New research highlights critical flaws in Ireland’s Children Disability Network Team (CDNT) model, leaving children without vital speech and language therapy services.

A new study led by Dr Noreen O’Leary from RCSI University of Medicine and Health Sciences and Dr Ciara O’Toole of University College Cork reveals that speech and language therapists (SLTs) working in children’s disability services are unable to deliver the direct interventions that children urgently need.

Twenty-eight SLTs from across Ireland took part in the study via an online questionnaire and focus group interviews to discuss their experiences in delivering services within Ireland's reconfigured disability services. First-hand accounts reveal significant flaws in the understanding of the needs of children with disabilities at a policy and managerial level and in the implementation of the CDNT model.

Lack of intervention

Speech and language therapists reported spending just 25% of their time delivering direct care to children, with most participants expressing dissatisfaction with this limited level of intervention. The majority of their time was consumed by administration, meetings, and indirect intervention. Those surveyed identified multiple barriers to delivering direct care, including challenging work environments, unmanageable caseloads, inadequate clinical supervision and staffing shortages, as well as non-standardised prioritisation systems for cases.

In response, the authors propose a range of solutions to address these challenges, outlining the state’s responsibility to create additional SLT posts with ring-fenced workloads supported by appropriate supervision structures and clearer prioritisation pathways. The importance of empowering SLTs to have greater autonomy in their clinical practice is also highlighted.

“We appreciate the opportunity to represent frontline speech and language therapists and highlight the challenges they face. These issues impact staff retention which in turn impact access to and continuity of care for children and families in CDNTs. We hope service providers will consider the proposed solutions to improve conditions for SLTs and outcomes for those they support,” said Dr O’Leary.

Dr O’Toole added: “One of the most striking findings is the limited time available to SLTs for intervention, less than a quarter of their overall working time. We know how important access to appropriate intervention is for children attending CDNTs and that families are also deeply frustrated by lack of intervention. This issue needs to be addressed as a matter of urgency.”

Health inequities

The findings come amid growing public concern about long waiting lists and inconsistent access to disability services. Between 2009 and 2021, reconfigurations in the Irish disability services aimed to reorganise existing staff and services without any additional resourcing. With the number of Irish children requiring disability services rising from 42,000 to 70,000 between 2013 and 2023, the shortcomings of the reconfigured CDNT model are becoming increasingly problematic.

SLTs interviewed described feeling “heartbroken” and having “a constant feeling of unmet need and unmet admin and upset families", warning that experienced clinicians are leaving the public system in favour of private practice – a shift that risks deepening health inequities and placing additional pressure on families and caregivers.

The researchers argue that without urgent action to redesign services, invest in staffing, and restore clinical autonomy, children with disabilities will continue to miss out on high-quality, essential support during critical developmental windows.