Tusla report: Concerns raised over placement of children with individuals who have not been assessed (Case Studies)

Children in need of out-of-home care are still being placed with individuals who have not been assessed, despite previous criticism of the practice by the health watchdog, the Health Information and Quality Authority (Hiqa).

In its overview of reports on child deaths 2010-2014, the National Review Panel (NRP) highlighted the use of “informal placements with non-assessed individuals and families”, albeit in a minority of cases. The NRP said reviews found placements were made “without sufficient forethought” and that they did not meet the children’s needs in some cases, and that carers did not always get the support they required.

“The NRP is aware of the efforts made first by the HSE and later by Tusla to address this issue after it was highlighted by Hiqa,” the NRP said.

The NRP, set up in 2010 on the back of the Report of the Commission to Inquire into Child Abuse (2009) (Ryan Report) to review deaths and serious incidents of children in care, after care or known to child protection services, identified a number of positive practices. These included a finding that where cases were regularly reviewed, particularly where children were in care, planning was usually appropriate and effective. Where regular contact between children and their families was maintained “it helped to preserve their attachments and sense of identity”. Where schools provided extra supports, “they helped some vulnerable young people to achieve good outcomes”.

The NRP acknowledged that a number of the policy and practice issues highlighted in earlier reports were addressed by the HSE first and later Tusla over the five years since the review process began including policies on supervision, thresholds, caseload management, domestic violence and child protection conferences.

In a separate report into the deaths in 2014 of six children and young people who died of natural causes, Tusla said there was no evidence to suggest that any action, or inaction, on the part of State services contributed to their deaths which were “sadly, predicted at the time of involvement”.

“It appears from the evidence presented in the internal reviews that a good standard of support was offered to the children by different services,” said the report.

Five of the children who died had been born with complex congenital diseases and were not expected to live to adulthood.

The sixth suffered from cancer and died a few months after her diagnosis when she was 12 years old.

One child never left hospital care and died at five-and-a-half months old.

Three out of the six children were never in care. Two of them lived with their families until they died, including the child with terminal cancer, and one stayed in hospital for medical reasons.

They were five-and-a-half months, two-and-a-half years and 12 years old respectively.

The report outlines the family problems that led to two of the children having to be placed in care. These were domestic violence, neglect, homelessness and parental alcohol abuse.

In three cases, the families in question had been known to the HSE either prior to the birth of the children or, in one case, prior to the diagnosis of the terminal illness.

CASE STUDY: Neglected and abused as a child

- Catherine Shanahan

It was an abrupt end to a short and largely tragic life in the case of 19-year-old Sam.

Joni, his mother, was drunk on the night he was born and her alcohol use continued to be a recurring problem for the family.

He suffered neglect and physical abuse as a young child, was undernourished and lived in a poorly supervised, very unhygienic environment. As a two-year-old, he was diagnosed as evidencing foetal alcohol syndrome. As he grew, he developed very challenging behaviour. He also had learning difficulties.

Sam suffered from a tremor as a young child which was diagnosed as nervous in origin.

A succession of social workers was involved with Sam’s family over the years.

At one stage, his mother got a barring order from her husband claiming he physically abused her but she later applied to have it withdraw. At primary school, Sam assaulted classmates, teachers and the principal. His placement with his foster carer ended at age 13 after he threatened his carer with a knife. Social workers tried to find appropriate secondary schooling for Sam. Schools were reluctant to take him but he got a place. He settled in a relative’s home and his secondary school years appeared more stable. Having a stable home was noted as having “a very positive effect” At age 18, he was allocated an aftercare worker who described him as “a very content young man”.

But at age 19, Sam was involved in a fatal accident.

A review of his case by the NRP concluded there was “no direct or indirect connection between any action or inaction” on the part of Tusla or Tusla-funded services with Sam’s accidental death. A key learning point was that the focus of concern should be on the child from the earliest opportunity. In Sam’s case, the NRP felt the focus was on the “mother’s incapacities”.

CASE STUDY: Tried to take his own life at just 12

- Conall Ó Fátharta

Lennie took his own life at the age of 17. He had made his first attempt aged just 12.

A member of the Travelling community, he had spent his early years in another country before moving to Ireland with his mother and older siblings when his parents separated. The family had been known to social work services in the other jurisdiction and had frequently moved. The reasons for the first referral after arriving in Ireland were antisocial and violent behaviour, and non school attendance.

Lennie was assessed by a HSE community psychologist and found to be in the borderline mild learning disability range. He was also diagnosed by child and adolescent mental health services with “severe ADHD”.

He became known to the gardaí before the age of 11 and, although close to his mother, his behaviour was beyond her ability to control. He spent time in detention centres and in high support care, HSE residential facilities and was living in a wrap around care arrangement at home when he died.

At 12 he tried to take his own life before he was due to appear in court for a trespassing charge.

At 13, he was prescribed Risperidone, a drug often used to treat psychotic and bipolar disorders. He was also drinking at this time.

Shortly after turning 16, he tried to take his own life on two separate occasions and was subsequently removed from the family home and placed with a relative.

By the following year, Lennie was being provided with an intensive level of support services in order to try and allow him to live at home safely. He took his own life at home at the age of 17.

The review found staff tried over a number of years to try and find a setting in which he would thrive and develop. However, it concluded that the lack of suitable placements added considerably to the challenge of keeping him safe.