Speech and language therapists 'heartbroken' over children’s disability services, study finds

They said this highlights critical flaws in the Children Disability Network Team model which needs reform, with experienced clinicians leaving the public system in favour of private practice – a move that risks deepening health inequalities.

Speech and language therapists describe feeling “heartbroken” and having a “constant feeling of unmet need and upset families”, as large caseloads and staffing issues prevent them offering vital care to children.

A new study from researchers at University College Cork and the Royal College of Surgeons of Ireland University of Medicine and Health Sciences found that such therapists working in children’s disability services are unable to deliver the direct interventions that children urgently need.

They said this highlights critical flaws in the Children Disability Network Team model which needs reform, with experienced clinicians leaving the public system in favour of private practice – a move that risks deepening health inequalities.

Based on online and focus group interviews with 28 speech and language therapists, the researchers said it revealed significant issues in the understanding of the needs of children with disabilities at a policy and managerial level.

“More than anything, clinicians spoke of large and unsafe caseloads and a lack of understanding from policy makers around the lifelong needs of those with disabilities,” the researchers said.

“They argued that traditional HSE models of service delivery where children are offered relatively short periods of weekly on/off ‘blocks’ of intervention regardless of their level of need were not appropriate or effective for these children and their families.” 

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The speech and language therapists reported spending only a quarter of their time delivering direct care to children, with most dissatisfied with this level of interaction. More of their time was taken up with administration, meetings and indirect intervention, they said.

The barriers to delivering direct care included challenging work environments, unmanageable caseloads, inadequate clinical supervision and staffing shortages, as well as non-standardised prioritisation systems for cases.

One speech and language therapist said they had a caseload of over 800 children between three or four colleagues. Another had a caseload of 350 children between two colleagues.

“There are overwhelming numbers of children sitting on lists and little support from ‘the top’ regarding regulation/maintenance of clinical decision making on who gets seen and for how long,” a participant said.

It sometimes feels like we’re making it up as we go along. I am heartbroken. It pains me to come into work every day. 

Another commented on the anger many parents felt due to uncertainty and delay in accessing services. 

They said: “Parents are being asked to be their child’s speech and language therapist, physical therapist, occupational therapist, etc. because we are not sufficiently staffed to provide meaningful and regular intervention.” 

Recommendations

The researchers, Dr Ciara O’Toole from UCC and Dr Noreen O’Leary from RCSI, suggested solutions to address these challenges including urgent action to redesign services, investment in staffing and more clinical autonomy.

Ring-fencing workloads along with more appropriate supervision structures and a clearer pathway to prioritise treatment would also help speech and language therapists.

Dr O’Leary said: “We hope service providers will consider the proposed solutions to improve conditions for speech and language therapists and outcomes for those they support.”