Falling through the cracks

IF you are not part of the solution, then maybe you are part of the problem.

That is one of the conclusions that could be gleaned from a new report into how the HSE’s special care service impacts on the lives of some of the most difficult children in the state.

The study, commissioned by the now defunct Children Acts Advisory Board (CAAB), charts whether the risk factors which brought these young people into special care in the first place increased, decreased or remained static between the time of the application in 2007 and November of last year.

In 2007 there were 70 applications for special care, for 61 children: 46% led to an admission for special care, 41% were refused admission and 13% were withdrawn.

Of the applications, 59% were female, 41% male; 74% were white Irish and 14% were Travellers – even in a very small number of cases involving Travellers 63% of those who entered special care in 2007 had risk factors which remained the same or got worse. Two-thirds of all applications were from the Dublin or greater Dublin area.

The detailed study takes the figures in the round, looking at factors in the applications that did not result in an admission to special care, and how special care affected the outcomes of those who entered into it.

Made in the High Court, these orders mean the young person stays in a facility such as Ballydowd (since closed), Coovagh House, or Gleann Alainn. The difficult behaviour displayed by many of these children can be extremely challenging, so it should perhaps come as no surprise that, in some cases, the placement does little to ease the risk factors. In some cases the situation had actually worsened when the cases were tracked up to last November.

Details of chaotic lives of those at the centre of the applications illustrate the scale of the problems:

* Some 79% of the applications identified alcohol and/or substance misuse as a risk factor.

* Nine of the girls were using heroin.

* Three of these were entered into special care.

* More girls than boys were also misusing ecstasy and cocaine.

* In total, 59% of the applications had one or more sexual health/behaviour risks, including risk of sexual exploitation/prostitution, usually relating to an older or adult boyfriend; a risk to sexual health, with a risk of sexually transmitted infections (STIs) or risk of pregnancy; or sexualised behaviour.

* In addition, 56% of the males were detained by the criminal justice system at some point after the application to special care in 2007 compared with 29% of the females, and the report points out if males are struggling to access special care, they are more likely than females to end up in juvenile criminal detention.

n46% of the applications were for children who had been admitted to hospital in the 12 months prior to the application linked to the risks identified in the application, including substance abuse (14 children), parasuicide (seven children), self-harm (six), injury after being assaulted (five), injury sustained in a criminal act (three) and psychiatric concerns (two). It should be borne in mind that some of these children were as young as 12 years old.

There was a less than 50% chance of a successful application for special care if based on the risk of endangering others, but the report also shows care staff were often in the firing line as a result of the behaviour of those in the system.

On discharge, the outcomes of those who were in special care were tracked, and by November last year, 46% (17 out of 37) of those who were still children were in residential care (mainstream, high support, special care) and 38% (14 children) were either at home, in independent/supported living arrangements or foster care. The remainder were accessing homeless services (three) or detained in the justice system (three). However, a third of those who were adults by November 2009 were either accessing homeless services or in detention, with 45% either at home, in independent/supported living arrangements or foster care, while 14% were in residential care, and the whereabouts of 9% was unknown.

There seems to be little point in blaming special care placements for notfully addressing the complex needs of those in the system, and the 83 social workers interviewed for the study felt that 26% of children settled down into improved behaviour soon after leaving special care. However, 39% were perceived to have immediately reverted to their risk-taking behaviour or their behaviour became even worse. A further 25% were perceived to be unstable for a while then settled down, while around 9% = were felt to have settled for a while, then reverted to their previous behaviour.

One argument could be that not enough special care places are available, while the social workers interviewed stress the need to “re-model” the current system, primarily by linking high-support units to special care units. Social workers feel units have too much power to deny entry or stop an admission unilaterally.

Earlier this year Minister for Children Barry Andrews said that, since the death of Tracey Fay, special carefacilities had been put in place and a new model of special care and high-support rolled out by the HSE. But it emerged last month that since the closure of 12-bed Ballydowd facility, no alternative special care places have been provided.

The report – released, incidentally, without fanfare on the CAAB website in recent weeks – makes aseries of recommendations, from amending the application form to greater coordination between the HSE and the National Education Welfare Board (NEWB) which monitors school attendance (76% of applications were for children who had not attended school in the previous 12 months).

It asks repeatedly, however, whether “the HSE finds [it] acceptable” the low level of admission and poor outcomes for those aged 16 and 17 and/or at risk of youth homelessness, and whether special care and associated services (from HSE and partner agencies) are appropriate to this group. It asks if it is acceptable that homelessness services or services for Travellers are sufficiently accessible and available nationally. It calls for better coordination between high support and special care, and states there could be a need for separate facilities for young children.

One other recommendation is that more research needs to be conducted that will expand on the findings of this report, so professionals working in the area and policymakers can see exactly how special care – and other aspects of the care system – influence the lives of those who pass through that system.

The fact that this complex report was posted, almost unnoticed, onto the website of a body that no longer exists might lead to questions over whether that particular aim will be achieved.

* www.caab.ie


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