M., who lives on a southern kibbutz, doesn’t know if her son, who’s almost six, will be able to start first grade in September with his friends or will have to be held back. Although his difficulty holding a pencil and copying from a blackboard was diagnosed over a year ago, the occupational therapy he needed got started only recently.
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“The therapist recommends holding him back, so we have a problem,” said M. “She said that if we had come a year or six months ago the problem would have been resolved long ago.”
M. said that when she called the Sdot Negev child development unit she was told the wait would be six to nine months. She was willing to go to a private therapist, but the nearest one, in Kfar Maimon, “said she had no room, that she was already working every day till 10:30 at night, that maybe she could see him in a month and a half.” They finally got a spot in a unit in Netivot, but only began therapy a few weeks ago.
Municipal child development units across the country are on the verge of collapse, with many of them suffering severe deficits and unable to take on additional employees even as the waiting lists for their services get longer. Six such units have already closed this year.
According to the National Forum for Community Child Development Units, some 20,000 children are wait-listed for therapy, including occupational, physical and speech therapy, mental health services and more. Around half will only be seen in three to five months, while 20 percent will have to wait even longer than that. Moreover, these children only got on the therapy waiting list after waiting months for evaluation and diagnosis at a child development institute. In some cases, even when therapy is started, it is interrupted so that understaffed units can give other children waiting a chance at a few sessions.
According to professionals and parents with children with developmental issues, the trend is getting worse because of the units’ financial crisis. There are around 100 such units set up by local authorities, often with the help of philanthropic foundations, to make such therapies accessible to families who live outside the major cities and cannot afford private treatment. They are essentially service providers for the Health Ministry through the HMOs, which will partially subsidize private therapy only if the child has been made to wait more than three months.
Some 10 percent of Israeli children, a total of 280,000, have been diagnosed with some kind of developmental delay. They are eligible for a therapy program that includes all kind of paramedical services, ranging from speech therapy to art therapy. There is universal agreement among professionals that the sooner therapy begins the more likely and the more quickly the child can be mainstreamed.
Since watchdog's report, situation has worsened
This past May the state comptroller issued a report on the situation and found that children in need can sometimes wait a year, and in extreme cases even two years, for speech or occupational therapy. Many families, particularly in outlying areas, simply give up and the children don’t get the therapy they need.
Since that report, six child development units have closed. Two were in Jerusalem and in the Jerusalem suburb of Kiryat Ye’arim (Telz-Stone), which treated primarily ultra-Orthodox children; the others were in Haifa, Hadera, Lakiya in the south, and the child development institute at Tel Aviv’s Ichilov Hospital. The child development institute at Barzilai Medical Center, the only unit in Ashkelon, is at risk of closure. Every unit that closes refers its patients to other units – which simply lengthens the waiting lists for those facilities.
“These are children who at a critical age will lose their chance because the health funds are underfunded,” says Shir Gur, director of the the National Forum for Community Child Development Units. She blames the Health Ministry, saying that the last time the tariff for an hour of therapy, 214 shekels ($59), was updated was in 1997. Meanwhile, it turns out that the HMOs don’t even pay that to the units; they pay only 120 to 140 shekels, which doesn’t cover the units’ operating, salary and maintenance expenses. The Health Ministry even admitted to the comptroller that “the unprofitable agreements between the units and the HMOs are the source of the long waits.”
The Health Ministry responded by saying it is aware of the problem and “is working hard to find a solution and improve service and availability, especially in the periphery areas. As part of the effort, a committee was established headed by Deputy Director-General Itamar Grotto, whose task it is to examine the issue in depth.”
The ministry also reiterated that ministry regulations call for the HMOs to provide refunds for private therapists to families forced to wait more than three months for services, and that such refunds are to be provided within 45 days of applying for them.
As for the tariff for therapeutic services, it said, “The Health Ministry tariff list is applied in accordance with the Price Control Law and defines the maximum price of the services provided. There is no precedent for a tariff constituting a binding price, and this contradicts the language of the law.” A binding price, the ministry added, would raise difficulties for the economics of the health system and in any case couldn’t be enforced.