Some familiar themes in deaths of children - here are their stories

The latest individual reports into the deaths of children known to the care services have some familiar themes — challenging family backdrops; sometimes substance abuse in the home; adverse events.

And in some cases, deficits in how these difficulties are handled.

The case of Jim is maybe the clearest case of shortcomings.

According to the National Review Panel, statutorily required reviews were not held in the early days and later, suitable placements and education were unavailable to meet his needs.

“This led to crisis management at the expense of a more strategic approach,” it said, before referring to a drop-off in service provision when his foster family moved from one part of the country to another.

Furthermore, the initial transfer between the two SWDs[social work departments] was poorly planned and implemented and resulted in Jim and his foster carers receiving a deficient service at a critical time.

It also said allegations made by Jim’s family about his care were handled “inadequately”.

It also said the service provided by SWD in the area he moved to with his longtime foster family was limited and that this was largely due to pressure on resources.

It also said the impact of the lack of an educational or training placement on Jim’s wellbeing cannot be underestimated and that, “in the later years, Jim’s needs were too complex to be met by any one agency or setting.

In the absence of the necessary resources and placements, the work became increasingly reactive and driven by crisis management when a high degree of shared assessment, planning and coordination was required. Furthermore, many of Jim’s behaviours clearly illustrated a number of high-risk factors were at play.”

The deficits highlighted in Jim’s case are not repeated elsewhere.

There is clearer evidence of social work and other departments working well, and of grabbing the nettle, sometimes belatedly so.

Tusla has said lessons will be learned and there is an undercurrent in some of the report that there can always be cases where, even when everyone tries their best, tragedies still occur. The Child and Family Agency’s job is to do all it can to stop them from happening.

Died of overdose despite aftercare

Jim's Story

Jim died from a drug overdose aged 19 and he had been in care up to his 18th birthday and was receiving aftercare at the time he died.

The NRP noted that the review of his case was delayed for many months while awaiting foster care records, which were ultimately declared missing, and again in awaiting a report from CAMHS.

Jim was in care from the age of three because of parental substance abuse, criminality, and domestic violence. At age six he was referred to CAMHS and diagnosed with ADHD. He had two foster placements, the second of which lasted nine years. He had intermittent contact with his parents and siblings.

He was well-settled with his second foster family when they moved house when he was 10, meaning he lost contact with his social worker and waited a year for her replacement to be allocated. He was also on a waiting list for two years in his new location for CAMHS.

Around this time, allegations of physical and emotional abuse in relation to Jim were made against his foster family by Jim’s own family members. Investigations ultimately concluded that the foster carers had used inappropriate methods and sometimes overused sanctions to manage Jim’s aggressive and sometimes violent behaviour and recommended that they attend CAMHS for support and guidance in behaviour management. Other allegations of physical and emotional abuse were unfounded.

The NRP was told it was never clear which social work department had responsibility for organising reviews.

At 14, Jim’s foster parents said they could no longer cope and he moved to a new foster placement and a series of residential units. His psychiatrist said Jim’s main problem was his anxiety about his placements and his experiences of loss.

“The CAMHS service acknowledged that it was not able to provide him with the therapeutic services he required.”

Jim moved back close to his birth family amid deteriorating behaviour. Prior to his death, he moved between his own flat, prison, and his mother’s accommodation.

The NRP said that, among other issues, the management of the case including the planning and implementation of interventions was inadequate at times.

Child with needs was also under investigation

Con’s story

Con died by suicide aged 15 and he had been known to the social work department (SWD) for five years after reports from his grandmother, who was concerned about the care the children were receiving from their mother.

According to the NRP: “The social work department initially had difficulty in locating the children’s mother at home and, following several other reports from their grandmother and other sources, eventually met their mother two years later following an allegation of physical abuse by her against the children.”

In a “very thorough initial assessment”, The social worker learned that Con had been recently implicated in two separate child sexual abuse allegations and was under investigation by the gardaí.

“During her interview with him, the social worker did not mention the alleged child sexual abuse allegations” — this was because the SWD, in line with their current policy, wanted to focus only on allegations his mother had physically abused him, which he denied, and to assess the sexual abuse allegations at a later stage. There was no notification on file from the gardaí to the SWD regarding Con and no formal discussion took place between them two organisations regarding Con’s welfare.

The review found that the response to the first report about Con and his siblings' welfare had been let drift, but that the response to the later allegations of physical abuse was prompt and thorough.

There was a 10-week gap between the time the SWD became aware of allegations against Con and his death and while Tusla was following policy.

The NRP said:

A case such as this where a child presents with needs and is at the same time the subject of a police investigation should be discussed at an early meeting between the gardaí and the SWD to work out the best way to proceed.

However, it said there is no evidence that any action or inaction on the part of the social work services was linked with his very sad death.

Generic file image of child appearing upset.

Under threat from drug dealers at time of death

Kevin's story

Kevin died by suicide aged 16. His family had been known to social work services for years and he had been in foster care for two months before he took his life while he was at home on a visit.

Kevin had behavioural problems as a young child amid concerns he may have had an underlying psychiatric condition. He was referred to child and adolescent mental health services.

Aged 10, he alleged he had been sexually abused by a person known to the family. An and a child sexual abuse assessment concluded that his account of events was credible. Gardaí investigated but No charges were brought, causing upset to Kevin and his parents.

In his teens, he began to miss school and abuse alcohol and drugs. He was linked with a youth advocacy programme and again referred to mental health services when he was found with a rope in his room.

Kevin and his family did not avail of the appointments and he denied any suicidal intent. He ran away from home at times and his mother gave up work so that she could supervise him.

Aged almost 16, he was placed in the first of a number of emergency placements at his parents’ request. His placement appeared to be going well and a Child in Care Review was scheduled to make further plans for him. His parents believed that Kevin was under threat from drug dealers to whom he owed money at the time of his death.

The review found a consistent thread of oversight by social work management throughout, although his parents were frustrated by the lack of out of hours cover at the time, particularly at weekends. The review said this deficit has since been addressed.

His parents also said that Kevin was extremely anxious about the outcome of a decision regarding the funding of his private placement and the NRP said delays should be minimised and as much assurance as possible given to young people in those circumstances.

Still born to mother with drug problems

Josh's story

Josh’s life never properly began. He was stillborn in circumstances where his mother, who had been using drugs, had been “very resistant” to contact with social workers.

Josh was the younger of two children to mother, Cora. His sister, Eve, had a serious medical condition requiring monitoring and treatment. The social work department (SWD) was already involved with the family because of reported medical neglect of Eve.

Cora was a problem drug user, had been prescribed methadone and had mental health problems.

The NRP said: “The involvement of the SWD at the outset was somewhat intermittent despite a number of concerns being referred by Eve’s medical team, and the case had been on a waiting list for a considerable period before an assessment was conducted, after which it was closed.

It was later allocated to a social worker but then left unallocated for a period after she ceased her involvement. At that time, the SWD had a waiting list of 600 cases and the PHN service was also very understaffed.

Following further concerns relating to Eve’s medical condition, social work involvement was consistent and regular and a number of services were involved. However, Cora’s pregnancy with Josh was not disclosed until six months into the pregnancy.

Closer to his birth, it emerged Cora was using cocaine. She was resistant to the four social workers in contact with her during the pregnancy and her attendance at her medical and antenatal appointments was poor. Three weeks before Josh’s birth, consideration was given to removing both children to care.

The review found that the response by the SWD to referrals about medical neglect was slow at the outset. It is acknowledged that the capacity of the area was reduced at the time. It said a parent’s persistent failure or delay in providing adequate care for their child’s medical needs may constitute medical neglect.

In light of the resistance shown by Cora it says “robust supervision may be necessary” and where drugs are involved “there may also be a need to challenge parents if their motivation is poor and the required changes and improvements in a child’s life are not forthcoming”.

Carer for her father but she needed care herself

Sandra's story

Sandra died from complications associated with a chronic long-term illness when she was 16. She had undertaken long-awaited surgery only to succumb to an infection.

In her short life, Sandra had taken on a level of responsibility far beyond her years. Her mother died and she became a carer for her father, who had an addiction and mental health problems.

Sandra herself needed caring. When she was in her teens, she was due to have an elective and potentially life-saving medical intervention which would require her to have intense support in very hygienic conditions. Her medical team was concerned about her father’s ability to provide this.

Four social workers were involved with Sandra, the last of whom had specific knowledge about her condition. Other services were involved and her father seemed to resent the implication that he was not up to providing the care she needed. There were also concerns about physical neglect.

Sandra’s father took his life when his drug use was out of control. The children, including Sandra, were cared for by relatives over the next few months on short-term arrangements. She died two weeks after her own operation.

The review found there could have been more focus on the impact of the father’s drug use on his capacity to look after his children.

It appears to the reviewers that when the case was first referred, the concerns of the medical team could have been addressed by the HSE primary care team social work service whose membership of a multidisciplinary and largely medical team would have brought distinct advantages.

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