LCQ18: Support for children with special needs

     Following is a question by the Hon Leung Che-cheung and a written reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (February 26):
 
Question:
 
     At present, children under 12 years old suspected to be suffering from developmental disorder may, through referral by various channels (including the Maternal and Child Health Centres, the Hospital Authority, doctors in private practice and psychologists), receive clinical assessment service provided under the Child Assessment Service of the Department of Health, and be subsequently referred for receiving follow-up services (including specialist medical services, education and training). It has been reported that the waiting time for those two types of services has lengthened in recent years. In this connection, will the Government inform this Council:
 
(1) of the number of children waiting for the assessment service at the end of each of the past three years;
 
(2) of the number of children who were assessed in each of the past three years as suffering from developmental disorder, with a tabulated breakdown by the type of follow-up services to which they were referred; in respect of each type of the follow-up services, the current (i) average waiting time and (ii) average duration for using such services;
 
(3) of the new measures put in place to shorten the respective waiting time for (i) the assessment service and (ii) the follow-up services; and
 
(4) regarding the children from families with financial needs who urgently need the assessment service or the follow-up services, whether the Government will consider distributing service vouchers to such children, through setting up a fund, for such children to obtain the relevant services provided by the private sector, so that they may receive the required services as early as possible; if not, of the reasons for that?
 
Reply:
 
President,
 
     In consultation with the Education Bureau, the Labour and Welfare Bureau, the Department of Health (DH) and the Hospital Authority (HA), I provide a consolidated reply to the question raised by Hon Leung Che-cheung as follows:
 
(1) The Child Assessment Service (CAS) of DH, which has seven Child Assessment Centres (CAC) in Hong Kong, provides comprehensive assessments and diagnosis for children under 12 years of age who are suspected to have developmental problems.  After assessment, follow-up plans will be formulated according to the individual needs of children.  Children will be referred to other appropriate service providers for training and education support.  While children await assessment and rehabilitation services, CAS will provide interim support to their parents to facilitate the development of the children.
 
     The number of newly referred cases received by the CAS in 2017, 2018 and 2019 are 10 438, 10 466 and 9 799 (provisional figure) respectively.  All new cases of the CAS were seen within three weeks after registration.  Due to continuous increase in the demand for services provided by the CAS and the high turnover rate and difficulties in recruiting doctors to the CAS, CAS has adopted a triage system to ensure that children with urgent and more serious conditions are accorded with higher priority in assessment.  As the assessment unit of the CAS comprises different professionals and the waiting time for their respective services is different, the actual waiting time depends on the complexity and conditions of individual cases.  DH does not maintain the number of children waiting for the assessment service at the end of each year.
 
(2) and (3)
 
Assessment services
 
     The number of newly diagnosed cases of developmental conditions in the CAS in the past three years are as follows:
 

Note: A child might have been diagnosed with more than one developmental condition. 
 
     The number of cases referred by the CAS to pre-school and school placement for training, remedial and special education in 2017, 2018 and 2019 are 14 294, 17 359 and 18 011 (provisional figure) respectively.  Breakdown figures by the type of follow-up services are not available.
 
     Noting the increasing demands for the services provided by the CAS, DH has started preparing for the establishment of a new CAC with a view to strengthening the manpower support and enhancing service capacity to handle the rising number of referred cases.  As an interim measure, a temporary CAC commenced operation in January 2018.  Besides, the Government has newly created 22 civil service posts in the CAS from 2019-20 onwards.  Save for some supporting staff, nurses and allied health professional staff have started to report for duty since mid/late 2019 to assist in handling the work relating to the CAS.  DH anticipates that the capacity of the CAS would be gradually improved after the strengthening of manpower.
 
     To further enhance the service, the CAS worked closely with Family Health Service (FHS) of the DH in streamlining the case referral arrangement.  From 2018, the FHS has directly referred children with mild language delay to HA speech therapy clinic for therapy while the CAS will provide interim support to their parents, such as talks, workshops, training programmes, etc.
 
Follow-up services
 
Specialist services
 
     The specialist services of HA, including but not limited to psychiatric and paediatric services, comprise healthcare professionals in various disciplines and provide early identification, assessment and treatment services for children and adolescents in need.  The multi-disciplinary professional team, involving doctors, clinical psychologists, nurses, speech therapists, occupational therapists and medical social workers, provides a range of appropriate treatment and follow-ups for children and adolescents, including in-patient service, specialist out-patient service, day rehabilitation training and community support services, according to their clinical conditions, with a view to enhancing their speech and communication, sociability, emotion management, problem solving, learning and life skills.
 
     Similar to the CAS of DH, the Child Assessment Centre of the Duchess of Kent Children's Hospital (DKCAC) under HA also provides assessment to the children attending kindergartens on Hong Kong Island, which is the referral catchment area of DKCAC, to ascertain the level of their physical fitness, cognition skills, language ability, self-care abilities and behavioural development.  Children with specific learning difficulties and behavioural problems will be referred to paediatric departments of HA for treatment and follow-ups.  The multi-disciplinary professional team also provides parents and carers of the children in need with information on the respective developmental problems so as to enhance their understanding of the symptoms and treatment needs of their children.  The professional team also maintains close communication with related organisations, such as early training centres and schools, to provide support according to the developmental needs of the children.  HA does not maintain statistics on waiting time for follow-up services in respect of cases referred to HA due to developmental conditions.
 
Education related services
 
     As regards education related follow-up services, schools should comply with the "intervention before assessment" strategy to provide students with appropriate service.  With reference to the assessment information provided by the CAS and after understanding the students' performance in various aspects like learning, emotion and behaviour, schools will provide the students with school-based support such as quality teaching, additional group or individual training and counselling, curriculum and assessment accommodation, etc.  Where appropriate, schools will refer the students in need to the school-based educational psychologists (SBEPs) or the school-based speech therapists (SBSTs) according to the school-based mechanism for further support.  In general, students referred to the SBSTs by schools will receive assessment and follow-up services within one to two months.  For SBEPs, about 80 per cent of the cases referred by schools were assessed within two months and about 10 per cent were within two to three months.  Some cases with a longer waiting time for assessment were due to special circumstances.  For example, parents requested to defer the assessment or assessment had to be held up pending the students' medical treatment.
 
Pre-school rehabilitation services
 
     In 2018-19, the average waiting time for respective types of subvented pre-school rehabilitation services is as follows:
 

Note: The average waiting time is computed on a financial-year basis (i.e. April 1 of a year to March 31 of the next year).  As OPRS was regularised in October 2018, statistics for the 2018-19 full year are not available.
 
     Generally, children concerned will be released from pre-school rehabilitation services prior to primary schooling.  As different applicants have started waiting for and receiving services at different ages, the duration of receiving services varies from one case to another.  The Social Welfare Department (SWD) has not maintained statistics on the duration of pre-school children receiving pre-school rehabilitation services.
 
     The Chief Executive has announced in the 2019 Policy Address and Policy Address Supplement that the Government will provide over 1 200 additional service places in SCCCs and EETCs in 2019-20 to 2021-22, and a total of 3 000 additional OPRS places in the 2020/21 to 2022/23 school years.  To enable pre-school children with special needs to receive support as soon as possible, the Government will keep in view the demand and supply of various types of pre-school rehabilitation services and the manpower supply of professionals concerned, and provide additional service places as appropriate to shorten the waiting time.
 
(4) Eligible children waiting for subvented pre-school rehabilitation services may apply to SWD for training subsidy under the Training Subsidy Programme for Children on the Waiting List of Subvented Pre-school Rehabilitation Services for obtaining self-financed pre-school rehabilitation services provided by recognised service providers as early as possible.