for them to refer a child for assessment of need under the Disability Act. This process may only be initiated by a parent or guardian.

(ii) School Response to pupil need following an Assessment of Needs

Where a child has been assessed as having a high incidence special need as set out in DES Circular 02/05, schools should support the child through the General Allocation Model for resource teaching.

As previously noted, assessment under the Disability Act focuses on a child's needs and does not necessarily result in a diagnosis which may be required to meet the DES criteria for low incidence special educational needs.

In cases where it is evident from the reports supplied by the parent/s from the assessment of need process that the child meets the criteria for additional resources under the DES criteria for low incidence special need, the principal may make an application to the SENO in the normal way. As in all cases, the principal may consult with the SENO as to whether or not the child meets the required criteria.

Schools may use the information from assessment of need report/s provided to them by the parents to plan for differentiation and/or additional teaching support depending on the level of need of the child. The school may consult the NEPS psychologist when planning for a child with complex needs.

(iii) Communication

It has been agreed between the HSE, NCSE and NEPS that the appropriate line of communication for exchange of information under the Act is between the Assessment Officer and the SENO. It is, therefore, not appropriate for school principals to make direct contact with Assessment Officers or other HSE staff in this regard. Any queries regarding the assessment of need or intervention with a particular child should be directed to the local SENO.

This circular can be accessed on the Department's website www.education.ie

If you have any queries with regards to this circular please contact Special Education Section on 090 648 3747. Teresa Griffin, Principal Officer, Special Education Section

Appendix 6: Children receiving disability services

Table 6 - Children under 9 by category of disability in 2011

Category of disability

Nos.

%

Intellectual Disability363763%
Physical disability64611%
Hearing loss/deafness340.5%
Visual disability561%
Speech and/or language disability70012%
Multiple disabilities73512.5%
Total5808100%

Source: Health Research Board



Appendix 7: Person hours required to complete a statutory assessment of need


Table 7 - Person hours required to complete a statutory assessment of need

Average hours required to complete average AON

Average hours required to complete more complex AON

Assessment as part of multi-disciplinary team

Typical number on team involved in multi-disciplinary team assessment

Total team hours

Clinical background

4

 

Yes

2

8

Clinical psychologist (senior)

14.5

26.5

No

NA

NA

Clinical psychologist (senior)

9

11

Yes

Determined by AO

NA

Clinical psychologist (senior)

10.5

 

Yes

Depends on referral question

NA

Clinical psychologist (senior)

14

 

No

NA

NA

Clinical psychologist (senior)

10

14

No

NA

NA

Clinical psychologist (senior) (school aged)

NA

NA

Yes

Depends on referral question

26*

Early Intervention Service Manager

4

6

Yes

Depends on referral question

 

Early Intervention Team Manager

3

 

Yes

2

6

Occupational Therapist

14

 

Yes

Depends on referral question

NA

Occupational Therapist

4

6

Yes

Depends on referral question

NA

Occupational Therapist

3

6

Yes

Depends on referral question

NA

Occupational Therapist

4

6

Yes

Depends on referral question

NA

Occupational Therapist

1.5

 

Yes

2

3

Occupational Therapist (senior)

40

 

No

NA

NA

Occupational Therapist (senior)

3

 

Yes

2

6

Occupational Therapist (senior)

4

 

No

NA

NA

Occupational Therapist (senior)

14

 

Yes

Depends on referral question

NA

Occupational Therapist (senior)

8**

 

No

NA

NA

Physiotherapist

4.5***

 

Yes

18

4

Physiotherapist

4

 

Yes

Depends on referral question

 

Principal Physiotherapist

5

 

No

NA

NA

Principal Speech and Language Therapist

15

24

No

NA

NA

Psychiatrist (Children and Adolescent Mental Health team)

20

30

No

NA

NA

Psychologist (0-18)

2.5

 

No

NA

NA

Speech and Language Therapist (0 - 18)

6

 

Yes

Determined by AO

NA

Speech and Language Therapist (senior)

4

 

Yes

6

24

Speech and Language Therapist (senior)

7

 

Yes

Depends on referral question

NA

Speech and Language Therapist (senior)

21.5

 

No

NA

NA

Speech and Language Therapist (senior) (0 - 18)

Source: Figures based on answers given to National Disability Authority as part of interviews with assessors and service / team managers.

The figures above need to be treated with considerable caution. As is clear from the rest of this report, clinicians complete a variety of assessment types as part of the "statutory assessment of need" ranging from a screening assessment to a diagnostic work up. Therefore, these figures are not comparing like-for-like assessments.

* The figure of 26 hours covers a fixed programme of intervention and hours to write a subsequent report (whether a statutory assessment of need report or not)
** and *** The figure of 8 and 4.5 hours were given by the same physiotherapist who performs some statutory assessments of need as part of a team and some as uni-disciplinary assessments.




[1] This refers to line manager of the assessors who carry out the assessments as part of the AON process. It could be a team lead, service manager or clinical lead. The purpose of these interviews is to try to ascertain the extent to which team / management guidance has shaped the manner in which assessors approach AON assessments.