Lost lives. A broken system

This week’s devastating report by the Independent Child Death Review Group spelled out the cases of 196 children who died while in contact with State services. What went wrong with the system that allowed this to happen, and how likely are we to ensure that history doesn’t repeat itself – again?

THE CHILD AND FAMILY SERVICE headquarters of Area 3 in Dublin’s south inner city sounds likes a neutral, bureaucratic office, but raw and disturbing human episodes unfold here every day. Every call to the social workers on the child-protection team here reveals details of another human catastrophe: family breakdown, drug addiction, mental illness or child abuse. It’s normally a hidden world of families living on the edge of society, on the edge of the health system and, in extreme circumstances, on the edge of life. This week, however, a shocking Government report shone a light on this tragic and often unexamined corner of Irish life.

The report, described by its authors as a devastating indictment of social services, found that 196 children who were in contact with State services died between 2000 and 2010. Of these, 112 died of overdoses, by suicide, in unlawful killings and of other non-natural causes.

It said that most of these children received an inadequate child-protection service, that files in some cases were in “complete disarray” and that it had found evidence that social services had closed files on some cases even though children were still at risk. But more shocking still were the individual stories of ruined childhoods and preventable deaths.

There was a little boy who suffered severe neglect as a toddler and was discovered with his mother’s body after she had died of an overdose; at one stage he was found eating frozen fish fingers from the freezer. That boy died of a suspected drugs overdose at the age of 16.

There was a girl who was placed in care at the age of nine, after serious abuse at home. Instead of structure and stability, she moved between respite foster placement on 32 occasions. She took her own life when she was 12.

There was a 14-year-old boy who asked to be placed in care after trouble at home. As two community-care areas bickered over who was responsible, he was placed in an out-of-hours emergency hostel in the inner city instead of in foster care. He died of a drugs overdose just over two years later.

There was evidence, too, of good practice by social workers in what were often highly complex cases: building up good relationships with vulnerable children, linking them in with a range of services, even using their own money to help young people when resources were denied by management. But too often, the report found, this kind of response was “sporadic and inconsistent”.

Overall, the picture of poor communication between State agencies, the lack of an early response to meet the needs of children and a failure to introduce a standardised approach to dealing with child-protection concerns were among the main faults exposed in the system.

“What we have found, in one word, is a disgrace,” Minister for Children Frances Fitzgerald said after the report was published. “If ever evidence was required of the scale of the challenge which this Government and I have had to face into, then this report is it.”

MANY OF THE social workers in the child and family services section of Area 3, which stretches from the south inner city towards the more middle-class suburbs of Terenure and Rathfarnham, had been waiting grimly for the report for months. The social workers here, who are, for the most part, young, college-educated women, are on the front lines of society’s failings, trying to help restore stability to chaotic families, linking them in with health or social supports, or meeting the needs of vulnerable children whose lives may be at serious risk.

The findings are not a surprise to most: they know all too well about the poor interagency communications and the pressure to deal with emergency cases rather than intervening earlier in children’s lives. But it is ultimately their responsibility to respond. The Health Service Executive has a primary responsibility under the Child Care Act of 1991 to “identify children who are not receiving adequate care and protection” and to provide them with suitable protection.

Whenever a teacher, garda or member of the public raises a concern about a child’s welfare, the phone rings in this office and the duty social-work team responds, A whiteboard in the corner of the duty room is filled with names of dozens of children at risk of abuse or neglect, written neatly in blue marker. They have come to the attention of social services over the past week or so.

The names in the first column are Priority 1 cases. These tend to be emergency concerns that require an immediate response. The names in the next column tend to be welfare issues, such as neglect, while the third tend to be children caught in custody or access disputes.

“Once we get a call about one of these children, the detective work begins,” says Rita Byrne, the duty manager. “It’s like putting a jigsaw puzzle together, getting all the pieces of information to build a picture of what’s going on.” If investigations reveal that a child is at serious risk, an emergency care order is taken out and the child is placed in foster care. This happens quite regularly.

Last week a teacher in the area phoned to say two girls, aged eight and 10, from an immigrant family had shown signs of distress in school. “It turned out their mother was forcing chopped- up pieces of chilli peppers into their vaginas for long periods and then making them cross their legs,” says one social worker, shaking her head in disbelief. “We had heard of this happening in African communities in London, but had never come across that here before.”

Other cases require ongoing support and linking children in with mental-health, psychological and therapeutic interventions.

More often than not, the parents require help. They may be using drugs or alcohol or be unable to cope. There are a range of options, such as parental support or detox programmes. Taking a child away from parents and into care is generally the last step in a series of actions, depending on the severity of the case.