John Gormley
Question:946 Mr. Gormley asked the Minister for Health and Children his plans to provide special care units for non-offending children with behavioural problems; and if he will make a statement on the matter. [20575/03]
Written Answers. - Mental Health Services.
Since 1997 approximately €179 million of additional revenue funding has been invested through the health boards in the development of child welfare and protection services, including an additional €8 million for 2003. This has provided for a wide range of developments including family support projects, preventive services and intensive community based services. Approximately €40 million in capital funding has been made available by this Government through the health boards to put in place additional high support and special care places to provide for a small group of non-offending children who need more intensive intervention than mainstream residential or foster care services.
The number of high support and special care places has increased from 17 in 1996 to a current total of more than 120. This includes the Ballydowd special care unit, in the eastern region, which provides a national service to young people aged 11 to 17 years, with capacity for 18 young people. It is anticipated that the Ballydowd service will incorporate an off-site step-down high-support facility with capacity for six young people in addition to the 18 places on site. In the Southern Health Board area the Gleann Álainn special care unit for girls provides a seven-place regional service for the Southern, South Eastern and Mid-Western Health Boards. In addition, work has been completed on Coovagh House special care unit for boys, which is located in the Mid-Western Health Board area and provides five places. This unit will provide a regional service for the Southern, South-Eastern and Mid-Western Health Boards. The Mid-Western Health Board has indicated that referrals are currently being considered for placement in Coovagh House.
While health boards have experienced some difficulty in recruiting and retaining suitably trained staff for these services, progress has been made in this area through targeted recruitment campaigns, recruitment abroad and the expansion of training courses. As I am sure the Deputy is aware, a new career and pay structure for child care workers was introduced in 2001. This aims to ensure that more people are attracted into child care and to ensure that child care workers are trained to an appropriate level. From time to time health boards have also put in place individual high support packages to meet the specific needs of children. A number of intensive community based services have also been put in place to provide for the needs of this group of children, including the Edge Project in County Mayo and the youth advocacy pilot projects in the Northern Area Health Board and Western Health Board areas, which commenced last year.
In addition, Extern, a voluntary organisation, has agreements with a number of health boards to provide intensive community based services for children at risk. These programmes provide an added dimension to the health boards' provision of community based services to meet the needs of children at risk. While High Court orders of detention are currently required by health boards to detain non-offending children with challenging behaviour in special care units, work is at an advanced stage with a view to introducing Parts II, III and XI of the Children Act 2001 later this year. These parts provide a statutory scheme for non-offending children in need of special care or protection to be placed in special care units on foot of a special care order made by the District Court in appropriate circumstances as a last resort and for as short a period of time as possible.
John Gormley
Question:947 Mr. Gormley asked the Minister for Health and Children his plans to provide community based early intervention services and programmes for the identification, assessment and treatment of children with emotional and behavioural problems as promised in the national children's strategy; and if he will make a statement on the matter. [20576/03]
The further actions proposed in the national children's strategy to meet the needs of children with emotional and behavioural difficulties are being addressed inter alia in the context of the implementation of the Children Act 2001. The National Children's Office is co-ordinating the cross-departmental implementation of the Act. Work is at an advanced stage with a view to introducing Parts II, III and XI of the Children Act 2001 later this year. These parts provide a statutory scheme for non-offending children in need of special care or protection to be placed in special care units on foot of a special care order made by the District Court in appropriate circumstances as a last resort and for as short a period of time as possible. Since 1997 approximately €179 million in additional revenue funding has been invested through the health boards in the development of child welfare and protection services. This includes an additional €8 million for 2003. This has provided for a wide range of developments including family support projects, preventive services and intensive community based services. These developments will support the implementation of the Children Act, 2001.
As stated in the health strategy, Quality and Fairness: A Health System for You, the dominant focus in child care services since the early 1990s has been on the protection and care of children who are at risk. This policy has shifted in recent times to a more preventive approach to child welfare involving support to families and individual children; the aim is to avoid the need for further more serious interventions later on. This year I established the review of family support services. This review will map out a national policy and plan for the future development of family support services by health boards in line with section 27 of the health strategy. It will report within 18 months.
The intensive community based services put in place to provide support for children who may have emotional and behavioural problems include the Springboard Initiative and the youth advocate pilot projects. In 1998 the Cabinet committee on social inclusion approved spending of €9.14 million over a three year period from the young persons' services and facilities fund on a number of pilot projects for children at risk, working intensively with children, mainly in the 7-12 age group, who are at risk of going into care or getting into trouble with their families. These projects – the Springboard Initiative – were funded and established through the health boards. Twenty-one such projects have been established throughout the country since 1998. Children and families are generally referred to Springboard through social work departments, schools and other statutory agencies. At present over 700 children attend the projects either for intensive group work or individual work. These children present with a variety of behavioural and psychological problems. There are almost 400 parents attending the projects and either through individual or group work programmes they are learning new patterns in parenting that improve their own self esteem and also the quality of life of their children.
Youth advocate programmes, YAP, have been established on a pilot basis since 2002 in the Northern Area Health Board and in the Western Health Board. The programme works with children and families to reduce the number of young people entering out-of-home placement, reduce the length of stay of young people in care and return children to the most appropriate family placement as quickly as possible by providing a range of intensive community based services. The service is an internationally successful community based alternative to special care and high support placement. About 50 young people are catered for at any one time by the two projects. YAP designs interventions to meet the unique needs of each family with connections to other services as needed and incorporates a crisis intervention service. It attributes its success to its core principles: no eject and reject, strength based approaches and unconditional care.
Among the many programmes which are operating in the various health boards are neighbourhood youth projects, health advice cafés and teen parents' support projects, which aim to provide direct intervention with young people who are at risk of experiencing personal, family, education or social problems, to enable them to grow and develop to their full potential. Another example of a community based support service for children is the Edge Project in Mayo. This is an intensive service for young people with extreme challenging behaviour developed by the Western Health Board to support families as an alternative to secure care placement as defined in the Children Act, 2001. Referrals to the service are assessed on the basis that the behaviour of the young person poses a real and substantial risk to his or her health, safety development or welfare. Young people identified by these services as needing further treatment are referred to other services as appropriate such as child and adolescent psychiatric services.
The Deputy will be aware that internationally acknowledged best practice for the provision of child and adolescent psychiatric services is through the multi-disciplinary team. In furtherance of the recommendations of the working group on child and adolescent psychiatry, additional revenue funding of €6.061 million was allocated in 2002 to provide for the appointment of additional child and adolescent consultants, for the enhancement of existing consultant led multi-disciplinary teams and towards the establishment of further teams. A further €1.64 million was allocated in 2003. Each health board now has a minimum of two teams in place. The working group also recommended that a total of seven child and adolescent in-patient psychiatric units for children ranging aged six to 16 should be developed throughout the country. Project teams have been established to develop child and adolescent in-patient psychiatric units in Cork, Limerick and Galway and in the Eastern Regional Health Authority area – at St. Vincent's Hospital, Fairview.
The second report of the working group on child and adolescent psychiatry, published in June 2003, contains proposals for the development of psychiatric services for 16 to 18 year olds. It recommends that in the further development of the child and adolescent psychiatric service, priority should be given to the recruitment in each health board area of a consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence. Further implementation of the recommendations of the reports of the working group on child and adolescent psychiatry will be considered in the context of the estimates process for 2004 and subsequent years. The future direction and delivery of all aspects of our mental health services, including child and adolescent psychiatry, will be considered in the context of the work of the recently established expert group on mental health policy. It is expected that the expert group will report within eighteen months.