Second Opinion: Building of trust is vital for proper interagency working

The new Child and Family Agency, established on January 1st, is good news for children's health, protection and welfare. HSE Children and Families Services, the Family Support Agency, and the National Educational and Welfare Board have become part of the new agency.

Significant partners include domestic, sexual, and gender-based violence services, Barnardos, ISPCC, Daughters of Charity Child and Family Services, and EPIC (Empowering Young People in Care).

Although the agency’s work plan prioritises partnership and interagency working, this won’t just happen automatically. Interagency working will be its biggest challenge.

Over the past 20 years every report into child abuse, and deaths of children in care or known to the HSE, has highlighted the almost complete absence of interagency collaboration.

Lack of interagency working
The latest Annual Report from the National Review Panel, set up to examine the deaths of children and young people in care or known to child protection services, published in November 2013, found that interagency working does not happen as often as necessary.

“Over half of the published reviews found that an interagency meeting would have assisted in the compiling of information but was not held.”

Four case studies from the report highlight the challenges.

Dara’s care involved 11 children’s services over a period of nine years including two hospitals, the Garda, her GP, education and welfare services, family support, HSE social workers, and mental health services. For most of the period under review there was poor interagency collaboration between the HSE and family support services.

“There was only one interagency meeting.” Interagency relationships were “strained” and “there were different expectations held by each organisation about the other and a lack of mutual agreement about responsibilities”.

Dermot was referred aged 11 and died by suicide in his mid-teens. Eleven services were involved in his care including the District Court, probation and welfare, his GP, mental health services, the Garda, and social workers from the HSE.

“The lack of a co-ordinated response meant that he tended to fall between [services].” There was “no direct evidence of any face-to-face contact” between social workers and mental health service providers.

Yvonne was in care from the age of five until she died at 19. Fifteen services were involved in her care including mental health services, a high support unit, the Garda, foster care, residential units, after-care and several other HSE services.

Fifty files were kept on Yvonne and her family by a range of different agencies.

“Despite the input of numerous services there was no evidence that her needs were identified . . . consequently, the case was allowed to drift.”

There were other “critical points where inter-agency meetings would have provided opportunities for information sharing and planning that might have been constructive but were not convened”.

Eight services were involved in Nathan’s care from his early teens until he killed himself aged 17. These included his GP, alcohol counselling, psychology, HSE social workers and an early school-leavers’ project.

"No child protection conference was convened," which "may have highlighted the fact that nobody was actually working with Nathan".

Improvement
In fairness to the HSE, the most recent Hiqa inspections show that interagency working is improving. Standard 2.9, "Interagency and inter-professional co-operation supports and promotes the protection and welfare of children", refers to how well agencies work together.

During 2013 Hiqa published inspection reports on Child Protection and Welfare Services in six Local Health Areas (LHAs). Of these, three LHAs met Standard 2.9 and three did not.

One LHA that did not meet the standard organised coffee mornings for other professionals involved in children’s protection and welfare. While informal meetings are important, they are not enough.

Agencies must actually work together every day to build trust. Cliques and little power bases are out. Hidden agendas are out. Roles and responsibilities must be understood and fulfilled by all.

Trust is the most important ingredient in interagency work and no amount of effort, or coffee mornings, will compensate for its absence.

Without trust all efforts to safeguard children are doomed. Trust is hard-won and easily lost. The Child and Family Agency must build trust with children, families and communities from the very beginning or we will be wondering why children are still not getting the services they need.

Dr Jacky Jones is a former HSE regional manager of health promotion

She developed a scale to measure trust in interagency partnerships and collaborations as part of her PhD. This scale has been peer reviewed and published in international journals. A free copy will be sent on request.

drjackyjones@gmail.com