Ongoing isolation of vulnerable child criticised

SOCIAL SERVICES have been criticised for leaving a vulnerable child separated from other young people almost continually for six months in a special care unit.

A new report by the Health Information and Quality Authority (Hiqa) found the child had spent significant amounts of time in a confined and sparse living environment at Ballydowd special care unit in Dublin.

Inspectors were concerned that, apart from a TV and computer games, there was little else to occupy the child’s time at the HSE-run unit such as books, even though the child expressed interest in reading.

In total, inspectors expressed concern over the inability of the unit to meet the complex needs of two children.

They were due to have been moved to more appropriate placements that would meet their therapeutic needs, but this was delayed for various reasons.

The practice of isolating one of the children was redefined by staff to avoid meeting standards for continuous separation. These guidelines state that the practice should be used for the least amount of time possible. This, inspectors said, was unacceptable and unsustainable.

Staff and professionals said they believed it was the most appropriate action to take, considering the limited therapeutic options available to the unit.

On a more positive note, inspectors found there was a marked improvement in the standard of care since the last round of inspections. The main areas of improvement were in management, the delivery of care to the children, and the overall presentation of the unit.

Ballydowd provides secure residential accommodation for up to nine children with serious emotional and behavioural difficulties. They are typically detained under a High Court Order for their safety and welfare.

This number was reduced from 12 following a review of the number of children the unit could safely care for.

Inspectors said they found improvements in management represented by the introduction of good systems of accountability and clear lines of responsibility. There was a clear link between the needs of the children outlined in their care plans and the direct work carried out by the staff team

In addition, the whole campus had been repainted and brought to a good overall standard.

Although the works being carried out in the unit were necessary and would benefit the children when completed, inspectors voiced concern that children living there had an unsatisfactory amount of living space that provided them with little privacy.

This also posed a safety concern for the unit as there was a minimum amount of space available to manage the environment in a situation of risk, inspectors said.

Responding to the report, Jennifer Gargan, director of the Epic group which represents children in care, said it was clear that more specialised services were required for children with complex needs.

“While we acknowledge that progress has been made in secure care facilities, Epic would like, as a matter of urgency, a national policy for the provision of secure care to be developed, resourced and implemented,” she said.

“Such a policy must reflect the recent reports by Hiqa and urgently address the need for specialist therapeutic intervention in this country.”

The HSE has tended to place some children with severe or complex behavioural problems in specialist facilities abroad.

Last year, the HSE said a total of 15 young people in State care were placed in special care units in Northern Ireland, Britain and the US.

While there was no breakdown provided for the cost of these placements abroad, previous figures indicated that care abroad costs in the region of €250,000 per child. This equates to about €3.75 million in total.

Secure care: A  troubled history

BALLYDOWD SPECIAL care unit in Dublin was opened in 2000 at a cost of €13 million to provide a place for troubled children to be detained for their own welfare and safety.

However, it has regularly been in the news over a litany of problems including difficulties with management, security of children and basic accommodation standards.

Inevitably, the Health Information and Quality Authority’s repeated criticism of special-care units has raised questions about the HSE’s ability to manage childcare services, though inspectors have reported progress across a number of areas in recent months.

A damning report by Hiqa in 2009 criticised conditions, reporting that it was “no longer fit for purpose” and “represented an unsafe situation for the children placed in special care units”.

On foot of this, the HSE announced it would close the facility. This decision was later reversed as a result of an acute shortage of special care places.

In August of 2010, another inspection report by Hiqa restated many of its concerns and recommended that the HSE close the unit immediately due to concerns over the safety of children in care.

A special report later that year into the three special units used by the HSE – Coovagh House in Limerick and Gleann Alainn in Co Cork, as well as Ballydowd – found that children admitted to them often felt more at risk after being admitted compared to when they were on the outside.

Hiqa found incidents of assault and self-harm were commonplace, while severe staff shortages and a breakdown in governance blighted a system struggling to cope with surge in admissions.

The following year, Hiqa’s inspectors found significant improvements in the governance and physical condition of the three special care units for children.

A recent report into Gleann Alainn reported further improvements, but inspectors voiced concern that children continued to feel unsafe and reported unacceptable incidents of bullying and assault by other residents.