HSE Adult Day Services for School Leavers in Ireland: How the Referral Process Works

When a young person with a significant intellectual disability, complex autism, or high medical needs finishes school, their immediate future depends almost entirely on whether an HSE-funded Adult Day Service placement has been secured. In 2025, over 34,650 adults engaged with HSE disability services nationally, with 6,219 in the 18–24 age bracket. Demand significantly outstrips supply — the HSE has reported that over 3,200 additional adults will require day services over the 2024–2029 planning period.

This is not a system that runs itself. Families who wait until their child's final year, or who assume the school will initiate things, regularly face a complete service void after graduation.

Who This Pathway Is For

The HSE Adult Day Services pathway is for young people with:

• Moderate to severe intellectual disabilities
• Significant or complex autism where independent living or open employment is not a feasible immediate goal
• Significant physical disabilities or medical needs requiring continuous daytime support

For this cohort, the post-school goal is not a university course or an open-market job — it is a funded, structured day placement within a Section 38 or Section 39 voluntary organisation running under a service level agreement with the HSE. These organisations include RehabCare, St. Michael's House, Brothers of Charity, and Enable Ireland, among many others.

For young people on the education and employment track (autism with strong academic ability, dyslexia, ADHD, physical disabilities without significant cognitive involvement), the relevant pathway is the DARE scheme, PLC courses, or EmployAbility — not HSE Day Services.

The School Leaver Referral Process: Step by Step

The HSE has a specific, formalised process for allocating day service placements to school leavers. It is time-driven and must begin in the penultimate year of school — typically when the young person is 16 or 17.

Step 1: Referral (March–April of the Penultimate Year)

The school, in collaboration with the family, completes and submits the HSE School Leaver Referral Form along with required consent documentation. This submission formally enters the young person on the national HSE Day Services database and triggers the allocation process.

The form is completed by the school's SEN team or career guidance teacher, not by the family directly. If the school has not initiated this, parents must ask — and ask early. March and April of 5th Year (or equivalent in a special school) is the target.

Families are sometimes caught off guard by the timing — the referral is submitted a full year before the young person graduates. The reason is that funding decisions, profiling assessments, and service matching all take time.

Step 2: Profiling and Support Assessment

After referral, the HSE assigns a Day Opportunities Officer (DOO) based on the family's geographic region. The DOO works with the school's SEN teacher to develop an "Understanding Support Needs" or "Support Profile" document.

This profile is not administrative paperwork — it is the document that determines the level of funding attached to the placement. A well-prepared, detailed profile that accurately describes the young person's support needs, daily living skills, communication profile, and behavioural considerations directly affects which services are appropriate and how much resource is allocated.

Parents should actively contribute to the profiling process. Ask to review the Support Profile before it is finalised. It should reflect the young person's full range of needs, not a minimised or "aspirational" version.

Step 3: Service Visits and Sampling (February–March of Final Year)

In February and March of the graduation year, families and school leavers visit identified Adult Day Services. This is the "sampling period" — the young person attends sessions at prospective services to assess fit.

This stage matters. The environmental and social fit of a day service is critical to long-term outcomes. A mismatch — an active, community-focused service for a young person who needs quiet, structured routines, for example — leads to rapid withdrawal and a placement breakdown.

Parents should bring questions: What does a typical day look like? What is the ratio of staff to participants? Is there a community integration element? What are the transport arrangements? What happens during transition periods (holidays, staff changes)?

Step 4: Commencement and Review (September)

The young person transitions into the Day Service in September of their graduation year. A formal review meeting is mandated approximately 8–12 weeks after commencement to assess settling-in and adjust supports if needed.

HSE Governance After the 2025 Restructure

One practical change that affects how families engage with HSE services is the complete abolition of the legacy Community Healthcare Organisation (CHO) structure in 2025. The HSE has transitioned entirely to Six Health Regions:

• HSE Dublin and North East
• HSE Dublin and Midlands
• HSE Dublin and South East
• HSE Mid West
• HSE South West
• HSE West and North West

Each region is further subdivided into 20 Integrated Healthcare Areas (IHAs). All disability resource allocation, service planning, and complaints now flow through these regional structures. If you need to escalate an issue — a missing allocation, a placement dispute, a service gap — you are now dealing with the Regional Executive Officer (REO) for your IHA, not a CHO structure.

The Person-Centred Planning Framework

Adult Day Services in Ireland operate under the HSE's New Directions policy framework, which mandates a philosophical shift away from traditional centre-based care toward community-integrated, individualised support.

At the core of New Directions is Person-Centred Planning (PCP) — a process where the young adult's own preferences, goals, and choices drive the content and structure of their day, rather than a standardised programme. Families play an active role in PCP meetings, particularly in the early years when the young person may need support to articulate their own preferences.

In practice, PCP implementation varies significantly between providers and regions. Families who understand the policy framework — and know that "New Directions" is HSE policy — are better positioned to challenge a service that is operating in a purely centre-based, institutional mode rather than pursuing genuine community integration.

The Transition from CDNT to Adult Services

The Children's Disability Network Team (CDNT) that managed your child's therapy since early childhood formally discharges them at 18. Adult multidisciplinary therapy services are a separate structure with separate referral pathways — and they are severely backlogged.

This clinical gap is one of the most documented failure points in the Irish transition system. Speech and Language Therapy, Occupational Therapy, and Psychology services in adult disability settings have years-long waiting lists in many regions.

The practical steps:

• At age 17, request a full discharge summary from the CDNT documenting ongoing therapy needs
• Ask the CDNT to initiate the formal referral to adult services at the point of discharge, not after
• Ensure the young person's GP is briefed and integrated into the transition — the GP becomes the primary medical coordinator once paediatric specialist care ends
• If financially viable, consider maintaining private therapy provision during the gap period

Pressing for a CDNT referral to adult services before discharge — not after — is the critical difference between a managed transition and a cliff edge.

What to Do If No Placement Is Allocated

Despite submitting referrals on time and completing all profiling, some families reach graduation year with no HSE placement confirmed. Regional funding constraints are real, and they do not follow the academic calendar.

If this happens:

1. Escalate immediately to the Regional Executive Officer (REO) for your IHA — go above the Day Opportunities Officer level
2. Submit a formal complaint citing the New Directions policy framework and the HSE's service planning commitments
3. Contact Inclusion Ireland — they have experience advocating collectively on behalf of families facing service voids
4. In the interim, explore whether the young person's Disability Allowance can fund private, community-based micro-services or social prescriptions to maintain routine and prevent skill regression
5. Ask whether the WALK PEER programme or a Rehabilitative Training place at the National Learning Network is available as a bridging option

A missed placement is not the end of the road — but it requires active, formal advocacy, not passive waiting.

Planning From Age 16

The HSE Day Services pathway requires a two-year runway. Families who begin engaging at age 16 — getting the referral in at the right time, understanding the profiling process, visiting services proactively — are far better positioned than those who start in final year.

The Ireland Post-School Transition Roadmap at /ie/transition/ maps the full school leaver process onto a year-by-year timeline from age 14 to 18, covering the HSE pathway alongside the financial transitions, legal changes at 18, and education routes — in a single resource designed specifically for Irish families.

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