Damning information found in review of ‘Mary’ foster care case

Woeful inter-agency co-operation, a string of communication failures, and poor record-keeping characterised the case of ‘Mary’, the intellectually disabled young woman left in a foster home for more than two years after sex abuse allegations were levelled against her foster father.

While other children were removed, Mary remained in the home in the Cork region until February 2016, even though the allegations were deemed “credible” by Tusla within months of being made in January 2014. The allegations related to claims that Mary’s foster father had sexually abused two children who were members of his extended family 15 years previously.

It took five weeks after the allegations were made before they were passed up the chain to senior Tusla management — a delay deemed “regrettable, but understandable” given “the demand on the service”.

It took two reviews before Mary was moved. The first, in 2014, had deemed the allegations credible. Neither the HSE nor Tusla could say yesterday what date that review was on.

A second review submitted to Tusla in January 2016 concluded “there were sufficient safeguards in place to protect Mary”.

Ultimately, greater weight was placed on the initial assessment and it was agreed to transfer Mary in a “gradual and planned manner” in view of her level of disability. This approach was dependent on the foster father — Mr A — giving an undertaking to temporarily ‘leave the family home. When he reneged on this arrangement, Mary was transferred to another home within days on foot of a directive from a senior HSE official.

Dr Cathleen Callanan’s review of the Mary case, published yesterday, highlights the confusion that reigned over where responsibility for Mary lay and the negative impact of that confusion on Mary’s welfare.

Dr Callanan said Tusla felt effectively hamstrung by Mary’s age (18) in relation to what action might be taken legally to protect her as she was no longer under a statutory care order.

Difficulties were compounded by the “legal lacunae around Mary’s status in terms of autonomy and decision-making capacity”.

Dr Callanan was critical of delays in finalising the review after she had completed her work in July 2016. While she was given to understand there was “considerable urgency” in completing the review, it was held up by Tusla concerns of being scapegoated — “insofar as [the review] did not adequately acknowledge attempts made by Tusla to refer the case to the HSE, and focused attention on the activity of Tusla in the case, without giving due regard to the responsibility of the HSE Disability Services”.

Children’s Minister Katherine Zappone said the review demonstrates the “potential risk posed to young people who are transitioning from State care into adult disability services”.

To address this risk, the HSE and Tusla published a joint working protocol yesterday “to support good collaboration and working relationships between the agencies”.

The protocol governs how children in care access HSE funded disability-related services, including what happens when they transition to adult services.

Disabilities Minister Finian McGrath said in relation to young people transitioning from State care into adult disability services, Tusla has agreed to meet the required expenditure outlay for such young people until the end of 2017. “Thereafter, all such young people, and indeed future cohorts of children in State care moving into adult services, will transfer to an appropriate HSE funded service upon turning 18,” he said.

Report’s key conclusions

Among the recommendation in the ‘Mary’ case review are:

• Deviation from procedures available to escalate the case to senior management in Tusla before 2016 contributed to Mary’s continued presence in the placement.
• Reliable safeguarding measures were not in place for Mary despite the fact that, in the initial phase of the period under review, Tusla responded comprehensively in terms of risk assessment when the allegations were first brought to their notice.
• The review undertaken by Tusla of the safeguarding measures in place for Mary in 2015 was not completed within an appropriate time frame.
• Individual staff demonstrated a clear desire to apply a person-centred care approach with respect to Mary’s welfare.
• Co-ordination of service delivery between the HSE Disability Services and the voluntary organisation was ineffective.
• A clear and formal written referral (there was none) from Tusla to the HSE in 2014 could have contributed to progressing the case and bringing clarity to the roles of both organisations.
• There was a lack of a shared understanding among all the agencies involved with regard to referral pathways between Tusla, HSE Disability Services and the voluntary organisation.
• The lack of clarity around role and function of post holders had a negative impact on the overall management of the case.

Among the conclusions are:

• Promotion of a shared awareness of intersecting policies and procedures for interagency working including the HSE safeguarding policy and the Tusla aftercare policy will facilitate a mutual understanding of roles, responsibilities and referral pathways, which would assist the management of complex cases such as Mary’s.
• Formal arrangements to include meetings to address complex cases pertaining to people with disabilities with multi-agency involvement would facilitate improved management, or shared management of specific cases.
• Requirements with regard to record keeping standards are an identified deficit. Clear guidance needs to be provided to staff in relation to good record-keeping practices.
• The review was undertaken by independent reviewer, Dr Cathleen Callanan, assisted by two senior staff nominees from the HSE and Tusla respectively: Helena Butler and Oliver Mawe.