SECOND OPINION: Co-ordinated early action is key to tackling child abuse
DESPITE THE many reports on child abuse to date, the most fundamental question has still not been answered: how can we stop this happening?
The 437-page report of the Independent Child Death Review Group (ICDRG) does not contain a single sentence on primary prevention or how children’s health and safety can be promoted from birth so that they are not neglected or abused.
The authors concentrate on secondary prevention, or how to stop neglect and abuse after it has started and prevent it from getting worse.
Although the report is very comprehensive in terms of what went wrong for the 196 cases studied, it offers no insights into what can be done to ensure better or even adequate parenting before children “become known to the HSE”.
The report highlights a number of parental behaviours common to many of the cases studied. These include alcohol and drug abuse in 56 cases, neglect in 44 cases, and domestic violence in 30 cases. Non-school attendance was a problem in 20 cases.
The range of factors affecting children’s lives shows the importance of intersectoral working between the HSE, and statutory agencies such as Social Protection, Education, and Justice. Communication, let alone partnership, is a problem within the HSE and between the HSE and other State agencies.
The ICDRG report gives no indication of how better partnerships can be developed other than to note that inter-agency work “poses challenges in all countries”, and has “emerged repeatedly in child protection reviews conducted in Ireland”. Partnership working is challenging because each agency has its own culture and priorities, which are not compatible with those of other agencies. Trust and leadership are key factors which affect partnership functioning and these are often in short supply within the public sector. Power struggles are common. Mind-sets are different because of training and “on the job” socialisation. Justice deals with crime and punishment, Social Protection provides family income, Education is mostly about passing exams, and the HSE is about delivering health services. These competing interests mean child protection falls through the cracks which is why the ICDRG report suggests that a new agency is needed. However, this new agency will not succeed, no matter how many new social workers are employed, unless the emphasis is on prevention and much earlier intervention.
Prevention requires that inter-agency working becomes normal everyday business practice and not just when things go wrong. There is little evidence that this is happening at present. Dealing with the extent of alcohol abuse in Ireland is just one example of inadequate joined-up thinking and action. The ICDRG report argues that “Failure on the part of society to comprehensively address the alcohol problem . . . leaves child protection systems to deal with insurmountable consequences”.
School attendance is a strong indicator of overall child welfare. The 2012 report from the National Educational Welfare Board shows that non-attendance is still a big problem, particularly in disadvantaged schools where it is almost twice that in non-disadvantaged schools.
More than one in 10 (58,000) primary school pupils and nearly one- fifth (53,000) of post-primary school pupils are absent for 20 days or more during the school year. The HSE does not intervene until a child comes to the attention of the HSE for other reasons, by which time the damage has already been done. This failure of inter-agency working represents a missed opportunity for early intervention and more positive outcomes for the child.
The National Strategy on Domestic, Sexual and Gender-based violence intends to include the prevention of domestic violence in the Social and Personal Health Education programme in second level schools.
A recent survey shows that programmes currently provided do not cover domestic violence and that raising the issue is “difficult”. Teachers are inadequately trained to deliver such programmes and a failure to effectively address widespread bullying in schools gives the impression that treating other people badly is acceptable behaviour. Schools see domestic violence as a Garda or HSE problem. This is another example of agencies not working together.
Working in partnership must be an integral part of service planning in all State agencies. Inter-agency working needs to become the norm or, in another 10 years, we will be back wringing our hands about why we still haven’t solved the problem of child abuse.
Jacky Jones is a former HSE regional manager of health promotion